Complex Sim - Digestion and Pancreatitis
Which clients are at the highest risk of being admitted to the emergency department with severe nausea and vomiting? Select all that apply. A. A 47-year-old with a 3-hour history of chest pressure B. A 61-year-old reporting sudden onset of vertigo C. A 23-year-old who sustained a head injury in a fall D. A 19-year-old who is 6 weeks pregnant E. A 72-year-old with an asthma exacerbation
A, B, C, D Rationale: The vomiting center in the medulla of the brain may be affected by the vestibular system of the ear, acute myocardial infarction, pregnancy, and increased intracranial pressure. An asthma exacerbation is least likely to cause severe nausea and vomiting.
A patient is experiencing constant heartburn. Which action should the nurse take to help this patient? A. Position the patient to decrease pressure on the abdomen. B. Encourage the patient to avoid food an hour before bedtime. C. Encourage the patient to drink juices and carbonated soft drinks. D. Advise the patient to incorporate bland foods into the diet
A. Positioning to decrease abdominal pressure is one action to help with heartburn. Bland foods are recommended for nausea, vomiting, and diarrhea. It is also recommended that the patient avoid eating several hours before going to bed. Juices and carbonated soft drinks can worsen heartburn.
A patient asks what can be done for heartburn that occurs during the night. Which recommendation should the nurse make to this patient? A. "Elevate your head with a few pillows." B. "Take an acid reducer before going to bed." C. "Avoid eating an hour before going to bed." D. "Take antacids before going to bed."
A. Rationale: Elevating the head of the bed at night decreases the chance of experiencing heartburn. Antacids are typically taken after heartburn has occurred; acid reducers are taken in advance of eating foods that may trigger heartburn. The patient should be encouraged to avoid eating several hours before going to bed.
A patient with ongoing gastrointestinal issues asks for ways to improve digestion. Which information should the nurse include when responding to this patient? A. Sit upright when eating. B. Reduce the amount of daily exercise. C. Lie down for 2 hours after eating. D. Limit the intake of fluids.
A. Rationale: A patient with a general digestive issue should be encouraged to sit upright when eating. There is no need to lie down for 2 hours after eating. Adequate fluid intake and daily activity is necessary to support healthy digestion.
The nurse is caring for a patient with a suspected bowel obstruction. Which diagnostic test should the nurse expect to be completed first for this patient? A. Abdominal x-ray B. Barium swallow C. Endoscopy D. Upper GI (gastrointestinal) series
A. Rationale: The abdominal x-ray will be used first to diagnose a suspected bowel obstruction. An upper GI series (also known as a barium swallow) is conducted to diagnose esophageal varices, inflammation, ulcerations, hiatal hernia, foreign bodies, polyps, diverticula, and tumors of the esophagus, stomach, and duodenal bulb. An endoscopy directly visualizes the mucous membrane lining of the esophagus, stomach, and duodenum.
The nurse is caring for a patient diagnosed with acute pancreatitis. For which systemic complication should the nurse assess the patient? A. Acute respiratory distress syndrome B. Congestive heart failure C. Diabetes D. Malabsorption
A. Acute respiratory distress syndrome Rationale: Systemic complications of acute pancreatitis include intravascular volume depletion with shock, acute tubularnecrosis and renal failure, and acute respiratory distress syndrome (ARDS). Hypovolemic shock and acute renal failure usually develop within 24 hours after the onset of acute pancreatitis. Manifestations of ARDS may be seen 3-7 days after the onset of pancreatitis, particularly in patients who have experienced severe volume depletion. Diabetes mellitus is a risk factor for chronic pancreatitis. Congestive heart failure occurs due to heart disease and may occur with hypervolemia. Malabsorption is a complication of chronic pancreatitis.
The nurse is seeing pregnant patients in the women's health clinic. Which digestive changes that affect the entire pregnancy should the nurse explain to a patient ? A. Constipation B. Vomiting C. Heartburn D. Dyspepsia
A. Constipation Both hormonal changes and fetal growth affect digestion in pregnant women. Pregnancy hormones slow the movement of digestive muscles, decreasing the movement of food through the digestive tract. Muscles in the bowels also relax because of high hormone levels. This combination of slowed digestion and muscle relaxation often results in constipation. Nausea and vomiting are one of the most common digestive problems related to increases in human chorionic gonadotropin (HCG) and other hormones in the first trimester. Hormones also relax the valve that separates the esophagus from the stomach, allowing food and stomach acid to move back into the esophagus. This results in heartburn, which often becomes more frequent in late pregnancy as the uterus pushes on the stomach. Functional dyspepsia, which is pain in the upper abdomen, occurs during childhood.
The nurse plans care for a pregnant patient with a history of gallstones. Which food should the nurse instruct this patient to avoid to prevent the development of pancreatitis? A. High fat B. Spicy C. Caffeinated beverages D. Gas producing
A. High Fat Rationale: The patient should be advised to avoid foods high in fat. High-fat foods activate the gallbladder, causing bile to be released, which may further result in the formation of gallstones. The majority of cases of pancreatitis in pregnancy are a result of gallstones that obstruct pancreatic outflow. Increased triglyceride levels can also lead to pancreatitis in pregnant patients. Gas forming foods, spicy foods, and caffeine stimulate gastric and pancreatic secretions and may precipitate pain in the patient already diagnosed with pancreatitis.
The nurse is preparing a presentation to a group of adolescent clients regarding proper nutrition. Which of the following teachings is appropriate for this group? A. It is normal for adolescents to consume a lot of calories, but their diet should still be balanced. B. The taste preferences of adolescents typically correlate to the nutritional value of what they eat. C. Roughly half of an adolescent's daily caloric intake should come from fats. D. The high metabolism of the typical adolescent lowers nutritional requirements.
