MedSurge Upper/Lower GI [Week 13]
A patient with intestinal obstruction receives stent placement under endoscopy prior to surgical intervention. Which assessment finding indicates that the stent has been effective? Flatus Normal stoma function Hypoactive bowel sounds Dark nasogastric drainage
A The patient is passing gas, so there is evidence that normal bowel function is returning.
A patient with stomach cancer presents with upper GI bleeding. The patient has a history of arthritis, anemia, and diabetes. Which medication is the most likely cause of the patient's upper GI bleeding? Correct Hydrocortisone Insulin Vitamin BU Tylenol
A Use of corticosteroids, such as hydrocortisone, can increase the risk for GI bleeding.
The nurse is caring for a patient with intestinal obstruction. The patient has an NG tube in place and is receiving IV fluid therapy. The nurse understands that which assessment findings indicate that treatment has been effective? Select all that apply. Normoactive bowel sounds Decrease in nausea and vomiting Serum potassium level of 3.8 mEq/L Fasting blood glucose level of 91 mg/dL White blood cell (WBC) count of 14.0 cells/mcL
A, B, C
Which statements accurately reflect dietary advice needed to help prevent dumping syndrome in a patient who underwent gastrectomy? Select all that apply. Divide meals into six small feedings. Take fluids 45 minutes before meals. Eliminate consumption of fluids with meals. Drink a glass of sweetened apple juice to increase caloric intake. Eat a piece of peppermint candy to help calm the stomach between meals. Increase only the fat content in each meal to meet caloric recommendations.
A, B, C
A nurse is caring for a patient diagnosed with acute gastritis who has a nasogastric tube inserted. The patient asks why the tube has been inserted. Which statements by the nurse would describe the purpose of the nasogastric tube? Select all that apply. "It is used for performing lavage." "It keeps the stomach empty." "It is used to monitor for bleeding." "It is used to provide clear fluid." "It is used to provide tube feedings as needed."
A, B, C Lavage can help reduce bleeding in patients with acute gastritis. A nasogastric tube can help reduce the amount of stomach contents by removing the excess and keeping the stomach empty. A nasogastric tube will help assess the level of bleeding during the acute episode and can also reveal information about the healing process. The color of blood in the tube will be bright red during an acute exacerbation and light red to yellow as the inflammation heals.
If a patient presents with acute exacerbation of peptic ulcer disease, which collaborative interventions need to be taken? Select all that apply. Give patient NPO orders Nasogastric (NG) suction Administration of intravenous Ringer's lactate solution Intravenous administration of a proton pump inhibitor Intravenous triple-antibiotic therapy for H. pylori infection
A, B, C, D Food and liquids need to be avoided so that they do not exacerbate the problem. NG suction needs to be a priority to prevent aspiration Ringer's lactate solution typically contains sodium chloride, potassium chloride, calcium chloride and sodium bicarbonate. This will help to balance the patient's pH.Providing this IV instead of PO form will address the symptoms immediately.
The nurse is providing postoperative care for a patient with an intestinal obstruction. The nurse takes the patient's vital signs and notes a HR of 105, RR 12, SpO2 92%, and a temperature of 102.3° F. Which nursing interventions should be implemented? Select all that apply. Provide stoma care Administer antibiotic Assess nasogastric tube Administer an antipyretic Assess abdominal incision Ask the patient to turn, cough, and breathe deeply
A, B, D, E
When educating a patient with gastritis, which recommendations should the nurse include regarding preventing an exacerbation? Select all that apply. Eliminate smoking. Reduce coffee intake. Avoid eating oily foods. Decrease alcohol consumption. Practice relaxation techniques.
A, B, D, E
The nurse is educating a patient newly diagnosed with gastritis. Which statements by the patient confirm an understanding of gastritis' pathophysiology? Select all that apply. "It may be local." "It may be diffuse." "It is a chronic issue only." "It is an erosion of the stomach's lining." "It causes edema and disruption of capillaries." "It is caused by the breakdown of the mucosal barrier by pepsin."
