Chapter 33 Nursing Care of Patients with Upper Gastrointestinal Disorders, Chapter 34. Nursing Care of Patients With Lower Gastrointestinal Disorders

The nurse is participating in a community health fair program focusing on risk factors for cancer. Which should be included as increasing the risk for colon cancer? (Select all that apply.)

Low-fiber diet History of rectal polyps History of ulcerative colitis

A patient with irritable bowel syndrome is being started on the FODMAP diet. What foods should the nurse instruct the patient to avoid when following this diet? (Select all that apply.)

Milk Pears Apples Brussels sprouts

The nurse reinforces teaching provided to a patient with constipation and straining who is experiencing abdominal distention and intestinal rumbling. What should be included in the teaching? (Select all that apply.)

Set a time for defecation every day. Increase intake of fiber, especially bran, in the diet. Drink water each morning and about 2 to 3 L throughout the day.

The nurse is caring for a patient with an absorption disorder. What term should the nurse use to document fat in the patients stool?

Steatorrhea

The nurse is caring for a patient recovering from ileostomy surgery. What should have the highest priority when caring for the patient after surgery?

Stoma condition every 8 hours

The nurse is evaluating a patients ability to change an ostomy appliance. Which observation indicates that the patient can safely provide self-ostomy care?

Stoma measured prior to applying new appliance

A patient with fecal incontinence has an excoriated perianal region. Which interventions should be discussed with the RN? (Select all that apply.)

Stool culture Protective barrier cream A low-pressure rectal tube

A patient with Crohns disease is scheduled for an ileoanal pouch. What should the nurse include when teaching the patient about this surgery? (Select all that apply.)

Stool will pass through the anus. A temporary ileostomy is needed. Several bowel movements occur per day.

The nurse is monitoring a patient and finds a bulging area in the patients groin. Which additional finding should cause the nurse the most concern?

The patient develops pain at the site and vomiting.

The nurse is collecting data from a newly admitted patient. Which finding should the nurse identify as a risk factor for constipation?

The patient has had hemorrhoids for the past 5 years.

A patient is experiencing melena. What does this observation indicate to the nurse?

The patient has ingested a large volume of red meat

The nurse is contributing to the plan of care for patient with an ostomy. Why should the nurse recommend the use of a skin barrier product under the ostomy appliance?

To keep stool from irritating the skin

While receiving report from the previous shift, the nurse is informed that a nasogastric tube was placed in a patient who has a bowel obstruction. For which reason should the nurse realize the tube was inserted?

To relieve distention

The nurse is reinforcing teaching provided to a patient with acute diarrhea. Which statement indicates the patient understands the most common cause for this health problem?

Viral or bacterial infection.

The nurse is reinforcing patient teaching on the best way to prevent transmission of infectious diarrhea. Which patient statement indicates correct understanding of the teaching?

Wash hands frequently and after toileting.

The nurse is contributing to the plan of care for a patient with gluten enteropathy (celiac disease). What should the nurse recommend be eliminated from the diet of the patient?

Wheat, rye, oats, and barley

A patient asks what causes diverticulitis. How should the nurse respond?

You have little pouches in your colon that are inflamed.

A patient scheduled for an ileostomy for Crohns disease asks the nurse to explain the procedure. What should the nurse respond?

You will have a loop of colon brought out onto your abdomen.

A patient with a new ileostomy asks if a bag needs to be worn on the abdomen. What is the most appropriate response by the nurse?

Your stool will be liquid, so you will always need a bag.

The nurse is caring for a patient admitted with a possible bowel obstruction. Which patient symptom should cause the nurse the most concern?

Fecal vomiting

A patient comes into the client after experiencing diarrhea with five liquid stools in the past 24 hours. Which additional patient symptoms should cause the nurse concern? (Select all that apply.)

Fever Blood in the stool Severe abdominal cramping

The nurse is caring for a patient who has an ileostomy and feels crampy. The nurse notes that the stoma has become edematous and pale and suspects a blockage. What action should the nurse take?

