NCLEX: Section 9 -Chapter 60 - Gastrointestinal Disorders

The nurse should evaluate results of which laboratory tests while caring for a client who has cirrhosis of the liver? Select all that apply. 1. Prothrombin time 2. Urinalysis 3. Serum lipase 4. Serum troponin 5. Serum albumin

Answer: 1, 5 Rationale: Many clotting factors are produced in the liver, including fibrinogen (factor I), prothrombin (factor II), factor V, serum prothrombin conversion accelerator (factor VII), factor IX, and factor X.

The nurse is educating the client with gastroesophageal reflux disease (GERD) about ways to minimize symptoms. Which information in the client's history should the nurse address as an indicator that needs to be changed? Select all that apply. 1. Lifting weights for exercise 2. Being a vegetarian 3. Having a body mass index of 26 4. Taking calcium carbonate tablets 5. Drinking 2-4 cups of coffee daily

Answer: 1, 3, 5 Rationale: Lifestyle modifications can minimize symptoms of GERD.

A client has a total gastrectomy. The nurse explains to the client the need for long-term injections of which vitamin? 1. Thiamine 2. Folic acid 3. Cyanocobalamin 4. Niacin

Answer: 3 Rationale: The loss of parietal cells that secrete intrinsic factor results in vitamin B12 (cyanocobalamin) defi- ciency postgastrectomy, because intrinsic factor is needed for absorption of vitamin B12.

The nurse is admitting a child with a diagnosis of "rule out appendicitis." The nurse assesses this client for which manifestations? Select all that apply. 1. Generalized abdominal pain 2. Pain localizing in right lower quadrant 3. Fatty stools 4. Elevated white blood cell count 5. Indigestion

1 Answer: 1, 2, 4 Rationale: Manifestations of appendicitis often begin with generalized abdominal pain.

The nurse is taking a history from the mother of a child being admitted with flare-up of celiac disease. What piece of information would the nurse expect the mother to report? 1. Stools that are fatty 2. An increased appetite with no weight gain 3. Episodes of abdominal pain that are wavelike just before meals 4. Soft, formed stools

Answer: 1 Rationale: Acute episodes of celiac disease are characterized by bulky, frothy stools with fat.

The nurse caring for a client with hemolytic jaundice anticipates which findings on laboratory test results? 1. Elevated serum indirect bilirubin 2. Decreased serum protein 3. Elevated urine bilirubin 4. Decreased urine pH

Answer: 1 Rationale: Hemolytic jaundice is caused by excessive breakdown of red blood cells, and the amount of bilirubin produced exceeds the ability of the liver to conjugate it, so there is an increase in indirect bilirubin.

The client with diverticular disease is scheduled for a sigmoidoscopy and suddenly reports severe abdominal pain. On examination, the nurse notes a rigid abdomen with guarding. What action should the nurse take next? 1. Notify the physician. 2. Place the client in a more comfortable position. 3. Keep the client distracted until the procedure begins. 4. Tell the client that the test will show what is causing his problem.

Answer: 1 Rationale: Perforation of an obstructed diverticulum can cause abscess formation or generalized peritonitis.

A client is being evaluated for possible duodenal ulcer. The nurse assesses the client for which manifestation that would support this diagnosis? 1. Epigastric pain relieved by food 2. History of chronic aspirin use 3. Distended abdomen 4. Positive fluid wave

Answer: 1 Rationale: The pain of a gastric ulcer is dull and aching, occurs after eating, and is not relieved by food as is the pain from duodenal ulcer. T

The post-cholecystectomy client asks the nurse when the T-tube will be removed. Which response by the nurse would be appropriate? 1. "When your stool returns to a normal brown color, the tube can be removed." 2. "The tube will be removed at the same time as your staples." 3. "When the tube stops draining, it will be removed." 4. "The tube is usually removed the day after surgery."

Answer: 1 Rationale: When T-tube drainage subsides and stools return to a normal brown color, the tube can be clamped 1 to 2 hours before and after meals in preparation for tube removal.

Which laboratory test would the nurse expect to be ordered for a child with dehydration caused by vomiting and diarrhea? Select all that apply. 1. Serum sodium 2. Urine specific gravity 3. Serum ammonia 4. Serum amylase 5. Blood urea nitrogen (BUN)

Answer: 1, 2, 5 Rationale: Serum sodium would be expected to increase in a client with dehydration because of hemoconcentration.

Which assessments made by the nurse could indicate the development of portal hypertension in a client with cirrhosis? Select all that apply. 1. Hemorrhoids 2. Bleeding gums 3. Muscle wasting 4. Splenomegaly 5. Ascites

Answer: 1, 4, 5 Rationale: Obstruction to portal blood flow causes a rise in portal venous pressure resulting in splenomeg- aly, ascites, and dilation of collateral venous channels predom- inantly in the paraumbilical and hemorrhoidal veins, the cardia of the stomach, and extending into the esophagus.

