Gastrointestinal Disorders (prep U additional)

When reporting to the outpatient cancer center for his first chemotherapy treatment, the client appears anxious and apprehensive. Which statement by the nurse may help allay the client's anxiety?

"As a precaution we wear gowns, goggles, and gloves to administer the medication."

A client is recovering from a small-bowel resection. To relieve pain, the physician prescribes meperidine (Demerol), 75 mg I.M. every 4 hours. How soon after administration should meperidine's onset of action occur?

10 to 15 minutes

As a client recovers from gastric resection, the nurse monitors closely for complications. When the client resumes oral feedings, the nurse observes for early manifestations of dumping syndrome. The vasomotor disturbances associated with this syndrome usually occur how soon after eating?

15 to 30 minutes

A client is evaluated for severe pain in the right upper abdominal quadrant, which is accompanied by nausea and vomiting. The physician diagnoses acute cholecystitis and cholelithiasis. For this client, which nursing diagnosis takes top priority?

Acute pain related to biliary spasms

While obtaining a client's medication history, the nurse learns that the client takes ranitidine (Zantac), as prescribed, to treat a peptic ulcer. The nurse continues gathering medication history data to assess for potential drug interactions. The client should avoid taking a drug from which class with ranitidine?

Antacids

To verify the placement of a gastric feeding tube, the nurse should perform at least two tests. One test requires instilling air into the tube with a syringe and listening with a stethoscope for air passing into the stomach. Which is another test method?

Aspiration of gastric contents and testing for a pH less than 6

The physician orders morphine for a client who complains of postoperative abdominal pain. For maximum pain relief, when should the nurse anticipate administering morphine?

Before the pain becomes severe

A client with inflammatory bowel disease undergoes an ileostomy. On the first day after surgery, the nurse notes that the client's stoma appears dusky. How should the nurse interpret this finding?

Blood supply to the stoma has been interrupted

Which nursing intervention should the nurse perform for a client receiving enteral feedings through a gastrostomy tube?

Change the tube feeding administration set at least every 24 hours.

After an exploratory laparotomy, a client develops a subhepatic abscess. After the abscess is incised and the drainage cultured, the infecting organism is identified as Bacteroides fragilis. The physician prescribes clindamycin (Cleocin), 300 mg I.V. every 6 hours. Before administering the antibiotic, the nurse reviews the client's medication history because clindamycin may enhance the action of:

Clindamycin may enhance the action of neuromuscular blocking agents by blocking neuromuscular transmission. It isn't known to interact with antiarrhythmics, anticonvulsants, or beta-adrenergic blocking agents.

During clindamycin (Cleocin) therapy, the nurse monitors a client for pseudomembranous colitis. This serious adverse reaction to clindamycin results from superinfection with which organism?

Clostridium difficile

A client with mild diarrhea, fever, and abdominal discomfort is being evaluated for inflammatory bowel disease (IBD). Which statement about IBD is true?

Diarrhea is the most common sign of IBD.

Which laboratory finding is the primary diagnostic indicator for pancreatitis?

Elevated serum lipase

The nurse asks a client who had abdominal surgery 3 days ago if he has moved his bowels since surgery. The client states, "I haven't moved my bowels, but I am passing gas." How should the nurse intervene?

Encourage the client to ambulate at least three times per day.

A client has just been diagnosed with hepatitis A. On assessment, the nurse expects to note:

Hallmark signs and symptoms of hepatitis A include anorexia, nausea, vomiting, fatigue, and weakness

The nurse is performing an assessment on a client who has developed a paralytic ileus. The client's bowel sounds will be:

If a paralytic ileus occurs, bowel sounds will be hypoactive or absent. Hyperactive bowel sounds may signify hunger, intestinal obstruction, or diarrhea

The nurse is providing dietary instructions to a client with a history of pancreatitis. Which instruction is correct?

Maintain a high-carbohydrate, low-fat diet."

A client is in the late stage of cirrhosis. When planning the client's diet, the nurse should focus on providing increased amounts of:

Normally, the liver performs many metabolic functions that provide energy for the body. In cirrhosis, the liver's metabolic function is compromised, increasing the client's need for dietary carbohydrates and other energy sources to provide for cellular metabolism

When preparing a client, age 50, for surgery to treat appendicitis, the nurse formulates a nursing diagnosis of Risk for infection related to inflammation, perforation, and surgery. What is the rationale for choosing this nursing diagnosis?

Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix.

A client who has been treated for diverticulitis is being discharged on oral propantheline bromide (Pro-Banthine). The nurse should instruct the client to take the drug at which times?

Propantheline bromide is used to reduce secretions and spasms of the GI tract in clients with diverticulitis, a condition characterized by bowel inflammation and colonic irritability and spasticity. The nurse should instruct the client to take the drug 30 minutes before meals and at bedtime to reduce GI motility, thus relieving spasticity

A 42-year-old 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?

