UWorld Adult Health: Gastrointestinal/Nutrition
The nurse receives new prescriptions for a client with right lower quadrant pain and suspected acute appendicitis. Which prescription should the nurse implement first?
initiate IV access and infuse NS - Nurses caring for clients with appendicitis should prioritize client care according to the ABCs (ie, airway, breathing, circulation). Initiating IV crystalloids (eg, normal saline) is a priority action that prevents circulatory collapse resulting from fluid losses (eg, vomiting, diarrhea) and NPO status.
What type of liquids should be avoided after gastrointestinal surgery?
liquids with red dye
The nurse is caring for a client with acute pancreatitis admitted 2 days ago. Which assessment finding is most concerning?
temp of 102.2 with increasing abdominal pain - The nurse should watch closely for high fever, increasing abdominal pain, and leukocytosis as these findings may indicate infection of the necrosed pancreas or pancreatic abscess formation. This condition may also cause high glucose.
The nurse prepares to assess a newly admitted client diagnosed with chronic alcohol abuse whose laboratory report shows a magnesium level of 1.0 mEq/L (0.5 mmol/L). Which assessment finding does the nurse anticipate?
tremors and brisk deep tendon reflexes
An 80-year-old client has been hospitalized with pneumonia and malnutrition. Physical assessment findings include weakness and decreased muscle mass. Which finding best indicates that the client is responding to treatment?
weight gain of 2 lbs in 2 weeks - The best assessment finding for indicating improved nutritional status is a steady weight gain over a specified period. - Serum prealbumin is a faster and more reliable indicator of current nutritional status than serum albumin.
During the admission assessment of a client with a small-bowel obstruction, the nurse anticipates which clinical manifestations?
- Abdominal distension - Colicky abdominal pain - Frequent vomiting
The nurse prepares to admit a client with worsening cirrhosis who is on the waiting list for a liver transplant. Based on the client's electronic health record, the nurse anticipates which assessment findings?
- Ascites - Bruising - Itching - Lethargy * Laboratory abnormalities common in liver failure include low serum albumin (causes ascites), elevated INR (increases risk for bruising and bleeding), elevated serum ammonia (causes lethargy and confusion), and increased bilirubin (causes jaundice and itching).
The nurse will implement which nursing actions when caring for a client recently diagnosed with a hiatal hernia?
- Elevate HOB - Avoid tobacco and caffeine - Offer small, frequent, low fat meals - Teach client to avoid lifting or straining
The nurse is counseling a client with obesity who is starting a weight reduction diet. The client reports consuming 4-5 regular cola beverages daily. Which of the following beverages should the nurse recommend as healthier substitutes?
- Flavored club soda - Fresh vegetable juice - Unsweetened tea
What should be included in the care plan for acute care of diverticulitis?
- NPO status - IV fluids - pain relief meds via IV rt NPO - no straining or laxatives (decrease gastric motility)
A healthy 50-year-old client asks the nurse, "What must I do in preparation for my screening colonoscopy?" Which statements by the nurse correctly answer the client's question?
- No food or drink is allowed 8 hrs prior to the test - The day prior to the procedure your diet will be clear liquids - You will drink polyethylene glycol as directed the day before
What should the patient be instructed on prior to the small bowel follow through test?
- This is an x-ray test - The client should fast for 8 hours prior to the examination. - Stools may be chalky for up to 72 hours. - Black, tarry stools indicate a potential gastrointestinal bleed and should be reported immediately.
A client with ascites due to cirrhosis has increasing shortness of breath and abdominal pain. The health care provider requests that the nurse prepare the client for a paracentesis. Which nursing actions would the nurse implement prior to the procedure?
- Verify that the client received necessary information to give consent and witness informed consent - Instruct the client to void to prevent puncturing the bladder (Option 5) - Assess the client's abdominal girth, weight, and vital signs (Option 3) - Place the client in the high Fowler position or as upright as possible
What are some risk factors for esophageal cancer?
- daily acid reflux - smoking - excessive alcohol consumption - obesity
What type of diet is recommended for ulcerative colitis?
