Medical Surgical Nursing - Gastrointestinal Disorders

A client is diagnosed with a hiatal hernia. Which statement indicates effective client teaching about hiatal hernia and its treatment? "I'll be able to eat most things as long as I eat small amounts." "I'll lie down for 30 minutes after I eat to promote digestion." "I'll gradually increase the amount of heavy lifting I do." "I'll eat frequent, small, bland meals that are high in fiber."

"I'll eat frequent, small, bland meals that are high in fiber."

An older adult is constipated and tells the nurse that this has not happened before. What should the nurse tell the client? "Constipation is an expected problem at your age. Wait to see if this continues." "You need to eat more fiber. I'll tell the dietician." "You need to drink more water. I'll start a record so you can keep track." "This may be a sign of a more serious problem; I'll report this to your health care provider (HCP)."

"This may be a sign of a more serious problem; I'll report this to your health care provider (HCP)."

During clindamycin therapy, a nurse monitors a client for pseudomembranous colitis. This serious adverse reaction to clindamycin results from superinfection with which organism? Staphylococcus aureus Bacteroides fragilis Escherichia coli Clostridium difficile

Clostridium difficile

A nurse is caring for a client with gastroenteritis. The nurse administers an as-needed dose of kaolin and pectin mixture as ordered. The nurse should complete which assessment 30 minutes after administering the medication? Determine if the client has had any more loose stools. Perform a pain assessment. Monitor for respiratory depression. Determine if the client has relief from nausea.

Determine if the client has had any more loose stools.

The nurse is caring for a client 1 day after having a colectomy. The client is lethargic and difficult to arouse; the temperature is 101.5°F (38.6°C), blood pressure is 92/36 mm Hg (MAP 55 mm Hg), and heart rate is 114 bpm with SpO2 of 88% on oxygen at 2 L/min per nasal cannula (previously 94%). A saline lock has been established and is patent. Which prescription should the nurse implement first? Obtain stat portable chest X-ray. Administer vancomycin intravenously. Draw blood cultures. Insert an indwelling urinary catheter.

Draw blood cultures.

The nurse develops a plan of care for a client with a t-tube. Which nursing intervention should be included? Inspect skin around the t-tube daily for irritation. Irrigate the t-tube every 4 hours to maintain patency. Maintain client in a supine position while the t-tube is in place. Keep the t-tube clamped except during meal times.

Inspect skin around the t-tube daily for irritation.

A client with ascites had a paracentesis. Which post-procedure intervention should the nurse implement? Instruct the client to void immediately. Keep the client NPO for 2 hours. Place the client on the left side. Monitor the client's temperature.

Monitor the client's temperature.

A client with diverticulitis has developed peritonitis following diverticular rupture. When assessing the client, what should the nurse do? Select all that apply. Percuss the abdomen to note tympany. Percuss the liver to note lack of dullness. Monitor the vital signs for fever. Assess presence of excessive thirst. Auscultate bowel sounds to note frequency.

Percuss the abdomen to note tympany. Percuss the liver to note lack of dullness. Monitor the vital signs for fever. Auscultate bowel sounds to note frequency.

An adult with appendicitis has severe abdominal pain. Which action will be the most effective to assist the client to manage pain prior to surgery? Place the client in semi-Fowler's position with the knees to the chest. Apply moist heat to the abdomen. Teach client to massage the painful area. Provide distraction with music.

Place the client in semi-Fowler's position with the knees to the chest.

The nurse is preparing a client for an ileostomy. Two weeks before the surgery, what should the nurse instruct the client to do? Stop taking drugs that will interfere with clotting. Follow a low-residue diet. Limit fluids to 1,000 ml/ day. Report having a temperature above 99° F (37.2° C).

Stop taking drugs that will interfere with clotting.

A client is to be discharged from same-day surgery 7 hours after his inguinal hernia repair. Which nursing observation indicates this client is ready to be discharged? The client voids 500 mL of urine. The client tolerates eating a hamburger. The client is pain free. The client walks in the hallway unassisted.

The client voids 500 mL of urine.

