GI/GU QUESTIONS #1

The nurse assessing a client with an upper gastrointestinal bleed would expect the client's stool to have which appearance? 1.Black tarry 2.Bright red bloody 3.Light gray "clay-colored" 4.Small, dry, rocky-hard masses

1 Option 1: Black tarry stool (melena) indicates an upper GI bleed, as the blood is digested in the GI tract. Option 2: Bright red blood (hematochezia) indicates a lower GI hemorrhage, as the blood would not be digested this far into the GI tract. Option 3: Clay-colored stool indicates a lack of bile due to a biliary obstruction. Option 4: Small, dry, hard masses indicate constipation, asthere is not enough fluid in the diet.

A client with diabetes receiving peritoneal dialysis experiences chills and abdominal discomfort. The nurse assesses the client's abdomen by pressing one hand firmly into the abdominal wall. The client experiences pain when the nurse quickly withdraws the hand. The client's most recent blood glucose level is 210 mg/dL. What is the priority action by the nurse? 1.Collect peritoneal fluid for culture and sensitivity 2.Heat the remaining dialysate fluid and increase the dwell time 3.Place the client in high Fowler's position 4.Prepare to administer regular insulin intravenously

1 Peritonitis is a common but serious complication of peritoneal dialysis that typically occurs as a result of contamination during infusion. The earliest indication of peritonitis is cloudy peritoneal fluid. Later symptoms are a low grade fever, chills, abd pain, and rebound tenderness (pain on removal after pressing against abdomen). Option 1: Check to see if the peritoneal effluent is cloudy is the easiest way to assess for peritonitis. Option 2: Dialysate is already pre-warmed prior to dialysis. Dwell time is specific to the client and should not be changed without a prescription. Option 3: High Fowler's can worsen abdominal pain. Option 4: Glucose is the osmotic agent in dialysis, so an increase in blood glucose is expected. A blood glucose of 210 mg/dL does not necessitate IV administration of insulin.

The post-anesthesia care unit nurse receives report on a client after abdominal surgery. What sounds would the nurse expect to hear when auscultating the bowel? 1.Absent bowel sounds 2.Borborygmi sounds 3.High-pitched and gurgling sounds 4.Swishing or buzzing sounds

1 Procedures that require bowel manipulation cause a temporary halting of peristalsis (paralytic ileus) for 24-48 hours. Small intestine peristalsis usually starts within 24 hours, but large intestine peristalsis may start within 3-5 days. Bowel sounds are normal if they are heard every 5-15 seconds. Option 1: Absent bowel tones are normal post-op from GI surgery Option 2: Borborygmi sounds are gurgling sounds heard in increased peristalsis and are attributable to the passage of fluid and gas in the intestine; this would not be heard after abdominal surgery, as the bowels are paralyzed Option 3: High-pitched, gurgling sounds are normal bowel sounds; these wouldn't be heard after abdominal surgery Option 4: A swishing, or buzzing sound (a bruit) indicates turbulent blood flow, and occurs with artery dilation (aneurism) or narrowing (obstruction) of a vessel.

A homeless man known to have chronic alcoholism and who has not eaten for 8 days is undergoing nutritional rehabilitation via oral and enteral feedings. Which of the following findings would indicate that the client is developing refeeding syndrome? 1.Phosphorus 2.0 mg/dL, potassium 2.9 mEq/L, magnesium 1.0 mEq/L 2.Phosphorus 4.0 mg/dL, potassium 3.5 mEq/L, magnesium 2.0 mEq/L 3.Blood glucose 60 mg/dL, sodium 120 mEq/dL, calcium 7.0 mg/dL 4.Blood glucose 100 mg/dL, sodium 140 mEq/dL, calcium 10.0 mg/dL

1 Refeeding syndrome is a life-threatening complication of nutritional replenishment in insignificantly malnourished clients after a period of starvation. Carbohydrate-rich nutrition (glucose) stimulates insulin production along with a shift of electrolytes from the blood into tissue cells, causing an ion shift. • hypophosphatemia, hypokalemia, hypomagnesemia • hyperglycemia, sodium retention, fluid overload • baseline electrolytes need to be obtained • closely monitor electrolytes during refeeding • gradually increase caloric intake • Normal phosphorous: 2.5-4.5 mg/dL • Normal potassium: 3.5-5.0 mEq/L • Normal magnesium: 1.5-2.5 mEq/L

During assessment of a client who had major abdominal surgery a week ago, the nurse notes that the incision has dehisced and evisceration has occurred. The nurse stays with the client while another staff member gets sterile gauze and saline. How should the nurse position the client while waiting to cover the wound? 1. Low Fowler's position with knees bent 2. Prone to prevent further evisceration 3. Side-lying lateral position 4. Supine with head of the bed flat

1 Dehiscence is splitting of the incision, and evisceration is when organs protrude from the incision. Evisceration is a rare but severe surgical complication and typically occurs ~a week after surgery and is an emergency. It commonly occurs when there is poor wound healing or obesity. The RN should stay with the patient, apply a sterile dressing, and call the HCP. Option 1: Low Fowler's lessons tension on the surgical incision and prevents further evisceration. Option 2: Prone puts more pressure on the incision and can cause further evisceration. Option 3: Lateral will not lesson tension on the wound. Option 4: Supine will put more tension on the surgical incision and could open it more.

