Lower GI

A client is recovering from an ileostomy that was performed to treat inflammatory bowel disease. During discharge teaching, the nurse should stress the importance of:

Because stool forms in the large intestine, an ileostomy typically drains liquid waste. To avoid fluid loss through ileostomy drainage, the nurse should instruct the client to increase fluid intake. The nurse should teach the client to wear a collection appliance at all times because ileostomy drainage is incontinent, to avoid high-fiber foods because they may irritate the intestines, and to avoid enteric-coated medications because the body can't absorb them after an ileostomy.

A physician suspects that a client has peptic ulcer disease. With which of the following diagnostic procedures would the nurse most likely prepare to assist?

Endoscopy

The nurse includes that chronic gastritis caused by Helicobacter pylori is implicated in which disease/condition?

Peptic ulcers

A patient is in the hospital for the treatment of peptic ulcer disease. The nurse finds the patient vomiting and complaining of a sudden severe pain in the abdomen. The nurse then assesses a board-like abdomen. What does the nurse suspect these symptoms indicate?

Perforation of the peptic ulcer

The nurse is creating a discharge plan of care for a client with a peptic ulcer. The nurse tells the client to avoid

decaffeinated coffee.

Acute gastritis is often caused by

dietary indiscretion—the person eats food that is irritating, too highly seasoned, or contaminated with disease-causing microorganisms. Other causes of acute gastritis include overuse of aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), excessive alcohol intake, bile reflux, and radiation therapy. A more severe form of acute gastritis is caused by the ingestion of strong acid or alkali, which may cause the mucosa to become gangrenous or to perforate.

Diet therapy for clients diagnosed with irritable bowel syndrome (IBS) includes:

high-fiber diet.

Dumping syndrome

is an unpleasant set of vasomotor and GI symptoms that occur in up to 76% of patients who have had bariatric surgery. Early symptoms include a sensation of fullness, weakness, faintness, dizziness, palpitations, diaphoresis, cramping pains, and diarrhea. These symptoms resolve once the intestine has been evacuated

A resident at a long-term care facility lost the ability to swallow following a stroke 4 years ago. The client receives nutrition via a PEG tube, has adapted well to the tube feedings, and remains physically and socially active. Occasionally, the client develops constipation that requires administration of a laxative to restore regular bowel function. What is the most likely cause of this client's constipation?

lack of free water intake

A metallic taste accompanies administration of

metronidazole (Flagyl)

A patient is scheduled for a Billroth I procedure for ulcer management. What does the nurse understand will occur when this procedure is performed?

A partial gastrectomy is performed with anastomosis of the stomach segment to the duodenum.

34s A client with a peptic ulcer is about to begin a therapeutic regimen that includes a bland diet, antacids, and famotidine (Pepcid). Before the client is discharged, the nurse should provide which instruction?

"Avoid aspirin and products that contain aspirin."

A nurse is providing discharge instruction for a client who is postoperative bariatric surgery. What statement will the nurse include when providing teaching aimed at decreasing the risk of gastric ulcers?

"Avoid taking non-steroidal anti-inflammatory drugs."

A client is prescribed tetracycline to treat peptic ulcer disease. Which of the following instructions would the nurse give the client?

"Be sure to wear sunscreen while taking this medicine." Tetracycline may cause a photosensitivity reaction in clients. The nurse should caution the client to use sunscreen when taking this drug. Dairy products can reduce the effectiveness of tetracycline, so the nurse should not advise him or her to take the medication with milk.

A nurse is performing discharge teaching with a client who had a total gastrectomy. Which statement indicates the need for further teaching?

"I will have to take vitamin B12 shots up to 1 year after surgery."

Morbid obesity is defined as being how many pounds over the person's ideal body weight?

100

The nursing student approaches his instructor to discuss the plan of care for his client diagnosed with peptic ulcer disease. The student asks what is the most common site for peptic ulcer formation? The instructor would state which one of the following?

Duodenum

Which term refers to the first portion of the small intestine?

Duodenum

A client has recently been diagnosed with gastric cancer. He has a history of tobacco use and was diagnosed 10 years ago with pernicious anemia. He and his family are shocked about the possibility of this diagnosis because he has been asymptomatic prior to recent complaints of pain and multiple gastrointestinal symptoms. On palpation, the nurse notes two signs that confirm metastasis to the liver. Which of the following are signs? Choose all that apply.

