RN Alterations in Digestion and Bowel Elimination Assessment

A nurse is caring for a client who has new diagnosis of ulcerative colitis. Which of the following manifestations would the nurse expect to observe?

- A metallic taste in the mouth - Nocturnal bowel movements - Abscess formation - Fistulas around the anus Correct Answer: Nocturnal bowel movements Rationale: The nurse should expect the client to report nocturnal bowl movements, due to the increased frequency of stools manifested by ulcerative colitis.

A nurse is caring for a client in the emergency department who is demonstrating manifestations of cholecystitis. Which of the following diagnostic exams is the preferred and initial imaging test to diagnose this condition?

-MRI -Abdominal ultrasound -Hepatobiliary iminodiacetic acid (HIDA) scan -CT scan Correct Answer: Abdominal ultrasound Rationale: An abdominal ultrasound is the preferred and initial imaging test when diagnosing cholecystitis.

A nurse is providing teaching to a client who has recently been diagnosed with a hiatal hernia. Which of the following statements should the nurse make?

- "Avoid bending over as much as possible." - "Do not practice yoga." - "Avoid tight-fitting clothes and heavy lifting." - "Elevate your legs when sitting or lying down." Correct Answer: "Avoid tight-fitting clothes and heavy lifting." Rationale: The client should avoid tight-fitting clothes and heavy lifting, because these can exacerbate the manifestations of GERD with a hiatal hernia.

A nurse is caring for a client who just finished treatment for their H. pylori infection. Which of the following should the nurse recommend to prevent a recurrent infection?

- "Avoid spicy foods." - "Only eat food that is overcooked." - "Make sure to wash your hands after handling raw fish." - "Prepare food so that it is slightly undercooked." Correct Answer: "Make sure to wash your hands after handling raw fish." Rationale: Proper hand washing after touching raw goods can decrease the risk of developing H. pylori infection.

A nurse is speaking with a client who called the community health information call center desk. The client states that they have been having a fever with severe epigastric pain that radiates to the right shoulder, mainly after eating, for the past 2 days now. Which of the following responses should the nurse make?

- "Come to the ED immediately. There is a possibility this may be an infected gallbladder, and if left untreated, you can develop a perforation and possible sepsis." - "Have you tried acetaminophen and an antacid medication first?" - "Try to not eat for the rest of the day, and if this continues into tomorrow morning, then you should see your doctor." - "Why don't you call your doctor's office to find out if you can be see?" Correct Answer: "Come to the ED immediately. There is a possibility this may be an infected gallbladder, and if left untreated, you can develop a perforation and possible sepsis." Rationale: An untreated gallbladder infection can cause complications such as gangrenous cholecystitis or gallbladder perforation that can lead to potential abscess formation or sepsis.

A nurse is providing education to the partner of a client who has been newly diagnosed with compensated cirrhosis of the liver. Which of the following statements should the nurse make?

- "Compensated means that the liver damage is so great, that other organs will need to pay back its deficit or lack of performance by working harder." - "Compensated means that the liver, although damaged, has naturally adjusted its workload to hid any outward and physical signs of the disease at this time." - "Compensated is the worst stage of cirrhosis and means that the liver can no longer be compensated for or repaired." - "Compensated means that the liver has completely recovered and that the client will no longer have liver disease." Correct Answer: "Compensated means that the liver, although damaged, has naturally adjusted its workload to hid any outward and physical signs of the disease at this time." Rationale: Some clients may have a diagnosis of cirrhosis but exhibit no physical manifestations of the disease, meaning the liver has compensated and continues to make corrections accordingly with no external indications of the disorder.

A nurse is assisting feeding a client who has dementia, and the client begins to cough after swallowing milk. Which of the following statements should the nurse to make to the client's visiting family?

- "Don't worry. Your mother's lower esophageal sphincter will close to prevent aspiration." - "I know it can be scary. The cough can be caused by a spasm of an area in our food pipe called the upper esophageal sphincter that prevents liquids from entering the airways." - "It's okay. Your mother's palatine tonsils keep the milk from entering the windpipe so that she won't aspirate." - "There's no need to be concerned because our diaphragm works by not allowing liquids to enter the lungs." Correct Answer: "I know it can be scary. The cough can be caused by a spasm of an area in our food pipe called the upper esophageal sphincter that prevents liquids from entering the airways." Rationale: The upper esophageal sphincter closes to prevent food or liquids from entering the airways when it is triggered by swallowing these substances.

