MS exam 4- GI

Asseessment, labs, and diagnostics- diverticulitus

assess- vital signs (fever & tachycardia), I&O, pain, mental status Labs- WBC and loss of potassium with NG tube. confirmed with a CT scan actions- iv fluids, antibiotics, NG tube, oral care.

Which dietary instruction would be appropriate to give a client recovering from acute pancreatitis?

avoid crash dieting

The nurse is talking with a woman in her second trimester of pregnancy who has been diagnosed with polyhydramnios. The physician has ordered an ultrasound be performed to check for the presence of esophageal atresia. Which statement by the woman indicates an understanding of the relationship between these conditions?

"Babies with esophageal atresia have an inability to swallow amniotic fluid causing the excess buildup."

The mother of an infant tells the nurse during a routine visit to the clinic that she often notices a bulging mass in the lower abdominal and groin area when her baby cries. She asks the nurse if this is normal. How should the nurse respond?

"I understand your concern. I will be sure to document this in your child's medical record and report this information to your child's physician immediately."

The student nurse is preparing a presentation on celiac disease. What information should be included? Select all apply.

"Symptoms of celiac disease include diarrhea, steatorrhea, anemia, and dental disorders." "The only treatment for celiac disease is a strict gluten-free diet." "Gluten is found in most wheat products, rye, barley and possibly oats."

S/s dumping syndrome

Fullness, weakness, palpitations, cramping, faintness, diarrhea. -secondary to rapid entry of hypertonic food into jejunum. - occurs 5-30 minutes after eating. S/S: vertigo, dizziness, sweating, pallor -exacerbated by fluids with meals.

An adolescent is diagnosed with hepatitis A. Which problem should be considered when planning care?

He will become fatigued easily

The nurse has performed client education for a 15-year-old boy with Crohn disease and his parents regarding the cobblestone lesions in his small intestine. Which comment by the family indicates learning has occurred?

I have to be careful because I am prone to not absorbing nutrients

A nurse has been asked to obtain a client's signature on an operative consent form. When the nurse approaches the client, who is scheduled for a cholecystectomy later in the day, the client asks the nurse why the procedure is needed. Which response by the nurse is appropriate?

I will ask the surgeon to come speak with you about the procedure

aphthous stomatitis

Inflammation of the mouth with small, painful ulcers; canker sores.

The nurse is developing a plan of care for a client with Crohn's disease who is receiving total parenteral nutrition (TPN). Which interventions should the nurse include? Select all that apply.

Monitor the IV infusion rate hourly. Tape all IV tubing connections securely. Weigh the client daily.

The nurse is teaching an in-service program to a group of nurses on the topic of gastrointestinal disorders. The nurses in the group make the following statements. Which statement is most accurate related to the diagnosis of gastroesophageal reflux?

The sphincter that leads into the stomach is relaxed

The nurse is caring for a client receiving narcotics for pain control. The client reports no bowel movement since admission. What interventions should the nurse consider? Select all that apply.

Offer hot drinks with meals. Encourage doubling hall walking. Suggest drinking more fluids like water. Order high-fiber foods to be added to the diet.

A client who is having an abdominal perineal resection with permanent colostomy asks, "Where will my colostomy be placed?" The nurse should tell the client:

Permanent is normally placed on the L side of the abdomen

Peptic Ulcer Disease (PUD)

S/s- belching, bloating, epigastric pain diagnosis- EGD, barium swallow complications- hemorrhage, perforation, obstruction NI- small frequent meals, monitor stools, meds 1-2 hrs after meals

the purpose of checking for tube placement in the stomach is to prevent:

aspiration

A physician recommends a gastrostomy for a 4-year-old client with an obstruction. The parents ask the certified wound, ostomy, and continence nurse (CWOCN) what the surgery entails. What is the nurse's best response?

The surgery creates an opening between the stomach and abdominal wall

What occurs in the gastrointestinal system of the child with Hirschsprung disease?

There is a partial or complete mechanical obstruction in the intestine

A child with inflammatory bowel disease is started on an anti-inflammatory medication. Which item(s) would the nurse teach the child and parents about being on this type of medication? Select all that apply.

