GI practice questions pt 3 (Disorders and Therapeutic Management)

A patient with a 10-year history of alcoholism was admitted to the critical care unit with the diagnosis of acute pancreatitis. Based on the diagnosis, the patient a. is at risk for hypovolemic shock from plasma volume depletion. b. requires observation for hypoglycemia and hypercalcemia. c. should be started on enteral feedings after the nasogastric tube is placed. d. is placed on a fluid restriction to avoid the fluid sequestration.

ANS: A Because pancreatitis if often associated with massive fluid shifts, intravenous crystalloids and colloids are administered immediately to prevent hypovolemic shock and maintain hemodynamic stability. Electrolytes are monitored closely, and abnormalities such as hypocalcemia, hypokalemia, and hypomagnesemia are corrected. If hyperglycemia develops, exogenous insulin may be required.

Esophagogastric varices are the result of a. portal hypertension resulting in diversion of blood from a high-pressure area to a low-pressure area. b. superficial mucosal erosions as a result of increased stress levels. c. proulcer forces breaking down the mucosal resistance. d. inflammation and ulceration secondary to nonsteroidal anti-inflammatory drug use.

ANS: A Esophagogastric varices are engorged and distended blood vessels of the esophagus and proximal stomach that develop as a result of portal hypertension secondary to hepatic cirrhosis, a chronic disease of the liver that results in damage to the liver sinusoids. Without adequate sinusoid function, resistance to portal blood flow is increased, and pressures within the liver are elevated. This leads to a rise in portal venous pressure (portal hypertension), causing collateral circulation to divert portal blood from areas of high pressure within the liver to adjacent areas of low pressure outside the liver, such as into the veins of the esophagus, spleen, intestines, and stomach.

Which of the following nursing interventions after GI surgery would have the highest priority of care? a. Oxygenation b. Pain management c. Circulation d. Preventing infection

ANS: A Nursing interventions in the postoperative period are focused first on promoting ventilation, adequate oxygenation, and preventing complications such as atelectasis and pneumonia. Adequate analgesia is necessary to promote the mobility of the patient and decrease pulmonary complications. Early ambulation is encouraged to reduce the risk of pulmonary embolus. Infection prevention with hand hygiene and antibiotics is important as well.

Which of the following is a potential cause for acute liver failure? (Select all that apply.) a. Ischemia b. Hepatitis A, B, C, D, E, non-A, non-B, non-C c. Acetaminophen toxicity d. Wilson disease e. Reye syndrome f. Diabetes

ANS: A, B, C, D, E Diabetes is not a primary cause of acute liver failure but is associated with pancreatitis.

Which of the following are clinical manifestations of pancreatitis? (Select all that apply.) a. Epigastric and abdominal pain b. Nausea and vomiting c. Diaphoresis d. Jaundice e. Hyperactive bowel sounds f. Fever

ANS: A, B, D, F Clinical manifestations of acute pancreatitis include pain, vomiting, nausea, fever, abdominal distention, abdominal guarding, abdominal tympany, hypoactive or absent bowel sounds, severe disease, peritoneal signs, ascites, jaundice, palpable abdominal mass, Grey-Turner sign, Cullen sign, and signs of hypovolemic shock. There may be peritonitis involved with pancreatitis and percussion will reveal a tympanic abdomen; bowel sounds will be decreased or absent.

A patient with a 10-year history of alcoholism was admitted to the critical care unit with the diagnosis of acute pancreatitis. The patient is preparing for discharge. Nursing intervention should include a. diabetes management. b. alcohol cessation program. c. frequency of hemoccult testing. d. frequency of PT and PTT testing.

ANS: B As the patient moves toward discharge, teaching should focus on the interventions necessary for preventing the recurrence of the precipitating disorder. If an alcohol abuser, the patient should be encouraged to stop drinking and be referred to an alcohol cessation program.

Esophagectomy is usually performed for a. cancer of the proximal esophagus and gastroesophageal junction. b. cancer of the distal esopha gus and gastroesophageal junction. c. cancer of the pancreatic head. d. varices of the distal esophagus and gastroesophageal junction.

ANS: B Esophagectomy is usually performed for cancer of the distal esophagus and gastroesophageal junction.

Which classification of medication is used to reduce volume and concentration of gastric secretions? a. Antacids b. Histamine2 (H2) antagonists c. Gastric mucosal agents d. Gastric proton pump inhibitors

ANS: B Histamine2 (H2) antagonists are used to reduce volume and concentration of gastric secretions. Antacids are used to buffer stomach acid and raise gastric ph. Gastric mucosal agents forms an ulcer-adherent complex with proteinaceous exudate. It covers the ulcer and protects against acid, pepsin, and bile salts. Gastric proton pump inhibitors inactivate acid or hydrogen acid pump, blocking secretion of hydrochloric acid by gastric parietal cells.

A patient with a 10-year history of alcoholism was admitted to the critical care unit with the diagnosis of acute pancreatitis. The patient is complaining of a pain in left upper quadrant. Using a 1- to 10-point pain scale, the patient states the current level is at an 8. To properly manage the patient's pain, the priority of nursing interventions is to a. administer antiemetics around the clock. b. administer analgesics around the clock. c. educate the patient and family on lifestyle changes. d. teach relaxation techniques.

ANS: B Pain management is a major priority in acute pancreatitis. Administration of around-the-clock analgesics to achieve pain relief is essential. Morphine, fentanyl, and hydromorphone are the commonly used narcotics for pain control. Relaxation techniques and the knee-chest position can also assist in pain control.