A nurse is caring for a 22-year-old client who has a diagnosis of GERD. The client states, "I thought I was too young to get this condition." Which of the following responses should the nurse make?

- "I'm sure the diagnosis is accurate. You should follow the recommendations provided." - "Well, it could have been a lot worse. You're lucky it wasn't anything bad." - "Researchers are see GERD in younger individuals now, and they think it is related to the types of food and drink we consume, as well as our lifestyle." - "This is very unusual at your age. Did your parent ever tell you that you had problems with spitting up as a baby?" Correct Answer: "Researchers are see GERD in younger individuals now, and they think it is related to the types of food and drink we consume, as well as our lifestyle." Rationale: Researchers have noticed an increase in the proportion of adults younger than 50 years of age experiencing GERD over the last decade. It is surmised that the increase in GERD among the younger population over the last decade might be related tot he types of food and drink that are being consumed, as well as smoking, increased prevalence of obesity, and decreased physical activity.

A nurse is caring for a client who has a diagnosis of alcoholic liver disease. The client is crying and states, "I might as well keep drinking because I'm going to die now anyway." Which of the following is the best response by the nurse?

- "If you stop drinking alcohol now you can reduce the progression of further liver damage." - "I'm sorry you are feeling this way. There is always a possibility of a liver transplant." - "There are a lot of people with liver disease that have it much worse than you." - "Have you ever heard chelation therapy? Maybe you should look into other alternatives." Correct Answer: "If you stop drinking alcohol now you can reduce the progression of further liver damage." Rationale: Abstaining from alcohol can assist in reducing the progression of further liver damage.

A nurse working in a clinic is caring for a client who states, "I do not know why I've had a cold sore on my lip since I have had an infection." Which of the following responses should the nurse make?

- "It is likely related to a gastrointestinal disorder." - "Oral herpes lays dormant and can appear during increased stress or with a weakened immune system." - "that should never happen, because once you have had herpes, you are immune from it reoccurring." - "That is likely not herpes, because it doesn't usually appear on the lips." Correct Answer: "Oral herpes lays dormant and can appear during increased stress or with a weakened immune system." Rationale: Following exposure to HSV-1, the virus remains dormant and can reappears later during increased stress or due to a weakened immune system, such as after a different infection.

A nurse is providing discharge education to a client who has a new diagnosis of celiac disease. Which of the following statements should the nurse include in the teaching?

- "It is okay to eat food made with bleached flour." - "You should not drink wine because that can cause an inflammatory response." - "You should avoid croutons in your salad or other foods you eat." - "If you like to enjoy a light beer, there should be not problem." Correct Answer: "You should avoid croutons in your salad or other foods you eat." Rationale: Celiac disease is an immune disorder caused by a reaction to gluten. Clients who have this condition should avoid foods that contain gluten, such as croutons.

A nurse is providing discharge teaching to a client who has a new diagnosis of inflammatory bowel disease (IBD). Which of the following statements should the nurse include?

- "Keep a food diary to monitor the foods that cause 'flare-ups' of your GI issues." - "You should be able to easily tolerate dairy products" - "Caffeine and carbonated beverages should not cause any issues with your disorder." - "A high-residue diet can help alleviate episodes of abdominal pain and diarrhea." Correct Answer: "Keep a food diary to monitor the foods that cause 'flare-ups' of your GI issues." Rationale: The client should keep a food diary and monitor the foods that can cause "flare-ups" of uncomfortable manifestations such as diarrhea, bloating, cramping, constipation, nausea, or vomiting.

A nurse is preparing discharge instructions for a client who has been diagnosed with thrombocytopenia related to liver failure. Which of the following statements should the nurse make?

- "Only shave with an electric razor and brush your teeth with a soft bristle toothbrush." - "It is okay to take NSAIDs for pain relief." - "You may continue to floss your teeth twice per day to resume good dental hygiene." - "Resuming contact sports is fine as long as you use a mouthpiece and ear protectors." Correct Answer: "Only shave with an electric razor and brush your teeth with a soft bristle toothbrush." Rationale: Clients who have thrombocytopenia caused by liver failure should exercise precautions to reduce bleeding, such as using an electric razor and a soft bristle toothbrush.

