MS II EXAM 1
The nurse is preparing a presentation on the differences between ulcerative colitis and Crohn's disease. What should the nurse include in the presentation? Select all that apply.
- Ulcerative colitis is confined to the mucosa and the submucosa of the intestine - The intestinal disease of ulcerative colitis is curable with a curable with a colectomy, whereas Crohn's disease often recurs after surgery - Blood is often present in the stools with ulcerative colitis; fat is usually present in the stools with Crohn's disease
What is the problem with GERD?
Backflow of acid
Which part of the body is responsible in converting proteins into ammonia?
Bacteria
Where is protein metabolized and by which part of the body?
Bacteria in the intestines
Why would they have pernicious anemia if they have the gastrectomy procedure?
Because of the absence of the intrinsic factor
Why would proanalog be given?
Because of the portal hypertension to reduce the risk of bleeding in patient
Why would you want to reduce the bleeding in patient?
Because patient already has various and when the pressure goes up into those veins, these various would rupture
What does the T-tube drain?
Bile
What will the conjugated bilirubin now mix with?
Bile
Where will this mixture of bile and bilirubin now be mixed with?
Bile duct ( GI tract ) , reason why stool is brown because the color of the bilirubin changes the color of the bile
What are the two common surgeries for stomach cancer ?
Billroth I & Billroth II
What is the difference between Billroth I & Billroth II?
Billroth I is direct anastomosis of the fundus of the stomach to the duodenum. Billroth II is the closure of the duodenum and anastomosis of the fundus of the stomach into the jejunum
What should be monitored for after this procedure?
Bleeding
What will be the concerns if melena and hematemesis is seen?
Bleeding will cause patient to become anemic
What is one of the complications of an EGD procedure?
Bleeding, perforation ( if scope pokes into the stomach )
What is a nursing intervention if there is active bleeding?
Blood transfusion, surgery, keep patients NPO, monitor patient's vital signs, Observe patient for vomitous
What kind of transmission is Hep B, Hep C, Hep D, Hep G?
Blood transmission
Where can Pancreatic Cancer metastasis to?
Bones, stomach and duodenum
A nurses is reviewing nutrition information with a client who has cholecystitis. Which of the following food choices can trigger cholecystitis?
Brownie with nuts
What should be checked first before patient goes in for a Liver Biopsy?
Clotting factors like PT (Prothrombin time ) INR, PTT ( Partial thromboplastin time ), Bleeding time, ensuring patients have close to normal in those values
Will Hepatic Encephalopathy be considered a part of cirrhosis or a complication of cirrhosis?
Complication
What is the appearance of the patient when patient has hepatic encephalopathy?
Confused, restless, stupor, comatose, inappropriate behavior, asterixis ( flapping tremors )
Why and how can CDIF be acquired from the facility?
Contamination and patients who are immunosuppressed, patients who are on prolonged antibiotic therapy
Which disease involves cobble stones?
Crohn's Disease
Which disease involves the entire full thickness of the intestines?
Crohn's Disease
Specifically which drug and why?
Cyclosporine, because this drug prevents bone marrow suppression and impairment of wound healing
What should be used during a lavage?
Iced saline
If patients go through a liver transplant, what drug should be given to the patient in order to prevent rejection?
Immunosuppressive Drug
What's the difference between Ulcerative Colitis and Crohn's Disease?
In Ulcerticollitis there is an occurrence of 15 - 20 stools with a liquid consistency, In Crohn's Disease there is an occurrence of 3 - 4 stools with a semi solid consistency
What is the problem with achalasia?
Inability of sphincter relaxation
What is the difference between a traditional Cholecystectomy and a Laparoscopic Cholecystectomy?
Incisions are smaller, heals easily and recovery is faster so patients can resume their activities within 1 week
How do patients get Hepatic Encephalopathy?
Increased Ammonia In the body
Why is there jaundice?
Increased levels of bilirubin
Who are those at risk for Candidiasis?
Infants, because they have a depressed immune system and they came out of the vaginal wall
What will the patient be at high risk for if given immunosuppressive medications?
Infection
What is gastritis?
Inflammation of the lining of the stomach
How can internal organs be visualized within that small of a hole?
Inflation of carbon dioxide
How should we replace the intrinsic factor in the patient? How should nurses replace the vitamin B12 in patients body?
Injection of Vitamin B12 because PO ( by mouth ) won't do the patient any good because of the patient's absence of the stomach
A nurse is assessing a client with a diagnosis inguinal hernia, at a scheduled clinic visit. The nurse suspects that client's hernia may be strangulated when which finding is noted on assessment?
Intense abdominal pain
Can varicose veins be at risk for rupture?
Internal bleeding
A nurse anticipates that the care of a client newly admitted to a medical unit with a diagnosis of peritonitis should include: Select all that apply.
Intravenous fluids, Antibiotics, NOP, Analgesic therapy, Nasogastric tube to suction
What happens to the pancreatic duct but it becomes destroyed?
It secretes an enzyme that will eat its own pancreas called "autodigestion"
What are the nursing procedure prior to sending patient to EGD procedure?
Kept NPO, signing consent for procedure to be done, IV access incase for medication administration such as Versed to calm patient or Fentanyl for pain relief
Where will the urea then go into?
Kidney
What has to be given to the patient to remove the ammonia?
