Ch. 38 - Assessment of GI system

Feeding tubes should be placed into the small intestine rather than the stomach if a.the patient is comatose. b.a regular polymeric formula is being used .c.the patient prefers not to have a tube passing through his or her nose. d.the patient is expected to resume oral feedings within 1 to 2 weeks

A

A 58 yr old woman has just returned to the nurse unit after an esophagogastroduodenoscopy (EGD). Which action by UAP requires that the RN intervene a. offering the patient a drink of water b. positioning the patient on the right side c. checking the vital signs every 30 mins d. swabbing the patients mouth with cold water

A. offering the patient a drink of water rationale: Immediately after EGD, the patient will have a decreased gag reflex and is at risk for aspiration. Assessment for return of the gag reflex should be done by the RN

Bolus enteral feedings would be appropriate for a patient who a.has had a gastrectomy. b.has a PEG tube.c.is being fed via a nasoduodenal tube. d.has a history of aspiration-related pneumonia.

B

If a patient is to receive enteral feedings for several weeks because of esophageal surgery but is otherwise generally healthy, he or she may be fed through a _____ tube. a.nasogastric b.nasoduodenal c.percutaneous endoscopic gastrostomy (PEG) d.jejunostomy

C

A 50 yr old patient who underwent a gastroduodenostomy (Billroth I) earlier today complains of increasing abdominal pain. The patient has no bowel sounds and 200 mL of bright red NG drainage in the last hour. The highest priority action by the nurse is to a. contact the surgeon b. irrigate the NG tube c. monitor the NG drainage d. administer the prescribed morphine

a. contact the surgeonrationale: increased pain and 200 mL of bright red NG drainage 12 hours after surgery indicate possible post-operative hemorrhage, and immediate actions such as blood transfusion and/or return to surgery are needed.

The nurse will anticipate preparing a 71 yr old female patient who is vomiting "coffee ground" emesis for a. endoscopy b. angiography c. barium studies d. gastric analysis

a. endoscopyrationale: endoscopy is the primary tool for visualization and diagnosis of upper gastrointestinal bleeding.

Which action should the nurse in the ED anticipate for a 23 yr old patient who has had several episodes of bloody diarrhea. a. obtain a stool specimen for culture b. administer antidiarrheal medication c. provide teaching about antibiotic therapy d. teach about adverse effects of acetaminophen

a. obtain a stool specimen for culturerationale: patients with bloody diarrhea should have a stool culture for E. Coli

A patient is being scheduled for endoscopic retrograde cholangiopancreatography (ERCP) as soon as possible. Which actions from the agency policy for ERCP should the nurse take first. a. Place the patient on NPO status. b. administer sedative medications c. ensure the consent form is signed. d. teach the patient about the procedure.

a. place the patient on NPO status rationale: the patient will need to be NPO for 8 hours before the ERCP is done, so the nurses initial action should be to place the patient on NPO status.

A 44 yr old man admitted with a peptic ulcer has a NG tube in place. When the patient develops sudden, severe upper abdominal pain, diaphoresis, and a firm abdomen, which action should the nurse take a. irrigate the NG tube b. check the vital signs c. give the ordered antacid d. elevate the foot of the bed

b. check the vital signsrationale: the patients symptoms suggest acute perforation, and the nurse should assess for signs of hypovolemic shock.

The nurse preparing for the annual physical exam of a 50 yr old man will plan to teach the patient about a. endoscopy b. colonoscopy c. computerized tomography screening d. carcinoembryonic antigen (CEA) testing.

b. colonoscopyrationale: at age 50, individuals with an average risk for colorectal cancer (CRC) should begin screening for CRC.

