GI Adaptive quiz
Produced by parietal cells of the stomach; neccessary for absorption of B12 in the intestines
Intrinsic factor
Diet for acute pancreatitis
NPO & IV fluids (to allow the pancreas to rest)
What grains should the nurse teach a client to avoid that has been diagnosed with celiac disease?
Rye, oats, wheat (contain gluten and irritate the GI mucosa)
Why is a T-tube placed after surgery for biliary complication?
-Maintain patency of common bile duct (until edema from trauma of surgery subsides) -Drain bile (to outside the body into a collection bag)
A client with a history of recurrent cholecystitis is scheduled for an abdominal cholecystectomy. What should the nurse specifically emphasize when planning preoperative teaching for this client?
Coughing and deep breathing exercises (The operative site's proximity to the diaphragm results in the client taking shallow respirations to limit pain; failure to expand the lungs can cause hypostatic pneumonia)
What should the nurse do when caring for a client with an ileostomy? A:Teach the client to eat foods high in residue. B: Explain that drainage can be controlled with daily irrigations. C: Expect the stoma to start draining on the third postoperative day. D: Anticipate that any emotional stress can increase intestinal peristalsis.
D: Anticipate than any emotional stress can increase intestinal peristalsis (and amount of drainage)
A client has a permanent sigmoid colostomy, and colostomy irrigations are prescribed. The client asks the nurse why they are needed. How should the nurse respond?
Helps establish bowel elimination pattern (Irrigations regulate the bowel to function at a specific time for the convenience of the client.)
How does hyperventilation affect ABGs?
Increases pH (Increased elimination of Co2 from blood, decreases carbonic acid, makes blood more alkaline)
Why does cirrhosis of the liver lead to bleeding tendencies?
Interference with manufacture of clotting factors (normally produced by the liver, if liver is cirrhotic patient should report ANY signs of bleeding, no matter how small)
What is the priority assessment of a patient following esophageal surgery?
Respiratory (because of trauma of surgery and proximity of the esophagus to the trachea - airway is the priority!)
Characteristics of dumping syndrome
Weakness, sweating, tachycardia, & pallor (30 minutes after meals)
BMI formula
weight (kg) / height (m^2)
What vitamins & minerals does the liver store?
A, D, E, K (fat-soluble), B1, B2, folic acid, B12/cobalmin, & iron (when liver is cirrhotic, storage of these is compromised)
After a partial gastrectomy is performed, a client is returned from the postanesthesia care unit to the surgical unit with an intravenous (IV) solution infusing and a nasogastric tube in place. The nurse identifies that there is no nasogastric drainage for 30 minutes. There is a prescription for instillation of the nasogastric tube as needed. What should the nurse instill, and what is the procedure that follows? A: 30 mL of NS, then continue the suction B: 20 mL of air, then clamp off the suction for 1 hour C: 50 mL of saline, then increase the pressure of the suction D: 15 mL of distilled water, then disconnect the suction for 30 minutes
A: 30 mL of NS, then continue to suction (Physiologic normal saline is used in gastric instillations to prevent electrolyte imbalance. Because of the fresh gastric sutures, slow and gentle instillation of saline should be performed to reestablish patency of the tube, and then the tube should be reconnected to suction to ensure stomach decompression)
A client is diagnosed with cancer of the stomach and is scheduled for a partial gastrectomy. The teaching on postoperative care provided by the nurse should cover what topic? A: Gastric suction B: Oxygen therapy C: Fluid restriction D: Urinary catheter
A: Gastric suction (After gastric surgery a nasogastric tube is in place for drainage of blood and gastric secretions that allow healing at the site of anastomosis)
A client has cholelithiasis with possible obstruction of the common bile duct. What should be determined about the client's nutritional status before surgery is scheduled? A: Is the client deficient in vitamins A, D, and K? B: Does the client eat adequate amounts of dietary fiber? C: Does the client consume excessive amounts of protein? D: Are the client's levels of potassium and folic acid increased?
A: Is the client deficient in vitamins A, D, & K? (Bile promotes the absorption of fat-soluble vitamins; an obstruction of the common bile duct limits the flow of bile to the duodenum, limiting absorption of fat-soluble vitamins A, D, and K. Vitamin K helps with clotting; surgery can be postponed if bleeding problems exist)
Signs of malabsorption of fat
Diarrhea, steatorrhea, weight loss
Signs and symptoms of B12 deficiency
Peripheral neuropathy, loss of balance/proprioception, mental status changes, impaired memory, dementia, or depression
What position should a patient be placed in after a needle biopsy of the liver?
