Gastrointestinal

The nurse provides medication instructions to a client with peptic ulcer disease. Which statement, if made by the client, indicates the best understanding of the medication therapy? A "The cimetidine (Tagamet) will cause me to produce less stomach acid." B "Sucralfate (Carafate) will change the fluid in my stomach." C "Antacids will coat my stomach." D "Omeprazole (Prilosec) will coat the ulcer and help it heal."

A "The cimetidine (Tagamet) will cause me to produce less stomach acid."

Fistulas are most common with which of the following bowel disorders? A Crohn's disease B Diverticulitis C Diverticulosis D Ulcerative colitis

A Crohn's disease The lesions of Crohn's disease are transmural; that is, they involve all thickness of the bowel. These lesions may perforate the bowel wall, forming fistulas with adjacent structures. Fistulas don't develop in diverticulitis or diverticulosis. The ulcers that occur in the submucosal and mucosal layers of the intestine in ulcerative colitis usually don't progress to fistula formation as in Crohn's disease.

Which diagnostic test would be used first to evaluate a client with upper GI bleeding? A Endoscopy B Upper GI series C Hemoglobin (Hb) levels and hematocrit (HCT) D Arteriography

A Endoscopy

Select ALL of the following that are complications associated with Crohn's Disease: A. Cobble-stone appearance of GI lining B. Lead-pipe sign C. Toxic megacolon D. Fistula E. Abscess F. Anal Fissure

A. Cobble-stone appearance of GI lining D. Fistula E. Abscess F. Anal Fissure

While caring for a client with peptic ulcer disease, the client reports that he has been nauseated most of the day and is now feeling lightheaded and dizzy. Based upon these findings, which nursing actions would be most appropriate for the nurse to take? Select all that apply. A Administering an antacid hourly until nausea subsides. B Monitoring the client's vital signs C Notifying the physician of the client's symptoms D Initiating oxygen therapy E Reassessing the client In an hour

B Monitoring the client's vital signs C Notifying the physician of the client's symptoms The symptoms of nausea and dizziness in a client with peptic ulcer disease may be indicative of hemorrhage and should not be ignored. The appropriate nursing actions at this time are for the nurse to monitor the client's vital signs and notify the physician of the client's symptoms. To administer an antacid hourly or to wait one hour to reassess the client would be inappropriate; prompt intervention is essential in a client who is potentially experiencing a gastrointestinal hemorrhage. The nurse would notify the physician of assessment findings and then initiate oxygen therapy if ordered by the physician.

The nurse is caring for a client who has had a gastroscopy. Which of the following symptoms may indicate that the client is developing a complication related to the procedure? Select all that apply. A The client complains of a sore throat B The client has a temperature of 100*F C The client appears drowsy following the procedure D The client complains of epigastric pain E The client experiences hematemesis

B The client has a temperature of 100*F D The client complains of epigastric pain E The client experiences hematemesis

A patient is prescribed antacids to decrease gastrointestinal discomfort. Nursing instructions associated with this prescription should include: A)Administer this drug with other drugs or food B)Administer the antacid 1 hour before or 2 hours after other oral medications C)Limit fluid intake to decrease fluid retention D)Swallow the antacid whole and do not crush or chew the tablet

B)Administer the antacid 1 hour before or 2 hours after other oral medications

When a client has peptic ulcer disease, the nurse would expect a priority intervention to be: A Assisting in inserting a Miller-Abbott tube B Assisting in inserting an arterial pressure line C Inserting a nasogastric tube D Inserting an I.V

C Inserting a nasogastric tube NG tube will detect presence of bleeding

When obtaining a nursing history on a client with a suspected gastric ulcer, which signs and symptoms would the nurse expect to see? Select all that apply. A Epigastric pain at night B Relief of epigastric pain after eating C Vomiting D Weight loss

C Vomiting D Weight loss Vomiting and weight loss are common with gastric ulcers. Clients with a gastric ulcer are most likely to complain of a burning epigastric pain that occurs about one hour after eating. Eating frequently aggravates the pain. Clients with duodenal ulcers are more likely to complain about pain that occurs during the night and is frequently relieved by eating.