Lactulose
What should be a nursing intervention for Esophageal bleeding / Esophageal Various?
Lavage, insertion of Sengstaken Blakemore Tube
Where is pain located for a patient with Pancreatitis?
Left Upper Quadrant
Where is the site of pain for patients with ulcerative colitis?
Left lower quadrant of the abdomen
Patients who have oral cancer also have whitish plaque but it's not a fungal infection, so what is that called?
Leukoplakia
What is the difference between candida rash and leukoplakia?
Leukoplakia can not be scraped off mechanically
A nurse is reinforcing teaching with a client who has hepatitis B about home care. Which of the following should the nurse include in the teaching? Select all that apply.
Limit physical activity (need to rest), Avoid alcohol consumption, eat small
A nurse is reinforcing teaching with a client who has a prescription for sulfasalazine ( Azulfidine). Which of the following should the nurse include in the teaching?
Notify the provider if you experience a sore throat
The serum ammonia level of a client with cirrhosis is elevated. As a priority, a nurse should plan to :
Observe for increasing confusion
Where should the blood volume go?
Outside of the blood vessel, then into the peritoneum causing patient to have acidis
What are some signs of perforating?
Pain and tenderness, appearance of the abdomen has rigidity, board abdomen, distended abdomen
What happens due to the obstruction?
Pancreatic juices will not come out
Where will those little stones go?
Pass through the bile route then into the GI tract then patient poops it out
The nurse is caring for a patient with hepatic encephalopathy. While assessing the patient, the nurse notes rapid, irregular flexion and extension (flapping) of the wrist when the nurse requests that the patient stretch out the arm and hyperextend the wrist with fingers separated. How should the nurse document this finding?
Patient demonstrates the presence of asterixis
Due to liver failure, patient can't have convert bile, jaundice occurs and liver is unable to convert the ammonia into urea, what would happen to the patient?
Patient goes into Hepatic Encephalopathy ( confusion )
What if the lymph nodes are also affected?
Patient has to go through radical neck dissection
What if there are more blood clots than normal in the drainage? What does that mean?
Patient is actually actively bleeding
Why won't there be a incision?
Patient just has to lie down on the table and a shock wave will be administered to pulverize ( break down into small pieces )the kidney stones
If sphincter cannot relax where will the food go?
Patient might get aspirated because the food will not make it down to the stomach
Prognosis of Pancreatic Cancer?
Patient might not survive
What is a complication of a colonoscopy?
Perforation ( abdominal distention )
What parts of the body will be affected in patients who consume take Neomycin?
Renal, Kidney, Ototoxicity ( Ears )
What is the most common surgery for Peptic Ulcer Disease?
Repairing the Perforation if patients have perforation
A nurse is caring for a client who is 6 hours post-open cholecystectomy. The client's T-tube drainage bag is empty, and the nurse notes slight jaundice of the sclera. Which action by the nurse is most important?
Repositioning the client to promote T-tube drainage.
Where is the site of pain for patients with Crohn's Disease?
Right Lower quadrant of the abdomen
What should the the best position for this patient after procedure?
Right Side Lying
What are the signs of symptoms of Cholecystitis? Where is the pain?
Right upper quadrant
A 78-year patient is admitted with common bile duct obstruction related to cancer of the pancreas. Which clinical manifestations would the nurse expect to find? Select all that apply.
Scleral icterus, Dark, tea-colored urine & Jaundice
What is the best position for a patient with peritonitis?
Semi Fowler's to allow fluids to flow by gravity into the lower abdomen to prevent the compression of the diaphragm
What is the characteristic of the pain in Cholecystitis?
Severe colicy pain, radiation to the scapula and shoulder on the right side of the body
A patient has been admitted with right upper quadrant pain and has been placed on a low-fat diet. Which tray would be acceptable for her ?
Skim milk, lean fish, tapioca pudding, and fruit
What is syndoscopine for?
Slows down circulation and flow of the blood
Would the abdominal incision heal faster than the perineal incision?
abdominal because the perineal incision will be exposed to urine so constant monitoring for drainage
How to tell if stomach is distended if you can't see the stomach with your naked eyes?
abdominal distention
What are signs and symptoms of liver cirrhosis?
acidis, abdominal pain on the right side upper quadrant, abdominal distention, jaundice due to increased amounts of bilirubin from red blood cell's break down into hemat then bilirubin
How can the we relieve the right shoulder pain?
ambulation helps reduce pain
What are the two properties / roles / effects of Sulfadiazine?
anti inflammatory and antibiotics
What else should be done for a patient with an edematous scrotum?
apply ice pack for comfort and allow patient to wear scrotal support in order to reduce edema
Should the patient eat before sleeping?
avoid food before sleeping
Why do we have hernias?
because of the weakening of the structures
What are some complications of hemorrhoids?
bleeding
What are the possible three complications a patient with Ulcerative Colitis can have?
bleeding, toxic megacolon ( rupture of the bowel ), risk for colon cancer
What would the patient complain of if they had colorectal cancer?
blood in the stool / rectal bleeding
What is found in Ulcerative Colitis Stools?
blood, mucous and pus
What is something to fear / complication when patients have hernias?
bowel obstruction, hernia becomes strangulated
A nurse is reinforcing discharge teaching with a client who is postoperative following open cholecystectomy with T-tube placement. Which of the following instructions should the nurse include in the teaching? Select all that apply.
clamp T-tube for 1-2 hour before and after meals & Empty drainage bag every 8 hour.
