ATI questions on GI/Endocrine
nurse is providing post op teaching about the management of dumping syndrome to a client who had a partial gastrectomy. which of the following instructions should the nurse include in the teaching?
"eat protein with each meal" bc protein delays gastric emptying
Complications of Cirrhosis
-Esophageal varices - Looking for bleeding -Portal systemic encephalopathy
An example of how the liver functions
-Glucose metabolism- stores energy as glycogen then converts to glucose when need energy -Vitamin K is needed for liver to make clotting factors- prothrombin time is a concern if liver fails -Ammonia conversion - ammonia is byproduct of protein metabolism, will be high if liver fails.
What would be elevated in ACUTE pancreatitis
-Lipase and Amylace would be elevated with acute Pancreatitis
Treatment for Chronic Pancreatitis
-NPO and NG suction - Helps reduce the pancreas from being stimulated
What diagnostic test would be done for Pancreatitis?
-Serum amylase & lipase (elevated)
colostomy care to a client who has new colostomy. what actions should nurse teach?
-empty bag when it is one-third to one-half full -cut skin barrier opening a little larger than ostomy -wash peristomal skin with mild soap and water
nurse is admitting a client who has cirrhosis. which of the following prescriptions should the nurse anticipate? select all that apply
-obtain the client's PT and INR measurements -administer lactulose 30 mL PO 4 times daily -obtain daily weight and abdominal girth measurements -administer daily multivitamin
a nurse is caring for a client who is 2 days post op following gastric surgery & has an NG tube inserted. Which of the following should the nurse report to the provider?
200 mL of bright red drainage from the NG tube
client who is 2 day post op following gastric surgery & has an NG tube inserted. which of the following findings should the nurse report?
200 mL of bright red drainage from the NG tube
nurse is presenting an in-service training session about nutrition. how many of the amino acids must be obtained from dietary intake?
9
The initial diagnosis of pancreatitis is confirmed if the clients blood work shows a significant elevation in which of the following serum values? A. Amylase B. Glucose C. Potassium D. Trypsin
A.
The initial treatment plan for a client with pancreatitis most likely would focus on which of the following as a priority? A. Resting the gastrointestinal tract B. Ensuring adequate nutrition C. Maintaining fluid and electrolyte balance D. Preventing a development of infection
A.
The nurse evaluates the client's most recent laboratory data. Which laboratory data finding would be consistent with a diagnosis of acute pancreatitis? A. Hyperglycemia B. Leukopenia C. Thrombocytopenia D. Hyperkalemia
A.
Which test should a nurse expect to be ordered for a pt with severe abdominal pain in Mid Epigastric (URQ) region with N/V & Back tenderness
Amylase test
What Diagnostic Tests/labs would you look at to confirm Cholecystitis? (Inflammation of the Gallbladder)
An increase in Amylase
The nurse would expect the client to exhibit which of the following symptoms during the ICTERIC phase of viral hepatitis? A. Tarry stools B. Yellowed sclera C. Shortness of breath D. Light, frothy urine
B.
When providing care for a patient hospitalized with acute pancreatitis who is complaining of acute abdominal pain, which of the following nursing interventions would be most appropriate for this client? SELECT ALL THAT APPLY A. Placing the client in a side lying position B. Administer morphine sulfate for pain prn as ordered C. Maintaining the client on high calorie/protien diet D. Monitoring the clients respiratory rate E. Obtaining daily weights
B.
Which of the following expecte outcomes would be appropriate for a client with Hepatitis? A. The client will demonstrate a decrease in fluid retention relate to ascites B. The client will verbalize the importance of reporting bleeding gums or bloody stools C. The client will limit use of alcohol to 2-3 drinks per week D. The client will restrict activity to within the home to prevent disease transmission
B.
A way to diagnose Liver Disease
Coagulation studies- PTT may be prolonged due to the lack of vitamin K and clotting factors
The client with Cirrhosis has developed Ascites. The nurse should recognize that the pathologic basis for the development of Ascites in clients with Cirrhosis is Portal Hypertension and ? A. An excess serum sodium level B. An increased metabolism of aldosterone C. A decreased flow of hepatic lymph D. A decreased serum albumin level
D.
Which of the following would most likely be a priority nursing diagnosis for a client with acute pancreatitis? A. Ineffective airway clearance B. Excess fluid volume C. Impaired swallowing D. Imbalanced nutrition: Less than body requirements
D.
Treatment for Cholecystitis
ERCP - Endoscopic retrograde cholangiopancreatography, used to differentiate fibrosis and inflammation from carcinoma.
Why would we put an NG tube down a patient with acute pancreatitis?
For GI rest
Who is at the greatest risk of being infected with Hep B?
Healthcare workers by needle sticks, from blood/body fluid contact
Lactalose is given for what reason in a pt w/Liver Disease
Helps absorb ammonia waste and is excreted in the stool
Signs of Liver disease
Hepatic encephalopathy (An Increased ammonia levels from protein waste) start low or no protein in diet depending on ammonia levels, Lactulose is given to patients to secrete ammonia in the stool
What are some complications of Cholecystitis?