Have the patient get into a tub full of warm water and drink warm liquids.

A patient with a colostomy says, My pouch blows up like a balloon when I pass gas. What is an appropriate response by the nurse?

Empty the gas like you would if the pouch was full of stool.

The nurse is caring for a patient who has diarrhea. Which nursing action is the highest priority?

Encourage oral fluid replacement.

The nurse is caring for a patient recovering from a bleeding gastric ulcer. Which patient statements indicate correct understanding of beverages to avoid after treatment of a bleeding gastric ulcer? (Select all that apply.) a. Beer b. Milk c. Coffee d. Iced tea e. Lemonade f. Diet soda pop

A, C, D, F A. Beer C. Coffee D. Iced Tea F. Diet soda pop

The nurse is caring for a patient with an exacerbation of Crohns disease. Which nursing action is most important to recommend for inclusion in the patients plan of care?

Encourage oral fluids.

A patient is considering surgery to treat obesity. Which factors meet established criteria for the use of surgery in the treatment of obesity? (Select all that apply.) a. Hypertension b. Presence of gallstones c. Gross obesity for 5 years d. Psychiatric and social stability e. Body weight 50% above ideal weight f. Failure to reduce weight with other forms of therapy

A, C, D, F A. Hypertension C. Gross obesity for 5 years D. Psychiatric and social stability F. Failure to reduce weight with other forms of therapy

The nurse is reviewing the process of digestion with a patient diagnosed with malabsorption syndrome. How many mL of fluid should the nurse instruct that is absorbed through the intestinal mucosa into the portal bloodstream?

8000

The nurse is contributing to a patients plan of care. For which patient would the nursing diagnosis of Risk for Constipation be most appropriate?

A 59-year-old taking narcotics for chronic pain control

The spouse of a patient with an ascending ostomy asks if the patient will always have to wear a pouch. What response should the nurse make?

A bag will be needed all of the time.

After collecting data the nurse suspects that an adolescent patient is at risk for developing anorexia nervosa. What data did the nurse use to come to this conclusion? (Select all that apply.) a. Age 17 years b. Phobia about weight gain c. Fearful of mother present during the interview d. Asked the nurse repeatedly why certain information was needed e. Texted with friends on the smartphone while interview in progress

A, B, C, D A. Age 17 years B. Phobia about weight gain C. Fearful of mother present during the interview D. Asked the nurse repeatedly why certain information was needed

The nurse is caring for a patient who has a nursing diagnosis of acute postoperative pain after a gastrectomy. The patient has a nasogastric (NG) tube. What interventions should the nurse implement? (Select all that apply.) a. Encourage total bedrest. b. Monitor NG tube functioning. c. Reposition NG tube once a shift. d. Provide pain medication as ordered. e. Start a regular diet once bowel sounds are detected. f. Evaluate pain regularly and report changes to the RN.

A, B, D A. Encourage total bedrest B. Monitor NG tube functioning D. Provide pain medication as ordered

The nurse is participating in planning care for a patient who is experiencing nausea. Which interventions should be included in this patients plan of care? (Select all that apply.) a. Provide antiemetics as prescribed b. Ensure the environment is odor-free c. Monitor intake, output, and vital signs d. Provide oral care every 2 hours as needed e. Instruct to avoid odors or foods that precipitate nausea

A, B, D, E A. Provide antiemetics as prescribed B. Ensure the environment is odor-free D. Provide oral care every 2 hours as needed E. Instruct to avoid odors or foods that precipitate nausea

A patient with morbid obesity is admitted to the hospital for leg wounds. Which observations should the nurse expect when collecting data from this patient? (Select all that apply.) a. BMI 41 b. Hyper-excitable c. Lethargy and malaise d. Shortness of breath with walking e. Body weight 120 lbs over ideal weight

A, D, E A. BMI 41 D. Shortness of breath with walking E. Body weight 120 lbs over ideal weight

The nurse is contributing to a patients teaching plan on how to avoid dumping syndrome after a gastrectomy. What should be included in the teaching? a. Avoid fluids with meals. b. Increase activity after eating. c. Increase carbohydrate intake. d. Eat heavy meals to delay emptying.

