Uworld GI #1

The nurse is educating the parents of a 6-month-old about introducing solid foods into the infant's diet. Which parental statement indicates a need for further teaching? a. I can introduce soft finger foods before my child has teeth b. I can offer a variety of foods within the first week of introducing solids c. I can prepare rice cereal with formula, breast milk, or water. d. I can save money by preparing baby food at home instead of buying it.

The introduction of solid foods generally occurs at age 4-6 months. When introducing new foods, parents should allow several (eg, 4-7) days between each new food to observe for any reactions to a specific food. Allergic responses often worsen with subsequent exposure, so it is a priority to identify food allergies early (Option 2). (Option 1) At age 6-8 months, an infant can try pureed fruits and vegetables, followed by simple finger foods (eg, teething crackers, small pieces of fruit or cooked vegetables, cheese). These foods help children develop motor skills and learn to chew, even before they have teeth. (Option 3) Parents should start introducing solids with an iron-fortified infant cereal (eg, rice, oatmeal) mixed with breast milk, formula, or water. (Option 4) Mashed soft fruits or cooked vegetables made at home are less expensive than commercially prepared baby food. Educational objective:Infants can begin eating solid foods at age 4-6 months. Parents should introduce each new food separately and wait several (eg, 4-7) days between each one to identify any food allergies. After starting with iron-fortified cereal (mixed with formula, breast milk, or water), parents can begin offering soft fruits and vegetables and simple finger foods. Answer: B

The nurse is developing teaching materials for a client diagnosed with ulcerative colitis. The client will receive sulfasalazine. Which of the following instructions are included in the discharge teaching plan? Select all that apply. a. Avoid small, frequent meals b. Can have a cup of coffee with each meal c. Eat a low-residue, high protein, high calorie diet d. Increase fluid intake to at least 2000 ml/day e. Medication should be continued even after the resolution of symptoms f. Take daily vitamin and mineral supplements

A low-residue, high-protein, high-calorie diet, along with daily vitamin and mineral supplements, is encouraged to meet the nutritional and metabolic needs of the client with ulcerative colitis. The low-residue diet limits trauma to the inflamed colon and may lessen symptoms. Easily digested foods such as enriched breads, rice, pastas, cooked vegetables, canned fruits, and tender meats are included in the diet. Raw fruits and vegetables, whole grains, highly seasoned foods, fried foods, and alcohol are avoided. The well-balanced diet includes at least 2000-3000 mL/day of fluid to maintain fluid and electrolyte balance and hydration. (Option 1) Small, frequent meals are encouraged to lessen the amount of fecal material present in the gastrointestinal tract and to decrease stimulation. (Option 2) Caffeine, alcohol, and tobacco are gastric irritants that stimulate the intestine and should be avoided. (Option 5) The prescribed sulfasalazine should be continued even when symptoms subside to prevent relapse. Because sulfasalazine hinders the absorption of folate, folic acid supplements are encouraged. Educational objective:A low-residue, high-protein, high-calorie diet with supplemental vitamins and minerals is recommended for a client diagnosed with ulcerative colitis. The well-balanced diet includes small, frequent meals and at least 2000-3000 mL/day of fluid to maintain fluid and electrolyte balance and hydration. c,d,e,f

The nurse is caring for a client who has undergone a colonoscopy. Which client assessment finding should most concern the nurse? a. Abdominal cramping b. Frequent, watery stools c. Positive rebound tenderness d. Recurring flatus

A risk of a colonoscopy (or any procedure in which a firm scope is inserted into a "hollow tube" organ) is perforation. Signs of perforation include abdominal pain (with shoulder tip pain), positive rebound tenderness, guarding, abdominal distension, tenesmus, and/or boardlike (rigid) abdomen. Another potential complication is rectal bleeding. (Option 1) Abdominal cramping post procedure is an expected finding. It is caused by the stimulation of peristalsis as the bowel is constantly inflated with air during the procedure. (Option 2) The preparation for the procedure, emptying the colon of stool, includes clear liquids, cathartics, and/or enemas. The stool is watery and copious and may continue for a short time after the procedure. It is not a concerning finding. (Option 4) During the procedure, air is inflated into the colon. The client needs to expel this "gas" afterward. It is an expected finding. Educational objective:The complication risks of a colonoscopy are perforation and rectal bleeding. Abdominal cramping, flatus, and watery stool are expected findings. Perforation can lead to peritonitis, with positive rebound tenderness, guarding, abdominal distension, tenesmus, and/or boardlike (rigid) abdomen.