The nurse is caring for a client in the post-anesthesia care unit following a gastroduodenostomy. Which of the following nursing interventions are appropriate? Select all that apply. 1.Applying bilateral sequential compression devices 2.Encouraging splinting of the incision with a pillow when coughing 3.Keeping the client NPO until bowel sounds return 4.Maintaining supine positioning at all times 5.Repositioning and irrigating a clogged nasogastric tube PRN

1, 2, 3 A gastroduodenostomy is the removal of two-thirds of the stomach and connecting the remainder to the duodenum. It is done in cases of stomach cancer, a malfunctioning pyloric valve, gastric obstruction, or peptic ulcers. Option 1: Post-op clients are at a higher risk for venous thromboembolism (VTE) and require VTE prophylaxis Option 2: Splinting an incision means holding it together with your hands; this should be encouraged so that the pressure from a cough does not open the wound edges during normal coughing, and during turn/cough/deep breathe exercises to prevent atelectasis Option 3: To not exacerbate any pressure build up and abdominal distention while the client has a paralytic ileus, they should remain NPO until bowel sounds return Option 4: Remaining supine can be uncomfortable, and it's an aspiration risk; only clients who experience dumping syndrome should be placed supine (and only after meals) Option 5: An NG tube may be placed for gastric decompression; any clogs should be reported to the HCP, as manipulating this can cause a perforation or hemorrhage

The nurse is reinforcing teaching about ulcer prevention with a client newly diagnosed with peptic ulcer disease. Which of the following client statements indicate appropriate understanding of teaching? Select all that apply. 1."I need to avoid taking medicines like ibuprofen without a prescription." 2."I should avoid drinking excess coffee or cola." 3."I should enroll in a smoking cessation program." 4."I should reduce or eliminate my intake of alcoholic beverages." 5."I will eliminate whole wheat foods, like breads and cereals, from my diet."

1, 2, 3, 4 Peptic ulcer disease causes ulcerations in the mucosa of the esophagus, stomach, and/or duodenum. Digestive enzymes are then able to digest underlying tissues, causing perforation and gastric bleeding. Risk factors: H. pylori infection, chronic NSAID use, stress, diet, lifestyle Option 1: NSAIDs like aspirin, ibuprofen, and naproxen block prostaglandins, which decrease acid and increase mucosa secretion in the stomach; this causes acid to eat away at the mucosa Option 2: Caffeine stimulates stomach acid secretion Option 3: Tobacco increases secretion of stomach acid and delays ulcer healing Option 4: Alcohol stimulates acid secretions Option 5: Whole wheat foods do not exacerbate PUD. However, the client should avoid foods that exacerbate their symptoms, if there are any. It's best to eat multiple small meals and not eat before sleeping.

The nurse assesses for cancer risk factors during a screening event at a gastroenterology clinic. Which of the following client statements include risk factors for esophageal cancer? Select all that apply. 1."A few years ago, I switched from smoking cigarettes to smoking cigars 1 or 2 times a week." 2."I am proud that I was able to lose 10 lb, but I'm still considered obese for my height." 3."I drink 3 or 4 beers nightly to relax, but I did switch to light beer recently." 4."I have struggled with daily episodes of acid reflux for years, especially at nighttime." 5."I snack on a lot of salted foods like popcorn and peanuts."

1, 2, 3, 4 Risk factors for esophageal cancer include other cancer diagnoses, alcohol use, tobacco use, esophageal diseases or injuries, GERD, and obesity

The nurse cares for a client with ulcerative colitis who is having abdominal pain and ≥10 bloody stools per day. Which of the following interventions should be included in the client's plan of care? Select all that apply. 1. Administer prescribed analgesic medications as needed 2. Encourage the client to discuss feelings about illness 3. Initiate strict, hourly intake and output monitoring 4. Investigate the client's compliance with the medication regimen 5. Offer the client high-protein foods during meals and snacks

1, 2, 3, 4, 5 Ulcerative colitis (UC) is a chronic inflammatory bowel disease characterized by inflammation and ulceration of the large intestine (colon) that results in abdominal pain, frequent bouts of bloody diarrhea, anorexia, and anemia. Option 1: UC can cause severe abdominal pain. Option 2: Chronic illnesses such as UC can icnrease the feelings of depression, hopelessness, and frustration. Option 3: Diarrhea, blood loss, and poor oral intake can cause dehydration in a patient with UC; this should be monitored to ensure adequate hydration. Option 4: UC exacerbations may just be spontaneous, or they may be precipitated by certain foods or lack of treatment adherence. Option 5: People with UC are at risk of anorexia and decreased nutrient absorption; foods should be nutrient dense and high in protein.