A. Avoid fluids with meals

The nurse is caring for a patient recovering from radical neck dissection for cancer and tracheostomy placement. What action by the nurse should take priority? a. Ensuring airway patency b. Ensuring adequate nutrition c. Teaching about smoking cessation d. Establishing ways of communication

A. Ensuring airway patency

The nurse is caring for a patient who complains of nausea related to gastric cancer. Which supplement should the nurse suggest? a. Ginger b. Lemon c. Butterscotch d. Black licorice

A. Ginger

The nurse is preparing to calculate a patients body mass index. What measurements does the nurse need to make this calculation? a. Height and weight b. Waist and hip measurements c. Weight and waist measurement d. Waist measurement and height

A. Height and weight

The nurse teaching a patient with gastroesophageal reflux about the influence of body position on the disease process. Which patient statement indicates that teaching has been effective? a. I elevate the head of the bed 4 to 6 inches. b. I elevate the foot of the bed 12 to 16 inches. c. I sleep on my back without a pillow under my head. d. I sleep on my stomach with my head turned to the left.

A. I elevate the head of the bed 4 to 6 inches

The nurse is teaching a patient about gastric surgery and dumping syndrome. Which statement indicates that the patient understands dumping syndrome? a. I need to eat small frequent meals. b. I should drink lots of fluids with meals. c. I need to sit up for 2 hours after each meal. d. I can expect the symptoms to begin 2 hours after eating.

A. I need to eat small frequent meals

The nurse is caring for a patient with gastroesophageal reflux disease (GERD). Which patient statement indicates a need for nutritional instruction? a. I should drink milk, as it is the perfect food. b. Nutrition can affect health positively or negatively. c. Excessive intake of a nutrient can interfere with others. d. Classes of nutrients are carbohydrates, fats, proteins, vitamins, minerals, and water.

A. I should drink milk, as it is the perfect food.

A patient is recovering from a Billroth I procedure and has a nasogastric Levin tube set to low intermittent suction. As the patient turns in bed, the Levin tube is partially pulled out. Which action should the nurse take? a. Notify the registered nurse (RN). b. Irrigate the tube. c. Advance the tube. d. Place suction on continuous.

A. Notify the RN

The nurse is visiting the home of a patient recovering from a sleeve gastrectomy. Which observation indicates that this surgery has been successful for the patient? a. Patient claims that she never feels hungry b. Patients skin is dry and hair is falling out c. Patient states that she is constantly hungry d. Patient has injected 100 mL of saline solution in the pouch

A. Patient claims that she never feels hungry

A patient with a nasogastric tube connected to suction is NPO (nothing by mouth) and reports a dry mouth and gagging feeling. What action should the nurse take? a. Provide oral care. b. Pull tube out 1 inch. c. Offer ice chips to swallow. d. Give lidocaine solution to coat the mouth.

A. Provide oral care

A patient who is unconscious begins to vomit blood. What action should the nurse take first? a. Turn patient onto side. b. Use water to rinse out mouth. c. Provide oral care to the patient. d. Administer antiemetic medication.

A. Turn patient onto side

The nurse is caring for a patient on a gastrointestinal unit. Which patient statement should cause the nurse the most concern? a. My stool has been dark green and hard to pass lately. b. Lately, Ive had two or three loose, sticky black stools every day. c. Usually I move my bowels every day and the stool is light brown. d. My stool is soft and dark brown; I usually move my bowels twice a day.