During the first few weeks after a cholecystectomy, the client should follow a diet that includes: a decreased intake of fruits, vegetables, whole grains, and nuts, to minimize pressure within the small intestine. at least four servings daily of meat, cheese, and peanut butter to increase protein intake that aids incisional healing. a limited intake of fat distributed throughout the day so that there is not an excessive amount in the intestine at any one time. ingestion of pancreatic enzymes with meals to replace the normal enzyme secretion that has been surgically altered.

a limited intake of fat distributed throughout the day so that there is not an excessive amount in the intestine at any one time.

A client with liver and renal failure has severe ascites. On initial shift rounds, the primary nurse finds the indwelling urinary catheter collection bag too full to store more urine. The nurse empties more than 2,000 ml from the collection bag. One hour later, the nurse finds the collection bag full again. The nurse notifies the physician, who suspects that a bladder rupture is allowing the drainage of peritoneal fluid. The physician orders a urinalysis to be obtained immediately. The presence of which substance is considered abnormal? creatinine urobilinogen chloride albumin

albumin

A nurse is caring for a client with cholelithiasis. Which sign indicates obstructive jaundice? straw-colored urine reduced hematocrit clay-colored stools elevated urobilinogen in the urine

clay-colored stools

A 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. use clean technique when changing the dressing. insert an indwelling urinary catheter. keep the client on complete bed rest.

cover the catheter insertion site with an occlusive dressing. TPN increases the client's risk of infection because the catheter insertion site creates a port of entry for bacteria. To reduce the risk of infection, the nurse should cover the insertion site with an occlusive dressing, which is airtight. Because the insertion site is an open wound, the nurse should use sterile technique, not clean technique, when changing the dressing. TPN doesn't necessitate placement of an indwelling urinary catheter or bed rest.

A nurse is caring for a client who underwent a subtotal gastrectomy. To manage dumping syndrome, the nurse should advise the client to restrict fluid intake to 1 qt (1,000 ml)/day. drink liquids only with meals. not drink liquids 2 hours before meals. drink liquids only between meals.

drink liquids only between meals.

A client with severe inflammatory bowel disease is receiving total parenteral nutrition (TPN). When administering TPN, the nurse must take care to maintain the ordered flow rate because giving TPN too rapidly may cause hyperglycemia. air embolism. constipation. dumping syndrome.

hyperglycemia

A nurse is assessing a client who is receiving total parenteral nutrition (TPN). Which finding suggests that the client has developed hyperglycemia? Cheyne-Stokes respirations increased urine output decreased appetite diaphoresis

increased urine output

A client is admitted with increased ascites related to cirrhosis. The client has a large round and firm abdomen. The client is not able to lie flat in bed and requests to be placed in a high Fowler's position to sleep. Which nursing diagnosis should receive top priority? fatigue excess fluid volume ineffective breathing pattern imbalanced nutrition: less than body requirements

ineffective breathing pattern

A nurse is assessing a client and obtains the following findings: abdominal discomfort, mild diarrhea, and a temperature of 100°F (37.8°C). The nurse questions the client about a past diagnosis of what condition? inflammatory bowel disease (IBD) colorectal cancer diverticulitis liver failure

inflammatory bowel disease (IBD)

The comatose victim of a car accident is to have a gastric lavage. Which position would be most appropriate for the client during this procedure? lateral supine Trendelenburg's lithotomy

lateral

A physician orders spironolactone, 50 mg by mouth four times daily, for a client with fluid retention caused by cirrhosis. Which finding indicates that the drug is producing a therapeutic effect? serum potassium level of 3.5 mEq/L loss of 2.2 lb (1 kg) in 24 hours serum sodium level of 135 mEq/L blood pH of 7.25

loss of 2.2 lb (1 kg) in 24 hours

The nurse should assess the client with severe diarrhea for which acid-base imbalance? respiratory acidosis respiratory alkalosis metabolic acidosis metabolic alkalosis

metabolic acidosis

Which symptom would the nurse most likely observe in a client with cholecystitis from cholelithiasis? black stools nausea after ingestion of high-fat foods elevated temperature of 103°F (39.4°C) decreased white blood cell count

nausea after ingestion of high-fat foods

A nurse presents a client with the informed consent form for an abdominal paracentesis. The client asks the nurse what the procedure involves. The nurse should have the client sign the form and ask the physician explain the procedure again. explain the form and have the client's healthcare power of attorney sign it. explain the procedure and the benefits and risks associated with it, then have the client sign the form. notify the physician that the client doesn't understand the procedure. TAKE ANOTHER QUIZ

notify the physician that the client doesn't understand the procedure.

