NU211 GI & GU Exam

While performing a physical assessment, the student nurse tells her instructor that she cannot palpate her patient's bladder. Which statement by the instructor is best? 1. "Try to palpate it again; it takes practice but you will locate it." 2. "Palpate the patient's bladder only when it is distended by urine." 3. "Document this abnormal finding on the patient's chart." 4. "Immediately notify the nurse assigned to the care of your patient."

"Palpate the patient's bladder only when it is distended by urine." -The bladder is not palpable unless it is distended by urine.

The nurse is caring for a client who underwent bowel surgery and returns to the floor with a nasogastric tube to low intermittent wall suction. The family questions the nurse as to why the client has the tube. What is the nurse's best response? 1. "The tube is in place to remove secretions until the bowels begin to work." 2. "The tube is in place in order for us to administer medications." 3. "The tube is in place to administer tube feedings until the bowel heals." 4. "The tube is in place to assess for gastrointestinal bleeding postoperatively."

"The tube is in place to remove secretions until the bowels begin to work."

A client asks the nurse why he or she needs to have a laxative with a strong bowel prep prior to a colonoscopy. How should the nurse respond? 1. "I will ask the doctor to speak with you." 2. "Your bowel needs to be completely empty in order to directly visualize your lower intestine." 3. "Colonoscopies need to be done while your bowel is working." 4. "Anything in your intestine could cause bleeding during the procedure."

"Your bowel needs to be completely empty in order to directly visualize your lower intestine."

How much do the kindeys produce an hour? A day?

-50-60mL urine per hour -1500/day

Paralytic Ileus

-Abdominal or pelvic surgery in which the bowel is manipulated may result in a paralytic ileus, a cessation of bowel peristalsis.  -Although peristalsis halts, the bowel continues to produce secretions. Without peristalsis, secretions remain stagnant, causing distention and discomfort.

In which ways can surgery or procedures contribute to sluggish bowel elimination? Select all that apply. 1. Anesthesia 2. Increased IV fluids 3. Stress 4. Decreased mobility 5. Manipulation of the bowel

-Anesthesia -Stress -Decreased mobility -Manipulation of the bowel

Which medications are associated with contributing to constipation? Select all that apply. 1. Antacids 2. Antibiotics 3. Laxatives 4. Iron 5. Antimotility drugs

-Antacids -Iron -Antimotility drugs

The nurse is assessing the urinalysis results for a client with an indwelling urinary catheter. Which findings indicate the presence of a urinary tract infection? Select all that apply. 1. Glucose 2. Ketones 3. Bacteria 4. Bilirubin 5. Hemoglobin 6. Leukocyte esterase

-Bacteria -Hemoglobin -Leukocyte esterase

The nurse just finished inserting an indwelling urinary catheter into a client and is sitting down to document the procedure. Which information should the nurse include in the medical record? Select all that apply. 1. Catheter size 2. Provision of privacy 3. Date and time of insertion 4. Projected date of removal 5. Amount of saline in balloon 6. Color, clarity, and amount of urine return

-Catheter size -Date and time of insertion -Amount of saline in balloon -Color, clarity, and amount of urine return

The nurse is reviewing the laboratory data for a client admitted with acute kidney injury. Which values would the nurse expect to see elevated? Select all that apply. 1. Sodium 2. Creatinine 3. Red blood cells (RBC) 4. Blood urea nitrogen (BUN) 5. Glomerular filtration rate (GFR)

-Creatinine -Blood urea nitrogen (BUN)

Which interventions should the nurse instruct the client to perform to decrease the incidence of urinary incontinence? Select all that apply. 1. Eliminate caffeine from the diet. 2. Limit the intake of fluids. 3. Stop smoking. 4. Lose weight. 5. Increase the use of artificial sweeteners.

-Eliminate caffeine from the diet. -Stop smoking. -Lose weight.

Which are measures a nurse can take to help prevent urinary tract infection in clients with an indwelling catheter? Select all that apply. 1. Disconnect the tubing regularly. 2. Empty the collection bag at least every 8 hours. 3. Regularly check connections. 4. Provide perineal care when the area becomes soiled. 5. Keep the collection bag below the level of the bladder. 6. Provide open irrigation as needed.

-Empty the collection bag at least every 8 hours. -Regularly check connections. -Provide perineal care when the area becomes soiled. -Keep the collection bag below the level of the bladder.

