Chapter 45 Care of a Patient With a Gastrointestinal Disorder

The risk for cancer of the stomach is associated with which factors? SELECT ALL THAT APPLY

hypochlorhydria chronic atrophic gastritis diet high in smoked and preserved foods gastric ulcers diet low in fresh fruits and whole grains

An obese male truck driver reports intense rectal itching. The HCP diagnosis hemorrhoids. Which nonsurgical approach would the nurse suggest to help the patient manage the condition?

increase fluid intake

Which post procedure instruction is the MOST important to give to a patient who has had an upper gastrointestinal study with barium?

increase fluid intake

When caring for a patient admitted with a bleeding peptic ulcer, the nurse will include what intervention in the patient's acute plan of care?

observing vomitus for color, consistency, and volume

The nurse is teaching a post gastrectomy patient about dumping syndrome. Which statement indicates that the patient needs further instruction?

"I will avoid fats and increase carbohydrates".

A patient has recently been diagnosed with celiac disease. What patient statement indicates that the need for further teaching regarding the disease? SELECT ALL THAT APPLY

"There is no cure for my disease, but I can manage it well with my diet". "My children are at a higher risk for developing celiac diesease because I have it". "I will need to eliminate foods containing wheat flour from my diet".

A patient has been prescribed infliximab for the treatment of Crohn disease. What information should the nurse include in patient teaching regarding this medication?

"This medication is given to suppress your immune system's overactive response".

The patient confides in the nurse that she feels angry because the HCP has hinted that irritable bowel syndrome(IBS) might be the problem but offers no definitive medical diagnosis. What is the MOST therapeutic response?

"You seem really frustrated. What has the HCP told you so far".

The nurse is reviewing the prescriptions of a client admitted to the hospital with a diagnosis of acute pancreatitis. Which interventions would the nurse expect to be prescribed? SELECT ALL THAT APPLY

Administer antacids, as prescribed. Encourage coughing and deep breathing administer anticholinergics, as prescribed

Which type of medication order should the nurse question when caring for a patient with E. Coli 0157:7?

Antilipidemic agents

What nursing intervention is most appropriate to decrease postoperative edema and pain in a male patient after an inguinal herniorrhaphy?

Applying a truss to the hernial site

The patient has an EGD several hours ago and now reports abdominal pain and tenderness. What would the nurse do FIRST?

Assess the abdominal pain

The patient is admitted for acute diverticulitis. The nurse would intervene if a nursing student performed which action?

Assists with a meal tray

A patient has undergone numerous diagnostic tests to determine whether a gastric malignancy is present. The patient asks the nurse what test will be most definitive for diagnosis. Chose the MOST LIKELY options for the information missing from the statements below by selecting from the list of options provided. Your health care provider has ordered a/an ______ in order to perform a ________ to determine if you have cancer in your stomach.

Esophagogastroduodenoscopy and biopsy

While obtaining the patient's health history and reviewing the medical records, which information will alert the nurse that the patient has an increased risk of developing peptic ulcer disease? SELECT ALL THAT APPLY

Excess of gastric acid or decrease in the natural ability of the GI mucosa to protect itself from acid and pepsin. Invasion of the stomach and or duodenum by Helicobacter Pylori Taking certain drugs, including corticosteroids and anti-inflammatory medications

According to research, removal or disease of the appendix could theoretically affect which function?

Immunologic response

Which patient is the BEST candidate for a bowel training program that will incorporate biofeedback?

Patient has a mobility disorder but is alert and motivated

Which patient situation MOST strongly indicates the need for further investigation as a potential public health problem?

Patient has bloody diarrhea after eating a grilled hamburger that was served at a fundraiser

Which patient is MOST likely to develop problems with blood coagulation?

Patient has liver failure

The nurse is monitoring for stoma prolapse in a client with a colostomy. Which stoma observation would indicate that a prolapse has occurred?

Protruding and swollen

Which part of the GI system is responsible for the formation and expulsion of feces?

Large intestine

The older adult patient has been put into contact isolation because of watery diarrhea. Laboratory results are pending, but C. Difficile pathogen is suspected. Which instruction would the nurse give to the unlicensed assistive personnel?

Use soap and water to wash hands, rather than the antiseptic hand rub

The nurse is caring for a client with a diagnosis of chronic gastritis. The nurse anticipates that the client is at risk for which vitamin deficiency?

Vit B 12

The nurse is caring for a patient who has admitted for peptic ulcer disease. Which abnormal finding is the GREATEST concern?

