MCA WEEK III
A 61-year-old patient with suspected bowel obstruction had a nasogastric tube inserted at 4:00 AM. The nurse shares in the morning report that the day shift staff should check the tube for patency at what times? Incorrect1 7:00 AM, 10:00 AM, and 1:00 PM Correct2 8:00 AM, 12:00 PM, and 4:00 PM 3 9:00 AM and 3:00 PM 4 9:00 AM, 12:00 PM, and 3:00 PM
A nasogastric tube should be checked for patency routinely at four-hour intervals. Thus, if the tube were inserted at 4:00 AM, it would be due to be checked at 8:00 AM, 12:00 PM, and 4:00 PM
Which surgical therapy is used to treat pyloric obstruction? 1 Vagotomy Correct2 Endoscopy Incorrect3 Gastrojejunostomy 4 Gastroduodenostomy
An endoscopy with balloon dilations is used in the treatment of pyloric obstruction. A vagotomy is the severing of the vagus nerve either totally or selectively to decrease gastric acid secretion. A gastrojejunostomy involves a partial gastrectomy with removal of two-thirds of the stomach and an anastomosis of the gastric stump to the jejunum. Gastroduodenostomy is a partial gastrectomy with removal of two-thirds of the stomach and an anastomosis of the gastric stump to the duodenum.
Which medication is prescribed for the prevention of peptic ulcer caused by nonsteroidal antiinflammatory drugs (NSAIDs) and aspirin? 1 Famotidine 2 Imipramine 3 Misoprostol 4 Clarithromycin
Because of its protective and antisecretory effects on gastric mucosa, misoprostol (a synthetic prostaglandin analog) is prescribed to prevent peptic ulcers caused by NSAIDS and aspirin. Famotidine is a histamine-receptor blocker used to heal ulcers. Imipramine is a tricyclic antidepressant prescribed for patients with peptic ulcer disease. Clarithromycin is a medication included in triple-drug therapy for treating Helicobacter pylori (H. pylori) infection.
While reviewing the laboratory reports of a patient with chronic inflammation of the gastrointestinal tract, the nurse suspects toxic megacolon in the patient. Which laboratory finding supports the nurse's suspicion? Incorrect1 Decreased albumin Correct2 Elevated leukocytes 3 Decreased serum sodium 4 Elevated C-reactive protein
Chronic inflammation of the gastrointestinal tract indicates inflammatory bowel disease. Toxic megacolon is a condition characterized by swelling and dilation of the large intestine due to inflammation of the intestinal wall and accumulation of excess gas. Toxic megacolon causes leukocytosis, resulting in an increased number of leukocytes. Decreased albumin indicates protein loss. Decreased serum sodium indicates fluid and electrolyte imbalance. Elevated C-reactive protein indicates inflammation.
A patient who has a family history of colon cancer asks the nurse about tests for colon cancer. Which of these is considered the best method for colorectal cancer (CRC) screening? Correct1 Colonoscopy Incorrect2 Barium enema 3 Sigmoidoscopy 4 Fecal occult blood test (FOBT)
Colonoscopy is the gold standard for CRC screening because the entire colon is examined (only 50 percent of CRCs are detected by sigmoidoscopy), biopsies can be obtained, and polyps can be removed immediately and sent to the laboratory for examination. A less favorable, but acceptable, screening method includes testing the stool for fecal blood. The FOBT and fecal immunochemical test (FIT) look for blood in the stool. Stool tests must be done frequently because tumor bleeding occurs at intervals and easily may be missed if only a single test is done.
What nursing diagnostic statement would be assigned the highest priority in the plan of care for a patient who has ulcerative colitis? 1 Activity intolerance 2 Deficient fluid volume 3 Impaired tissue integrity 4 Risk for impaired skin integrity
In ulcerative colitis, fluid is not absorbed from the distal large intestine because of ulceration, bleeding, and, later, scarring and narrowing of the lumen of the bowel. Fluid and electrolytes are also lost in the stool; therefore, deficient fluid volume is the priority nursing diagnostic statement. Activity intolerance, impaired tissue integrity, and risk for impaired skin integrity are all possibilities related to ulcerative colitis, but they are not as high of a risk as deficient fluid volume. 78%of students nationwide answered this question correctly.
