NURS 370 Class 9: GI/Hepatobiliary Practice Questions
The nurse is caring for a patient with a duodenal ulcer and is relating the patients symptoms to the physiologic functions of the small intestine. What do these functions include? Select all that apply. A) Secretion of hydrochloric acid (HCl) B) Reabsorption of water C) Secretion of mucus D) Absorption of nutrients E) Movement of nutrients into the bloodstream
Ans: C, D, E The small intestine folds back and forth on itself, providing approximately 7000 cm2 (70 m2) of surface area for secretion and absorption, the process by which nutrients enter the bloodstream through the intestinal walls. Water reabsorption primarily takes place in the large bowel. HCl is secreted by the stomach.
A patient has had an ileostomy created for the treatment of irritable bowel disease and the patient is now preparing for discharge. What should the patient be taught about changing this device in the home setting? A) Apply antibiotic ointment as ordered after cleaning the stoma. B) Apply a skin barrier to the peristomal skin prior to applying the pouch. C) Dispose of the clamp with each bag change. D) Cleanse the area surrounding the stoma with alcohol or chlorhexidine.
B) Apply a skin barrier to the peristomal skin prior to applying the pouch. Guidelines for changing an ileostomy appliance are as follows. Skin should be washed with soap and water, and dried. A skin barrier should be applied to the peristomal skin prior to applying the pouch. Clamps are supplied one per box and should be reused with each bag change. Topical antibiotics are not utilized, but an antifungal spray or powder may be used.
A patient admitted with acute diverticulitis has experienced a sudden increase in temperature and complains of a sudden onset of exquisite abdominal tenderness. The nurses rapid assessment reveals that the patients abdomen is uncharacteristically rigid on palpation. What is the nurses best response? A) Administer a Fleet enema as ordered and remain with the patient. B) Contact the primary care provider promptly and report these signs of perforation. C) Position the patient supine and insert an NG tube. D) Page the primary care provider and report that the patient may be obstructed.
B) Contact the primary care provider promptly and report these signs of perforation. The patients change in status is suggestive of perforation, which is a surgical emergency. Obstruction does not have this presentation involving fever and abdominal rigidity. An enema would be strongly contraindicated. An order is needed for NG insertion and repositioning is not a priority.
A nurse is caring for a patient who just has been diagnosed with a peptic ulcer. When teaching the patient about his new diagnosis, how should the nurse best describe a peptic ulcer? A) Inflammation of the lining of the stomach B) Erosion of the lining of the stomach or intestine C) Bleeding from the mucosa in the stomach D) Viral invasion of the stomach wall
B) Erosion of the lining of the stomach or intestine A peptic ulcer is erosion of the lining of the stomach or intestine. Peptic ulcers are often accompanied by bleeding and inflammation, but these are not the definitive characteristics.
A patient has been admitted to the hospital after diagnostic imaging revealed the presence of a gastric outlet obstruction (GOO). What is the nurses priority intervention? A) Administration of antiemetics B) Insertion of an NG tube for decompression C) Infusion of hypotonic IV solution D) Administration of proton pump inhibitors as ordered
B) Insertion of an NG tube for decompression In treating the patient with gastric outlet obstruction, the first consideration is to insert an NG tube to decompress the stomach. This is a priority over fluid or medication administration.
A nurse caring for a patient with a newly created ileostomy assesses the patient and notes that the patient has had not ostomy output for the past 12 hours. The patient also complains of worsening nausea. What is the nurses priority action? A) Facilitate a referral to the wound-ostomy-continence (WOC) nurse. B) Report signs and symptoms of obstruction to the physician. C) Encourage the patient to mobilize in order to enhance motility. D) Contact the physician and obtain a swab of the stoma for culture.
B) Report signs and symptoms of obstruction to the physician. It is important to report nausea and abdominal distention, which may indicate intestinal obstruction. This Requires prompt medical intervention. Referral to the WOC nurse is not an appropriate short-term response, since medical treatment is necessary. Physical mobility will not normally resolve an obstruction.
Which of the following is a primary classification of colchicine? A. Analgesic B. Antigout C. Antibiotic D. Antiplatelet
B. Antigout
The nurse is assessing a patient who has a nasogastric tube (NGT) in place following gastric surgery. What complications should the patient be monitored for? A. Fluid and electrolyte imbalance B. Aspiration pneumonia C. Constipation D. Gastroesophageal reflux
B. Aspiration pneumonia
A nurse is caring for a client who has been admitted for the treatment of advanced cirrhosis. What assessment should the nurse prioritize in this client's plan of care? A. Measurement of abdominal girth and body weight B. Assessment for variceal bleeding. C. Assessment for signs and symptoms of jaundice. D. Monitoring of results of liver function testing.
B. Assessment for variceal bleeding. d/t fatality of about 20%
The patient with right upper quadrant abdominal pain has an abdominal ultrasound that reveals cholelithiasis. What should the nurse expect to do for this patient? A. Prevent all oral intake. B. Control abdominal pain. C. Provide enteral feedings. D. Avoid dietary cholesterol.
B. Control abdominal pain. Patients with cholelithiasis can have severe pain, so controlling pain is important until the problem can be treated. NPO status may be needed if the patient will have surgery but will not be used for all patients with cholelithiasis. Enteral feedings should not be needed, and avoiding dietary cholesterol is not used to treat cholelithiasis
A patient who is undergoing abdominal surgery will need a feeding tube. When would the surgeon place the tube? A. Prior to surgery B. During surgery C. The day after surgery D. Two to three weeks after surgery
B. During surgery
A client with acute cholecystitis is experiencing jaundice. Which should the nurse consider as the reason for the jaundice? A. Viral infection of the gallbladder B. Obstruction of the cystic duct by a gallstone C. Accumulation of bile in the hepatic duct D. Accumulation of fat in the wall of the gallbladder
B. Obstruction of the cystic duct by a gallstone When acute cholecystitis is accompanied by jaundice, partial common duct obstruction is likely, which is usually due to stones or inflammation.