White blood cell count is elevated

The large intestine is the site of bacterial action that produces vitamin k. Potentially, loss of the large colon or disruption of this bacterial action could disrupt which body function?

blood clotting

When caring for a patient diagnosed with Crohn's disease, which signs and symptoms does the nurse expect to observe? SELECT ALL THAT APPLY

Diarrhea and abdominal pain weight loss and malnutrition fatigue and fever

A patient was admitted during the evening shift with a tentative diagnosis of cancer of the esophagus. What complaint does the nurse anticipate finding in the initial assessment of the patient?

Dysphagia

During assessment of a patient with esophageal achalasia, what does the nurse expect the patient to report when the health history is obtained?

Dysphagia, especially with liquids

The nurse is monitoring a client for the early signs/symptoms of dumping syndrome. Which indicates this occurrence?

Sweating and pallor

The nurse reinforces postoperative liver biopsy instructions to a client. Which would the nurse tell the client?

Lie on the right side for 2 hours

Which sign/symptom would be investigated as an EARLY warning of colorectal cancer?

rectal bleeding

Which medical diagnosis requires extra vigilance for concurrent UTI infections?

Crohn's disease

The patient who has surgery for a peptic ulcer several weeks ago reports experiencing an episode of diaphoresis, nausea, vomiting, epigastric pain, explosive diarrhea, and dyspepsia. Which question is MOST relevant to the symptoms and the surgical history?

"did you eat before the symptoms? And if so, what did you eat?

The nurse is reinforcing teaching to a client about an upcoming colonoscopy procedure. The nurse would include in the instructions that the client will be placed in which position for the procedure?

Modified left lateral recumbent position

The nurse is providing care to a patient suspected of having acute appendicitis. Which interventions may be included in the care? SELECT ALL THAT APPLY

Maintain bedrest and nothing by mouth (NPO) Monitor vital signs including temperature administer antibiotics as prescribed.

The nurse is reviewing the record of a client with Crohn's disease. Which stool characteristic would the nurse expect to see documented in the record?

Diarrhea

The patient is admitted for an exacerbation of ulcerative colitis and the nurse hears in report that the patient had 20 liquid stools within the past 24 hours. Which laboratory results is the MOST important to follow up on?

Electrolyte levels

A patient is scheduled for a hemicolectomy for removal of a cancerous tumor of the ascending colon. The patient asks the nurse why he is taking intestinal antibiotics preoperatively. Which response by the nurse is correct?

To reduce the bacteria content of the colon.

The nurse is preparing a presentation on the differences between ulcerative colitis and Crohn disease. What should the nurse include in the presentation? SELECT ALL THAT APPLY?

Ulcerative colitis is confined to the mucosa and the submucosa of the colon. The intestinal disease of ulcerative colitis is curable with a colectomy , whereas Crohn disease often recurs after surgery. Blood is often present in the stools with ulcerative colitis; fat is usually present in the stools with Crohn disease.

The nurse is discharging a patient after a hemorrhoidectomy. Which teaching point should the nurse include in the discharge instructions?

Use a prescribed analgesic before a bowel movement

The patient is practicing a bowel training program. Which food will the nurse encourage the patient to eat?

Whole grain cereal

A client with ascites is scheduled for a paracentesis. The nurse is assisting the primary health care provider (PHCP) with performing the procedure. Which position would the nurse assist the client into for this procedure?

upright

The nurse is reviewing the primary health care providers prescriptions written for a client admitted with acute pancreatitis. Which PHCP prescription would the nurse verify if noted in the clients chart?

position the client supine and flat

A patient has been admitted with a diagnosis of peptic ulcers. Which drugs would the nurse expect this patient to be prescribed to decrease gastric acid secretion? SELECT ALL THAT APPLY

ranitidine famotidine

The patient needs to have a series of tests of the GI system. Which test must be scheduled LAST?

Barium studies

A patient has a partial gastrectomy. Because this surgery creates an increased risk for pernicious anemia, which teaching point is important to emphasize?

Blood serum vit b 12 level should be measured every 1-2 years

After a transverse loop colostomy, the nurse inspects the patient's stoma. The stoma appears pale pink with some dusky discoloration at the lower border. What is the most appropriate action by the nurse?

Clean the area around the stoma, apply a clean pouch, and notify the health care provider bout the discoloration

A patient is being treated with sucralfate for gastroesophageal reflux disease. Which teaching point would the nurse emphasize?

Coating action may interfere with the absorption of other drugs-separate by 2 hours

The nurse is talking to a neighbor who says that she has has a sore on her lip for about 3 weeks. Which advice would the nurse give?

Consult the HCP because of the duration of the sore

The nurse is caring for a patient scheduled for an esophagogastroduodenoscopy. Which intervention should the nurse include in the patient's plan of care? SELECT ALL THAT APPLY

Encourage the patient to not smoke before the examination' Maintain NPO status until the gag reflex returns post procedure instruct the patient to contact the health care provider if intense abdominal pain occurs post procedure.

