Passpoint - Gastrointestinal Disorders

A client with severe abdominal pain is being evaluated for appendicitis. The client asks what is the most common cause of appendicitis. How would the nurse best respond?

"Appendicitis is caused by an obstruction of the appendix."

A client was hospitalized and treated for acute diverticulitis. The nurse has reinforced discharge education. Which statement by the client indicates that the client understands the discharge instructions?

"I'll take all of my antibiotics."

A nurse is caring for a client with chronic pancreatitis. Which response by the client indicates that discharge education has been effective?

"I'll take pancreatic enzymes with each meal."

A nurse is assigned to care for four clients. Which client should a nurse assess first?

A postoperative client who just returned from surgery and is vomiting

The nurse caring for a client with small-bowel obstruction would plan to implement which nursing intervention first?

Administering I.V. fluids

While obtaining a client's medication history, the nurse learns that the client takes ranitidine, as prescribed, to treat a peptic ulcer. The nurse continues gathering medication history data to assess for potential drug interactions. The nurse should instruct the client to avoid taking a drug from which class with ranitidine?

Antacids

A nurse is working with a nursing assistant, who is given the task of calculating three clients' intake and output at the end of the shift. When the nurse reviews the nursing assistant's work, she discovers inaccuracies in the nursing assistant's results. What should the nurse do?

Ask the nursing assistant to show her how she determined the results.

An elderly client with Alzheimer's disease begins supplemental tube feedings through a gastrostomy tube to provide adequate calorie intake. The nurse observes the client during feeding and is concerned most with which potential development?

Aspiration

To verify the placement of a gastric feeding tube, the nurse should perform at least two tests. One test requires instilling air into the tube with a syringe and listening with a stethoscope for air passing into the stomach. What is another test method?

Aspiration of gastric contents and testing for a pH less than 6

A client is admitted to the health care facility with a diagnosis of a bleeding gastric ulcer. The nurse instructs the nursing student to observe this client's stools for which finding?

Black and tarry

A client with inflammatory bowel disease undergoes an ileostomy. On the first day after surgery, the nurse notes that the client's dusky-appearing stoma is related to which factor?

Blood supply to the stoma has been interrupted.

A client with a new colostomy asks the nurse how to avoid detachment from the ostomy bag. What is the best response by the nurse?

Empty the bag when it's about half full.

Which information should the nurse include when reinforcing instructions regarding routine screening recommendations for colorectal cancer?

Guaiac-based fecal occult blood test (gFOBT) should begin at age 50 years.

A client is recovering from an ileostomy that was performed to treat inflammatory bowel disease. During discharge teaching, the nurse stresses the importance of which action?

Increasing fluid intake to prevent dehydration

Which nursing intervention is important for the nurse to perform preoperatively for a child with appendicitis?

Maintain complete bed rest.

A client with abdominal pain secondary to a malignant mass in the colon is receiving fentanyl by transdermal patch. His current patch expires in 48 hours and he reports a pain level of 8 on a 1-to-10 scale. What should a nurse do?

Notify the client's physician.

A nurse is caring for a client with an ileostomy. What is the most common complication of this procedure?

Peristomal skin irritation

When caring for a client who has had constipation for 4 days, what should be the nurse's primary client care concern?

Promoting defecation

Which nursing intervention is the best way to help reduce the occurrence of poisoning in children?

Provide education to those who care for children.

The nurse cares for a client who is post-op bowel resection and has a nasogastric (NG) tube to low intermittent suction. Which care intervention should the nurse administer?

Provide meticulous mouth care as needed.

A client is scheduled for bowel resection with anastomosis involving the large intestine. Because of the surgical site, the nurse assists in formulating the nursing diagnosis of Risk for infection. To complete the nursing diagnosis statement, which "related-to" phrase should be added?

Related to the presence of bacteria at the surgical site

A physician asks a nurse to witness an informed consent of a client scheduled for gastric bypass surgery. What should the nurse do?