What would be done to prepare patient for surgery?
cleansing the bowel
How can patients get hemorrhoids?
decreased fiber intake causes hemorrhoids
When can a patient get peritonitis?
leakage of food or acid into the peritoneum that can cause an infection
Which quadrant will the pain be felt in diverticulitis?
left lower quadrant because the common site of infection would be the sigmoid colon which is located in the left lower quadrant.
Which organ should convert the bilirubin?
liver
What type of diet should be given to a patient with ulcerative colitis?
low fiber and low residue diet
A client is hospitalized for conservative treatment of cirrhosis. As part of the collaborative plan of care, a nurse would anticipate:
monitoring patient's blood sugar
What is found in Crohn's Disease Stools?
mucous and pus with no blood
A nurse is reviewing the medical record of a client who has a small bowel obstruction. Which of the following findings should the nurse report to the provider? Select all that apply.
urine specific gravity 1.040, Hematocrit 60% & Serum potassium 3.0 mEq/L
What are the different types of hernias?
ventral, intrical, appenditical
What are some examples of gluten?
wheat , rye and barley
Diverticulitis is asymptomatic, but when will it become symptomatic?
when it becomes diverticulitis
Can patient with gastritis have hematemesis ( vomiting of the blood ) ?
yes
Is Crohn's disease considered an immune problem?
yes because of the exacerbation and the remission ( comes back and forth )
Would patient have to go for surgery?
Yes
Would patient with bowel obstruction develop fluid and electrolyte imbalance?
Yes
Should meals be taken with liquids?
Yes because it will allow easier passage of the food
If bicarbonate is lost, will patient developed acidosis?
Yes because the body needs an acid and base to maintain balance, if the body loses alkalinity, only thing left is acid in the body which causes the body to be acidosis
Will a patient with esophageal cancer complain of chest pain?
Yes because the chest pain is related to indigestion and heartburns
Will WBC ( white blood cells ) be elevated in a patient with appendicitis?
Yes due to infection
Can the patient be at risk for dehydration?
Yes due to the frequent stools
Should an appendicitis patient be kept NPO?
Yes, because it will prepare patients for surgery
If patients have melena, is it something to be concerned about?
Yes, because it'll be signs of internal bleeding so the nurse should check if there are still signs of active bleeding
If patients not being able to pee, is it a complication of hemorrhoidectomy?
Yes, because of the obstruction
Will there be a problem with the absorption of Vitamin A, D, E and K and Why?
Yes, because patients will not be able to emulsify the fat
Patient with achalasia, on area where there is a spasm of the sphincter, will there be a dilation of the esophagus?
Yes, because the food will not go down to the stomach causing food to accumulate before the area of the sphincter
Should biologic modifiers be given to patients in Ulcerative Colitis and Crohn's disease?
Yes, biologic modifier and immune modulators
Is edema seen in a patient with acidis?
Yes, due to hypoalbuminemia
Will patient have respiratory complication after the Whipple Procedure?
Yes, due to the enlargement of the wound
Is it harmless to cause discoloration in skin and why?
Yes, it will change the skin yellow but that has nothing to do with having liver disease
Is there radiation for a patient with Pancreatitis?
Yes, radiates to the Back
Can joints and bones be affected in patients with Celiac Disease?
Yes, this is why patients with Celiac disease have joint pain and osteoporosis
Will there be a problem with the production of clotting factors in a patient with liver cirrhosis?
Yes, which will cause patients to bleed easily
Why will patient complain of severe pain?
Due to the contraction and spasm of the gall bladder
What are the three words patients describe the pain with peptic ulcer disease?
Dull, burning and gnawing
What types of ulcers will cause patients to wake up at night?
Duodenal Ulcer
When should Lubiprostone be given?
During Constipation
When should Alosetron be given?
During Diarrhea
Which nursing intervention is most appropriate to decrease postoperative edema and pain in a male patient following an inguinal herniorrhaphy?
Elevating the scrotum with a support or small pillow
A nurse is caring for a client who has a small bowel obstruction from adhesions. Which of the following findings are consistent with this diagnosis? Select all that apply.
Emesis greater than 500 ml with a fecal odor and Report of spasmodic abdominal pain
Where would the internal bleeding occur?
Esophageal bleeding / Esophageal Various
A nurse is a clinic is reviewing self-care information with a client who has ulcerative colitis. Which of the following statements by the client indicates understanding of the teaching?
I will plan to limit fiber in my diet.
Would a Laparoscopic Cholecystectomy patient be expected to have a t-tube?
No
Would patient have presence of flatus?
No
Should patient with cholecystitis be given a low fat food?
No Low Fat , because it causes more spasm on the Gallbladder
Can NSAIDs be given to patients with peptic ulcer?
No NSAIDs because it will increase chances of bleeding
Should a patient be given morphine?
No because it causes the spasm of sphincter of oddi
Can a hot / warm compress be applied to on the site ( right lower quadrant ) if patient complains of pain?
No because it will cause the appendix to rupture
Should an enema be given to patients with appendicitis?
No enema due to the risk of fracture
Can nurses irrigate the tube?
No especially if the NG tube was inserted in the OR
Can antibiotics be used to treat Candidiasis?