Which are common disorders that are primary causes of bowel function? Select all that apply. 1. Food allergies 2. Diverticulosis 3. Pneumonia 4. Seasonal allergies 5.Food intolerance

-Food allergies -Diverticulosis -Food intolerance

Which can result in hyperactive bowel sounds? Select all that apply. 1. Inflammatory disorders 2. Paralytic ileus 3. Abdominal surgery 4. Small bowel obstruction 5. Food poisoning

-Inflammatory disorders -Small bowel obstruction -Food poisoning

Which medications would the nurse instruct the client with chronic constipation to avoid taking? Select all that apply. 1. Iron 2. Aspirin 3. Opioids 4. Laxatives 5. Antibiotics

-Iron -Opiods

Which are urinary symptoms that may occur as a result of the aging process? Select all that apply. 1. Leakage of urine 2. Decreased frequency of urination 3. Decreased volume of urine 4. Nocturnal frequency of urine 5. Bladder infections

-Leakage of urine -Nocturnal frequency of urine -Bladder infections

Which factors place female clients at higher risk for urinary tract infections? Select all that apply. 1. Pregnancy 2. Menopause 3. Sexual activity 4. Prostate enlargement 5. Longer urethral length

-Pregnancy -Menopause -Sexual activity

Which are ways the nurse can promote regular defecation for clients? Select all that apply. 1. Provide privacy. 2. Remind the client that constipation could occur if he or she does not defecate regularly. 3. Take a matter-of-fact straightforward approach. 4. Control odors to prevent embarrassment. 5. Accompany the client and provide encouragement while he or she is attempting defecation.

-Provide privacy. -Take a matter-of-fact straightforward approach. -Control odors to prevent embarrassment.

The home health nurse just removed an indwelling urinary catheter from a client per the health-care provider's order. Which instructions should the nurse provide the client? Select all that apply. 1. Report any pain or burning upon urination. 2. Increase oral fluid intake to promote urine production. 3. Contact the health-care provider if unable to urinate 8 hours after catheter removal. 4. Notify the health-care provider after the first void with color and amount of urine. 5. Discard the first urine sample after removing the catheter and then collect the urine in a jug for the next 24 hours.

-Report any pain or burning upon urination. -Increase oral fluid intake to promote urine production. -Contact the health-care provider if unable to urinate 8 hours after catheter removal.

Which interventions should the nurse incorporate into the plan of care for a client with a new ostomy that is having difficulty coping with the body change? Select all that apply. 1. Show acceptance when working with the stoma. 2. Explain to the client that his or her sexual relations would not change. 3. Instruct the client that a dressing can be placed over the ostomy during sexual relations. 4. Provide information regarding support groups available for clients with ostomies. 5. Allow the client to ventilate feelings about having a new colostomy and how it changes his or her life. 6. Show the client how to take care of the ostomy, including changing the bag and wafer.

-Show acceptance when working with the stoma. -Explain to the client that his or her sexual relations would not change. -Provide information regarding support groups available for clients with ostomies. -Allow the client to ventilate feelings about having a new colostomy and how it changes his or her life.

The nurse is educating unlicensed nursing assistive personnel (NAP) about recording output for a client. What fluids should the nurse include in the output for accuracy? Select all that apply. 1. Urine 2. Emesis 3. Diarrhea 4. Nasal drainage 5. Intravenous fluids 6. Nasogastric drainage

-Urine -Emesis -Diarrhea -Nasogastric drainage

Which are functions of the colon? Select all that apply. 1. Lipid digestion 2. Water absorption 3. Protein absorption 4. Vitamin absorption 5. Facilitate stool passage

-Water absorption -Vitamin absorption -Facilitate stool passage

Colostomy Textures: Ascending: Transverse colon: Descending colon:

1. Liquid, hasn't had time to go through intestines 2. Soft but more formed 3. Most formed

Normal Specific Gravity of Urine

1.002-1.030

Which is a normal specific gravity for urine? 1. 0.12 2. 1.30 3. 1.02 4. 13.0

1.02

Which urine specific gravity would be expected in a patient with dehydration? 1. 1.002 2. 1.010 3. 1.025 4. 1.030

1.030 -Specific gravity greater than 1.025 is a sign of deficient fluid volume that occurs, for example, as a result of blood loss or dehydration.

Infant Urine Production

15 to 60 mL per kg Produce 8 to 10 wet diapers per day No voluntary control

How long should the nurse auscultate each quadrant prior to documenting the absence of bowel sounds?

3-5 minutes

A nurse is teaching wellness to a women's group. The nurse should explain the importance of consuming at least how many 8-ounce servings of fluid to promote healthy bowel function? 1) 2 to 3 2) 4 to 5 3) 6 to 8 4) 9 to 10

6 to 8

Irritable Bowel Syndrome

A disorder associated with bloating, pain, and altered bowel function.