A. It is normal for adolescents to consume a lot of calories, but their diet should still be balanced. Rationale: The high metabolism of the typical adolescent raises nutritional requirements. The adolescent growth spurt is accompanied by rapid gains in height and weight. Bodily demands for calories and nutrients increase dramatically during this time. Adolescent girls require about 2200 calories per day, and adolescent boys require about 2800 calories per day. Roughly 50% of calories should come from complex carbohydrates, 30% from fats, and 20% from proteins. Taste preferences are one of the contributing factors to adolescents exceeding fat intake requirements and not getting enough other nutrients or vitamins, minerals, and fiber.
A patient is traveling out of the country. Which information should the nurse provide to help the patient prevent developing a problem with digestion while traveling? A. Obtain immunizations. B. Increase fiber and water intake. C. Avoid spicy foods. D. Take a probiotic daily.
A. Obtain immunizations Immunizations will help prevent infectious hepatitis A and B, both of which contribute to digestive disorders. Avoiding spicy foods is important for the patient experiencing indigestion. Increasing water and fiber intake prevents constipation; however, for the patient traveling out of the country, drinking the water may cause severe gastrointestinal disturbance. Taking a probiotic is not an intervention specific to traveling outside of the country.
A patient with chronic pancreatitis is scheduled for laparoscopic surgery. Which information should the nurse reinforce with the patient about the purpose of the surgery? A. Promote drainage of the pancreatic enzymes B. Promote drainage of the pseudocysts C. Remove a gallstone D. Remove the fluid collection around the pancreas
A. Promote drainage of the pancreatic enzymes Rationale: Treatment for chronic pancreatitis often focuses on managing pain and treating malabsorption and malnutrition. Surgical procedures to promote drainage of pancreatic enzymes into the duodenum or resection of all or part of the pancreas may be done to provide pain relief in patients with chronic pancreatitis. Pseudocysts are drained endoscopically or surgically. If cholelithiasis is an identified causative factor, an endoscopic transduodenal sphincterotomy is performed to remove a gallstone from the sphincter of Oddi.
A patient receiving chemotherapy continues to experience nausea after receiving medication. Which additional action should the nurse take to help with this patient's nausea? A. Remove food from the room. B. Coach the patient to lean forward and place the head between the legs. C. Assist the patient to ambulate. D. Encourage the patient to relax in a supine position.
A. Remove food from the room Smells are a common reason for the development of nausea. By removing food from the room, the smell from the meal tray may help reduce the patient's symptoms. Laying supine, ambulating, and placing the head between the legs are not actions to help this patient with nausea.
A patient with suspected pancreatitis is having laboratory and diagnostic testing. Which laboratory value should the nurse monitor in this patient? A. Serum amylase and lipase levels B. Serum creatinine and bloodurea nitrogen (BUN) levels C. Pancreas-associated antigen CA 19-9 D. Fasting glucose and HbA1c levels
A. Serum amylase and lipase levels Rationale: Serum amylase and lipase levels are increased due to the release of enzymes from the pancreas as a result of inflammation. Pancreas-associated antigen CA 19-9 is a tumor marker for diagnosing pancreatic cancer. Serum creatinine and BUN levels are monitored for patients in kidney failure. Fasting glucose and HbA1c levels are monitored for patients with diabetes mellitus.
The nurse notes that a patient is prescribed an antacid. Which information should the nurse include when teaching the patient about this medication? A. "Antacids work to help suppress the volume of acidity coming from the lower gastrointestinal (GI) tract." B. "Antacids are alkaline substances that are commonly used to relieve simple acid indigestion." C. "Antacids bind the acid-secreting enzyme that functions as the proton pump, thereby disabling it." D. "Antacids promote motility by enhancing esophageal clearance and gastric emptying."
B. Antacids are alkaline substances that are commonly used to relieve simple acid indigestion. Histamine H2-receptor antagonists are useful in the treatment of gastroesophageal reflux disease and peptic ulcer disease because they help to suppress volume and acidity of parietal cell secretions. A potent dopamine receptor agonist such as metoclopramide hydrochloride promotes motility by enhancing esophageal clearance and gastric emptying. Proton pump inhibitors bind the acid-secreting enzyme (H+,K+-ATPase) that functions as the proton pump, disabling it for up to 24 hours.
A patient has been experiencing nausea and vomiting for several days. Which action should the nurse recommend to promote this patient's fluid and electrolyte balance? A. Avoiding all food preparation B. Taking small sips of apple juice C. Ingesting small quantities of broth and crackers D. Restricting fluid intake to 1 hour after meals
B. Encourage patients to restrict intake to small quantities of clear liquids (tea, apple juice, broth, Jell-O) and dry foods such as soda crackers to help reduce nausea and prevent vomiting. Teach patients to avoid food-preparation odors if they produce nausea. Instruct them to restrict fluid intake for 1 hour before and after meals; otherwise stress the need to maintain fluid intake to prevent dehydration.
A patient with nausea and vomiting does not like the prescribed medication because it causes drowsiness. Which statement by the nurse is appropriate? A. "Metoclopramide is a drug used for nausea and vomiting and is a better choice for you." B. "Peppermint oil can be used when you are nauseated, and it will not make you sleepy." C. "Currently, there is nothing as effective as the medication you have been prescribed." D. "Probiotics are an excellent choice and do not have the side effects the medication does."