Jaundice (Main one) & Ascites
Why is neomycin given to a pt w/ Liver Disease
Kills good and bad bacteria from breaking down protien and making ammonia.
Hep B can also develop from a patient that has ?
Liver Cancer
Postop Nursing Interventions for Cholecystitis
Observe for abdominal ridgidity - Sign of internal bleeding (Increased pulse, decreased blood pressure) if clamp comes off
What vaccines are available for Hepatitic A,B,C & E?
Only ones for A & B
Mainifestations (signs) of Cholecystits (Inflammation of the Gallbladder)
Pain in the epigastric region and RUQ, guarding, & Abdominal distention
What are some nursing interventions for acute pancreatitis?
Pain meds and antibiotics
Medical Management of Cirrhosis
Paracentesis - draining fluid from the abdomen (ascites) monitor BP & fluid shifts
RN considerations for a pt w/ Liver Disease
Safety from Decreased LOC (side rails up, restraints) Meds - Lactalose & Neomycin Low to no protien diet Skin integrity - Puritis (itching) from the buildup of bile salt on the skin. Give benadryl
Important info on Hep B
Should be vaccinated if you work where there is a risk Cirrhosis can cause Liver Cancer can develop
Which statement best characterizes cholecystitis?
URQ Pain
What should you avoid with Hep C
alcohol & Tylenol
nurse is completing a history and physical assessment for a client who has chronic pancreatitis. which of the following findings should the nurse identify as a likely cause of a client's condition
alcohol use
client who has acute pancreatitis. which serum lab values should return to expected reference range within 72 hr of treatment?
amylase
nurse assisting a provider with performing a paracentesis on a client. which of the following actions should the nurse take?
ask client to empty his bladder before the procedure
nurse's plan of care for gastroesophageal reflux disease (GERD). nurse should plan to monitor for what complications?
aspiration
nurse in a provider's office is assessing a client who has GERD. when documenting the client's history, the nurse should expect the client to report that symptoms worsen with which of following actions?
bending over (activities that increase intraabdominal presurre)
nurse is obtaining a guaiac test from client. test detects what?
blood in stool
the nurse is assessing a client who has cholecystitis. which of the following finds should the nurse expect
blumberg's sign (rebound tenderness)
nurse is assessing a client who is experiencing perforation of a peptic ulcer. which of the following manifestations should the nurse expect?
boardlike abdomen
client recovered from acute diverticulitis. increase intake of which of the following foods when inflammation subsides
cabbage and peaches
nurse is caring for a client who is 2 days post op following a gastric bypass. nurse notes that bowel sounds are present. which of the following foods should the nurse provide as an initial feedind?
clear liquids
a nurse is caring for a client who has diverticulitis and a new prescription fro a low fiber diet. which of the following food items should the nurse remove from the client's meal tray?
coleslaw
nurse is caring for a client who has diverticulitis and new prescription for a low fiber diet. which of the following food items should the nurse remove?
coleslaw
a nurse is providing pre-op teaching to a client who will undergo surgery to create a temporary colostomy. the client asks the nurse about the difference between colostomies and ileostomies. which of the following responses should the nurse make?
colostomy is from large intestine and illeostomy is from small intestine
client post op following a traditional open cholecystectomy. which learning needs of client is priority?
coughing and deep breathing exercises
3 days post-op following abdominal surgery. the client states, "something just popped when i coughed." which action should the nurse take?
cover the wound with a sterile, moist dressing
nurse planning care for client who has cholelithiasis. which intervention should be included?
decrease the client's fat intake (reduce occurrence of biliary colic)
nurse should explain that alcohol can cause liver cirrhosis through which of the following actions?
destroying liver cells that are later replaced with scar tissue
child who had her spleen removed following bicycle accident. the child's parent asks the nurse about the role of spleen in the body. the nurse should explain that the spleen performs which of the following functions?
destroys old blood cells
client from middle east who has celiac disease. which of the following actions should the nurse perform regarding client's diet?
determine the client's dietary preferences
client who is receiving TPN therapy has just returned to the room following PT. the nurse notes that the infusion pump is turned off for TPN. after restarting the infusion pump, nurse monitors for?
diaphoresis
a nurse is teaching a client who has diabetes mellitus about hyoglycemia. which of the following manifestations should the nurse include?
diaphoresis palpitations shakiness
nurse teaching about the functions of the liver and gallbladder. what is the purpose of bile?
digesting fats
nurse is updating plan of care for a client who has dumping syndrome. which of the following instructions should the nurse include?
eat a source of protein with each meal
colostomy: how to reduce flatus and odor
eat crackers and yogurt regularly
nurse is providing teaching to a client who has constipation. what instructions should the nurse make?
eat yogurt with live cultures
client who has a bleeding duodenal ulcer. which of the following findings should the nurse expect?
