Med/Surg Exam 2
A nurse is providing discharge teaching for a client following Roux-En-Y (RYGB) surgery. What should the nurse include in the teaching? Select all that apply.
Stop eating when you feel full. Avoid all sweets. Choose breads, cereals, and grains that provide less than 2 g of fiber per serving.
The presence of mucus and pus in the stools suggests which condition?
Ulcerative colitis
The nurse is caring for a client 6 hours post surgery. The nurse observes that the client voids urine frequently and in small amounts. The nurse knows that this most probably indicates what?
Urine retention
The nurse's assessment of a postop client reveals a temperature of 103.2°F, tachycardia, and client complaints of increased incisional pain. What does the nurse recognize that this client is experiencing?
Wound infection
A client is preparing for a surgical procedure is taking corticosteroids for Crohn's disease. What is most important for the nurse to monitor during the operative experience with the client?
adrenal insufficiency
When inserting a peripheral IV, the patient's arm should _______
be placed in a dependent position
Which drug is considered a stimulant laxative?
bisacodyl
Is TPN administered via peripheral IV, G-tube or central line?
central venous catheter
A laproscopic ______________ is the standard therapy for symptomatic gallstones
chloecystectomy
Patients with _______ ulcers feel pain immediately after eating
gastric
Greater than 5 to 6 bowel sounds in 30 sec is considered
hyperactive
Which response is a parasympathetic response in the GI tract?
increased peristalsis
Dyspepsia
indigestion; upper abdominal discomfort associated with eating
The nurse recognizes that the client diagnosed with a duodenal ulcer will likely experience
pain 2 to 3 hours after a meal.
A nursing assessment of a client with peritonitis reveals hypotension, tachycardia, and signs and symptoms of dehydration. What else would the nurse expect to find?
severe abdominal pain with direct palpation or rebound tenderness
Emergent surgery examples
severe bleeding, bladder or intestinal obstruction, fractured skull, gunshot or stab wounds, extensive burns (surgery is done without delay)
Instruct clients with hypertensive, cardiac, or renal disease to avoid antacids containing
sodium
A patient with chronic pancreatitis has frequent, frothy, foul-smelling stools called ___________
steatorrhea
What is the actual measurement of "regular"?
stool consistency and client comfort
Which enzyme aids in the digestion of protein?
trypsin
The nurse recognizes which change of the gastrointestinal system is an age-related change?
weakened gag reflex
A client is prescribed tetracycline to treat peptic ulcer disease. Which instruction would the nurse give the client?
"Be sure to wear sunscreen while taking this medicine."
Pancreas
(on the left) makes digestive enzymes which break down protein and carbs, amylase and lipase.
Liver
(on the right) makes bile, which helps us break down fat.
Chyme can stay in the small intestine for ____ to ___ hours
3 to 6
The nurse is preparing to discharge a client from the PACU using a PACU room scoring guide. With what score can the client be transferred out of the recovery room?
7
When should the client stop taking the aspirin before the surgery?
7 to 10 days
Which of the following is the primary function of the small intestine?
Absorption
Which of the following digestive enzymes aids in the digesting of starch?
Amylase
The American Cancer Society recommends routine screening to detect colorectal cancer. Which screening test for colorectal cancer should a nurse recommend?
Annual digital examination after age 40
A client with peptic ulcer disease has a blood pressure of 88/40 mm Hg, dizziness, and nausea. Which complication will the nurse suspect is occurring with this client?
Bleeding from the ulcer
Which of the following would a nurse expect to assess in a client with peritonitis?
Board-like abdomen
The nurse is responsible for monitoring cardiovascular function in a postoperative patient. What method can the nurse use to measure cardiovascular function?
Central venous pressure
Which test does NOT require a contrast medium?
Colonoscopy
What would turn a patient's stool a dark brown, and milky white?
Dark brown: presence of bile Milky white: Barium
Which is one of the primary symptoms of irritable bowel syndrome (IBS)?
Diarrhea
The nurse is caring for a client who has developed dumping syndrome while recovering from a gastrectomy. What recommendation should the nurse make to the client?
Eat several small meals daily spaced at equal intervals.
Amylase
Enzyme in saliva that breaks the chemical bonds in starches
Gastrin has which of the following effects on gastrointestinal (GI) motility?
Increased motility of the stomach
Identify the quadrant of the abdomen to be palpated or percussed for a patient with pancreatitis.
Left upper
The nurse is assisting the health care provider with a gastric acid stimulation test for a client. What medication should the nurse prepare to administer subcutaneously to stimulate gastric secretions?
Pentagastrin
Which of the following is an enzyme secreted by the gastric mucosa?