Use sunscreen and protective clothing while outside. Increase folic acid intake. Drink adequate fluids to avoid crystallization of sulfa in urine. Administer the medication just after meals to avoid gastrointestinal irritation.

assessment for crohns disease

abd pain RLQ, diarrhea, constant fluid loss, low grade fever, perforation of intestine, anorexia, weight loss, anemia, and malnutrition

A client who had a splenectomy yesterday has a nasogastric (NG) tube. What should the nurse assess to determine the effectiveness of the NG tube?

absence of abdominal distension

A mother brings her 3-year-old son to the ER and tells the triage nurse that he has been vomiting blood. A medical history determines that the 3-year-old has no history of GI disturbances and his only symptoms are a slightly elevated fever and vomiting bright red blood. Based on these symptoms, what condition might the nurse suspect?

acute upper GI bleeding

treatment for peritonitis

antibiotics and appendectomy.

The nurse is caring for a pediatric client with idiopathic celiac disease. Which meal will the nurse select for this client?

baked salmon, potato slices, vanilla ice cream, and apple juice,

what do you assess for with a diagnosis of ulcerative colititis?

bloody, diarrheal stools

The parent reports that the health care provider said that the infant had a hernia but cannot remember which type. When recalling what the health care provider said, the parent said that a surgeon will repair it soon and there is no problem with the testes. Which hernia type is anticipated?

inguinal hernia

why does the client take antacid so frequently?

it has a short duration of action

indication of wound inflammation?

localized warmth over incisional area

The nurse is discussing the treatment of congenital aganglionic megacolon with the caregivers of a child diagnosed with this disorder. Which statement is the best explanation of the treatment for this diagnosis?

surgical procedure

The nurse is caring for a 6-month-old infant who was admitted to the emergency department 24 hours ago with signs of severe diarrhea. The infant's rectal temperature is 104°F (40°C), with weak and rapid pulse and respirations. The skin is pale and cool. The child is on IV rehydration therapy, but the diarrhea is persisting. The infant has not voided since being admitted. Which is the priority nursing intervention?

take a stool culture

The nurse is collecting data on a 2-year-old child admitted with a diagnosis of gastroenteritis. When interviewing the caregivers, which question is most important for the nurse to ask?

tell me about the types of stools your child has been having

As the nurse administers a tap water enema, the client begins to have abdominal cramping. The nurse should first:

temporarily stop until the cramping subsides

S/S of dehydration

tenting of skin

Etiology of Crohn's Disease

unknown, immunologic factors may be triggered by normal intestinal flora

Crohn's disease

may lead to fistulas, abscesses, and peritonitis. stools are soft and semi-liquid. Nutritional deficits and electrolye imbalances. RLQ pain

The nurse is caring for a client admitted with pyloric stenosis. A nasogastric tube placed upon admission is on low intermittent suction. Upon review of the morning's blood work, the nurse observes that the patient's potassium is below reference range. The nurse should recognize that the patient may be at risk for what imbalance?

metabolic alkalosis

several episodes of vomiting = a risk for

metabolic alkalosis

Which finding requires immediate attention for a patient recovering from moderate sedation?

o2 sat of 89%

The nurse teaches a parent to differentiate between regurgitation and vomiting in the infant. The parent correctly states which characteristic of regurgitation? Select all that apply.

occurs with feeding no appearance of distress

Which lab level would require notifying the HCP when a patient has pancreatic cancer?

potassium 2.2 mEq/L

The nurse is providing care to a child who has had an appendectomy for a perforated appendix. The nurse would anticipate intravenous antibiotic therapy for how long?

7 to 14 days

When preparing for a colonoscopy, the procedure will involve:

cleansing the bowel with laxatives

What types of food can the client with a peptic ulcer eat?

any foods that are tolerated

A child is diagnosed with intussusception. The nurse anticipates that what action would be attempted first to reduce this condition?

barium enema

which would be an indication hepatic encephalopathy is developing?

decreased mental status

urea breath test

detects H. pylori

A client who can't tolerate oral feedings begins receiving intermittent enteral feedings. When monitoring for evidence of intolerance to these feedings, the nurse must remain alert for

diaphoresis, vomiting, and diarrhea

assessment for ulcerative colitis

diarrhea, abd pain and crampin, rectal bleeding, liquid stools, weakness and fatigue, anemia

A client is scheduled to have surgery to relieve an intestinal obstruction. Prior to surgery, the nurse should verify that the client has followed which preoperative instructions?

discontinued the use of blood thinners

peritonitis=

rigid abdominal wall

Nursing assessment of a client with peritonitis reveals hypotension, tachycardia, and S/S of dehydration. which additional assessment finding will the nurse assess for?

severe abdominal pain with direct palpation or rebound tenderness

A 3-month-old is admitted with severe diarrhea. Yesterday, the infant weighed 11 pounds (5 kg). Today, this infant weighs 9 pounds, 8 ounces (4.3 kg). Based on this information the nurse documents that the infant has:

severe dehydration

Patient teaching dumping syndrome

small frequent meals

Patho of Crohns disease

subacute chronic inflammation from all layers of the intestinal mucosa.