- eat small frequent meals - diet should be low residue, high protein, and high calorie diet - supplemental vitamins and minerals
What is a small bowel follow through test?
- examines the anatomy and function of the small intestine using x-ray images taken in succession. - Barium is ingested, and x-ray images are taken every 15-60 minutes to visualize the barium as it passes through the small intestine. - Using this technique, decreased motility (eg, ileus), increased motility (eg, malabsorption syndromes), fistulas, or obstructions are identified.
What should the nurse do when caring for patient with bowel obstruction?
- placing the client on NPO status - inserting a nasogastric tube - administering prescribed IV fluids - instituting pain control measures.
What instructions should be followed to prevent dumping syndrome?
1) Add high protein foods to diet 2) Eat small, frequent meals 3) Lie down after eating
The nurse is teaching a client with newly diagnosed lactase deficiency about dietary management. Which statements by the client indicate a correct understanding of this condition?
1) I can still eat cheese and yogurt as long as they don't make me sick 2) I should take daily Ca+ and vitamin D supplement 3) Lactase enzyme supplement should be taken with meals containing dairy
A nurse is precepting a new graduate nurse who is caring for a client with a paralytic ileus and a Salem sump tube attached to continuous suction. The preceptor should intervene when the graduate nurse performs which interventions?
1) Maintaining client in semi-Fowler's position 2) Accurate assessment of bowel sounds 3) Keeping the air vent (blue pigtail) open and above the level of the client's stomach 4) Providing mouth care every 4 hours to maintain moisture of oral mucosa and promote comfort 5) Inspecting the drainage system for patency - checking residual is not needed bc this tube is continuous suction and not used for gastric feeding.
What are the benefits of a fiber rich diet?
1) regulates bowel movements 2) promotes weight loss 3) improves glycemic control 4) prevents colorectal cancer 5) reduces risk of vascular disease
How long may bowel sounds be absent after abdominal surgery?
24-48 hours
A client tells the nurse of wanting to lose 20 lb (9 kg) in time for the client's daughter's wedding, which is 16 weeks away. How many calories (kcal) will the client have to eliminate from the diet each day to meet this goal?
625 kcal/day - A reduction or energy expenditure of 3500 calories (kcal) will result in a weight loss of 1 lb. - 3500 kcal x 20 lb [9 kg] = 70,000 kcal 625 kcal (70,000 kcal / [16 weeks x 7 days] = 625 kcal/day)
How long should diarrhea last for until patient needs to go to doctor?
>48 hrs
The nurse who is caring for a client with acute diverticulitis will immediately report which finding to the health care provider?
Abdominal pain has progressed to the left upper quadrant - Complications that can occur in some clients are abscess formation (continuous fever despite antibiotics and palpable mass) and intestinal perforation resulting in diffuse peritonitis (progressive pain in other quadrants of the abdomen, rigidity, guarding, rebound tenderness).
What is pain at the umbilicus associated with?
Appendicitis
What is McBurney's point?
Associated with appendicitis. Surface projection onto anterior abdominal wall of the location where the appendix originates from the cecum.
The nurse is teaching the home health client how to perform colostomy irrigation. Which client action reveals that further teaching is required?
Colostomy irrigation allows the client to create a bowel regimen and to apply a dressing or smaller pouch device over the stoma. To properly irrigate the stoma, use 500-1000 mL of lukewarm water, hang the bag 18-24 inches above the stoma, use the cone-tipped irrigator to slowly infuse the solution, and allow stool to drain through the sleeve into the toilet.
The nurse is providing postoperative care to a client returning from a hemorrhoidectomy. Which action is the priority for the nurse to perform?
Give pain medications and instructions related to pain control - Providing pain relief and preventing constipation are the primary goals for these clients. Sitz baths should begin 1-2 days postoperatively. - Hemorrhoids may recur with increased anorectal pressure. Therefore, clients should maintain a high-fiber diet, use stool softeners, and drink adequate fluids (at least 1500 mL/day) to prevent constipation.
What foods should be avoided with an ileostomy?
