Gastrointestinal Disorders

A client with extreme weakness, pallor, weak peripheral pulses, and disorientation is admitted to the emergency department. The client's partner reports that the client has been "spitting up blood." A Mallory-Weiss tear is suspected, and the nurse begins taking a client history from the client's partner. The question by the nurse that demonstrates the nurse's understanding of Mallory-Weiss tearing is

"Has your partner had recent forceful vomiting?"

The nurse uses 30 ml of solution to irrigate a nasogastric tube and notes that 20 ml returns promptly into the drainage container. When the nurse records the results of the irrigation, how much solution should be recorded as intake?

30 ml

The nurse is providing discharge instructions for a client who had an inguinal herniorrhaphy. What information should the nurse give the client?

avoid lifting anything heavier than 5 lbs

A nurse must provide total parenteral nutrition (TPN) to a client through a triple-lumen central line. To prevent complications of TPN, the nurse should

cover the catheter insertion site with an occlusive dressing.

A client is recovering from an ileostomy that was performed to treat inflammatory bowel disease. During discharge teaching, the nurse should stress the importance of

increasing fluid intake to prevent dehydration.

A client is admitted with increased ascites related to cirrhosis. The client has a large round and firm abdomen. The client is not able to lie flat in bed and requests to be placed in a high Fowler's position to sleep. Which nursing diagnosis should receive top priority?

ineffective breathing pattern

The comatose victim of a car accident is to have a gastric lavage. Which position would be mostappropriate for the client during this procedure?

lateral

A client has a nasogastric tube inserted at the time of abdominal perineal resection with permanent colostomy. This tube will most likely be removed when the client demonstrates:

passage of gas and fecal material from the colostomy.

A client with acute appendicitis develops a fever, tachycardia, and hypotension. Based on these findings, the nurse should further assess the client for which complication?

peritonitis

Which client requires immediate nursing intervention? The client who

presents with a rigid, boardlike abdomen.

When caring for a client with ulcerative colitis the nurse should:

suggest sitz baths as needed.

A client with viral hepatitis A is being treated in an acute care facility. Because the client requires enteric precautions, the nurse should

wash their hands after touching the client.

Which client statement indicates a need for further instruction about a duodenal ulcer?

"I will need to take an antacid before every meal."

After teaching the parents of an infant diagnosed with Hirschsprung's disease, the nurse determines that the parents understand the diagnosis when the parent makes which statement?

"The nerves at the end of the large colon are missing."

A client has been diagnosed with cirrhosis. When obtaining a health history, the nurse should specifically determine if the client takes?

Acetaminophen.

A client who underwent abdominal surgery and has a nasogastric (NG) tube in place begins to complain of abdominal pain described as "feeling full and uncomfortable." Which assessment should the nurse perform first?

Assess patency of the NG tube.

A nurse is talking to a neighbor who asks about reoccurring symptoms of gnawing epigastric pain following meals and heartburn. Recognizing these symptoms, what suggestion could the nurse make?

Avoid alcohol and nonsteroidal anti-inflammatory medications.

Following an emergency cholecystectomy, the client has a Jackson-Pratt drain with closed suction. After 4 hours, the drainage unit is full. What should the nurse do?

Empty the drainage unit.

A client with an esophageal stricture is about to undergo esophageal dilatation. As the bougies are passed down the esophagus, the nurse should instruct the client to do which action to minimize the vomiting urge?

Take long, slow breaths.

While changing the client's colostomy bag and dressing, what will indicate to the nurse that the client is ready to participate in self-care?

The client asks about the supplies used during the dressing change.

Which goal is most important for a client with acute pancreatitis?

The client reports minimal abdominal pain.

A client has a newly created colostomy. After participating in a teaching session with the nurse and receiving support from the spouse, the client decides to change the colostomy pouch unaided. Which behavior suggests that the client is beginning to accept the change in body image?

The client touches the altered body part.

A nurse is caring for a client who had gastric bypass surgery two days ago. Which assessment finding requires immediate intervention?

The client's right lower leg is red, swollen, and warm to touch.

When caring for the client with hepatitis B, which situation would expose the nurse to the virus?

a blood splash into the nurse's eyes

A client who had a splenectomy yesterday has a nasogastric (NG) tube. What should the nurse assess to determine the effectiveness of the NG tube?

absence of abdominal distention

A client presents with cirrhosis of the liver secondary to alcohol abuse. Which assessment findings would warrant immediate action by the nurse?

ascites and hematemesis

A client is scheduled for oral cholecystography. Prior to the test, the nurse should:

ask the client about possible allergies to iodine or shellfish.

The nurse is assigned a client with a nasogastric (NG) tube. What intervention will the nurse include in the client's plan of care?

assessment of lung sounds every 4 hours

A client is admitted with a diagnosis of ulcerative colitis. The nurse should assess the client for:

bloody, diarrheal stools.