Minimum Fluid Intake to Regulate Normal Stool

A minimum of six to eight 8-ounce glasses (1,500 to 2,000 mL) of fluid per day is required to promote healthful bowel function.

The major function of the large intestines:

Absorption of water, vitamins, and minerals.

The nurse knows that the results of a fecal occult blood test can be inaccurate if 1. The client has had an excessive intake of red meat 2. The female client is menstruating 3. The client takes high doses of vitamin C 4. All of the above

All of the above

Which piece of information is most important for the nurse to obtain prior to removing an indwelling urinary catheter? 1. Date of insertion 2. Type of catheter material 3. Amount of saline in balloon 4. Allergy to betadine or shellfish

Amount of saline in balloon

A client has been having severe diarrhea and fever for the past few days with decreased urinary output. Which would be the expected effect on the urine specific gravity? 1. An increase in specific gravity 2. A decrease in specific gravity 3. No change in specific gravity of urine 4. Unable to determine with the information provided

An increase in specific gravity

Nephrotic Medications

Antibiotics Long term use of aspirin and ibuprofen

The nurse calculates urinary output for a client admitted with dehydration and determines the client's output is 800 mL/day. Which nursing intervention is most appropriate for the nurse to perform first? 1. Notify the health-care provider. 2. Document the finding as normal. 3. Assess the urine color and clarity. 4. Insert an indwelling urinary catheter.

Assess the urine color and clarity.

Foods that trigger flatulence

Beans, cabbage, cauliflower, onions, spicy foods

The nurse is instructing a patient about performing home testing for fecal occult blood. What food should the patient state to avoid eating for 3 days before the test? 1) Beef 2) Milk 3) Eggs 4) Oatmeal

Beef

Which is an advantage of intermittent catheterization over indwelling catheters? 1. Convenience to the client 2. Decreased risk of infection 3. Can be removed immediately and client can void normally 4. Convenient for the nurse

Can be removed immediately and client can void normally

The nurse has an order to obtain a urine specimen for a culture and sensitivity test from a client with an indwelling urinary catheter. Which procedure is accurate for obtaining the specimen? 1. Obtaining the specimen from the drainage bag 2. Disconnecting the tubing and obtaining the specimen 3. Inserting a new indwelling urinary catheter to obtain a sterile urine specimen 4. Clamping the tubing and withdrawing a fresh specimen from the tubing aseptically

Clamping the tubing and withdrawing a fresh specimen from the tubing aseptically

Normal Urinalysis Results

Color-pale yellow- deep amber pH- 5.0-9.0- average 6.0 Specific gravity- 1.002-1.030 Clarity- translucent, not cloudy Odor- fresh urine has a scent Protein- <20 mg/day Glucose- negative Ketones- negative Hemoglobin- no RBC's Bilirubin- negative Bacteria- none

Colostomy

Consistency of drainage depends upon location

A nurse is auscultating bowel sounds on a client who has had recent abdominal surgery. She hears approximately 1 to 2 sounds per minute in each quadrant. Which condition should the nurse expect? 1. Infection 2. Diarrhea 3. Constipation 4. Ileus

Constipation

Which is the result of the passage of stool through the colon being slowed? 1. Diarrhea 2. Constipation 3. Distention 4. Ileus

Constipation

During digital removal of stool, which is the most serious complication the client is at risk of developing? 1. Bleeding 2. Decreased blood pressure 3. Hypertension 4. Decreased heart rate

Decreased heart rate

A nurse is inserting an indwelling catheter into a client. She begins to inflate the balloon, she feels resistance, and the client complains of discomfort. Which action should the nurse take? 1. Remove the catheter and discard it. 2. Notify the physician and document that the client refused a catheter. 3. Deflate the balloon and advance the catheter about an inch before attempting again. 4. Leave the catheter in place without inflating the balloon.

Deflate the balloon and advance the catheter about an inch before attempting again.

A client presents to the emergency department with nausea and vomiting for 2 days. The client states he or she has not urinated at all for the past 8 hours. Which is the most likely cause of his lack of urine output? 1. Impaired renal function 2. Renal calculi 3. Dehydration 4. Prostatic hypertrophy

Dehydration

Where does Diverticulitis usually occur

Descending Colon

Double Lumen Catheter

Designed for indwelling catheters, provides one lumen for drainage and second to inflate the balloon

The nurse is caring for a client in the endoscopy recovery area after undergoing an esophagogastroduodenoscopy (EGD). The client asks for a sip of water. What should the nurse do first? 1. Determine if the gag reflex has returned. 2. Telephone the gastroenterologist for orders. 3. Review the electronic health record (EHR). 4. Inform the client that he or she is still NPO for 12 to 24 hours.

