Gastro Quiz 2

A self-help group of clients with irritable bowel syndrome have invited a nurse to present a program on nutrition. Which substance should the nurse teach the clients to minimize in the diet to decrease G.I. irritability?

1. Cola drinks

Which food selections by a client with malabsorption syndrome indicate at the nurses dietary teaching was successful? Select all that apply

1. Green beans 2. Baked potato

You are caring for an obese post operative client who underwent surgery for bowel resection. As the client is moving in bed, he comments "something popped open". Upon examination you note wound evisceration. Place in order the steps for handling this complication.

1. Stay calm and stay with the patient 2. Put the clients into semi Fowler position with knees slightly flexed 3. Check the vital signs especially blood pressure and pulse 4. Have a colleague gather sterile supplies and contact the physician 5. Cover the intestine with sterile moisten gauze 6. Prepare the client for surgery as ordered

A nurse is reviewing the laboratory results of and collecting a health history from client with a diagnosis of colitis. Which common clinical manifestation of colitis should the nurse expect?

1. Weight loss

A client who had surgery for a ruptured appendix develops peritonitis. What clinical findings related to peritonitis should the nurse expect the client to exhibit? Select all that apply

1. fever 5. Abdominal muscle rigidity

A client is scheduled for a colonoscopy, and the healthcare provider orders a tap water enema. In which position should the nurse place the client during the enema?

1. left sims

When advising a college student about dietary choices the nurse should consider the caloric value of the most commonly ordered fast foods eaten by active young adults. List the following foods in order from the one with the least number of calories to the one with the most number of calories.

1. one slice of French toast 2. French fries 3. Six pieces of chicken tenders 4. Garden salad 5. Whopper with cheese

Neomycin 1g is prescribed preoperatively for a client with a diagnosis of cancer of the colon. The client asks why neomycin is being given. Which is the best response by the nurse?

2. "It will kill the bacteria in your bowel and decrease the risk of infection after surgery"

An exploratory laparotomy is performed on a client with melena, and gastric cancer is discovered. A partial gastrectomy is performed, and a jejunostomy tube is surgically implanted. A nasogastric tube to suction is in place. What should the nurse expect regarding the clients nasogastric tube drainage during the first 24 hours after surgery?

2. Contain some blood and clots

A nurse is teaching a client who has a full time job how to care for a new colostomy. At which time should the nurse suggest scheduling the colostomy irrigations?

2. approximately a half hour after breakfast

For clients coming to the ambulatory care G.I. clinic, which tasks would be most appropriate to assign to an LPN?

2. assisting the physician in incision and drainage of a pilonidal cyst

A client is diagnosed as having colitis. Which clinical findings should the nurse expect the client to report? Select all that apply

2. diarrhea 5. Abdominal cramps

A nurse is caring for a client with a new colostomy. Which client outcome is most important for achievement of long-range goals associated with adjusting to a new colostomy?

2. readiness to accept an altered body function

When a client is being prepared for a colonoscopy procedure, which task is most suitable to delegate to the UAP?

2. reinforcing NPO status eight hours before the procedure

A nurse is teaching a client with an acute exacerbation of colitis about the most appropriate diet. Which food selected by the client indicates that the dietary teaching is effective?

2. scrambled eggs

For which classic clinical findings should the nurse assess the stool of clients with malabsorption syndrome?

3. Fat globules

A client is diagnosed with malabsorption syndrome. Which foods should the nurse teach the client to avoid? Select all that apply

3. Oatmeal 4. Rye bread

A client with cancer of the colon had surgery for a resection of the tumor and the creation of a colostomy. During the six week post operative check up, the nurse teaches the client about nutrition. The nurse evaluates that learning has taken place when the client states, "I should follow a diet that is:

3. as close to usual as possible"

What should the nurse do when caring for a client with an ileostomy?