After gastric resection surgery, which signs alert the nurse to the development of a leaking anastomosis? pain, fever, and abdominal rigidity diarrhea with fat in the stool palpitations, pallor, and diaphoresis after eating feelings of fullness and nausea after eating

pain, fever, and abdominal rigidity

A client with acute appendicitis develops a fever, tachycardia, and hypotension. Based on these findings, the nurse should further assess the client for which complication? deficient fluid volume intestinal obstruction bowel ischemia peritonitis

peritonitis

When assessing a client's inguinal hernia, the nurse should place the client in which position? standing sitting left side-lying right side-lying

standing

Which outcomes would be most appropriate for a client with peptic ulcer disease? The client will: verbalize absence of epigastric pain. accept the need to inject vitamin B12. understand the need to increase exercise. state an intention to eliminate stress.

verbalize absence of epigastric pain.

Which finding is the best indication that the goals for total parenteral nutrition (TPN) are being achieved for the client? urine negative for glucose serum potassium level of 4 mEq/L (4 mmol/L) serum glucose level of 96 mg/dL (5.3 mmol/L) weight gain of 0.5 lb/day (0.2 kg/day)

weight gain of 0.5 lb/day (0.2 kg/day)

Which finding is normal for a client during the icteric phase of hepatitis A? tarry stools yellowed sclera shortness of breath light, frothy urine

yellowed sclera Liver inflammation and obstruction block the normal flow of bile. Excess bilirubin turns the skin and sclera yellow and the urine dark and frothy. Profound anorexia is also common. Tarry stools are indicative of gastrointestinal bleeding and would not be expected in hepatitis. Light- or clay-colored stools may occur in hepatitis owing to bile duct obstruction. Shortness of breath would be unexpected.

The nurse is teaching a client with stomatitis about managing oral discomfort. Which instruction is most appropriate? Drink hot tea at frequent intervals. Gargle with antiseptic mouthwash. Use an electric toothbrush. Eat a soft, bland diet.

Eat a soft, bland diet.

A client is admitted to the healthcare facility with a diagnosis of a bleeding gastric ulcer. What stool appearance will the nurse document as consistent with a gastric ulcer? coffee ground-like clay-colored black and tarry bright red

black and tarry

A client with a bleeding ulcer is vomiting bright red blood. The nurse should assess the client for which indicator of early shock? heart rate above 100 beats/minute dry, flushed skin increased urine output loss of consciousness

heart rate above 100 beats/minute

A client has just returned from surgery for a gastrectomy. The nurse should position the client in which position? prone supine low Fowler's right or left Sims'

low Fowler's

A client has a percutaneous endoscopic gastrostomy tube in place for tube feedings. Before starting a continuous feeding, the nurse would place the client in which position? semi-Fowler's supine dorsal recumbent high Fowler's

semi-Fowler's

A client with nausea, vomiting, and abdominal cramps and distention is admitted to the healthcare facility. Which test result is most significant? blood urea nitrogen (BUN) level of [29 mg/dl (10.4 mmol/L)] serum sodium level of [132 mEq/L 132 mmol/L)] urine specific gravity of 1.025 serum potassium level of [3 mEq/L (3.0 mmol/L)]

serum potassium level of [3 mEq/L (3.0 mmol/L)]

A client has had a laparoscopic cholecystectomy. Which statement indicates that the client understands the nurse's discharge instructions about activity restrictions? "I'll need to stay in bed the 1st 2 days I'm home." "I won't be able to lift objects until 6 weeks after my surgery." "I can return to my normal activities within 7 days." "I should avoid sitting upright for 1 week after my surgery."

"I can return to my normal activities within 7 days."

