Prep U: GI

A client with a well-managed ileostomy has sudden onset of abdominal cramps, vomiting, and watery discharge from the ileostomy. What should the nurse tell the client to do?

- Take an antiemetic. - Use 30 mL of milk of magnesia daily. ** Notify the health care provider (HCP). - Increase fluid intake to 3 L/day.

A client is admitted with inflammatory bowel syndrome (Crohn's disease). When planning care for the healthcare team, which would be included? Select all that apply.

- antidiarrheal medications - corticosteroid therapy

A nurse is monitoring a client recovering from moderate sedation that was administered during a colonoscopy. Which finding requires the nurse's immediate attention?

- decreased cough and gag reflexes ** oxygen saturation (SaO2) of 89% - blood-tinged stools - heart rate of 94 beats/minute

A nurse is caring for a client with active upper GI bleeding. What is the appropriate diet for this client during the first 24 hours after admission?

- ice chips only - iron-rich diet ** nothing by mouth - increased dairy products

TPN is prescribed for a client with Crohn's disease. What indicates to the nurse that the TPN has been effective? The client:

- is hydrated. ** has met nutritional needs. - is not in metabolic acidosis. - is in a negative nitrogen balance.

The client who is in Buck's traction is constipated. A plan of care that incorporates which breakfast would be most helpful in reestablishing a normal bowel routine?

- orange juice, breakfast pastries (doughnut and Danish), and coffee - corn flakes with sliced banana, milk, and English muffin and jelly - eggs and bacon, buttered white toast, orange juice, and coffee ** an orange, raisin bran and milk, and wheat toast with butter

A nurse is assessing a client who has a history of a bleeding peptic ulcer. What assessment findings should the nurse report immediately?

- strong, irregular pulse; lower abdominal pain; cool, dry skin - abdominal cramping; slow, regular pulse; warm, pale skin ** abdominal distention; cool, clammy skin; weak, thready pulse - warm, dry skin; hypotension; bounding, regular pulse

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.

A client with a history of alcohol abuse was admitted with bleeding esophageal varices. After several days of treatment, the client is ready for discharge. The nurse enters the client's room to review discharge instructions with the client when the client tells the nurse that they want help to quit drinking. How should the nurse respond?

** "I'll notify your physician and call the social worker so they can discuss treatment options with you." - "Let me finish reviewing your discharge instructions then we can discuss your concerns."

Which instruction should the nurse include in the teaching plan for a client who is experiencing gastroesophageal reflux disease?

Follow a low-protein diet. Take medications with milk to decrease irritation. Limit caffeine intake to two cups of coffee per day. **Do not lie down for 2 hours after eating.

In the early postoperative period following abdominal surgery, the nurse notes a bright red, 3″ × 5″ (7.6 × 12.7 cm) area of drainage on the client's dressing. What should be the nurse's first action in response to this observation?

Take the client's vital signs.

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

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

When admitting an elderly client for nausea and vomiting that has lasted for 3 days, the nurse should assess for which clinical findings?

poor skin turgor

When assessing a client during a routine checkup, the nurse reviews the history and notes that the client had aphthous stomatitis at the time of the last visit. Aphthous stomatitis is best described as

a canker sore of the oral soft tissues.

A client who has ulcerative colitis says to the nurse, "I can't take this anymore; I'm constantly in pain, and I can't leave my room because I need to stay by the toilet. I don't know how to deal with this." Based on these comments, what judgment should the nurse make about what the client is experiencing?

difficulty coping

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.

When preparing a client for surgery to treat appendicitis, the nurse formulates a nursing diagnosis of "Risk for infection related to inflammation, perforation, and surgery." What is the rationale for choosing this nursing diagnosis?

** Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix. - The appendix may develop gangrene and rupture, especially in a middle-aged client. - Obstruction of the appendix may increase venous drainage and cause the appendix to rupture. - Infection of the appendix diminishes necrotic arterial blood flow and increases venous drainage.

A client with inflammatory bowel disease undergoes an ileostomy. On the first day after surgery, the nurse notes that the client's stoma appears dusky. How should the nurse interpret this finding?

Blood supply to the stoma has been interrupted.

A client presents to the emergency department with reports of acute GI distress, bloody diarrhea, weight loss, and fever. A family history of what would be significant to this client's diagnosis?

ulcerative colitis

After completing assessment rounds, which client should the nurse discuss with the health care provider (HCP) first?

** a client with hepatitis whose pulse was 84 bpm and regular and is now 118 bpm and irregular - a client with stable vital signs that has been receiving IV cipro following a cholecystectomy for 1 day and has developed a rash on the chest and arms - a client with pancreatitis whose family requests to speak with the HCP regarding the treatment plan - a client with cirrhosis who is depressed and has refused to eat for the past 2 days

A client who has been diagnosed with gastroesophageal reflux disease (GERD) reports heartburn. To decrease the heartburn, the nurse should instruct the client to eliminate which item from the diet?

** hot chocolate - air-popped popcorn - raw vegetables - lean beef

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

** lateral - lithotomy - Trendelenburg's - supine

A physician orders spironolactone, 50 mg by mouth four times daily, for a client with fluid retention caused by cirrhosis. Which finding indicates that the drug is producing a therapeutic effect?

** loss of 2.2 lb (1 kg) in 24 hours - blood pH of 7.25 - serum sodium level of 135 mEq/L - serum potassium level of 3.5 mEq/L

Two days following a colon resection, an elderly client shows new onset of confusion. When contacting the health care provider, the nurse should make which recommendation?

- "Would you like a stat potassium level done?" ** "Shall I collect and send a urine sample for culture and sensitivity?" - "Do you want to request a computed tomography scan to rule out stroke?" - "May we have a prescription for restraining this client?"

A client diagnosed with ulcerative colitis also experiences obsessive compulsive anxiety disorder (OCD). In helping the client understand her illness, the nurse should respond with which statement?

- "Your ulcerative colitis has made you perfectionistic, and it has caused your OCD." ** "It's possible that your desire to have everything be perfect has caused stress that may have worsened your colitis, but there is no proof that either disorder caused the other." - "The perfectionism and anxiety related to your obsessions and compulsions have led to your colitis." - "There is no relationship at all between your colitis and your OCD. They are separate disorders."

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

A client is receiving a tube feeding and has developed diarrhea, cramps, and abdominal distention. What should the nurse do? Select all that apply.

- Change the feeding apparatus every 24 hours. - Slow the administration rate. - Use a diluted formula, gradually increasing the volume and concentration. - Anticipate changing to a lactose-free formula.

A client is preparing to undergo abdominal paracentesis. Which nursing interventions should be performed before the procedure? Select all that apply.

- Instruct the client to void. - Explain the procedure to the client. - Make sure informed consent was obtained.

A client who is legally blind must undergo a colonoscopy. The nurse is helping the healthcare provider obtain informed consent. When obtaining informed consent from a client who is visually impaired, the nurse should take which step?

- Make sure the client's family is present when the consent form is signed. - Document on the consent form that the client is unable to sign the consent because of being legally blind. - Contact the client's nearest relative to obtain consent. ** Read the consent form to the client and ask if there are any questions.