Determine if the gag reflex has returned.

The major function of the small intestines:

Digestion and absorption of carbohydrates, fat, and protein.

A nurse is placing an indwelling catheter in an obese female client and realizes that the catheter is in the vagina rather than the urinary meatus. Which action should the nurse take? 1. Remove the catheter from the vagina and again try to place the catheter. 2. Adjust the client's position or lighting and attempt again with the same catheter. 3. Discard the catheter, adjust the client's position and lighting, and try again with a new catheter. 4. Discard the catheter and ask another nurse to try to place the catheter.

Discard the catheter, adjust the client's position and lighting, and try again with a new catheter

There is a 24-hr urine collection in process for a client. The nursing assistive personnel (NAP) inadvertently empties one specimen into the toilet instead of the collection "hat." The nurse should A. Continue with the collection of urine until the 24-hr time period is finished. B. Make a note to the lab to inform them that one specimen was missed during the collection. C. Begin filling a new collection container and take both containers to the lab at the end of the collection period. D. Dispose of the urine already collected and begin an entirely new 24-hr collection.

Dispose of the urine already collected and begin an entirely new 24-hr collection.

Which lab test can be done at the bedside and requires the least amount of stool specimen?

Fecal occult blood test

Process of Urinary Elimination

Filling of bladder 200 to 450 mL of urine Activation of stretch receptors in bladder wall Signaling to the voiding reflex center Contraction of detrusor muscle Conscious relaxation of external urethral sphincter

Which food item should the nurse instruct the patient to consume to prevent or treat constipation? 1) Milk and cheese 2) Bread and pasta 3) Fruits and vegetables 4) Lean meats

Fruits and vegetables

Nursing Diagnosis for Bowel and Urine Elimination

Functional urinary incontinence Stress urinary incontinence Urge urinary incontinence Risk for infection Toileting self-care deficit Impaired skin integrity Impaired urinary elimination Urinary retention Disturbed body image Bowel incontinence Constipation Perceived constipation Risk for constipation Diarrhea Nausea Deficit knowledge (nutrition)

What is the most significant change in kidney function that occurs with aging? 1. Decreased glomerular filtration rate 2. Proliferation of micro-blood vessels to renal cortex 3. Formation of urate crystals 4. Increased renal mass

Glomerular filtration rate: the amount of filtrate formed by the kidneys in 1 minute. A decrease in glomerular filtration is the most important functional deficit caused by aging.

The nurse auscultates low-pitched infrequent bowel sounds in a patient recovering from a bowel resection. How should this finding be documented? 1) Hyperactive bowel sounds 2) Abdominal bruit sounds 3) Normal bowel sounds 4) Hypoactive bowel sounds

Hypoactive bowel sounds

Which procedure produces a surgical opening in the abdomen and bypasses the large intestine entirely? 1. Sigmoid colostomy 2. Kock pouch 3. Ileostomy 4. Loop colostomy

Ileostomy

Valsalva Maneuver

Increase pressure to expel feces by contracting abdominal muscles (straining) while maintaining a closed airway. -Caution for clients with: heart disease, glaucoma, new surgical wounds. -Process increase blood pressure

What is the effect of physical activity on normal defecation? 1. Increased physical activity can increase constipation. 2. Decreased physical activity can result in diarrhea. 3. Increased physical activity promotes normal defecation patterns. 4. Physical activity has no effect on defecation patterns.

Increased physical activity promotes normal defecation patterns.

Ileostomy

Liquid drainage

Upper GI Structures

Mouth, pharynx, esophagus, and stomach.

Mrs. Addie is 70 years old. While the nurse is gathering admission assessment data, the patient states, "I've taken a tablespoon of Milk of Magnesia every day for 3 years." Which nursing diagnosis is most appropriate for the nurse to use in her plan of care? 1. Diarrhea 2. Constipation 3. Risk for Ineffective Therapeutic Regimen 4. Perceived Constipation

Perceived Constipation

Which nursing diagnosis applies to a client who feels it is important to have a bowel movement every day, and resorts to taking laxative suppositories or enemas to facilitate this? 1. Dysfunctional gastrointestinal motility 2. Perceived constipation 3. Irritable bowel syndrome 4. Chronic constipation

Perceived constipation

Which condition in older men can result in impaired flow of urine from the bladder into the urethra? 1. Renal calculi 2. Prostatic hypertrophy 3. Cardiovascular disorders 4. Stroke

Prostatic hypertrophy

What is the purpose of using a drape when inserting a catheter? 1. Reduces the risk of infection 2. Improves lighting for the procedure 3. Provides privacy for the client 4. Helps regulate temperature

Provides privacy for the client

What can cause a false positive fecal occult test?