Sign the consent only if she sees the client sign it.

A nurse is gathering data on a client receiving an enteral feeding who suddenly states, "I feel very faint and sweaty." What is the nurse's immediate action?

Stop the feeding.

Which outcome indicates effective client teaching to prevent constipation?

The client reports engaging in a regular exercise regimen.

The nurse is caring for a client with alcohol-related acute pancreatitis. Which intervention is most appropriate to reduce the exacerbation of pain?

abstaining from alcohol

A client who takes famotidine for gastritis asks the home care nurse which medication is best to take for a headache. Which over-the-counter medication should the nurse suggest for this client?

acetaminophen

The nurse prepares to administer morning medications to a client with hepatitis. The client's medications are listed below. Which medication should the nurse withhold?

acetaminophen 650 mg orally every day

The 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 avoid:

aspiration.

A nurse is caring for a client who is receiving enteral feedings through a feeding tube. Which action takes priority in this client's care?

checking placement of the tube

Several children at a day care center have been infected with hepatitis A virus. Which instruction reinforced by the nurse would reduce the risk of spreading hepatitis A to other children and staff members?

hand washing after diaper changes

The nurse is performing an assessment on a client who has developed a paralytic ileus. The nurse expects the client's bowel sounds will be:

hypoactive.

A client with cholecystitis is receiving propantheline bromide. The client is given this medication because it

inhibits contraction of the bile duct and gallbladder.

A nurse is verifying orders from a health care provider. Which diet will the nurse discuss with child and family related to a new diagnosis of celiac disease?

no-gluten diet

The nurse is caring for a client with esophageal varices. What is a priority intervention when caring for this client?

recognizing hemorrhage

The nurse receives a client at the clinic for follow-up after being treated in the hospital for pancreatitis. When gathering data from the client, which finding should immediately be reported to the health care provider?

shortness of breath with minimal exertion

A client suspected of having colorectal cancer would require which diagnostic study to confirm the diagnosis?

sigmoidoscopy

A client diagnosed with glossitis is prescribed a diet high in folic acid. When assisting with the development of a teaching plan for this client, which food products will the nurse reinforce to fulfill the need for increased folic acid?

spinach

A client who has just arrived on the medical-surgical unit after an appendectomy appears to be malnourished. Which nutritional deficiency can delay wound healing?

vitamin C

A client comes to the clinic for a follow-up appointment after diagnostic tests show gastroesophageal reflux disease. What instructions should the nurse reinforce?

"Avoid alcohol and caffeine."

A client with recent onset of epigastric discomfort is scheduled for an upper GI series (barium swallow). When teaching the client how to prepare for the test, which instruction should the nurse provide?

"Avoid eating or drinking anything for 6 to 12 hours before the test."

The nurse reinforces discharge education for a client with Crohn's disease. Which long-term symptom management instruction should the nurse reinforce to this client?

"Keep a food diary and eat small, frequent meals."

A client is evaluated for severe pain in the right upper abdominal quadrant, which is accompanied by nausea and vomiting. The physician diagnoses acute cholecystitis and cholelithiasis. For this client, which nursing diagnosis takes top priority?

Acute pain related to biliary spasms

A client has just been diagnosed with hepatitis A. During assessment, which signs and/or symptoms would the nurse anticipate to find?

Anorexia, nausea, and vomiting.

The nurse is monitoring a client receiving paregoric to treat diarrhea for drug interactions. Which drugs can produce additive constipation when given with an opium preparation?

Anticholinergic drugs

A client is being discharged from the acute care facility after experiencing acute pancreatitis. Which instruction should the nurse reinforce to this client during discharge education?

Avoid spicy foods and caffeine.

A client had a gastroscopy while under local anesthesia. Before resuming the client's oral fluid intake, which action should the nurse take first?

Check for a gag reflex.

Which nursing intervention would be the priority in the immediate postoperative care of a client who has undergone gastric resection?

