G. I Final

31 . What is the most common sign of inflammatory bowel disease

Diarrhea

The nurse assisting in the treatment of a patient with ruptured esophageal varices who has received vasopressin IV will carefully assess for:

Evidence of cardiac ischemia

A client undergoes a barium swallow fluoroscopy that confirms gastroesophageal reflux disease (GERD). Based on this diagnosis, the client should be instructed to take which action? Select all that apply. a) Stop smoking. b) Take antacids 1 hour and 3 hours after meals. c) Sleep with the head of bed flat. d) Limit alcohol consumption to one drink per day. e) Avoid caffeine and carbonated beverages. f) Follow a high-fat, low-fiber diet.

A. Stop smoking. B. Take antacids 1 hour and 3 hours after meals. E. Avoid caffeine and carbonated beverages. Explanation: The nurse should instruct the client with GERD to follow a low-fat, high-fiber diet. Caffeine, carbonated beverages, alcohol, and smoking should be avoided because they aggravate GERD. In addition, the client should take antacids as prescribed (typically 1 hour and 3 hours after meals and at bedtime). Lying down with the head of bed elevated, not flat, reduces intra-abdominal pressure, thereby reducing the symptoms of GERD

36. Suspected cholecystitis characteristics

-Transient epigastric pain radiating to the back and right shoulder, -burning in the chest after eating, - flatulence

14. The nurse is providing initial nutritional teaching for a client with a new ileostomy. Which foods in the initial postoperative teaching plan are most important for the nurse to instruct the client to avoid? Select all that apply. 1. Apple slices 2. Bananas 3. Broccoli with cheese 4. Multigrain bagel 5. Scrambled eggs with oatmeal 6. White rice

1. Apple slices 3. Broccoli with cheese 4. Multigrain bagel 5. Scrambled eggs with oatmeal

4. When providing discharge teaching for the patient after a laparoscopic cholecystectomy, what information should the nurse include?

A lower-fat diet may be better tolerated for several weeks

A client is preparing to undergo abdominal paracentesis. Which nursing interventions should be performed before the procedure? Select all that apply. a) Make sure informed consent was obtained. b) Explain the procedure to the client. c) Have the client lie flat in bed. d) Instruct the client to void. e) Open the paracentesis tray using clean technique.

A. Make sure informed consent was obtained. B. Explain the procedure to the client. D. Instruct the client to void. Explanation: The nurse should explain the procedure to the client and make sure informed consent has been obtained. The nurse should instruct the client to void before the procedure to minimize the risk of accidental bladder injury from the needle or trocar and cannula. The nurse should then help the client sit up in bed, expose the client's abdomen, wash hands, and then open the paracentesis tray using sterile technique.

A nurse caring for a client with small-bowel obstruction should plan to implement which nursing intervention first? a) Preparing to insert a nasogastric (NG) tube b) Obtaining a blood sample for laboratory studies c) Administering I.V. fluids d) Administering pain medication

Administering I.V. fluids Explanation: The nurse should first administer I.V. infusions containing normal saline solution and potassium to maintain fluid and electrolyte balance. For the client's comfort and to assist in bowel decompression, the nurse should prepare to insert an NG tube next. A blood sample is then obtained for laboratory studies to help diagnose bowel obstruction and guide treatment. Blood studies usually include a complete blood count, serum electrolyte levels, and blood urea nitrogen level. Pain medication commonly is withheld until obstruction is diagnosed because analgesics can decrease intestinal motility. (less)

A client, age 82, is admitted to an acute care facility for treatment of an acute flare-up of a chronic GI condition. In addition to assessing the client for complications of the current illness, the nurse monitors for age-related changes in the GI tract. Which age-related change increases the risk of anemia?

Atrophy of the gastric mucosa Atrophy of the gastric mucosa reduces hydrochloric acid secretion; this, in turn, impairs absorption of iron and vitamin B12, increasing the risk of anemia as a person ages.

14. Which food should be included in the client diet during the first 6 to 8 weeks after ileostomy surgery?

Banana

A client with cholecystitis is receiving propantheline bromide. The client is given this medication because it: A)reduces gastric solution production and hypermobility. B)slows emptying of the stomach and reduces chyme in the duodenum. C)inhibits contraction of the bile duct and gallbladder. D)decreases bile secretions

C)inhibits contraction of the bile duct and gallbladder. Rational For gallbladder disease, propantheline has an antispasmodic effect on the bile duct and gallbladder

A patient experiencing nausea reports to the nurse that she adds ginger root to her morning tea to calm her stomach. Which classification of medication in the patient history alerts the nurse to provide further education? a. Antidepressants b. Proton pump inhibitors c. Anticoagulants d. Narcotics

C. Anticoagulants Rational Ginger enhances the action of coagulants and antiplatelet agents

Which factors may increase a patient's risk of developing cancer of the pancreas?