A parent rushes a 4-year-old child to the emergency department after finding the child sitting on the kitchen floor holding an empty bottle of aspirin. The parent has no idea how many tablets were left in the container. The child is sniffling and quietly crying. The nurse anticipates initially implementing which treatment? a. Activated charcoal b. Gastric lavage c. Sodium bicarbonate d. Syrup of ipecac

Activated charcoal is an important treatment in early acetylsalicylic acid (ASA) toxicity; it is recommended for gastrointestinal decontamination in clients with clinical signs of ASA poisoning (disorientation, vomiting, hyperpnea, diaphoresis, restlessness) as well as in those who are asymptomatic. Activated charcoal binds to available salicylates, thus limiting further absorption in the small intestine and enhancing elimination. (Option 2) Similar to syrup of ipecac, gastric lavage is associated with risk of aspiration. In addition, there is no convincing evidence that it decreases morbidity. It is not routinely recommended but may be performed for the ingestion of a massive or life-threatening amount of drug. If necessary, it should be administered within 1 hour of ingestion and requires a protected airway and possible sedation. (Option 3) IV sodium bicarbonate is an appropriate treatment for aspirin toxicity after the administration of activated charcoal. It is given to make the blood and urine more alkaline, therefore promoting urinary excretion of salicylate. (Option 4) Syrup of ipecac has been shown to have minimal benefit in treating aspirin overdose; in addition, it is not recommended due to the risk of aspiration pneumonia secondary to induced vomiting. Educational objective:Activated charcoal is used as the initial treatment for aspirin overdose in clients with clinical signs of salicylate toxicity as well as in those who are asymptomatic. Activated charcoal binds with salicylate and therefore inhibits absorption by the small intestine. IV sodium bicarbonate is also used for treating aspirin overdose after treatment with activated charcoal has been initiated. A

The nurse prepares to admit a client with worsening cirrhosis who is on the waiting list for a liver transplant. Based on the client's electronic health record, the nurse anticipates which assessment findings? Select all that apply. Click on the exhibit button for additional information. Lab results: Medication: Albumin - 1.5 g/dL Lactulose 30 g Ammonia - 112 mcg/dL PO TID INR - 1.9 0700,1400,2100 Bilirubin - 22 mg/dL Platelets - 55,000/mm a. Ascites b. Bruising c. Constipation d. Itching e. Lethargy

Cirrhosis of the liver occurs when chronic liver disease (eg, hepatitis C infection) causes scar tissue and nodules, which can decrease liver function and lead to liver failure. Clients with end-stage liver disease may experience exacerbations requiring hospitalization and acute intervention. Numerous laboratory abnormalities occur in the setting of liver failure and correlate with assessment findings (eg, high serum ammonia resulting in hepatic encephalopathy) (Options 1, 2, 4, and 5). (Option 3) Lactulose, an osmotic laxative, decreases serum ammonia levels by causing ammonia to be excreted through stool. The desired therapeutic effect is the production of 2 or 3 soft bowel movements each day; therefore, clients receiving lactulose should not exhibit constipation. Educational objective:Laboratory abnormalities common in liver failure include low serum albumin (causes ascites), elevated INR (increases risk for bruising and bleeding), elevated serum ammonia (causes lethargy and confusion), and increased bilirubin (causes jaundice and itching). a,b,d,e

The nurse teaching the parents of a child diagnosed with cystic fibrosis will advise the parents to choose foods that satisfy which recommended diet? a. Gluten-free with added protein b. High calorie, high protein, high fat c. High protein, low fat, low phosphate d. High protein, low fat, low sodium