Pepsin
Drug Class: Bismuth Salt
Pepto-Bismol
What is the action called that moves food and waste thru the GI tract?
Peristalsis
the suffix for this class of drugs is "prazole"
Proton Pump Inhibitors (PPIs)
What is the opening between the stomach and duodenum?
Pyloric sphincter
Which of the following is the most common symptom of a polyp?
Rectal bleeding
The nurse advises the patient who has just been diagnosed with acute gastritis to:
Refrain from food until the GI symptoms subside.
A nurse is performing discharge teaching with a client who had a total gastrectomy. Which statement indicates the need for further teaching?
"I will have to take vitamin B12 shots up to 1 year after surgery."
Expected BUN level
10-20 mg/dL
Expected Sodium
136-145 mEq/L
Expected sodium level
136-145 mEq/L
Expected Potassium
3.5-5 mEq/L
The nurse determines that a patient has postoperative abdominal distention. What does the nurse determine that the distention may be directly related to?
A temporary loss of peristalsis and gas accumulation in the intestines
After assessing a client with peritonitis, how would the nurse most likely document the client's bowel sounds?
Absent
A client recovering from abdominal surgery has abdominal distention and nausea. Which action will the nurse take?
Assist with ambulation.
______________prevents or relieves nausea and emesis. Centrally, it blocks dopamine receptors in the CTZ; peripherally, it increases motility of the upper GI tract, increases peristalsis, and overcomes the immobility, dilation, and reverse motility that occurs with the vomiting reflex.
Benzamide / Prokinetic Agent Reglan (metoclopramide)
Drug Class: Antacids
Calcium Compounds (Tums) Milk of Magnesium (MOM) Aluminum Compounds Mylanta (Maalox)
A client receives a local anesthetic to suppress the gag reflex for a diagnostic procedure of the upper GI tract. Which nursing intervention is advised for this client?
Do not give any food and fluids until the gag reflex returns.
Transmission precaution type for pharyngeal diptheria
Droplet
The suffix for this class of drugs is "dine"
H2 Receptor Antagonists
Ulcer healing is treated with
H2 receptor antagonists: Cime/Famo/Nazatidine PPIs: Esome/Lanso/Ome/Panto/Rabeprazole
A client with Crohn's disease is losing weight. For which reason will the nurse anticipate the client being prescribed parenteral nutrition?
Impaired ability to absorb food
A client is scheduled for an upper gastrointestinal series. Upon returning to the nursing unit, what does the nurse identify as the client goal?
Increase in the amount of fluids
Which medication classification represents a proton (gastric acid) pump inhibitor?
Omeprazole
Which is a classic sign of hypovolemic shock?
Pallor
Which diagnostic produces images of the body by detecting the radiation emitted from radioactive substances?
Positron emission tomography (PET)
The nurse is caring for a client who is scheduled for a percutaneous liver biopsy. Which diagnostic test is obtained prior?
Prothrombin time (PT)
The nurse is scheduling gastrointestinal (GI) diagnostic testing for a client. Which GI test should be scheduled first?
Radiography of the gallbladder
_______________ syndrome is characterized by tumors on the islets of Langerhans which result in the hypersecretion of acid
Zollinger-Ellison
H. pylori
a spiral-shaped gram-negative bacterium that colonizes the gastric mucosa; is involved in most cases of peptic ulcer disease
The most common manifestations of Crohn's Disease are:
abdominal pain and diarrhea
When discussing risk factors for peptic ulcers, the nurse should mention:
alcohol abuse and smoking.
Trypsin
an enzyme from the pancreas that digests proteins in the small intestine
Which drug classification may cause respiratory depression from an associated electrolyte imbalance during anesthesia?
diuretics
Patients with ________ ulcers awake with pain at night and report relief of pain after eating or taking an antacid. Pain occurs 2-3 hours after eating
duodenal
When gastric analysis testing reveals excess secretion of gastric acid, the nurse recognizes which medical diagnoses is supported?
duodenal ulcer
H2blockers are used to treat and prevent
duodenal ulcers and to treat gastritis, gastric ulcers, gastroesophageal reflux, and hypersecretory gastric states.
Most PPIs are very well tolerated, however, __________ can cause stomach pain and infrequently, abdominal distress, weakness, muscle aches, dizziness, headache, sedation, chest pain, heartburn, constipation or diarrhea, gas, nausea, vomiting, or skin rash.
omeprazole
Acute ________ presents with fever, jaundice, confusion, agitation, and abdominal guarding
pancreatitis
_____________ are chemical compounds that buffer or neutralize hydrochloric acid in the stomach and thereby increase gastric pH. Indicated for relief of symptoms associated with hyperacidity in peptic ulcer, gastritis, gastric esophageal reflux disease (GERD), gastric hyperacidity, heartburn, or hiatal hernia.
