Care of Patients with Gastrointestinal Disorders

1. A client is admitted to the hospital after vomiting bright red blood and is diagnosed with a bleeding duodenal ulcer. The client develops a sudden, sharp pain in the mid-epigastric region along with a rigid, board-like abdomen. These clinical manifestations most likely indicate which of the following: A. An intestinal obstruction has developed B. Additional ulcers have developed C. The esophagus has become inflamed D. The ulcer has perforated.

1. Answer: D. Perforated ulcer causes peritonitis as manifested by sudden, sharp pain.

10. Which of the following factors would most likely contribute to the development of a client's hiatal hernia? A. Having a sedentary desk job. B. Being 5 feet, 3 inches tall and weighing 190 pounds. C. Using laxatives frequently. D. Being 40 years old.

10. Answer: B. Obesity is a common factor that may contribute to the development of hiatal hernia.

11. The nurse instructs the client on health maintenance activities to help control symptoms form her hiatal hernia. Which of the following statements would indicate that the client has understood the instruction? A. "I'll avoid lying down after meal." B. "I can still enjoy my potato chips and cola at bedtime." C. "I wish I didn't have to give up swimming." D. "If I wear a girdle, I'll have more support for my stomach."

11. Answer: A. The client with hiatal hernia should remain in an upright position after a meal. This is to prevent protrusion of the stomach into the chest cavity. Bedtime snacks may cause nighttime reflux. Swimming is allowed for the client Constricting clothing will increase intraabdominal pressure and will further cause protrusion of the stomach into the chest cavity.

12. Which of the following has been identified as a potential risk factor for the development of colon cancer? A. Chronic constipation B. Long-term use of laxatives - Sprun C. History of smoking D. History of inflammatory bowel disease

12. Answer: D. A common risk factor for the development of colon cancer is inflammatory bowel disorder like Crohn's disease.

13. The client with colon cancer has an abdomino perineal resection with a colostomy. Which of the following nursing interventions is most appropriate for this client in the postop period? A. Maintain the client in semi- Fowler's position. B. Assist the client with a warm bath C. Administer 30 ml. of milk of magnesia to stimulate colostomy activity. D. Remove the ostomy pouch as needed so the stoma can be assessed.

13. Answer: B. The client who had underdone abdomino-perineal resection (APR) will have a warm sitz bath after 24 hours postop. This improves circulation to the perineal area, thereby relieving pain and promoting healing.

14. The nurse evaluates the client's stoma during the initial postoperative period. Which of the following observations should be reported immediately to the physician? A. The stoma is slightly edematous. B. The stoma is dark red to purple C. The stoma oozes a small amount of blood. D. The stoma does not expel stool.

14. Answer: B. Dark red to purple discoloration of the stoma indicates impaired circulation and necrosis. This requires immediate reporting to the physician.

15. While changing the client's colostomy bag and dressing, the nurse assesses that the client is ready to participate on her care by noting which of the following? A. The client asks what time the doctor will visit that day. B. The client asks on the supplies used during the dressing change. C. The client talks about something she read in the morning newspaper. D. The client complains about the way the night nurse changed the dressing.

15. Answer: B. When the clients begins to show interest on the colostomy and colostomy care, this indicates readiness to learn and participate in his care.

16. When planning diet teaching for a client with a colostomy, the nurse would develop a plan that emphasizes which of the following dietary instruction? A. Foods containing roughage should not be eaten. B. Liquid is best limited to prevent diarrhea. C. Clients should experiment to find the diet that is best for them D. A high-fiber diet will produce a regular passage of stool.

16. Answer: C. Food tolerance varies among individuals. The client can experiment to find the diet that is best for him. Gas - forming and foul - odor foods are particularly avoided.

17. Which position would be ideal for a client in the early postoperative period after a hemorrhoidectomy? A. High Fowler's B. Supine C. Side lying D. Trendelenburg's

17. Answer: C. Side lying position prevents pressure in the anal area after hemorrhoidectomy.

18. The nurse teaches the client who has rectal surgery the proper timing for sitz baths. The nurse knows that the client has understood the teaching when the client states that it is most important to take a sitz bath A. First thing each morning B. As needed for discomfort C. After a bowel movement D. At bedtime

18. Answer: C. The best time to perform warm sitz bath after a rectal surgery is after a bowel movement. This ensures adequate cleansing of the area and prevents infection.