A client with an esophageal stricture is about to undergo esophageal dilatation. As the bougies are passed down the esophagus, the nurse should instruct the client to do which action to minimize the vomiting urge? Hold his breath Take long, slow breaths Bear down as if having a bowel movement Pant like a dog

Take long, slow breaths

A client with pancreatitis has been receiving total parenteral nutrition (TPN) for the past week. Which nursing intervention best determines the TPN is providing adequate nutrition? monitoring blood glucose levels every 6 hours evaluating serum electrolyte levels daily monitoring the client's weight every day recording fluid intake and output

monitoring the client's weight every day

A nurse is teaching a client about nonpharmacologic comfort measures to alleviate postoperative pain. Which client statement indicates a need for further teaching? "Music therapy can help me relax, so the pain won't be so bad." "The transcutaneous electrical nerve stimulation, or TENS, unit uses an electrical stimulator to block painful stimuli." "Applying warm moist compresses to my incision can relax my abdominal muscles." "With patient-controlled analgesia, or PCA, I can control my pain by administering my own pain medication."

"With patient-controlled analgesia, or PCA, I can control my pain by administering my own pain medication."

Which statement, made by a client with a hiatal hernia, indicates that the client understands the treatment plan? "I will sit in a chair for several hours after I eat." "I will lie down for 15 minutes after I eat." "I will lie on my left side at night to decrease reflux." "I will need to have my INR/PT every two weeks."

"I will sit in a chair for several hours after I eat."

After the nurse teaches the parent of an infant with pyloric stenosis about the condition, which cause, if stated by the parent, indicates effective teaching? "a telescoping of the large bowel into the smaller bowel" "a result of giving the baby more formula than is necessary" "an enlarged muscle below the stomach" "a genetically smaller stomach than normal"

"an enlarged muscle below the stomach"

A client who has been treated for diverticulitis is being discharged on oral propantheline bromide. The nurse should instruct the client to take the drug with meals and at bedtime. immediately before meals and at bedtime. 30 minutes before meals and at bedtime. 1 hour after meals and at bedtime.

30 minutes before meals and at bedtime.

The nurse is caring for a client who is 24 hours after gastric bypass surgery. The client has experienced four episodes of vomiting in the past 12 hours, each producing between 500 and 800 ml of bright yellow-green liquid emesis. What action should the nurse take? Request additional antiemetic medication be prescribed. Ask client to only take clear fluids until the health care provider can assess. Contact health are provider for a STAT abdominal x-ray prescription. Increase the client's intravenous fluid rate to replace losses.

Contact health are provider for a STAT abdominal x-ray prescription.

A client presents to the emergency department, reporting that they have been vomiting every 30 to 40 minutes for the past 8 hours. Frequent vomiting puts this client at risk for which imbalances? metabolic acidosis and hyperkalemia metabolic acidosis and hypokalemia metabolic alkalosis and hyperkalemia metabolic alkalosis and hypokalemia

metabolic alkalosis and hypokalemia Gastric acid contains large amounts of potassium, chloride, and hydrogen ions. Excessive vomiting causes loss of these substances, which can lead to metabolic alkalosis and hypokalemia. Excessive vomiting doesn't cause metabolic acidosis or hyperkalemia.

A client is scheduled for oral cholecystography. Prior to the test, the nurse should: have the client drink 1,000 mL of water. ask the client about possible allergies to iodine or shellfish. administer an intravenous contrast agent the evening before the test. give tap water enemas until clear.

ask the client about possible allergies to iodine or shellfish.

A nurse is caring for a client with an endotracheal tube who receives enteral feedings through a feeding tube. Before each tube feeding, the nurse checks for tube placement in the stomach as well as residual volume. The purpose of the nurse's actions is to prevent gastric ulcers. aspiration. abdominal distention. diarrhea.

aspiration

A client is recovering from an ileostomy that was performed to treat inflammatory bowel disease. During discharge teaching, the nurse should stress the importance of increasing fluid intake to prevent dehydration. wearing an appliance pouch only at bedtime. consuming a low-protein, high-fiber diet. taking only enteric-coated medications.

increasing fluid intake to prevent dehydration.

A client with constipation takes psyllium granules as 1 rounded teaspoon mixed in fruit juice 3 times daily. Which of the following statements by the client indicates that further teaching is required? "I will mix this medication with at least 8 oz (240 mL) of water or juice immediately before taking it." "I will check for soft to semi-liquid stools being passed within 1 to 3 days of taking this medication." "I will drink 6 to 10 glasses of water or juice daily when taking this laxative." "I will need to take the medication for 4 weeks."