Antacids
__________________ is indicated for prevention of chemotherapy-induced and radiation-induced nausea and vomiting and for prevention of postoperative nausea and vomiting.
Anti-emetic Zofran (ondansetron)
A client has recently been diagnosed with gastric cancer. On palpation, the nurse would note what two signs that confirm metastasis to the liver?
Ascites Hepatomegaly
The nurse is preparing the client for an assessment of the abdomen. What should the nurse complete prior to this assessment?
Ask the client to empty the bladder.
When caring for a client with an acute exacerbation of a peptic ulcer, the nurse finds the client doubled up in bed with severe pain in the right shoulder. What is the initial appropriate action by the nurse?
Assess the client's abdomen and vital signs.
To prevent thromboembolism in the postoperative client, the nurse should include which of the following in the plan of care?
Assist with oral fluid intake.
When assisting with preparing a client scheduled for a barium swallow, which of the following would be appropriate to include?
Avoid smoking for at least 12 to 24 hours before the procedure.
Intrinsic factor, which is secreted by gastric mucosa, cannot be absorbed without the presence of vitamin ____
B12
Which of the following is the most definitive means of assessing for liver disease?
Biopsy
Which assessment finding indicates to the nurse that the client may be experiencing dehydration because of taking nothing by mouth after midnight for the surgery?
Blood pressure 80/50 mm Hg
A client reports a history of bleeding hemorrhoids to the nurse. Which observation supports the client's statement?
Blood streaks on stool
A patient comes to the clinic with the complaint, "I think I have an ulcer." What is a characteristic associated with peptic ulcer pain that the nurse should inquire about?
Burning sensation localized in the back or mid-epigastrium Feeling of emptiness that precedes meals from 1 to 3 hours Severe gnawing pain that increases in severity as the day progresses
Which is the most common presenting symptom of colon cancer?
Change in bowel habits
When examining the skin of a client who is dehydrated due to fluid losses from the gastrointestinal tract, which of the following would be most important?
Checking if the mucous membranes are dry
A client informs the nurse of having abdominal pain that is relieved when having a bowel movement. The health care provider diagnosed the client with irritable bowel syndrome. What does the nurse recognize as characteristic of this disorder?
Chronic constipation with sporadic bouts of diarrhea
A PACU nurse is caring for a postoperative client who received general anesthesia and has a hard, plastic oral airway in place. The patient has clear lung sounds, even and unlabored respirations of 16, and 98% oxygen saturation. The client is minimally responsive to painful stimuli. What action by the nurse is most appropriate?
Continue with frequent client assessments.
A client sustained second- and third-degree burns over 30% of the body surface area approximately 72 hours ago. What type of ulcer should the nurse be alert for while caring for this client?
Curling's ulcer
After ingestion of the cookie, the client reported cramping pains, dizziness, and palpitation. After having a bowel movement, the symptoms resolved. What should the nurse educate the client about regarding this event?
Dumping syndrome
Clients with Type O blood are at higher risk for which of the following GI disorders?
Duodenal ulcers
Age related changes seen in the senior adult as it relates to the GI system.
Dysphagia, anorexia, dyspepsia, disorders of colonic function. (IBS symptoms decrease)
A health care provider suspects that a client has peptic ulcer disease. With which diagnostic procedure would the nurse most likely prepare to assist?
Endoscopy
Pepsin
Enzyme that breaks down proteins in the stomach
The nurse is investigating a client's report of pain in the duodenal area. Where should the nurse perform the assessment?
Epigastric area and consider possible radiation of pain to the right subscapular region
Drug Class: Proton Pump Inhibitors (PPIs)
Esomeprazole (Nexium) Omeprazole (Prilosec) Lansoprazole (Prevacid) Pantoprazole (Protonix)
Which medication is classified as a histamine-2 receptor antagonist?
Famotidine
Drug Class: H2 Receptor Antagonists
Famotidine (Pepcid) Cimetidine (Tagamet) Rantadine (Zantac) Nizatidine (Axid, Tazac)
A client has been taking famotidine at home. What teaching should the nurse include with the client?
Famotidine will inhibit gastric acid secretions.
The nurse is caring for a client with a suspected megacolon. The nurse anticipates that one of the findings of assessment will be
Fecal incontinence
Which type of healing occurs when granulation tissue is not visible and scar formation is minimal?
First intention
________________ disease is the most common disorder of the biliary system
Gallbladder disease with stones
A client is being scheduled for a gastric analysis test. The nurse knows that which conditions can be diagnosed from this type of test?