Red meat, Vitamin C, anti-coagulant therapy

Which type of enema may be ordered to help a client pass flatus and relieve abdominal distention? 1. Oil-retention enema 2. Medicated enema 3. Nutritive enema 4. Return-flow enema

Return-flow enema

Which is an appropriate elimination-related nursing diagnosis for a client who is on bedrest following surgery, and is also taking opioid pain medications? 1. Risk for bowel incontinence 2. Risk for infection related to diarrhea 3. Altered tissue integrity related to incontinence 4. Risk for constipation related to immobility

Risk for constipation related to immobility

Feces

Semisolid mass of fiber, undigested food, inorganic material

Brown Urine

Sign of dehydration or kidney disease

Foamy Urine

Sign of kidney disease

Red Urine

Sign of kidney disease, UTI, or tumor

Green Urine

Sign of rare genetic disorder

The nurse identifies the diagnosis Impaired Urinary Elimination in an older adult patient admitted after a stroke. Impaired Urinary Elimination places the patient at risk for which complication? 1. Skin breakdown 2. Urinary tract infection 3. Bowel incontinence 4. Renal calculi

Skin breakdown

Most digestion and absorption of food occurs in the small intestine

Small intestines: 1 in diameter, 20 ft long. Takes up majority of abdomen

Characteristics of stool

Soft, formed semisolid, approximately 25% solid, 75% water

The female client states to the nurse, "I'm so distressed. It seems like every time I laugh hard, I wet myself." The nurse knows that this condition is known as A. Stress incontinence B. Urge incontinence C. Functional incontinence D. Unconscious incontinence

Stress incontinence: results from increased pressure within the abdominal cavity.

The nurse is caring for a client who is being discharged after sustaining a myocardial infarction. What is most important for the nurse to instruct the client? 1. Consume a bland diet. 2. Use a salt substitute on foods. 3. Avoid consuming grapefruits and its juice. 4. Take stool softeners to prevent straining.

Take stool softeners to prevent straining.

Which describes the glomerular filtration rate? 1. The amount of filtrate formed by the kidneys per minute 2. The volume of blood that passes through the kidneys in each cardiac cycle 3. The amount of waste removed by the kidney each minute 4. The amount of urine that collects in the bladder per minute

The amount of filtrate formed by the kidneys per minute

Segments in the large intestines (colon)

The cecum, ascending colon, transverse colon, descending colon, sigmoid colon, rectum, and anus.

A client has a tendency to develop frequent constipation. Which dietary consideration should the nurse recommend? 1. The client should increase iron intake. 2. The client should decrease fiber intake. 3. The client should increase intake of fats. 4. The client should increase fiber intake.

The client should increase fiber intake.

A nurse is performing a health history interview. The client has a complaint of chronic constipation. Which piece of information is most helpful to the nurse in determining contributing factors to the constipation? 1. The client has recently been on antibiotics. 2. The client takes iron supplements. 3. The client tires easily and does not exercise much. 4. The client has been having trouble sleeping.

The client takes iron supplements.

A client asks the nurse to take a laxative, as he or she has not had a bowel movement today. What is the first information the nurse should obtain prior to administering the laxative? 1. The amount of fiber in daily diet 2. The last dose of laxative received 3. If the client has had any flatus 4. The client's normal bowel elimination pattern

The client's normal bowel elimination pattern

The nurse is discussing ways to treat functional incontinence with a group of older adults in a senior citizens center. Which intervention would be most appropriate for the nurse to include in the presentation? 1. Timed voiding 2. Kegel exercises 3. Straight catheterization 4. Pharmacological treatment

Timed voiding

The nurse prepares to insert an indwelling urinary catheter. Which statement least explains the reason for this intervention? A. Empty your bladder prior to your procedure. B. Treat your problem of leaking urine. C. Obtain a sterile urine specimen for culture. D. Measure the amount of urine left after you emptied your bladder.

Treat your problem of leaking urine.

Triple Lumen Catheter

Used for continuous bladder irrigation or when it becomes necessary to instill medications into the bladder

Single Lumen Catheter

Used for intermittent/straight catheterization

Which describes a normal defecation pattern? 1. Defecation at the same time every day 2. Defecation at least every other day 3. Defecation several times a day 4. Varies among individuals

Varies among individuals

A patient is diagnosed with an intestinal infection after traveling abroad. The nurse should encourage the intake of which food to promote healing? 1) Yogurt 2) Pasta 3) Oatmeal 4) Broccoli

Yogurt