N 403 Ch 43 PrepU
A patient is scheduled for a fiberoptic colonoscopy. What does the nurse know that fiberoptic colonoscopy is most frequently used to diagnose? - Bowel disease of unknown origin - Cancer - Inflammatory bowel disease - Occult bleeding
Correct response: Cancer Explanation: This procedure is used commonly as a diagnostic aid and screening device. It is most frequently used for cancer screening and for surveillance in patients with previous colon cancer or polyps. In addition, tissue biopsies can be obtained as needed, and polyps can be removed and evaluated. Other uses of colonoscopy include the evaluation of patients with diarrhea of unknown cause, occult bleeding, or anemia; further study of abnormalities detected on barium enema; and diagnosis, clarification, and determination of the extent of inflammatory or other bowel disease.
A nurse is preparing a client with Crohn's disease for a barium enema. What should the nurse do the day before the test? - Serve the client his usual diet. - Order a high-fiber diet. - Encourage plenty of fluids. - Serve dairy products.
Correct response: Encourage plenty of fluids. Explanation: The nurse should encourage plenty of fluids because adequate fluid intake is necessary to avoid dehydration that may be caused by the bowel preparation and to prevent fecal impaction after the procedure. The client may be placed on a low-residue diet 1 to 2 days before the procedure to reduce the contents in the GI tract. Fiber intake is limited in a low-residue diet. Because dairy products leave a residue, they aren't allowed the evening before the test. Clear liquids only are allowed the evening before the test.
The nurse is working on a general medical unit. A client is scheduled for an upper gastrointestinal series. Upon returning to the nursing unit, what does the nurse identify as the client goal? - Recovery from the general anesthesia - Decrease in nausea and vomiting - Increase in the amount of fluids - Ambulates independently
Correct response: Increase in the amount of fluids Explanation: The client, returning from an upper gastrointestinal series, needs to increase fluids in an effort to eliminate the barium from the body through a bowel movement. General anesthesia is not used. The client typically does not have nausea and vomiting following the procedure. If the client is able to ambulate independently prior to the procedure, the client will be able to ambulate independently following.
A client is scheduled for bowel resection with anastomosis involving the large intestine. Because of the surgical site, the nurse formulates the nursing diagnosis of Risk for infection. To complete the nursing diagnosis statement, the nurse should add which "related-to" phrase? - Related to major surgery required by bowel resection - Related to the presence of bacteria at the surgical site - Related to malnutrition secondary to bowel resection with anastomosis - Related to the presence of a nasogastric (NG) tube postoperatively
Correct response: Related to the presence of bacteria at the surgical site Explanation: The nurse should add "Related to the presence of bacteria at the surgical site" to the diagnosis of Risk for infection. The large intestine normally contains bacteria because its alkaline environment permits growth of organisms that putrefy and break down remaining proteins and indigestible residue. These organisms include Escherichia coli, Aerobacter aerogenes, Clostridium perfringens, and Lactobacillus. Although bowel resection with anastomosis is considered major surgery, it poses no greater risk of infection than any other type of major surgery. Malnutrition seldom follows bowel resection with anastomosis because nutritional absorption (except for some water, sodium, and chloride) is completed in the small intestine. An NG tube is placed through a natural opening, not a wound, and therefore doesn't increase the client's risk of infection.
It is important for a nurse to have an understanding of the major digestive enzymes and their actions. Choose the gastric mucosa secretion that plays an important role in the digestion of triglycerides. - Ptyalin - Trypsin - Amylase - Steapsin
Correct response: Steapsin Explanation: Ptyalin and amylase work to digest starch; trypsin works on proteins and polypeptides. Triglycerides are digested by steapsin, and pharyngeal and pancreatic lipase.
A client with diabetes begins to have digestive problems and is told by the physician that they are a complication of the diabetes. Which of the following explanations from the nurse is most accurate? - The nerve fibers of the intestinal lining are experiencing neuropathy. - The pancreas secretes digestive enzymes. - Elevated glucose levels cause bacteria overgrowth in the large intestine. - Insulin has an adverse effect of constipation.
Correct response: The pancreas secretes digestive enzymes. Explanation: While the pancreas has the well-known function of secreting insulin, it also secretes digestive enzymes. These enzymes include trypsin, amylase, and lipase. If the secretion of these enzymes are affected by a diseased pancreas as found with diabetes, the digestive functioning may be impaired.
When completing a nutritional assessment of a patient who is admitted for a GI disorder, the nurse notes a recent history of dietary intake. This is based on the knowledge that a portion of digested waste products can remain in the rectum for how many days after a meal is digested? - 1 day - 2 days - 3 days - 4 days
Correct response: 3 days Explanation: As much as 25% of the waste products from a meal may still be in the rectum 3 days after a meal is ingested.
When describing the role of the pancreas to a client with a pancreatic dysfunction, the nurse would identify which substance as being acted on by pancreatic lipase? - Starch - Protein - Triglycerides - Glucose
Correct response: Triglycerides Explanation: Pancreatic lipase acts on lipids, especially triglycerides. Salivary amylase and pancreatic amylase act on starch. Pepsin and hydrochloric acid in the stomach and trypsin from the pancreas act on proteins. Insulin acts on glucose.
The nurse prepares to administer the lavage solution to a client having a colonoscopy completed. The nurse stops and notifies the physician when noting that the client has which condition? - inflammatory bowel disease - chronic obstructive pulmonary disease - congestive heart failure - pulmonary hypertension
Correct response: inflammatory bowel disease Explanation: The nurse stops administering the lavage solution and notifies the physician when the nurse notes that the client has inflammatory bowel disease. Another contraindication for use of lavage solution is intestinal obstruction. Chronic obstructive pulmonary disease (COPD), congestive heart failure, and pulmonary hypertension are not contraindications to administration of lavage solution in preparation for a colonoscopy.
