PP gastrointestinal

A client with acute pancreatitis has a blood pressure of 88/40 mm Hg, a heart rate of 128 bpm, respirations of 28 breaths/min, and Grey Turner sign. What prescription should the nurse implement first?

Place an intravenous (IV) line.

A client with diverticular disease is receiving psyllium hydrophilic mucilloid. Which response from the client indicates to the nurse that the drug is having the intended effect?

"I can pass stool without cramping."

Which statement about ileostomy care indicates that the client understands the discharge instructions?

"I need to drink at least 3000 mL a day of fluid."

Which statement indicates that the client with a peptic ulcer understands the dietary modifications to follow at home?

"I should avoid alcohol and caffeine."

A home health nurse is educating a client who has been diagnosed with diverticulitis about dietary modifications necessary to prevent future episodes. Which statement by the client indicates effective teaching?

"I should increase my intake of fresh fruits and vegetables during remissions."

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

"I will ask the surgeon to come speak to you about the procedure."

Which client statement indicates a need for further instruction about a duodenal ulcer?

"I will need to take an antacid before every meal."

A client with constipation takes psyllium granules as 1 rounded teaspoon mixed in fruit juice 3 times daily. Which of the following statements by the client indicates that further teaching is required?

"I will need to take the medication for 4 weeks."

Which statement, made by a client with a hiatal hernia, indicates that the client understands the treatment plan?

"I will sit in a chair for several hours after I eat."

A client diagnosed with gastroenteritis and mild dehydration has a history of being unable to tolerate oral intake for 3 days. Intravenous therapy is prescribed. The nurse anticipates administering what solution to treat the mild dehydration?

D5 NS solution injection

The nurse is teaching a client with stomatitis about managing oral discomfort. Which instruction is most appropriate?

Eat a soft, bland diet.

An adult with appendicitis has severe abdominal pain. Which action will be the most effective to assist the client to manage pain before surgery?

Place the client in semi-Fowler position with the knee gatch raised.

The nurse is caring for a client who had a bowel resection one week ago. Which interventions are most appropriate to promote wound healing and reduce risk of infection at the incision site? Select all that apply.

Provide the client with Ensure supplements. Increase intake of protein and vitamin C in the diet. Teach the client to wash hands before touching the incision.

A nurse is caring for a client with an endotracheal tube who receives enteral feedings through a feeding tube. Before each tube feeding, the nurse checks for tube placement in the stomach as well as residual volume. The purpose of the nurse's actions is to prevent

aspiration.

The nurse is assigned a client with a nasogastric (NG) tube. What intervention will the nurse include in the client's plan of care?

assessment of lung sounds every 4 hours

A client, age 82, is admitted to an acute care facility for treatment of an acute flare-up of a chronic GI condition. In addition to assessing the client for complications of the current illness, the nurse monitors for age-related changes in the GI tract. Which age-related change increases the risk of anemia?

atrophy of the gastric mucosa

A client had a nephrectomy 2 days ago and is now complaining of abdominal pressure and nausea. The first nursing action should be to

auscultate bowel sounds.

A client with esophageal cancer decides against placement of a jejunostomy tube. Which ethical principle is a nurse upholding by supporting the client's decision?

autonomy

The nurse is obtaining a health history for an adult with a possible hiatal hernia. Which of the following is a risk factor for this client that would most likely contribute to the development of a hiatal hernia?

being 5 feet, 3 inches (160 cm) tall and weighing 190 lb (86.2 kg)

A client who had a cholecystectomy has a T-tube for drainage. The nurse measures the amount of bile drainage from the T-tube at the end of each shift. How should the nurse record the drainage?

charting it separately on the output record

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

diaphoresis, vomiting, and diarrhea.

Metoclopramide is prescribed as a premedication for a client about to undergo a gastroduodenoscopy. What expected therapeutic effect of this drug should the nurse assess in this client?

increased gastric emptying

A client is recovering from an ileostomy that was performed to treat inflammatory bowel disease. During discharge teaching, the nurse should stress the importance of

increasing fluid intake to prevent dehydration.

A nurse is assessing a client and obtains the following findings: abdominal discomfort, mild diarrhea, and a temperature of 100°F (37.8°C). The nurse questions the client about a past diagnosis of what condition?

inflammatory bowel disease (IBD)

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

discontinued use of blood thinners

A client with an esophageal stricture is about to undergo esophageal dilatation. As the bougies are passed down the esophagus, the nurse should instruct the client to do which action to minimize the vomiting urge?