A nurse is caring for a client with a blocked bile duct from a tumor. What manifestation of obstructive jaundice should the nurse anticipate? A. Watery, blood-streaked diarrhea B. Orange and foamy urine C. Increased abdominal girth D. Decreased cognition
B. Orange and foamy urine If the bile duct is obstructed, the bile will be reabsorbed into the blood and carried throughout the entire body. It is excreted in the urine, which becomes deep orange and foamy. Bloody diarrhea, ascites, and cognitive changes are not associated with obstructive jaundice.
What is the priority intervention when hypergranulation tissue is present around a feeding tube placement site? A. Cleaning the area around the tube with hydrogen peroxide B. Stabilizing the tube to reduce movement of the tube in the tract C. Replacing the tube with another type of tube D. Removing the tissue by rubbing briskly with an alcohol-soaked gauze
B. Stabilizing the tube to reduce movement of the tube in the tract
Which assessment information will be most important for the nurse to report to the health care provider about a patient with acute cholecystitis? A. The patient's urine is bright yellow. B. The patient's stools are tan colored. C. The patient has increased pain after eating. D. The patient complains of chronic heartburn.
B. The patient's stools are tan colored. Tan or grey stools indicate biliary obstruction, which requires rapid intervention to resolve. The other data are not unusual for a patient with this diagnosis, although the nurse would also report the other assessment information to the health care provider.
The nurse is providing care for a patient with a gastrostomy tube. What is a recommended intervention when using the tube to administer feeding or medication? A. Flush the tube with 60mL water before and after each feeding B. Use 10mL water to flush the tube before and after giving medications C. Flush the tube with water every 8 hours with continuous feedings D. Dilute all feedings with water to be sure the tube does not become clogged
B. Use 10mL water to flush the tube before and after giving medications
A patients health history is suggestive of inflammatory bowel disease. Which of the following would suggest Crohns disease, rather that ulcerative colitis, as the cause of the patients signs and symptoms? A) A pattern of distinct exacerbations and remissions B) Severe diarrhea C) An absence of blood in stool D) Involvement of the rectal mucosa
C) An absence of blood in stool Bloody stool is far more common in cases of UC than in Crohns. Rectal involvement is nearly 100% in cases of UC (versus 20% in Crohns) and patients with UC typically experience severe diarrhea. UC is also characterized by a pattern of remissions and exacerbations, while Crohns often has a more prolonged and variable course.
A nurse is assessing a patients stoma on postoperative day 3. The nurse notes that the stoma has a shiny appearance and a bright red color. How should the nurse best respond to this assessment finding? A) Irrigate the ostomy to clear a possible obstruction. B) Contact the primary care provider to report this finding. C) Document that the stoma appears healthy and well perfused. D) Document a nursing diagnosis of Impaired Skin Integrity.
C) Document that the stoma appears healthy and well perfused. A healthy, viable stoma should be shiny and pink to bright red. This finding does not indicate that the stoma is blocked or that skin integrity is compromised.
A patient asks the nursing assistant for a bedpan. When the patient is finished, the nursing assistant notifies the nurse that the patient has bright red streaking of blood in the stool. What is this most likely result of? A) Diet high in red meat B) Upper GI bleed C) Hemorrhoids D) Use of iron supplements
C) Hemorrhoids Feedback: Lower rectal or anal bleeding is suspected if there is streaking of blood on the surface of the stool. Hemorrhoids are often a cause of anal bleeding since they occur in the rectum. Blood from an upper GI bleed would be dark rather than frank. Iron supplements make the stool dark, but not bloody and red meat consumption would not cause frank blood.
A patients screening colonoscopy revealed the presence of numerous polyps in the large bowel. What principle should guide the subsequent treatment of this patients health problem? A) Adherence to a high-fiber diet will help the polyps resolve. B) The patient should be assured that these are a normal, age-related physiologic change. C) The patients polyps constitute a risk factor for cancer. D) The presence of polyps is associated with an increased risk of bowel obstruction.
C) The patients polyps constitute a risk factor for cancer. Although most polyps do not develop into invasive neoplasms, they must be identified and followed closely. They are very common, but are not classified as a normal, age-related physiologic change. Diet Will not help them resolve and they do not typically lead to obstructions.
The nurse provides discharge instructions for a 64-year-old woman with ascites and peripheral edema related to cirrhosis. Which statement, if made by the patient, indicates teaching was effective? A. "It is safe to take acetaminophen up to four times a day for pain." B. "Lactulose (Cephulac) should be taken every day to prevent constipation." C. "Herbs and other spices should be used to season my foods instead of salt." D. "I will eat foods high in potassium while taking spironolactone (Aldactone)."
C. "Herbs and other spices should be used to season my foods instead of salt." A low-sodium diet is indicated for the patient with ascites and edema related to cirrhosis. Table salt is a well-known source of sodium and should be avoided. Alternatives to salt to season foods include the use of seasonings such as garlic, parsley, onion, lemon juice, and spices. Pain medications such as acetaminophen, aspirin, and ibuprofen should be avoided as these medications may be toxic to the liver. The patient should avoid potentially hepatotoxic over-the-counter drugs (e.g., acetaminophen) because the diseased liver is unable to metabolize these drugs. Spironolactone is a potassium-sparing diuretic. Lactulose results in the acidification of feces in bowel and trapping of ammonia, causing its elimination in feces.