What is the cause of nonmechanical intestinal obstruction? 1 Hernia 2 Intussusception Correct3 Thoracic spinal fracture 4 Strictures from Crohn's disease
Intestinal obstruction occurs when intestinal contents are unable to pass through the gastrointestinal tract. Paralytic ileus is the most common form of nonmechanical obstruction. A thoracic spinal fracture is a cause of paralytic ileus. Hernia, intussusceptions, and strictures from Crohn's disease cause mechanical obstruction.
When assessing a patient with a gastrointestinal disorder, the nurse finds an absence of bowel sounds and peristalsis. The assessment findings are indicative of what condition? 1 Volvulus 2 Borborygmi Correct3 Paralytic ileus 4 Pseudopolyps
Lack of intestinal peristalsis and an absence of bowel sounds indicate paralytic ileus, which occurs due to paralysis of intestinal muscles. Volvulus is an intestinal obstruction that occurs by the bowel twisting around a focal point. Borborygmi are audible abdominal sounds due to hyperactive intestinal motility. Pseudopolyps are tongue-like projections into the bowel lumen. Test-Taking Tip: Do not worry if you select the same numbered answer repeatedly because there usually is no pattern to the answers.
The nurse recognizes that which treatment strategy is beneficial for patients with stage I colorectal tumors? 1 Resection 2 Reanastomosis 3 Chemotherapy 4 Laparoscopic surgery
Laparoscopic surgery is used to treat stage I colorectal tumors. Stage II colorectal tumors are treated with resection and reanastomosis. Chemotherapy is used to treat high-risk stage II, stage III, and stage IV colorectal tumors.
Which medication for peptic ulcer disease causes hallucinations? 1 Nizatidine Incorrect2 Sucralfate 3 Omeprazole Correct4 Metoclopramide
Metoclopramide is a prokinetic agent that causes central nervous system side effects such as hallucinations and anxiety. Nizatidine is a histamine (H2) receptor blocker that causes abdominal pain, headache, diarrhea, and constipation. Sucralfate is an antiulcer medication that causes constipation. Omeprazole is a proton pump inhibitor that causes nausea, abdominal pain, headache, diarrhea, and flatulence.
Which histamine-receptor blocker is available only for oral administration? 1 Nizatidine 2 Ranitidine 3 Cimetidine 4 Famotidine
Nizatidine is available only for oral administration but not for intravenous (IV) administration; the medication is used to promote ulcer healing. Ranitidine, cimetidine, and famotidine are histamine (H2) blockers that can be given orally or through IV.
A patient has what is suspected to be a gastric ulcer perforation. Which symptom does the nurse expect will be present? Incorrect1 Pyrosis Correct2 Rigid abdomen 3 Bright-red emesis 4 Clay-colored stools
Perforation results in spillage of gastric or duodenal contents into the upper peritoneal cavity. The patient experiences sudden upper abdominal pain because the spillage causes irritation of pain receptors in the visceral and parietal layers of the peritoneum. The body then attempts to protect the area by contracting the abdominal muscles, resulting in a rigid, board-like abdomen. Pyrosis, a painful and burning sensation in the esophagus, just below the breastbone, is usually associated with regurgitation of gastric acid, also known as heartburn. Bright-red emesis may be present as a result of hemorrhage from the gastric ulcer but is not as common as the rigid, board-like abdomen. Clay-colored stools are associated with hepatic disease, such as hepatitis, not gastric ulcer perforation.
A colectomy is scheduled for an 81-year-old man with an abdominal mass, suspected bowel obstruction, and a history of rectal polyps. The nurse should plan to include which prescribed measure in the preoperative preparation of this patient? 1 Rectal acetaminophen to reduce postoperative pain 2 Administration of intravenous (IV) anticoagulants to prevent blood clots Incorrect3 Strict adherence to a liquid diet for three days before surgery Correct4 Administration of a cleansing enema
Preoperative preparation for bowel surgery typically includes bowel cleansing with oral antibiotics such as oral neomycin and cleansing enemas, including Fleet enemas. Rectal acetaminophen is not the best choice for pain control. Anticoagulants should not be administered before surgery because of the risk of bleeding; they should be administered subcutaneously after surgery to prevent clotting. The patient will be nothing by mouth (NPO) for eight hours before surgery; before that, the patient can have a normal diet.
Which type of intestinal obstruction does the nurse recall is observed in a patient with collagen vascular disease? 1 Pseudo-obstruction 2 Vascular obstruction 3 Mechanical obstruction 4 Nonmechanical obstruction
Pseudo-obstruction is a type of intestinal obstruction caused by collagen vascular disease. Vascular obstruction occurs due to emboli and atherosclerosis of the mesenteric arteries. Hernias and strictures due to Crohn's disease cause mechanical obstruction. Neuromuscular and vascular diseases cause nonmechanical obstruction.