Cigarette smokers and people with diabetes mellitus

One day after undergoing a traditional cholecystectomy, a client is scheduled to stand at the bedside and walk. What should a nurse teach the client to do before standing and walking for the first time after surgery?

Flex her legs when moving to a sitting position. Rational Flexing the legs when moving to a sitting position reduces the tension on the abdomen and the pain associated with moving. The bed should be placed in the sitting position rather than flat.

25. Ulcerative colitis is more common in people who

Have family members with the same disease

14 . Which foods should be avoided after ileostomy surgery?

High fiber foods such as fresh corn, celery and bran cereal

What should the nurse expect of a patient with a malabsorption of vitamin K?

Increased prothrombin time Rational Prothrombin times are increased because malabsorption of vitamin K or inability to produce the clotting factors VII, IX, and X cause the patient to have bleeding tendencies.

A nurse is assessing a client who is receiving total parenteral nutrition (TPN). Which finding suggests that the client has developed hyperglycemia?

Increased urine output Explanation: Glucose supplies most of the calories in TPN; if the glucose infusion rate exceeds the client's rate of glucose metabolism, hyperglycemia arises. When the renal threshold for glucose reabsorption is exceeded, osmotic diuresis occurs, causing an increased urine output.

11. While examining the clients abdomen, which sequence should the nurse use?

Inspection, auscultation, percussion, palpation

When caring for a client with hepatitis B, the nurse should monitor closely for the development of which finding associated with a decrease in hepatic function?

Irritability and drowsiness

A client seeks medical attention after developing acute abdominal pain. Which action by the nurse would help ensure accurate auscultation of the client's bowel sounds?

Making sure the client's bladder is empty before auscultating

Alterations in hepatic blood flow resulting from a drug interaction can affect:

Metabolism and excretion

A nurse is caring for a patient receiving total parenteral nutrition (TPN). Which nursing action is most appropriate to implement? a. Use a clean technique for site care. b. Infuse the solution rapidly. c. Administer medications through the TPN line. d. Monitor the temperature for elevation.

Monitor the temperature for elevation. Rational Temperature should be monitored for signs of potential infection. When caring for a patient receiving TPN, sterile technique is used for site care. If solution is given too rapidly, the patient may have circulatory overload. The TPN catheter should NEVER be used for medication administration.

Why is morphine contraindicated in the patient with pancreatitis?

Morphine may cause spasms of the sphincter of Oddi. ....In such cases Meperidine (Demerol) PCA is often administered

35. Abdominal perineal resection- what three incisions will be present

On the abdomen, colostomy , perineum

A client with advanced cirrhosis has a prothrombin time (PT) of 15 seconds, compared with a control time of 11 seconds. The nurse expects to administer:

Phytonadione (Mephyton) Rational Prothrombin synthesis in the liver requires vitamin K. In cirrhosis, vitamin K is lacking, precluding prothrombin synthesis and, in turn, increasing the client's PT. An increased PT, which indicates clotting time, increases the risk of bleeding. Therefore, the nurse should expect to administer phytonadione (vitamin K1) to promote prothrombin synthesis.

Which of the following is a classic symptom of cholecystitis?

Right upper abdomen, radiating to the back or right scapula

A home health nurse is instructing an older adult patient regarding dietary changes to help prevent constipation. What changes should the nurse indicate when providing this education? (Select all that apply.) a. Addition of whole-grain cereal b. Cessation of laxative use c. Increase in liquid intake d. Increase in sugar intake e. Eating fresh vegetables

a. Addition of whole-grain cereal b. Cessation of laxative use c. Increase in liquid intake e. Eating fresh vegetables Rational A decrease in sugar intake will help stem diarrhea.

A clinical symptom of gallbladder inflammation or gallstones is a. pain and distention after eating. b. jaundice. c. anorexia. d. weakness and apathy.

a. pain and distention after eating. A clinical symptom of gallbladder inflammation is pain and distention after eating. When infection, stones, or both are present, the normal contraction of the gallbladder, triggered by fat entering the intestine, causes pain.

A goal of medical treatment for patients with cirrhosis is to prevent complications and limit cell damage. A major approach is to promote rest. What rationale supports this approach? a. Allows time for a transplant b. Allows the liver to regenerate c. Prevents red cell destruction d. Decreases the risk of trauma

b. Allows the liver to regenerate With rest, the liver will regenerate healthy tissue and return to normal functioning. Rest must include other measures to promote healing, such as dietary measures and no alcohol.

Which of the following are indicators of colorectal cancer? (Select all that apply.) a. Constant diarrhea b. Excessive flatulence c. Cachexia d. Cramps e. Rectal bleeding f. Anemia

b. Excessive flatulence c. Cachexia d. Cramps e. Rectal bleeding f. Anemia The indicators for colorectal cancer are changing bowel habits between diarrhea and constipation, flatulence, cachexia, cramps, rectal bleeding, and anemia.