A, B, E, F
The nurse is assessing a patient with Crohn's disease. Which assessment findings suggest the development of complications related to the disorder? Select all that apply. Jaundice Nystagmus Clubbed fingers Aphthous ulcers Peripheral neuropathy
A, C, D
The nurse is caring for a patient with inflammatory bowel disease (IBD) who reports frequent diarrhea, nausea, poor appetite, and a weight lost 10 pounds in the last 2 weeks. The nurse notes pallor, poor skin turgor, mild peripheral edema, and dry mucus membranes. Which actions would be a priority for the nurse to take? Select all that apply. Calculate intake and output Administer a narcotic analgesic Infuse intravenous (IV) albumin Administer intravenous (IV) fluids Provide a dose of intravenous (IV) antibiotic
A, C, D
Which assessments should be made before administering a sedative in a restless patient with upper GI bleeding? Select all that apply. Heart rate Temperature Blood pressure Respiratory rate Previous 8-hour urine output
A, C, D
Which risk factors will the nurse include when planning to teach a group of teenagers about inflammatory bowel disease (IBD)? Select all that apply. Stress Hypertension A high-fat diet Cigarette smoking Sexually transmitted diseases
A, C, D
A patient with gastritis presents with vomiting and nausea after an overdose of nonsteroidal anti-inflammatory drugs (NSAIDs). What care is indicated for this patient? Select all that apply. Nothing by mouth (NPO) Sedatives Antiemetics Ambulation Gastric lavage
A, C, E
A patient with a suspected Helicobacter pylori infection and complications is being prepared for an endoscopy. The patient asks why the procedure is being done. How can the nurse respond? Select all that apply. "This study will confirm the infection is present." "We need to develop your treatment regimen." "We need to take a sample of the stomach lining." "Other studies cannot confirm an H. pylori infection." "The procedure allows us to determine whether there is any internal damage."
A, C, E Endoscopy provides a definitive diagnosis of H. pylori infection. Endoscopy is used to confirm the absence or presence of malignancy because samples of the tissue can be obtained during the procedure. H. pylori can cause both gastritis and peptic ulcer disease. Endoscopy will allow the health care provider to see the extent of damage.
The nurse would identify which parts of the medical and social history as placing a patient at increased risk for development of gastritis? Select all that apply. Habitual use of nonsteroidal anti-inflammatory drugs Frequent constipation Occasional alcohol use Previous Helicobacter pylori infection Consumption of spicy foods
A, D, E Frequent use of NSAIDs will erode the lining of the stomach and leave the patient susceptible to gastritis. H. pylori is a species of bacteria that can increase the risk for developing gastritis. Certain foods, including spicy foods, contain acid, which interferes with the stomach's acid-base balance.
The nurse is caring for a patient with suspected inflammatory bowel disease (IBD). Which assessment finding warrants immediate health care provider notification? Albumin level 2.8 g/dL Potassium level 2.6 mEq/L Hemoglobin (Hb) level 10.0 g/dL White blood cell (WBC) count 11.2 cells/mcL
B
Which action will allow the nurse to monitor the patient with an upper GI bleed for adequate fluid replacement therapy? Assess stool output Document urine output hourly Document patient vital signs hourly Document the patient's food intake
B
A patient with upper GI bleeding has a blood pressure of 110/60, a temperature of 98.8° F, and a heart rate of 98 bpm. The patient does not require volume repletion. What is the next step in nursing management of this patient? Suggest a clear liquid diet Conduct a focused assessment Provide patient education on the disease Reevaluate vital signs every 5 to 10 minutes
B A focused GI assessment would include assessing bowel sounds and abdominal pain and distension, which would provide more information of the patient's diagnosis.
A patient is diagnosed with acute gastritis associated with a diet heavy in spicy foods and is currently experiencing severe nausea. Which treatment is appropriate for this patient? Corticosteroids Nasogastric tube Antibiotic therapy A diet of bland food
B A nasogastric tube is appropriate to keep the stomach empty until symptoms are relieved, and it can also be used to monitor for bleeding
A patient presents with colicky abdominal pain, nausea, vomiting, and abdominal distention. The health care provider has prescribed diagnostic tests to determine if the patient has an intestinal obstruction. Which physical assessment finding would indicate that the condition has worsened? Hypoactive bowel sounds A rigid, board-like abdomen Diarrheal bowel movement Positive stool for occult blood
B A rigid, board-like abdomen indicates peritonitis, which is a sign that the patient's condition has worsened.
A patient with a massive GI hemorrhage and a history of heart disease presents to the emergency department. Which immediate action is indicated for this patient? Vasopressin treatment Fluid replacement with packed RBCs Fluid replacement with whole blood Fluid replacement with Ringer's solution
B Fluid replacement with packed RBCs is the preferred method for fluid replacement to avoid fluid overload and may be preferred in a patient with heart disease.