Which of the following groups of drugs used to treat peptic ulcers suppress the secretion of hydrochloric acid into the lumen of the stomach? A)Antipeptic agents B)Histamine-2 (H2) antagonists C)Proton pump inhibitors D)Prostaglandins

C)Proton pump inhibitors

The nurse is developing a teaching plan for a patient who is going to need pancreatic enzyme replacement. It will be important to teach the patient which of the following? A)To take the enzymes on an empty stomach B)To crush the capsules and take with food C)To avoid spilling the powder on the skin because it may be irritating D)That pancreatin and pancrelipase are interchangeable

C)To avoid spilling the powder on the skin because it may be irritating

The client with GERD complains of a chronic cough. The nurse understands that in a client with GERD this symptom may be indicative of which of the following conditions? A Development of laryngeal cancer B Irritation of the esophagus C Esophageal scar tissue formation D Aspiration of gastric contents

D Aspiration of gastric contents Clients with GERD can develop pulmonary symptoms such as coughing, wheezing, and dyspnea that are caused by the aspiration of gastric contents. GERD does not predispose the client to the development of laryngeal cancer. Irritation of the esophagus and esophageal scar tissue formation can develop as a result of GERD. However, GERD is more likely to cause painful and difficult swallowing.

Crohn's disease can be described as a chronic relapsing disease. Which of the following areas in the GI system may be involved with this disease? A The entire length of the large colon B Only the sigmoid area C The entire large colon through the layers of mucosa and submucosa D The small intestine and colon; affecting the entire thickness of the bowel

D The small intestine and colon; affecting the entire thickness of the bowel

A patient is awaiting surgery for acute peritonitis. Which action will the nurse include in the plan of care? a.Position patient with the knees flexed. b.Avoid use of opioids or sedative drugs. c.Offer frequent small sips of clear liquids. d.Assist patient to breathe deeply and cough.

a. Position patient with the knees flexed.

The nurse is assessing a patient with abdominal pain. The nurse, who notes that there is ecchymosis around the area of umbilicus, will document this finding as a.Cullen sign. c.McBurney sign. b.Rovsing sign. d.Grey-Turner's sign.

a.Cullen sign.

The nurse is aware that which factors are related to the development of gastroesophageal reflux disease (GERD)? (Select all that apply.) a.Delayed gastric emptying b.Eating large meals c.Hiatal hernia d.Obesity e.Viral infections

a.Delayed gastric emptying b.Eating large meals c.Hiatal hernia d.Obesity Many factors predispose a person to GERD, including delayed gastric emptying, eating large meals, hiatal hernia, and obesity. Viral infections are not implicated in the development of GERD, although infection with Helicobacter pylori is.

A nurse assesses a client with peritonitis. Which clinical manifestations should the nurse expect to find? (Select all that apply.) a.Distended abdomen b.Inability to pass flatus c.Bradycardia d.Hyperactive bowel sounds e.Decreased urine output

a.Distended abdomen b.Inability to pass flatus e.Decreased urine output A client with peritonitis may present with a distended abdomen, diminished bowel sounds, inability to pass flatus or feces, tachycardia, and decreased urine output secondary to dehydration. Bradycardia and hyperactive bowel sounds are not associated with peritonitis.

A patient complains of gas pains and abdominal distention 2 days after a small bowel resection. Which nursing action should the nurse take? a.Encourage the patient to ambulate. b.Instill a mineral oil retention enema. c.Administer the prescribed IV morphine sulfate. d.Offer the prescribed promethazine (Phenergan).

a.Encourage the patient to ambulate. Ambulation will improve peristalsis and help the patient eliminate flatus and reduce gas pain. A mineral oil retention enema is helpful for constipation with hard stool. A return-flow enema might be used to relieve persistent gas pains. Morphine will further reduce peristalsis. Promethazine is used as an antiemetic rather than to decrease gas pains or distention.