No, because antibiotics are for bacteria so it will not be effective for a fungal infection
Can Surgery Cure Crohn's Disease?
No, patient can only be symptomatically treated
Can a regular meal be given during the acute phase of diverticulitis?
No, patient should be NPO but antibiotics will be given
Should patient eat large meals?
No, small meals
Should a patient be given a diet moderate in protein if they have acidis to replace the lost albumin?
Yes
Should a patient with peritonitis be NPO?
Yes
Should a patient with peritonitis be given antibiotics?
Yes
Should vital signs be monitored?
Yes
What type of abdominal pain would this patient have? Can pain be relieved after a bowel movement?
Yes
Will there be a pathway for the food to go down to the stomach for patients who have achalasia?
No, there will be no passage
When there is perforation and patients goes out for surgery, will it still be necessary for NG tube to be inserted into patient?
Yes
Will a peristaltic wave be seen because of the peristaltic movement?
Yes
Will hematemesis and melena be common in patients with peptic ulcer disease?
Yes
Will patient with gastritis complain of epigastric pain?
Yes
Will scrotum become edematous after inguinal hernia?
Yes
Will the patient with a perforation complain of pain?
Yes
Will there be an incision during the procedure of a Cholecystectomy?
Yes
Will there be odynophagia?
Yes
If the patient has intestinal obstruction and vomits, what should be asked about emesis?
" Do you smell feces in your emesis? "
Will there be presence of mucous in the stool?
Yes
Will varicose veins cause an enlargement of the veins?
Yes
Would a pancreatic patient's WBC be elevated?
Yes
How many balloons can be inflated in the Sengstaken Blakemore Tube?
2 ( 1 gastric and 1 esophagus balloon )
Would a patient with an abdominal incision be at risk for dehiscence?
Yes
Would a patient with peritonitis have pain?
Yes
Would an obese patient be at risk for hiatal hernia?
Yes
How many ports does this Sengstaken Blakemore Tube have?
3
The nurse is caring for a patient with cholecystitis associated with cholelithiasis. Which statement by the nurse is most accurate when answering patient questions?
A heavy meal with a high fat content may precipitate the signs and symptoms of the disease
What is the cause of Liver Cancer?
Alcohol, Liver Cirrhosis, Hepatitis B and Hepatitis C
What causes gastritis?
Alcohol, smoking & stress
What types of medication should be given?
Alosetron and Lubiprostone
What is the problem with IBS ( Irritable Bowel Syndrome )?
Alternation between constipation and diarrhea
How many incisions are made during a Laparoscopic Cholecystectomy?
4 incisions
How much drainage should be present in 24 hours?
500 ML
What should be reported to the doctor after taking Sulfadiazine?
A sore throat because that is a sign of an infection
A patient is scheduled for surgery for a common bile duct exploration. The nurse would expect the patient to return from surgery with which device in place?
A t-tube connected to gravity drainage
What laboratory results will be elevated in patients with liver cirrhosis?
ALT, AST and bilirubin
A nurse is reviewing the history and physical of a teenager admitted to a hospital with a diagnosis of ulcerative colitis. Based on this diagnosis, which information should the nurse expect to see on this client's medical record?
Abdominal pain and bloody diarrhea
Why is there a presence of pruritus?
Accumulation of bile in the skin which causes irritation
What other conditions can be found in Cirrhosis?
Acidis
During the emergency insertion of a central venous line in a client diagnosed with hepatitis B, a nurse suffers a needlestick injury from a blood-contaminated needle. The nurse goes directly to the hospital's occupational health service. Which immediate treatment should the nurse anticipate receiving?
Administration of hepatitis B immune globulin and initiation of the hepatitis vaccine if the nurse has not been previously vaccinated
What medications cannot be given to patients?
Advil, aspirin, mobic because these will increase the chances for bleeding
When do patients with gastric ulcer usually complain of pain?
After 30 minutes to 1 hour of food intake
A client with ulcerative colitis is started on the medication sulfasalazine (Azulfidine). A nurse overhears the client talking with family members about this medication and recognize the need for more teaching when the client says:
After taking this medication for a year, I will be cured of the disease
What should we look out for after esophageal cancer surgery?
Airway because of the site of the surgery is done
What is one of the complication of the surgery?
Airway obstruction
What are the causes of liver cirrhosis?
Alcohol
What causes pancreatitis?
Alcohol
What is pancreatic cancer caused by?
Alcohol and Smoking
When doing a blood test, what levels will be elevated?
Amylase and Lipase
What should be given to patients if H. Pylori is one of the causes of peptic ulcers?
Antibiotics
What is the medication given for patient with candidiasis?
Antifungals like fluconazole, nystatin, mycostatin (swish and swallow or swish and spit)
What medications should be given to patients with liver cirrhosis for pain?
Anything but tylenol because tylenol will cause hepatic toxicity
A health care provider writes the following admission orders for a client with possible appendicitis. Which order should the nurse question?
Apply heat to abdomen to decrease pain
If a patient has tracheoesophageal fistula, what are they at risk for?
Aspiration
A nurse is contributing to the plan of care for a client who has a small bowel obstruction and a nasogastric tube in place. Which of the following nursing interventions should be included in the plan of care? Select all that apply.