The nurse is providing discharge teaching to a client newly diagnosed with ulcerative colitis. Which of the following statements by the client indicate that teaching has been effective? Select all that apply. 1."I need to eat a diet high in calories and protein so that I avoid losing weight." 2."I need to take multivitamins containing calcium daily." 3."I should avoid consuming alcoholic beverages." 4."I should drink at least 2 liters of water daily and more when I have diarrhea." 5."I will keep a symptom journal to note what I eat and drink during the day."

1, 2, 4, 3, 5 Ulcerative colitis (UC) is an inflammatory bowel disease characterized by periods of mucosal irritation in the large intestine, resulting in profuse, bloody diarrhea. Option 1: diets should be high in calories and protein to prevent weight loss and muscle waisting Option 2: people with UC tend to be on corticosteroids to decrease inflammation; steroids decrease bone density Option 3: Alcohol (along with caffeine and tobacco) are gastric irritants Option 4: People with UC can have 10+ liquid stools a day during a flare up, placing them at risk for dehydration Option 5: Tracking foods can help you determine what triggers flare ups

The nurse is reviewing lifestyle and nutritional strategies to help reduce symptoms in a client with newly diagnosed gastroesophageal reflux disease. Which strategies should the nurse include? Select all that apply. 1.Choose foods that are low in fat 2.Do not consume any foods containing dairy 3.Eat three large meals a day and minimize snacking 4.Limit or eliminate the use of alcohol and tobacco 5.Try to avoid caffeine, chocolate, and peppermint.

1, 3, 4, 5 Gastroesophageal reflux disease (GERD) occurs when stomach acid is able to enter and inflame the esophagus. Sleeping and eating with HOB elevated, weight loss (↓ gastric pressure), chewing gum (promotes salivation to clear acid from esophagus) may alleviate GERD symptoms. Option 1: High fat foods delay gastric emptying, which can lead to reflux of acid into the esophagus for a longer amount of time Option 2: Dairy does not affect GERD Option 3: Large meals increase gastric pressure and stay in the stomach longer, causing more stomach acid production; small meals and sips of water will facilitate passage of stomach content. Options 4, 5: Alcohol, tobacco, caffeine, high fat foods, chocolate, peppermint, spicy foods, and carbonated beverages all exacerbate GERD.

A client with ascites due to cirrhosis has increasing shortness of breath and abdominal pain. The health care provider requests that the nurse prepare the client for a paracentesis. Which nursing actions would the nurse implement prior to the procedure? Select all that apply. 1.Educate client about the procedure and obtain informed consent 2.Initiate NPO status 6 hours prior to the procedure 3.Obtain baseline vital signs, abdominal circumference, and weight 4.Place client in high Fowler position or as upright as possible 5.Request that the client empty the bladder

1, 3, 4, 5 Option 1: A paracentesis is an invasive procedure of sticking a needle into the abdominal cavity to drain fluid (ascites); informed consent is required. Option 2: NPO status is not required for the procedure; it is completed at bedside with a local anesthetic. Option 3: Baseline abd girth, weight, and vital signs should be recorded. Option 4: Placing the patient as upright as possible so the fluid collects in a single area. Option 5: The client should void to prevent puncturing the bladder during the procedure

A client admitted 3 days ago with upper gastrointestinal bleeding underwent an endoscopic procedure to stop the bleeding. The client is started on a clear liquid diet today. Which foods are appropriate for the nurse to offer the client? Select all that apply. 1.Apple juice 2.Cherry popsicle 3.Chicken broth4.Frozen yogurt 5.Unsweetened tea 6.Vanilla ice cream

1, 3, 5 Although popsicles are part of a clear liquid diet, red dyes should not be given to clients with GI bleeds because it can leave a residue in the bowel that resembles blood, making it more difficult to assess if GI bleed symptoms are improving or not.

The health care provider orders a small bowel follow-through (SBFT) for a client. Which instructions should the nurse include when teaching the client about this test? 1."After the test, you may notice your stools are tarry black for a few days." 2."During the test, a series of x-rays will be taken to assess the function of the small bowel." 3."The HCP will use an endoscope to visualize your small bowel." 4."Your examination is scheduled for 8:00 AM. Please drink all of the polyethylene glycol by midnight."