A patient presents 2 weeks after removal of a large portion of the stomach and pyloric sphincter. The patient is complaining of abdominal cramping, dizziness, and a sensation of fullness. On assessment, the patient's heart rate is 125 bpm. The nursing team will prepare to treat which condition? Gastric adenoma Dumping syndrome Postvagotomy acidosis Perforation of the abdominal wall
B Patients with dumping syndrome will have cramping, weakness, dizziness, sweating, a sensation of fullness, and tachycardia.
The care team is treating a post-operative patient who has recently undergone a gastrectomy. The patient is showing signs of anxiety and lab results reveal excessive amounts of insulin. The nurse understands that these symptoms may be indicative of which postoperative complication? Dumping syndrome Postprandial hypoglycemia Bile reflux gastritis Vitamin B12 deficiency
B Postprandial hypoglycemia is a post-operative complication which results from an uncontrolled gastric emptying of a large bolus of fluid high in carbohydrates, causing hyperglycemia, excessive amounts of insulin, and resultant hypoglycemia. The patient's high insulin levels and anxiousness are due to the low blood sugar.
A patient with inflammatory bowel disease (IBD) presents with a weight loss of 10 pounds in the past month. The patient reports poor appetite and frequent diarrhea. Which lab value is most concerning? Hematocrit 35% Albumin level 2.2 g/dL Fasting blood glucose level 76 g/dL White blood cell (WBC) count 10.9 cells/mcL
B The albumin level measures a patient's nutritional status. This lab value is most concerning, and measures need to be implemented to improve the patient's nutritional status.
Which action by the nurse demonstrates the first step in providing care to a patient with nausea and a new diagnosis of gastritis? Beginning rehydration therapy Confirming medical history accuracy Vital sign monitoring for hemorrhage Preparing the patient for an endoscopic procedure
B The factors causing the gastritis need to be identified and avoided. Being able to recognize the causative factors will help the patient avoid them in the future
A patient presents with vomiting and nausea. On assessment, the nurse notes epigastric tenderness. Endoscopic studies confirm infection with H. pylori. The patient is prescribed triple-drug therapy. What patient education topic is a priority to ensure symptoms do not recur? Recognizing signs of bleeding Importance of completing antibiotics Importance of adhering to a nonsteroidal anti-inflammatory drugs (NSAID) regimen Guidance on eating a low-calorie and low-fat diet
B The patient should be taught the importance of completing the medication regimen to ensure symptoms do not recur. H. pylori is very difficult to eradicate, and completing the medication regimen is especially important for this patient.
A patient presents with melena associated with pallor, tachypnea, and decreased urine output. Which action is a priority during collaborative care of this patient? Endoscopy Begin IV fluids Administration of vasopressin Argon plasma coagulation (APC)
B The symptoms the patient is experiencing are signs of hypovolemic shock. The priority nursing action would be to begin IV fluids to prevent the patient from declining
A patient comes to the clinic complaining of bright red bloody emesis. What information can be obtained from observing the stool of the patient? Risk of going into shock The duration of the bleed Specific location of the GI bleed Amount of time the blood has been in the stomach
B When emesis contains bright red blood but the stool contains no gross or occult blood, the hemorrhage is considered to have been of short duration.
A patient complains of burning pain across the midepigastric area 3 hours after eating dinner. The pain is relieved by antacids. Which diagnosis would the nurse suspect based on these symptoms? Gastric ulcer Duodenal ulcer Acute gastritis Chronic gastritis
B When food is ingested, it takes roughly 2 to 3 hours for the contents to be emptied in the duodenum. Hydrochloric acid from the stomach contents will enter the duodenum and affect the exposed mucosa, causing pain. Taking antacids will decrease the amount of acid entering the duodenum and therefore decrease the pain.
A patient with gastritis asks the nurse how to prevent future exacerbations. The patient is a heavy smoker and drinker, takes an aspirin daily for heart problems, and eats a relatively simple and bland diet. The patient walks 1 mile every night for exercise. What is the best response by the nurse? Select all that apply. Walk further Stop drinking Cease smoking Change your diet Take additional aspirin
B, C Drinking alcohol is a risk factor for the development of chronic gastritis and should be avoided. Smoking is a risk factor for the development of chronic gastritis and should be avoided.