What is the most lethal complication of a peptic ulcer? a. Bleeding b. Perforation c. Severe pain d. Gastric outlet obstruction

b. Perforation Rational Perforation is considered the most lethal complication of peptic ulcer. Bleeding may occur when the ulcer erodes into a blood vessel; however, perforation occurs when the ulcer crater penetrates the entire thickness of the wall of the stomach or duodenum. Gastric outlet obstruction can occur at any time and can be relieved by NG aspiration of stomach contents.

The nurse caring for a patient who has had an open cholecystectomy with a T-Tube will: a. open the T-tube to the air so that it will drain freely. b. position and secure the drainage bag at the chest level. c. Place the collection bag so the tube is not kinked. d. Irrigate the T-tube with normal saline to ensure the free flow of bile.

b. position and secure the drainage bag at the chest level. Rational The T-tube is placed below the level of the common bile duct to prevent the reflux of bile. The bag must be positioned so the tube is not kinked, or bile cannot drain from the liver. Normally T-tubes are not irrigated.

Which dietary selection should lead the nurse to conclude that the dietary teaching is successful for a patient on a low-sodium diet? a. Bologna sandwich with tomato juice b. Hotdog on a bun with pickle relish and skim milk c. Baked chicken, white rice, and apple juice d. Peanut butter and jelly sandwich with tomato soup

c. Baked chicken, white rice, and apple juice A meal of baked chicken, white rice, and apple juice has the lowest sodium levels.

When assisting with the admission of a new resident to a long-term care facility, a nurse notes a current history of peptic ulcer disease. What type of pain should the nurse expect the resident to describe? a. Sharp b. Dull c. Burning d. Stabbing

c. Burning Rational Some patients with gastric ulcers have no pain, but others experience a burning or cramping pain 2 to 4 hours after meals.

Which nursing measure takes priority in relation to the care of a patient with a gastroesophageal balloon tube? a. Deflate the balloon periodically. b. Advance the tube as instructed. c. Monitor respiratory status. d. Withhold medications that could decrease restlessness.

c. Monitor respiratory status. Because of the close proximity of the esophagus and trachea, any upward movement of the tube could cause airway obstruction.

A client with hepatitis C develops liver failure and GI hemorrhage. The blood products that most likely bring about hemostasis in the client are:

cryoprecipitate and fresh frozen plasma. Rational The liver is vital in the synthesis of clotting factors, so when it's diseased or dysfunctional as in hepatitis C, bleeding occurs. The treatment consists of administering blood products at aid clotting.

What should the nurse include in a teaching plan for a patient with a hiatal hernia to reduce the frequency of heartburn? a. Drinking 10 oz of milk with every meal b. Lie down after eating c. Panting through mouth when symptoms begin d. Eating small meals

d. Eating small meals

A nurse administers promethazine (Phenergan) for nausea. Which extra precautionary action should the nurse implement because of the common side effect of antiemetic medications? a. Check vital signs for erratic blood pressure. b. Add a blanket to prevent chilling. c. Provide extra water to combat thirst. d. Put up side rails to prevent falls.

d. Put up side rails to prevent falls. Rational Most antiemetic medications cause drowsiness because of their effects on the central nervous system, resulting in dizziness and confusion.

A patient complains about the placement of the total parenteral nutrition (TPN) line and asks why it cannot be inserted in the arm. What fact regarding the placement of this line should the nurse base a response on? a. Arm would limit patient mobility. b. Subclavian artery allows for ease in dressing the puncture site. c. Arm prevents the use of large-bore cannulas. d. Subclavian artery allows for rapid dilution.

d. Subclavian artery allows for rapid dilution. Rational The rich TPN solution is rapidly diluted in the larger vessel, preventing phlebitis.

A physician orders lactulose (Cephulac), 30 ml three times daily, when a client with cirrhosis develops an increased serum ammonia level. To evaluate the effectiveness of lactulose, the nurse should monitor:

level of consciousness (LOC) Rational In cirrhosis, the liver fails to convert ammonia to urea. Ammonia then builds up in the blood and is carried to the brain, causing cerebral dysfunction. When this occurs, lactulose is administered to promote ammonia excretion in the stool and thus improve cerebral function. Because LOC is an accurate indicator of cerebral function, the nurse can evaluate the effectiveness of lactulose by monitoring the client's LOC. Monitoring urine output, abdominal girth, and stool frequency helps evaluate the progress of cirrhosis, not the effectiveness of lactulose.

A patient who is being evaluated for episodes of hematemesis and dyspepsia tells the nurse that pain occurs when he eats, but pain does not waken him. The nurse recognizes a diagnostic sign of which condition?

peptic ulcer

A 53-year-old client undergoes colonoscopy for colorectal cancer screening. A polyp was removed during the procedure. Which nursing interventions are necessary when caring for the client immediately after colonoscopy? Select all that apply.

• Monitor vital signs frequently until they are stable. • Observe the client closely for signs and symptoms of bowel perforation. • Inform the client that there may be blood in the stool and to report excessive blood immediately.