Auscultate for bowel sounds, Provide oral hygiene every 2 hours, Clamp the NG tube during ambulation
What is the management for patient with Celiac Disease?
Avoid and eliminate gluten from their diet
Nursing Interventions for patients with GERD?
Avoid spicy foods are anything with acid, no smoking or alcohol, no laying down after meals, do not eat 2 to 3 hours before bedtime
A nurse is reviewing discharge teaching to a client who has Crohn's disease. Which of the following should be included in the teaching?
Drink canned protein supplements
A nurse is caring for a client who has advanced cirrhosis with worsening hepatic encephalopathy. Which of the following is an expected assessment finding? Select all that apply
Change in orientation, Asterixis & Inappropriate behavior
If patient wants to eat after procedure, what should be done?
Check for gag reflex because patient might have lost gag reflex with the usage of sprayed on lidocaine during procedure which might cause aspiration
If there is no drainage and patient becomes Jaundice, what is the next thing to do?
Check patient for any signs of occlusion or change
A nurse is reviewing the health history of a client being evaluated for treatment of hemorrhoids. Which information related to the development of hemorrhoids should the nurse expect to find in the client's medical history?
Chronic constipation
While caring for a patient with hepatitis A, the nurse expects the stools of the patient to appear what color?
Clay-colored
What to prepare the patient for before going to the procedure?
Clean colon with enema, goLytely will be given to patient
After a transverse loop colostomy, the nurse inspects the patient's stoma. The stoma appears pale pink with some dusky discoloration at the lower border. What is the most appropriate action by the nurse?
Clean the area around the stoma, apply a clean pouch, and notify the health care provider about the discoloration
What should the patient's diet be the day before a colonoscopy procedure?
Clear liquid diet or light meal
What should be given to patient instead?
Demerol, Bentyl (Dicyclomine)
While discharging a patient following a laparoscopic cholecystectomy the patient reports mild shoulder pain. The nurse is aware that the pain is likely caused by which factor?
Diaphragmatic irritation secondary to residual carbon dioxide
The nurse is reviewing the record of a client with Crohn's disease. Which stool characteristic should the nurse expect to see documented in the record?
Diarrhea
What will be a common complain for a patient with esophageal cancer?
Difficult swallowing for 6 months
What are signs and symptoms of perforation?
Distended Stomach
A nurse is caring for a client who has cirrhosis. Which of the following medications can the nurse expect to administer to this client? Select all that apply.
Diuretic, Beta-blocking agent, Opioid analgesic & Lactulose
A nurse is caring for a client who had surgery for colon cancer, which included the creation of a temporary colostomy. The client is 24 hours post-surgery. During an assessment of the client, a nurse notes no stool in the colostomy bag. A review of the client's medication records indicates that, since surgery, there has not been stool in the bag. Considering this information, the nurse should:
Document the findings
Why will they be deficient of Vitamin A, D, E and K?
Fat is unable to emulsify due to the bile redirecting to the blood
What type of transmission is Type A?
Fecal Oral
What position will relieve the pain for a patient with pancreatitis?
Fetal position or leaning forward
What is inserted into the colon?
Flexible scope is inserted
What would be a nursing intervention for a patient with acidis, how should fluid be removed?
Fluid restriction, paracentesis ( procedure used to aspirate fluid )
What causes Candidiasis?
Fungal
What is Laparoscopic Cholecystectomy?
Gallbladder is removed by laparoscopic techniques
Because of this procedure patient develops dumping syndrome, what is dumping syndrome?
Gastric emptying of undigested food into the small intestines
What interventions should be implemented in patients that bleed easily?
Give soft bristle toothbrushes, electric razors, avoid straining, vigorously blowing the nose and reducing the amount of venule puncture
What is the surgery for patients who have Oral Cancer?
Glossectomy ( removal of the tongue )
What should patients with celiac disease avoid?
Gluten
What color will the stool be in patients with Cholecystitis?
Gray colored due to the lack of bile
What are the two significant signs and symptoms of pancreatitis?
Grey Turner's sign ( bluish discoloration of the flank ) & Cullen's sign (ecchymosis or bruising on the umbilical area )
Common causes of peptic ulcers?
H. pylori
What is the best prevention for hepatitis A and E?
Handwashing
What would the patient be at risk for if they were given only vasopressin?
Heart Attack due to vasoconstriction occlusion of the coronary arteries
A nurse is reviewing the laboratory findings of a client who has an acute exacerbation of Crohn's disease. Which of the following laboratory findings should the nurse expect to be increased with Crohn's disease? Select all that apply
Hematocrit, Erythrocyte sedimentation rate (ESR), WBC
After completing discharge education, a nurse recognizes the need for further teaching when a client, diagnosed with cirrhosis, says:
I know propranolol (Inderal) has been ordered to decrease my blood pressure
It has been determined that a client which hepatitis has contracted the infection from contaminated food. Which type of hepatitis is this client most likely experiencing?
Hepatitis A
Hepatitis E coexist with which other one?
Hepatitis B and Hepatitis D
Which vaccine should a nurse recommend for prevention of liver cancer?
Hepatitis B vaccine
What other type of Hepatitis is also Fecal Oral?
Hepatitis E
Hepatitis C coexist with which other one?
Hepatitis G
An experienced nurse is most likely to teach a new nurse that surgery to repair a hiatal hernia is becoming more common to prevent the emergency complication of :
Hernia strangulation
What position should the nurse place the patient for the procedure?