19. Which goal for the client's care should take priority during the first day of hospitalization for an exacerbation of ulcerative colitis? A. Promoting self-care and independence. B. Managing diarrhea C. Maintaining adequate nutrition. D. Promoting rest and comfort.

19. Answer: B. The primary problem of the client with ulcerative colitis is severe diarrhea. Therefore, managing diarrhea should take priority in his care.

2. The nurse is preparing to teach a client with peptic ulcer disease about the diet that should be followed after discharge. The nurse should explain that the diet will most likely consist of the following: A. Bland foods. B. High protein foods. C. Any foods that are tolerated. D. Large amounts of milk.

2. Answer: C. Food tolerance varies among individuals. The client with peptic ulcer disease may eat foods that he can tolerate if he is asymptomatic.

20. A client who has ulcerative colitis says to the nurse, "I can't take this anymore! I'm constantly in pain and I can't leave my room because! need to stay by the toilet. I don't know how to deal with this!" Based on these comments, an appropriate nursing diagnosis for the client would be: A. Impaired physical mobility related to fatigue B. Disturbed thought processes related to chronic fatigue. C. Social isolation related to chronic fatigue. D. Ineffective coping related to chronic abdominal pain.

20. Answer: D. Ineffective coping is evidenced by the client's inability to deal successfully with his present situation. And the client feels that he is no longer in control of himself and his situation.

21. A client who has ulcerative colitis has persistent diarrhea. He is thin and has lost 12 pounds since the exacerbation of his ulcerative colitis. The nurse should anticipate that the physician will order which of the following treatment approaches to help his nutritional needs? A. Initiate continuous enteral feeding B. Encourage a high-calorie, high protein diet. C. Implement total parenteral nutrition (TPN). D. Provide six small meals a day.

21. Answer: C Severe malnutrition as evidenced by excessive weight loss in a client with ulcerative colitis requires administration of TPN as prescribed.

22. A client with Crohn's disease experiences rectal bleeding with 15 to 20 watery stools per day. Which of the following signs would be indicative of dehydration? A. Sunken eyeballs. B. Decreased pulse rate C. Moist skin D. Pitting enema

22. Answer: A. Sunken eyeballs is indicative of dehydration. Other manifestations of dehydration are as follows: increased. pulse rate, dry and warm skin, oliguria, dark concentrated urine, increased respiratory rate, fever, increased specific gravity or urine, low BP.

23. Which of the following would be a priority focus of care for the client experiencing an exacerbation of Chron's disease? A. Encouraging regular ambulation. B. Promoting bowel rest. C. Maintaining current weight. D. Decreasing episodes of rectal bleeding.

23. Answer: B. In Crohn's disease, there is hyperactive bowel, causing diarrhea. Promoting bowel rest will relieve diarrhea and abdominal pain.

24. The physician orders intestinal decompression with a Cantor tube for the client. The primary purpose of a nasosoenteric tube such as Cantor tube is: A. To remove fluids and gas from intestines. B. To prevent fluid accumulation in the stomach. C. The break up the obstruction. D. To provide an alternate route for drug administration.

24. Answer: A. The primary purpose of naso-enteric tubes like Cantor tube is for decompression or drainage of fluids and gas from intestines.

25. After insertion of a naso-enteric tube, the nurse should place the client in which position? A. Supine B. Right side - lying C. Semi Fowler's D. Upright in a bedside chair.

25. Answer: B. Right side lying position allows passage of naso- enteric tube into the duodenum.

26. Which of the following nursing diagnosis would be most appropriate for a client with an intestinal obstruction? A. Impaired swallowing related to NPO status. B. Urinary retention related to deficient fluid volume. C. Deficient fluid volume related to nausea and vomiting. D. Chronic pain related to abdominal distention.

26. Answer: C. Intestinal obstruction causes reverse peristalsis. It is characterized by severe nausea and vomiting. This results to fluid- electrolyte imbalances.