What position should the patient's head be in when receiving a tube feeding to prevent aspiration? A. Flat B. 10 degrees of elevation C. 30 degrees of elevation D. 45 degrees of elevation
C. 30 degrees of elevation Rationale: The semi-Fowler position is necessary for an NG feeding with the patient's head elevated at least 30 degrees to reduce the risk of aspiration. The nurse must assess external tube marking to avoid drift in placement and observe the patient for signs and symptoms of nausea that could lead to gastric reflux and aspiration.
A client with portal hypertension has been admitted to the medical floor. The nurse should prioritize what assessments? A. Assessment of blood pressure and assessment for headaches and visual changes B. Assessments for signs and symptoms of venous thromboembolism C. Daily weights and abdominal girth measurement D. Blood glucose monitoring q4h
C. Daily weights and abdominal girth measurement Obstruction to blood flow through the damaged liver results in increased blood pressure (portal hypertension) throughout the portal venous system. This can result in varices and ascites in the abdominal cavity. Assessments related to ascites are daily weights and abdominal girths. Portal hypertension is not synonymous with cardiovascular hypertension and does not create a risk for unstable blood glucose or VTE.
A nurse is performing an admission assessment of a client with a diagnosis of cirrhosis. What technique should the nurse use to palpate the client's liver? A. Place hand under the right lower abdominal quadrant and press down lightly with the other hand. B. Place the left hand over the abdomen and behind the left side at the 11th rib. C. Place hand under right lower rib cage and press down lightly with the other hand. D. Hold hand 90 degrees to right side of the abdomen and push down firmly.
C. Place hand under right lower rib cage and press down lightly with the other hand. To palpate the liver, the examiner places one hand under the right lower rib cage and presses downward with light pressure with the other hand. The liver is not on the left side or in the right lower abdominal quadrant.
A client who has undergone liver transplantation is ready to be discharged home. Which outcome of health education should the nurse prioritize? A. The client will obtain measurement of drainage from the T-tube. B. The client will exercise three times a week. C. The client will take immunosuppressive agents as required. D. The client will monitor for signs of liver dysfunction.
C. The client will take immunosuppressive agents as required. The client is given written and verbal instructions about immunosuppressive agent doses and dosing schedules. The client is also instructed on steps to follow to ensure that an adequate supply of medication is available so that there is no chance of running out of the medication or skipping a dose. Failure to take medications as instructed may precipitate rejection. The nurse would not teach the client to measure drainage from a T-tube as the client wouldn't go home with a T-tube. The nurse may teach the client about the need to exercise or what the signs of liver dysfunction are, but the nurse would not stress these topics over the immunosuppressive drug regimen.
The nurse is teaching a patient routine tube care for a newly placed percutaneous endoscopic gastrostomy (PEG) tube. What statement follows recommended guidelines for this care? A. Following placement of the tube, the external bolster will be left in place for one week B. A water-resistant dressing should be placed over the tube and insertion site and left in place for 48 hours C. The site of the tube should be washed with mild soap and water, rinsed well with water, and dried daily D. One gauze drain sponge may be placed under the bumper of a tube that is sutured in place to absorb any drainage from the site
C. The site of the tube should be washed with mild soap and water, rinsed well with water, and dried daily
A patient is scheduled for placement of a feeding tube in interventional radiology. What potential complication is avoided by using this method instead of the endoscopic methods? A. Bleeding B. Soft tissue infection C. Upper tract trauma D. Liver trauma
C. Upper tract trauma
A nurse is teaching a group of adults about screening and prevention of colorectal cancer. The nurse should describe which of the following as the most common sign of possible colon cancer? A) Development of new hemorrhoids B) Abdominal bloating and flank pain C) Unexplained weight gain D) Change in bowel habits
D) Change in bowel habits The most common presenting symptom associated with colorectal cancer is a change in bowel habits. The passage of blood is the second most common symptom. Symptoms may also include unexplained anemia, anorexia, weight loss, and fatigue. Hemorrhoids and bloating are atypical.
A nurse is creating a care plan for a patient with a nasogastric tube. How should the nurse direct other members of the care team to check correct placement of the tube? A) Auscultate the patients abdomen after injecting air through the tube. B) Assess the color and pH of aspirate. C) Locate the marking made after the initial x-ray confirming placement. D) Use a combination of at least two accepted methods for confirming placement.
D) Use a combination of at least two accepted methods for confirming placement. There are a variety of methods to check tube placement. The safest way to confirm placement is to utilize a combination of assessment methods.
When teaching the patient with acute hepatitis C (HCV), the patient demonstrates understanding when the patient makes which statement? A. "I will use care when kissing my wife to prevent giving it to her." B. "I will need to take adofevir (Hepsera) to prevent chronic HCV." C. "Now that I have had HCV, I will have immunity and not get it again." D. "I will need to be checked for chronic HCV and other liver problems."
D. "I will need to be checked for chronic HCV and other liver problems." The majority of patients who acquire HCV usually develop chronic infection, which may lead to cirrhosis or liver cancer. HCV is not transmitted via saliva, but percutaneously and via high-risk sexual activity exposure. The treatment for acute viral hepatitis focuses on resting the body and adequate nutrition for liver regeneration. Adofevir (Hepsera) is taken for severe hepatitis B (HBV) with liver failure. Chronic HCV is treated with pegylated interferon with ribavirin. Immunity with HCV does not occur as it does with HAV and HBV, so the patient may be reinfected with another type of HCV.
