213 Days

A nurse is assessing a patient who has been diagnosed with cholecystitis, and is experiencing localized abdominal pain. When assessing the characteristics of the patient's pain, the nurse should anticipate that it may radiate to what region? •Left upper chest • Inguinal region •Neck or jaw • Right shoulder

-Right Shoulder

The nurse is conducting a gastrointestinal assessment. When the patient complains of the presence of mucus and pus in his stools, the nurse assesses for additional signs/symptoms of which of the following disease/conditions? •Small-bowel disease •Ulcerative colitis •Disorders of the colon •Intestinal malabsorption

-Ulcerative Colitis

Which test may be indicted when diarrhea is the primary symptom? •1. Computed tomography •2. Ultrasound •3. Capsule endoscopy •4. Barium enema

Barium enema looks at colon Diagnostic tests : Chole- Nephritis- ultrasound early stages no dye Gastritis—endoscopy wth biopsy and gastric analysis (lack of HCL Gerd- - Diverticulitis- 'UC - Crohns-

Which pain medication should be used sparingly for IBD? •1. corticosteroids •2. acetaminophen •3. opiods •4. aminosalicylates

Opiods increases the risk of toxic megacolon Why do we use steriods with IBD? Aminosalicylates?

Malnutrition results from Crohns' diseases effect on the 1.Small bowel 2. Cecum 3. Ascending colon 4.Sigmoid colon

Small bowel leads to malabsorption def. in electrolytes, minerals and fat soluble vitamins

A nurse is caring for a client diagnosed with cholelithiasis. Which of the following would be most appropriate for a client who is experiencing biliary colic? •Ensure that the client rests. •Ensure that the client has eaten a full meal •Avoid administering antispasmodics •Administer analgesics to the client

•Administer analgesics to the client

•What nursing measures should the nurse implement to prevent potential complications related to patient's enteral feeding?

Keep head of bed at 30 to 45 degrees to help prevent aspiration, in addition to protection that the nasojejunal tube provides by being past the pyloric sphincter. Assess placement of tube every 8 hours. Check residuals every 4 hours with a continuous feeding. Note and report residuals greater than 200 mL, although this may not be a reason to hold the feeding. Assess the insertion site that the tape is secure and inspect the skin for breakdown. Use 30 mL of water before and after each dose of medication. Normal saline may help decrease injury to the small bowel. Flushing the enteral feeding tube since it is a small bore tube helps to prevent it from clogging. Assess fluid and electrolyte status ongoing and report imbalances to the physician and receive orders. Observe for signs and symptoms of dehydration: dry mucous membranes, increased thirst, or decreased urine output. Assess for intolerance to tube feeding: dumping syndrome. The patient self-reports bloating, nausea, and has bouts of watery diarrhea. Report intolerance to the physician.

A client who has undergone a laparoscopic cholecystectomy complains of "free air pain." What would be the nurse's best action? a. Assist the client to ambulate b. Instruct the client to breathe deeply and cough. c. Maintain the client on bedrest with his or her legs elevated. d. Insert a rectal tube to facilitate the passage of flatus.

a. Assist the client to ambulate

A client who has ulcerative colitis has persistent diarrhea and has lost 12 lb (5.5 kg) since the exacerbation of the ulcerative colitis. Which approach will be most effective in helping the client meet nutritional needs? •continuous enteral feedings •following a high-calorie, high-protein diet •total parenteral nutrition (TPN) • eating six small meals a day

•total parenteral nutrition (TPN)

Ulcerative colitis usually affects which layer of the intestinal wall 1.Inner 2. Middle 3. Outer 4.All layers

1. Inner

When Crohn's affects the colon, do not give- •1. 5- ASA •2. bulking laxatives •3. parenteral lipids •4. Oral potassium

2. Bulking laxatives can trigger toxic megacolon Why might we give the other choices listed?

A healthy stoma should appear . Dusky 2. Moist 3. Pale 4. Cyanotic

2. Moist

Unlike Crohn's disease, ulcerative colitis 1.doesn't cause bloody diarrhea 2.Is curable 3.Typically affects only the small intestine 4.Has no familial tendency

2.Is curable

The most common complication of crohn's disease is 1. Abscess 2. Esophageal strictures 3. Intestinal obstruction 4. fistula