27. A client who is scheduled for an ileostomy has an order for oral neomycin to be administered before surgery. The nurse understands that the rationale for administering oral neomycin before surgery is to: A. Prevent postoperative bladder infection. B. Reduce number of intestinal bacteria. C. Decrease the potential for postoperative pneumonia. D. Increase the body's immunologic response to the stressors surgery.

27. Answer: B. Neomycin sulfate is antibacterial. It is a drug of choice for colonic surgery because it is poorly absorbed in the G.I. tract and therefore, it enhances excretion of intestinal bacteria.

28. The nurse should instruct the client with an ileostomy which of the following symptoms immediately? A. Passage of liquid from stoma. B. Occasional presence of undigested food in the effluent. C. Absence of drainage format the ileostomy hours. D. Temperature of 99.8°F (37.7°C).

28. Answer: C. lleostomy normally expels watery stools continuously. Absence of drainage for 6 hours or more indicates obstruction. This needs to be reported immediately to the physician. To prevent severe fluid - electrolyte imbalances and infection.

29. The nurse evaluates the client's understanding for 6 or more of ileostomy care that the discharge 2 weeks." Which of the following statements indicates teaching has been effective? A. "I should be able to resume weight lifting in B. "I can return to work in 2 weeks." C. "I will need to drink 3000 ml. of fluids a day." D. "I will need to avoid getting my stoma wet while bathing."

29. Answer: C. Ample fluid intake is necessary for a patient with ileostomy. This ensures adequate evacuation of stools. Resuming weightlifting and returning to work in two weeks is too soon. The stoma may be cleaned with water during bathing.

3. A client is taking an antacid for treatment for peptic ulcer disease. Which of the following statements best indicates that the client understands how to correctly take the antacid? A. "I should take my antacid before I take my other medications." B. "I need to decrease my intake of fluids so that I don't dilute the effects of my antacid." C. "My antacid will be most effective if I take it whenever I experience stomach pains." D. "It is best for me to take my antacid 1 to 3 hours after meals."

3. Answer: D. Antacid is best taken 1 to 3 hours after meals. This is the time of the peak of gastric acid secretion.

30. The nurse discovers the client's TPN solution was running at an incorrect rate and is now 2 hours behind schedule. Which action is most appropriate for the nurse to take to correct the problem? A. Readjust the solution to infuse the desired amount. B. Continue the infusion at the desired amount. C. Double the infusion rate for 2 hours D. Notify the physician.

30. Answer: D. When TPN infusion is delayed, the nurse should notify the physician. The physician orders recalculation of the TPN. The nurse should not attempt to "catch up" with the infusion, without the physician's orders.

31. Which of the following should the nurse interpret as an indication of complication after the first few days of TPN therapy? A. Glucosuria B. A 1-to-2 lb. weight gain C. Decreased appetite D. Elevated temperature

31. Answer: D. The most common complication of TPN is infections, as manifested by elevated temperature. Infection usually occurs at the TPN catheter insertion site. Glucosuria, initially is expected because TPN solutions have high glucose content. Weight gain indicates the effectiveness of TPN.

32. Which of the following medications would the nurse anticipate administering to a client with diverticular disease? A. Psyllium hydrophilic mucilloid (Metamucil) B. Diphenoxylate with atropine sulfate (Lomotil) C. Diazepam (Valium) D. Aluminum hydroxide (Amphogel)

32. Answer: A. Metamucil is a bulk - forming laxative. It is the laxative of choice in diverticular disease. Because the primary cause of diverticular disease is the low bulk of the stool due to the low fiber diet.

33. A client who had an appendectomy for a returns from surgery with a drain inserted in the incisional site. The perforated appendix nurse understands that the purpose of the drain is to accomplish which of the following? A. Provide access for wound irrigation. B. Promote drainage of wound exudates. C. Minimize development of scar tissue. D. Decrease postoperative discomfort.

33. Answer: B. Wound drain, like Penrose drain promotes drainage of wound exudates from perforated appendicitis.

34. In a client with acute appendicitis, the nurse should anticipate which of the following treatment? A. Administration of enemas to cleanse the bowel. B. Insertion of a nasogastric tube. C. Placement of client on NPO status. D. Administration of heat to the abdomen.

