GI first 15

A nurse is caring for a client who has cirrhosis. Which of the following medications can the nurse expect to administer to this client? (select all that apply.) A. Diuretic B. Beta‑blocking agent C. opioid analgesic D. lactulose E. sedative

A, B, D A. Diuretic - treats ascites (accumulation of fluid in abdomen) caused by portal hypertension- high blood pressure in the veins that bring blood to the liver ● B. Beta‑blocking agent -By slowing the heart rate and widening the blood vessels, beta-blocker medicines such as propranolol help to lower the blood pressure in the portal veins D. Lactulose - rids the body of ammonia through the GI system (BM). It will prevent a build of ammonia that could lead to hepatic encephalopathy.

You're providing an in-service to new nurse graduates about esophageal varices in patients with cirrhosis. You ask the graduates to list activities that should be avoided by a patient with this condition. Which activities listed are correct: Select all that apply A. Excessive coughing B. Sleeping on the back C. Drinking juice D. Alcohol consumption E. Straining during a bowel movement F. Vomiting

A, D, E, and F Esophageal varices are dilated vessels that are connected from the throat to the stomach. They can become enlarged due to portal hypertension in cirrhosis and can rupture (this is a medical emergency). The patient should avoid activities that could rupture these vessels, such as excessive cough, vomiting, drinking alcohol, and constipation (straining increases thoracic pressure.)

Select all the signs and symptoms associated with Hepatitis? A. Arthralgia B. Bilirubin 1 mg/dL C. Ammonia 15 mcg/dL D. Dark urine E. Vision changes F. Yellowing of the sclera G. Fever H. Loss of appetite

A, D, F, G, and H The bilirubin and ammonia levels are normal in these options, but they would be abnormal in Hepatitis. A normal bilirubin is 1 or less, and a normal ammonia is 15-45 mcg/dL.

A nurse is preparing to administer medications to a client who is NPO and is receiving enteral feedings through an NG tube. Which of the following prescriptions should the nurse clarify with the provider? •A. Aspirin EC 325 mg per NG tube daily •B. Atorvastatin 40 mg per NG tube daily •C. Propranolol 20 mg per NG tube daily •D. Sucralfate 2 g oral suspension per NG tube BID

A. Aspirin cannot be crushed • •Atorvastatin is a used to treat high cholesterol •Propanol is a beta blocker used to treat tachycardia • •Sucralfate is an antacid, that can be used to treat ulcers

A nurse is providing discharge teaching to the partner of a client who has a new diagnosis of hepatitis A. Which of the following instructions should the nurse include in the teaching? •A. Encourage her to eat foods high in carbs •B. Have her perform moderate exercise to restore her strength more quickly •C. During the illness, she may take Tylenol (acetaminophen) for fever or discomfort •D. The provider will prescribe medication to help her liver heal faster.

A. Clients diet should be high in carbs and calories, with only moderate amounts of protein, and fat, especially if nausea is present.

Your patient is diagnosed with acute cholecystitis. The patient is extremely nauseous. A nasogastric tube is inserted with GI decompression. The patient reports a pain rating of 9 on 1-10 scale and states the pain radiates to the shoulder blade. Select all the appropriate nursing interventions for the patient: •A. Encourage the patient to consume clear liquids. •B. Administered IV fluids per MD order •C. Provide mouth care routinely. •D. Keep the patient NPO. •E. Administer analgesic as ordered. •F. Maintain low intermittent suction to NG tube.

B, C, D, E, and F The treatment for cholecystitis includes managing pain, managing nausea/vomiting (a NG tube with GI decompression (removal of stomach contents) to low intermittent suction may be ordered to help severe cases), keep patient NPO until signs and symptoms subside, mouth care from vomiting and nasogastric tube, and administer IV fluids to keep the patient hydrated.

Select all the ways a person can become infected with Hepatitis B: A. Contaminated food/water B. During the birth process C. IV drug use D. Undercooked pork or wild game E. Hemodialysis F. Sexual intercourse

B, C, E and F Hepatitis B is spread via blood and body fluids. It could be transmitted via the birthing process, IV drug use, hemodialysis, or sexual intercourse etc.

Which patients below are at risk for developing complications related to a chronic hepatitis infection, such as cirrhosis, liver cancer, and liver failure? Select all that apply: A. A 55-year-old male with Hepatitis A. B. An infant who contracted Hepatitis B at birth. C. A 32-year-old female with Hepatitis C who reports using IV drugs. D. A 50-year-old male with alcoholism and Hepatitis D. E. A 30-year-old who contracted Hepatitis E.

B, C, and D Infants or young children who contract Hepatitis B are at a very high risk of developing chronic Hepatitis B (which is why option B is correct). Option C is correct because most cases of Hepatitis C turn into chronic cases and IV drug use increases this risk even more. Option D is correct because Hepatitis D occurs when Hepatitis B is present and constant usage of alcohol damages the liver. Therefore, the patient is at high risk of developing chronic hepatitis. Hepatitis A and E tend to only cause acute infections....not chronic.

A patient with late-stage cirrhosis develops portal hypertension. Which of the following options below are complications that can develop from this condition? Select all that apply: •A. Increase albumin levels B. Ascities C. Splenomegaly D. Fluid volume deficient E. Esophageal varices

B, C, and E Portal Hypertension is where the portal vein becomes narrow due to scar tissue in the liver, which is restricting the flow of blood to the liver. Therefore, pressure becomes increased in the portal vein and affects the organs connected via the vein to the liver. The patient may experience ascites, enlarged spleen "splenomegaly", and esophageal varices etc.