A nurse is teaching a client about reducing risk factors for developing recurring oral herpes (HSV-1). Which statement should the nurse include?

- "Protect your lips from exposure to direct sunlight or other ultraviolet light." - "Join an early-morning exercise class at the gym to wear off steam." - "Distract yourself by taking harder classes in school." - "Avoid getting the flu shot every year." Correct Answer: "Protect your lips from exposure to direct sunlight or other ultraviolet light." Rationale: Exposure to sunlight or other ultraviolet light is a risk factor for oral herpes (HSV-1).

A nurse in the emergency department is caring for a client who has acute pancreatitis. Which of the following statements should the nurse make to explain to the client's partner why the client is being admitted to the intensive care unit (ICU)?

- "Since your partner has pancreatitis, we will admit them to ICU in order to prepare them for a pancreatectomy procedure." - "We'd rather have your partner in ICU to assist in keeping them calm due to the amount of pain that they are experiencing." - "People who have potential pancreatitis are often misdiagnosed so we want to be on the safe side." - "The complications of pancreatitis can be serious or life threatening." Correct Answer: "The complications of pancreatitis can be serious or life threatening." Rationale: Pancreatitis can be serious. Acute pancreatitis requires intensive care and treatment. Complications of pancreatitis can include kidney failure, breathing problems, sepsis, and internal bleeding if a cyst-like pocket in the pancreas ruptures.

A nurse is caring for a group of clients who are experiencing abdominal pain. The nurse would identify that which of the following clients is at risk for developing cholecystitis?

- 58-year-old female who has osteoarthritis - 25-year-old male who has type 1 diabetes - 31-year-old female who takes oral contraceptives - 46-year-old male who eats a high-fiber diet Correct Answer: 31-year-old female who takes oral contraceptives Rationale: Individuals who are assigned female at birth, are younger than 50 years old, and take oral contraceptives are more likely to develop cholecystitis.

A nurse is providing teaching to a client who has a new diagnosis of hepatitis B and lives in a large household. Which of the following recommendations should the nurse make about the other members of the client's household?

- All individuals living with a newly infected person should move out right away. - There is nothing new or different that these individuals need to do. - All individuals living with a newly infected person should contact their health care provider. - All individuals living with a newly infected person should not be told because this is HIPAA-protected information. Correct Answer: All individuals living with a newly infected person should contact their health care provider. Rationale: All individuals exposed to or living with a newly infected person should contact their provider and should get vaccinated if not yet infected.

A nurse is caring for a client who states, "I think I might have the beginnings of oral cancer." Which of the following manifestations can be indicative of oral cancer?

- Serous-filled blister in the oral cavity or on the lips - A white, scaly patch inside the mouth - White cottage cheese appearance in the mouth - Strawberry appearance of the tongue Correct Answer: A white, scaly patch inside the mouth Rationale: A white or reddish patch on the inside of the mouth can be an indication of oral cancer.

A nurse is caring for a client who has a recent diagnosis of liver disease and is returning for a follow-up visit. The client presents with a new onset of a tiny, superficial grouping of small blood vessels on the chest. The nurse should identify the client likely has which of the following?

- Spider veins or spider angioma - Contact dermatitis - Eczema - Acne vulgaris Correct Answer: Spider veins or spider angioma Rationale: Cirrhosis and liver failure can cause spider-like veins on the skin.

A nurse is caring for an older adult client who has been taking NSAIDs for chronic pain related to osteoarthritis. The nurse should identify that long-term use of NSAIDs places the client at risk for which of the following?

- Type 2 diabetes - GI bleeding -Neuropathy -Pancreatitis Correct Answer: GI bleeding Rationale: Clients who suffer from chronic pain might have a history of taking NSAIDs for long periods of time, which increases the risk for GI bleeding and can be especially dangerous in older adults.

A nurse is caring for a client who has acute pancreatitis. Which of the following types of bowel sounds should the nurse expect to auscultate?

-Absent -Normoactive -Hyperactive -Hypoactive Correct Answer: Hypoactive Rationale: On physical examination of a client who has acute pancreatitis, the client will be reluctant for the nurse to touch their abdomen due to pain, and bowel sounds will be reduced during auscultation.

A nurse is caring for an older adult client with a long history of alcohol use disorder who has manifestations of confusion and incoherence. The nurse should suspect that which of the following is causing the client's manifestations?

