EAQ-CONTENT AREA-MED-SUG-GI

A nurse is teaching a newly admitted client who has acute pancreatitis about dietary restrictions. What should the education include? A. Use of IV fluids B. Season foods sparingly C. Eat small meals frequently D. Limit coffee to three cups per day

ANSWER: A RATIONALE: Acute pancreatitis requires an NPO status to allow the pancreas to rest. IV fluids are administered. Spicy, seasoned foods stimulate the pancreas and should be avoided, not just sparingly used. Small, frequent feedings place less demand on the pancreas to release digestive enzymes and are instituted when the acute phase is resolved. Fats stimulate the release of lipase from the pancreas, whether they are saturated or unsaturated fats, and should be avoided. Coffee stimulates pancreatic secretions and should be avoided.

For which clinical indicator associated with a complication of portal hypertension should the nurse assess the client?

ANSWER: Hemorrhage from esophageal varices RATIONALE: The increased pressure within the portal circulatory system causes increased pressure in areas of portal systemic collateral circulation (most important, in the distal esophagus and proximal stomach). Hemorrhage is a possible complication. Liver abscesses may occur as a complication of intestinal infections, not portal hypertension. Intestinal obstruction may be caused by manipulation of the bowel during surgery, peritonitis, neurologic disorders, or organic obstruction, not portal hypertension. Perforation of the duodenum usually is caused by peptic ulcers; it is not a direct result of portal hypertension or cirrhosis.

A client is admitted to the hospital with a history of cancer of the liver and jaundice. In relation to the jaundice, the nurse expects the client to report the presence of what symptom? A. Pruritus B. Diarrhea C. Blurred Vision D. Bleeding gums

ANSWER: A RATIONALE: Itching associated with jaundice is believed to be caused by accumulating bile salts in the skin. Diarrhea, blurred vision, and bleeding gums are not related to jaundice.

A nurse is preparing a morbidly obese client for gastric bypass surgery. What should the nurse teach the client to do after surgery? a. Take medications in liquid form. b. Lie on the right side for one hour after meals. c. Ingest a high-carbohydrate diet once eating is resumed. d. Receive patient-controlled analgesia for six days after surgery

ANSWER: A RATIONALE: Taking medications in liquid form allows for easier digestion and absorption of medication in the stomach. This client should lie on the left side for 20 to 30 minutes to delay gastric emptying. This client should be ingesting a high-protein diet with limited carbohydrates and no simple sugars; this will help minimize the dumping syndrome. Barring any complications, this client should be discharged in five days and will not need patient-controlled analgesia.

A nurse is providing dietary teaching for a client with celiac disease. Which foods should the nurse teach the client to avoid when following a gluten-free diet? Select all that apply. A. Rye B. Oats C. Rice D. Corn E. Wheat

ANSWER: A,B,E RATIONALE: Rye, oats, and wheat should be avoided because they are irritating to the gastrointestinal mucosa. Gluten is not found in rice or corn; therefore, these items do not have to be avoided.

Following surgery, a client asks the nurse to help with measuring intake and output. What is the best nursing response? a. Determine the client's willingness to really help b. Identify the client's reason for wanting to do this task c. Assess the client's ability to measure the intake and output d. Explain that measuring intake and output is the responsibility of the nurse

ANSWER: C RATIONALE: Clients should be allowed to maintain some control, depending on their ability to perform a given task; involve the client by allowing to measure intake and output after assessment of abilities. The client has already indicated willingness by the request. Determining the client's willingness to really help is immaterial. Able clients should be supported to perform self-care.

An older adult is returned to the surgical unit after having a subtotal gastrectomy. Which dietary modification should the nurse anticipate that the healthcare provider will most likely prescribe? A. Increase intake of dietary roughage quickly B. Avoid oral feedings for a prolonged period C. Resume small, easily digested feedings gradually D. Limit intake to self-selection of personally preferred foods

ANSWER: C RATIONALE: Small, frequent feedings are tolerated best after a subtotal gastrectomy. Roughage may be irritating to the gastrointestinal (GI) tract after surgery. As soon as edema subsides, the individual generally is given small amounts of fluid, and then the diet is progressed gradually. Allowing only personal food preferences does not ensure inclusion of nutrients necessary for recovery.