4. anticipate that any emotional stress can increase intestinal peristalsis

Which information does the nurse include when teaching a patient with new onset hemorrhoids about prevention of hemorrhoid flare-up? Select all that apply

a. " increase the fiber in your diet to prevent constipation" c. "Maintain a healthy weight" d. "Increase your amount of fluid intake"

A patient is prescribed sulfasalazine (Azulfidine) for the treatment of ulcerative colitis. Which patient statement indicates the patient is experiencing a side effect of this drug?

a. " my skin is covered with a rash"

The nurse is to administer alvimopan (Entereg) to a patient with postoperative ileus (POI). What is the action of this drug?

a. Increases gastrointestinal motility

In caring for patients with Crohn's disease, the nurse observes for which complications? Select all that apply

a. Peritonitis b. Small bowel obstruction c. Nutritional and fluid imbalances d. Presence of fistulas

Which NG tube can be connected to low continuous suction?

a. Salem sump

Which intervention is contraindicated in the nonsurgical management of hemorrhoids?

a. diets low in fiber and fluids

Which discharge information does the nurse include for the patient who has had an intestinal obstruction caused by fecal impaction?

a. encourage the patient to report abdominal distention, nausea, or vomiting, and constipation

What is the nature of pain associated with diverticulitis?

a. intermittent becoming progressively steady

Which description best defines an anal fissure?

a. perianal tear that can be very painful

Which statements about peritonitis are true? Select all that apply

a. peritonitis is caused by contamination of the peritoneal cavity by bacteria or chemicals b. continuous ambulatory peritoneal dialysis (CAPD) can cause peritonitis d. abdominal wall rigidity is a classic finding in patients with peritonitis

The emergency department nurse is assessing a patient admitted with frequent, liquid, foul-smelling stools containing mucus and blood. Assessment findings include a temperature of the 103.8°F, tenesmus, abdominal tenderness, and vomiting. Which additional laboratory tests does the nurse expect to collect?

a. serial stool samples

The nurse is teaching a patient about what to expect after a descending colon colostomy. The nurse tells the patient to expect this stool to have what kind of form?

a. similar to that of stool expelled from the rectum

What is the priority nursing concern for a patient with gastroenteritis?

b. Fluid replacement

Which diagnostic test measures urinary excretion of vitamin B12 for diagnosis of pernicious anemia and other malabsorption syndromes?

b. Schilling test

The nurse on the surgical unit is expecting to admit the patient who has had an appendectomy with abscess. What does the nurse anticipates care for this patient will include? Select all that apply

b. Wound drains c. IV antibiotics e. Nasogastric tube care

Which are examples of mechanical bowel obstructions? Select all that apply

b. adhesions c. Tumors e. Fecal impaction

After colostomy surgery, which intervention does the nurse employ?

b. apply a pouch system as soon as possible

What do post operative measures for a male patient who has had an inguinal herniorrhaphy include?

b. elevating the scrotum on a pillow

What statement is true about the medical treatment of ulcerative colitis?

b. immunomodulators are not thought to be effective, however, in combination with steroids, they may offer a synergistic effect.

The trauma patient has ecchymosis in the shape and distribution of a seatbelt. What is the nurses best first action?

b. notify the healthcare provider

The patient has been diagnosed with acute appendicitis. Based on this diagnosis, which intervention does the nurse perform?

b. prepare the patient for surgery

What are the cardinal signs of peritonitis?

c. Abdominal pain, distention, and tenderness

Which parasitic infection is manifested by diarrhea and occurs most commonly in immunosuppressed patients, especially those with human immunodeficiency virus?

c. Giardia lamblia

Which test may be used in diagnosing IBS?

c. Hydrogen breath test

Which statement is true about drug therapy for crohn's disease?

c. Metronidazole (Flagyl) has been helpful in patients with fistulas and crohn's disease

Which is a preventative measure for diverticular disease?

c. Taking bulk agents such as psyllium hydrophilic mucilloid (Metamucil)