A nurse is caring for a client who has a percutaneous endoscopic gastrostomy (PEG) tube and is receiving intermittent feedings. Prior to initiating the feeding, which of the following actions should the nurse take first? Select all A.Flush the tube with water B.Place the client in the semi-fowlers position C.Cleanse the skin around the tube site D.Aspirate the tube for residual contents

B. Place the client in the semi-fowlers position. (Use ABC priority framework D. To see if patient is tolerating the feeding

Your recent admission has acute cholecystitis. The patient is awaiting a cholecystostomy. What signs and symptoms are associated with this condition? Select all that apply: A. Right lower quadrant pain with rebound tenderness B. Negative Murphy's Sign C. Epigastric pain that radiates to the right scapula D. Pain and fullness that increases after a greasy or spicy meal E. Fever F. Tachycardia G. Nausea

C, D, E, F, and G

During your morning assessment of a patient with cirrhosis, you note the patient is disoriented to person and place. In addition while assessing the upper extremities, the patient's hands demonstrate a flapping motion. What lab result would explain these abnormal assessment findings? •A. Decreased magnesium level •B. Increased calcium level •C. Increased ammonia level •D. Increased creatinine level

C. Based on the assessment findings and the fact the patient has cirrhosis, the patient is experiencing hepatic encephalopathy. This is due to the buildup of toxins in the blood, specifically ammonia. The flapping motion of the hands is called "asterixis". Therefore, an increased ammonia level would confirm these abnormal assessment findings.

What is the BEST preventive measure to take to help prevent ALL types of viral Hepatitis? A. Vaccination B. Proper disposal of needles C. Hand hygiene D. Blood and organ donation screening

C. Hand hygiene can help prevent all types of viral hepatitis. However, not all types of viral Hepatitis have a vaccine available or are spread through needle sticks or blood/organs donations. Don't forget - Hepatitis A and E are spread only via fecal-oral routes. Vaccination is the best protection against HAV & HBV So if a person is exposed to Hep A, make sure others living in the household get the vaccination.

A nurse is planning care for a client who has cholelithiasis. Which of the following interventions should the nurse include in the plan? A. Restrict the client's fluid intake B. Restrict the clients calcium intake C. Decrease the clients fat intake D. Decrease the clients potassium intake

C. Decrease the clients fat intake The nurse should decrease the client's fat intake to reduce the occurrence of biliary colic

A nurse is monitoring the lab results of a client who has end-stage liver failure. Which of the following results should the nurse expect? A.Decreased lactate dehydrogenase B.Increased serum albumin C.Decreased serum ammonia D.Increased prothrombin time

D. Clients who have end-stage liver failure have an inadequate supply of clotting factors and an increased (prolonged) prothrombin time. -All other levels are reversed. Lactate dehydrogenase is an enzyme involved in energy production that is found in almost all of the body's cells. Patients with advanced cirrhosis almost always have hypoalbuminemia caused both by decreased synthesis by the hepatocytes and water and sodium retention that dilutes the content of albumin in the extracellular space.

You're caring for a 45 year old patient who is admitted with suspected acute pancreatitis. The patient reports having extreme mid-epigastric pain that radiates to the back. The patient states the pain started last night after eating fast food. As the nurse, you know the two most common causes of acute pancreatitis are: •A. High cholesterol and alcohol abuse •B. History of diabetes and smoking •C. Pancreatic cancer and obesity D. Gallstones and alcohol abuse

D. Main causes of acute pancreatitis are gallstones and alcohol consumption. **Remember: Abdominal pain is the predominant symptom. LUQ or mid-epigastrium, commonly radiates to shoulder or back, often occurs 24-48 hrs after fatty meal or heavy alcohol intake. Can have abdominal tenderness with guarding and rigidity, also can be deep, severe, piercing and continuous pain. frequent onset when patient lying down

The physician orders a patient with pancreatitis to take a pancreatic enzyme. What assessment finding demonstrates the pancreatic enzymes are working properly? A. Abdominal girth is decreased B. Skin turgor is less than 2 seconds C. Blood glucose is 250 D. Stools appear formed and solid

D. Pancreatic enzymes help the body break down carbs, proteins, and fats because the body is not sufficiently producing digestive enzymes anymore. Hence, the stool will not appear as oily or greasy (decrease in steatorrhea) but appear solid and formed. Remember these treatments: •Effective pain management •Low-fat, bland diet •Supplemental pancreatic enzymes •ELIMINATE ALCOHOL •Bile salts to facilitate absorption of fat soluble vitamins (ADEK) •Control diabetes à teach to monitor blood glucose •Antacids and anticholinergics to decrease gastric acid •it sometimes takes large, frequent doses of analgesic to relieve pain •small frequent meals, patient do not tolerate fatty, rich and stimulating foods •take after meals, have little overall effect on pt outcomes

A patient is admitted to the ER with the following signs and symptoms: very painful mid-epigastric pain felt in the back, elevated glucose, fever, and vomiting. During the head-to-toe assessment, you notice bluish discoloration around the belly button. As the nurse, you know this is called? A. Grey-Turner's sign B. McBurney's sign C. Homan's Sign D. Cullens sign

D. This is known as Cullen's Sign. It represents retroperitoneal bleeding from the leakage of digestive enzymes from the inflamed pancreas into the surrounding tissues which is causing bleeding and it is leaking down to umbilicus tissue. Remember the C in Cullen for "circle" and the belly button forms a circle. The patient can also have Grey-Turner's Sign which is a bluish discoloration at the flanks (side of the abdomen). Remember this by TURNER ("turn her" over on her side) which is where the bluish discoloration will be.