Monitoring for symptoms of hemorrhage

A client with left hemiparesis is having difficulty handling eating utensils. A nurse asks the physician to request a consult with which discipline?

Occupational therapy

Which intervention should the nurse expect to perform when caring for a client with acute pancreatitis?

Withhold oral intake as ordered.

A parent brings a 12-month-old to the primary health care provider's office for a well-child visit. Which data collected by the nurse suggests that the infant has cystic fibrosis?

presence of fat in the stool

The nurse is assisting a client to ambulate following a bowel resection for diverticulitis. The client reports sudden, sharp abdominal pain and the nurse observes that the wound has eviscerated. Prioritize the following nursing actions in chronological order to show how the nurse should respond. All options must be used.

Call for assistance from other nursing personnel. Place the client in low Fowler's position. Cover the wound with sterile, nonadherent dressing moistened with sterile normal saline solution. Assess the client's response. Document the incident, including the client's condition.

The nurse is teaching a client how to irrigate his stoma. Which action indicates that the client needs more teaching?

Hanging the irrigation bag 24" to 36" (60 to 90 cm) above the stoma

The nurse is assessing a client who complains of abdominal pain, nausea, and diarrhea. When examining the client's abdomen, which sequence should the nurse use?

Inspection, auscultation, percussion, and palpation

The nurse is reinforcing education for the parents of a child that has been diagnosed with celiac disease. To help promote a normal life for the child, which intervention should the nurse reinforce for the parents to use?

Introduce the child to a peer with celiac disease.

A client seeks medical attention after developing acute abdominal pain. Which action by the nurse would help ensure accurate auscultation of the client's bowel sounds?

Making sure the client's bladder is empty before auscultating

The nurse is assisting with the care of an infant following surgical repair of esophageal atresia and tracheoesophageal fistula. Which nursing intervention takes the highest priority during the first 24 hours following the surgical repair?

Monitor for excessive secretions.

A client with cirrhosis is admitted to the hospital. While reviewing the client's file, the nurse determines which data collection findings indicate that this client has deficient vitamin K absorption caused by this hepatic disease?

Purpura and petechiae

A client is admitted to the health care facility with abdominal pain, a low-grade fever, abdominal distention, and weight loss. The physician diagnoses acute pancreatitis. What is the primary goal of nursing care for this client?

Relieving abdominal pain

A client is scheduled for a laparoscopic cholecystectomy under general anesthesia. When the nurse asks the client what procedure the client will be having to compare with the informed consent, the client responds, "The doctor is going to take a piece of my liver out." What action should the nurse take at this time?

Request that the health care provider speak with the client before surgery to clarify the surgical procedure.

For a client who must undergo colon surgery, the physician orders preoperative cleansing enemas. The nurse anticipates administration of neomycin to this client to:

decrease the intestinal bacteria count.

The nurse is caring for a client who has undergone an open surgical procedure for hiatal hernia repair. Which nursing intervention is a priority?

encouraging incentive spirometer use

A client with cholecystitis is receiving propantheline bromide. The client is given this medication because it:

inhibits contraction of the bile duct and gallbladder.

When assisting with development of a postoperative care plan for a client after gastric resection, which would be the priority?

nutritional needs

A nurse reinforces education that has been provided to an older adult about good bowel habits. Which statement indicates that the client understands the information?

"Fifteen minutes of exercise three times a week improves bowel habits."

A client with colon cancer asks the nurse why radiation therapy is being received before surgery. Which response would be most appropriate?

"It helps reduce the size of the tumor."

A nurse is caring for a child who has been treated in the emergency department after ingesting drain cleaner. Which nursing interventions would be appropriate in this child care? (Select all that apply.)

Observe vital signs for subtle changes. Determine the child's ability to speak. Observe for swelling of the tongue.

A client is scheduled for an endoscopy. On admission, the nurse asks the client if he has an advance directive, and the client states, "No." What should the nurse do next?