In cystic fibrosis (CF), a protein responsible for transporting sodium and chloride is defective and causes the secretions from the exocrine glands to be thicker and stickier than normal. These abnormal secretions plug smaller airway passages and ducts in the gastrointestinal (GI) tract. The thick secretions block pancreatic ducts, resulting in a deficient amount of pancreatic enzymes entering the bowel to aid in digestion and nutrient absorption. Clients require multiple vitamin supplements and supplemental pancreatic enzymes that are administered with meals. To meet the growth needs of clients with CF, a diet high in calories, fat, and protein is required. (Options 1, 3, and 4) A gluten-free diet is required for clients with celiac disease who cannot tolerate barley, rye, oats, or wheat (mnemonic: BROW). Low-phosphate diets are indicated for clients with certain kidney disorders. Low-sodium diets are indicated for volume overload states (eg, heart failure, ascites) and hypertension. Educational objective:Cystic fibrosis causes damage to the GI tract and pancreas, leading to impaired absorption of nutrients and resulting growth deficits. Clients must consume a diet high in calories, fat, and protein. B

During the admission assessment of a client with a small-bowel obstruction, the nurse anticipates which clinical manifestations? Select all that apply. a. Abdominal distention b. Absolute constipation c. Colicky abdominal pain d. Frequent vomiting e. Pain during defecation

Small-bowel obstruction can have mechanical or non-mechanical causes. Mechanical obstruction is commonly caused by obstruction of the bowel resulting from surgical adhesions, hernias, intussusception, or tumors. Paralytic ileus, a non-mechanical obstruction, may occur after abdominal surgery or narcotic use. When a small-bowel obstruction develops, fluid and gas collect proximal to the obstruction, producing rapid onset of nausea and vomiting (Option 4), colicky intermittent abdominal pain (Option 3), and abdominal distension (Option 1). The nurse should recognize symptoms of bowel obstruction quickly as delay could lead to vascular compromise, bowel ischemia, or perforation. Nursing management of an obstruction includes placing the client on NPO status, inserting a nasogastric tube, administering prescribed IV fluids, and instituting pain control measures. (Option 2) Symptoms of a large-bowel obstruction differ slightly from small-bowel obstruction and include gradual onset of symptoms, cramping abdominal pain, abdominal distension, absolute constipation, and lack of flatus. Constipation and decreased flatus resulting from small-bowel obstruction would occur later, as the stool and gas in the large colon would be expelled for a few days. (Option 5) Pain during defecation usually indicates a rectal problem such as inflammation, anal fissure, or thrombosed hemorrhoids. Educational objective:Common symptoms of small-bowel obstruction include rapid onset of nausea and vomiting, colicky intermittent abdominal pain, and abdominal distension. Absolute constipation and lack of flatus are usually seen with large-bowel obstruction. Initial treatment of an obstruction includes placing the client on NPO status, inserting a nasogastric tube, administering IV fluids, and instituting pain control measures. A,C,D

The nurse is caring for a client with an inflammatory bowel disease exacerbation. The client is prescribed sulfasalazine. Which finding would require a priority follow-up by the nurse? a. Elevated erythrocyte sedimentation rate b. Hgb 10.5g/dL c. Urine with yellow orange discoloration d. Urine specific gravity 1.035