To promote comfort after a colonoscopy, in what position does the nurse place the client? a.Left lateral b.Prone c.Right lateral d.Supine

a.Left lateral

Which menu choice by the patient with diverticulosis is best for preventing diverticulitis? a.Navy bean soup and vegetable salad b.Whole grain pasta with tomato sauce c.Baked potato with low-fat sour cream d.Roast beef sandwich on whole wheat bread

a.Navy bean soup and vegetable salad

A nurse assesses a client who has appendicitis. Which clinical manifestation should the nurse expect to find? a.Severe, steady right lower quadrant pain b.Abdominal pain associated with nausea and vomiting c.Marked peristalsis and hyperactive bowel sounds d.Abdominal pain that increases with knee flexion

a.Severe, steady right lower quadrant pain

The nurse admitting a patient with acute diverticulitis explains that the initial plan of care is to a.administer IV fluids. b.prepare for colonoscopy. c.give stool softeners and enemas. d.order a diet high in fiber and fluids.

a.administer IV fluids. A patient with acute diverticulitis will be NPO and given parenteral fluids. A diet high in fiber and fluids will be implemented before discharge. Bulk-forming laxatives, rather than stool softeners, are usually given, and these will be implemented later in the hospitalization. The patient with acute diverticulitis will not have enemas or a colonoscopy because of the risk for perforation and peritonitis.

A patient who underwent a gastroduodenostomy (Billroth I) 12 hours ago complains of increasing abdominal pain. The patient has no bowel sounds and 200 mL of bright red nasogastric (NG) drainage in the past hour. The highest priority action by the nurse is to a.contact the surgeon. b.irrigate the NG tube. c.monitor the NG drainage. d.administer the prescribed morphine.

a.contact the surgeon.

A patient being admitted with an acute exacerbation of ulcerative colitis reports crampy abdominal pain and passing 15 or more bloody stools a day. The nurse will plan to a.administer IV metoclopramide (Reglan). b.discontinue the patient's oral food intake. c.administer cobalamin (vitamin B12) injections. d.teach the patient about total colectomy surgery.

b. discontinue the patient's oral food intake. An initial therapy for an acute exacerbation of inflammatory bowel disease (IBD) is to rest the bowel by making the patient NPO. Metoclopramide increases peristalsis and will worsen symptoms. Cobalamin (vitamin B12) is absorbed in the ileum, which is not affected by ulcerative colitis. Although total colectomy is needed for some patients, there is no indication that this patient is a candidate.

The nurse determines that teaching regarding cobalamin injections has been effective when the patient with chronic atrophic gastritis states a."The cobalamin injections will prevent gastric inflammation." b."The cobalamin injections will prevent me from becoming anemic." c."These injections will increase the hydrochloric acid in my stomach." d."These injections will decrease my risk for developing stomach cancer."

b."The cobalamin injections will prevent me from becoming anemic." Cobalamin supplementation prevents the development of pernicious anemia. Chronic gastritis may cause achlorhydria, but cobalamin does not correct this. The loss of intrinsic factor secretion with chronic gastritis is permanent, and the patient will need lifelong supplementation with cobalamin. The incidence of stomach cancer is higher in patients with chronic gastritis, but cobalamin does not reduce the risk for stomach cancer.

Which information will the nurse include when teaching a patient how to avoid chronic constipation (select all that apply)? a.Stimulant and saline laxatives can be used regularly. b.Bulk-forming laxatives are an excellent source of fiber. c.Walking or cycling frequently will help bowel motility. d.A good time for a bowel movement may be after breakfast. e.Some over-the-counter (OTC) medications cause constipation.

b.Bulk-forming laxatives are an excellent source of fiber. c.Walking or cycling frequently will help bowel motility. d.A good time for a bowel movement may be after breakfast. e.Some over-the-counter (OTC) medications cause constipation. Stimulant and saline laxatives should be used infrequently. Use of bulk-forming laxatives, regular early morning timing of defecation, regular exercise, and avoiding many OTC medications will help the patient avoid constipation.

A patient admitted with a peptic ulcer has a nasogastric (NG) tube in place. When the patient develops sudden, severe upper abdominal pain, diaphoresis, and a firm abdomen, which action should the nurse take? a.Irrigate the NG tube. c.Give the ordered antacid. b.Check the vital signs. d.Elevate the foot of the bed.

b.Check the vital signs. The patient's symptoms suggest acute perforation, and the nurse should assess for signs of hypovolemic shock. Irrigation of the NG tube, administration of antacids, or both would be contraindicated because any material in the stomach will increase the spillage into the peritoneal cavity. Elevating the foot of the bed may increase abdominal pressure and discomfort, as well as making it more difficult for the patient to breathe.