High Fowlers Position
If patient is able to eat, what kind of diet?
High calorie, high carbohydrate, low fat, not caffeine / stimulant
What kinds of diet should be encouraged for dumping syndrome?
High protein and high calorie diet only
Would hyperglycemia or hypoglycemia be seen in patients with pancreatitis?
Hyperglycemia because of the pancreas disorder, the pancreas is unable to secrete insulin
What else would a patient with pancreatitis have?
Hypoalbuminemia
Why would acidis appear in patients?
Hypoalbuminemia, portal hypertension (decrease amount of albumin in order to hold fluid inside the blood volume )
Patient suddenly developed diaphoresis, palpitations, cold and clammy, What are those signs of?
Hypoglycemia, the pancreas response to the rapid transit of the food which causes an increased amount of insulin being produced and before the insulin can even react the food has already been gone out of the anus that's why patients have explosive diarrhea and borborygmi (gur gur gur sounds ) in the abdomen
How to tell if patients have liver cancer? What is the diagnostic test for patient with liver cancer?
Liver Biopsy
When protein is broken down it's converts to an ammonia, which part of the body will convert the ammonia?
Liver converts the ammonia into urea
If there is no drainage coming out from the NG tube, what is the first thing that the nurse should do?
Look for kink or obstruction of the NG tube because that might be the cause of it
Should protein be given to patients with hepatic encephalopathy?
Low amounts of protein
What other instructions should be given to patients with dumping syndrome?
Low fluids during meals, fluids should be taken between meals, recline ( lie down ) after meals
The student nurse is teaching a patient about his Crohn's disease. The student is correct in identifying what complication as being the result of granulomatous cobblestone lesions of the small intestine?
Malabsorption of nutrients
What specific point would the pain be felt?
Mcburney's Point
A patient has advanced cirrhosis of the liver with an acute exacerbation of hepatic encephalopathy? What type of food might be limited in his diet?
Meat
Is Liver Cancer primary or metastatic?
Metastatic
Can morphine be given to patient with cholecystitis?
Morphine will cause spasm and closure of the oddi
A client is admitted to a hospital for medical treatment of acute diverticulitis. A nurse should anticipate that this client's treatment plan will include: Select all that apply.
NPO, Antibiotics & Antiemetic medication
All signs and symptoms will include what?
Nausea, vomiting, dyspepsia and irritation
How do we kill the bacteria that's converting proteins into ammonia? What should be given to patient?
Neomycin
What else would be done in order to cleanse the bowel?
Neomycin or Erythromycin and antibiotics in order to sterilize the bowel
What other medications does vasopressin have to be given with?
Nitroglycerin
After a Lithotripsy procedure, will there be an incision?
No
Are EGD and colonoscopy procedures only for diagnostic testing?
No
Can nurses adjust the NG tube?
No
Can patients with Hepatitis B, Hep C, Hep D, Hep G donate blood, donate organs and breastfeed?
No
Do patients wake up at night for patients with gastric ulcers?
No
During the acute phase of pancreatitis, should the patient be allowed to eat?
No
Is gas able to pass for a patient with bowel obstruction?
No
Should patients with esophageal varices be asked to do valsalva maneuver?
No
Should patients with varices be asked to cough?
No
What if patient all of a sudden develops severe pain and rigid abdomen, why would this be reportable to the doctor?
Perforation of the stomach
What can be seen in patients with liver cirrhosis?
Petechiae, ecchymosis and purpura
The student nurse asks the nurse why a patient with advanced cirrhosis has an abdomen that is so swollen. Which response by the nurse is correct?
Portal hypertension and hypoalbuminemia cause a fluid shift into the peritoneal space
A nurse is caring for a client following a liver biopsy with the assistance of a student nurse. The nurse evaluates that the student understands the postprocedure care when the student nurse:
Positions the client on the right side
Is Pancreatic Cancer considered primary or metastatic?
Primary
A nurse on a medical-surgical unit is helping admit a client who has hepatitis B with ascites. Which of the following actions should the nurse include in the plan of care?
Provide a high-calorie, high-carbohydrate diet ( weight client daily NOT weekly)
What should be checked for after Whipple Procedure?
Pulmonary, cardiac or renal complications
Signs and Symptoms of GERD?
Pyrosis ( heartburn ), regurgitation, sore throat, hoarseness in larynx, difficulty swallowing, dysphagia and odynophagia
Why would there be a backflow of acid?
Relaxation of the lower esophageal sphincter
What is done during a whipple procedure?
Removal of pancreas, addition of the stomach, duodenum and common bile duct and gallbladder
If patient has achalasia, will small meals or large meals be given to them?
Small meals
A nurse is caring for an older adult client in an extended care facility. Which of the following findings indicates the client has a stool impaction causing a large intestine obstruction?
Small, frequent liquid stools
What is cancer of the stomach caused by?
Smoking & alcohol
What are the causes of esophageal cancer?
Smoking, alcohol
What foods can aggravate dumping syndrome condition?
Spicy, acidic and high carbohydrate
If Cholecystectomy patient has a Jackson Pratt after surgery, how should negative pressure be applied with Jackson Pratt?