Take long, slow breaths.

A client with a history of alcohol abuse was admitted with bleeding esophageal varices. After several days of treatment, the client is ready for discharge. The nurse enters the client's room to review discharge instructions with the client when the client tells the nurse that they want help to quit drinking. How should the nurse respond?

"I'll notify your physician and call the social worker so they can discuss treatment options with you."

A client diagnosed with ulcerative colitis also experiences obsessive-compulsive anxiety disorder (OCD). In helping the client understand their illness, the nurse should respond with which statement?

"It's possible that your desire to have everything be perfect has caused stress that may have worsened your colitis, but there is no proof that either disorder caused the other."

Two days following a colon resection, an older adult client shows new-onset confusion. When contacting the health care provider, the nurse should make which recommendation?

"Shall I collect and send a urine sample for culture and sensitivity?"

A client newly diagnosed with ulcerative colitis who has been placed on steroids asks the nurse why steroids are prescribed. What should the nurse tell the client?

"Steroids are used in severe flare-ups because they can decrease the incidence of bleeding."

A nurse is caring for a client immediately following an appendectomy. The nurse should assign which nursing diagnosis the highest priority?

Acute pain

A client is evaluated for severe pain in the right upper abdominal quadrant, which is accompanied by nausea and vomiting. The physician diagnoses acute cholecystitis and cholelithiasis. For this client, which nursing diagnosis takes top priority?

Acute pain related to biliary spasms

Which outcome is appropriate for the client with hepatitis B?

Adhere to measures to prevent the spread of infection to others.

A nurse presents a client with the informed consent form for an abdominal paracentesis. The client asks the nurse what the procedure involves. The nurse should

notify the physician that the client doesn't understand the procedure.

A client with a history of a hiatal hernia presents to the clinic with reports of worsening pain, and the health care provider orders an endoscopy. Which nursing actions will be provided after upper endoscopy? Select all that apply.

Assess for sudden pain. Assess for shock. Assess for rapid pulse. Assess for decreased blood pressure.

A nurse is caring for a client that received a colostomy 2 days ago. Which is the priorityintervention?

Assess the drainage from the stoma.

A client is admitted with a bowel obstruction. The client has nausea, vomiting, and crampy abdominal pain. The health care provider (HCP) has written the following prescriptions: for the client to be up ad lib, have narcotics for pain, have a nasogastric tube inserted if needed, and for intravenous (IV) Ringer's lactate and hyperalimentation fluids. What should the nurse do in order of priority from first to last? All options must be used.

Assist with ambulation to promote peristalsis. Insert a nasogastric tube. Administer IV Ringer's lactate. Start an infusion of hyperalimentation fluids.

Which nursing intervention should the nurse perform for a client receiving enteral feedings through a gastrostomy tube?

Change the tube feeding administration set at least every 24 hours.

During clindamycin therapy, a nurse monitors a client for pseudomembranous colitis. This serious adverse reaction to clindamycin results from superinfection with which organism?

Clostridioides difficile

The nurse is teaching a client to prevent dumping syndrome after bariatric surgery. Which suggestions will the nurse discuss? Select all that apply.

Include a protein with each meal. Limit fluids with meals. Eat six small meals a day. Lie down for 15 minutes after a meal.

A nurse is planning care for an adult who is hospitalized for diarrhea and dehydration. The client is receiving intravenous fluids but continues to have watery stools. The nurse reviews the intake and output record for the last 24 hours (view the chart). Which action should the nurse take?

Increase fluids.

The nurse is assessing a client's abdominal incision 48 hours after surgery. Which finding indicates that the wound is inflamed?

Localized warmth is felt over the incisional area.

A client has been taking aluminum hydroxide 30 mL six times per day at home to treat a peptic ulcer. The client has been unable to have a bowel movement for 3 days. What should the nurse determine is the most likely cause of the client's constipation?

The client is experiencing an adverse effect of aluminum hydroxide.

The nurse working in an internal medicine clinic receives four phone calls from clients with chronic pancreatitis. Which client should the nurse contact first?

The client reporting increased thirst and hunger.

A client arrives for an annual physical examination. During the history, the client reports recurrent symptoms of heartburn, a sour taste in the mouth, and hoarseness in the throat. In anticipation of client teaching, illustrate on the diagram the location of the structure which frequently enables these symptoms to occur.