Gastric ulcer Gastric cancer Duodenal ulcer Pernicious anemia
Which medication has side effects that include constipation, confusion, and dry mouth, diarrhea, headache, stomach cramps or pain, dizziness, and rash. Breast swelling or pain in males and females has been reported.
H2 Receptor Antagonists, "dine" drugs
Which medication should you give Patient Education: Swallow the capsule whole - do not crush or chew.
H2 Receptor Antagonists: Famotidine (Pepcid) Cimetidine (Tagamet) Rantadine (Zantac) Nizatidine (Axid, Tazac)
The nurse is assessing a client with an ulcer for signs and symptoms of hemorrhage. The nurse interprets which condition as a sign/symptom of possible hemorrhage?
Hematemesis
A patient who is post-op for peptic ulcer disease has cool skin, tachycardia, labored breathing, and appears to be confused, what should the nurse suspect?
Hemorrhage
A client with abdominal pain is scheduled for a CT scan of the abdomen with contrast. Which assessment will the nurse complete before transporting the client for the diagnostic test?
History of allergies
Which kind of dressing is used for a stage 2 pressure ulcer?
Hydrocolloid
The nurse auscultates the abdomen to assess bowel sounds. She documents five to six sounds heard in less than 30 seconds. How does the nurse document the bowel sounds?
Hyperactive
A patient with uncontrolled diabetes is scheduled for a surgical procedure. What chief life-threatening hazard should the nurse monitor for?
Hypoglycemia
An elderly client diagnosed with diarrhea is taking digoxin. Which electrolyte imbalance should the nurse be alert to?
Hypokalemia
A client is scheduled for an upper gastrointestinal barium study. Which teaching will the nurse provide for the client to prepare for this diagnostic test?
Ingest nothing by mouth after midnight.
A patient visited a nurse practitioner because he had diarrhea for 2 weeks. He described his stool as large and greasy. The nurse knows that this description is consistent with a diagnosis of:
Intestinal malabsorption.
Which substance influences vitamin B12 absorption?
Intrinsic factor
A client reports getting a rash when eating kiwi and bananas. For which potential allergy will the nurse plan care for this client?
Latex
Organs adjacent to the stomach are also affected. Which of the following organs may be affected?
Liver Pancreas Duodenum
Can you list in correct order how to complete an abdominal assessment and why?
Look, Listen, Feel RUQ, RLQ, LUQ, LLQ 1. Look: skin assessment, note distention or bulging, injuries 2. Listen: normally there are 5-30 sounds per minute, listen for one minute in each quadrant 3. Feel: last because it can change the sounds, used to assess size and density of organs, and presence of fluid/air/solid masses, areas of tenderness and muscular resistance
The instructor is teaching a group of students about irritable bowel syndrome (IBS) and antidiarrheal agents, the instructor determines that the teaching was effective when the students identify which of the following as an example of an antidiarrheal agent commonly administered for IBS?
Loperamide
Swallowing is regulated by which area of the central nervous system (CNS)?
Medulla oblongata
Rebleeding may occur from a peptic ulcer and often warrants surgical interventions. Signs of bleeding include which of the following?
Mental confusion
Vomiting results in which of the following acid-base imbalances?
Metabolic alkalosis
___________is used for gastroesophageal reflux, and parenterally for the prevention of nausea and vomiting. Also used as an adjunct for GI radiologic examinations because it hastens transit of barium through the upper GI tract by stimulating gastric emptying and accelerating intestinal transit.
Metoclopramide
What is the most important assessment a nurse would make to ensure that a client does not retain any barium after a barium swallow?
Monitoring the stool passage and its color.
What part of the GI tract begins the digestion of food?
Mouth
Celiac disease (celiac sprue) is an example of which category of malabsorption?
Mucosal disorders causing generalized malabsorption
erosive form of acute gastritis is caused by
NSAIDs, corticosteroids, gastric radiation therapy, alcohol
A client diagnosed with colon cancer presents with the characteristic symptoms of a left-sided lesion. Which symptoms are indicative of this disorder?
Narrowing stools Constipation Abdominal Distention
A client who sustained traumatic injuries caused by intoxication needs emergency surgery. Which device will be inserted before general anesthesia is given to prevent the development of a postoperative complication?
Nasogastric tube
The nurse in the ED admits a client with suspected gastric outlet obstruction. The client's symptoms include nausea and vomiting. The nurse anticipates that the physician will issue which order?
Nasogastric tube insertion
A client is prescribed a histamine (H2)-receptor antagonist. The nurse understands that this might include which medication(s)? Select all that apply.