A nurse is caring for a client with cholelithiasis. Which sign indicates obstructive jaundice?

clay-colored stools

A physician orders a stool culture to help diagnose a client with prolonged diarrhea. The nurse who obtains the stool specimen should

collect the specimen in a sterile container.

A client who can't tolerate oral feedings begins receiving intermittent enteral feedings. When monitoring for evidence of intolerance to these feedings, the nurse must remain alert for

diaphoresis, vomiting, and diarrhea.

A client with gastroenteritis is admitted to an acute care facility and presents with severe dehydration and electrolyte imbalances. Diagnostic tests reveal the Norwalk virus as the cause of gastroenteritis. Based on this information, the nurse knows that

enteric precautions must be continued.

A client is admitted with acute pancreatitis. The nurse should monitor which laboratory values?

increased serum amylase and lipase levels

A nurse has been asked to obtain a client's signature on an operative consent form. When the nurse approaches the client, who is scheduled for a cholycystectomy later in the day, the client asks the nurse why the procedure is needed. Which response by the nurse is appropriate?

"I will ask the surgeon to come speak to you about the procedure."

The health care provider prescribes sulfasalazine for the client with ulcerative colitis. Which instruction should the nurse give the client about taking this medication?

Take it with a full glass (240 mL) of water.

The nurse is developing a plan of care for a client with Crohn's disease who is receiving total parenteral nutrition (TPN). Which interventions should the nurse include? Select all that apply.

Tape all IV tubing connections securely. Weigh the client daily. Monitor the IV infusion rate hourly.

The nurse is caring for a client who is 24 hours after gastric bypass surgery. The client has experienced four episodes of vomiting in the past 12 hours, each producing between 500 and 800 ml of bright yellow-green liquid emesis. What action should the nurse take?

Contact health are provider for a STAT abdominal x-ray prescription.

The health care provider prescribes metoclopramide hydrochloride for the client with hiatal hernia. The nurse should assess the client to determine which expected outcome?

Increase tone of the esophageal sphincter.

A client with peptic ulcer disease is taking ranitidine. What is the expected outcome of this drug?

Limit gastric acid secretion.

When administering intermittent enteral feeding to an unconscious client, what should the nurse do?

Place the client in a semi-Fowler's position.

When planning the care for a client diagnosed with hepatitis A, the nurse should include which interventions? Select all that apply.

Provide relief from nausea and vomiting. Encourage multiple small meals daily. Plan frequent rest periods.

Which measure should be implemented promptly after a client's nasogastric (NG) tube has been removed?

Provide the client with oral hygiene.

A client has undergone a laparoscopic cholecystectomy. Which instruction should the nurse include in the discharge teaching?

Report bile-colored drainage from any incision.

A physician calls the nurse for an update on a client who underwent abdominal surgery 5 hours ago. The physician asks the nurse for the total amount of drainage collected in the Hemovac since surgery. The nurse reports that according to documentation, no drainage has been recorded. When the nurse finishes on the telephone, the nurse goes to assess the client. Which assessment finding explains the absence of drainage?

The Hemovac drain isn't compressed; instead it's fully expanded.

What observation should the nurse instruct the client with an ileostomy to report immediately?

absence of drainage from the ileostomy for 6 or more hours

A nurse is caring for a client 1 hour post-laparotomy who reports abdominal pain rating 5/10. What will the nurse prioritize when administering the ordered morphine?

administer the medication before the pain becomes severe

A client has been placed on long-term sulfasalazine therapy for treatment of ulcerative colitis. The nurse should encourage the client to eat which foods to help avoid the nutrient deficiencies that may develop as a result of this medication?

green, leafy vegetables

Which statement indicates that the client understands the home care of a colostomy?

"I should be able to establish a regular pattern of elimination with my colostomy."

A client has been diagnosed with an intestinal obstruction and has a nasogastric tube set to low continuous suction. Which acid-base disturbance is this client at risk for developing?

metabolic alkalosis

The nurse administers fat emulsion solution during TPN to a malnourished client. What should the nurse tell the client about the purpose of this solution? Fat emulsion solution:

provides essential fatty acids.

The nurse is developing a care management plan with a client who has been diagnosed with gastroesophageal reflux disease. What should the nurse should instruct the client to do? Select all that apply.

Avoid all alcoholic beverages. Avoid a diet high in fatty foods. Avoid beverages that contain caffeine.

A client with end-stage pancreatic cancer has decided to terminate medical intervention. What should a nurse anticipate when consulting with palliative care?

referral for bereavement counseling

A client with appendicitis is experiencing excruciating abdominal pain. An abdominal X-ray film reveals intraperitoneal air. What should the nurse prepare the client for?

surgery