The lower esophageal sphincter is a ring of muscle fibers that prevents food from moving backward from the stomach into the esophagus. If this sphincter does not close well, food, fluids, and stomach contents can irritate and even damage the esophagus. Symptoms include heartburn, a sour taste in the mouth, hoarseness, dysphagia, and feelings of a lump in the throat.

After a nasogastric (NG) tube has been inserted, which finding helps the nurse determine that the tube is in the proper place?

The pH of the aspirated fluid is measured.

When caring for a client with hepatitis B, which situation would expose the nurse to the virus?

a blood splash into the nurse's eyes

The nurse is making staffing assignments. Which client can be assigned to an unlicensed assistive personnel (UAP)?

a client who is having radiation for cancer of the stomach and is to have the radiation site bathed with warm water, followed by an application of a moisturizer

The nurse has made rounds on a team of clients. The nurse should discuss which client with the health care provider (HCP)?

a client with hepatitis whose pulse was 84 bpm and regular and is now 118 bpm and irregular

An adult client had an abdominal perineal resection with a colostomy 4 days ago and is ready for discharge. Which is an expected outcome at this point? The client:

discusses concerns about sexual functioning.

A client with cirrhosis of the liver is in the hospital. The nurse involves the client in developing a plan of care. What would be important aspects to include in this plan?

discussing collaborative goals and involving the client in identifying and prioritizing important interventions

The client attends two sessions with the dietitian to learn about diet modifications to minimize gastroesophageal reflux. The teaching would be considered successful if the client decreases the intake of which foods?

fats

A client with a bleeding ulcer is vomiting bright red blood. The nurse should assess the client for which indicator of early shock?

heart rate above 100 beats/min

A client who has been diagnosed with gastroesophageal reflux disease (GERD) has heartburn. To decrease the heartburn, the nurse should instruct the client to eliminate which item from their diet?

hot chocolate

A client is scheduled to undergo an exploratory laparoscopy. The registered nurse (RN) asks the licensed practical nurse (LPN) to prepare the client for surgery. The RN must confirm that the LPN has specialized training before delegating which task?

initiating I.V. therapy, as ordered

The nurse assesses the client's stoma during the initial postoperative period. What observation should the nurse report to the health care provider (HCP) immediately? The Stoma:

is dark red to purple.

When planning care for a client with a small-bowel obstruction, which should the nurse consider to be the primary goal?

maintaining fluid balance

While ambulating, a client who had an open cholecystectomy complains of feeling dizzy and then falls to the floor. After attending to the client, a nurse completes an incident report. Which action by the nurse should the charge nurse correct?

making a copy of the incident report for the client

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

metabolic alkalosis

A nurse should expect to administer which vaccine to the client after a splenectomy?

pneumococcal vaccine-injection

What would be the priority treatment of a client who has reported severe lower right quadrant pain that has now resolved?

preparation for emergency surgery

The nurse diagnoses a client with acute pancreatitis. The client is being transferred to another facility. The nurse completes the transfer summary, which includes information about the client's drinking history and other assessment findings. Which assessment findings confirm the nurse's diagnosis?

recent weight loss and temperature elevation

A nurse is caring for a client who has had paraplegia for 6 years. The client is admitted with a bleeding peptic ulcer. What would be a priority teaching concern for the nurse?

recommending foods included in a bland diet

The nurse assigns an unlicensed assistive personnel (UAP) to provide care for a client with peptic ulcer disease. Concerned about possible ulcer perforation, the nurse should instruct the UAP to report to the nurse immediately if the client has:

severe abdominal pain.

Thirty minutes after a Sengstaken-Blakemore tube is inserted, the client appears to be having difficulty breathing. What should the nurse do first?

Determine whether the tube is obstructing the airway.

The client with a peptic ulcer is taking antibiotics and bismuth salts. The nurse should give the client which information about the expected outcome of these medications?

Eradicate the Helicobacter pylori bacteria.

On the second day following an abdominal-perineal resection, the nurse notes that the wound edges are not approximated and one-half of the incision has torn apart. What should the nurse do first?

Cover the wound with a sterile dressing moistened with normal saline.

The nurse teaches the parents of an infant diagnosed with Hirschsprung disease about the disease. The nurse determines that the parents understand the diagnosis when the parent makes which statement?