What is the duration of treatment for proton pump inhibitors in a patient diagnosed with peptic ulcer disease? A. 1-2 weeks B. 7 days C. At least 2 years based on risk factors D. 4-8 weeks
D. 4-8 weeks Rationale: Proton pump inhibitors should be used for 4-8 weeks to allow complete peptic ulcer heading. Patients at high risk require a maintenance dose for 1 year.
What is total nutrient admixture? A. Method of supplying nutrients to the body by the intravenous route B. An oil in water emulsion of oils, egg phospholipids, and glycerin C. A device designed and used for long-term administration of medications and fluids into central veins D. An admixture of lipid emulsions, proteins, carbohydrates, electrolytes, vitamins, trace minerals, and water
D. An admixture of lipid emulsions, proteins, carbohydrates, electrolytes, vitamins, trace minerals, and water Rationale: Parenteral nutrition is a method of supplying nutrients to the body by the intravenous route. Intravenous fat emulsion is an oil-in-water emulsion of oils, egg phospholipids, and glycerin. A central venous access device is designed and used fo long-term administration of medications and fluids into central veins. Total nutrient admixture is lipid emulsions, proteins, carbohydrates, electrolytes, vitamins, trace minerals, and water.
The health care provider orders lactulose for a patient with hepatic encephalopathy. The nurse will monitor the effectiveness of this medication for this patient by assessing what? A. Relief of constipation B. Relief of abdominal pain C. Decreased liver enzymes D. Decreased ammonia levels
D. Decreased ammonia levels Hepatic encephalopathy is a complication of liver disease and is associated with elevated serum ammonia levels. Lactulose traps ammonia in the intestinal tract. Its laxative effect then expels the ammonia from the colon, resulting in decreased serum ammonia levels and correction of hepatic encephalopathy
What is xerostomia? A. Protrusion of an organ in the mouth B. Difficulty swallowing C. Heartburn D. Dry mouth
D. Dry mouth Rationale: Xerostomia, or dryness of the mouth, is a frequent sequela of oral cancer. It is also seen inpatients who are receiving psychopharmacologic agents, taking multiple medications, or using drugs recreationally; in patients who have rheumatic diseases, eating disorders, or HIV infection; and inpatients who cannot close the mouth and, as a result, breathe through the mouth instead of the nose.
A patient who has hepatitis B surface antigen (HBsAg) in the serum is being discharged with pain medication after knee surgery. Which medication order should the nurse question because it is most likely to cause hepatic complications? A. Tramadol (Ultram) B. Hydromorphone (Dilaudid) C. Oxycodone with aspirin (Percodan) D. Hydrocodone with acetaminophen (Vicodin)
D. Hydrocodone with acetaminophen (Vicodin) The analgesic with acetaminophen should be questioned because this patient is a chronic carrier of hepatitis B and is likely to have impaired liver function. Acetaminophen is not suitable for this patient because it is converted to a toxic metabolite in the liver after absorption, increasing the risk of hepatocellular damage.
Which of the following would the nurse recognize as indication of biliary tube blockage? A. Increase the bile drainage output B. A change in the color of the drainage C. Cyanosis D. Inability to flush the tube
D. Inability to flush the tube
When planning care for a patient with cirrhosis, the nurse will give highest priority to which nursing diagnosis? A. Impaired skin integrity related to edema, ascites, and pruritus B. Imbalanced nutrition: less than body requirements related to anorexia C. Excess fluid volume related to portal hypertension and hyperaldosteronism D. Ineffective breathing pattern related to pressure on diaphragm and reduced lung volume
D. Ineffective breathing pattern related to pressure on diaphragm and reduced lung volume Although all of these nursing diagnoses are appropriate and important in the care of a patient with cirrhosis, airway and breathing are always the highest priorities.
The nurse is assessing a patient who has severe gastroesophageal reflux for placement of a feeding tube. What type of tube is the most appropriate for this patient? A. Percutaneous endoscopic gastrostomy (PEG) tube B. Nasogastric tube (NGT) C. Stamm gastrostomy tube D. Percutaneous gastrojejunal tube
D. Percutaneous gastrojejunal tube
Which is an example of a laxative osmotic agent? A. Bisacodyl B. Ducosate C. Magnesium hydroxide D. Polyethylene glycol and electrolytes
D. Polyethylene glycol and electrolytes Rationale: Polyethylene glycol and electrolytes is an osmotic agent. Bisacodyl is a stimulant laxative. Ducosate is an emollient stool softener. Magnesium hydroxide is a saline agent.
Which diuretic medication would most often be used for a patient with ascites? A. Actazolamide B. Ammonium chloride C. Furosemide D. Spironolactone
D. Spironolactone Rationale: Spironolactone is most often the first-line therapy in patients with ascites from cirrhosis. Oral diuretics such as furosemide may be added but should be used cautiously. Ammonium chloride and acetazolamide are contraindicated because of the possibility of precipitating hepatic coma
The nurse recognizes early signs of hepatic encephalopathy in the patient who A. manifests asterixis (liver flap) B. becomes unconscious C. has increasing oliguria D. is irritable and lethargic
D. is irritable and lethargic Early signs of this neurologic condition include euphoria, depression, apathy, irritability, confusion, agitation, drowsiness, and lethargy. Loss of consciousness is usually preceded by asterixis (late sign), disorientation, hyperventilation, hypothermia, and alterations in reflexes. Increasing oliguria is a sign of hepatorenal syndrome.
Normal color for T-tube drainage from bile duct or gallbladder is?
Dark-green/brownish yellow
How do we know difference between upper and lower GI bleed?
Depending on color of the blood; so upper would be darker bc digested and lower would be bright red
Is the following statement true or false? The most common site for diverticulitis is the ileum.