A client with acute liver failure exhibits confusion, a declining level of consciousness, and slowed respirations. The nurse finds the client very difficult to arouse. The diagnostic information which best explains the client's behavior is

subnormal serum glucose and elevated serum ammonia levels

A client is admitted to the hospital for diagnostic testing to rule out colorectal cancer. Which intervention should the nurse include on the plan of care?

test all stools for occult blood

A child with Hirschsprung's is to be discharged 1-2 days after colostomy take down surgery. after teaching the parents about the overall effects of their infants surgery, the nurse determines that the teaching has been effective when:

they state, "toilet training may be difficult."

acute GI distess, bloody diarrhea, weight loss, and fever. What family history would be significant to this diagnosis?

ulcerative colitis

The nurse is caring for a newborn diagnosed with imperforate anus following delivery. The physician has discussed the treatment options and prognosis with the parents. The nurse is talking with the parents and determines that learning has occurred when the parents make which statement?

we are worried that our child may have other congenital problems that we aren't aware of

etiology of ulcerative colitis

• genetic/familial • infectious • immunologic • psychosomatic • dietary

After teaching a client about collecting a stool sample for occult testing, which client statement indicates effective teaching? Select all that apply.

"I will avoid eating meat for 1 to 3 days before getting a stool sample." "I will take the sample from different areas of the stool that I have passed."

The nurse is preparing a client for surgery and the client asks, "What does it mean when they say they are going to reduce my abdominal hernia?" Which response by the nurse is most appropriate?

"This means the hernia contents will be manipulated back into your peritoneal cavity during surgery."

patho of ulcerative colitis

- Inflammation begins in the rectum - Spreads proximally, may extend to the entire colon - Causing ulcers, edema, and thickening of the bowel wall ---- affects the superficial mucosa of the large intestines and rectum causing the bowel to eventually narrow, shorten, and thicken due to muscular hypertrophy.

What are the important considerations by the nurse before administering feedings to a client through a NG tube.

- determine patency by aspiration of GI contents -Measure pH of aspirated contents

care plan for GERD

-avoid alcohol, coffee, and high fatty foods

When assessing a client who has been diagnosed with hepatic cirrhosis, what do you include in the focused assessment?

-current use of alcohol -nutritional status -mental status

implementations for crohns disease

-determine bowel elimination pattern -low residue, lowfat diet -TPN -vitamin and iron supplement -avoid foods that cause diarrhea -avoid smoking, caffeine, pepper, alcohol -I&O & electrolyte monitoring

implementations for ulcerative colitis

-determine bowel elimination pattern -low residue, lowfat diet -vitamin and iron supplement -avoid foods that cause diarrhea -avoid smoking, caffeine, pepper, alcohol -I&O & electrolyte monitoring

Assessments for peptic ulcer disease

-how food intake affects pain -presence of stool -history of antacid, histamine, or PPI use

The nurse is caring for a newborn with a cleft palate. Which findings in the maternal medical record are considered to be contributing factors? Select all that apply.

-maternal tobacco use -anticonvulsant therapy used

S/S for peritonitis

-severe abd pain -distention and tenderness of stomach -N&V -may aviod moving the abd -abd is rigid and board like -absent bowel sounds -pulse is elevated -respiration's are rapid

Which is a s/s that hepatic encephalopathy is improving?

-the client can circle choices on the menu -the client is able to eat previously restricted food items

A client who has been treated for diverticulitis is being discharged on oral propantheline bromide. The nurse should instruct the client to take the drug

30 minutes before meals and at bedtime

A 4-month-old has had a fever, vomiting, and loose watery stools every few hours for 2 days. The mother calls the physician's office and asks the nurse what she should do. Which response by the nurse is most appropriate?