Ascites Hepatomegaly

A nurse applies an ostomy appliance to a client who is recovering from ileostomy surgery. Which intervention should the nurse utilize to prevent leakage from the appliance?

Ask the client to remain inactive for 5 minutes.

When caring for a client with an acute exacerbation of a peptic ulcer, the nurse finds the client doubled up in bed with severe pain to his right shoulder. The intial appropriate action by the nurse is to

Assess the client's abdomen and vital signs.

A client with anorexia complains of constipation. Which of the following nursing measures would be most effective in helping the client reduce constipation?

Assist client to increase dietary fiber.

The nurse is evaluating a client's ulcer symptoms to differentiate ulcer as duodenal or gastric. Which symptom should the nurse at attribute to a duodenal ulcer?

Awakening in pain. The client with a gastric ulcer often awakens between 1 to 2 AM with pain, and ingestion of food brings relief.

A patient is scheduled for removal of the lower portion of the antrum of the stomach and a small portion of the duodenum and pylorus. What is the name of this surgical procedure for peptic ulcer disease?

Billroth I

The client states that the physician told him he has irritable bowel syndrome. What does the nurse recognize as characteristic of this disorder?

Chronic constipation with sporadic bouts of diarrhea. Most clients with irritable bowel syndrome (IBS) describe having chronic constipation with sporadic bouts of diarrhea. Some report the opposite pattern, although less commonly. Most clients experience various degrees of abdominal pain that defecation may relieve. Weight usually remains stable, indicating that when diarrhea occurs, malabsorption of nutrients does not accompany it. Stools may have mucus, but blood is not usually found because the bowel is not locally inflamed.

he nurse is irrigating a colostomy when the patient says, "You will have to stop, I am cramping so badly." What is the priority action by the nurse?

Clamp the tubing and give the patient a rest period.

Which of the following clients is at highest risk for peptic ulcer disease?

Client with blood type O

A patient is having a diagnostic workup for complaints of frequent diarrhea, right lower abdominal pain, and weight loss. The nurse is reviewing the results of the barium study and notes the presence of "string sign." What does the nurse understand that this is significant of?

Crohn's disease. The most conclusive diagnostic aid for Crohn's disease has classically been a barium study of the upper GI tract that shows a "string sign" on an x-ray film of the terminal ileum, indicating the constriction of a segment of intestine.

The nurse is developing a plan of care for a patient with peptic ulcer disease. What nursing interventions should be included in the care plan? Select all that apply.

Frequently monitoring hemoglobin and hematocrit levels Observing stools and vomitus for color, consistency, and volume Checking the blood pressure and pulse rate every 15 to 20 minutes

The nurse is assessing a client with an ulcer for signs and symptoms of hemorrhage. The nurse interprets which condition as a sign/symptom of possible hemorrhage?

Hematemesis

The nurse is cautiously assessing a client admitted with peptic ulcer disease because the most common complication that occurs in 10% to 20% of clients is:

Hemorrhage

A client with severe peptic ulcer disease has undergone surgery and is several hours postoperative. During assessment, the nurse notes that the client has developed cool skin, tachycardia, and labored breathing; the client also appears to be confused. Which of the following complications has the client most likely developed?

Hemorrhage (NOT perforation)

The client has been taking famotidine (Pepcid) at home. The nurse prepares a teaching plan for the client indicating that the medication acts primarily to achieve which of the following?

Inhibit gastric acid secretions.

In gastric cancer, what organs adjacent to the stomach are also affected?

Liver Pancreas Duodenum

After teaching a group of students about irritable bowel syndrome and antidiarrheal agents, the instructor determines that the teaching was effective when the students identify which of the following as an example of an opiate-related antidiarrheal agent?

Loperamide

Diet modifications for patient diagnosed with chronic inflammatory bowel disease include which of the following?

Low residue

The nurse is caring for an older adult patient experiencing fecal incontinence. When planning the care of this patient, what should the nurse designate as a priority goal?

Maintaining skin integrity

Rebleeding may occur from a peptic ulcer and often warrants surgical interventions. Signs of bleeding include which of the following?

Mental confusion. Signs of bleeding include tachycardia, tachypnea, hypotension, mental confusion, thirst, and oliguria.

Celiac sprue is an example of which category of malabsorption?

Mucosal disorders causing generalized malabsorption

The nurse in the ED admits a client with suspected gastric outlet obstruction. The client's symptoms include nausea and vomiting. The nurse anticipates that the physician will issue which order?