"The nerves at the end of the large colon are missing."

The nurse is preparing to administer a 75% strength tube-feeding formula. The full-strength formula is available. To prepare 500 ml of feeding, the nurse would plan to dilute how many milliliters of the full-strength formula with water? Record your answer as a whole number.

375

A client with ascites is experiencing severe respiratory distress and refuses endotracheal intubation. What should be the nurse's first action?

Determine whether the client is competent to make the decision.

A client's abdominal incision eviscerates. What should the nurse do first?

Cover the incision with a dressing moistened with sterile normal saline solution.

Following a subtotal gastrectomy, a client has a nasogastric (NG) tube connected to low suction. What should the nurse do?

Monitor the client for nausea, vomiting, and abdominal distention.

A client who is recovering from a subtotal gastrectomy experiences dumping syndrome and is to eat six small meals a day. The client asks the nurse, "When will I be able to eat three meals a day again like I used to?" Which response by the nurse is most appropriate?

Most clients can resume their normal meal patterns in about 6 to 12 months."

A client with a well-managed ileostomy has the sudden onset of abdominal cramps, vomiting, and watery discharge from the ileostomy. What should the nurse tell the client to do?

Notify the health care provider (HCP).

An adult client is admitted to the hospital after vomiting bright red blood and is diagnosed with a bleeding duodenal ulcer. The client develops a sudden, sharp pain in the midepigastric region along with a rigid, boardlike abdomen. After obtaining the client's vital signs, the nurse should do what next?

Notify the health care provider.

The nurse is caring for a client that has undergone a colon resection. While turning the client, wound dehiscence with evisceration occurs. What is the nurse's first response?

Place saline-soaked sterile dressings on the wound.

A client has had a subtotal gastrectomy and has a nasogastric tube with intermittent suction. Twenty-four hours after the surgery, the drainage in the client's nasogastric tube is dark brown. What should the nurse do?

Reassure the client that this is normal drainage.

An elderly client asks the nurse how to treat chronic constipation. What is the best recommendation the nurse can make?

Take a stool softener such as docusate sodium daily.

As the nurse administers a tap water enema, the client begins to have abdominal cramping. What should the nurse do first?

Temporarily stop the infusion until the cramping subsides.

A client develops chronic pancreatitis. The nurse should suggest which diet?

a low-fat, bland diet distributed over five to six small meals daily

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

absence of abdominal distention

The nurse is teaching a client about managing an ileostomy. What observation should the nurse instruct the client with an ileostomy to report immediately?

absence of drainage from the ileostomy for 6 or more hours

A nurse is caring for a client 1 hour post-laparotomy who reports abdominal pain rating 5/10. What will the nurse prioritize when administering the ordered morphine?

administer the medication before the pain becomes severe

A client with a recent history of rectal bleeding is being prepared for a colonoscopy. The nurse knows that positioning the client lying on the left side with the knees bent is an appropriate intervention. The nurse recognizes that this position will

allow proper visualization of the large intestine.

A client presents to the emergency department, reporting that they have been vomiting every 30 to 40 minutes for the past 8 hours. Frequent vomiting puts this client at risk for which imbalances?

metabolic alkalosis and hypokalemia

Prochlorperazine is prescribed postoperatively. The nurse should evaluate the drug's therapeutic effect when the client expresses relief from which symptom?

nausea

The nurse is assessing the client who had a gastric resection yesterday. Which finding indicates the development of a leaking anastomosis?

pain, fever, and abdominal rigidity

A client has a nasogastric tube inserted at the time of abdominal perineal resection with a permanent colostomy. This tube will most likely be removed when the client demonstrates which finding?

passage of flatus and feces from the colostomy

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

subnormal serum glucose and elevated serum ammonia levels.

After a gastrectomy, the client has a nasogastric (NG) tube in place. The nurse should tell the client the tube is used for which reason?

to prevent excessive pressure on suture lines

Diphenoxylate/atropine has been prescribed to treat a client's diarrhea. The nurse should teach the client to report:

urine retention.

What is an appropriate nursing goal for a client who has ulcerative colitis?

verbalizes the importance of small, frequent feedings

A nurse is supervising a new nurse who is preparing to perform wound care for a client whose abdominal wound is infected with vancomycin-resistant enterococci. The supervising nurse should make sure that the new nurse:

wears a gown and gloves while caring for the client.