Read the consent form to the client and ask him if he has any questions.

The nurse and the nursing assistant are caring for a paraplegic client admitted with peptic ulcer disease. Which intervention should be performed by the registered nurse?

Teaching the client about consuming a bland diet

The nurse must administer an enema to an adult client. The appropriate depth for inserting an enema into an average-sized adult is:

The appropriate depth for inserting an enema into an average-sized adult is 3″ to 4″.

Which outcome indicates effective client teaching to prevent constipation?

The client reports engaging in a regular exercise regimen.

A client has a newly created colostomy. After participating in counseling with the nurse and receiving support from the spouse, the client decides to change the colostomy pouch unaided. Which behavior suggests that the client is beginning to accept the change in body image?

The client touches the altered body part.

The nurse is assessing a client who complains of abdominal pain, nausea, and diarrhea. When examining the client's abdomen, which sequence should the nurse use?

The correct sequence for abdominal examination is inspection, auscultation, percussion, and palpation. This sequence differs from that used for other body regions (inspection, palpation, percussion, and auscultation) because palpation and percussion increase intestinal activity, altering bowel sounds. Therefore, the nurse shouldn't palpate or percuss the abdomen before auscultating.

A client with hepatitis C develops liver failure and GI hemorrhage. The blood products that would most likely bring about hemostasis in the client are:

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 include fresh frozen plasma containing fibrinogen and cryoprecipitate, which have most of the clotting factors

The graduate nurse and her preceptor are establishing priorities for their morning assessments. Which client should they assess first?

The newly admitted client with acute abdominal pain

A client has undergone a colon resection. While turning him, wound dehiscence with evisceration occurs. The nurse's first response is to:

The nurse should first place saline-soaked sterile dressings on the open wound to prevent tissue drying and possible infection. Then the nurse should call the physician and take the client's vital signs. The dehiscence needs to be surgically closed, so the nurse should never try to close it.

After being hospitalized with peritonitis for one month, a client is ready for discharge. The client is unable to prepare his meals and requires physical therapy and I.V. therapy after discharge. Based on these client needs, the client requires a home care agency that provides:

This client requires a home health care agency that provides nursing care, home health aid care, meals on wheels, and physical therapy. The other options don't meet all of the client's health care needs.

A client with peptic ulcer disease is prescribed aluminum-magnesium complex (Riopan). When teaching about this antacid preparation, the nurse should instruct the client to take it with:

Water helps transport an antacid to the stomach.

A client who has just been diagnosed with hepatitis A asks, "How could I have gotten this disease?" What is the nurse's best response?

You may have eaten contaminated restaurant food."

While reviewing the admission assessment of a client scheduled for colorectal surgery, the nurse discovers that the client stopped taking her medications to treat emphysema three months ago. When questioned, the client states that she stopped taking the medications because she couldn't afford them. The nurse should collaborate with the respiratory therapist to plan care for this client to:

administer breathing treatments, as prescribed and closely assess the client's respiratory status.

The nurse must provide total parenteral nutrition (TPN) to a client through a triple-lumen central line. To prevent complications of TPN, the nurse should:

cover the catheter insertion site with an occlusive dressing.

A client who can't tolerate oral feedings begins receiving intermittent enteral feedings. When monitoring for evidence of intolerance to these feedings, the nurse must stay alert for:

diaphoresis, vomiting, and diarrhea.

A client with pancreatitis complains of pain. The nurse expects the physician to prescribe meperidine (Demerol) instead of morphine to relieve pain because:

morphine may cause spasms of Oddi's sphincter.

Following an earthquake, a client who was rescued from a collapsed building is seen in the emergency department. He has blunt trauma to the thorax and abdomen. The nursing observation that most suggests the client is bleeding is:

orthostatic hypotension.

A client who received an inhalation anesthetic during GI surgery experiences severe shivering postoperatively. In addition to providing extra blankets, the nurse should:

provide oxygen as prescribed.

The nurse is teaching a client with malabsorption syndrome about the disorder and its treatment. The client asks which part of the GI tract absorbs food. The nurse tells the client that products of digestion are absorbed mainly in the:

small intestine.

A client with acute liver failure exhibits confusion, a declining level of consciousness, and slowed respirations. The nurse finds him very difficult to arouse. The diagnostic information which best explains the client's behavior is:

subnormal serum glucose and elevated serum ammonia levels

A client with viral hepatitis A is being treated in an acute care facility. Because the client requires enteric precautions, the nurse should:

wash the hands after touching the client.