34. Answer: C. A client with appendicitis is placed on NPO status to observe patterns of abdominal pain more accurately and in preparation for surgery. Enema, laxative and warm application over the abdomen should be avoided. These factors increase peristalsis and may cause rupture of appendicitis.

35. A client who has history of inguinal hernia is admitted to the hospital with complaints of a sudden, severe abdominal pain; vomiting; and abdominal distention. Based on these assessment finding, the nurse A. Peritonitis B. Incarcerated hernia C. Strangulated hernia D. Intestinal perforation

35. Answer: C. Strangulated hernia is characterized by sudden, severe abdominal pain, vomiting and abdominal distention. This requires immediate herniorrhaphy.

36. A client has just had an inguinal hemiorrhaphy. Which of the following nursing interventions would be appropriate for his care? A. Help the client to turn, cough, and deep breathe every 2 hours. B. Apply an ice bag to the scrotum. C. Apply a truss before the client ambulates. D. Maintain the client in high Fowler's position while in bed.

36. Answer B. After inguinal herniorrhaphy, prevent edema of the scrotum by applying an ice bag in the area, and elevating the scrotum with a rolled towel. Coughing is to be avoided postop because it can weaken the repair. Truss (scrotal support) is no longer indicated because the hernia is already repaired. High Fowler's position may cause edema of the scrotum.

4. A client has been diagnosed with adenocarcinoma of the stomach and is scheduled to undergo a subtotal gastrectomy (Billroth II procedure). During preop teaching, the nurse is reinforcing information about the surgical procedure. Which of the following explanations is most appropriate? A. The procedure will result in enlargement of sphincter. B. The procedure will result in anastomosis of the gastric stump to the jejunum. C. The procedure will result in removal of the duodenum. D. The procedure will result in repositioning of the vagus nerves.

4. Answer: B. Billroth II is gastrojejunostomy.

5. The client tells the nurse that since his diagnosis of stomach cancer, he has been having trouble sleeping and frequently preoccupied with thought about how his life will change. He says, "I wish my life could stay the same." Based on this information, which of the following habo nursing diagnoses would be appropriate at this time? A. Ineffective coping related to the diagnosis of cancer. B. Disturbed sleep pattern related to fear of the unknown C. Anticipatory grieving related to the diagnosis of cancer. D. Anxiety related to the need for gastric surgery.

5. Answer: C. Anticipatory grieving is grieving before actual loss occurs.

6. After a subtotal gastrectomy, care of the client's nasograstric tube and drainage system should include which of the following nursing interventions? A. Irrigate the tube with 30 ml. of sterile water every hour as needed. B. Reposition the tube if it is not draining well. C. Monitor the client for nausea, vomiting and abdominal distention.

6. Answer: C. Nausea, vomiting and abdominal distention indicate obstruction of NG tube. The NG tube should not be routinely irrigated. It should not be repositioned unnecessarily. It should not be connected to high suction. To prevent bleeding.

7. As a result of gastric resection, the client is at risk for development for dumping syndrome. The nurse would prepare a plan of care for this client based on knowledge that this problem stems primarily from which of the following gastrointestinal changes? A. Excess secretion of digestive enzymes in the intestines. B. Rapid emptying of stomach content into the small intestine. C. Excess glycogen production by the liver. D. Loss of gastric enzymes.

7. Answer: B. Dumping syndrome results from rapid emptying of hypertonic gastric content to the small intestine. This causes shock-like reaction.

8. The client is scheduled to have an upper gastrointestinal tract series. Which of the following treatments should the nurse anticipate after the examination? A. Administering a laxative. B. Placing the client on a clear liquid diet. C. Giving the client a tap water enema. D. Starting an intravenous infusion.

8. Answer: A. The contrast medium used in UGIS is barium sulfate, which may cause constipation. Laxative is given to evacuate barium sulfate and prevent constipation.

9. A client who has been diagnosed with gastroesophageal reflux disease Nale (GERD) complains of heartburns. To decrease the heartburns, the nurse should instruct the client to eliminate which of the following items from the diet? A. Lean beef B. Air-popped popcorn C. Hot chocolate D. Raw vegetables

9. Answer: C. Caffeine containing beverages like coffee, tea and chocolate lower LES (lower esophageal sphincter) pressure and will further cause gastroesophageal reflux.