Right side-lying (The client should be positioned in the right side-lying position for two hours after the procedure because this applies pressure to the insertion site and reduces the risk of bleeding)
A client had surgery for a perforated appendix with localized peritonitis. In which position should the nurse place this client?
Semi-fowler
Yellowish tinge caused by bile deposits; often first observed in the sclera of patients with liver disease
Jaundice (icterus)
What position should a patient be put in when administering an enema?
Left Sims or left side-lying (facilitates flow of fluid into sigmoid colon by gravity)
A client with hepatic cirrhosis begins to develop slurred speech, confusion, drowsiness, and a flapping tremor. Which diet can the nurse expect will be prescribed for this client based upon the assessment?
Moderate protein (Because the liver is unable to detoxify ammonia to urea and the client is experiencing impending hepatic encephalopathy coma, protein intake should be moderately restricted. Strict protein and no protein restrictions are not required because clients need protein for healing. High protein is contraindicated in hepatic encephalopathy)
Signs of hepatic encephalopathy (seen in cirrhosis of the liver)
-Confusion (accumulation of nitrogenous waste affects the CNS) -Flapping tremors (2nd stage) and generalized twitching (3rd stage) -Musty, sweet breath odor (fetor hepaticus)
Why is a patient at risk for anemia after part of the ileum is removed?
B12 (needed to make RBCs) combines with intrinsic factor (from the parietal cells of the stomach) and is absorbed in the ileum
A nurse is providing discharge instructions to a client diagnosed with cirrhosis and varices. Which information should the nurse include in the teaching session?
-Avoid aspirin (damages gastric mucosa and may precipitate hemorrhage) -Avoid acetaminophen (toxic to liver, do not use with cirrhosis) -Abstain from alcohol -Avoid coughing, sneezing, straining to have BM (increases portal pressure and increase risk of varicile hemorrhage) -High-carb diet (diseased liver has diminished ability to make and store glucose)
What is a Sengstaken-Blakemore tube used for? How many lumens does it have & what are they used for?
-Esophageal varices -Three lumens -Inflation of esophageal baloon (compresses esophagus and stops bleeding) -Inflation of gastric balloon -Suction (to decompress the stomach)
A client reports pain four hours after a liver biopsy. The nurse identifies that there is leakage of a large amount of bile on the dressing over the biopsy site. What should the nurse do first? What position should patient be in?
-Notify HCP (small amount of bile-colored spotting on dressing is normal; large amount is not normal) -Right side-lying (to compress liver capsule against chest wall)
Two weeks after sustaining a spinal cord injury, a client begins vomiting thick coffee-ground material and appears restless and apprehensive. What is the most important initial nursing action? A: Prepare to insert an NG tube B: Obtain stool sample to check for occult blood C: Change diet to bland D: Check most recent hemoglobin level
-Prepare to insert an NG tube (The client should have a nasogastric tube inserted to keep the stomach decompressed; the nurse should monitor the amount and characteristics of the drainage. Coffee-ground gastric fluid indicates blood that has been influenced by gastric juices. The healthcare provider should be notified)
Diet for pancreatitis (after acute phase is over)
-Small, frequent feedings (put less demand on pancreas to release enzymes) -Avoid spicy/seasoned foods, caffeine (stimulates pancreatic secretions), and fats (stimulate the release of lipase from pancreas)
When inserting a catheter to irrigate a client's colostomy, the nurse meets some resistance. What should the nurse do? A: Probe with the irrigating catheter to determine the contour of the bowel B:Obtain a more rigid tip for the irrigating catheter to insert into the stoma C:Apply pressure to the irrigating catheter to overcome the spasm of the bowel D: Instill a small amount of solution from the irrigating container into the stoma
D: Instill a small amount of solution from the irrigating container into the stoma (Instilling a small amount of solution from the irrigating container into the stoma helps distend the bowel ahead of the catheter and eases catheter insertion)
For which clinical indicator associated with a complication of portal hypertension should the nurse assess the client?
Hemorrhage from esophageal varices (Increased pressure within the portal circulatory system causes increased pressure in areas of portal systemic collateral circulation; most important, in the distal esophagus and proximal stomach).