False Rationale: The most common site for diverticulitis is not the ileum. The most common site for diverticulitis is the SIGMOID.
Is the following statement true or false? After a radial neck dissection, when the endotracheal tube or airway has been removed and the effects of the anesthesia have worn off, the patient may be placed in the supine position to facilitate breathing and promote comfort.
False Rationale: After a radial neck dissection when the endotracheal tube or airway has been removed and the effects of the anesthesia have worn off, the patient may be placed in the Fowler position, not supine position, to facilitate breathing and promote comfort.
Is the following statement true or false? Measuring gastric residual volumes by removing gastric contents with a large syringe at routine intervals is common practice and recommended nursing management for patients receiving enteral nutrition.
False Rationale: Assessment of gastric residual volume has not been substantiated by research and may cause clogging of gastric tubes. This practice is not usually recommended
Is the following statement true or false? Bleeding esophageal varices result in an increase in renal perfusion
False Rationale: Bleeding esophageal varices do not result in an increase in renal perfusion. Bleeding esophageal varices result in a decrease in renal perfusion due to loss of blood
Is the following statement true or false? The majority of blood supply to the liver, which is poor in nutrients, comes from the portal vein.
False Rationale: The majority of blood supply to the liver, which is RICH in nutrients from the gastrointestinal tract, comes from the portal vein.
Is the following statement true or false? The most common site for peptic ulcer formation is the pylorus.
False Rationale: The most common site for peptic ulcer formation is not the pylorus. The most common site for peptic ulcer formation is the duodenum.
Is the following statement true or false? Lipase is an enzyme that aids in the digestion of protein.
False! Rationale: Lipase is an enzyme that aids in the digestion of FATS. Trypsin is an enzyme that aids in the digestion of protein.
Which clinical manifestations are attributed to compensated hepatic cirrhosis?
H. Reddened palms I. Vascular spiders J. Morning indigestion K. Abdominal p L. Flatulent dyspepsia M. Firm, enlarged liver
Diet for chronic constipation?
High fiber, high residue
Is the following statement true or false? Older adults with gastric cancer may have no gastric symptoms
True Rationale: Confusion, agitation, restlessness, and reduced functional ability may be the only symptoms in older adults with gastric cancer. These clinical manifestations are often due to metastasis.
Is the following statement true or false? Only persons with hepatitis B are at risk for hepatitis D
True Rationale: Only persons with hepatitis B are at risk for hepatitis D. Hepatitis D is common among those w house IV or injection drugs, patients undergoing hemodialysis, and recipients of multiple blood transfusions. Sexual contact with those who have hepatitis B is considered to be an important mode of transmission of hepatitis B and D.
Is the following statement true or false? Fistulas are common in Crohn's disease.
True Rationale: Perianal involvement, fistulas, and abdominal mass are common in Crohn's disease.
Is the following statement true or false? When a colonoscopy is performed, the flexible scope is passed through the rectum and sigmoid colon in to the descending, transverse, and ascending colon.
True! Rationale: When a colonoscopy is performed, the flexible scope is passed through the rectum and sigmoid colon into the descending, transverse, and ascending colon. When a flexible fiber optic sigmoidoscopy is performed, the flexible scope is advanced past the proximal sigmoid and then into the descending colon.
A patient has been admitted with diabetes mellitus, malnutrition, osteomyelitis, and alcohol abuse. Laboratory results are significant for an alanine aminotransferase (ALT) of 198 IU/L and aspartate transaminase (AST) of 224 IU/L. Which diagnosis does the nurse attribute these findings to? a. Diabetes mellitus b. Alcohol abuse c. Malnutrition d. Osteomyelitis
b. Alcohol abuse In the patient with alcohol abuse, liver disease could develop as a complication, increasing the liver function tests above the normal levels. The normal ALT range is 7 to 56 IU/L and the normal AST range is 5 to 40 IU/L. Diabetes would result in elevated blood sugar levels. Malnutrition would be evidenced by low protein levels. Osteomyelitis is an infection of the bone, which would result in an elevated white blood cell count.
A patient has an increased ammonia level associated with hepatic encephalopathy. What assessment finding does the nurse expect? a. Aphasia b. Asterixis c. Hyperactivity d. Acute dementia
b. Asterixis Asterixis is a twitching spasm of the hands and wrists seen in patients with increased ammonia levels in conditions such as hepatic encephalopathy. Aphasia, hyperactivity, and acute dementia are manifestations not associated with hepatic encephalopathy. Besides asterixis, an increased serum ammonia level causes sedation and confusion that progress to a comatose state.
The patient with advanced cirrhosis asks why his or her skin is so yellow. The nurse's response is based on the knowledge that: a. Decreased peristalsis in the gastrointestinal tract contributes to a buildup of bile salts. b. Jaundice results from the body's inability to conjugate and excrete bilirubin. c. A lack of clotting factors promotes the collection of blood under the skin surface. d. Decreased colloidal oncotic pressure from hypoalbuminemia causes the yellowish skin discoloration.
b. Jaundice results from the body's inability to conjugate and excrete bilirubin. Jaundice results from the functional derangement of liver cells and compression of bile ducts by connective tissue overgrowth. Jaundice occurs as a result of the decreased ability to conjugate and excrete bilirubin Jaundice is not caused by a build-up of bile salts, a lack of clotting factors, or decreased colloidal oncotic pressure.
A patient with cancer that has metastasized to the liver manifests symptoms of fluid retention, including edema and ascites. To determine the effectiveness of the diuretic therapy that has been prescribed, what should the nurse assess? a. Breath sounds b. Bowel sounds c. Abdominal girth d. Recent blood work
c. Abdominal girth Daily measurement of the abdominal girth provides a direct indication of ascitic fluid increase or decrease. Breath and bowel sounds are usually not affected by liver metastasis until the late stages, when fluid overload and multisystem organ involvement occur. Reviewing the results of the most recent blood work will not show direct measurement of the effectiveness of diuretic therapy.