It has been determined that a client with hepatitis has contracted the infection from contaminated food. Which type of hepatitis is this client most likely experiencing?

Hepatitis A

When planning care for a patient with a motor paralysis, which interventions is the MOST important as a long term solution for the patient's defecation?

Include the patient and family in planning a bowel training program

What are the functions of the saliva? SELECT ALL THAT APPLY

Initiates carbohydrate metabolism Protects the teeth from decay by destroying bacteria continued secretion of saliva cleanses the mouth protects the mucous membranes from infections keeps the mucous membranes of the mouth moist

What are the common causes of fecal incontinence? SELECT ALL THAT APPLY

Injury during anal intercourse surgical trauma to anal sphincter injury during childbirth spinal cord lesions

The nurse is preparing to perform an abdominal examination. Which step would be taken FIRST?

Inspection

The nurse inserts a NG tube so a patient can undergo a Bernstein test to determine the cause of esophageal pain. Which outcome is considered a positive test result?

Instilling hydrochloric acid causes pain

The nurse is caring for a client after a Billroth II (gastrojejunostomy) procedure. During review of the postoperative prescriptions, which would the nurse clarify?

Irrigating the NG tube

The nurse is caring for a patient who has had a partial gastrectomy. Which vitamin will the nurse anticipate educating the patient about?

K

The nurse is reinforcing discharge instructions to a client after a gastrectomy. Which measure would the nurse include during client teaching to help prevent dumping syndrome?

Limit the fluids taken with meals

The patient is admitted for hemorrhagic colitis cause by the E. Coli pathogen. Which order would the nurse question?

Loperamide 2 mg after unformed stool.

What is considered an EARLY sign of mechanical obstruction of the intestines?

Loud, frequent, high-pitched bowel sounds

A client with hiatal hernia chronically experiences heartburn after meals. Which would the nurse teach the client to avoid?

Lying recumbent after meals

The nurse is caring for a patient who had a right hemicolectomy for colorectal cancer. Which postoperative interventions will the nurse use in the care of this patient? SELECT ALL THAT APPLY

Monitor vital signs, pain level, and return of bowel sounds check dressings for drainage and bleeding and change as ordered. encourage the patient to cough, deep-breathe and turn,. Keep accurate I and O records to monitor fluid balance.

The nurse is planning care for several patients who will be undergoing diagnostic testing for disorders of the GI system. Which patient is going to require the MOST time for postprocedural care?

Patient needs an esophagogastroduodenoscopy for evaluation of an ulcer

The nursing student reports seeing a pearly, bluesish-white "milk curd" on the mucous membranes of the older patient's mouth. The nurse would intervene if the student performs which action?

Removes the plaques with a soft toothbrush.

Which points would be included in the patient teaching plan for the prevention of dental caries and plaque? SELECT ALL THAT APPLY

See a dentist at least once a year brush and floss at least twice a day eat low carb foods drink fluoridated water

A parent says, "I think my son has an appendicitis. He won't eat and complains of pain to the right of his belly button. On the examination table, which position is the child MOST likely to assume if the mother is correct about appendicitis?

Side-lying with knees flexed

A young woman tearfully states "The doctor told me I need surgery and an ileostomy. I'll be pooping into a bag!. I'm leaving the hospital right now! What would the nurse do FIRST?

Sit with the patient and help her verbalize her fears and concerns.

The nurse is assisting a patient who is newly diagnosed with celiac disease. Which lunch tray would be the BEST choice?

Stir-fry vegetables with rice and orange slices

The HCP has recommended a conservative approach to manage the patient's gastroesophageal reflux disease. Which nursing intervention would support the HCP's recommendation?

Suggest methods for elevating the HOB at home.

A patient sustained blunt trauma to the abdomen. Several hours after admission, the patient reports severe abdominal pain with exquisite tenderness to light palpation. Which action would the nurse take FIRST?

Take vital signs and perform additional assessment of the abdomen.

the patient had a capsule endoscopy. Which discharge instructions should the nurse give to the patient?

The capsule will pass with bowel movements in 2-3 days; no need to retrieve.

The nurse is caring for several patients on a medical-surgical unit. Which patient is the nurse most concerned may develop a paralytic(adynamic) ileus?

The patient with an electrolyte imbalance, or acute inflammatory reactions

The patient reports a substernal burning sensation that radiates into the neck and jaw. He says "I think It's heartburn". The nurse decides to check vital signs and conduct further assessments of the pain. What is the BEST rationale for the nurse's decision?

The subjective sensations mimic angina and a potential cardiac condition should not be overlooked

An ultrasound of the gallbladder is scheduled for the client with a suspected diagnosis of cholecystitis. Which would the nurse explain to the client about this test?

The test requires the client to lie still for short intervals