A patient in the emergency department has just been diagnosed with peritonitis caused by a ruptured diverticulum. Which prescribed intervention will the nurse implement first? a.Insert a urinary catheter to drainage. b.Infuse metronidazole (Flagyl) 500 mg IV. c.Send the patient for a computerized tomography scan. d.Place a nasogastric (NG) tube to intermittent low suction.

b.Infuse metronidazole (Flagyl) 500 mg IV. Because peritonitis can be fatal if treatment is delayed, the initial action should be to start antibiotic therapy (after any ordered cultures are obtained). The other actions can be done after antibiotic therapy is initiated.

A 58-yr-old patient with blunt abdominal trauma from a motor vehicle crash undergoes peritoneal lavage. If the lavage returns brown fecal drainage, which action will the nurse plan to take next? a.Auscultate the bowel sounds. b.Prepare the patient for surgery. c.Check the patient's oral temperature. d.Obtain information about the accident.

b.Prepare the patient for surgery. Return of brown drainage and fecal material suggests perforation of the bowel and the need for immediate surgery. Auscultation of bowel sounds, checking the temperature, and obtaining information about the accident are appropriate actions, but the priority is to prepare to send the patient for emergency surgery.

A young adult patient is hospitalized with massive abdominal trauma from a motor vehicle crash. The patient asks the nurse about the purpose of receiving famotidine (Pepcid). The nurse will explain that the medication will a.decrease nausea and vomiting. b.inhibit development of stress ulcers. c.lower the risk for H. pylori infection. d.prevent aspiration of gastric contents.

b.inhibit development of stress ulcers. Famotidine is administered to prevent the development of physiologic stress ulcers, which are associated with a major physiologic insult such as massive trauma. Famotidine does not decrease nausea or vomiting, prevent aspiration, or prevent Helicobacter pylori infection.

An older patient with a bleeding duodenal ulcer has a nasogastric (NG) tube in place. The health care provider prescribes 30 mL of aluminum hydroxide/magnesium hydroxide (Maalox) to be instilled through the tube every hour. To evaluate the effectiveness of this treatment, the nurse a.monitors arterial blood gas values daily. b.periodically aspirates and tests gastric pH. c.checks each stool for the presence of occult blood. d.measures the volume of residual stomach contents.

b.periodically aspirates and tests gastric pH.

The nurse has been directed to position a patient for an examination of the abdomen. She knows to place the patient in the: a. prone position with pillows positioned to alleviate pressure on the abdomen. b. semi-Fowler's position with the left leg bent to minimize pressure on the abdomen. c. supine position with the knees flexed to relax the abdominal muscles. d. reverse Trendelenburg position to facilitate the natural propulsion of intestinal contents.

c. supine position with the knees flexed to relax the abdominal muscles.

On examination of a patient's stool, the nurse suspects the presence of an upper gastrointestinal bleed when she observes a stool that is: a. clay-colored. b. greasy and foamy. c. tarry and black. d. threaded with mucus.

c. tarry and black.

A patient who has gastroesophageal reflux disease (GERD) is experiencing increasing discomfort. Which patient statement to the nurse indicates that additional teaching about GERD is needed? a."I take antacids between meals and at bedtime each night." b."I sleep with the head of the bed elevated on 4-inch blocks." c."I eat small meals during the day and have a bedtime snack." d."I quit smoking several years ago, but I still chew a lot of gum."

c."I eat small meals during the day and have a bedtime snack." No bedtime snacks for GERD!