Nizatidine Famotidine Cimetidine
Should TPN be given in combination with other IV solutions? Why or why not?
No, because adding a medication that contains lipid emulsions increases the risk of a fat embolism
The nurse is caring for a postoperative client with an indwelling urinary catheter. The hourly urinary output is 80 mL at 9 am. At 10 am, the nurse assesses the hourly urinary output as 20 mL. What is the priority action by the nurse?
Notify the primary care provider immediately.
During a home visit the nurse notes that a client recovering from peptic ulcer disease is experiencing cool clammy skin and has a heart rate of 96 beats a minute. Which action will the nurse take?
Notify the primary health care provider.
Peptic ulcer disease occurs more frequently in people with which blood type?
O
The nurse is caring for a client with intussusception of the bowel. What does the nurse understand occurs with this disorder?
One part of the intestine telescopes into another portion of the intestine.
The nurse observes bloody drainage on the surgical dressing of the client who has just arrived on the nursing unit. Which intervention should the nurse plan to do next?
Outline the drainage with a pen and record the date and time next to the drainage.
block the final step of acid production, inhibiting gastric acid secretion. They are indicated for the treatment of GERD and peptic ulcer disease (PUD). Indicated in combination with antibiotics in peptic ulcer disease treatment protocols to eradicate H. pylori. In addition, they are used to prevent and treat NSAID-induced upper GI ulcers.
PPIs
Which of the following organs does the nurse realize has effects as an exocrine gland and an endocrine gland?
Pancreas
_______ causes peristalsis and increases secretory activities
Parasympathetic nerve stimulation
The nurse is conducting a community education class on gastritis. The nurse includes that chronic gastritis caused by Helicobacter pylori is implicated in which disease/condition?
Peptic ulcers
A client is in the hospital for the treatment of peptic ulcer disease. The client reports vomiting and a sudden severe pain in the abdomen. The nurse then assesses a board-like abdomen. What does the nurse suspect these symptoms indicate?
Perforation of the peptic ulcer
A client undergoing a diagnostic examination for gastrointestinal disorder was given polyethylene glycol/electrolyte solution as a part of the test preparation. Which of the following measures should the nurse take once the solution is administered?
Permit the client to drink only clear liquids.
Absorption
Phase of the digestive process that occurs when small molecules, vitamins, and minerals pass through the walls of the small and large intestine and into the blood stream
A postoperative client is experiencing a flash pulmonary edema. What finding in the client's sputum is consistent with this problem?
Pink color
Place in order the instructions the nurse will provide the client to perform diaphragmatic breathing.
Place bed in at 30- to 45-degree angle. Place the hands on the front of the lower ribs. Breathe out gently and fully to feel the ribs sink downward. Take a deep breath through the nose and mouth to make the abdomen rise. Hold the breath for a count of five. Exhale and let all the air out through the nose and mouth. Repeat the exercise 15 times with a rest after each group of five. Practice this breathing twice a day before the surgery.
What does the nurse recognize as one of the most common postoperative respiratory complications in elderly clients?
Pneumonia
The client tells the nurse, "I think I'm going to puke." What is the primary action taken by the nurse?
Position the client in the side-lying position. Turn the client's head completely to one side to prevent aspiration of vomitus into the lungs.
Dumping syndrome
Rapid emptying of gastric contents into small intestines. Client experience ab pain, nausea, vomiting, explosive diarrhea, weakness, dizziness, palpitations & tachycardia.
Drug Class: Benzamide / Prokinetic Agent
Reglan (metoclopramide)
Which drug can cause include diarrhea, sleepiness, restlessness, increased weakness and, rarely, extrapyramidal (parkinsonian) effects, hypotension, hypertension, tachycardia, and agranulocytosis.
Reglan (metoclopramide) which is a Benzamide / Prokinetic Agent
Which of the following is the most successful treatment for gastric cancer?
Removal of the tumor
A client is admitted with a diagnosis of acute appendicitis. When assessing the abdomen, the nurse would expect to find rebound tenderness at which location?
Right lower quadrant
The nurse is instructing the client who was newly diagnosed with peptic ulcers. Which of the following diagnostic studies would the nurse anticipate reviewing with the client?
Serum antibodies for H. pylori
A client is preparing for discharge to home following a partial gastrectomy and vagotomy. Which is the best rationale for the client being taught to lie down for 30 minutes after each meal?
Slows gastric emptying
A nurse is planning care for a client scheduled to undergo a thoracotomy. After tolerating full liquids, which dietary recommendation will the nurse consider?