Which are true statements about caring for a patient with a truss? Select all that apply

c. The truss is only used after the hernia has been reduced by the physician e. Powder should be applied to the skin under the truss daily

Which observation of a patient with an intestinal obstruction does the nurse report immediately?

c. abdominal pain changing from colicky to constant discomfort

The patient comes to the emergency department with lower right quadrant pain. What does the ED nurse suspect?

c. appendicitis

Which test is definitive for the diagnosis of CRC?

c. colonoscopy with biopsy

Which statement about intra-abdominal pressure (IAP) monitoring is correct?

c. high IAP leads to increased afterload and decreased preload

The nurse is performing an abdominal assessment on a patient suspected of having an abdominal hernia. The nurse auscultates the abdomen and determines the absence of bowel sounds. What does the nurse suspect in this patient?

c. obstruction and strangulation

Which description best defines intussusception of the intestine?

c. telescoping of a segment of the intestine within itself

What is the classic symptom of malabsorption syndrome?

d. chronic diarrhea

The nurse is assessing a patient with viral gastroenteritis. Which symptom is the nurse most concerned about?

d. rebound tenderness

The patient has an abdominal hernia with a sac that can be replaced into the abdominal cavity by gentle pressure. Which type of hernia does the nurse recognize?

d. reducible

Which surgical procedure involves removal of the colon, rectum, and anus with surgical closure of the anus?

d. total proctocolectomy with a permanent ileostomy

Place the steps for performing colostomy care in the correct order.

1. Don a pair of clean gloves and remove the old pouch 2. Assess the color and appearance of the stoma 3. Wash the skin with mild soap and rinse with warm water 4. Dry the skin carefully 5. Apply a skin barrier to protect the peristomal skin 6. Fit the pouch snugly around the stoma

A female client with the diagnosis of Crohn's 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?

1. Help the client explore attitudes about herself

A client hospitalized with ulcerative colitis reports 10 to 20 small diarrhea stools per day, with abdominal pain before defecation. The client appears depressed and underweight and is uninterested in self-care or suggested therapies. What is the priority nursing diagnosis?

1. diarrhea related to irritated bowel

An active adolescent is admitted to the hospital for surgery for an ileostomy. When planning a teaching session about self-care, the nurse includes sports that should be avoided by a client with an ileostomy. Which should be included on the list of sports to be avoided? Select all that apply

1. football 3. Ice hockey

You are teaching the client and family how to perform colostomy irrigation. Place the following information in the correct order.

1. put on a pair of clean gloves 2. Put 500 to 1000 mL of lukewarm water in the container 3. Hang the container at about shoulder height 4. Lubricate the stoma cone and gently insert the tubing tip into the stoma 5. Allow the solution to flow slowly and steadily for 5 to 10 minutes 6. Allowed 15 to 20 minutes for the initial evacuation 7. Clip the irrigation sleeve and have the client walk for about 30 to 45 minutes for a secondary evacuation 8. Clean, rinse, and dry the skin, and apply a new drainage pouch

A nurse teaches a client with G.I. irritability to minimize the intake of dietary irritants. Which products did the nurse teach the client to avoid? Select all that apply

2. Milk 3. Cheese 5. Chocolate candy

A nurse obtains daily's stool specimens for a client with chronic bowel inflammation. The nurse concludes that these stool examinations were ordered to determine:

2. Occult blood

After many years of coping with colitis, a patient makes a decision to have a colectomy as advised by the healthcare provider. Which is most likely the significant factor that impacted on the clients decision?

2. Surgical treatment cures ulcerative colitis

A nurse is educating a client with a colostomy of the ascending colon about using a colostomy appliance. Which instruction should the nurse provide to help prevent leakage of stool from the appliance?

2. empty the appliance when it is approximately one half full with feces

A client had part of the ileum surgically removed. Why is it necessary for the nurse to monitor the client for clinical indicators of anemia?