Which nursing action should be included in the postoperative plan of care for a patient after a laparoscopic esophagectomy a. notify the HCP about bloody nasogastric drainage b. elevate the head of the bed to at least 30 degrees c. reposition the NG tube if drainage stops d. start oral fluids when the patient has active bowel sounds

b. elevate the head of the bed to at least 30 degreesrationale: elevation of the head of the bed decreases the risk for reflux and aspiration of gastric secretions

A 49 yr old man has been admitted with hypotension and dehydration after 3 days of nausea and vomiting. Which order from the HCP will the nurse implement first. a. insert a NG tube b. infuse normal saline at 250 ml/hr c. administer IV ondansetron (Zofran) d. provide oral care with moistened swabs

b. infuse normal saline at 250 ml/hrrationale: because the patient has severe dehydration, re-hydration with IV fluids is the priority.

A 68 yr old patient with a bleeding duodenal ulcer has a NG tube in place, and the HCP orders 30 mL of aluminum hydroxide/magnesium hydroxide (Maalox) to be instilled through the tube every hour. To evaluate the effectiveness of this treatment, the nurse a. monitors arterial blood gas values daily b. periodically aspirates and tests gastric pH c. checks each stool for the presence of occult blood d. measures the volume of residual stomach contents.

b. periodically aspirates and tests gastric pHrationale: the purpose for antacids is to increase gastric pH. Checking the gastric pH is the most direct way of evaluating the effectiveness of the medication

Four hours after a bowel resection, a 74 yr old male patient with a NG tube to suction complains of nausea and abdominal distention. The first action by the nurse should be to a. auscultate for hypotonic bowel sounds b. notify the patients HCP c. reposition the tube and check for placement d. remove the tube and replace it with a new one.

c. reposition the tube and check for placement.rationale: repositioning the tube will frequently facilitate drainage. Because this is a common occurrence, it is not appropriate to notify the HCP unless other interventions do not resolve the problem.

A 54 yr old man has just arrived in the recovery area after an upper endoscopy. Which information collected by the nruse is most important to communicate to the HCP. a. The patient is very drowsy b. the patient reports a sore throat c. the oral temp is 101.6ºF d. the apical pulse is 104bpm

c. the oral temp is 101.6º rationale: a temp elevation may indicate that a perforation has occurred.

A patient returned from a laparoscopic Nissen fundoplication for hiatal hernia 4 hours ago. Which assessment finding is most important for the nurse to address immediately. a. the patient is experiencing intermittent waves of nausea b. the patient complains of 7/10 abdominal pain c. the patient has absent breath sounds in the left anterior chest d. the patient has hypoactive bowel sounds in all four quadrants.

c. the patient has absent breath sounds in the left anterior chestrationale: decreased breath sounds on one side may indicate a pneumothorax, which requires rapid diagnosis and treatment.

Which assessment should the nurse perform first for a patient who just vomited bright red blood. a. measuring the quantity of emesis b. palpating the abdomen for distention c. auscultating the chest for breath sounds d. taking blood pressure and pulse

d. taking blood pressure and pulserationale: the nurse is concerned about blood loss and possible hypovolemic shock in a patient with acute GI bleeding

The nurse receives the following information about a 51 yr old woman who is scheduled for a colonoscopy. Which information should be communicated to the HCP before sending the patient for the procedure. a. The patient has a permanent pacemaker to prevent bradycardia b. the patient is worried about discomfort during the examination c. the patient has had an allergic reaction to shellfish and iodine in the past d. the patient refused to drink the ordered polyethylene glycol (Golytely)

d. the patient refused to drink the ordered polyethylene glycol (Golytely) rationale: if the patient has had inadequate bowel preparation, the colon cannot be visualized and the procedure should be rescheduled.

When a 72 yr old patient is diagnosed with achalasia, the nurse will teach the patient that a. lying down after meals is recommended b. a liquid or blenderize d diet will be necessary c. drinking fluids with meals should be avoided d. treatment may include endoscopic procedures

d. treatment may include endoscopic proceduresrationale: endoscopic and laparoscopic procedures are the most effective therapy for improving symptoms caused by achalasia.