2 An SBFT examines the anatomy and function of the small intestine using x-ray images taken in succession. Barium is ingested, and x-ray images are taken every 15-60 minutes to visualize the barium as it passes through the small intestine. It's used to identify fistulas, decreased motility (paralytic ileus), obstructions (mechanical ileus), or increased motility (malabsorption syndromes) Option 1: Barium will make the stool white and chalky, not tarry and black. Black stools (melena) are a sign of an upper GI bleed and need to be reported to the HCP. Normal stool should return within 72 hours. Option 2: The test usually takes 60-120 minutes. Option 3: No tools are inserted into the patient for this procedure. Option 4: Patients should not eat 8 hours prior to the exam, but they do not have to drink polyethylene glycol to clear themselves out.

A student nurse asks why enteral (tube) feedings, rather than total parenteral nutrition (TPN), are being administered to a client with sepsis and respiratory failure. Which is the best response by the registered nurse? 1. "Enteral feedings have no complications." 2. "Enteral feedings maintain gut integrity and help prevent stress ulcers." 3. "Enteral feedings provide higher calorie content." 4. "Risk of hyperglycemia is lower with enteral feedings than with TPN."

2 Enteral feedings are nutrition that passes thru the intestines and are given via a tube from the nose, mouth, or percutaneously through the abdominal wall into the stomach. Total parenteral nutrition is given via a central line and bypasses the intestines. The enteral route is always preferred. Option 1: Enteral feedings have their own set of complications and depend on which route it takes (aspiration, tube displacement, hyperglycemia, diarrhea, abd distention, clogging) Option 2: enteral feedings utilize the digestive tract, which helps maintain gut bacteria; stress ulcers develop in critically ill patients because the GI tract is not as vital as other organs in times of stress, and blood is shunted away; enteral feedings preserve GI function Option 3: Caloric needs can be met by either enteral or parenteral feedings Option 4: hyperglycemia can occur with both enteral and parenteral feedings

The hospitalized client with anorexia nervosa is started on nutrition via enteral and parenteral routes. Which client assessment is the most important for the nurse to check during the first 24-48 hours of administration? 1.Serum albumin level and body weight[31%] 2.Serum potassium and phosphate[41%] 3.Symptoms of dumping syndrome[24%] 4.White blood cell count and neutrophils[2%]

2 Option 1: Daily weights and albumin level can help evaluate the efficacy of treatment, but not checking these will not result in death, so they are not the priority. Option 2: Refeeding syndrome is a potentially fat complication in severely malnourished patients. A lack of oral intake results in pancreas making less insulin and once nutrition is received, insulin spikes, resulting in a shift of phosphorous, potassium and magnesium into cells. This can cause muscle weakness and respiratory failure (hypophosphatemia) and cardiac arrhythmias (hypokalemia, hypomagnesemia). Electrolyte repletion is necessary to prevent cardiopulmonary failure. Option 3: Dumping syndrome is decrease storage area in the stomach, resulting in feed being rapidly "dumped" into the small intestine. This can cause poor absorption, diaphoresis, cramping, and diarrhea within 30 minutes after eating. Since the client is on parenteral nutrition (via IV), this is not an issue. Option 4: Due to central line placement (for TPN administration), there is risk for infection. However, this isn't a priority.

A client receiving total parenteral nutrition complains of nausea, abdominal pain, and excessive thirst. What is the best action for the nurse to take? 1.Assess the client's vital signs 2.Check the client's blood glucose 3.Report the findings to the health care provider 4.Slow down the rate of infusion

2 Parenteral nutrition contains dextrose, which can cause hyperglycemia. Common signs/symptoms of hypoglycemia include excessive thirst, increase urination, fatigue, and blurred vision. Option 1: Assessing vitals will not confirm hyperglycemia. Option 2: Checking blood glucose will obviously confirm hyperglycemia. Option 3: Findings cannot be reported to the HCP until they are...found. Option 4: Slowing down the infusion rate can resolve hyperglycemia, but it needs to be confirmed as hyperglycemia first.

After performing a physical assessment and obtaining vital signs for a client immediately after a laparoscopic cholecystectomy, which nursing intervention is the priority? 1. Apply anti-embolism stockings 2. Assist with early ambulation 3. Offer stool softeners 4. Provide low-fat foods

2 Post-op care for a client after a cholecystectomy is prevention of complications. CO2 is used in this procedure to expand the abdominal cavity, which can irritate the phrenic nerve and diaphragm, causing shallow breathing. Option 1: Compression stockings can prevent thromboemboli, but they are not as effective as ambulation. Option 2: Early ambulation after surgery decreases the risk of thromboembolism, stimulates peristalsis, and facilitates dissipation of CO2 (along with deep breathing exercises). Option 3: Post-op clients may have decreased peristalsis due to anesthesia and opioids, but early ambulation promotes GI motility. Option 4: Clients needs to remain on a clear liquid diet until bowel sounds return.