Which patient should the nurse assess first after receiving change-of-shift report? a.A patient with nausea who has a dose of metoclopramide (Reglan) due b.A patient who is crying after receiving a diagnosis of esophageal cancer c.A patient with esophageal varices who has a blood pressure of 92/58 mm Hg d.A patient admitted yesterday with gastrointestinal (GI) bleeding who has melena

c.A patient with esophageal varices who has a blood pressure of 92/58 mm Hg

A 71-yr-old patient had an abdominal-perineal resection for colon cancer. Which nursing action is most important to include in the plan of care for the day after surgery? a.Teach about a low-residue diet. b.Monitor output from the stoma. c.Assess the perineal drainage and incision. d.Encourage acceptance of the colostomy stoma.

c.Assess the perineal drainage and incision. Because the perineal wound is at high risk for infection, the initial care is focused on assessment and care of this wound. Teaching about diet is best done closer to discharge from the hospital. There will be very little drainage into the colostomy until peristalsis returns. The patient will be encouraged to assist with the colostomy, but this is not the highest priority in the immediate postoperative period.

A nurse assesses a client who has ulcerative colitis and severe diarrhea. Which assessment should the nurse complete first? a.Inspection of oral mucosa b.Recent dietary intake c.Heart rate and rhythm d.Percussion of abdomen

c.Heart rate and rhythm Although the client with severe diarrhea may experience skin irritation and hypovolemia, the client is most at risk for cardiac dysrhythmias secondary to potassium and magnesium loss from severe diarrhea. The client should have her or his electrolyte levels monitored, and electrolyte replacement may be necessary. Oral mucosa inspection, recent dietary intake, and abdominal percussion are important parts of physical assessment but are lower priority for this client than heart rate and rhythm.

A nurse assesses a client who is hospitalized with an exacerbation of Crohn's disease. Which clinical manifestation should the nurse expect to find? a.Positive Murphy's sign with rebound tenderness to palpitation b.Dull, hypoactive bowel sounds in the lower abdominal quadrants c.High-pitched, rushing bowel sounds in the right lower quadrant d.Reports of abdominal cramping that is worse at night

c.High-pitched, rushing bowel sounds in the right lower quadrant The nurse expects high-pitched, rushing bowel sounds due to narrowing of the bowel lumen in Crohn's disease. A positive Murphy's sign is indicative of gallbladder disease, and rebound tenderness often indicates peritonitis. Dullness in the lower abdominal quadrants and hypoactive bowel sounds are not commonly found with Crohn's disease. Nightly worsening of abdominal cramping is not consistent with Crohn's disease.

A client had a colonoscopy and biopsy yesterday and calls the gastrointestinal clinic to report a spot of bright red blood on the toilet paper today. What response by the nurse is best? a.Ask the client to call back if this happens again today. b.Instruct the client to go to the emergency department. c.Remind the client that a small amount of bleeding is possible. d.Tell the client to come in to the clinic this afternoon.

c.Remind the client that a small amount of bleeding is possible.

A young adult patient is admitted to the hospital for evaluation of right lower quadrant abdominal pain with nausea and vomiting. Which action should the nurse take? a.Assist the patient to cough and deep breathe. b.Palpate the abdomen for rebound tenderness. c.Suggest the patient lie on the side, flexing the right leg. d.Encourage the patient to sip clear, noncarbonated liquids.

c.Suggest the patient lie on the side, flexing the right leg. The patient's clinical manifestations are consistent with appendicitis. Lying still with the right leg flexed is often the most comfortable position. Checking for rebound tenderness frequently is unnecessary and uncomfortable for the patient. The patient should be NPO in case immediate surgery is needed. The patient will need to know how to cough and deep breathe postoperatively, but coughing will increase pain at this time.

A patient has just arrived in the recovery area after an upper endoscopy. Which information collected by the nurse is most important to communicate to the health care provider? a. The patient is very drowsy. b.The patient reports a sore throat. c.The oral temperature is 101.4°F. d.The apical pulse is 100 beats/minute.

c.The oral temperature is 101.4°F. A temperature elevation may indicate that an acute perforation has occurred. The other assessment data are normal immediately after the procedure.

A patient with diverticulosis has a large bowel obstruction. The nurse will monitor for a.referred back pain. c.projectile vomiting. b.metabolic alkalosis. d.abdominal distention.

d. abdominal distention. Abdominal distention is seen in lower intestinal obstruction. Referred back pain is not a common clinical manifestation of intestinal obstruction. Metabolic alkalosis is common in high intestinal obstruction because of the loss of HCl acid from vomiting. Projectile vomiting is associated with higher intestinal obstruction.