B. Rationale: Complementary health approaches for digestive disorders include hypnotherapy, acupuncture, and a variety of herbal remedies, including peppermint oil, turmeric, and ginger. Probiotics are microorganisms that aid in digestion and help to protect the body from harmful bacteria. They may be taken along with prebiotics, which act as food for probiotics. There are alternatives available without the undesired side effect of drowsiness. Metoclopramide is a dopamine agonist used for nausea and vomiting and can have a sedative effect.
A patient seeks medical attention for nausea and vomiting that has been occurring for 3 days. Which question should the nurse ask to help determine the reason for this patient's symptoms? A. "Have your bowel movements been normal?" B. "Do you currently take any medications?" C. "Do you have a history of digestive problems?" D. "Have you experienced any weight loss?"
B. Rationale: Nausea and vomiting are symptoms of underlying disorders. Food, stress, medications, smells, and tastes are common causes of this disorder. Nausea and vomiting are commonly associated with food poisoning, drug and alcohol overuse, and infectious gastroenteritis. Weight loss occurs over time and may be indicative of a chronic disease. Asking about a history of digestive problems may be the next question after the patient's medication information has been obtained. The patient did not complain of any bowel conditions and likely has not had a recent bowel movement because of nausea and vomiting over the past 3 days.
A patient receiving total parenteral nutrition (TPN) comments that the fat emulsion infusion looks like milk and asks if it should be given through the IV. Which response by the nurse is best? A. "I will review the solution with your prescriber and the pharmacist." B. "The ingredients in the solution can be safely administered through the TPN line." C. "We will have to insert a peripheral line to administer this solution." D. "We have added an antacid to the solution so your digestive system can tolerate the fats."
B. Rationale: The response made by the nurse, "The ingredients in the solution can be safely administered through the TPN line" is an appropriate response. Fat emulsions (lipids) may be added to the solution, although often they are administered separately. The prescribed ingredients in the total parenteral nutrition (TPN) are double-checked against the orders before administration in accordance with the rights of medication administration. Antacids are not added to the solution, and a peripheral line is unnecessary.
The nurse is caring for a patient with diverticular disease. Which statement should the nurse include when teaching the patient about this health problem? A. "The diverticula result from an inflamed colon." B. "Small sacs form and push through weak spots in the colon." C. "The disease results from a weakened intestinal wall." D. "Infection causes the small sacs, or diverticula."
B. Rationale: Diverticular disease results from small sacs, called diverticula, that push outward through weak spots in the wall of the colon. The diverticula may become inflamed or infected, and bleeding may occur if blood vessels in the sac wall burst.
The nurse teaches a patient with nausea and vomiting caused by chemotherapy about ways to improve oral intake. Which patient statement should indicate to the nurse that additional teaching is required? A. "I will try clear liquids and dry foods and see how I feel afterward." B. "I will drink clear fluids and eat dry foods at the same time." C. "As soon as I feel better, I will start eating bland foods." D. "I will sit up straight to avoid feeling nauseated after I eat."
B. The patient experiencing nausea and vomiting should be encouraged to consume small amounts of clear fluids and dry foods at separate times. Clear liquids will be initiated first. Bland foods can be integrated after it has been established that the patient can tolerate liquids. A semi-Fowler position will not relieve nausea. A semi-Fowler position decreases pressure on the abdomen to prevent indigestion.
A patient with severe pancreatitis asks why antibiotics are prescribed. Which response should the nurse make to this patient? A. "The medication will decrease the length of your illness." B. "It is to prevent an infection." C. "The antibiotic will kill the bacteria that has caused the pancreatitis." D. "This will help prevent chronic pancreatitis from occurring."
B. "It is to prevent an infection." Rationale: Prophylactic antibiotics are prescribed for patients with severe or necrotizing pancreatitis to prevent infection. Viral, bacterial, or parasitic infectious agents can cause acute pancreatitis. The treatment will be based on the infectious agent. Chronic pancreatitis is not caused by an infection. If the pancreatitis is not linked to a treatable infectious agent, antibiotic treatment will not decrease the length of severe pancreatitis.
A patient with a nasogastric tube for treatment of acute pancreatitis asks when eating can resume. Which response should the nurse make to this patient? A. "You can have liquids within the next 24 hours." B. "When your lab work returns to normal." C. "When the results come back from your endoscopic ultrasound." D. "You can have liquids when the tube is removed."
B. "When your lab work returns to normal." Rationale: Oral food and fluids generally are withheld during acute episodes of pancreatitis to reduce pancreatic secretions and allow the organ to rest. The patient may have oral food and fluids once the serum amylase levels have returned to normal, bowel sounds are present, and pain disappears.
A client is scheduled for a diagnostic test to determine digestion status. Which test does not require fasting or other preparation? A. Lipid panel B. Amylase C. Barium swallow D. Endoscopy
B. Amylase
A patient with acute pancreatitis is diagnosed with gallstones in the sphincter of Oddi. Which treatment should the nurse anticipate for the patient? A. Resection of the pancreas B. Endoscopic transduodenal sphincterotomy C. Endoscopic retrograde cholangiopancreatography (ERCP) D. Cholecystectomy
B. Endoscopic transduodenal sphincterotomy Rationale: An endoscopic transduodenal sphincterotomy is performed to remove gallstones lodged in the sphincter of Oddi. When cholelithiasis is identified as a causative factor, a cholecystectomy is performed once the acute pancreatitis has resolved. A resection of the pancreas is done to promote pancreatic drainage into the duodenum and may be done to provide pain relief in patients with chronic pancreatitis. Endoscopic retrograde cholangiopancreatography (ERCP) may be performed to diagnose chronic pancreatitis and to differentiate inflammation and fibrosis from carcinoma.