A nurse is treating a patient with acute gastritis. Which information should the nurse provide to help the patient prevent future exacerbations? Select all that apply. Do not eat or drink anything. Eat only bland food. Join a smoking cessation support group. Take a daily regimen of nonsteroidal anti-inflammatory drugs (NSAIDs). Graze on food throughout the day.
B, C, E Eating bland or nonirritating food can help prevent the development of chronic gastritis Eliminating smoking can lower the risk for developing chronic gastritis. Eating six small meals throughout the day may help prevent the development of chronic gastritis.
The nurse is caring for a patient with ulcerative colitis and abdominal cramping who reports 10-15 episodes of diarrhea daily. Which lab tests would the nurse anticipate? Select all that apply. Lipase Albumin Hemoglobin Total cholesterol Erythrocyte sedimentation rate (ESR)
B, C, E The patient will have problems with absorbing nutrients, so the nurse will anticipate an order for albumin level testing. The patient may also have rectal bleeding, so the nurse will anticipate an order for hemoglobin level testing. The patient is having a flare-up, so the nurse will anticipate an order for an ESR test to assess for inflammation.
During assessment of a patient with reports of nausea, vomiting, and severe abdominal pain, the nurse notes increased abdominal girth and tenderness. Which additional symptoms indicate the presence of an intestinal obstruction? Select all that apply. Hyperkalemia Abdominal rigidity Respiratory alkalosis Hypoactive bowel sounds Presence of skip lesions in the colonoscopy
B, D
A patient with ulcerative colitis (UC) is admitted to the medical surgical unit for treatment of symptoms. Which provider orders should the nurse anticipate? Select all that apply. Elevate the head of the bed Initiate intravenous (IV) fluids Prepare the patient for surgery Place the patient on NPO status Administer antibiotic therapy
B, D, E The nurse would anticipate IV fluids to be ordered for a patient with UC. Goals include nutritional support and resting the bowel. IV fluids will support these goals. NPO status to rest the bowel. The nurse understands that a patient with UC is at risk for secondary infections that should be treated with antibiotics.
Which patients are at an increased risk for developing a mechanical obstruction? Select all that apply. A patient with a L5 spinal compression fracture A patient with a 10-year history of Crohn's disease A patient with a serum potassium level of 2.5 mEq/L A patient with atherosclerosis of the mesenteric artery A patient who has undergone multiple abdominal surgeries
B, E
A patient presents with bloody emesis and is incoherent. The patient smells strongly of alcohol. What action will the nurse take after immediate care is provided? Patient history Evaluate for signs of shock Provide patient education Monitoring for delirium tremens
C
A patient with an intestinal obstruction recently had surgery to create an ileostomy. In the immediate postoperative period, the nurse who is caring for the patient anticipates assessing for which frequent complication of this surgery? Fatty stools Rectal bleeding Electrolyte imbalances Formation of adhesions
C
The nurse is caring for a patient with an intestinal obstruction caused by strictures. For which procedure would the nurse anticipate to prepare the patient? Obstructive series Surgical ileostomy formation Stent placement via endoscopy Computerized tomography (CT) scan
C
The nurse is caring for a patient with inflammatory bowel disease (IBD) who reports palpitations and weakness. The nurse notes a thready, irregular heartbeat. Which lab result would the nurse review first? Serum glucose level Serum albumin level Serum potassium level Complete blood count (CBC)
C
The nurse is caring for a patient with intestinal obstruction who has been vomiting for 4 days. The nurse notes pallor, dry mucosa, and poor skin turgor. Which diagnostic tests are most important for the nurse to obtain? Hemoglobin Total bilirubin Serum electrolytes Amylase and lipase
C
The nurse is caring for a patient with intestinal obstruction who reports severe abdominal pain, nausea, and vomiting. The nurse notes 36 ml of urine output in 3 hours and an elevated BUN. Which action is most important for the nurse to take? Auscultate bowel sounds Measure the abdominal girth Administer a bolus of IV fluids Prepare the patient for surgery
C
The nurse is caring for a patient who presents with nausea and vomiting. X-ray results reveal a lower intestinal obstruction. Which provider order would the nurse implement first? Administer an oral laxative Provide a bland, low-fat diet Insert a nasogastric (NG) tube Offer the patient pain medication
C An NG tube will help alleviate the nausea, vomiting, and abdominal distention that occurs with an intestinal obstruction.