Which of the following disorders is the leading cause of upper GI hemorrhage? a. Stress ulcers b. Peptic ulcers c. Nonspecific erosive gastritis d. Esophageal varices

ANS: B Peptic ulcer disease (gastric and duodenal ulcers), resulting from the breakdown of the gastromucosal lining, is the leading cause of upper GI hemorrhage, accounting for approximately 21% of cases.

A patient is admitted with the diagnosis of acute pancreatitis. The nurse expects which of the following laboratory test results to be elevated? (Select all that apply.) a. Calcium b. Serum amylase c. Serum glucose d. Potassium e. WBC f. Serum triglycerides

ANS: B, C, E, F Calcium and potassium decrease with acute pancreatitis.

Which of the following interventions would you expect in the management of hepatic failure? (Select all that apply.) a. Benzodiazepines for agitation b. Pulse oximetry and serial arterial blood gas measurements c. Insulin drip for hyperglycemia and hyperkalemia d. Monitor electrolyte blood levels e. Assess for signs of cerebral edema

ANS: B, D, E The patient may experience a variety of other complications, including cerebral edema, cardiac dysrhythmias, acute respiratory failure, sepsis, and acute kidney injury. Cerebral edema and increased intracranial pressure develop as a result of breakdown of the blood-brain barrier and astrocyte swelling. Circulatory failure that mimics sepsis is common in acute liver failure and may exacerbate low cerebral perfusion pressure. Hypoxemia, acidosis, electrolyte imbalances, and cerebral edema can precipitate the development of cardiac dysrhythmias. Acute respiratory failure, progressing to acute respiratory distress syndrome, intrapulmonary shunting, ventilation-perfusion mismatch, sepsis, and aspiration may be attributed to the universal arterial hypoxemia.

The physician orders gastric lavage to control GI bleeding. The nurse has inserted a large-bore NG tube. What temperature and irrigating fluid would be used to obtain the best results? a. Warm NS or water b. Iced NS or water c. Room temperature NS or water d. Iced NS only

ANS: C Historically, iced saline was favored as a lavage irrigant. Research has shown, however, that low-temperature fluids shift the oxyhemoglobin dissociation curve to the left, decrease oxygen delivery to vital organs, and prolong bleeding time and prothrombin time. Iced saline also may further aggravate bleeding; therefore, room temperature water or saline is the preferred irrigant for use in gastric lavage.

A patient with a 10-year history of alcoholism was admitted to the critical care unit with the diagnosis of acute pancreatitis. The physiologic alteration that occurs in acute pancreatitis is a. uncontrolled hypoglycemia caused by an increased release of insulin. b. loss of storage capacity for senescent red blood cells. c. premature activation of inactive digestive enzymes, resulting in autodigestion. d. release of glycogen into the serum, resulting in hyperglycemia.

ANS: C In acute pancreatitis, the normally inactive digestive enzymes become prematurely activated within the pancreas itself, creating the central pathophysiologic mechanism of acute pancreatitis, namely autodigestion.

Which of the following medications is/are given to help control ammonia levels in a patient with acute liver failure (ALF)? a. Insulin b. Vitamin K c. Lactulose d. Benzodiazepines

ANS: C Lactulose, a synthetic Ketoanalogue of lactose split into lactic acid and acetic acid in the intestine, is given orally through a nasogastric tube or as a retention enema. The result is the creation of an acidic environment that results in ammonia being drawn out of the portal circulation. Lactulose has a laxative effect that promotes expulsion. Vitamin K is used to help control bleeding. Insulin would be given to control hyperglycemia. Use of benzodiazepines and other sedatives is discouraged in a patient with ALF because pertinent neurologic changes may be masked, and hepatic encephalopathy may be exacerbated.

Verification of feeding tube placement includes a. auscultation for position. b. aspiration of stomach contents. c. x-ray study for confirmation. d. gastric pH measurement.

ANS: C The traditional practice of confirming placement by auscultating air inserted through the tube over the epigastrium is not reliable and is not recommended. Aspiration of stomach contents and gastric pH measurement are also not recommended. If there is any doubt as to the tube's position, a repeat radiograph should be obtained.

A nursing priority for a patient with GI hemorrhage is a. positioning the patient in a high-Fowler position. b. airway protection. c. irrigating the nasogastric tube with iced saline. d. maintaining venous access so that fluids and blood can be administered.

ANS: D Priorities in the medical management of a patient with gastrointestinal hemorrhage include airway protection, fluid resuscitation to achieve hemodynamic stability, correction of co-morbid conditions (e.g., coagulopathy), therapeutic procedures to control or stop bleeding, and diagnostic procedures to determine the exact cause of the bleeding.

The patient at risk for GI hemorrhage should be monitored for which of the following signs and symptoms? a. Metabolic acidosis and hypovolemia b. Decreasing hemoglobin and hematocrit c. Hyperkalemia and hypernatremia d. Hematemesis and melena

ANS: D The initial clinical presentation of the patient with acute gastrointestinal (GI) hemorrhage is that of a patient in hypovolemic shock; the clinical presentation depends on the amount of blood lost. Hematemesis (bright red or brown, coffee grounds emesis), hematochezia (bright red stools), and melena (black, tarry, or dark red stools) are the hallmarks of GI hemorrhage.