A patient reports constipation that has been occurring over the past few weeks. Which finding should the nurse expect when listening to this patient's bowel sounds? A. Hyperactive bowel sounds B. Hypoactive bowel sounds C. Normal bowel sounds D. Absent bowel sounds
B. Hypoactive bowel sounds Rationale: Normal bowel sounds are irregular, high-pitched gurgling sounds that occur 5-30 times a minute. The nurse can anticipate hearing hypoactive bowel sounds in a patient with constipation. Hypoactive bowel sounds are also common after abdominal surgery or a bowel obstruction. Normal bowel sounds may be a finding if the patient has experienced constipation in the very recent past. Hyperactive bowel sounds occur when a patient has an infection or diarrhea. Absent bowel sounds may indicate a paralytic ileus and should be confirmed by listening over each quadrant for a minimum of 3-5 minutes.
A patient with intermittent constipation and diarrhea admits to not eating a healthy diet. Which teaching should the nurse provide to help this patient? A. Discuss vitamin supplementation. B. Suggest using probiotics. C. Encourage the patient to see a dietitian. D. Discuss the advantages of restricting caloric intake.
B. Suggest using probiotics Probiotics are microorganisms that aid in digestion and help to protect the body from harmful bacteria. Research suggests that probiotics and prebiotics can help with treatment of diarrhea and irritable bowel syndrome (IBS) and promote faster recovery from intestinal infections. Calorie restriction will not help with the patient's constipation and diarrhea. After further assessment of the patient and their dietary intake, vitamin supplementation may be needed. The nurse can provide dietary teaching. A dietitian is not needed at this time.
The nurse suspects that a patient with acute pancreatitis is experiencing an intravascular fluid shift. Which finding should the nurse expect when assessing this patient? A. Bradypnea B. Tachycardia C. Decreased urine output D. Pulmonary edema
B. Tachycardia Rationale: The patient with acute pancreatitis is at risk for a fluid shift from the intravascular space into the abdominal cavity (third spacing), which may cause hypovolemic shock, affecting cardiovascular function, respiratory function, renal function, and mental status. The initial physiological response to a fluid shift from the intravascular space into the abdominal cavity is tachycardia. Tachypnea will accompany the tachycardia; both are compensatory mechanisms for the decreased circulatory volume. The amount of urine that is acceptable is 30 mL/hr. or above. Pulmonary edema occurs as a result of right-sided heart failure or circulatory overload.
The nurse is considering nutritional support for a client experiencing severe side effects of chemotherapy. Which independent and collaborative interventions will best limit the adverse digestive and nutritional effects of chemotherapy? A. Encourage client to drink 350 mL of clear liquids within 1 hour prior to meals. B. Teach the client relaxation techniques in addition to offering IV ondansetron. C. Verify that enteral nutrition and total parenteral nutrition (TPN) are never used concurrently. D. Position the client flat during intermittent enteral nutrition feedings.
B. Teach the client relaxation techniques in addition to offering IV ondansetron.
A patient with acute pancreatitis is suspected of having pseudocysts. For which diagnostic test should the nurse anticipate orders to prepare this patient? A. Drainage of pancreatic enzymes B. Ultrasound C. Endoscopic retrograde cholangiopancreatography (ERCP) D. Surgery
B. Ultrasound Rationale: Pancreatic pseudocysts are diagnosed with ultrasound. Pancreatic pseudocysts are encapsulated collections of fluid that may develop both within the pancreas itself and in the abdominal cavity. They may impinge on other structures or may rupture, causing generalized peritonitis. Rupture of a pseudocyst or of the pancreatic duct can lead to pancreatic ascites. An infected pancreatic pseudocyst becomes a pancreatic abscess. A pancreatic abscess may also form as areas in damaged and infected pancreatic tissue become encapsulated. Large pancreatic pseudocysts may be drained endoscopically or surgically. For the patient diagnosed with acute pancreatitis localized complications may include pancreatic necrosis, abscess, pseudocysts, and pancreatic ascites.
The nurse is caring for a patient with chronic pancreatitis. Which finding should the nurse expect during the patient's pain assessment? A. Intermittent, sharp pains localized to the lower abdomen B. Steady, dull abdominal pain that radiates to the back C. Intermittent pain to midabdomen and midback D. Severe upper abdominal pain that usually radiates to the back
C. Patients with chronic pancreatitis experience intermittent attacks of severe pain, often in the midabdomen or left upper abdomen and occasionally radiating in a band like fashion or localized to the midback. Steady, dull abdominal pain that radiates to the back is a clinical manifestation of acute pancreatitis. Patients with pancreatic cancer experience severe upper abdominal pain, which usually radiates to the back. The pain may be relieved by bending forward or assuming the fetal position.
An older adult patient asks the nurse to explain the difference between prebiotics and probiotics. Which response should the nurse make to this patient? A. "Probiotics are ineffective without prebiotics." B. "Prebiotics are microbiotics that help with digestion and prevent infection." C. "Prebiotics act as food for the probiotics." D. "Prebiotics help control the growth of the probiotics."
C. Probiotics are microorganisms that aid in digestion and help to protect the body from harmful bacteria. They may be taken along with prebiotics, which act as food for probiotics. Probiotics are effective without prebiotics; however, prebiotics support the growth of the probiotics.
What statement made by the client would indicate understanding of discharge teaching for self-care after hospitalization for acute pancreatitis? A. "I will get immunized prior to my vacation." B. "I will take the antibiotics for 2 weeks." C. "I will avoid alcoholic beverages." D. "I will avoid onions, caffeine, and spices."