A client is receiving an infusion of total parenteral nutrition (TPN) with 20% dextrose through a central line at 75 mL/hr. The nurse responds to the client's IV pump alarm, which indicates that the bag is empty. The new bag is not expected to arrive from the pharmacy for an hour. What is the most appropriate nursing action? 1. Hang 0.9% normal saline until new bag arrives, then increase TPN to 150 mL/hr for 1 hour 2. Hang 10% dextrose in water until the new bag arrives, then resume TPN at 75 mL/hr 3. Hang dextran in saline until the new bag arrives, then resume TPN at 75 mL/hr 4. Hang lactated Ringer's until the new bag arrives, then resume TPN at 75 mL/hr

2 TPN is high in sugar, so a sudden loss in sugar intake can cause hypoglycemia. When TPN is being discontinued, the infusion is slowly reduced in rate, and then replaced with a solution containing dextrose. Option 1: NS does not contain any dextrose, and rapid infusion of an isotonic solution can cause fluid overload. Option 2: 10% dextrose in water will help prevent hypoglycemia. It should be infused at the same rate as the TPN (75 ml/hr). Option 3: Dextran is a colloid used to expand intravascular volume in clients with hypovolemia. It can cause fluid overload and will not prevent hypoglycemia. Option 4: LR contains electrolytes, but not glucose.

The registered nurse is developing a nursing care plan for a client who has just undergone surgery for treatment of ulcerative colitis with the creation of a permanent ileostomy. What is the priority outcome for this client? 1.The client will contact the United Ostomy Association of America 2.The client will look at and touch the stoma 3.The client will read the materials provided on ostomy care 4.The client will verbalize methods to control gas and odor

2 The priority outcome should always be independent self-care, which requires the client to adapt to their altered body image and manipulate the stoma and bag.

The nurse is reinforcing strategies to manage symptoms for a client with irritable bowel syndrome. Which of the following instructions should the nurse include? Select all that apply. 1.Consume only clear liquids with severe symptoms 2.Keep a record of symptoms, diet, and stress levels 3.Limit dietary intake of gas-producing foods like legumes 4.Perform aerobic exercise at least three times weekly 5.Reduce the amount of caffeine consumed each day

2, 3, 4, 5 Irritable bowel syndrome (IBS) is a chronic GI disorder characterized by abdominal pain and altered bowel motility (diarrhea or constipation). Option 1: IBS clients are at risk for malnutrition, so they need to consume calories and nutrients whenever possible. A clear liquid diet would not provide adequate nutrition. Option 2: Keeping a record can determine what foods cause flare ups. Option 3: Gas-producing foods can exacerbate symptoms; beans, cruciferous vegetables, and fructose should be avoided. Option 4: Physical exercise can improves GI motility and may prevent bloating and constipation, and may also reduce stress (another potential cause of IBS flare ups) Option 5: Caffeine affects bowel motility and can exacerbate symptoms

The nurse is caring for a client with right upper quadrant pain and jaundice. The client's alanine aminotransferase /aspartate aminotransferase (ALT/AST) levels are 7 times the normal values. What questions would be most helpful regarding the etiology for these findings? Select all that apply. 1.Do you have black tarry stool? 2.Do you use intravenous (IV) illicit drugs? 3.How much alcohol do you typically drink? 4.Were you recently immunized for pneumonia? 5.What over-the-counter drugs do you take?

2, 3, 5 RUQ pain, jaundice, and elevated ALT and AST levels are signs of liver damage. Alcohol and OTC drugs like acetaminophen cause liver damage, and IV illicit drugs increase the risk of contracting hepatitis B and C infections, which are viral infections of the liver. Black, tarry stool is a sign of an upper GI bleed.

The emergency department nurse cares for 5 clients. Which of the clients below are at risk for developing metabolic acidosis? Select all that apply. 1. 25-year-old client with claustrophobia who was stuck in an elevator for 2 hours 2. 36-year-old client with food poisoning and severe diarrhea for the past 3 days 3. 40-year-old client with 3-day history of chemotherapy-induced vomiting 4. 75-year-old client with pyelonephritis and hypotension 5. 82-year-old client due for hemodialysis with clotted arteriovenous shunt

2, 4, 5 Metabolic acidosis is due to an increase in production of acid, retention of acid, or depletion of base via the kidneys or GI tract. Option 1: Claustrophobia will lead to panic and increased respiratory rate. This would increase CO2 and lead to respiratory acidosis. Option 2: "Below the waist, lose base." Diarrhea causes a loss of bicarbonate, which would cause metabolic acidosis. Option 3: Vomiting will cause a loss of hydrogen ions from stomach acid, which would cause metabolic alkalosis. Option 4: Pyelonephritis (kidney infection, usually caused by a UTI) causes impaired kidney function, which makes the kidneys unable to adequately filter out hydrogen and ammonium ions. Option 5: Much like pyelonephritis, a client who needs dialysis has impaired kidney function, therefore there is a build up of acid in their blood.