A nurse is caring for a client after surgical creation of an ostomy. The nurse observes that the stool is formed. In which part of the colon should the nurse assess the ostomy? A. Ileum B. Ascending C. Transverse D. Descending

ANSWER: D RATIONALE: As the effluent passes through the gastrointestinal system, water is absorbed, and the stool becomes more formed. The stool from an ostomy in the descending colon will be formed. The ileum is a component of the small intestines and produces very liquid stools. The stool from an ostomy in the ascending colon will be liquid because it is the first portion of the large intestine that the stool enters, and fluid has not yet been reabsorbed. The stool from an ostomy in the transverse colon will be soft and pasty because fluid still can be absorbed in the rest of the large intestine.

A client experiences occasional right upper quadrant pain attributed to cholecystitis. The nurse is providing discharge instructions, including a list of foods that cause dyspepsia. Which foods should be on the list the nurse provided the client? A. Nuts and popcorn B. Meatloaf and baked potato C. Chocolate and boiled shrimp D. Fried chicken and buttered corn

ANSWER: D RATIONALE: Cholecystitis is often accompanied by intolerance to fatty foods, including fried foods and butter. Nuts and popcorn have a high fiber content but have less fat than fried foods; nuts and popcorn cause flatulence and pain for clients with lower intestinal problems, such as diverticulosis. Meatloaf and baked potato contain less fat than do fried foods or butter. Neither chocolate nor boiled seafood contains as much fat as fried chicken or butter.

The nurse is creating a dietary plan for a client with cholecystitis who has been placed on a modified diet. Which will be most appropriate to include in the client's dietary plan? A. Offer soft-textured foods to reduce the digestive burden B. Offer low-cholesterol foods to avoid further formation of gallstones C. Increase protein intake to promote tissue healing and improve energy reserves D. Decrease fat intake to avoid stimulation of the cholecystokinin mechanism for bile release

ANSWER: D RATIONALE: Fat intake stimulates cholecystokinin release that signals the gallbladder to contract, causing pain. Soft-textured foods are unnecessary. Eating low-cholesterol foods to avoid further formation of gallstones is not true for all clients with cholecystitis; low-cholesterol foods are necessary if the cholecystitis is precipitated by cholelithiasis and the stones are composed of cholesterol. An increase in protein intake is necessary to promote tissue healing and improve energy reserves after a cholecystectomy, but is not as important as fat intake for cholecystitis.

A client who recently has had an abdominoperineal resection and colostomy accuses the nurse of being uncomfortable during a dressing change because the "wound looks terrible." The nurse identifies the client as using which defense mechanism? A. Projection B. Sublimation C. Compensation D. Intellectualization

ANSWER: A RATIONALE: Projection is the attribution of unacceptable feelings and emotions to others. Sublimation is the substitution of socially acceptable feelings or instincts to replace those that are threatening to the ego. Compensation is overachievement in a more comfortable area, thereby covering up a weakness. Intellectualization is the use of mental reasoning processes to deny facing emotions and feelings involved in a situation.

Six hours after major abdominal surgery, a client reports severe abdominal pain and feeling faint. The nurse identifies a thready, rapid pulse. The nurse checks the medication administration record (MAR) (Physiological Aspects of Care record) and determines that the client can receive another injection of pain medication in an hour. Which is the most appropriate action by the nurse? A. Notify the healthcare provider about the client's symptoms B. Explain to the client that it is too early to have an injection for pain C. Reposition the client for greater comfort and turn on the television as a distraction D. Prepare the injection to administer it to the client early because of the severe pain

ANSWER: A RATIONALE: The client's signs and symptoms suggest the possibility of shock; the primary healthcare provider must be alerted to this possible life-threatening condition. Explaining to the client that it is too early is missing the big picture; the client may be hemorrhaging. The client has unmet needs that must be addressed first. Distraction is effective with mild, not severe, pain. Preparing and administering the pain medication early are outside the scope of nursing practice. Healthcare provider prescriptions must be followed as prescribed, or the healthcare provider should be notified.

Which food selections by a client with celiac disease indicate that the nurse's dietary teaching is successful? Select all that apply. A. Green beans B. Baked potato C. Noodle pudding D. Turkey sandwich E. Whole wheat cereal

ANSWER: A,B RATIONALE: Clients with celiac disease need to follow a gluten-free diet. Green beans are a vegetable; fresh fruits and vegetables are permitted on a gluten-free diet. A baked potato is permitted on a gluten-free diet. Noodles are made of flour high in gluten and should be avoided. Bread in the turkey sandwich is made with flour high in gluten and should be avoided. Whole wheat cereal is high in gluten and should be avoided.