Lisa Bentley, a 32-year-old teacher, presents to the gastroenterology office where you work. She is known to have a history of Crohn's disease, and you have met with her several times to discuss the various health concerns that she has related to her diagnosis. When talking with the client, the nurse explains that having a GI disorder doesn't mean her problems are limited to the one area that is diseased but might also involve all of the following except ________. - metabolism - ingestion - digestion - absorption - elimination
Correct response: metabolism Explanation: The client with a GI disorder may experience a wide variety of health problems that involve disturbances of ingestion, digestion, absorption, and elimination.
When bowel sounds are heard about every 15 seconds, the nurse would record that the bowel sounds are - normal. - hypoactive. - sluggish. - absent.
Correct response: normal. Explanation: Normal bowel sounds are heard every 5 to 20 seconds. Hypoactive bowel sound is the description given to auscultation of one to two bowel sounds in 2 minutes. Sluggish is not a term a nurse would use to accurately describe bowel sounds. The nurse records that bowel sounds are absent when no sound is heard in 3 to 5 minutes.
Upon hearing that the small intestine lining has thinned, an elderly client asks, "What can this lead to?" What is the best response by the nurse? - "You may frequently have diarrhea." - "You may frequently experience constipation." - "It is the aging process." - "At times you may see mucus in your stool."
Correct response: "You may frequently experience constipation." Explanation: As a person ages, the epithelial cells and villi thin in the small intestine. Implications of this consequence include decreased intestinal motility and transit time, which can lead to constipation. This would lead the nurse to discuss and advise the client on ways to prevent constipation.
The nurse is preparing the client for an assessment of the abdomen. What should the nurse complete prior to this assessment? Prepare for a prostate examination. Ask the client to empty the bladder. Assist the client to a Fowler's position. Dim the lights for privacy.
Correct response: Ask the client to empty the bladder. Explanation: The physical examination of the gastrointestinal system includes assessment of the mouth, abdomen, and rectum. It requires good light, full exposure of the abdomen, warm hands with short nails, and a relaxed client with an empty bladder. A full bladder will interfere with inspection and may elicit discomfort with palpation and percussion, thereby altering results.
A client is scheduled for several diagnostic tests to evaluate gastrointestinal function. After teaching the client about these tests, the nurse determines that the client has understood the teaching when the client identifies which test as not requiring the use of a contrast medium? Small bowel series Computer tomography Colonoscopy Upper GI series
Correct response: Colonoscopy Explanation: A colonoscopy is a direct visual examination of the entire large intestine. It does not involve the use of a contrast agent. Contrast medium may be used with a small bowel series, computed tomography, and upper GI series.
The nurse prepares a client for a barium enema. The nurse should place the client on which diet prior to the procedure? high-fiber diet 1 to 2 days prior soft diet 1 day prior nothing by mouth (NPO) 2 days prior clear liquids day before
Correct response: clear liquids day before Explanation: The nurse should place the client on clear liquids the evening before the procedure, a low-residue diet 1 to 2 days before the test, and NPO at midnight in preparation for the barium enema.
The nurse is reviewing the results of a hemoccult test with the client. Which question asked by the nurse is important in screening for the potential of a false-positive result. Select all that apply. - "Do you take an iron supplement on a daily basis?" - "Does your diet include a moderate amount of vitamin C?" - "Are you prescribed regular strength aspirin daily?" - "Can you tell me the amount of alcohol that you drink on an average week?" - "When was the last time that you included red meat in your diet?"
Correct response: "Are you prescribed regular strength aspirin daily?" "Can you tell me the amount of alcohol that you drink on an average week?" "When was the last time that you included red meat in your diet?" Explanation: When obtaining a positive Hemoccult test, the client needs to be screened for a false-positive test result. Substances that may cause a false-positive include red meat, aspirin, and excessive alcohol. Screening for the frequency and amount of these are important. False-negative results are screened in individuals who ingest ascorbic acid and iron supplements.
The nurse provides client education to a client about to undergo hydrogen breath testing. The nurse evaluates that the client understands the test when the client makes which statement? "First, I will drink a cherry flavored liquid." "The test will detect the presence of staph." "I should avoid antibiotics for 1 month before the test." "The test will detect the presence of oral cancer."
Correct response: "I should avoid antibiotics for 1 month before the test." Explanation: The nurse evaluates that the client understands the education when the client states antibiotics should be avoided one month before the test. In addition, the client should avoid loperamide, sucralfate, and omeprazole for 1 week prior to the test, and cimetidine, famotidine, and nizatidine for 24 hours before the test. During the test, the client swallows a capsule of carbon-labeled urea and a breath sample is obtained 10 to 20 minutes later. The hydrogen breath test detects the presence of <italic>Helicobacter pylori, the bacteria that causes peptic ulcer disease.
When assisting with preparing a client scheduled for a barium swallow, which of the following would be appropriate to include? - Avoid smoking for at least 12 to 24 hours before the procedure. - Take vitamin K before the procedure. - Take three cleansing enemas before the procedure. - Avoid the intake of red meat before the procedure.
Correct response: Avoid smoking for at least 12 to 24 hours before the procedure. Explanation: The nurse should instruct the client to avoid smoking for at least a day before the procedure of barium swallow because smoking stimulates gastric motility. The client is advised to take vitamin K before a liver biopsy and instructed to take three cleansing enemas before a barium enema. Instruction to avoid red meat would be appropriate for a client who is having a Hemoccult test.