-Dementia associated with Alzheimer's disease -Manifestations of thrombocytopenia -Delirium -Complications associated with hepatic encephalopathy Correct Answer: Complications associated with hepatic encephalopathy Rationale: Nurses should recognize that hepatic encephalopathy is a neurological condition that causes changes in level of consciousness such as confusion or lethargy and develops when the liver is unable to remove toxins from the blood. This may be confused with other causes of confusion.

A nurse in the emergency department is caring for a client who reports severe pain of 10 on a scale from 0 to 10 in their abdomen that radiates to their back. The client states that the pain started about 4 hrs ago. They are diaphoretic, anxious, and nauseated. There is abdominal guarding noted on the exam. The client has a history of alcohol use disorder and states that they drank "a lot of booze" last night. Which of the following actions should the nurse take first?

-Prepare the client for admission to the ICU -Obtain an order for an anti-emetic medication -Start a peripheral IV for hydration -Obtain an order for a fast-acting pain relief medication Correct Answer: Start a peripheral IV for hydration Rationale: This client is presenting with manifestations of acute pancreatitis. The nurse should first establish an IV access because this client will need urgent hydration and intravenous pain relief medication.

A nurse is caring for a client who has a BMI of 31, is a heavy smoker, and reports working long hours and eating fast food frequently. Vital signs are stable, but the client reports frequent throat irritation. The nurse should recognize that the client may be at risk for which of the following conditions?

-Tonsilitis -Rhinovirus -GERD -Mononucleosis Correct Answer: GERD Rationale: GERD, gastroesophageal reflux disease, is a chronic disease in countries with high rates of risk factors such as obesity and smoking. When the gastric contents are regurgitated back up into the esophagus, it can cause chest pain and a burning sensation or irritation in the throat.

A nurse is caring for a client who has been admitted to the hospital with a small bowel obstruction. Which of the following medical/surgical histories placed the client at increased risk for this obstruction?

-Type 1 diabetes -Crohn's disease -Addison's disease -Brain cancer Correct Answer: Crohn's disease Rationale: A history of Crohn's disease places a client at an increased risk of developing small bowel obstructions due to past scarring, strictures, or surgery.

The client is at highest risk for developing ______1________ as evidenced by the client's _________2_________.

1. - Barrett's esophagus - Myocardial Infarction - Tonsilitis - Emphysema 2. - Increased stress - Ongoing GERD - Discomfort with heartburn - History of smoking Correct Answer: 1. Barrett's esophagus 2. Ongoing GERD Rationale: The nurse should recognize that ongoing, unrelieved, or chronic gastroesophageal reflux disease (GERD) places the client at the greatest risk for developing Barrett's esophagus. Barrett's esophagus can progress to esophageal cancer, which is a serious condition with a high mortality rate. Using the acute vs. chronic approach to client care, this finding of ongoing, unrelieved GERD is the priority.

The client is at highest risk for developing ______1_____ as evidenced by the client's ______2______.

1. -Heart murmur -Lactose intolerance -Anal fissures or fistulas -Vitamin B12 deficiency 2. -Dehydration -Crohn's disease -Immunosuppression -Malnutrition Correct Answer: 1. Anal fissures or fistulas 2. Crohn's disease Rationale: The nurse should recognize that a diagnosis of Crohn's disease places the client at a greater risk for developing anal fissures or fistulas. The nurse should ensure that they inspect the perianal and anal areas for any manifestations of these complications. For instance, the client's high level of pain with pus-like drainage is a priority finding because it could indicate that the client might be developing a fistula and/or an abscess to the rectal areas. Further inspection might be warranted under endoscopy and the provider should be made aware.

The client is at the highest risk for developing ______1_____ as evidenced by the client's _____2_____.

1. -Hepatitis B -Spontaneous bleeding -Pancreatitis -Encephalopathy 2. -Liver disease -Thrombocytopenia -Hyperammonemia -Anemia Correct Answer: 1. Spontaneous bleeding 2. Thrombocytopenia Rationale: The nurse should recognize that the laboratory value for the platelet count is low, which indicates this client is at the greatest risk for spontaneous bleeding related to thrombocytopenia. Therefore, the priority action at this time is to address the client's thrombocytopenia. Treatment can include platelet transfusion and education on the prevention of injury or bleeding.