GI Systems Questions

1. After a subtotal gastrectomy a client demonstrates signs of dumping syndrome. About 90 minutes after the initial attack, the client reports feeling shaky. The nurse determines that the latter effect is caused by:

A. A second more extensive rise in glucose. B. An overwhelmed insulin-adjusting mechanism. C. A distention of the duodenum from an excessive amount of chyme. D. An overproduction of insulin that occurs in response to the rise in blood glucose. The rapid absorption of carbohydrates from the food mass causes an elevation of blood glucose, and the insulin response often causes transient hypoglycemic symptoms. The elevation in insulin usually occurs 90 minutes to 3 hours after eating and is known as late dumping syndrome. The physiological adaptations related to late dumping syndrome are caused by an increase in insulin, not glucose. The insulin-adjusting mechanism is not overwhelmed, but responds vigorously, causing rebound hypoglycemia. Dumping syndrome is related to the high glucose content of food, not the amount of food, entering the duodenum

2. A client with a history of food intolerance has abdominal pain, abdominal distention, and a feeling of fullness. The client is admitted to the hospital for diagnostic testing. What specific information should the nurse collect when performing the nursing admission history and physical?

A. Client's food preferences B. Presence of clay-colored stools C. Amount of splinting by the client D. Detailed characteristics of the pain The results of a detailed pain assessment help to differentiate among the many possible gastrointestinal problems. The actual food ingested in relation to the occurrence of pain is more important information than food preferences. Although the color of stool should be assessed, it is not the priority. Although self-splinting may help to identify the location of pain, this observation does not clarify the type or severity of the pain.

3. A nurse observes bright red blood in a client's nasogastric drainage four hours after a subtotal gastrectomy. What is the next nursing intervention?

A. Verify tube placement and then irrigate with normal saline. B. Clamp the nasogastric tube and call the health care provider. C. Continue to monitor the drainage and document observations. D. Reduce suction pressure and observe for changes in the drainage Some bright blood is an expected finding that should be monitored; large amounts of blood should be reported immediately. If the tube is draining, there is no need to verify placement or irrigate. Clamping the nasogastric tube and calling the health care provider is contraindicated; secretions will accumulate and cause pressure on the suture line; this prevents observation of drainage. Reducing suction allows secretions to accumulate, which will cause pressure on the suture line.