Small, frequent full-fat meals
The instructor has just finished teaching a group of students about the various organs of the upper gastrointestinal tract and possible disorders. The instructor determines that the teaching was successful when the students identify which structure as possibly being affected?
Stomach
If the skin around an IV site is swollen, cool to the touch and blanched and is not infusing, what should the nurse do?
Stop the infusion Elevate the arm Apply heat to the hand
The nurse is preparing to examine the abdomen of a client who reports a change in bowel pattern. The nurse would place the client in which position?
Supine with knees flexed
__________ nerves have an inhibitory effect on the GI tract: constricting blood vessels and sphincters, decreases gastric secretions and motility
Sympathetic
signs of fluid volume deficit
Tachycardia, orthostatic hypotension, increased BUN, poor skin turgor, increased RR
A client with peptic ulcer disease has been prescribed sucralfate. What health education should the nurse provide to this client?
Take the medication 2 hours before or after other medications
What would the nurse recognize as preventing a client from being able to take a fecal occult blood test (FOBT)?
The client has hemorrhoidal bleeding
A previously stable client now appears anxious, apprehensive, and has a blood pressure of 90/56. What does the nurse consider is the most likely cause of the client's change in condition?
The client is displaying early signs of shock.
Which is a true statement regarding regional enteritis (Crohn's disease)?
The clusters of ulcers take on a cobblestone appearance.
A client with diabetes begins to have digestive problems and is told by the physician that they are a complication of the diabetes. Which of the following explanations from the nurse is most accurate?
The pancreas secretes digestive enzymes.
A client is to have an upper GI procedure with barium ingestion and abdominal ultrasonography. While scheduling these diagnostic tests, the nurse must consider which factor?
The ultrasonography should be scheduled before the GI procedure.
The nurse in the ED is caring for a client who has returned to the ED 4 days after receiving stitches for a knife wound on his hand. The wound is now infected, so the stitches were removed, and the wound is cleaned and packed with gauze. The ED doctor plans to have the man return tomorrow to remove the packing and resuture the wound. The nurse is aware that the wound will now heal by what means?
Third intention
The nurse is assisting the health care provider with a colonoscopy for a client with rectal bleeding. The health care provider requests the nurse to administer glucagon during the procedure. Why is the nurse administering this medication during the procedure?
To relax colonic musculature and reduce spasm.
When describing the role of the pancreas to a client with a pancreatic dysfunction, the nurse would identify which substance as being acted on by pancreatic lipase?
Triglycerides
During assessment, the client exhibits pallor, perspiration, palpitations, headache, and feelings of warmth, dizziness, and drowsiness. The client reports eating 90 minutes ago. What will the nurse suspect?
Vasomotor symptoms associated with dumping syndrome
While completing an abdominal assessment, the nurse will use which landmark as the upper boundary for auscultating bowel sounds?
Xiphoid process
Drug Class: Anti-emetic
Zofran (ondansetron)
Which drug can cause fever, headache, constipation, diarrhea and, rarely, anaphylaxis, chest pain, and bronchospasm?
Zofran (ondansetron) which is an anti-emetic
Hydrochloric Acid
acid secreted by the glands in the stomach; mixes with chyme to break it down into absorbable molecules and to aid in the destruction of bacteria
Stress Ulcers
acute gastric mucosal lesions occuring after medical crisis or trauma: burns, shock, sepsis, multiple organ dysfunction, brain injuries, being on a ventilator
Most common therapy for peptic ulcers
antibiotics, proton pumps inhibitors, and bismuth salts to eradicate H. pylori
coat the walls of the GI tract, absorbing the bacteria or toxins causing the diarrhea, and passing them out with the stools
bismuth salts (Pepto-Bismol) and kaolin/pectin or attapulgite (Kaopectate)
A major nursing diagnosis in the post op period may include decreased _________ output related to shock and hemorrhage
cardiac
The client is experiencing intractable hiccups following surgery. What would the nurse expect the surgeon to order?
chlorpromazine
urgent surgery examples
closed fractures, infected wounds, done within 24-30 hours
Esophagus
collapsible tube connecting mouth to stomach, through which food passes as it is ingested. Muscular, peristalsis. Epiglottis is top sphincter, pyloric is bottom. Red meat is the most common bolus caught in the esophagus
Cystic fibrosis, a genetic disorder characterized by pulmonary and pancreatic dysfunction, usually appears in young children but can also affect adults. If the pancreas was functioning correctly, where would the bile and pancreatic enzymes enter the GI system?
duodenum
_____________ is indigestion, an upper abdominal discomfort associated with eating
dyspepsia
_____________ is the gastric discomfort associated with eating
dyspepsia
___________ is the most common symptom of esophageal disease
dysphagia
Where are peptic ulcers found?
esophagus, stomach, or duodenum
A PACU nurse is caring for an older adult who presents with clinical manifestations of delirium. What short-term outcome would be most important for this client?
experiences pain within tolerable limits.
steatorrhea
fat in the feces; frothy, foul-smelling fecal matter
GERD
gastroesophageal reflux disease
Antacid dosing schedule
given immediately after meals will delay gastric emptying and the buffering effect. When given at 1 and 3 hours after meals and at bedtime, the gastric pH remains at approximately 3 throughout the day. Administer antacids 1 hour before or 2 hours after other medications.