C. "I will avoid alcoholic beverages"
After hearing about enteral and parenteral nutrition approaches, a patient asks, "What's the difference between them?" Which statement should the nurse make to this patient? A. "Enteral nutrition is used short term, while parenteral nutrition is used long term." B. "Enteral nutrition provides only part of the nutritional needs, while parenteral nutrition provides all the nutritional needs." C. "Enteral nutrition is achieved through a tube into the stomach or small intestine, while parenteral nutrition is achieved through the veins." D. "Parenteral nutrition is achieved through a tube into the stomach or small intestine, while enteral nutrition is achieved through the veins."
C. Rationale: Enteral nutrition is achieved through a tube into the stomach or small intestine; parenteral nutrition is achieved through the veins. Enteral nutrition may be used short term or long term and may provide part or all of the patient's nutritional needs. The illustration below shows parenteral nutrition infusing through a catheter in the right subclavian vein.
During an assessment, the mother of a 2-month-old baby who is being breastfed reports that the baby is experiencing frequent episodes of flatulence but appears happy most of the day. Which response should the nurse make to this mother? A. "This is not normal. Your child is likely reacting adversely to a protein in your milk." B. "This is normal. Your child has an increased level of digestive C. enzymes, which leads to flatulence." D. "This is normal. Your child has a decreased level of digestive enzymes, which leads to flatulence." E. "This is not normal. Your child has an increased inflammatory reaction, which should be discussed with the healthcare provider."
C. Rationale: Infants have a deficiency of the pancreatic enzymes amylase, lipase, and trypsin. Levels of these enzymes will not be sufficient to aid in digestion until the infant is 4-6 months of age. This deficiency of enzyme production causes frequent abdominal distention and flatulence. The other statements are incorrect.
A patient with suspected acute pancreatitis seeks medical care. Which question should the nurse ask when assessing risk factors for the patient to develop this condition? A. "What does your daily diet usually consist of?" B. "Do you take any over-the-counter medications?" C. "How much alcohol do you drink each week?" D. "When was your last bowel movement?"
C. Rationale: One of the most common risk factors for acute pancreatitis is heavy alcohol intake. Nutritional deficiencies are a risk factor for chronic, not acute, pancreatitis. Medications that are known to cause acute pancreatitis include thiazide diuretics, such as furosemide and ACE inhibitors. These medications are prescribed, not over the counter. Changes in bowel patterns can indicate symptoms of other GI disorders and are not specific to risk factors related to acute pancreatitis.
A patient is having diagnostic testing to differentiate between chronic pancreatitis and pancreatic cancer. For which diagnostic study should the nurse prepare the patient? A. Contrast-enhanced CT scan B. Endoscopic ultrasonography C. Percutaneous fine-needle aspiration biopsy D. Magnetic resonance cholangiopancreatography (MRCP)
C. Rationale: Percutaneous fine-needle aspiration biopsy may be performed to differentiate chronic pancreatitis from cancer of the pancreas. The cells that are aspirated are examined for malignancy. A contrast-enhanced CT scan, endoscopic ultrasonography, and magnetic resonance cholangiopancreatography (MRCP) are used to visualize and detect changes in the pancreas and bile ducts.
A patient experiencing severe constipation and blood in the stool is scheduled for an endoscopy. Which teaching should the nurse provide about this procedure? A. "You will be drinking 16 to 20 ounces of liquid barium before the procedure." B. "After the test, you will be prescribed laxatives to help with constipation." C. "Do not eat any food or drink fluid for 8 hours before the procedure." D. "You can have something to eat and drink immediately after the procedure."
C. The patient should be instructed to not eat any food or drink fluid for 8 hours before the procedure. Barium and laxatives are not required for an endoscopy. Since the throat will be anesthetized, food and fluids will be withheld until the patient's gag reflex returns.
A patient recovering from acute pancreatitis asks why alcohol should be avoided. Which statement should the nurse make to this patient? A. "Alcohol is quickly absorbed into the bloodstream, causing toxicity of the pancreatic cells and resulting in decreased production of pancreatic enzymes." B. "Alcohol interacts with an enzyme, causing rapid digestion of pancreatic tissue and resulting in pancreatic necrosis." C. "Alcohol causes swelling in the duodenum, which raises the pressure within the pancreas and obstructs the outflow of pancreatic enzymes from the gland." D. "Alcohol in the bloodstream softens and destroys the elastin of the blood vessels, allowing for fluid shifts into the abdomen."
C. "Alcohol causes swelling in the duodenum, which raises the pressure within the pancreas and obstructs the outflow of pancreatic enzymes from the gland." Rationale: Alcohol causes swelling to occur in the duodenum, which results in an increase in pressure in the duodenum and entrance of the common bile duct and pancreatic duct. This increase in pressure reduces the outflow of pancreatic enzymes into the small intestine. Alcohol consumption may result in liver toxicity after prolonged use but does not decrease pancreatic enzyme production. Alcohol is not responsible for activating trypsin and does not cause pancreatic necrosis. Phospholipase A, which is activated by trypsin, not alcohol, is responsible for the destruction of elastin in the walls of the blood vessels.
The nurse is providing care for several clients on a medical-surgical unit. The nurse anticipates that the client with which condition may require surgery? A. Hepatitis B. Pancreatitis C. Malabsorption disorder D. Pyloric stenosis
D. Pyloric stenosis
A patient with chronic pancreatitis is prescribed pancrelipase. Which patient statement demonstrates an understanding of the correct way to take the medication? A. "I will take my medication when I wake and before bed." B. "I should take these before I drink alcohol." C. "I will take my medication every time I eat." D. "I can take these with a glass of soy milk."
