ATI RN
Gastrointestinal System ATI
1. Which stoma would you expect a malodorous, enzyme-rich, caustic liquid output that is yellow, green, or brown?
- A. Ileostomy.
- B. Ascending colostomy.
- C. Transverse colostomy.
- D. Descending colostomy.
Correct answer: A
Rationale: An ileostomy would have a malodorous, enzyme-rich, caustic liquid output that is yellow, green, or brown.
2. Which of the following symptoms is a client with colon cancer most likely to exhibit?
- A. A change in appetite
- B. A change in bowel habits
- C. An increase in body weight
- D. An increase in body temperature
Correct answer: B
Rationale: A change in bowel habits is the most common symptom of colon cancer.
3. An enema is prescribed for a client with suspected appendicitis. Which of the following actions should the nurse take?
- A. Prepare 750 ml of irrigating solution warmed to 100*F
- B. Question the physician about the order
- C. Provide privacy and explain the procedure to the client
- D. Assist the client to left lateral Sim’s position
Correct answer: B
Rationale: An enema is contraindicated in clients with suspected appendicitis because it can increase the risk of perforation. It is important to verify the appropriateness of this order with the physician.
4. The client with a colostomy has an order for irrigation of the colostomy. The nurse uses which solution for the irrigation?
- A. Distilled water
- B. Tap water
- C. Sterile water
- D. Lactated Ringer’s
Correct answer: B
Rationale: The correct solution to use for the irrigation of a colostomy is warm tap water or saline solution. If tap water is not suitable for drinking, bottled water can be used. Distilled water, sterile water, and Lactated Ringer’s are not appropriate solutions for colostomy irrigation. Distilled water lacks essential minerals, sterile water may not provide adequate cleaning, and Lactated Ringer’s is not indicated for this procedure.
5. The client has been admitted with a diagnosis of acute pancreatitis. The nurse would assess this client for pain that is:
- A. Severe and unrelenting, located in the epigastric area and radiating to the back.
- B. Severe and unrelenting, located in the left lower quadrant and radiating to the groin.
- C. Burning and aching, located in the epigastric area and radiating to the umbilicus.
- D. Burning and aching, located in the left lower quadrant and radiating to the hip.
Correct answer: A
Rationale: Acute pancreatitis typically presents with severe, unrelenting pain in the epigastric area that radiates to the back. This pain is due to inflammation and autodigestion of the pancreas.
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