A patient vomiting blood-streaked fluid is admitted to the hospital with acute gastritis. To determine possible risk factors for gastritis, the nurse will ask the patient about a. the amount of saturated fat in the diet. b. a family history of gastric or colon cancer. c. a history of a large recent weight gain or loss. d. use of nonsteroidal antiinflammatory drugs (NSAIDs).

d. use of nonsteroidal antiinflammatory drugs (NSAIDs). Use of an NSAID is associated with damage to the gastric mucosa, which can result in acute gastritis. Family history, recent weight gain or loss, and fatty foods are not risk factors for acute gastritis.

After hiatal hernia repair surgery, a client is on IV pantoprazole (Protonix). The client asks the nurse why this medication is given since there is no history of ulcers. What response by the nurse is best? a."Bacteria can often cause ulcers." b."This operation often causes ulcers." c."The medication keeps your blood pH low." d."It prevents stress-related ulcers."

d."It prevents stress-related ulcers."

Which patient should the nurse assess first after receiving change-of-shift report? a.A 60-yr-old patient whose new ileostomy has drained 800 mL over the previous 8 hours b.A 50-yr-old patient with familial adenomatous polyposis who has occult blood in the stool c.A 40-yr-old patient with ulcerative colitis who has had six liquid stools in the previous 4 hours d.A 30-yr-old patient who has abdominal distention and an apical heart rate of 136 beats/minute

d.A 30-yr-old patient who has abdominal distention and an apical heart rate of 136 beats/minute

A nurse assesses a client with a mechanical bowel obstruction who reports intermittent abdominal pain. An hour later the client reports constant abdominal pain. Which action should the nurse take next? a.Administer intravenous opioid medications. b.Position the client with knees to chest. c.Insert a nasogastric tube for decompression. d.Assess the client's bowel sounds.

d.Assess the client's bowel sounds. A change in the nature and timing of abdominal pain in a client with a bowel obstruction can signal peritonitis or perforation. The nurse should immediately check for rebound tenderness and the absence of bowel sounds. The nurse should not medicate the client until the provider has been notified of the change in his or her condition. The nurse may help the client to the knee-chest position for comfort, but this is not the priority action. The nurse need not insert a nasogastric tube for decompression.

After teaching a client with diverticular disease, a nurse assesses the client's understanding. Which menu selection made by the client indicates the client correctly understood the teaching? a.Roasted chicken with rice pilaf and a cup of coffee with cream b.Spaghetti with meat sauce, a fresh fruit cup, and hot tea c.Garden salad with a cup of bean soup and a glass of low-fat milk d.Baked fish with steamed carrots and a glass of apple juice

d.Baked fish with steamed carrots and a glass of apple juice Clients who have diverticular disease are prescribed a low-residue diet. Whole grains (rice pilaf), uncooked fruits and vegetables (salad, fresh fruit cup), and high-fiber foods (cup of bean soup) should be avoided with a low-residue diet. Canned or cooked vegetables are appropriate. Apple juice does not contain fiber and is acceptable for a low-residue diet.

Which assessment should the nurse perform first for a patient who just vomited bright red blood? a.Measuring the quantity of emesis b.Palpating the abdomen for distention c.Auscultating the chest for breath sounds d.Taking the blood pressure (BP) and pulse

d.Taking the blood pressure (BP) and pulse

The nurse will plan to teach a patient with Crohn's disease who has megaloblastic anemia about the need for a.iron dextran infusions b.oral ferrous sulfate tablets. c.routine blood transfusions. d.cobalamin (B12) supplements.

d.cobalamin (B12) supplements.

The nurse explaining esomeprazole (Nexium) to a patient with recurring heartburn describes that the medication a.reduces gastroesophageal reflux by increasing the rate of gastric emptying. b.neutralizes stomach acid and provides relief of symptoms in a few minutes. c.coats and protects the lining of the stomach and esophagus from gastric acid. d.treats gastroesophageal reflux disease by decreasing stomach acid production.

d.treats gastroesophageal reflux disease by decreasing stomach acid production.