A client has a colon resection with an anastomosis. What assessments by the nurse support a suspicion of impending shock? Select all that apply. A. Oliguria B. Lethargy C. Irritability D. Hypotension E. Slurred speech

ANSWER: A,C,D RATIONALE: Decreased blood flow to the kidneys leads to oliguria or anuria. Irritability, along with restlessness and anxiety, occurs because of a decrease in oxygen to the brain. Hypotension and a narrowing of the pulse pressure occur because of declining blood volume. Restlessness, not lethargy, usually occurs because of decreased cerebral blood flow. There are various changes in sensorium, but slurred speech is not a manifestation of shock.

Before discharge, a client with a colostomy questions the nurse about resuming prior activities. What is the nurse's best response? A. "Most sporting activities, except for swimming, can be resumed based on your overall physical condition." B. "With guidance, a near normal lifestyle, including complete sexual function, is possible." C. "Activities of daily living should be resumed as quickly as possible to avoid depression and further dependency." D. "After surgery, drastic changes in lifestyle must be made to accommodate the physiologic changes caused by the operation."

ANSWER: B RATIONALE: A near normal lifestyle can be resumed, including sexual functioning. Few physical restraints on activity are required postoperatively, but the client may have emotional problems as a result of body image changes. Swimming is not prohibited because water does not harm the stoma. Resuming activities of daily living is important, but they do not have to be resumed as quickly as possible to avoid depression. No drastic changes in lifestyle are necessary.

A client who had an abdominoperineal resection and colostomy refuses to allow any family members to see the incision or stoma. The client is noncompliant with most of the dietary recommendations. The nurse concludes that the client is experiencing what response? a. Reaction formation; this is related to the client's recent altered body image b. Denial; the client is having difficulty accepting reality c. Impotency resulting from the surgery; sexual counseling may be indicated d. Suicidal thoughts; consultation with a psychiatrist should be prescribed

ANSWER: B RATIONALE: As long as no one else confirms the presence of the stoma and the client does not adhere to a prescribed regimen, the client's denial is supported. There is no evidence to document that reaction formation is being used. There are no data to support the conclusion that the client has an inability to function sexually. There is no evidence that suicidal thoughts are present or will be acted upon.

A client who has a history of alcohol abuse now has recurrent exacerbations of chronic pancreatitis. The nurse asks the client to obtain a stool specimen. When assessing the client's stool, what would the nurse expect to observe? a. Melena b. Steatorrhea c. Hard, dry stool d. Ribbon-shaped stool

ANSWER: B RATIONALE: Decreased secretion of lipase from the pancreas limits fat breakdown in the small intestine, resulting in increased fat content in feces; steatorrhea is soft, frothy, foul-smelling feces. Melena refers to black, tarry stool containing digested blood; melena is caused by upper gastrointestinal bleeding. Hard, dry stool reflects constipation; stools associated with pancreatitis are soft and frothy. Ribbon-shaped stool is associated with obstruction of the descending or sigmoid colon.

On the third postoperative day after a subtotal gastrectomy, a client reports having severe abdominal pain. The nurse palpates the client's abdomen and determines rigidity. What should be the nurse's first action? A. Assist the client to ambulate. B. Obtain the client's vital signs. C. Administer the prescribed analgesic. D. Encourage using the incentive spirometer.

ANSWER: B RATIONALE: Rigidity and pain are hallmarks of bleeding from the suture line or of peritonitis; vital signs provide supporting data. Ambulation is indicated if pain was the result of flatulence; however, rigidity is associated with bleeding or peritonitis, and additional data are needed. An analgesic may mask the symptoms, thereby delaying diagnosis. Encouraging use of the incentive spirometer is unrelated to the symptoms presented.

A client who is suspected of having salmonellosis asks the nurse how the diagnosis is confirmed. The nurse responds that the medical diagnosis is established with what laboratory test? A. Urinalysis B. Stool culture C. Febrile agglutinin test D. Complete blood count

ANSWER: B RATIONALE: The Salmonella bacilli can be visualized via microscopic examination of stool. Although a urinalysis might be done, it is not definitive for the diagnosis of salmonellosis. Although a febrile agglutinin test might be done, it is not definitive for the diagnosis of salmonellosis. Although a complete blood count might be done, it is not definitive for the diagnosis of salmonellosis.