C. "I will take my medication every time I eat." Rationale: Pancrelipase enhances the digestion of starches and fats in the GI tract by supplying anexogenous source of the enzymes protease, amylase, and lipase. The drug promotes nutrition and decreases the number of bowel movements. Pancrelipase is taken with meals or snacks. Alcohol should be completely avoided. The medication should not be mixed with alkaline foods; soy milk is alkaline.
A patient with history of alcohol abuse asks how chronic pancreatitis can be cured. Which response should the nurse make to this patient? A. "If you abstain from alcohol, the majority of the damage can be reversed." B. "There is no cure, but decreasing your alcohol intake will slow the disease process down." C. "Unfortunately the disease process cannot be reversed, but we can manage the symptoms." D. "We can get you started on a low-fat diet to improve the efficiency of your pancreas."
C. "Unfortunately the disease process cannot be reversed, but we can manage the symptoms." Rationale: Chronic pancreatitis is an irreversible process that eventually leads to pancreatic insufficiency. Alcoholism is the primary risk factor for chronic pancreatitis. A low-fat diet and abstinence from alcohol are recommended therapies that will help prevent recurrent episodes.
After inserting a nasogastric tube, the patient complains of nausea and begins to vomit. Which action should the nurse take? A. Provide the patient with sips of water. B. Administer an antiemetic as prescribed. C. Assess tube placement. D. Instruct the patient about relaxation techniques.
C. Assess tube placement If the patient experiences nausea and vomiting after nasogastric tube placement, reassess for tube placement. Instructing on relaxation techniques or administering an antiemetic may be appropriate but only after the tube placement has been reassessed. Providing small sips of water to a patient with a nasogastric tube is inappropriate.
The nurse is assessing a patient with acute pancreatitis. Which physical assessment finding should the nurse expect? A. Steatorrhea B. Left upper abdominal pain radiating to the back C. Cold clammy skin D. Bradycardia
C. Cold clammy skin Rationale: Systemic complications of acute pancreatitis include intravascular volume depletion. Hypotension and tachycardia occur as a result of decreased circulatory volume. Steatorrhea and left upper abdominal pain radiating to the back are symptoms of chronic pancreatitis.
A patient is admitted for treatment of malnutrition. Which information should the nurse collect first when assessing this patient? A. Serum electrolyte lab results B. Nutritional history C. Current height and weight D. Signs of lethargy and poor skin turgor
C. Current height and weight Rationale: The height and weight are used to calculate a body mass index (BMI), and a low BMI is a sign of malnutrition. An electrolyte imbalance can occur in many conditions and may not necessarily be a result of malnutrition. The patient's nutritional history is important information to be obtained in any situation in which there is an actual or potential nutritional deficit, but it is not the priority when evaluating a patient for malnutrion. Lethargy and poor skin turgor are findings that are associated with dehydration.
The nurse is obtaining a history on a patient experiencing constipation. Which finding should the nurse expect when assessing this patient? A. Marked pulsations in the abdomen B. Tympany over the left lower quadrant C. Hemorroids D. Hyperactive bowel sounds
C. Hemorroids In a patient with constipation, hemorrhoids may be present and develop as a result of straining during bowel movements. Bowel sounds will be normal or hypoactive. Dullness on percussion may be found in the left lower quadrant, which can indicate stool in the colon. Marked pulsations in the abdomen is an abnormal finding not associated with constipation.
The nurse is caring for a patient experiencing nausea and vomiting due to the side effects of chemotherapy. Which center of the brain, when stimulated, should the nurse explain as contributing to this patient's nausea? A. Pons B. Hippocampus C. Medulla D. Midbrain
C. Medulla Rationale: Nausea occurs when the vomiting center in the medulla of the brain is stimulated. The pons and midbrain are located in the brainstem with the medulla. The pons relays messages between several parts of the brain. The midbrain is responsible for motor-movement functions, particularly movement of the eye. It also is important for visual and auditory processing. The hippocampus is associated with the limbic system and long-term memory.
The nurse is caring for a 6-month-old infant with pyloric stenosis. Which of the following statements regarding this client's digestive system is false? A. The client's tongue is larger than an adult's in comparison to the nasal and oral passages. B. Enzymes from the client's pancreas are sufficient to aid in digestion. C. The client has a complete set of primary teeth. D. The client has voluntary control over swallowing.
C. The client has a complete set of primary teeth.
A patient with bloating, bloody stools, and difficulty swalllowing is prescribed a barium swallow. What reason should the nurse realize this diagnostic test has been prescribed for the patient? A. To complete a swallow study B. To Assess vocal cords C. To diagnose esophageal varices D. To diagnose throat cancer
C. To diagnose esophageal varices Rationale: An upper GI (gastrointestinal) series (also called barium swallow) is used to diagnose esophageal varices, inflammation, ulcerations, hiatal hernia, foreign bodies, polyps, diverticula, and tumors of the esophagus, stomach, and duodenal bulb. The test is done by observing movement of a contrast medium with a fluoroscope, an instrument with a screen that uses x-rays to show the internal structure of the body. The vocal chords are not part of the GI tract and are not assessed with a barium swallow. This test can identify tumors, but it is not a definitive diagnosis for cancer; further testing would need to be completed. Below is a photo of a barium x-ray of a healthy stomach.
A child who has been vomiting for several days has abdominal distention and pain upon palpation. Which other physical assessment finding should the nurse expect to assess in this patient? A. Tachypnea B. Anorexia C. Yellow sclera D. Hypotension
C. Yellow sclera Rationale: Children with pancreatitis typically experiences abdominal pain, vomiting, and abdominal tenderness and distention. Fever, jaundice, and nausea may also be present. Yellow sclera is related to jaundice. Anorexia may be noted in a pregnant patient suspected to have acute pancreatitis. Hypotension and tachypnea are symptoms of pancreatitis in older adults.