2. the hemopoietic factor is absorbed in the ileum

A nurse is teaching a client with a permanent colostomy about self-care in preparation for discharge from the hospital. Which intervention should the nurse discuss with the client?

3. Dilating the stoma periodically

A nurse is evaluating a client who has been receiving medical intervention for the diagnosis of Crohn's disease. Which expected outcome is most important for this client?

3. Gains a half pound per week

You are planning a treatment intervention program for chronic fecal incontinence for an elderly client. Which intervention should you try first?

3. assist the client to the bedpan or toilet 30 minutes after meals

Two hours after a subtotal gastrectomy, the nurse identifies that the drainage from the clients nasogastric tube is bright red. What should the nurse do first?

3. determine that this is an expected finding

You are caring for a client with a nasal gastric tube. Which task can be delegated to an experienced UAP?

3. disconnecting the suction to allow ambulation to the toilet

An 18-year-old is admitted with an acute onset of right lower quadrant pain at McBurney's point. Appendicitis is suspected. For which clinical indicator should the nurse assess the client to determine if the pain is secondary to appendicitis?

3. rebound tenderness

A client with ulcerative colitis has experienced frequent severe exacerbations over the past several years. The client is admitted to the hospital with intense pain, severe diarrhea, and cachexia. Which therapeutic course should the nurse expect the healthcare provider to explore with this client?

3. surgical therapy (colectomy)

Which explanation is most accurate when the nurse teaches a client about intussusception of the bowel?

3. telescoping of a proximal loop of bowel into a distal loop

A nurse is admitting a client with the diagnosis of malabsorption syndrome to the medical unit at lunchtime. Which foods can be included on the clients ordered diet?

4. cheese omelette with chopped spinach

A nurse is assessing two clients. One client has ulcerative colitis and the other client has Crohn's disease. Which is more likely to be identified in the client with ulcerative colitis than the client with Crohn's disease?

4. involvement starting distally with rectal bleeding at that spreads continuously up the colon

You are caring for a client who was recently admitted for severe diverticulitis. Which task is appropriate to delegate for the care of this client?

4. tell the UAP that a stool specimen must be saved to test for occult blood

Which statements does the nurse include while providing discharge instructions for a patient with giardiasis? Select all that apply

a. "Avoid contact with stool from dogs and beavers" b. "All household and sexual partners should have stool examinations for parasites" c. "Treatment will most likely consist of metronidazole (Flagyl)" d. "Infection can't be transmitted to others until the amebicides kill the parasites"

A patient with ulcerative colitis who has had an ileostomy is being discharged home. The nurse has provided discharge teaching. Which statements by the patient indicate the teaching has been effective? Select all that apply

a. "I will avoid foods that cause gas" b. "I will call the health care provider if I have a fever over 101°F" e. "I will call the healthcare provider if I feel like my heart is beating fast"

Which discharge instructions does the nurse include for a patient after abdominoperitoneal resection?

a. "use a soft pillow to sit on whenever you sit down"

Which drug is the drug of choice for the treatment of IBS when pain is the predominant symptom?

a. Amitriptyline (Elavil)

The patient has a diagnosis of irritable bowel syndrome. What forms can IBS take? select all that apply

a. Diarrhea (IBS-D) b. Constipation (IBS-C) d. Alternating diarrhea and constipation (IBS-A) e. Mix of constipation and diarrhea (IBS-M)

Which are potential complications of polyps? Select all that apply

a. Gross rectal bleeding c. Intestinal obstruction e. Intussusception

Darifenacin (Enablex) is an example of a new group of drugs that may be used to manage IBS. What action of this drug would make it suitable for treatment of IBS?

a. Inhibits intestinal motility

Which laboratory results are expected with malabsorption syndrome resulting in hypochromic microcytic anemia? Select all that apply

a. Low mean corpuscular hemoglobin (MCH) f. Low mean corpuscular hemoglobin concentration (MCHC)