Sulfasalazine (Azulfidine) contains sulfapyridine and aspirin (5-ASA) and is used as a topical gastrointestinal anti-inflammatory and immunomodulatory agent in inflammatory bowel disease (IBD). When the 5-ASA is combined with the sulfa preparation, the drug does not become absorbed until it reaches the colon. Dehydration is a risk with IBD as the client can have up to 20 diarrheal stools a day. The client usually does not feel thirsty until after there is a fluid volume deficit. Sulfa can crystallize in the kidney if the client is dehydrated. Normal urine specific gravity is 1.003-1.030. Elevated specific gravity can indicate concentrated urine and be a sign of dehydration (Option 4). (Option 1) Due to the inflammatory nature of IBD, erythrocyte sedimentation rate, C-reactive protein, and white blood cells can be elevated. This is an expected finding during an exacerbation. (Option 2) Mild to moderate anemia (normal hemoglobin 13.2-17.3 g/dL [132-173 g/L] for males, 11.7-15.5 g/dL [117-155 g/L] for females) is common with most chronic inflammatory conditions (eg, rheumatoid arthritis, IBD) as the body cannot use the available iron in bone marrow with active inflammation. In addition, IBD exacerbation usually includes bloody stools, resulting in blood loss iron deficiency anemia. This needs follow-up but is not a priority. (Option 3) Yellow-orange discoloration of the client's skin and urine is an expected side effect from the drug. Educational objective: Dehydration is a concern with sulfasalazine and most other "sulfa" medications due to the risk of crystal formation in the kidney. It is also a potential complication of inflammatory bowel disease. Answer: D

A nurse in the neonatal intensive care unit discovers a cyanotic newborn with excessive frothy mucus in the mouth. What should be the nurse's first action? a. Administer 100% oxygen b. Auscultate the lungs c. Place infant in knee-chest position d. Suction the infant's mouth

The initial nursing action for a client experiencing cyanosis and excess oral secretions is suctioning the mouth (ie, oropharynx) to clear the airway (Option 4). Excessive frothy mucus and cyanosis in a newborn could be due to esophageal atresia (EA) and tracheoesophageal fistula (TEF). If EA/TEF is suspected, the infant should be kept supine with the head elevated at least 30 degrees to prevent aspiration. A nasogastric tube should be inserted and connected to continuous or intermittent suction until surgical repair. (Option 1) Oxygen cannot be delivered to the lungs if secretions obstruct the airway. Therefore, suctioning is a priority. (Option 2) This infant is aspirating and in immediate distress, which should be addressed without delay. After suctioning the excess saliva and ensuring a clear airway, the nurse may perform further assessments. (Option 3) This infant's cyanosis is a result of aspirating secretions and does not indicate a circulatory problem. The knee-chest position is appropriate to increase pulmonary blood flow in infants with a cyanotic heart defect (eg, tetralogy of Fallot). Educational objective:The initial nursing action for a client experiencing cyanosis and excess oral secretions is oropharyngeal suctioning to ensure airway patency.

The nurse is providing nutritional teaching for a client with a new ileostomy. Which foods should the nurse instruct the client to avoid? Select all that apply. a. Bananas b. Broccoli with cheese c. Multigrain bagel d. Popcorn e. Spaghettin with sauce

An ileostomy is a surgically created opening (stoma) in the abdominal wall that connects the small intestine to the external abdomen. Stool from the small intestine bypasses the colon and exits through the ileostomy. Functions of the colon (eg, fluid and electrolyte absorption, vitamin K production) do not occur, resulting in liquid stool that drains into an external ostomy appliance attached to the skin. In the immediate postoperative period of an ileostomy, a low-residue diet (low-fiber) is prescribed to prevent obstruction of the narrow lumen of the small intestine and stoma (1-in [2.54-cm] diameter or less). After the ileostomy heals, the client reintroduces fibrous foods one at a time. The client is instructed to thoroughly chew food and monitor for changes in stool output. Foods to be avoided include: High fiber: popcorn, coconut, brown rice, multigrain bread (Options 3 and 4) Stringy vegetables: celery, broccoli, asparagus (Option 2) Seeds or pits: strawberries, raspberries, olives Edible peels: apple slices, cucumber, dried fruit (Option 1) After an ileostomy, a client may consume fruits and vegetables that are pitted, peeled, and/or cooked (eg, peaches, bananas, potatoes). (Option 5) Low-fiber carbohydrate options include white rice, refined grains, and pasta. Educational objective:The low-residue diet of a client with a new ileostomy helps prevent obstruction of the narrow lumen of the stoma. During the immediate postoperative period, the client should avoid foods that are high in fiber; stringy vegetables; and fruits and vegetables with pits, seeds, or edible peels. B,C,D