Bring the child to the office today so we can evaluate and get the best treatment

The nurse is caring for a 6-month-old infant with diarrhea and dehydration. The parent is concerned because the infant has some patches on the tongue. Which feature indicates a geographic tongue?

Some patches are light in color and other patches are dark in color

A client who has ulcerative colitis has persistent diarrhea and has lost 12 lb (5.5 kg) since the exacerbation of the ulcerative colitis. Which approach will be most effective in helping the client meet nutritional needs?

TPN

Patient education for peptic ulcer disease

Teach about dumping syndrome- secondary to rapid entry of hypertonic food into jejunum, occurs 5-30 minutes after eating, S/S: vertigo, dizziness, sweating, pallor, minimized by small frequent meals, exacerbated by fluids with meals. - avoid aspirin, NSAIDS, corticosteroids, anticoagulants -teach smoking cessation and stress mgmt -teach S/S of GI bleeding

A client with cancer of the stomach had a total gastrectomy 2 days earlier. Which indicates the client is ready to try a liquid diet?

The client has frequent bowel sounds

What would you instruct the parent/ child of appendicitis?

do not rub or put pressure on the abdomen

A preschooler has celiac disease. The parent is preparing a gluten-free diet. The nurse knows that the parent understands the diet when the parent prepares which breakfast foods?

eggs and orange juice.

Which lab finding is expected when a client has diverticulitis

elevated WBC

the client with a peptic ulcer is prescribed antibiotics and bismuth salts. the nurse explains that this combinations of medications will:

eradicate the H. pylori bacteria

A nurse taking a health history of a newborn notes that there is a maternal history of polyhydramnios. What GI condition might this history precipitate?

esophageal atresia

The labor and delivery nurse is caring for a mother who has demonstrated polyhydramnios upon delivery. The newborn displays copious, frothy bubbles of mucus in the mouth and nose, as well as drooling. The nurse is concerned that the infant has what disorder?

esophageal atresia

at 0800, the nurse reviews the amount of T-tube drainage. After reviewing the output record, what should the nurse do next?

evaluate the tube for patency

What do you do when wound dehiscence with evisceration occurs?

place saline-soaked sterile dressings on the wound

When admitting an older adult client for nausea and vomiting that has lasted for 3 days, the nurse should assess for which clinical findings?

poor skin turgor

The nurse is conducting a physical examination of an infant with suspected pyloric stenosis. Which finding indicates pyloric stenosis?

hard, moveable "olive- like mass" in the upper right quadrant

A client who has been vomiting for 2 days has a nasogastric tube inserted. The nurse notes that over the past 10 hours, the tube has drained 2 L of fluid. The nurse should further assess the client for which electrolyte imbalance?

hypokalemia

The nurse is caring for a child with a diagnosis of pyloric stenosis during the preoperative phase of the child's treatment. What is the highest priority at this time?

improving hydration

What lab values do you monitor with acute pancreatitis?

increased serum amylase and lipase levels

A 9-month-old girl is brought to the emergency room with what appears to be bouts of intense abdominal pain 15 minutes apart in which she draws up her legs and cries, often accompanied by vomiting. In between the bouts, the child recovers and appears to be without symptoms. Blood is found in the stool. What condition should the nurse suspect in this case?

intussusception

What instruction should the nurse give the client about caring for the incision with a perforated appendix?

leave the adhesive strips in place until they fall off

ulcerative colitis

looks like: diarrhea- often up to 20x per day with blood, mucus, and pus. Abdominal pain and tenderness that is worse in the LLQ, spasms of the anal sphincter. cure- total colectomy

A physician orders spironolactone, 50 mg by mouth four times daily, for a client with fluid retention caused by cirrhosis. Which finding indicates that the drug is producing a therapeutic effect?

loss of 2.2lb in 24 hours

where to check for rebound tenderness in appendicitis?

lower right

Which goal for the client's care should take priority during the first days of hospitalization for an exacerbation of ulcerative colitis?

managing diarrhea

A parent brings a 10-year-old child to the emergency room with reports of abdominal pain. The nurse performing a physical assessment notes the following symptoms: upper right quadrant pain that radiates to the back; fever; nausea; and abdominal distention. Which disease would the nurse suspect?

pancreatitis

When obtaining a nursing history on a client with a suspected gastric ulcer, which signs and symptoms should the nurse assess? Select all that apply.

weight loss melena vomiting