The nurse evaluates the effectiveness of a paracentesis in a patient who has ascites. Which measurement is most important for the nurse to note? a. Cardiac output b. Blood pressure c. Abdominal girth d. Intake and output
c. Abdominal girth Paracentesis involves the removal of fluid from the abdominal cavity. A large-bore needle connected to tubing is inserted by the health care provider into the distended abdomen. The other end of the tubing also has a large-bore needle, which is inserted into a vacuum bottle. The vacuum bottle is then held below the level of the abdomen, facilitating gravity-flowed removal of the ascites. Several bottles of fluid can be removed, with the result measured by reduction in abdominal girth. Cardiac output may improve after paracentesis, but it is unlikely that this measurement needs to be recorded. Paracentesis has no major effect on blood pressure. Likewise, intake and output continue to be monitored to account for the paracentesis fluid but these are not as informative as abdominal girth.
The nurse recalls that hepatic coma results primarily from accumulation of which substance in the blood? a. Sodium b. Calcium c. Ammonia d. Potassium
c. Ammonia A high ammonia level in the blood is a late manifestation of liver failure that results in hepatic coma, causing neurologic dysfunction and brain damage. Sodium, calcium, and potassium are not directly affected by liver dysfunction or hepatic coma.
A patient admitted to the hospital with cirrhosis of the liver suddenly starts vomiting blood. What is the priority action that the nurse should take in this situation? a. Send for endoscopic variceal ligation. b. Give propranolol orally. c. Stabilize the patient and manage the airway. d. Check for signs of cirrhosis
c. Stabilize the patient and manage the airway. Individuals with cirrhosis of the liver are at risk of bleeding from esophageal and gastric varices. Hematemesis in the patient with cirrhosis of the liver is likely to be variceal bleeding. In this case, the nurse should first stabilize the patient and manage the airway. Once the patient is stable, other steps in treatment can be initiated, such as assessing further and administering necessary medications.
A patient with hepatitis A asks whether other family members are at risk for "catching" the disease. The nurse's response will be based on the knowledge that hepatitis A is transmitted primarily: a. During sexual intercourse b. By contact with infected body secretions c. Through fecal contamination of food or water d. Through kissing that involves contact with mucous membranes
c. Through fecal contamination of food or water Hepatitis A is primarily transmitted through ingestion of organisms on fecally contaminated hands, food, or water. Care should be taken in the handling of food and water, as well as contaminated items such as bed linens, bedpans, and toilets. Hand hygiene and personal protective equipment such as gloves are important in preventing the spread of infection for hospital personnel. In the home, hand hygiene and good personal hygiene are important in decreasing the risk of transmission. Sexual intercourse, contact with infected body secretions, and contact through mucous membranes all present higher risk for hepatitis B and C than for hepatitis A.
During the treatment of the patient with bleeding esophageal varices, it is most important that the nurse a. prepare the patient for immediate portal shunting surgery b. perform guaiac testing on all stools to detect occult blood c. maintain the patient's airway and prevent aspiration of blood d. monitor for the cardiac effects of IV vasopressin and nitroglycerin
c. maintain the patient's airway and prevent aspiration of blood Bleeding esophageal varices are a medical emergency. During an episode of bleeding, management of the airway and prevention of aspiration of blood are critical factors. Occult blood as well as fresh blood from the GI tract would be expected and is not tested. Vasopressin causes vasoconstriction, decreased HR, and decreased coronary blood flow; nitroglycerin is given with the vasopressin to counter these side effects. Portal shunting surgery is performed for esophageal varices but not during an acute hemorrhage
The nurse is admitting a patient with cirrhosis. The nurse checks the patient's history for which most frequent risk factor associated with cirrhosis? a. Polypharmacy b. Intravenous drug abuse c. Hepatitis A d. Alcohol abuse
d. Alcohol abuse Cirrhosis is highly correlated with alcohol abuse. Polypharmacy, drug abuse, and hepatitis A are not linked to cirrhosis.
A patient with a 3-year history of liver cirrhosis is hospitalized for treatment of recently diagnosed esophageal varices. What is the most important information for the nurse to include in the teaching plan for this patient? a. Decrease fluid intake to avoid ascites. b. Eat foods quickly so they do not get cold and cause distress. c. Avoid exercise because it may cause bleeding of the varices. d. Avoid straining during defecation to keep venous pressure low
d. Avoid straining during defecation to keep venous pressure low Straining during a bowel movement increases venous pressure and could cause rupture of the varices. Fluid restrictions may be a recommendation for ascites but are not directly associated with esophageal varices. If the patient is able to eat, meals should be soft or liquid, and the patient should be instructed to eat slowly and avoid extremes in food temperature to prevent irritation. Excessive exercise and activity should be avoided in a patient with esophageal varices to prevent hypertension, however, avoiding straining and other activities that cause the Valsalva maneuver is still a higher-priority recommendation.
AST is an enzyme found mainly in what organs of the body? Choose all that apply A. Heart B. Gallbladder C. Liver D. Lungs
A Heart C Liver
A patient comes to the clinic complaining of pain in the epigastric region. What assessment question during the health interview would most help the nurse determine if the patient has a peptic ulcer? A) Does your pain resolve when you have something to eat? B) Do over-the-counter pain medications help your pain? C) Does your pain get worse if you get up and do some exercise? D) Do you find that your pain is worse when you need to have a bowel movement?