3. Intestinal obstructions . Lesions as disease progresses bowel becomes thickened and hypertrophy of bowel muscle leads to fibrosis and strictures. Only 30% develop fistulas Why do bowel obstructions occur ? What other inflammatory diseases do we see abscesses? Fistulas ? What is a fistula and how do we treat it? Perforation? abscesses and perforation can lead to peritonitis Other complications we talked about _ Pernicious anemia with gastritis, Barrett's esphagus with GERD Hemorrhage with Diverticulitis, gastritis(gi bleed) and UC Fluid and electrolyte imbalance- -UC crohns - when ever diarrhea /vomiting and what electrolytes are we looking at ? Extraintestinal disorders_mouth sores, lupus, uveitis, erythema nodosum

Which trigger increases the risk of Crohn's disease but not ulcerative colitis •1. infection •2. diet •3. smoking •4. environment

3. Smoking

Ulcerative colitis is usually confined to the I.leum 2. Cecum 3. Duodenum 4. Rectum and lower colon

4. Rectum and lower colon

Which blood test best monitors nutritional status in a patient with Crohn's disease? •1. Electrolytes •2. C -reactive protein •3. Erythrocyte sedimentation rate •4. Transferrin

4. Transferrin

• What nursing measures should the nurse implement to prevent potential complications related to the administration of TPN?

Have two nurses confirm the TPN label with the orders for the TPN. Inspect the central line insertion site that the dressing is dry and intact and that there are no signs of infection at the insertion site. Change the transparent dressing weekly or if it is not intact. Both the nurse and patient wear a surgical mask and the nurse uses sterile technique to change the dressing. Follow the hospital policy and procedure when administering the TPN. Hospitals vary on the time of day that the TPN is ordered and administered for each 24-hour period. The pharmacy at institutions often have the IV tubing and filter primed and ready to hang because the pharmacist spiked the bag under a special hood that has laminar flow to ensure aseptic technique. Weigh patient daily or as ordered and obtain ordered labs at the specific times ordered on the TPN order sheet. It is important to follow the orders so that the lab values are accurate. If the TPN runs out, 10% dextrose and water must be infused at the specified rate on the TPN order sheet until the next bag of TPN may be obtained. Stopping the administration of TPN abruptly can lead to rebound hypoglycemia. Check the flow rate of the TPN at the beginning of the shift and periodically to ensure that the rate has not been changed accidently by someone because if the patient receives the solution too rapidly, hyperosmolar diuresis can occur.

•An adult client with a history of dyspepsia has been diagnosed with chronic gastritis. The nurse's health education should include what guidelines? Select all that apply. • a. Avoid drinking alcohol b. Adopt a low-residue diet c. Avoid nonsteroidal anti-inflammatories d. Take calcium gluconate as prescribed e. Prepare for the possibility of surgery

a. Avoid drinking alcohol c. Avoid nonsteroidal anti-inflammatories

•The nurse is assessing a client with pyelonephritis. The nurse should expect to address the following clinical manifestations of this health problem? •A. Hematuria •b. Decrease serum creatinine level •c. Hypotension unresolved by fluid administration d Glycosuria

a. hematuria

When a client has an acute attack of diverticulitis, the nurse should first: prepare the client for a colonoscopy. • encourage the client to eat a high-fiber diet. • assess the client for signs of peritonitis. • encourage the client to drink a glass of water every 2 hr.

assess the client for signs of peritonitis.

Which of the following symptoms would the nurse most likely observe in a client with cholelithiasis? a. Black stools. b. Nausea and abdominal discomfort after eating high-fat foods. c. Elevated temperature of 103°F. d. Decreased white blood cell count.

b. Nausea and abdominal discomfort after eating high-fat foods.

•a client has been diagnosed with diverticular disease after ongoing challenge with constipation . The client will be treated as an outpatient basis. What components of treatment should the nurse anticipate? ( select all that apply •a. Anticholinergic medications •b. Increase fiber intake •c. Enemas on alternating days •d. Reduced fat intake •e. Fluid reduction

•b. Increase fiber intake •d. Reduced fat intake

•A client has been diagnosed with diverticular disease based on their recent complaints and results of a computered tomography (CT) scan. Which of the client's statement demonstrates and accurate understanding of this diagnosis? •a. From now on, I'm going to stick to an organic diet and start taking supplements •b. I think this might have happened because of I've used enemas and laxatives too much •c. I have struggles with heartburn and indigestion and I guess I shouldn't have ignored those warning signs •d. I suppose I should try and eat more fiber and become more active

•d. I suppose I should try and eat more fiber and become more active