__________ can result from blood loss, hypoventilation, pooling of blood in the extremities, or side effects from medications
hypotension
nonerosive gastritis causes
infection with H. pylori
The nurse prepares to administer the lavage solution to a client having a colonoscopy completed. The nurse stops and notifies the physician when noting that the client has which condition?
inflammatory bowel disease
A nurse is assessing a client and obtains the following findings: abdominal discomfort, mild diarrhea, blood pressure of 100/80 mm Hg, pulse rate of 88 beats/minute, respiratory rate of 20 breaths/minute, temperature 100° F (37.8° C). What diagnosis will the nurse suspect for this client?
inflammatory bowel disease (IBD)
Which term describes a gastric secretion that combines with vitamin B12 so that it can be absorbed?
intrinsic factor
What are the 3 main components of TPN?
lipids emulsions, proteins, and dextrose
Do not administer calcium carbonate antacids with
milk, milk products, or other foods or vitamin supplements high in vitamin D, because milk-alkali syndrome may occur.
Chyme
mixture of food with saliva, salivary enzymes, and gastric secretions that is produced as food passes through the mouth, esophagus, and stomach
The Zollinger-Ellison syndrome (ZES) consists of severe peptic ulcers, extreme gastric hyperacidity, and gastrin-secreting benign or malignant tumors of the pancreas. The nurse recognizes that an agent that is used to decrease bleeding and decrease gastric acid secretions is
octreotide (Sandostatin)
Alcohol and gallbladder disease are the most common causes of
pancreatitis
Large Intestine
portion in which waste from the small intestine passes as absorption continues and elimination begins, consists of: ascending colon, transverse, descending, sigmoid colon, and rectum. Absorbs water and electrolytes, produces Vitamin K.
Assessment of respiratory status in the post op patient is essential because _________ complications are the most common problem encountered by the surgical patient
pulmonary
____________ is a burning sensation in the stomach and esophagus that moves up to the mouth
pyrosis
Which procedure is performed to examine and visualize the lumen of the small bowel?
small bowel enteroscopy
The nurse teaches the client whose surgery will result in a sigmoid colostomy that the feces expelled through the colostomy will be
solid
Fluid volume deficit causes
tachycardia
The nurses assesses the client for blood in the stool due to an upper GI condition. The nurse understands that if there is blood in the stool, the stool will be which color?
tarry black
The client describes a test previously completed to detect a small bowel obstruction prior to admission to the hospital. The client states that the test involved insertion of a tube through the nose and lasted over 6 hours. The nurse determines which test name should be documented?
upper GI enteroclysis
The nurse recognizes which change of the GI system is an age-related change?
weakened gag reflex
A client is scheduled for an ultrasound of the abdomen. Which statement indicates that teaching provided to the client to prepare for the test was effective?
"I will not eat or drink for 8 to 12 hours before the test."
The nurse instructs a client with a peptic ulcer on modifications to make to their diet. Which statement indicates to the nurse that teaching has been effective?
"I will stop drinking decaffeinated coffee."
A home care nurse is caring for a client with reports of epigastric discomfort who is scheduled for a barium swallow. Which statement by the client indicates an understanding of the test?
"I'll avoid eating or drinking anything 6 to 8 hours before the test."
A client with an H. pylori infection asks why bismuth subsalicylate is prescribed. Which response will the nurse make?
"It aids in the healing of the stomach lining."
A patient has been diagnosed with acute gastritis and asks the nurse what could have caused it. What is the best response by the nurse? (Select all that apply.)
"It can be caused by ingestion of strong acids." "You may have ingested some irritating foods." "Is it possible that you are overusing aspirin."
A client asks the nurse why the physician ordered the blood test carcinoembryonic antigen (CEA). The nurse answers:
"It indicates if a cancer is present."
A client with gastric ulcers caused by H. pylori is prescribed metronidazole. Which client statement indicates to the nurse that teaching about this medication was effective?
"It might cause a metallic taste in my mouth."
In caring for a patient that is receiving tube feedings (G-tube or J-tube), list 4 actions that will be part of your assessment and care.