The nurse prepares to administer the first dose of a proton pump inhibitor (PPI) to a patient with gastroesophageal reflux disease (GERD). Which information should the nurse include when teaching about the mechanism of action of this medication? A. "It temporarily reduces gastric pain." B. "It neutralizes gastric acid secretion." C. "It stimulates gastric emptying." D. "It reduces gastric acid secretion."
D. A proton pump inhibitor (PPI) reduces gastric acid secretion by inhibiting the action of the hydrogen-potassium-ATP pump. Antacids neutralize gastric acid and relieve pain at the site of esophageal and gastric mucosa. Metoclopramide, a promotility agent, stimulates gastric emptying.
The nurse is caring for an infant who has not had a bowel movement for over 3 days. Which finding should the nurse expect when assessing this patient's abdomen? A. Dullness over the liver and spleen B. Absence of peristolic waves C. Tympany over the bladder D. Dullness over the abdominal region
D. Dullness in the abdominal region may indicate that the infant has an obstruction. The bladder cannot be percussed unless it is distended. Peristaltic waves should be absent on inspection. Abdominal movements such as peristaltic waves are considered abnormal and may indicate intestinal obstruction or pyloric stenosis. Percussed dullness over the liver and spleen is an anticipated finding.
The nurse notes that a patient is prescribed an antacid. Which information should the nurse include when teaching the patient about this medication? A. "Antacids bind the acid-secreting enzyme that functions as the proton pump, thereby disabling it." B. "Antacids promote motility by enhancing esophageal clearance and gastric emptying." C. "Antacids work to help suppress the volume of acidity coming from the lower gastrointestinal (GI) tract." D. "Antacids are alkaline substances that are commonly used to relieve simple acid indigestion."
D. Rationale: Antacids are alkaline substances that are commonly used to relieve simple acid indigestion. Histamine H2-receptor antagonists are useful in the treatment of gastroesophageal reflux disease and peptic ulcer disease because they help to suppress volume and acidity of parietal cell secretions. A potent dopamine receptor agonist such as metoclopramide hydrochloride promotes motility by enhancing esophageal clearance and gastric emptying. Proton pump inhibitors bind the acid-secreting enzyme (H+,K+-ATPase) that functions as the proton pump, disabling it for up to 24 hours.
Which intervention would best improve diet adherence of an older male immigrant recently diagnosed with gastroesophageal reflux disorder (GERD)? A. Giving a list of foods to avoid to the client's wife B. Scheduling low-fat meal deliveries to the home C. Providing printed diet information in his native language D. Interviewing the client to assess his current diet
D. Rationale: Interviewing the client to assess his current diet will provide information on which to base a collaborative nutrition plan. Scheduling low-fat meal delivery to the home, giving printed diet information in his native language, and giving a list of foods to avoid to the client's wife are not appropriate until the nurse has information on which to base an individualized culturally sensitive teaching plan.
The nurse is caring for a patient with intractable nausea and vomiting. Which intervention should the nurse make a priority? A. Giving clear liquids as tolerated B. Encouraging separate intake of clear fluids and food C. Restricting fluid intake for 1 hour before and after meals D. Monitoring vital signs, skin turgor and condition, and weight
D. Rationale: The priority should be to to monitor vital signs, skin turgor and condition, and weight. The patient is at risk for dehydration and fluid and an electrolyte imbalance. The remaining interventions are implemented after the nausea and vomiting are under control.
The nurse suspects that an older adult patient has diverticular disease. Which question should the nurse ask to determine if the patient is experiencing this health problem? A. "How much fluid have you had to drink in the last 24 hours?" B. "When was the last time you had anything to eat?" C. "Have you eaten any new foods?" D. "Have you experienced any constipation or diarrhea?"
D. "Have you experienced any constipation or diarrhea?" Rationale: People over age 50 are at increased risk of developing diverticular disease. The most common symptom of diverticular disease is sudden pain or cramping in the lower abdomen that worsens over the course of several days. Constipation, diarrhea, nausea, and vomiting may also occur. Assessing the patient's food and fluid intake will alert the nurse to a potential fluid and electrolyte imbalance. Eating a new food will not cause diverticulitis.
The nurse is reviewing the care needs for a patient with acute pancreatitis. Which intervention should the nurse make a priority for this patient? A. Monitor for malnutrition B. Provide oral care every 2 hours C. Measure daily weights D. Administer analgesics as prescribed
D. Administer analgesics as prescribed Rationale: The patient's comfort is a priority. The other options are appropriate; however, are not the priority at this time.
A patient with acute pancreatitis is determined to have compression of the common bile duct. Which laboratory value is elevated due to this condition? A. White blood cells B. Lipase C. Urine amylase D. Bilirubin
D. Bilirubin Rationale: The laboratory values indicating compression of the bile duct include serum bilirubin as the bile is unable to drain. Alkaline phosphate is also elevated due to this condition. Elevated white blood cell count indicates inflammation and is usually present with pancreatitis. The serum amylase levels rise within 2-12 hours of onset of acute pancreatitis to two to three times normal. Urine amylase levels rise in acute pancreatitis.
The nurse is assigned to a 4-month-old infant with vomiting and diarrhea who is brought to the pediatric clinic. The infant's vital signs are temperature: 37°C, apical HR: 130, R: 40/min. The abdominal assessment reveals a soft, concave abdomen, 10 gurgles auscultated in 1 minute in all four quadrants, and tympani to percussion. Which collaborative care action does the nurse anticipate? A. Prepare a milk-based infant formula to replace fluids. B. Place the infant NPO for a barium swallow. C. Check the surgical call schedule and reserve an operating suite. D. Complete a thorough digestion assessment interview with the mother.