emesis with a coffee-ground appearance
indwelling urinary catheter: which action should nurse take
empty bag when half-full of urine
teaching about ostomy care while at home for a client newly placed ileostomy. instructions should nurse include?
empty pouch when it becomes half full
nurse providing discharge teaching to a partner of a client who has a new diagnosis of hepatitis A. which of the following instructions should the nurse include in the teaching?
encourage her to eat foods that are high in carbohydrates
client who has an acute exacerbation of Crohn's disease. which action should nurse take first?
ensure bowel rest
providing dietary teaching to a client who has diverticulitis about preventing acute attacks. which food should the nurse recommend?
foods high in fiber
which lab test to determine possibility of recent excessive alcohol use?
gamma-glutamyl transferase (GGT)
client who has complete intestinal obstruction. which should the nurse expect?
hyperactive bowel sounds above the obstruction
nurse is providing teaching to a client who is scheduled for a sigmoid colon resection with colostomy. which statement indicates further teaching
i'll have to consume a soft diet after surgery
secondary prevention actions for colorectal cancer for a health fair for adults in the community. Which of the following topics should be included>
importance of colonoscopy screening starting at the age of 50 y.o
end-stage liver failure. which result should nurse expect?
increased prothrombin time
nurse is assessing a client who is 12 hr post-op following an open cholecystectomy. which of the following findings should the nurse report?
indwelling urinary cath output of 25 mL/hr
a nurse is planning an in-service training session regarding nutrition. which of the following minerals should the nurse identify as involved in oxygen transportation?
iron
client who is NPO and has an NG tube to suction. client reports nausea, which of the following actions should the nurse take?
irrigate the tube with normal saline solution
client who has fulminant hepatic failure. which of the following procedures should nurse anticipate for client?
liver transplant
client who has dumping syndrome following gastric bypass surgery 4 days ago. what recommendations should nurse teach?
maintain supine position after meals
recommending dietary modifications for a client who has GERD. nurse should suggest eliminating what foods?
oranges and tomatoes
which of the following enzymes play a role in digestion of protein?
pepsin
client who has colitis and reported increased exacerbation due to stress at work. which response should nurse make?
perhaps we should review your coping mechanisms and talk about other alternatives
nurse caring for a client who had a gastric resection to treat adenocarcinoma of stomach. the client tells the nurse in the PACU that he doesn't remember why the surgeon said he had to have a tube in the nose. explain how NG tube serves what purpose?
prevents excessive pressure on suture lines
nurse providing teaching about nutrients to client. which statementt is correct
protein builds and repairs body tissue
nurse is caring for a client who is scheduled to undergo liver biopsy for a suspected malignancy. which of the following lab findings should the nurse monitor prior to the procedure?
prothrombin time
client who is 4 hr post-op following a laparoscopic cholecystectomy. which findings should the nurse expect?
right shoulder pain
nurse is caring for a client who 4 hr post op following a laparoscopic cholecystectomy. which of the following findings should the nurse expect?
right shoulder pain
client with bowel obstruction. reports severe abdominal pain. which indicates possible bowel perforation has occurred?
rigid abdomen
nurse is providing dietary teaching to a client who has ulcerative colitis. which food selection of indicates understanding of the teaching
roast chicken and white rice
nurse is performing GI assessment of a client who has liver cirrhosis w/ abdominal distention. which actions should nurse take to assess for changes in abdominal distention?
take serial measurements of the abdomen with a tape measure
a nurse is teaching a newly licensed nurse about caring for a client who is scheduled for an esophagogastric balloon tamponade tube to treat bleeding esophageal varices. which of the following pieces of info should the nurse include in the teaching?
the client will be placed on mechanical ventilation prior to this procedure
client who is scheduled for an esophogasatric balloon tamponade tube to treat bleeding esophageal varices. which info should be taught?
the client will be placed on mechanical ventilation prior to this procedure
client who is dehydrated & is receiving continuous tube feeding through a pump at 75 mL/hr. when nurse assesses the client at 0800, which of the following findings requires intervention?
the head of the bed is elevated 20 degrees
nurse is teaching a client with barrett's esophagus who is scheduled to undergo an esophagogastroduodenoscopy (EGD). which of the following statements should the nurse include in the teaching?
this procedure can determine how well the lower part of your esophagus works
a nurse is caring for a client who is scheduled to undergo an esophagogastroduodenoscopy (EGD). the nurse should identify that this procedure is for which reason?
to detect an ulceration in the stomach
nurse enters client's room and notes smoke coming from a wastebasket in the adjacent bathroom. which action should the nurse take first?
transport the client to an area away from the smoke
ER is caring for client who has bleeding esophageal varices. what prescription should be given?
vasopressin
child who has celiac disease should omit what food?
wheat bread
a nurse is caring for a client who has acute diverticulitis. while the client has active inflammation, the nurse should instruct the client to include which of the following foods in her diet?
white bread and plain yogurt