Nasogastric tube insertion to decompress the stomach

When preparing a client for surgery to treat appendicitis, the nurse formulates a nursing diagnosis of Risk for infection related to inflammation, perforation, and surgery. What is the rationale for choosing this nursing diagnosis?

Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix.

A nurse practitioner prescribes drug therapy for a patient with peptic ulcer disease. Choose the drug that can be used for 4 weeks and has a 90% chance of healing the ulcer.

Omeprazole (Prilosec)

The nurse is caring for a client with intussusception of the bowel. What does the nurse understand occurs with this disorder?

One part of the intestine telescopes into another portion of the intestine.

The nurse is teaching a client with peptic ulcer disease who has been prescribed misoprostol (Cytotec). What information from the nurse would be most accurate about misoprostol?

Prevents ulceration in clients taking nonsteroidal anti-inflammatory drugs (NSAIDs). Misoprostol is a synthetic prostaglandin that protects the gastric mucosa against ulceration and is used in clients who take NSAIDs. Misoprostol should be taken with food.

Which of the following is the most common symptom of a polyp?

Rectal bleeding

most common symptom of a polyp?

Rectal bleeding

In addition to teaching a client with constipation to increase dietary fiber intake to 25 g/day, which of the following would the nurse include as important?

The nurse instructs the client to add fiber-rich foods to the diet gradually to avoid bloating, gas, and diarrhea. It is essential for a client to include bran cereals and beans in the diet because they ease defecation. The nurse also instructs the client to increase fluids to 6 to 8 glasses per day to prevent hard, dry stools. The client should also develop a regular exercise program to increase peristalsis and promote bowel elimination.

primary symptoms of irritable bowel syndrome (IBS)?

The primary symptoms of IBS include constipation, diarrhea, or a combination of both. Pain, bloating, and abdominal distention often accompany changes in bowel pattern.

The presence of mucus and pus in the stools suggests which condition?

Ulcerative colitis

Metamucil is

a bulk-forming laxative

Famotidine is

a histamine-2 receptor antagonist

After assessing a client with peritonitis, the nurse most likely would document the client's bowel sounds as:

absent

The nurse is assessing an 80-year-old client for signs and symptoms of gastric cancer. The nurse differentiates which as a sign/symptom of gastric cancer in the geriatric client, but not in a client under the age of 75?

agitation

When discussing risk factors for peptic ulcers, the nurse should mention:

alcohol abuse and smoking.

A Billroth I procedure involves

removal of the lower portion of the antrum of the stomach (which contains the cells that secrete gastrin) as well as a small portion of the duodenum and pylorus. The remaining segment is anastomosed to the duodenum.

Nursing assessment of a client with peritonitis reveals hypotension, tachycardia, and signs and symptoms of dehydration. The nurse also expects to find:

severe abdominal pain with direct palpation or rebound tenderness.

A client has been experiencing lower GI difficulties that have increased in severity, and the gastroenterologist is concerned that the client's bowel is not functioning properly. What function of the lower GI tract is most likely to be affected by the client's disorder?

water and electrolyte absorption

The nurse is performing an abdominal assessment for a patient with diarrhea and auscultates a loud rumbling sound in the left lower quadrant. What will the nurse document this sound as on the nurse's notes?

Borborygmus

A patient with IBD would be encouraged to increase fluids, use vitamins and iron supplements, and follow a diet designed to reduce inflammation. Select the meal choice that would be recommended for a low-residue diet.

Broiled chicken with low-fiber pasta Explanation: A low-residue, high-protein, and high-calorie diet is recommended to reduce the size and number of stools. Foods to avoid include yogurt, fruit, salami, and peanut butter.

What is a characteristic associated with peptic ulcer pain that the nurse should inquire about? Select all that apply.

Burning sensation localized in the back or mid-epigastrium Feeling of emptiness that precedes meals from 1 to 3 hours Severe gnawing pain that increases in severity as the day progresses

A morbidly obese client asks the nurse if medications are available to assist with weight loss. The nurse knows that the client would not be a candidate for phentermine if the following is part of the client's health history:

CAD

Which is the most common presenting symptom of colon cancer?

Change in bowel habits

A patient sustained second- and third-degree burns over 30% of the body surface area approximately 72 hours ago. What type of ulcer should the nurse be alert for while caring for this patient?

Curling's ulcer

What is the primary nursing diagnosis for a client with a bowel obstruction?