The nurse on the medical-surgical unit receives report on assigned clients. Which client warrants immediate attention? 1.Client experiencing abdominal cramps 2 hours after colonoscopy 2.Client reporting white stools 8 hours after barium swallow study 3.Client with epigastric pain after endoscopic retrograde cholangiopancreatography 4.Client with small bowel obstruction with copious, greenish-brown drainage from the nasogastric tube

3 A ERCP is a procedure in which an endoscope is passed through the mouth into the duodenum to assess the pancreatic and biliary ducts. Irritation or perforation during the procedure can cause acute pancreatitis. Option 1: Air during inflation of a colonoscopy can cause cramping Option 2: Barium contrast solution can make a client's stool white for 3 days; encourage fluids to expel the contrast medium Option 3: This may indicate acute pancreatitis; other s/s include LUQ pain, radiating back pain, rapid rise in pancreatic enzymes (amylase, lipase) Option 4: Greenish-brown drainage indicates bile, which is expected if there is a small bowel obstruction; the nurse needs to watch for signs of electrolyte imbalances, dehydration, and metabolic alkalosis

The nurse admits a client with cirrhosis who has an upper gastrointestinal bleed from suspected gastroesophageal varices. Which new prescription should the nurse question? 1.Administer pantoprazole IV piggyback every 12 hours 2.Initiate continuous octreotide IV infusion 3.Insert and maintain a nasogastric tube 4.Maintain NPO status except for PO medications

3 An upper gastrointestinal bleed (UGIB) can be a life-threatening condition caused by peptic ulcers or by variceal rupture (rupture of esophageal varices; fragile, distended veins caused by cirrhosis). Variceal rupture can occur from increased portal venous pressure (straining, coughing, vomiting) or mechanical injury (eating hard foods, chest trauma). Option 1: Pantoprazole is a proton pump inhibitor that reduces gastric acid secretion and helps prevent mucosal damage and ulceration; this will keep the upper GI bleed from getting worse Option 2: Octreotide reduces portal venous pressure, which will reduce bleeding in the GI tract Option 3: Insertion of an NG tube without visualization of the esophagus may cause further variceal rupture and cause a hemorrhage; an NG tube may be inserted with visualization for gastric decompression. Option 4: NPO status may be prescribed to prepare the client for an invasive diagnostic procedure or surgery

The nurse provides discharge instructions to a client with cirrhosis who has portal hypertension, ascites, and esophageal varices. Which statement by the client indicates that the teaching was effective? 1."I may have one alcoholic drink a day, but no more." 2."I may take aspirin instead of acetaminophen for fever or pain." 3."I should avoid straining while having a bowel movement." 4."I should eat a protein- and sodium-restricted diet."

3 Cirrhosis is scarring/dysfunction of the liver, portal hypertension is increased pressure in the portal vein that brings blood from the intestine to the liver and is caused by the liver's inability to process blood inefficiently, and esophageal varices are weak/enlarged veins due to increased blood flow/pressure in esophageal veins (cirrhosis is the #1 cause). Option 1: Alcoholism is the leading cause of cirrhosis, so alcohol should be avoided Option 2: Aspirin and acetaminophen can increase GI bleeding; this client is at a high risk for bleeds due to the portal hypertension and varices, so these should be avoided. Option 3: Straining increases GI pressure, which can increase bleeding from the portal vein and esophageal varices. Option 4: Sodium restriction can ease hypertension, but patients with cirrhosis usually are malnourished and need the protein.

The nurse is caring for a client who has undergone a colonoscopy. Which client assessment finding should most concern the nurse?1.Abdominal cramping 2.Frequent, watery stools 3.Positive rebound tenderness 4.Recurring flatus

3 Option 1: Abdominal cramping is caused by the stimulation of peristalsis from the bowel being inflated with air during the procedure. Option 2: The preparation prior to the procedure (GoLYTELY) cleanses the colon and the symptoms may persist even after the procedure is complete. Option 3: Positive rebound tenderness, guarding, abdominal distension, and a boardlike abdomen are signs of a perforated bowel. Option 4: Air inserted into the bowel for the procedure causes gas.

The nurse is assessing 4 clients in the emergency department. Which client should the nurse prioritize for care? 1.Client with liver cirrhosis and ascites who has increasing abdominal distension and needs therapeutic paracentesis 2.Client with new-onset ascites from a suspected ovarian mass who needs paracentesis for diagnostic studies 3.Client with ulcerative colitis who has fever, bloody diarrhea, and abdominal distension and needs an abdominal x-ray 4.Nursing home client with dementia who has stool impaction and abdominal distension and needs stool disimpaction

3 Option 1: Clients with advanced stage cirrhosis will occasionally need paracentesis and diuretics to relieve distension. This is therapeutic, and is not an emergency. Option 2: This is to test for malignancy (cancer) of the ovarian mass causing ascites; it is not an emergency. Option 3: A client with a UC flare-up (bloody diarrhea, abdominal distension) who is also experiencing a fever may have an infection. The symptoms presented are likely toxic megacolon, which is common in UC and is caused by c. diff bacteria. Option 4: Elderly clients with dementia have decreased mobility (↓ GI motility), drink less fluids, and do not eat adequate fiber and are at a higher risk of constipation. This client is not a priority.