The client returning from a colonoscopy has been given a diagnosis of Crohn's disease. The oncoming shift nurse expects to note which manifestations in the client? Select all that apply. 1. Steatorrhea 2. Firm, rigid abdomen 3. Constipation 4. Enlarged hemorrhoids 5. Diarrhea

Answer: 1, 5 Rationale: Steatorrhea is often present in the client with Crohn's disease.

The client who has ulcerative colitis is scheduled for an ileostomy. When the client asks the nurse what to expect related to bowel function and care after surgery, what response should the nurse make? 1. "You will be able to have some control over your bowel movements." 2. "The stoma will require that you wear a collection device all the time." 3. "After the stoma heals, you can irrigate your bowel so you will not have to wear a pouch." 4. "The drainage will gradually become semisolid and formed."

Answer: 2 Rationale: A client with an ileostomy has no control over bowel movements and must always wear a collection device.

A nurse who floats to the infant and toddlers nursing unit asks the pediatric nurse about the notation "ESSR" on the care plan of a client. The nurse explains that this documentation refers to which item? 1. The feeding method for children with gastroesophageal reflux 2. The feeding method for children with cleft lip or palate 3. The procedure for repair of pyloric stenosis 4 . The procedure for repair of Hirschsprung's disease

Answer: 2 Rationale: ESSR is the abbreviation for the four key steps in feeding the infant or child with cleft lip or palate.

The client with a duodenal ulcer asks the nurse why an antibiotic is part of the treatment regimen. Which infor- mation should the nurse include in the response? 1. Antibiotics decrease the likelihood of a secondary infection. 2. Many duodenal ulcers are caused by the Helicobacter pylori organism. 3. Antibiotics are used in an attempt to sterilize the stomach. 4. Many people have Clostridium difficile, which can lead to ulcer formation.

Answer: 2 Rationale: Helicobacter pylori infection is a major cause of peptic ulcers so treatment includes antibiotic therapy to eradicate the microorganisms.

The nurse caring for a client with uncomplicated cholelithiasis anticipates that the client's laboratory test results will show an elevation in which of the following? 1. Serum amylase 2. Alkaline phosphatase 3. Mean corpuscular hemoglobin concentration (MCHC) 4. Indirect bilirubin

Answer: 2 Rationale: Obstructive biliary disease causes a significant elevation in alkaline phosphatase.

The mother of a child undergoing an emergency appendectomy tells the nurse, "If I had brought him in yesterday when he complained of an upset stomach, this wouldn't have happened." What is the best response by the nurse? 1. "It's okay; you got him here just in time before it ruptured." 2. "It is often difficult to predict when a simple complaint will become more serious." 3. "Next time he seems sick, you should bring him in immediately." 4. "Sometimes parents can make a mistake without meaning to do so."

Answer: 2 Rationale: Parents often react to a child's illness with feelings of guilt for not recognizing the severity of the condition sooner.

A client with diverticular disease undergoes a colonoscopy. During an abdominal assessment, the nurse looks for which sign to indicate a possible complication of the procedure? 1. Diarrhea 2. Nausea and vomiting 3. Guarding and rebound tenderness 4. Redness and warmth of the abdominal skin

Answer: 3 Rationale: Bowel perforation is a possible result of colonoscopy if the colonoscope accidentally pierces the bowel wall.

The nurse is teaching home feeding guidelines to the mother of a child with nonorganic failure to thrive. Essential information for the nurse to include would be the importance of which item? 1. Restricting eating except at mealtimes 2. Allowing the child to eat alone to minimize distraction 3. Allowing the child to snack on finger foods, such as circular oat cereal and bananas 4. A relaxed mealtime with few limits on behavior

Answer: 3 Rationale: Finger foods are helpful in encouraging children with failure to thrive to increase food intake.

The nurse is caring for a child with a history of severe diarrhea. Which notation about acid-base imbalance would the nurse expect to find in the medical record? 1. Respiratory acidosis 2. Respiratory alkalosis 3. Metabolic acidosis 4. Metabolic alkalosis

Answer: 3 Rationale: In severe diarrhea, excess bicarbonate (base) is lost, which predisposes to metabolic acidosis.

A mother arrives at the pediatric clinic with her 6-month- old infant. While the nurse assesses the child, the mother points to the umbilicus and says: "What am I going to do about this? When he cries, it looks like it's going to burst." What is the best response by the nurse? 1. "It's best if you don't let him cry." 2. "It probably won't rupture unless he gets excessively upset. I wouldn't worry about it at this time." 3. "I know it looks frightening, but it really won't burst." 4. "Put a binder around it, and that will keep it from bursting when he

Answer: 3 Rationale: It is a common finding that when the infant with an umbilical hernia cries, the hernia protrudes but will not rupture.