A) Does your pain resolve when you have something to eat? Pain relief after eating is associated with duodenal ulcers. The pain of peptic ulcers is generally unrelated to activity or bowel function and may or may not respond to analgesics.
A 35-year-old male patient presents at the emergency department with symptoms of a small bowel obstruction. In collaboration with the primary care provider, what intervention should the nurse prioritize? A) Insertion of a nasogastric tube B) Insertion of a central venous catheter C) Administration of a mineral oil enema D) Administration of a glycerin suppository and an oral laxative
A) Insertion of a nasogastric tube Decompression of the bowel through a nasogastric tube is necessary for all patients with small bowel obstruction. Peripheral IV access is normally sufficient. Enemas, suppositories, and laxatives are not indicated if an obstruction is present.
The nurse is preparing to perform a patients abdominal assessment. What examination sequence should the nurse follow? A) Inspection, auscultation, percussion, and palpation B) Inspection, palpation, auscultation, and percussion C) Inspection, percussion, palpation, and auscultation D) Inspection, palpation, percussion, and auscultation
A) Inspection, auscultation, percussion, and palpation When performing a focused assessment of the patients abdomen, auscultation should always precede percussion and palpation because they may alter bowel sounds. The traditional sequence for all other focused assessments is inspection, palpation, percussion, and auscultation.
Diagnostic imaging and physical assessment have revealed that a patient with peptic ulcer disease has suffered a perforated ulcer. The nurse recognizes that emergency interventions must be performed as soon as possible in order to prevent the development of what complication? A) Peritonitis B) Gastritis C) Gastroesophageal reflux D) Acute pancreatitis
A) Peritonitis Perforation is the erosion of the ulcer through the gastric serosa into the peritoneal cavity without warning. Chemical peritonitis develops within a few hours of perforation and is followed by bacterial peritonitis. Gastritis, reflux, and pancreatitis are not acute complications of a perforated ulcer.
A patient who experienced an upper GI bleed due to gastritis has had the bleeding controlled and the patients condition is now stable. For the next several hours, the nurse caring for this patient should assess for what signs and symptoms of recurrence? A) Tachycardia, hypotension, and tachypnea B) Tarry, foul-smelling stools C) Diaphoresis and sudden onset of abdominal pain D) Sudden thirst, unrelieved by oral fluid administration
A) Tachycardia, hypotension, and tachypnea Tachycardia, hypotension, and tachypnea are signs of recurrent bleeding. Patients who have had one GI bleed are at risk for recurrence. Tarry stools are expected short-term findings after a hemorrhage. Hemorrhage is not normally associated with sudden thirst or diaphoresis.
A nurse is preparing to provide care for a patient whose exacerbation of ulcerative colitis has required hospital admission. During an exacerbation of this health problem, the nurse would anticipate that the patients stools will have what characteristics? A) Watery with blood and mucus B) Hard and black or tarry C) Dry and streaked with blood D) Loose with visible fatty streaks
A) Watery with blood and mucus The predominant symptoms of ulcerative colitis are diarrhea and abdominal pain. Stools may be bloody and contain mucus. Stools are not hard, dry, tarry, black or fatty in patients who have ulcerative colitis.
When providing discharge teaching for the patient after a laparoscopic cholecystectomy, what information should the nurse include? A. A lower-fat diet may be better tolerated for several weeks. B. Do not return to work or normal activities for 3 weeks. C. Bile-colored drainage will probably drain from the incision. D. Keep the bandages on and the puncture site dry until it heals.
A. A lower-fat diet may be better tolerated for several weeks. Although the usual diet can be resumed, a low-fat diet is usually better tolerated for several weeks following surgery. Normal activities can be gradually resumed as the patient tolerates. Bile-colored drainage or pus, redness, swelling, severe pain, and fever may all indicate infection. The bandage may be removed the day after surgery, and the patient can shower.
A nurse is teaching a client who has hepatitis B about home care. Which of the following should the nurse include in the teaching? (Select all that apply.) A. Limit physical activity. B. Avoid alcohol. C. Take acetaminophen for comfort. D. Wear a mask when in public places. E. Eat small frequent meals.
A. CORRECT: Limiting physical activity and taking frequent rest breaks conserves energy and assists in the recovery process for a client who has hepatitis B. B. CORRECT: Alcohol is metabolized in the liver and should be avoided by the client who has hepatitis B. E. CORRECT: A client who has hepatitis B should eat small frequent meals to promote improved nutrition due to the presence of anorexia.
Your patient with liver cirrhosis exhibits ascites. Which of the following are appropriate actions to take while caring for this patient? A. Elevate HOB at least 30 degrees for respiratory support B. Administer diuretics C.Feed patient a normal diet 3x/day D. Restrict sodium
A. Elevate HOB at least 30 degrees for respiratory support B. Administer diuretics D. Restrict sodium
Which complication is the most commonly associated with surgically placed gastrostomy tubes as opposed to percutaneous endoscopic? A. Incisional hernia B. Perforation of the GI tract C. Injury to intra-abdominal viscera D. Fistula creation
A. Incisional hernia
Which is the correct order to complete an abdominal assessment? A. Inspection, auscultation, percussion, and palpation B. Auscultation, inspection, palpation, and percussion C. Percussion, palpation, inspection, and auscultation D. Palpation, percussion, auscultation, and inspection
A. Inspection, auscultation, percussion, and palpation Rationale: The correct order for an abdominal assessment is inspection, auscultation, percussion, and palpation. Auscultation must be completed before manipulation of the abdomen because it has an impact on motility and can lead to an inaccurate interpretation of bowel sounds.