B. Lately, I've had two or three loose, sticky black stools every day

The nurse is caring for a patient with a sliding hiatal hernia. In which position should the nurse expect the patient to report that the symptoms are more acute? a. Sitting b. Standing c. Lying down d. Semi-Fowlers

C. Lying down

The nurse is monitoring a patient recovering from an emergency appendectomy. Which finding should be reported to the physician immediately?

Abdomen rigid on palpation

The nurse is providing care to a patient anticipating radiation therapy for head and neck cancer. What should the nurse include in pre-therapy education? (Select all that apply.) a. Water is an appropriate substitute for saliva. b. Good oral hygiene habits are important to prevent decay. c. Tooth decay occurs less frequently when oral tissues are dry. d. It is important that you visit the dentist before radiation therapy begins. e. All of your teeth will need to be pulled before you start radiation therapy. f. Artificial saliva can be used if the radiation therapy causes drying of the mouth.

B, D, F B. Good oral hygiene habits are important to prevent decay D. It is important that you visit the dentist before radiation therapy begins F. Artificial saliva can be used if the radiation therapy causes drying of the mouth

A patient with a hiatal hernia is experiencing heartburn. Which should the nurse suggest to this patient? a. Eat large meals. b. Avoid bedtime snacks. c. Sleep flat without a pillow. d. Recline 1 hour before meals.

B. Avoid bedtime snacks

A patient with a duodenal peptic ulcer vomits old blood. What description should the nurse use to document the appearance of the vomitus? a. Duodenal fecal matter b. Coffee-ground particles c. Undigested particles of food d. Chyme streaked with a black syrupy material

B. Coffee-ground particles

The nurse is caring for a patient who has a nasogastric tube in place following gastric surgery. Why should the nurse use normal saline to irrigate the nasogastric tube? a. It decreases electrolytes. b. It maintains electrolytes. c. It maintains fluid volume. d. It increases fluid volume.

B. It maintains electrolytes

The nurse is evaluating care provided to a patient with bulimia nervosa. Which observation indicates that addition care is required? a. Patient sits and talks with others after eating a meal b. Patient states that looking in a mirror makes her nauseated c. Patient states importance of continuing with therapy sessions d. Patient plans meals and appropriate snacks at the beginning of the day

B. Patient states that looking in a mirror makes her nauseated

The nurse is reinforcing teaching with a patient who had a large portion of the stomach removed. Which patient statement indicates understanding of why the patient will need to receive vitamin B12 for life? a. Sickle cell anemia b. Pernicious anemia c. Iron-deficiency anemia d. Acquired hemolytic anemia

B. Pernicious anemia (A decrease in red blood cells when the body can't absorb enough vitamin B-12.)

The nurse is checks the gastric pH and provides antacids as prescribed to a patient recovering from a motor vehicle crash. What is the nurse attempting to prevent by these interventions? a. Shock b. Stress ulcers c. Malnutrition d. Metabolic acidosis

B. Stress ulcers

The nurse is collecting data for a patient who is taking Prevacid for peptic ulcer disease. Which data collection finding requires immediate intervention? a. A rash b. Tarry stools c. Constipation d. Changes in mental status

B. Tarry stools

On admission, a patient with gastrointestinal bleeding had vital signs of a blood pressure of 140/80 mm Hg, pulse 72 beats/minute, respirations 14 breaths/minute, and temperature 98.8F (37.1C). What finding should be reported to the registered nurse (RN) or physician immediately?

Blood pressure 104/68 mm Hg

The nurse is caring for a patient who has aphthous stomatitis. What care should the nurse provide? (Select all that apply.) a. Make patient NPO. b. Place on fluid restriction. c. Apply a topical anesthetic. d. Teach to avoid irritating foods. e. Suggest stress management techniques.