A child with Hirschsprung's disease is being discharged after Soave endorectal pull-through procedure for colostomy closure. Which item should the nurse include in the discharge teaching plan? 1. Stools may be infrequent and uncomfortable for the first few weeks. 2. It will be necessary to perform weekly rectal irrigations for approximately 6 weeks. 3. Report fever, increasing pain or discomfort, or redness of the incision to the surgeon. 4. Stools will be fatty for a week or so and then gradually return to normal.

Answer: 3 Rationale: It is important that any signs of infection be reported at once.

A 9-year-old male client with severe esophagitis is 12 hours status/post-Nissen fundoplication for gastroesophageal reflux. What action by the nurse would be appropriate while providing nursing care? 1. Encourage him to take small amounts of clear liquids every 4 hours. 2. Administer nasogstric or gastrostomy feedings every 4 hours. 3. Ask him to choose a face on the Wong FACES pain rating scale. 4. Insert a pH probe to monitor esophageal acidity.

Answer: 3 Rationale: Pain management is a high priority following gastric surgery, and the nurse should use age- appropriate tools to assess for pain, such as the Wong FACES rating scale. A

The nurse is caring for a client who has ascites, and the health care provider prescribes spironolactone (Aldactone). The client asks why this drug is being used. What is the best response by the nurse? 1. "This drug will help increase the level of protein in your blood." 2. "The drug will cause an increase in the amount of the hormone aldosterone your body produces." 3. "This medication is a diuretic but does not make the kidneys excrete potassium." 4. "This will help you excrete larger amounts of ammonia."

Answer: 3 Rationale: Spironolactone is used in clients with asci- tes who show no improvement with bedrest and fluid restric- tion. It inhibits sodium reabsorption in the distal tubule and promotes potassium retention by inhibiting aldosterone.

In caring for a client 4 days post-cholecystectomy, the nurse notices that drainage from the T-tube is 600 mL in 24 hours. Which is the most appropriate action by the nurse? 1. Clamp the tube q 2 hours for 30 minutes 2. Place the patient in a supine position 3. Assess drainage characteristics and notify the physician 4. Encourage an increased fluid intake

Answer: 3 Rationale: The T-tube may drain up to 500 mL in the first 24 hours and decreases steadily thereafter.

The nurse is conducting dietary teaching with a client who has dumping syndrome. The nurse encourages the client to avoid which foods that the client usually enjoys? Select all that apply. 1. Eggs 2. Cheese 3. Fruit 4. Pork 5. Cookies

Answer: 3, 5 Rationale: Dumping syndrome, in which gastric contents rapidly enter the bowel, can occur following gastrectomy.

The nurse is caring for a client with a history of alcoholism. Which findings would indicate that the client has possibly developed chronic pancreatitis? Select all that apply. 1. Steady weight gain 2. Flank pain on left side only 3. Fatty stools 4. Excessive hunger 5. Constipation and flatulence

Answer: 3, 5 Rationale: Steatorrhea (fatty stools) result from a decrease in pancreatic enzyme secretion with pancreatitis.

When caring for a client who has cirrhosis, the nurse notices flapping tremors of the wrist and fingers. How should the nurse chart this finding? 1. "Trousseau's sign noted." 2. "Caput medusa noted." 3. "Fetor hepaticus noted." 4. "Asterixis noted."

Answer: 4 Rationale: Asterixis, also called liver flap, is the flapping tremor of the hands when the arms are extended. Trousseau's sign reflects hypocalcemia.

A 10-month-old female infant with biliary atresia is being discharged after a Kasai procedure. Which statement, if made by the parents, indicates that teaching with regard to prognosis has been understood? 1. "We are glad this problem was found so early; now everything will be fine." 2. "We will stop her liver medicine now that she is being discharged." 3. "We are happy to be able to stop that special formula and many of those vitamins." 4. "We know that even though surgery is over, she will likely need a liver transplant."

Answer: 4 Rationale: Because the Kasai procedure is palliative, a liver transplant is required in 80 to 90% of cases. T

A client is scheduled for a fecal fat exam. In planning client education, the nurse includes that which dietary modification is necessary before the test? 1. Eat a fat-free diet the day before the exam. 2. Eat a high-fat meal right before the exam. 3. Eat a diet containing 35 grams of fat for 36 hours before the test. 4. Eat at least 100 grams of fat for 3 days before and during the test.

Answer: 4 Rationale: It is suggested that adults consume at least 100 grams of fat per day for 3 days before the test and throughout specimen collection.

A client was admitted to the hospital with cholelithiasis the previous day. Which new assessment finding indicates to the nurse that the stone has probably obstructed the common bile duct? 1. Nausea 2. Elevated cholesterol level 3. Right upper quadrant (RUQ) pain 4. Jaundice

Answer: 4 Rationale: Nausea and RUQ pain occur in cholelithiasis, but obstruction of the common bile duct results in reflux of bile into the liver, which produces jaundice.