Gastrointestinal Disorders

A client who is recovering from gastric surgery is receiving I.V. fluids to be infused at 100 mL/hour. The I.V. tubing delivers 15 gtt/mL. The nurse should infuse the solution at a flow rate of how many drops per minute to ensure that the client receives 100 mL/hour? _______gtt/minute

25 To administer I.V. fluids at 100 mL/hour using tubing that has a drip factor of 15 gtt/mL, the nurse should use the following formula: 100 mL/60 minutes × 15 gtts/1 mL = 25 gtt/minute.

Following a gastrectomy, the nurse should postion the client in which of the following positions? a) Low Fowler's. b) Prone. c) Right or left Sims. d) Supine.

A. Low Fowler's. A client who has had abdominal surgery is best placed in a low Fowler's position postoperatively. This positioning relaxes abdominal muscles and provides for maximum respiratory and cardiovascular function. The prone, supine, or Sims position would not be tolerated by a client who has had abdominal surgery, nor do those positions support respiratory or cardiovascular functioning.

A client who is legally blind must undergo a colonoscopy. The nurse is helping the physician obtain informed consent. When obtaining informed consent from a client who is visually impaired, the nurse should take which step? a) Read the consent form to the client and ask him if he has any questions. b) Encourage the client to read the form. c) Document on the consent form that the client is unable to sign the consent because he is legally blind. d) Make sure the client's family is present when he signs the consent form.

A. Read the consent form to the client and ask him if he has any questions. The nurse should read the consent form to the client and make sure that he understands what was read to him. The physician and nurse should answer any questions the client has before he signs the consent form. The client's family doesn't need to be present. The legally blind client may sign the consent form.

A client has been taking aluminum hydroxide 30 ml six times per day at home to treat his peptic ulcer. He tells the nurse that he has been unable to have a bowel movement for 3 days. Based on this information, the nurse would determine that which of the following is the most likely cause of the client's constipation? a) The client is experiencing an adverse effect of the aluminum hydroxide. b) The client has developed a gastrointestinal obstruction. c) The client needs to increase his daily exercise. d) The client has not been including enough fiber in his diet.

A. The client is experiencing an adverse effect of the aluminum hydroxide. It is most likely that the client is experiencing an adverse effect of the antacid. Antacids with aluminum salt products, such as aluminum hydroxide, form insoluble salts in the body. These precipitate and accumulate in the intestines, causing constipation. Increasing dietary fiber intake or daily exercise may be a beneficial lifestyle change for the client but is not likely to relieve the constipation caused by the aluminum hydroxide. Constipation, in isolation from other symptoms, is not a sign of a bowel obstruction.

A client is admitted to the hospital after vomiting bright red blood and is diagnosed with a bleeding duodenal ulcer. The client develops a sudden, sharp pain in the mid-epigastric region along with a rigid, boardlike abdomen. The nurse should do which of the following first? a) Prepare to insert a nasogastric tube. b) Notify the physician. c) Raise the head of the bed. d) Administer pain medication as ordered.

B. Notify the physician. The client is experiencing a perforation of the ulcer and the nurse should notify the physician immediately. The body reacts to perforation of an ulcer by immobilizing the area as much as possible. This results in boardlike abdominal rigidity, usually with extreme pain. Perforation is a medical emergency requiring immediate surgical intervention because peritonitis develops quickly after perforation. Administering pain medication is not the first action, although the nurse later should institute measures to relieve pain. Elevating the head of the bed will not minimize the perforation. A nasogastric tube may be used following surgery.

A client with hepatitis C develops complications of liver failure including a prolonged prothrombin time (PT) and partial-prothrombin time (PTT). The client is told to anticipate blood products to be administered today and asks the nurse what the blood products will be. What should the nurse tell the client? a) platelets and packed red blood cells b) cryoprecipitate and fresh frozen plasma c) whole blood and albumin d) fresh frozen plasma and whole blood

B. cryoprecipitate and fresh frozen plasma The liver is vital in the synthesis of clotting factors, so when it's diseased or dysfunctional, as in hepatitis C, bleeding occurs. Treatment consists of administering blood products that aid clotting. These products include fresh frozen plasma containing fibrinogen and cryoprecipitate, which have most of the clotting factors. Although administering whole blood, albumin, and packed cells will contribute to hemostasis, these products aren't specifically used to treat hemostasis. Although platelets may be helpful, the best answer is cryoprecipitate and fresh frozen plasma.

A client with peptic ulcer disease is taking ranitidine. What is the expected outcome of this drug? a) Heal the ulcer. b) Protect the ulcer surface from acids. c) Limit gastric acid secretion. d) Reduce acid concentration.

C. Limit gastric acid secretion. Histamine-2 (H2) receptor antagonists, such as ranitidine, reduce gastric acid secretion. Antisecretory, or proton-pump inhibitors, such as omeprazole, help ulcers heal quickly in 4 to 8 weeks. Cytoprotective drugs, such as sucralfate, protect the ulcer surface against acid, bile, and pepsin. Antacids reduce acid concentration and help reduce symptoms

Why are antacids administered regularly, rather than as needed, in peptic ulcer disease? a) To increase pepsin activity b) To maintain a regular bowel pattern c) To promote client compliance d) To keep gastric pH at 3.0 to 3.5

D. To keep gastric pH at 3.0 to 3.5 To maintain a gastric pH of 3.0 to 3.5 throughout each 24-hour period, regular (not as needed) doses of an antacid are needed to treat peptic ulcer disease. Frequent administration of an antacid tends to decrease client compliance rather than promote it. Antacids don't regulate bowel patterns, and they decrease pepsin activity.

A client has had an incisional cholecystectomy. Which of the following nursing interventions has the highest priority in postoperative care for this client? a) Maintaining a weight-reduction diet. b) Performing leg exercises every shift. c) Promoting incisional healing. d) Using incentive spirometry every 2 hours while awake.

D. Using incentive spirometry every 2 hours while awake. A major goal of postoperative care for the client who has had an incisional cholecystectomy is the prevention of respiratory complications. Because of the location of the incision, the client has a difficult time breathing deeply. Use of incentive spirometry promotes chest expansion and decreases atelectasis. Performing leg exercises each shift is not frequent enough; they should be performed hourly. Maintaining a weight reduction diet may be appropriate for the client, but it is not the highest priority in the immediate postoperative phase. Promoting wound healing is important, but respiratory complications are most common after a cholecystectomy.