A 78-year-old client with pancreatic cancer has the following blood chemistry profile: Glucose, fasting: 204 mg/dL; BUN: 12 mg/dL; Creatinine: 0.9 mg/dL; Sodium: 136 mEq/L; Potassium: 2.2 mEq/L; Chloride: 99 mEq/L; CO2: 33 mEq/L. Which result should the nurse identify as critical and report immediately?

A normal potassium level is 3.8 to 5.5mEq/L. Severe hypokalemia can cause cardiac and respiratory arrest, possibly leading to death. Hypokalemia also depresses the release of insulin and results in glucose intolerance. The glucose level is above normal (normal is 75 to 110 mg/dL) and the chloride level is a bit low (normal is 100 to 110 mEq/L). Although these levels should be reported, neither is life-threatening. The BUN (normal is 8 to 26 mg/dL) and creatinine (normal is 0.8 to 1.4 mg/dL) are within normal range.

The nurse caring for a client with small-bowel obstruction would plan to implement which nursing intervention first?

Administering I.V. fluids

A client is scheduled for bowel resection with anastomosis involving the large intestine. Because of the surgical site, the nurse formulates the nursing diagnosis of Risk for infection. To complete the nursing diagnosis statement, the nurse should add which "related-to" phrase?

Related to the presence of bacteria at the surgical site

A client admitted for treatment of a gastric ulcer is being prepared for discharge on antacid therapy. Discharge teaching should include which instruction?

Continue to take antacids even if your symptoms subside."

Which diagnostic test would be used first to evaluate a client with upper GI bleeding?

Hemoglobin and hematocrit are typically performed first in clients with upper GI bleeding to evaluate the extent of blood loss. Endoscopy is then performed to directly visualize the upper GI tract and locate the source of bleeding.

A client is readmitted with an exacerbation of sprue two weeks after discharge. Which statement by the client indicates the need for a dietary consult?

I didn't eat anything I shouldn't have; I just ate roast beef on rye bread."

The nurse is teaching an elderly client about good bowel habits. Which statement by the client would indicate to the nurse that additional teaching is required?

I need to use laxatives regularly to prevent constipation

A client with a history of alcohol abuse was admitted with bleeding esophageal varices. After several days of treatment, the client is ready for discharge. The nurse enters the client's room to review discharge instructions with the client when he tells the nurse that he wants help quitting drinking. How should the nurse respond?

I'll notify your physician and call the social worker so she can discuss treatment options with you

A client is scheduled to undergo an exploratory laparoscopy. The registered nurse asks the licensed practical nurse (LPN) to prepare the client for surgery. The registered nurse must confirm that the LPN has specialized training before delegating which task?

Initiating intravenous therapy, as ordered

One year ago, a client was diagnosed with cirrhosis of the liver caused by alcohol abuse. Since then, he has been noncompliant with the prescribed protein-restricted diet. After a friend finds him semiconscious at home, the client is admitted to the hospital. When initial laboratory test results show an elevated ammonia level, he's diagnosed with hepatic encephalopathy. The physician prescribes lactulose (Cephulac), 200 g diluted in 700 ml of tap water, given as a retention enema every 4 hours. For which other condition is lactulose prescribed?

Lactulose also may be used to treat constipation because it produces osmotic diarrhea. It isn't therapeutic in the treatment of hyperkalemia, lactic acidosis, or hypoglycemia.

The physician prescribes lactulose (Cephulac), 30 ml three times daily, when a client with cirrhosis develops an increased serum ammonia level. To evaluate the effectiveness of lactulose, the nurse should monitor

Level of consciousness (LOC). In cirrhosis, the liver fails to convert ammonia to urea. Ammonia then builds up in the blood and is carried to the brain, causing cerebral dysfunction. When this occurs, lactulose is administered to promote ammonia excretion in the stool and thus improve cerebral function. Because LOC is an accurate indicator of cerebral function, the nurse can evaluate the effectiveness of lactulose by monitoring the client's LOC. Monitoring urine output, abdominal girth, and stool frequency helps evaluate the progress of cirrhosis, not the effectiveness of lactulose.

An elderly client with Alzheimer's disease begins supplemental tube feedings through a gastrostomy tube to provide adequate calorie intake. The nurse should be concerned most with the potential for:

Of the choices listed, aspiration is the most serious potential complication of tube feedings. Dehydration — not fluid volume excess — is a concern because of decreased free water intake

A client diagnosed with acute pancreatitis is being transferred to another facility. The nurse caring for the client completes the transfer summary, which includes information about the client's drinking history and other assessment findings. Which assessment findings confirm his diagnosis?

Recent weight loss and temperature elevation

Why are antacids administered regularly, rather than as needed, to treat peptic ulcer disease?

To keep gastric pH at 3.0 to 3.5

A home care agency has seen a rise in the number of clients with GI disorders. The staff education coordinator is concerned that her staff may not have knowledge of the latest advances in GI care. The staff education coordinator should provide the staff with:

an educational session.