The nurse is caring for the patient with acute appendicitis. Which interventions will the nurse perform? Select all that apply

a. Maintain the patient on NPO status b. Administer IV fluids as prescribed

Which intervention does the nurse delegate to the unlicensed assistive personnel when caring for a post operative patients with peritonitis?

a. Measure intake and output

Which statement about diverticular disease is true?

a. Most diverticula occur in the sigmoid colon

Which findings for a patient with a new colostomy will the nurse report to the surgeon? Select all that apply

a. a dark-red, dry stoma c. mucocutaneous separation e. large amount of bleeding

Respiratory problems that may accompany peritonitis are a result of which factor?

a. associated pain interfering with ventilation

What are the major focus areas for interventions aimed at treating malabsorption syndromes? Select all that apply

a. avoiding substances that aggravate malabsorption c. Supplementation of nutrients

Which interventions are useful in preventing the spread of gastroenteritis? Select all that apply

a. careful handwashing b. Sanitize all surfaces that may be contaminated d. Easily accessible hand sanitizers

Which are the most common signs of colorectal cancer (CRC)? Select all that apply

a. change in stool consistency d. anemia e. rectal bleeding

A patient is suspected to have ulcerative colitis. Which definitive diagnostic test does the nurse expect the patient to undergo in order to confirm the diagnosis?

a. colonoscopy

The nurse is assessing a patient newly admitted with constipation and failure to pass flatus. Which condition is the most likely cause of this patient's symptoms?

a. complete obstruction

The nurse is teaching a patient about how to control gas in odor from a colostomy. Which information does the nurse include?

a. do not chew gum

The emergency department nurse is assessing a patient with abdominal trauma after a motor motor vehicle accident. The patient has become somewhat confused, his skin is pale, cool, and moist and he has had only 20 mL of urine output during the past hour. What does the nurse suspect?

a. hypovolemic shock

The nurse is providing teaching about ways to reduce the risk for colorectal cancer. Which dietary suggestions will the nurse be sure to include? Select all that apply

a. low fat c. high fiber e. low in refined carbohydrates

Which findings does the nurse expect for a post operative colostomy patient? Select all that apply

a. reddish-pink, moist stoma b. small amount of bleeding e. smooth, intact peristomal skin

Why does the nurse place a patient with a bowel obstruction in semi Fowler's position? Select all that apply

a. to promote increased peristalsis b. To alleviate the pressure of abdominal distention on the chest d. to facilitate breathing

Which key features does the nurse most likely find when performing a physical assessment on a patient with a small bowel obstruction?

a. visible peristaltic waves in the upper and middle abdomen

The patient with gastroenteritis due to infection with the Norovirus asked the nurse how this illness occurred. Which statement by the patient indicates correct understanding of the nurses teaching?

b. "It is likely that I got this illness from either contaminated water or food"

The nurse is teaching a patient with IBS about complementary and alternative therapies for the disease. Which patient statements indicate that teaching has been effective? Select all that apply

b. "Probiotics can help decrease bacteria and decrease my IBS symptoms" c. "Peppermint oil has been used to expel gas and relax spastic intestinal muscles"

The nurse is providing teaching for a patient with an anal fissure as a complication of Crohn's disease. Which statement by the patient indicates the need for further teaching?

b. "a diet that is low in bulk producing agents is best for me"

Which statement by a patient indicates an understanding of surgical management of hemorrhoids?

b. "my first bowel movement after the surgery may be very painful"

Which are common manifestation in a 28-year-old patient with dehydration secondary to gastroenteritis? Select all that apply

b. Elevated temperature c. Dry mucous membranes e. Oliguria

Which interventions does the nurse expect to implement when caring for a patient with diverticulitis? Select all that apply

b. IV fluids to prevent dehydration c. Broad spectrum antibiotics d. Teach the patients to refrain from lifting or straining e. Keep the patient NPO if symptoms are severe