The nurse is providing care to a client with ascites secondary to liver failure. What is appropriate to include in this client's care? Select all that apply. A. High protein diet B. Low sodium diet C. Daily abdominal girth measurements D. Encourage increased by mouth fluid intake E. Daily weights

ANSWER: B,C,E RATIONALE: In the client with liver failure and ascites, the liver has lost its ability to synthesize proteins. This leads to hypoalbuminemia and decreased oncotic pressure in the vessels. This decrease in oncotic pressure leads to fluids leaking out of the vessels and into the interstitial spaces and peritoneum, causing edema and ascites. A low sodium and low protein diet is recommended. A high protein diet will worsen the symptoms, and often these clients are on a fluid restriction. Taking daily weights is the most reliable indicator of fluid retention.

A client has been diagnosed with cholelithiasis. Which fact about cholelithiasis should the nurse recall when assessing this client for risk factors? A. Men are more likely to be affected than women B. Young people are affected more frequently than older people C. Individuals who are obese are more prone to this condition than those who are thin D. People who are physically active are more apt to develop this condition than those who are sedentary

ANSWER: C RATIONALE: Cholelithiasis occurs more frequently in individuals who are obese and have hyperlipidemia. Women are more likely to develop cholelithiasis. Middle aged people, usually over 40 years, are more likely to develop this condition than younger people; aging increases risk. People who have sedentary lifestyles are more likely to develop this condition than those who are active.

A client tells the nurse about recent recurrent episodes of bleeding hemorrhoids. What should the nurse advise the client to do to help prevent future hemorrhoidal episodes? A. Exercise to improve circulation B. Eat bland foods and avoid spices C. Consume a high-fiber diet and drink adequate water D. Use laxatives to avoid constipation and the Valsalva maneuver

ANSWER: C RATIONALE: Consuming a high-fiber diet and drinking adequate water promote regular bowel function, prevents constipation, and prevent straining, which can make hemorrhoids worse; a high-fiber diet provides bulk that stimulates peristalsis, and water promotes a soft stool. Exercise is advisable, but the purpose in this instance is to increase peristalsis, not improve circulation. Bland foods and spices are unrelated to hemorrhoids; bland foods are preferred for clients with gastric or intestinal problems. Laxatives are contraindicated because they are irritating to the bowel, decrease intestinal tone, and promote dependency. The Valsalva maneuver should also be avoided.

Six weeks after discharge, a client with a jejunoileal bypass for morbid obesity returns to the outpatient clinic reporting palpitations, abdominal cramps, diarrhea, and dizziness 30 minutes after meals. What complication should the nurse consider that the client is most likely experiencing? A. Gastric reflux B. Reflux gastritis C. Dumping syndrome D. Abdominal peritonitis

ANSWER: C RATIONALE: When ingested food rapidly enters the jejunum without having gone through the usual mixing and digestive process, the hypertonic bolus causes rapid movement of extracellular fluid into the bowel; this rapid shift decreases the circulating blood volume. Decreased peripheral vascular resistance, visceral pooling of blood, and reactive hypoglycemia also are implicated. Also, the distended jejunum increases intestinal peristalsis and motility. Backward flow of gastric contents into the esophagus, or gastric reflux, causes heartburn, dysphagia, water brash, acid regurgitation, or belching (eructation). Reflux gastritis is a chronic inflammation of the lining of the stomach caused by reflux of duodenal contents; epigastric pain, nausea, vomiting, and hematemesis are common clinical manifestations. Abdominal peritonitis is an inflammation of the peritoneal membrane; rigidity of abdominal muscles, abdominal pain, low-grade fever, malaise, absent bowel sounds, and shallow respirations are common clinical manifestations.

A client with the diagnosis of Crohn disease tells the nurse that her boyfriend dates other women. She believes that this behavior causes an increase in her symptoms. What should the nurse do first when counseling this client? A. Help the client explore attitudes about herself B. Educate the client's boyfriend about her illness C. Suggest the client should not see her boyfriend for a while D. Schedule the client and her boyfriend for a counseling session

ANSWER: A RATIONALE: Because emotional stress can influence the progress of Crohn disease, initially the nurse should help the client to explore self-attitudes to aid in better understanding the feelings engendered by her boyfriend dating others. Initially the nurse should help the client explore the situation and the feelings it engenders rather than involve the boyfriend. The client should make the decision about seeing her boyfriend. Scheduling the client and her boyfriend for a counseling session is premature; the client is not ready for a joint counseling session.