A patient has noticed possible blood in the stool but has no other obvious symptoms of GI bleed. Which test is used to determine if this patient has an upper GI bleed? CBC BNP Guaiac test Blood culture
C The guaiac test is used to identify occult blood in the stool and would be appropriate for investigating suspected blood in the stool in the context of minimal symptoms.
Why would the nurse discuss vitamin B12 deficiency with a patient who has undergone a gastrectomy? Vitamin B12 is recommended for all postsurgical patients. Vitamin B12 supplements are needed to promote the healing process. The parietal cells of the stomach produce intrinsic factor, which is needed for vitamin B12 absorption. The parietal cells of the stomach produce hydrochloric acid (HCl), which is an essential factor for vitamin B12 absorption.
C The nurse would discuss the relationship between the gastrectomy and the possible loss of intrinsic factor and how the loss of intrinsic factor is related to vitamin B12 deficiency. The patient will need to be assessed for vitamin B12 deficiency at a later date.
The nurse is caring for a patient with inflammatory bowel disease (IBD) who reports frequent diarrhea and vomiting and a pain level of 8/10. The nurse notes poor skin turgor, dry mucus membranes, and abdominal tenderness to palpation. Which provider order would the nurse implement first? Administer corticosteroids Administer a bulking agent Administer pain medication Administer intravenous (IV) fluids
C The patient rates their pain at an 8/10, so the nurse will administer the pain medication first.
A patient with Crohn's disease reports passing stool when urinating. Which surgical treatment would the nurse anticipate? Fistula repair Colostomy formation Ileal pouch formation Total proctocolectomy
A A fistula is an abnormal passage between two areas. In this situation, the patient has a fistula between the colon and the bladder that needs to be repaired.
A patient with a massive GI hemorrhage from an esophageal tear has a heartrate of 105 bpm, blood pressure 75/45, and is exhibiting signs of agitation. The patient's status has not improved in the last 36 hours despite multipolar electrocoagulation treatment. What is the indicated treatment for this patient? Surgery Endoscopy Vasopressin Pantoprazole
A
Which information would the nurse include in the discharge teaching for a patient with an upper GI bleed? Managing reflux Strict low-calorie diet Limiting aspirin intake Limiting alcohol consumption
A
A patient with peptic ulcer disease (PUD) presents with severe upper abdominal pain that spreads to the back. The patient reports that they cannot find any way to relieve the pain. On assessment, the abdomen is rigid and the patient has tachycardia. Which treatment is indicated for this patient? CT scan Omentum graft Pyloroplasty and vagotomy Nonsteroidal anti-inflammatory drugs (NSAIDs)
B The patient is exhibiting signs of a perforation and should be treated with a simple omentum graft.
A patient presents with a history of hypertension and has just started treatment for peptic ulcer disease (PUD). What important medication topic needs to be discussed in the management of this patient? A proton pump inhibitor (PPI) needs to be used with caution. Antacids need to be used with caution. Electrolyte balances need to be checked regularly. The patient's antihypertensive medication should be stopped.
C Antacids can be high in sodium and exacerbate symptoms of hypertension.
A patient presents with sudden, bright red vomitus, is experiencing fatigue and dyspnea, and is hypotensive. What is the priority action that should be taken to address the needs of this patient? Endoscopy Assess urine output Administer IV lactated Ringer's solution Ascertain the cause for bleeding
C Emergency care for the patient with GI bleeding consists of fluid replacement using lactated Ringer's solution, or whole blood, packed RBCs, or plasma. After stabilization of the patient, a cause for bleeding can be assessed and specifically treated.
A patient with suspected inflammatory bowel disease (IBD) reports 15-20 diarrheal stools per day. Which question would the nurse ask the patient to help determine a diagnosis of ulcerative colitis versus Crohn's disease? "Do you have any family members with IBD?" "Have you been tested for colorectal cancer?" "Have you noticed a lot of blood in your stool?" "When did you first begin experiencing these symptoms?"
C Patients with ulcerative colitis will have bloody stools so the nurse will question the patient about this occurrence.
A patient with a massive upper GI hemorrhage who loses 1600 mL of blood may exhibit which symptoms? Fever Deep breathing Heart rate 110 bpm Blood pressure 190/80
C Tachycardia, or a rapid heart rate, is a symptom of shock and may be experienced after a massive hemorrhage.