Squeezing, compress and cover it to apply negative pressure
A nurse admits a male client to a hospital with exacerbation of asthma. During the admission history, the nurse learns that the client has a history of chronic hepatitis C. Which precautions should the nurse plan to implement based on the transmission of the hepatitis C virus?
Standard
How to tell if patient's colon has been cleaned and ready for colonoscopy?
Stool is clear liquid stool with no formed feces
What else is found in the stool of Crohn's disease?
Strattera ( fat found in stool )
What are the nursing management for patients with IBS?
Stress management, avoid gas forming foods
What types of medications can be used to treat inflammatory?
Sulfadoxine ( Sulfadiazine )
How can Ulcer Colitis be cured?
Surgery
What else can be done for a patient with ruptured esophageal varices?
Surgery, band ligation, give medication such as vasopressin ( decreases circulation, portal blood pressure )
What are the treatments for esophageal cancer?
Surgery, chemotherapy, radiation
After the procedure, other than seeing drainage, what else is seen?
Swelling
If patient has bleeding in upper GI, and patient poops, what color will be the stool?
Tar colored which is our melana
What color will be the urine in patients with Cholecystitis?
Tea colored because of the excretion of the bilirubin excreted into the urine
If there is swelling around the neck area, patient will have difficulty breathing, if so what should be in place?
Temporary tracheostomy to relieve edema
in the elimination of the ammonia?
The GI tract
A nurse anticipates that the conservative treatment of a client with acute cholecystitis will include:
The administration of anticholinergic medications
What other problems can occur in portal hypertension, only in the liver because of the blockage / injury in the liver that enables the liver to accept blood from the esophagus, stomach, spleen and intestines?
Varicose ( enlargement of veins, because the blood is backed up to where they came from )
Would hypocalcemia ( decreased amounts of calcium ) be seen in pancreatic patients?
Yes
Would patient develop absence of bowel sounds?
Yes
Why would patient complain of right shoulder pain after surgery?
The carbon dioxide
Which part of the body converts ammonia into urea?
The liver
What happens with the pancreatic juice does not come out?
The pancreatic duct will be destroyed
What is tracheoesophageal fistula?
There is a bridge between the trachea and esophagus, so whatever food that goes into the esophagus goes into the trachea
Why would a patient have pancreatitis?
There is an obstruction
What happens when there is edema in the common bile duct?
There is occlusion of the pathway
A patient has been prescribed infliximab (Remicade) for the treatment of Crohn's disease. What information should the nurse include in patient teaching regarding this medication?
This medication is given to suppress your immune system's overactive response.
What would be a complication of Sulfadiazine?
This medication will depress the immune system
A client with ulcerative colitis is started on the medication sulfasalazine (Azulfidine). A nurse overhears the client talking with family members about this medication and recognize the need for more teaching when the client says:
This medication will help to control my diarrhea
What are the usage of these balloons?
To compress the site of the bleeding by connecting one to the lavage
When caring for a patient with acute exacerbation of hepatic encephalopathy, the nurse may give a lactulose enema, provide a low-protein diet, and limit physical activity. The nurse explains to the patient that these measures are taken for what reason?
To decrease ammonia production
What would the NG Tube do?
To drain all the food content to prevent the food going into the peritoneum because the contact of the food and acid will lead to further complications such as peritonitis
Why would a T-tube be placed by doctor?
To redirect bile in order to provide rest for the common bile duct while it reduces or is absent in edema before the removal of the t-tube.
A patient is scheduled for a hemicolectomy for removal of a cancerous tumor of the ascending colon. The patient asks the nurse why he is taking intestinal antibiotic preoperatively. Which response by the nurse is correct?
To reduce the bacteria content of the colon
Why will lactulose be given to patient?
To remove the excessive ammonia in the body by making the patient poop out all the ammonia
If patients with peptic ulcer have pain, what should be given?
Tylenol
Which disease involves the mucosa and submucosa only?
Ulcerative Colitis
What are the different kinds of inflammatory diseases?
Ulcerative Colitis and Crohn's disease
When clamping the t -tube and patient complains of severe pain and becomes nauseous, what should be done next?
Unclamp the t-tube
If patient with perforation bleeds where will the bleeding likely occur?
Upper GI or hematemesis (vomiting of blood)
If patient patients needs a paracentesis procedure done, what should the nurse have the patient do first for preparation?
Urinate because if bladder is distended you might accidentally poke into the bladder
Should a patent airway be maintained?
Yes
What other things can be done during an EGD and colonoscopy procedure?
Visualize stomach ulcers, remove polyps to be sent to lab for a biopsy if something suspicious pops up
What will the patient be at risk for if there is no bile secreting into the duodenum?
Vitamin A, D, E and K deficiency
What does the liver produce?
Vitamin K
What types of actions will increase the abdominal pressure and should be avoided?
Vomiting, coughing, valsalva maneuver, and sneezing should be avoided
Best methods of preventing contamination?
Wash hands with soap and water
A nurse is reinforcing teaching on prevention of transmission of hepatitis A with a recently infected client. Which of the following should the nurse include?
Wash your hands after toileting
What is a hiatal hernia?
When a portion of the stomach goes up to the diaphragm
What position aggravates the pain for a patient with pancreatitis?
When patient is lying flat or in supine position
What is the Rovsing sign?
When you press on the left side of the abdomen and pain is felt on the right side
How can ammonia be removed / from the body?