Deficient fluid volume. Feces, fluid, and gas accumulate above a bowel obstruction. Then the absorption of fluids decreases and gastric secretions increase. This process leads to a loss of fluids and electrolytes in circulation. Therefore, Deficient fluid volume is the primary diagnosis. Deficient knowledge, Acute pain, and Ineffective tissue perfusion are applicable but not the primary nursing diagnosis.

A client with acute gastritis asks the nurse what might have caused the problem. Which of the following are possible causes?

Dietary indiscretion Excessive alcohol intake Radiation therapy

When interviewing a client with internal hemorrhoids, which of the following would the nurse expect the client to report?

Rectal bleeding. Internal hemorrhoids cause bleeding but are less likely to cause pain, unless they protrude through the anus. External hemorrhoids may cause few symptoms, or they can produce pain, itching, and soreness of the anal area.

Which of the following is the most successful treatment for gastric cancer?

Removal of the tumor

A longitudinal tear or ulceration in the lining of the anal canal is termed a(n):

anal fissure.

acute gastritis s/s

may have a rapid onset of symptoms, including abdominal discomfort, headache, lassitude, nausea, anorexia, vomiting, and hiccuping, which can last from a few hours to a few days. Acute gastritis is often caused by dietary indiscretion—a person eats food that is irritating, too highly seasoned, or contaminated with disease-causing microorganisms.

The nurse is caring for a patient who has been diagnosed with gastritis. To promote fluid balance when treating gastritis, the nurse knows that what minimal daily intake of fluids is required?

Daily fluid intake and output are monitored to detect early signs of dehydration (minimal fluid intake of 1.5 L/day, minimal output of 0.5 mL/kg/h).

The nurse is preparing a client for a test that involves inserting a thick barium paste into the rectum with radiographs taken as the client expels the barium. What test will the nurse prepare the client for?

Defecography. In defecography, a thick barium paste is inserted into the rectum. Radiographs are taken as the client expels the barium to determine whether there are any anatomic abnormalities or problems with the muscles surrounding the anal sphincter.

The nurse reviews dietary guidelines with a patient who had a gastric banding. Which of the following teaching points are included? Select all that apply

Do not eat and drink at the same time. Drink plenty of water, from 90 minutes after each meal to 15 minutes before each meal. Avoid fruit drinks and soda. Total meal size should be restricted to less than 8 oz or 240 mL. Three meals a day are recommended.

The nurse is teaching a client with an ostomy how to change the pouching system. Which information should the nurse include when teaching a client with no peristomal skin irritation?

Dry skin thoroughly after washing

A patient who had a Roux-en-Y bypass procedure for morbid obesity ate a chocolate chip cookie after a meal. After ingestion of the cookie, the patient complained of cramping pains, dizziness, and palpitation. After having a bowel movement, the symptoms resolved. What should the patient be educated about regarding this event?

Dumping syndrome

A client is admitted with a diagnosis of acute appendicitis. When assessing the abdomen, the nurse would expect to find rebound tenderness at which location?

Right lower quadrant

characteristics associated with the Zollinger-Ellison syndrome (ZES)

Severe peptic ulcers Extreme gastric hyperacidity Gastrin-secreting tumors of the pancreas

Which of the following will the nurse observe as symptoms of perforation in a patient with intestinal obstruction?

Sudden, sustained pain, abdominal distention, and fever are symptoms of perforation in a client with intestinal obstruction

Symptoms associated with pyloric obstruction (also called gastric outlet obstruction, GOO)

The client may have nausea and vomiting, constipation, epigastric fullness, anorexia, and, later, weight loss.

Which is a true statement regarding regional enteritis (Crohn's disease)?

The clusters of ulcers take on a cobblestone appearance.

Medical management of a patient with peritonitis includes fluid, electrolyte, and colloid replacement. The nurse knows to prepare the initial, most appropriate intravenous solution. Which of the following is the correct solution?

0.9% NS. The administration of several liters of an isotonic solution is immediately prescribed. Hypovolemia occurs because massive amounts of fluid and electrolytes move from the intestinal lumen into the peritoneal cavity and deplete the fluid in the vascular space.

A nursing student is preparing a teaching plan about peptic ulcer disease. The student knows to include teaching about the percentage of clients with peptic ulcers who experience bleeding. The percentage is

15%

A nurse is preparing a presentation for a local community group of older adults about colon cancer. Which of the following would the nurse include as the primary characteristic associated with this disorder?

A change in bowel habits