Which characteristics pertain to Crohn's disease? Select all that apply

b. fistulas commonly develop c. 5-6 soft, loose stools per day that are nonbloody f. Cobblestone appearance of the internal intestine

Which nursing intervention is part of nonsurgical management for a patient with peritonitis?

b. insert a nasogastric tube to decompress the stomach

What nursing care does a patient with a nasogastric tube require? select all that apply

b. keep the patient in a semi Fowler's position c. Confirmation of NG tube placement by x-ray if it is repositioned d. Monitor contents of the NG tube e. Irrigation of the tube with 30 mL of normal saline as ordered

The nurses providing care for a patient with a bowel obstruction notes that the patient has started passing flatulence and had a small bowel movement. What has occurred with this patient?

b. peristalsis has returned

Which nursing care actions should the nurse delegate to the unlicensed assistant personnel for an older patient with a bowel obstruction? Select all that apply

b. provide mouth care every 2 hours e. provide the patient with a few ice chips

Emergency care of a patient with abdominal trauma includes which interventions? Select all that apply

b. type and cross matching of 4-8 units of blood c. Measurement of arterial blood gases d. Continuous hemodynamic monitoring e. insertion of a foley catheter

A patient with a colostomy may safely include which food item into the diet?

b. yogurt

The nurse is instructing a patient about home care after an exploratory laparotomy for peritonitis. Which statement by the patient indicates that teaching has been effective?

c. "I will call the healthcare provider for a temperature greater than 101°F"

Which type of stoma will a patient with diverticulitis most likely have postoperatively?

c. colostomy

Which sign/symptom is a patient who had an AP resection instructed to report to healthcare provider immediately?

c. constant perineal odor and pain

Which activity does the nurse tell patient to avoid after surgery for a hernia repair?

c. coughing

The fluid shifts that occurs in peritonitis may result in which of the following?

c. decreased circulatory volume and hypovolemic shock

The nurse assesses a patient with a hernia and finds that the patient's symptoms include abdominal distention, nausea, vomiting, and pain. The patient's heart rate is 118 bpm and temperature is 101°F. Which type of hernia does the nurse suspect?

c. strangulated

The nurses caring for a patient with gastroenteritis who has frequent stools. Which task is best to delegate to the UAP?

c. use a warm washcloth to remove stool from the skin

The patient with IBS reports abdominal distention and feeling bloated to the nurse. The patient states she had a bowel movement that morning. What drug treatment does the nurse expect the healthcare provider to order?

d. Rifaximin (Xifaxan)

As part of the routine treatment plan for a patient with bacterial gastroenteritis, which drugs does the nurse anticipates the patient will most likely be prescribed?

d. antibiotics

The nurse is teaching a patient about colostomy care. Which information does the nurse include in the teaching plan?

d. antifungal cream or powder can be used if a fungal rash develops

Which intervention applies to the nursing care of an older patients with heart failure and hypovolemia related to an intestinal obstruction?

d. assess for crackles in the lungs

A patient with Crohn's disease has a fistula. Which assessment findings indicates possible dehydration?

d. decreased urinary output

Which laboratory finding does the nurse expect may occur with a diagnosis of appendicitis?

d. increased white blood cell count

Which type of diet has been implicated in the formation of diverticula?

d. low-fiber diet

Which acid-base abnormality results from a bowel obstruction high in the small intestine?

d. metabolic alkalosis

Which drug is often used in older patients for pain management of moderate to severe diverticulitis?

d. morphine sulfate (Duramorph)

The nurse is assessing an older adult patient with abdominal pain. Assessment findings include generalized abdominal pain with ridigity, nausea, and vomiting, elevated temperature (101.2F), increased HR (122/min), and chills. The patient is also somewhat confused and does not know where he is. What does the nurse suspect with this patient?

d. peritonitis