Peptic ulcer disease (PUD) is most likely to affect which areas of the gastrointestinal (GI) lining? Serosa Dermis Mucosa Submucosa Muscularis
C, D, E
A patient is taking a corticosteroid. Which action of the corticosteroid places the patient at risk for development of gastritis? Erosion of the gastrointestinal (GI) lining Inhibition of coagulation Increasing hydrochloric acid (HCl) production Inhibition of prostaglandin synthesis
D Corticosteroids inhibit the synthesis of prostaglandins which are protective to the gastric mucosa.
Which patient is at an increased risk for a nonmechanical obstruction? A patient with a history of hernias A patient being treated for diverticulitis A patient who is admitted who had a colonoscopy A patient who underwent an open cholecystectomy
D General anesthesia is a risk factor for a paralytic ileus, which is a nonmechanical obstruction. This patient would be at highest risk.
A patient presents with blood-tinged emesis. An endoscopy does not reveal a cause for the blood. What is the next step in assessing this patient? Biopsy CT Scan Ultrasound Angiography
D If an endoscopy does not reveal the cause for upper GI bleeding, an angiography should be the next diagnostic tool.
The nurse is caring for a patient with an intestinal obstruction with severe nausea and vomiting. The health care provider orders insertion of a nasogastric (NG) tube, administration of a bolus of IV fluids, hydromorphone 2 mg IVP every 3 hours PRN, and a urinalysis. Which intervention is most important for the nurse to implement first? Obtain a urinalysis Give hydromorphone Administer a bolus of IV fluids Insert the nasogastric (NG) tube
D The patient has severe nausea and vomiting, and the NG tube will help alleviate these symptoms. This intervention will be performed first.
A patient with H. pylori infection is prescribed a triple-drug regimen. Which medications are included in this therapy? A proton pump inhibitor (PPI), amoxicillin, and clarithromycin A proton pump inhibitor (PPI), tetracycline, and metronidazole A proton pump inhibitor (PPI), angiotensin-converting enzyme inhibitor, and metronidazole A proton pump inhibitor (PPI), amoxicillin, and magnesium sulfate
A
A patient with a history of smoking complains of burning in the upper abdomen and upper back 45 minutes after eating. Which condition would be suspected by the nurse? Gastric ulcer Duodenal ulcer Acute gastritis Chronic gastritis
A
Early detection of peptic ulcer disease (PUD) needs to be the priority in a nursing management plan for patients with symptoms of chronic gastritis. Which action is the nurse's next priority? Assess for anemia and guaiac-positive stools. Monitor patient for pain and administer antibiotics. Assess for anemia and give triple-antibiotic therapy for H. pylori. Review patient chart for history of smoking and alcoholism.
A Assessing for anemia and guaiac-positive stools will help determine whether the patient has a possible complication of PUD. This assessment will help the nurse detect PUD early and should be the next course of action
The laboratory results of a patient with ulcerative colitis (UC) indicate anemia. The nurse determines that which factor is most likely responsible for this laboratory finding? Blood loss A diet low in iron Frequent diarrhea Intestinal malabsorption of B12
A Bloody stools are a common manifestation of UC. Loss of blood would result in anemia.
Which medication may be most appropriate for a patient with minor symptoms presenting with upper GI bleeding due to a peptic ulcer? Tagamet Analgesic Lisinopril Epinephrine
A H2-receptor blockers such as Tagamet reduce stomach acid and would be an appropriate treatment for a patient with a bleeding peptic ulcer.
Which goals are appropriate for a patient with upper GI bleeding? Select all that apply. The patient will experience minimal anxiety The patient will have no further GI bleeding The patient will continue treatment after discharge The patient will experience a return to a normal hemodynamic state The patient will remain in the hospital for 1 week after bleeding has stopped
A, B, D
A patient with chronic peptic ulcer disease (PUD) does not respond to medical therapy. After the treatment team finishes discussing a certain surgical treatment option, the patient asks for more information on how the procedure will affect his small intestine. Which surgical treatments have likely been discussed? Select all that apply. Billroth I Billroth II Vagotomy Gastrectomy Pyloroplasty
A, B, D, E
The nurse is caring for a patient with nausea, vomiting, and severe pain. For which health care provider order would the nurse anticipate to prepare the patient? Fecal occult blood Obstructive series Exploratory laparotomy Magnetic resonance imaging (MRI)
B An obstructive series is a radiographic procedure used to determine the presence of intestinal obstructions.