D. Complete a thorough digestion assessment interview with the mother
The nurse plans to assess a patient for indications of pancreatitis. Which area should the nurse assess to determine if the Grey-Turner sign is positive? A. Periumbilical area B. Right upper quadrant area C. Epigastric area D. Flank area
D. Flank area Rationale: Grey-Turner sign is flank area ecchymosis. With acute pancreatitis, the patient may also have periumbilical ecchymosis (Cullen sign). The other choices are incorrect.
The nurse prepares information to teach a group of community members about foods to promote digestive health. Which foods should the nurse recommend in this teaching? A. Ham B. Cheese C. Yogurt D. Fruit
D. Fruit A healthy diet that is low in fat, cholesterol, and sugar and includes a variety of fruits, vegetables, grains, and protein sources is recommended for optimal digestive health. Yogurt, ham, and cheese are not identified as foods recommended to promote digestive health.
The nurse reviews the reasons for a patient to develop a problem with digestion. Which alteration in digestion should the nurse consider to be an alteration in motility? A. Crohn disease B. Gastrectomy C. Celiac disease D. Gastroesophageal reflux disease (GERD)
D. GERD Alterations of motility include gastroesophageal reflux (GERD), diarrhea, and pyloric stenosis. Crohn disease, gastrectomy, and celiac disease are examples of alterations of absorption. These diseases result in malabsorption, which is a condition in which the intestinal mucosa is unable to absorb nutrients, resulting in nutrients being excreted in the stool.
A patient with acute pancreatitis experiences severe nausea, vomiting, and epigastric pain in the left upper quadrant that radiates to the back with a distended and rigid abdomen. Which heart rate and blood pressure should the nurse expect when assessing this patient? A. HR: 62 beats/min; BP: 90/48 mmHg B. HR: 96 beats/min; BP: 186/92 mmHg C. HR: 60 beats/min; BP: 198/104 mmHg D. HR: 104 beats/min; BP: 94/52 mmHg
D. HR: 104 beats/min; BP: 94/52 mmHg Rationale: Manifestations of acute pancreatitis include tachycardia and hypotension. The vital signs that indicate these conditions are a heart rate of 104 beats/min and blood pressure of 94/52 mmHg. These physiological occurrences happen because of vascular damage resulting from enzymatic activity. The vascular permeability results in fluid shift from the bloodstream to the retroperitoneal and abdominal cavities. The heart rate increases in an attempt to perfuse the body with the decreased circulating volume. The blood pressure is reduced because of the diminished circulating volume. An increase in heart rate with an increase in blood pressure, a low heart rate with low blood pressure, and a low heart rate with high blood pressure will not occur.
A patient with severe pain is diagnosed with acute pancreatitis. Which pathophysiological condition should the nurse recall as causing this health problem? A. There is a decreased blood flow to the pancreas. B. Pancreatic enzymes are unable to be absorbed in the intestine. C. Infection has occurred causing pancreatic tissue necrosis. D. Pancreatic enzymes have been activated too early in the pancreas.
D. Pancreatic enzymes have been activated too early in the pancreas. Rationale: Pancreatic enzymes are secreted primarily in an inactive form and are activated in the intestine, a modification that prevents digestion of pancreatic tissue by its own enzymes. The cause of acute pancreatitis is not known. It is thought that the gallstones may activate pancreatic enzymes within the pancreas, leading to autodigestion, inflammation, edema, and/or necrosis.
A client presents with delayed wound healing. During the physical assessment, which nutrient deficiency does the nurse anticipate based on the data? A. Carbohydrates B. Digestive enzymes C. Insulin D. Protein
D. Protein
The nurse is preparing a presentation on the different types of problems with digestion that have a genetic tendency. Which condition should the nurse include in the session? A. Diarrhea B. Acute enteritis C. Hepatitis D. Pyloric stenosis
D. Pyloric stenosis Genetics may play a role in Crohn disese, GERD, pyloric stenosis, celiac disease, and pancreatitis. Hepatitis is not a condition of familial tendency, and diarrhea is a manifestation of another condition, not a primary disorder. Acute enteritis is inflammation of the small intestine caused by bacteria or viruses.
The nurse is caring for a patient with acute pancreatitis. For which potential complication should the nurse closely monitor this patient? A. Hypertension B. Malabsorption syndrome C. Acute respiratory distress syndrome (ARDS) D. Renal failure
D. Renal failure Rationale: The clinical manifestations of tachycardia and hypotension that are noted with acute pancreatitis may develop into hypovolemic shock as a result of depletion of intravascular fluid volume. Because of the reduction of circulating blood volume, the kidneys will not be adequately perfused, which may result in renal failure. Hypertension will not occur as a result of the reduction of blood flow. Malabsorption syndrome is a potential complication of chronic, not acute, pancreatitis, because the permanent fibrotic changes and tissue destruction that cause this disorder develop over a prolonged period. ARDS is a potential systemic complication that would be noted within 3 to 7 days of the onset of the disorder.
The nurse is assessing a patient with chronic pancreatitis. Which clinical manifestation should the nurse expect to assess in this patient? A. Diarrhea B. Weight gain C. Lower abdominal pain D. Steatorrhea
D. Steatorrhea Rationale: Steatorrhea, the fatty, frothy, foul-smelling stools caused by a decrease in pancreatic enzyme secretion, occurs in chronic pancreatitis. The other clinical manifestations do not occur in chronic pancreatitis.