"I will need to take the medication for 4 weeks." It is usually taken 1 to 3 times daily. It should not be taken for more than 1 week unless advised. Clients cannot continue this drug for 4 weeks. Regular use may prevent normal bowel function, cause adverse drug reactions, and delay treatment for conditions that cause constipation.

A client admitted for treatment of a gastric ulcer is being prepared for discharge on antacid therapy. Which statement made by the client indicates understanding of discharge teaching? "I'll continue to take my antacid even if I feel better." "I'll take my antacid in the morning with my other medications." "I should not take antacids with magnesium, because I have a heart problem." "My antacid will work best if I take it with my meals."

"I'll continue to take my antacid even if I feel better."

A physician calls the nurse for an update on a client who underwent abdominal surgery 5 hours ago. The physician asks the nurse for the total amount of drainage collected in the Hemovac since surgery. The nurse reports that according to documentation, no drainage has been recorded. When the nurse finishes on the telephone, the nurse goes to assess the client. Which assessment finding explains the absence of drainage? The client has been lying on their side for 2 hours with the drain positioned upward. The client has a nasogastric (NG) tube in place that drained 400 ml. The Hemovac drain isn't compressed; instead it's fully expanded. There is a moderate amount of dry drainage on the outside of the dressing.

The Hemovac drain isn't compressed; instead it's fully expanded.

A client has had an incisional cholecystectomy. Which of the following nursing interventions has the highest priority in postoperative care for this client? Using incentive spirometry every 2 hours while awake. Performing leg exercises every shift. Maintaining a weight-reduction diet. Promoting incisional healing.

Using incentive spirometry every 2 hours while awake.

A nurse is caring for a client who underwent a subtotal gastrectomy 24 hours ago. The client has a nasogastric (NG) tube. The nurse should apply suction to the NG tube every hour. clamp the NG tube if the client complains of nausea. irrigate the NG tube gently with normal saline solution if ordered. reposition the NG tube if pulled out.

irrigate the NG tube gently with normal saline solution if ordered. The nurse can gently irrigate the tube if ordered, but must be careful not to reposition it. Repositioning can cause bleeding. The nurse should apply suction continuously — not every hour. The nurse shouldn't clamp the NG tube postoperatively because secretions and gas will accumulate, stressing the suture line.

The nurse is assessing a client who has been admitted to the hospital with chest pain. The client has been taking simvastatin 40 mg daily for 3 years. The nurse notes that the client has yellow sclerae and a dark skin color. The client tells the nurse that urine is getting darker. The nurse should: tell the client to lower the amount of saturated fats in the diet. ask the client about alcohol intake. notify the health care provider. instruct the client to increase the fluid intake to prevent the concentration of the urine.

notify the health care provider.

An adult client had an abdominal perineal resection with a colostomy 4 days ago and is ready for discharge. Which is an expected outcome at this point? The client maintains a high-fiber diet. The client discusses concerns about sexual functioning. The client maintains bed rest. The client limits fluid intake to 1,000 mL/day.

The client discusses concerns about sexual functioning.

Nursing assessment of a client with peritonitis reveals hypotension, tachycardia, and signs and symptoms of dehydration. Which additional assessment finding will the nurse assess for? tenderness and pain in the right upper abdominal quadrant jaundice of the sclera and nausea and vomiting severe abdominal pain with direct palpation or rebound tenderness rectal bleeding and a change in bowel habits

severe abdominal pain with direct palpation or rebound tenderness Peritonitis decreases intestinal motility and causes intestinal distention. A classic sign of peritonitis is a sudden, diffuse, severe abdominal pain that intensifies in the area of the underlying causative disorder (such as appendicitis, diverticulitis, ulcerative colitis, or a strangulated obstruction). The client may also have rebound tenderness. Tenderness and pain in the right upper abdominal quadrant suggest cholecystitis. Jaundice and vomiting are signs of cirrhosis of the liver. Rectal bleeding or a change in bowel habits may indicate colorectal cancer.