Which assessment findings would the nurse expect to find for a patient with diagnosed Crohn's disease that has developed complications outside the gastrointestinal (GI) tract? Select all that apply. Epistaxis Joint pain Periorbital edema Red patches on the legs Eye redness and itching
B, D, E
Which patient would be most at risk for upper GI bleeding? An avid runner A heroin addict A patient who eats a Mediterranean diet A heavy smoker who is taking aspirin daily
D
A patient has a gastrointestinal bleed. Which assessment findings would alert the nurse to melena? Bright red stool Black tarry stool Coffee-ground stool Flecks of blood in the sputum
B
The nurse is caring for a patient with Crohn's disease after surgery to treat an intestinal stricture. The patient has normal respiratory effort, is lethargic, and reports pain 7/10. The nurse notes redness and inflammation around the incision, absent bowel sounds, and a temperature of 101.8° F. Which action is most important for the nurse to take? Apply oxygen via nasal cannula Administer a scheduled antibiotic Administer a laxative suppository Change the dressing to the incision
B
A patient is suspected of having a gastric ulcer. The patient cannot have an endoscopy because a non-life-threatening cardiac arrhythmia is present. Which diagnostic test should the patient undergo? Complete blood count (CBC) Biopsy Stool examination Barium contrast study
D A barium contrast study may be used to diagnose gastric outlet obstruction or for ulcer detection in those who cannot undergo endoscopy, although it is not the diagnostic tool of choice.
A patient presents with symptoms of acute gastritis. Which diagnostic tool would be used to definitively diagnose the patient with this disease? Complete blood count (CBC) Fecal analysis Serum analysis Endoscopy with biopsy
D
The nurse is caring for a patient with an intestinal obstruction and severe vomiting who reports palpitations and fatigue. The nurse notes a potassium level of 2.2 mEq/L and a thready pulse. Which action would the nurse take first? Administer an antiemetic Administer oxygen via nasal cannula Administer a bolus of intravenous fluids Administer an IV piggyback with potassium
D
The nurse is caring for a patient with intestinal obstruction. Which laboratory finding would be most concerning? Potassium 5.0 mEq/L Hemoglobin 11.0 g/dL Platelet count of 150,000/mcL White blood cell (WBC) count of 18.0 cells/mcL
D
Which patient has the highest risk for developing inflammatory bowel disease (IBD)? A 45-year-old Asian female A 35-year-old Hispanic female A 55-year-old African American male A 25-year-old Ashkenazic Jewish male
D
Which is the rationale for the nurse to instruct the patient with inflammatory bowel disease (IBD) who is receiving antibiotics to eat yogurt daily? To alleviate nausea and calm the stomach To provide a source of protein for the patient To meet calcium needs when a deficiency is present To prevent the occurrence of Clostridium difficile infection
D C. difficile is an infection that can happen in patients with IBD and also as a result of taking antibiotics. Therefore, the nurse will instruct the patient to eat a yogurt every day.
The nurse is caring for a patient admitted with nausea, vomiting, and abdominal pain. Which additional finding indicates the possibility of intestinal obstruction? Active bowel sounds Soft and rounded abdomen Report of occasional flatulence Last bowel movement a week ago
D Constipation, as indicated by the lack of a bowel movement in a week, is a sign of an intestinal obstruction.
A patient with gastritis asks the nurse about the bodily process behind the diagnosis. The nurse explains that which physiologic event is responsible for the patient's symptoms? Alkalization of the intestines Necrosis of the stomach wall Inhibition of protein production Disruption of the stomach mucosa
D Gastritis may be caused by hydrochloric acid and pepsin diffusing into the mucosa, resulting in tissue edema, disruption of capillary walls with loss of plasma into the gastric lumen, and possible hemorrhage.
A patient has been treated in the hospital for peptic ulcer disease (PUD) and is now looking forward to recovery. The patient has a 2-week postoperative appointment scheduled and asks the nurse what to expect in terms of healing time. Which is an appropriate response? "The ulcer will have significant progress in healing within a week." "The ulcer will have significant progress in healing within 3 days." "The ulcer will have significant progress in healing within 2 weeks." "The ulcer will not be completely healed by the first postoperative appointment."
D With appropriate medical therapy, the patient can expect the ulcer to heal within 3 to 9 weeks, depending on ulcer size, treatment regimen, and patient's adherence to the treatment regimen.