Which medication is prescribed for cytoprotective drug therapy? 1 Tofranil 2 Sucralfate 3 Cimetidine 4 Misoprostol
Sucralfate provides cytoprotective for the esophagus, stomach, and duodenum by forming a protective layer and serves as a barrier against acids, bile salts, and enzymes. Tofranil is a tricyclic antidepressant that provides pain relief in peptic ulcer disease. Cimetidine is a histamine blocker that provides ulcer healing. Misoprostol is prescribed to prevent gastric ulcers caused by nonsteroidal antiinflammatory drugs.
The nurse is caring for a patient who presents with tachycardia, lower abdominal pain, and nausea and vomiting. Upon clinical examination, the primary health care provider identifies a rigid and board-like abdomen. Which surgical therapy is beneficial for the patient? 1 Billroth I 2 Vagotomy Correct3 Laparoscopy 4 Pyloroplasty
Tachycardia, lower abdomen pain, nausea, and vomiting are the clinical manifestations of perforation, a complication of peptic ulcer disease. A laparoscopy involves a simple closure with an omentum graft, which will repair the perforation with appropriate source control and limit the parietal cell acid secretion. Billroth I involves a partial gastrectomy where two-thirds of the stomach is removed and there is an anastomosis of the gastric stump to the duodenum. A vagotomy involves severing the vagus nerve either totally or selectively. Pyloroplasty consists of surgical enlargement of the pyloric sphincter.
The nurse is preparing to insert a nasogastric (NG) tube into a 68-year-old female patient who is nauseated and vomiting. The patient has an abdominal mass and suspected small intestinal obstruction. The patient asks the nurse why this procedure is necessary. What response by the nurse is most appropriate? Correct1 "The tube will help to drain the stomach contents and prevent further vomiting." 2 "The tube will push past the area that is blocked and thus help to stop the vomiting." 3 "The tube is just a standard procedure before many types of surgery to the abdomen." 4 "The tube will let us measure your stomach contents so that we can plan what type of intravenous fluid replacement would be best."
The NG tube is used to decompress the stomach by draining stomach contents, and thereby prevent further vomiting. The NG tube will not push past the blocked area. Potential surgery is not indicated currently. The location of the obstruction will determine the type of fluid to use, not measuring the amount of stomach contents.
The nurse is caring for a patient who is scheduled to receive a course of long-term broad spectrum antibiotic therapy. The nurse knows the patient will need instruction on actions to take to prevent infection with which organism? 1 Salmonella Correct2 Clostridium difficile Incorrect3 Rotavirus 4 Escherichia coli 0157:H7
The development of C. difficile is associated with the administration of broad-spectrum antibiotics. Although Salmonella, Rotavirus, and E. coli 0157:H7 are bacterial infections affecting the colon, their occurrence is not associated with antibiotic administration.
A patient is admitted to the hospital with a severe duodenal ulcer. The patient suddenly complains of severe pain spreading over the entire abdomen, likely due to a perforation. What should be the most immediate intervention by the nurse, if prescribed? 1 Administer nitrates. 2 Administer pain medication. 3 Prepare for laparoscopic surgery. 4 Insert a nasogastric (NG) tube into the stomach.
The immediate focus of management for a patient with a perforation is to stop the spillage of gastric or duodenal contents into the peritoneal cavity and restore blood volume. An NG tube is inserted into the stomach to provide continuous aspiration and gastric decompression to stop spillage through the perforation and thereby prevent peritonitis. Administering nitrates to such a patient will not be helpful in relieving the condition. Administration of pain medications and preparations for laparoscopic surgery are done later.
Which condition can be diagnosed by measuring fasting serum gastrin levels? 1 Acute gastritis 2 Pyloric obstruction 3 Gastric outlet obstruction Correct4 Zollinger-Ellison syndrome
Zollinger-Ellison syndrome can be diagnosed by measuring fasting serum gastrin levels, which will determine the amount of gastrin secreted by G cells of the stomach. Acute gastritis is diagnosed by endoscopic examination with biopsy. Pyloric obstruction is diagnosed by performing an endoscopy with dilated balloons. Gastric outlet obstruction is diagnosed by performing a barium contrast study.