C, D, E C. Apply a topical anesthetic D. Teach to avoid irritating foods E. Suggest stress management techniques

The nurse has instructed a patient prescribed omeprazole (Prilosec) for peptic ulcer disease on use of the medication. What patient statements indicate understanding of the instructions? (Select all that apply.) a. I should not take antacids while Im on this medication. b. If I wish, I can open the capsule and sprinkle it on food. c. I will take the capsule before eating a meal in the morning. d. I will need to take this drug for 3 weeks for my ulcer to heal. e. I will report any abdominal pain, diarrhea, or bleeding that occurs. f. Ill have to have regular blood counts and tests of my liver enzymes.

C, E, F C. I will take the capsule before eating a meal in the morning E. I will report any abdominal pain, diarrhea, or bleeding that occurs F. I'll have to have regular blood counts and test of my liver enzymes

The nurse is reinforcing teaching provided to a patient with a hiatal hernia. Which patient statement indicates a correct understanding of lifestyle modification to reduce symptoms? a. Avoid high-stress situations. b. Perform daily aerobic exercise. c. Avoid nicotine and alcohol use. d. Carefully space activity periods with rest.

C. Avoid nicotine and alcohol use

The nurse is caring for a patient who has developed esophagitis from gastroesophageal reflux disease (GERD). For which additional complication should the nurse anticipate providing care to this patient? a. Laryngospasm b. Bronchospasm c. Barretts esophagus d. Aspiration pneumonia

C. Barretts esophagus

The nursing assistant is delivering patient meals. Which meal should the nurse expect to be delivered to a patient who had gastric bypass surgery the day before? a. Soft diet b. Full liquids c. Clear liquids d. General diet

C. Clear liquids

The nurse is caring for a patient with a vented nasogastric tube ordered to suction after a gastrectomy. What type of suction should the nurse use to decrease the development of complications? a. Continuous low suction b. Continuous high suction c. Intermittent low suction d. Intermittent high suction

C. Intermittent low suction

The nurse is caring for a patient who suddenly begins having large amounts of bright red hematemesis. After the patient is turned onto the side, what should the nurse do? a. Encourage iced oral fluids. b. Lower the head of the bed. c. Obtain the patients vital signs. d. Place a cool cloth on the patients forehead.

C. Obtain the patients vital signs

The nurse is contributing to a patients plan of care. Which foods should the nurse recommend to be avoided or used with caution to reduce the possibility of ileostomy blockage? (Select all that apply.)

Celery Apples Dried fruits Mushrooms

The nurse is caring for a patient who reports feeling constipated, yet passes frequent small liquid stools. Which action should the nurse take?

Check the patient for a fecal impaction

The nurse is caring for a patient who is being screened for diverticulosis. Which patient statement indicates understanding of conditions that predispose to diverticulosis?

Chronic constipation.

A patient is to be started on clear liquids after an appendectomy. Which food should the nurse identify as being a clear liquid?

Cranberry juice.

The nurse is reinforcing teaching provided to a patient being tested for type B gastritis. Which patient statement indicates a correct understanding of the test that is used to diagnose this condition? a. Colonoscopy. b. Barium enema. c. Abdominal x-ray. d. Esophagogastroduodenoscopy.

D. Esophagogastroduodenoscopy

The nurse is reinforcing teaching provided to a patient with a peptic ulcer. Which patient statement indicates understanding of the medication ranitidine (Zantac)? a. It clings to the ulcer. b. It coats your stomach. c. It neutralizes stomach acid. d. It reduces production of gastric acid.

D. It reduces production of gastric acid

The nurse is caring for a patient with bulimia. Which complication should the nurse recognize that this patient is at risk for developing? a. Weight gain b. Fluid overload c. Ischemic stroke d. Metabolic alkalosis

D. Metabolic alkalosis

The nurse is providing care to a patient 3 days after a Billroth I procedure. About which observation should the nurse be most concerned? a. Pulse 58 beats per minute b. Incisional pain score 4 on a 1 to 10 scale c. Patient becomes tearful while viewing the incision d. Reports of abdominal cramping shortly after eating

D. Reports of abdominal cramping shortly after eating

The nurse is reinforcing teaching provided to a patient scheduled for pyloroplasty. Which patient statement indicates a correct understanding of the procedure? a. The doctor will stitch the top of my stomach to help me lose weight. b. The doctor will cut the nerve that goes to my stomach so less acid is released. c. The pylorus will be narrowed to prevent gastric reflux and help my ulcers heal. d. The surgery will improve the movement of food from my stomach to my small intestine.