What wound be the first intervention when a feeding tube become clogged? A. Milk the tube to remove any mechanical obstruction B. Aspirate fluid from the tube and instill 20mL warm water into the tube C. If the tube remains clogged after instilling water, use pancreatic enzyme tablet and sodium carbonate tablet cursed and mixed in 10 mL water D. Use 60 -ml catheter filled with air and pull back and forth on the plunger to dislodge the obstruction
A. Milk the tube to remove any mechanical obstruction
Which clinical manifestations are attributed to decompensated hepatic cirrhosis?
A. Muscle wasting B. Ascites C. Jaundice D. Weight loss E. Clubbing of fingers F. Hypotension G. Sparse body hair
What type of tube wound be used for a patient who needs kidney stone removal? A. Nephrostomy tube B. Biliary tube C. Gastrostomy tube D. Jejunostomy tube
A. Nephrostomy tube
A client is experiencing severe upper abdominal pain and jaundice. Which finding on the cholescintigraphy should indicate to the nurse that the client has cholelithiasis? A. Obstruction of the cystic duct by a gallstone B. Viral infection of the gallbladder C. Accumulation of fat in the wall of the gallbladder D. Accumulation of bile in the hepatic duct
A. Obstruction of the cystic duct by a gallstone Cholelithiasis is almost always caused by a gallstone lodged in the cystic duct. Accumulation of bile in the hepatic duct would not lead to cholecystitis. Neither the accumulation of fat nor a viral infection leads to cholecystitis.
What is ingestion? A. Occurs when food is taken into the GI tract via the mouth and esophagus B. Occurs when enzymes mix with ingested food and when proteins, fats, and sugars are broken down into their component molecules C. Occurs when small molecules, vitamins, and minerals pass through the walls of the small and large intestine and into the bloodstream D. Occurs after digestion and absorption when waste products are eliminated from the body
A. Occurs when food is taken into the GI tract via the mouth and esophagus Rationale: Ingestion occurs when food is taken in to the GI tract via the mouth and esophagus. Digestion occurs when enzymes mix with ingested food and when proteins, fats, and sugars are broken down in to their component molecules. Absorption occurs when small molecules, vitamins, and minerals pass through the walls of the small and large intestine and into the bloodstream. Elimination occurs after digestion and absorption when waste products are eliminated from the body.
A percutaneous endoscopic gastrostomy (PEG) tube may be contraindicated in a patient with the following diagnosis? A. Severe ascites B. Ulcerative colitis C. Peptic ulcer D. Crohn's disease
A. Severe ascites
A client has developed hepatic encephalopathy secondary to cirrhosis and is receiving care on the medical unit. The client's current medication regimen includes lactulose four times daily. What desired outcome should the nurse relate to this pharmacologic intervention? A. Two to three soft bowel movements daily B. Significant increase in appetite and food intake C. Absence of nausea and vomiting D. Absence of blood or mucus in stool
A. Two to three soft bowel movements daily Lactulose is given to reduce serum ammonia levels. Two or three soft stools per day are desirable; this indicates that lactulose is performing as intended. Lactulose does not address the client's appetite, symptoms of nausea and vomiting, or the development of blood and mucus in the stool.
The patient with cirrhosis has an increased abdominal girth from ascites. The nurse should know that this fluid gathers in the abdomen for which reasons (select all that apply)? A. There is decreased colloid oncotic pressure from the liver's inability to synthesize albumin. B. Hyperaldosteronism related to damaged hepatocytes increases sodium and fluid retention. C. Portal hypertension pushes proteins from the blood vessels, causing leaking into the peritoneal cavity. D. Osmoreceptors in the hypothalamus stimulate thirst, which causes the stimulation to take in fluids orally. E. Overactivity of the enlarged spleen results in increased removal of blood cells from the circulation, which decreases the vascular pressure.
ANS: A, B, C The ascites related to cirrhosis are caused by decreased colloid oncotic pressure from the lack of albumin from liver inability to synthesize it and the portal hypertension that shifts the protein from the blood vessels to the peritoneal cavity, and hyperaldosteronism which increases sodium and fluid retention. The intake of fl
When caring for a patient with a biliary obstruction, the nurse will anticipate administering which vitamin supplements (select all that apply)? A. Vitamin A B. Vitamin D C. Vitamin E D. Vitamin K E. Vitamin B
ANS: A, B, C, D Biliary obstruction prevents bile from entering the small intestine and thus prevents the absorption of fat-soluble vitamins. Vitamins A, D, E, and K are all fat-soluble and thus would need to be supplemented in a patient with biliary obstruction.
When caring for a patient with liver disease, the nurse recognizes the need to prevent bleeding resulting from altered clotting factors and rupture of varices. Which nursing interventions would be appropriate to achieve this outcome (select all that apply)? A. Use smallest gauge needle possible when giving injections or drawing blood. B. Teach patient to avoid straining at stool, vigorous blowing of nose, and coughing. C. Advise patient to use soft-bristle toothbrush and avoid ingestion of irritating food. D. Apply gentle pressure for the shortest possible time period after performing venipuncture. E. Instruct patient to avoid aspirin and NSAIDs to prevent hemorrhage when varices are present.
ANS: A, B, C, E Using the smallest gauge needle for injections will minimize the risk of bleeding into the tissues. Avoiding straining, nose blowing, and coughing will reduce the risk of hemorrhage at these sites. The use of a soft-bristle toothbrush and avoidance of irritating food will reduce injury to highly vascular mucous membranes. The nurse should apply gentle but prolonged pressure to venipuncture sites to minimize the risk of bleeding. Aspirin and NSAIDs should not be used in patients with liver disease because they interfere with platelet aggregation, thus increasing the risk for bleeding