High fiber: popcorn, coconut, brown rice, multigrain bread Stringy vegetables: celery, broccoli, asparagus Seeds or pits: strawberries, raspberries, olives Edible peels: apple slices, cucumber, dried fruit
An adolescent client seen in the ambulatory care center is going on a one-week fasting regimen of water and juice to jump start weight loss. The nurse's response is based on an understanding of which of the following?
Initial weight loss from fasting is primarily from fluid loss
The nurse admits a postoperative client following weight loss surgery. Which prescription should the nurse question?
Insert an NG tube for uncontrolled nausea - Nasogastric tube placement is contraindicated after gastric surgery due to the potential for disturbing the surgical site, which can result in hemorrhage and anastomotic leak.
A homeless man known to have chronic alcoholism and who has not eaten for 8 days is undergoing nutritional rehabilitation via oral and enteral feedings. Which of the following findings would indicate that the client is developing refeeding syndrome?
It is marked by declines in serum phosphorus, potassium, and/or magnesium (mnemonic PPM). Clients can also develop fluid overload.
The hospitalized client with anorexia nervosa is started on nutrition via enteral and parenteral routes. Which client assessment is the most important for the nurse to check during the first 24-48 hours of administration?
K+ and phosphate levels - Refeeding syndrome is a potentially fatal complication of nutritional rehabilitation in chronically malnourished clients. Electrolytes, especially phosphorous, potassium, and magnesium, must be monitored frequently during the first few days of nutritional replenishment.
What position is best after a bariatric surgery?
Low Fowler position is preferred during mealtimes as it slows gastric emptying, reducing the risk of dumping syndrome.
How is refeeding syndrome prevented?
Low-calorie feedings and a gradual increase in calories can prevent refeeding syndrome. Electrolytes should be monitored frequently.
A 70-year-old client is admitted to the hospital with a lower gastrointestinal bleed. After assisting the client back to bed, the nurse finds approximately 600 mL of frank red blood in the commode. The client is now pale and diaphoretic and reports dizziness. Which action should the nurse perform first?
Lower the head of bed - Lowering the head of the bed or placing the client in the supine position maintains blood perfusion to the brain and other vital organs. This can be done quickly to help stabilize the client before performing other interventions.
The nurse is admitting a client with cholelithiasis and acute cholecystitis. Suddenly, the client vomits 250 mL of greenish-yellow stomach contents and reports severe pain in the right upper quadrant with radiation to the right shoulder. Which intervention would have the highest priority?
Maintain NPO status - Additional priorities include management of nausea and vomiting, pain, fluid balance, semi-fowlers position, and gastric decompression.
The nurse is caring for a debilitated client with a percutaneous endoscopic gastrostomy (PEG) tube that was inserted 3 days ago for the long-term administration of enteral feedings and medications. While the nurse is preparing to administer the feeding, the tube becomes dislodged. What is the most appropriate intervention?
Notify the HCP who inserted the PEG tube -
What type of meals are good for IBS?
Steak, tomato basil soup, and cornbread - Clients can manage symptoms by avoiding gas-producing foods (eg, broccoli), caffeine, alcohol, and gastrointestinal irritants (eg, high-fructose corn syrup, spices, dairy products) and by increasing fiber.
The clinic nurse educator is developing a teaching plan for the following 6 clients. The nurse should instruct which client to avoid the Valsalva maneuver when defecating?
The Valsalva maneuver is contraindicated in the client diagnosed with increased intracranial pressure, stroke, head injury, heart disease, glaucoma, eye surgery, abdominal surgery, and liver cirrhosis.
Guidelines for eating with a gastric bypass (roux en y)
To prevent dumping syndrome, the client should consume small meals, eat a low-carbohydrate diet, and consume food and fluids 30 minutes apart.
The nurse is evaluating a client with liver cirrhosis who received IV albumin after a paracentesis to drain ascites. Which assessment finding indicates that the albumin has been effective?
Vitals remain within their normal parameters - Clients undergoing paracentesis to alleviate symptoms related to ascites are at risk for hypotension due to changes in abdominal pressure. IV albumin increases intravascular fluid volume and may be used to prevent hypotension associated with paracentesis.