Which part of the body will have to help
What surgery is done for a patient with pancreatic cancer?
Whipple Procedure (Pancreaticoduodenectomy)
What is seen in the mouth for patient with Candidiasis?
White plaque
If feces falls to the floor, what is the best way to clean it?
With bleach
After a cholecystectomy, will a T- tube also be inserted into the patient?
Yes
Because of the cobble stones in Crohn's disease will absorption capabilities be affected?
Yes
Can CDIF be acquired from the facility?
Yes
Can Trauma cause hiatal hernia?
Yes
Can a patient consume clear liquids after Laparoscopic Cholecystectomy?
Yes
Can a patient with appendicitis be at risk for shock?
Yes
Can a patient with esophageal cancer develop tracheoesophageal fistula?
Yes
Can a patient with pancreatitis develop paralytic ileus?
Yes
Can analgesic be given?
Yes
Can antibiotics and prolonged use or steroids cause Candidiasis?
Yes
Can damage of the biliary tract transcend to pancreatitis?
Yes
Can esophageal cancer metastasize to other areas of the body?
Yes
Can infectious disease cause pancreatitis?
Yes
Can patients suffer from pernicious anemia if they have the gastrectomy procedure done?
Yes
Can patients with cobble stones develop vitamin deficiency?
Yes
Can patients with gallbladder cancer develop hyperglycemia?
Yes
Can spider spider telangiectasias be seen?
Yes
Can the white plaque be scraped off?
Yes
Can these ulcers perforate?
Yes
Can weakness of the supporting structures cause hiatal hernia?
Yes
If a patient is at risk for esophageal varices, should we watch out for aspiration?
Yes
If aspiration is a risk, will breathing be a problem?
Yes
If patient has jaundice, will patient complain of pruritus?
Yes
Is a colonoscopy an outpatient procedure?
Yes
Is a consent required for a paracentesis procedure?
Yes
Is celiac disease genetic?
Yes
Is it normal for patients to have an NG tube after gastrectomy?
Yes
Is it normal to see bloody drainage 24 hours after surgery coming out of the NG tube?
Yes
Is there a feeling of incomplete evacuation even though they have indeed defecated? Is there flatulence?
Yes
Other that hematemesis, will patients also show signs of tarry stool ( melena ) ?
Yes
What should be done with the edematous scrotum?
elevate the scrotum with a little rolled up towel under a pillow to elevate scrotum to reduce edema and allow venous to return
How can dumping syndrome be prevented?
encourage patient to eat high in protein, low in carbohydrates, and six small meals.
What are we looking for during EGD ( esophagogastroduodenoscopy ) procedure?
esophagus, stomach, duodenum ( small intestines )
What position does the patient with appendicitis usually prefer to lay at?
fetal position
How is the liver converting the bilirubin?
from unconjugated to a conjugated bilirubin
What causes Diverticulosis?
herniation to the left lower quadrant caused by smoking, obesity, lack of activities, and diet especially if diet is low in fiber
What kind of diet causes colorectal cancer?
high fat and low fiber diet
Signs and symptoms of bowel obstruction?
high pitched sound will be heard during auscultation because peristalsis will be increased in order to relieve the obstruction
How to prevent hemorrhoids?
increase fiber intake and increase fluid intake to prevent constipation
How can you tell if patient is in shock, what would the the changes in vital signs?
increase in respiration, low blood pressure and increase in heart rate
What causes Diverticulitis?
inflammation of diverticulosis because of the feces obstructing the herniation
What would cause the patient to have urinary retention after a hemorrhoidectomy?
injured nerve during procedure which will cause patient to be unable to sense that there is urine present in the bladder
What types of hemorrhoids are there?
internal and external
What can be the other causes of peritonitis?
perforation of a gastric ulcer or ruptured diverticulitis
Due to the patient having frequent stools, what electrolytes will be lost?
potassium, sodium, chloride, bicarbonate
What type of pain would a patient with appendicitis have?
rebound tenderness ( pain felt when compression is released )
What part of the GI tract does Ulcerative Colitis affect?
rectum all the way up to the secum
What can be a prevention from diverticulosis?
reversing causes such as stop smoking, eating foods high in fiber and doing more physical activities
Where would the pain be for appendicitis?
right lower quadrant
What are some possible symptoms / complaints that patients may have if the hernia becomes strangulated?
severe sudden abdominal pain because patient has a hernia and and doesn't complain of pain until sudden pain occurs due to strangulation
What are some signs and symptoms of hiatal hernia?
similar symptoms of gerd, such as pyrosis ( heartburn ) and regurgitation
Which part of the GI tract is being affected in Crohn's Disease?
specifically concentrated on the ilium and proximal colon but it can start from the mouth all the way to the anus that is why patients complain of lower right quadrant pain
What is a nursing intervention for hemorrhoids?
stop the bleeding, invasive procedure such as surgery ( hemorrhoidectomy ) , noninvasive procedure such as rubber band ligation, cryotherapy, laser removal
Can the abdominal distention be decompressed and if so how?
suction with the insertion of NG ( nasal gastric ) tube and connection it to a suction
Why should you ask if patient's vomit smells like feces even though it doesn't look like feces?
these are retained products in the intestines for a prolonged period of time
What is done during a rubberband ligation?
tying of the hemorrhoids until the hemorrhoids slough off in one week