Provide the client with information about an advance directive.

A client with cholelithiasis has a gallstone lodged in the common bile duct is admitted to the medical-surgical unit. During the nurse's assessment of this client, he or she will document which finding?

Yellow sclerae.

The nurse is gathering data from a child suspected of ingesting paint chips from an old home. Which system does the nurse closely monitor for serious effects?

central nervous system (CNS)

Progress Note Client admitted to the emergency department with severe right upper quadrant pain radiating to the back, nausea and vomiting, and fever. Laboratory results received via telephone as follows: glucose 46 mg/dL, WBC 14,000 cells/mm3, lipase 214 units/L and calcium 6.5 mg/dL A client has been admitted to the emergency department with severe right upper quadrant pain. Based on the signs and symptoms and laboratory data documented in the chart shown, the nurse would expect the client to have which diagnosis?

pancreatitis

Which process best describes the mode of action of medications such as ranitidine, which are used in the treatment of peptic ulcer disease?

reduce acid secretions

A patient underwent open abdominal surgery to remove an intestinal mass 5 days previously and calls the clinic reporting cramping abdominal pain, vomiting, and passing no stool or gas. Which response is most appropriate for the nurse to give to this client?

"Go to the emergency department for evaluation."

A client needs to have a fecal occult blood test performed on three consecutive bowel movements. To prepare the client for this test, the nurse provides information about the required dietary restrictions. The nurse knows the teaching has been successful when the client makes which statement?

"I should not eat any poultry, red meat, and turnips for 4 days before I begin this test."

The nurse is reinforcing discharge instructions to a client with chronic cholecystitis. Which response by the client indicates the education has been effective?

"I will take my anticholinergic medications as prescribed."

A 2-year-old child is admitted through the emergency department with a suspected diagnosis of Hirschsprung's disease (aganglionic megacolon). The parent asks about treatment of the disease. What would be an appropriate response from the nurse?

"Initially the child will have a temporary colostomy; later a second operation removes the abnormal part of bowel and reattaches the normal bowel down to the rectum."

The nurse is reinforcing education for a client who underwent a subtotal gastrectomy for managing dumping syndrome. Which client statement indicates an understanding of the education?

"Liquids should be consumed between each meal."

At the beginning of the shift, the nurse is assigned a client with an ascending colostomy. Which picture identifies the correct placement where the nurse will assess the stoma?

***The location of an ascending colostomy is on the right side of the abdomen

A client is brought to the emergency room with suspected cholecystitis. Which findings are characteristic of this diagnosis? Select all that apply.

- epigastric pain radiating to the back - indigestion after eating fatty foods

After laparoscopic cholecystectomy, a client reports abdominal pain. The nurse prepares morphine 2 mg. If the label on the morphine reads 10 mg/ml, how many milliliters should the nurse have in the syringe after the correct dose is drawn up? Record your answer using one decimal place.

0.2

When caring for a client with hepatitis B, the nurse should monitor closely for the development of which finding associated with a decrease in hepatic function?

Irritability and drowsiness

A client is scheduled to have a cholecystectomy. Which education should the nurse reinforce regarding the use of incentive spirometry? Select all that apply.

It increases alveolar inflation. It will promote lung expansion. It will promote deep breathing.

A client had a nephrectomy 2 days ago and is now complaining of abdominal pressure and nausea. The first nursing action should be to:

auscultate bowel sounds.

A client experiences weight loss, abdominal distention, crampy abdominal pain, and intermittent diarrhea after the birth of her second child. Diagnostic tests reveal gluten-induced enteropathy. Which foods would the nurse instruct the client to eliminate from her diet permanently?

cereal grains (except rice and corn)

A nurse is caring for a postoperative client with a new colostomy. Which findings are of concern for the nurse? Select all that apply.

changing mental status muscle cramps dry mucous membranes hyperpnea

The ingestion of substances containing lead is mostly influenced by which risk factor?

child's age