D. The surgery will improve the movement of food from my stomach to my small intestine

The nurse is reinforcing teaching provided to a patient with dumping syndrome. Which patient statement indicates a correct understanding of this condition? a. It is delayed gastric emptying. b. Glucose is dumped into the bloodstream. c. Digestive secretions enter the esophagus. d. There is rapid entry of food into the jejunum.

D. There is rapid entry of food into the jejunum

A patient with a nasogastric tube to low intermittent suction after surgery begins to vomit bright red blood. Which action should the nurse take first? a. Administer oxygen. b. Irrigate the nasogastric tube. c. Increase the intravenous rate. d. Turn the patient onto his or her side.

D. Turn patient onto his or her side

The nurse is teaching a patient newly diagnosed with ulcerative colitis about triggers for exacerbation of the disease. What should the nurse urge the patient to do to prevent a future exacerbation? (Select all that apply.)

Do not use tobacco Reduce exposure to stress Read food labels to avoid food additives Avoid ingesting foods sprayed with pesticides

The nurse provides teaching to a patient prescribed budesonide (Entocort EC) for Crohns disease inflammation. Which patient statements indicate that more teaching is necessary? (Select all that apply.)

I must avoid the sun while taking this drug. I will take the pill each evening before going to bed. I can just stop taking the medication once I feel better.

The nurse is reinforcing teaching provided to a patient about appropriate diet modifications to help prevent exacerbations of inflammatory bowel disease. Which patient statements indicate that teaching has been effective? (Select all that apply.)

I should avoid caffeine and spicy fiber foods. High-fiber foods should not be included in my diet. Milk and other dairy products should be limited in my diet.

The nurse is reinforcing teaching provided to a patient who is being discharged with a new colostomy. Which comments by the patient indicate understanding of the discharge teaching? (Select all that apply.)

I will empty the pouch when it is less than half full. I can spray deodorant into the pouch after I clean it. I always check the seal and tape around the stoma after I shower.

The nurse is teaching a patient with diverticulosis how to avoid complications. Which patient statement indicates that teaching has been effective?

I will increase fluids and fiber in my diet.

A patient with a bowel obstruction asks for the term that describes telescoping of the bowel. Which should the nurse respond to this patient?

Intussusception

The nurse is providing discharge teaching to a patient with diarrhea. Which patient statement indicates that teaching has been effective?

It is important that I increase fluid intake to prevent dehydration.

The nurse notes that a patient with a history of a myocardial infarction is straining during defecation. Which response by the nurse is best?

It is important that you not strain because it could cause damage to your heart.

The nurse is collecting data from a patient who is reporting abdominal pain. Which symptom suggests that the patient is experiencing appendicitis?

Pain in the right lower abdominal quadrant

The nurse suspects appendicitis in a patient complaining of abdominal pain. Which assessment finding should cause the nurse to notify the physician?

Palpation of the abdomen is positive for rebound tenderness.

The nurse is assisting to prepare dietary teaching for a patient with diverticulosis. Which food items should the nurse suggest be added to this patients teaching plan? (Select all that apply.)

Peas Salad Prunes Raisins

The nurse is caring for a patient with an inflamed appendix. Which complication is most likely to occur if the appendix ruptures?

Peritonitis

The nurse is collecting data from a patient with a stoma. What should the nurse document for a health stoma?

Pink and moist

During a health history, the nurse learns that a patient uses laxatives every day to ensure a bowel movement. What should the nurse expect to be prescribed for this patient? (Select all that apply.)

Psyllium (Metamucil) Docusate sodium (Colace)