-Aspirate gastric secretions every 15 min for the first hour -Assess vital signs, pain, signs of nausea, skin around insertion site -Assess patency of tube, signs of leakage, tube integrity -Prevent infection
What patient teaching would be given to the patient experiencing GERD?
-Avoid foods that cause heartburn -Avoid alcohol and coffee -Small and frequent meals are easier to digest. Instruct to remain in upright position at least 2 hours after meals; avoiding eating 3 hours before bedtime. Helps control reflux and causes less irritation from reflux action into esophagus. Instruct patient to eat slowly and masticate foods well. -Sleep on left side, being on your left side is the best sleeping position for people with GERD. Sleeping with your left side down reduces reflux episodes and exposure of the esophagus to stomach acid
List the duties the nurse must complete for the newly admitted patient that is having an EGD and colonoscopy.
-Get a health history -Patient should be NPO for 8 hours before the examination -(For a colonoscopy maybe RX'd laxative and saline enema) -(Colonoscopies cannot be done if there is colon perforation, acute/severe diverticulitis, or acute colitis) -(Monitor for signs of perforation) -Give local anesthetic gargle or spray, Midazolam, which is a sedative that relaxes gag reflex and relieves anxiety -Position them in a left lateral position to clear pulmonary secretions and allow scope to enter -After: Assess LOC, vitals, pain, signs of perforation -Give written and verbal instructions to patient and whoever is taking care of them until the next morning -Maybe call them the next day and see if they have questions
Why would a nasogastric tube be ordered for a patient?
-Suction may be useful for relieving nausea and vomiting, decrease painful abdominal distention, and paralytic ileus -short-term tube feeding (and medication administration) and gastric suctioning (stomach pumping)
What is TPN and list 2 reasons a patient would need TPN?
-Total parenteral nutrition (TPN) is a method of feeding that bypasses the gastrointestinal tract. A special formula given through a vein provides most of the nutrients the body needs. The method is used when someone can't or shouldn't receive feedings or fluids by mouth. -Long term pre/post op nutritional needs because of acute pancreatitis or extensive bowel surgery -Impaired ability to ingest food orally or enterally because of paralytic ileus, or Crohn's disease
Expected Creatinine
0.5-1.1 mg/dL for women 0.6-1.3 for men
Expected creatinine level
0.5-1.1 mg/dL for women 0.6-1.3 mg/dL for men
Medical management of a patient with peritonitis includes fluid, electrolyte, and colloid replacement. The nurse knows to prepare the initial, most appropriate intravenous solution. Which of the following is the correct solution?
0.9% NS
How much saliva is normally secreted daily?
1.5 L
A client with peptic ulcer disease must begin triple medication therapy. For how long will the client follow this regimen?
10 to 14 days
Expected BUN
10-20mg/dL
A portion of digested waste products can remain in the rectum for how many days after a meal is digested?
3 days
Expected potassium level
3.5-5mEq/L
A client who is being treated for pyloric obstruction has a nasogastric (NG) tube in place to decompress the stomach. The nurse routinely checks for obstruction which would be indicated by what amount?
450 mL
Small Intestine
70 m, 230 feet long. longest portion of GI tract consisting of: duodenum, jejunum, ileum. Food/chyme is mixed with all secretions and enzymes as it passes and continues to be digested and begins to be absorbed into the bloodstream. Eats for us.
What is the blood glucose level goal for a diabetic client who will be having a surgical procedure?
80 to 110 mg/dL
A patient with renal failure is scheduled for a surgical procedure. When would surgery be contraindicated for this patient due to laboratory results?
A blood urea nitrogen level of 42 mg/dL
A patient is scheduled for a Billroth I procedure for ulcer management. What does the nurse understand will occur when this procedure is performed?
A partial gastrectomy is performed with anastomosis of the stomach segment to the duodenum.
A client comes to the clinic after developing a headache, abdominal pain, nausea, hiccupping, and fatigue about 2 hours ago. The client tells the nurse that the last food was buffalo chicken wings and beer. Which medical condition does the nurse find to be most consistent with the client's presenting problems?
Acute gastritis
A nurse is caring for a client admitted with symptoms of an anorectal infection; cultures indicate that the client has a viral infection. The nurse should anticipate the administration of what drug?
Acyclovir
A client with chronic peptic ulcers is considering a vagotomy. Which information will the nurse provide to the client about this surgical procedure?
Adverse effects such as dumping syndrome and gastritis can occur.
To prevent pneumonia and promote the integrity of the pulmonary system, an essential postoperative nursing intervention includes:
Ambulating the client as soon as possible