The nurse is caring for a client with end-stage liver failure from hepatitis C who is being seen in the clinic for worsening ascites. The client is treated in the infusion center with intravenous (IV) albumin, IV furosemide, and oral spironolactone. The following day the nurse checks the client's labs. Which of the following lab findings is most important for the nurse to communicate to the health care provider? 1.Albumin 2.5 g/dL (25 g/L) 2.INR 1.4 3.Potassium 3.0 mEq/L (3.0 mmol/L) 4.Sodium 131 mEq/L (131 mmol/L)

3 Option 1: normal albumin levels are 3.5-5 g/dL; lower albumin levels are normal with liver failure due to decrease protein synthesis. Option 2: Normal INR is <1 second. However, liver failure causes a decrease in clotting factor synthesis, so prothrombin time and INR would be increased. Intervention is only indicated if there is evidence of increased bleeding. Option 3: Normal potassium is 3.5 to 5 mmol/L. A potassium of 3.0 is considered very low and may be caused by the diuretics. Hypokalemia must be corrected to prevent arrhythmias and hepatic encephalopathy. Option 4: Normal sodium is 135-145 mmol/L, so this is slightly lower. This may be due to the diuretics and is not a major concern as it's barely lower normal.

A client calls the primary care clinic reporting diarrhea for 4 days and a low grade fever. What instruction is most important for the nurse to give to the client? 1.Encourage client to eat bulk-forming foods such as whole grain bread 2.Encourage rest, fluids, and acetaminophen for the fever 3.Make an appointment for the client with the health care provider today 4.Take 2 tablets of loperamide followed by 1 tablet after each loose stool

3 Options 1, 2: These will treat the symptoms, but not the underlying cause Option 3: Any client whose diarrhea lasts >48 hours should be seen by their HCP. This is especially true if accompanied by a fever or bloody stools. After 4 days of diarrhea, the client is at risk of a fluid and electrolyte imbalance. Option 4: Loperamide (Imodium) is an anti-diarrheal drug, and will treat the symptoms but not the underlying cause. It should never be used for more than 2 days. It should also never be used with a fever, as it solidifies diarrhea, retaining it in the intestines longer, and may make whatever toxin is causing the fever remain in the intestines longer; this can cause toxic megacolon.

The nurse is developing teaching materials for a client diagnosed with ulcerative colitis. The client will receive sulfasalazine. Which of the following instructions are included in the discharge teaching plan? Select all that apply. 1.Avoid small, frequent meals 2.Can have a cup of coffee with each meal 3.Eat a low-residue, high-protein, high-calorie diet 4.Increase fluid intake to at least 2000 mL/day 5.Medication should be continued even after the resolution of symptoms 6.Take daily vitamin and mineral supplements

3, 4, 5, 6 Sulfasalazine is a disease-modifying anti-rheumatic drug (DMARD) that reduces inflammation; it is used to treat ulcerative colitis and rheumatoid arthritis. Option 1: Small, frequent meals should be eaten to lessen the amount of fecal matter present in the GI tract Option 2: Caffeine, alcohol, and tobacco are gastric irritants and stimulate GI motility Option 3: Fiber will increase bulks, causing more trauma to the GI tract. Avoid raw fruits and veggies, whole grains, highly seasoned foods, and high fat foods. Option 4: Increased fluid will ease passage of stool, as well as ensure hydration. People with ulcerative colitis have poor absorption of fluids during flare-ups and are at a higher risk for dehydration. Option 5: Sulfasalazine should be continued even after symptoms subside to prevent a relapse. Option 6: People with UC are at a higher risk for nutritional deficits due to malabsorption and altered diet. Sulfasalazine also hinders folate absorption.

Which prescription should the nurse question when caring for a hospitalized client diagnosed with acute diverticulitis?1.Metronidazole 500 mg IV every 8 hours 2.Nasogastric (NG) tube to suction 3.Nothing by mouth (NPO) 4.Prepare for barium enema in AM

4 Acute care of diverticulitis focuses on allowing the colon to rest and the inflammation to resolve. Option 1: Metronidazole (Flagyl) is an antibiotic used to treat any bacteria causing the flare up. Option 2: NG tube suction can reduce any intra-abdominal pressure and distention, as well as relieve nausea and vomiting. Option 3: NPO status allows the colon time to rest. If food can be tolerated, it should be clear liquids or a low residue diet only. Option 4: Any procedure that increase intra-abdominal pressure (coughing, bending), increases, peristalsis (laxatives, enemas), or leads to perforation should be avoided.

The nurse prepares to administer intravenous albumin to a client with severe liver disease who has a low serum albumin level of 1.5 g/dL (15 g/L). Which characteristic finding associated with hypoalbuminemia should the nurse anticipate assessing? 1.Altered mental status 2.Easy bruising 3.Loss of body hair 4.Pitting edema

4 Fluid is pulled back into the intravascular compartment (vessels) via osmotic pressure. Albumin is the major component that controls osmotic pressure (↑ albumin in vessels = ↑ osmotic pressure = ↑ pulling force into vessels). When serum albumin is low, fluid is not pulled back into vessels and will leak into interstitial spaces. Normal albumin is 3.5-5 g/dL. Clients with severe liver disease may have hypoalbuminemia, because the liver synthesizes albumin. Option 1: AMS is a sign of liver disease; hepatic encephalopathy (condition in which brain function is altered) is due to elevated serum ammonia levels, as the liver fails to process ammonia into urea as waste. Option 2: Easy bruising is a sign of liver disease; the liver is unable to produce prothrombin (clotting factors) Option 3: Body hair loss is a sign of liver disease; liver is unable to metabolism hormones effectively Option 4: Pitting edema is fluid that's collected in interstitial space

A 70-year-old client is admitted to the hospital with a lower gastrointestinal bleed. After assisting the client back to bed, the nurse finds approximately 600 mL of frank red blood in the commode. The client is now pale and diaphoretic and reports dizziness. Which action should the nurse perform first? 1.Check the vital signs 2.Draw blood for hemoglobin and hematocrit 3.Lower the head of the bed 4.Maintain an IV line with normal saline

4 Human bodies contain 4-5 liters of blood. Allowable blood loss (ABL) is dependent on age/gender/weight and is 1000 L or less for an adult. Any loss of blood greater than 40% is considered exsanguination and would cause irreversible shock. Option 1: Checking vital signs is always important, but this is not the priority. Option 2: Monitoring Hgb and Hct status is important and can indicate the need for transfusion, but it's not the priority right now; also, changes in RBC status take a few hours after blood loss to show up on labs. Option 3: Lowering the head of the bed (especially if Trendelenburg) can help prevent shock by maintaining perfusion to the brain and vital organs. Option 4: After acute blood loss, blood volume is the priority to maintain blood pressure and tissue perfusion. NS is isotonic and can expand intravascular volume.

The nurse is reinforcing education to a client with irritable bowel syndrome who is experiencing diarrhea. Which of these meals selected by the client indicates an understanding of diet management? 1.Beans, yogurt, and a fruit cup 2.Beef, broccoli, and a glass of wine 3.Eggs, a bagel, and black coffee 4.Steak, tomato basil soup, and cornbread

4 IBS is a chronic condition in which peristalsis is affected, causing diarrhea, constipation, and abdominal pain. A lot of clients find relief by sticking to a low FODMAP diet and increasing fiber intake. Gas-producing foods, high fructose corn syrup, spices, and non-fermented dairy products should be avoided. Option 1: Beans increase gas and should be avoided; yogurt and fruit without small seeds are ok. Option 2: Broccoli increases gas and alcohol is a GI irritant. Option 3: Eggs are OK, but bagels are gas-producing and coffee is a GI irritant. Hot beverages should be avoided. Option 4: Protein, breads and whole grains, and non-spicy foods low in fat are OK.

The clinic nurse provides teaching for a client scheduled for a barium enema the next day. Which statement by the client shows a need for further instruction? 1."I can expect chalky white stool after the procedure." 2."I cannot eat or drink 8 hours before the procedure." 3."I may have abdominal cramping during the procedure." 4."I will avoid laxatives after the procedure."

4 Laxatives can be used to help expel the barium from the body after the procedure. The client should be encouraged plenty of fluids and a high fiber diet to facilitate expulsion and prevent constipation.

The nurse is assessing a client who had an esophagogastro-duodenoscopy (EGD) 2 hours ago. Which finding requires an immediate report to the health care provider? 1.Blood pressure drop from 122/88 mm Hg to 106/72 mm Hg 2.Gag reflex has not returned 3.Sore throat when swallowing 4.Temperature spike to 101.2 F (38.4 C)

4 Option 1: 106/72 mmHg is still within normal range; if there are no other symptoms to indicate something more severe is going on (blood loss, sepsis) then it's likely just from the sedation Option 2: Gag reflex may takes a few hours after an EGD to return; report to HCP if gag reflex has not returned after 6 hours Option 3: A sore throat is expected after an EGD Option 4: Fever after an EGD or colonoscopy indicates an infection from a perforation