Gastroenterology

The nurse is teaching a client with a newly diagnosed hiatal hernia about measures to prevent recurrence of symptoms. Which statement should be included in the teaching?

"Avoid lying down for an hour after eating." Most clients with a hiatal hernia can be managed by conservative measures, which include a low-fat diet, avoiding lying down for an hour after eating, and raising the head of the bed.

The nurse is instructing a client who had a herniorrhaphy about how to reduce postoperative swelling following the procedure. Which should the nurse suggest to the client to prevent swelling?

Elevate the scrotum. Following herniorrhaphy, the client should be instructed to elevate the scrotum and apply ice packs while in bed to decrease pain and swelling. The client also is instructed to apply a scrotal support when out of bed.

The nurse has assisted in the insertion of a Levin tube for gastrointestinal (GI) decompression. The nurse plans to set the suction to which pressure?

Low and intermittent.

The nurse is preparing to administer an enteral feeding through a nasogastric tube. The nurse should place the client in which position during and after the feedings?

Fowler's. The client is placed with the head of the bed elevated 30 to 45 degrees both during and after feedings to prevent aspiration.

The nurse is caring for a client suspected of having appendicitis. Which should the nurse anticipate will be prescribed for this client?

No oral intake of liquids or food. For the client with suspected or known appendicitis, the nurse should ensure the client remains on nothing by mouth status in anticipation of emergency surgery and also to avoid worsening the inflammation.

A sexually active 20-year-old client has developed viral hepatitis. Which statement made by the client would indicate a need for teaching?

"I can never drink alcohol again." To prevent transmission of hepatitis, a condom is advised during sexual intercourse, as well as vaccination of the partner or close friends. Alcohol should be avoided for 1 year because it is detoxified in the liver and may interfere with recovery.

The nurse has given the client with hepatitis instructions about postdischarge management during convalescence. The nurse determines that the client needs further teaching if the client makes which statement?

"I should resume a full activity level within 1 week." The client with hepatitis is easily fatigued and may require several weeks to resume a full activity level. It is important for the client to get adequate rest so that the liver may heal.

The nurse is collecting data from a client admitted to the hospital with a diagnosis of suspected gastric ulcer and is asking the client questions about pain. Which statement made by the client supports the diagnosis of gastric ulcer?

"My pain comes shortly after I eat, maybe a half hour or so later." The pain occurs a half hour to an hour after a meal and rarely occurs at night.

The nurse is reviewing the health care provider's prescriptions for a client admitted to the hospital with a diagnosis of liver disease. Which medication prescription should the nurse question?

Acetaminophen (Tylenol) Acetaminophen can cause hepatotoxicity, and its use is avoided in the client with liver disease.

The nurse gathers data from a client admitted to the hospital with gastroesophageal reflux disease (GERD) who is scheduled for a Nissen fundoplication. Based on an understanding of this disease, the nurse determines that the client may be at risk for which complication?

Aspiration. The client reports the feeling of warm fluid traveling up the throat. If the fluid reaches the level of the pharynx, the client notes a sour or bitter taste in the mouth. This effortless regurgitation frequently occurs when the client is in the upright position. If regurgitation occurs when the client is recumbent, the client is at risk for aspiration.

A client with viral hepatitis states to the nurse, "I am so yellow." The nurse should take which action?

Assist the client in expressing feelings. The client's feelings should be explored to discover how the client feels about the disease process and appearance so appropriate interventions can be planned.

The nurse is collecting admission data on the client with hepatitis. Which finding would be a direct result of this client's condition?

Drowsiness. Many of those wastes are protein by-products, especially ammonia, which are harmful to the central nervous system. An increased ammonia level is the primary cause of the neurological changes seen in liver disease, beginning first with drowsiness.

A client who has undergone a subtotal gastrectomy is being prepared for discharge. Which items concerning ongoing self-management should the nurse reinforce to the client? Select all that apply.

Eat smaller and more frequent meals. Drink fluids between meals not with them. Following gastric surgery, the client should eat smaller, more frequent meals to facilitate digestion. Fluids should be taken between meals not with them to avoid dumping syndrome. The client should resume activity gradually and should minimize stressors to prevent recurrence of symptoms.

A client is receiving bolus feedings via a nasogastric tube. The nurse plans to place the client's head of the bed (HOB) in which optimal position once the feeding is completed?

Elevated 30 to 45 degrees with the client in the right lateral position for 60 minutes

A client is admitted to the hospital with acute viral hepatitis. Which sign/symptom should the nurse expect to note based on this diagnosis?

Fatigue. Common signs of acute viral hepatitis include weight loss, dark urine, and fatigue. The client is anorexic and finds food distasteful.

A client is admitted to the hospital with severe jaundice and is having diagnostic testing. Because the client has no complaints of fatigue, the client is encouraged to ambulate in the hall to maintain muscle strength. The client paces around the room but will not enter the hall. Which problem most likely is the reason for the client's reluctance to walk in the hall?

Feeling self-conscious about appearance. Clients with jaundice frequently have a body image disturbance because of a change in appearance. This can be manifested in negative verbal or nonverbal behavior.

The nurse analyzes the results of laboratory studies performed on a client with peptic ulcer disease (PUD). Which laboratory value would indicate a complication associated with the disease?

Hemoglobin 10.2 g/dL The most common complications of peptic ulcer disease are hemorrhage, perforation, pyloric obstruction, and intractable disease. A low hemoglobin and hematocrit level indicate bleeding. The normal hemoglobin range in females is 12 to 16 g/dL and in males is 14 to 18 g/dL.

The nurse is interpreting the laboratory results of a client who has a history of chronic ulcerative colitis. Which result indicates a complication of ulcerative colitis?

Hemoglobin 10.2 g/dL. normal hemoglobin level ranges from 12 to 16 g/dL. The client with ulcerative colitis is most likely anemic because of chronic blood loss in small amounts with exacerbations of the disease. These clients often have bloody stools and are at increased risk for anemia.

The nurse is collecting data on a client with a diagnosis of peptic ulcer disease. Which history is least likely associated with this disease?

History of the use of acetaminophen (Tylenol) for pain and discomfort Unlike aspirin (acetylsalicylic acid [ASA]), acetaminophen has little effect on platelet function, doesn't affect bleeding time, and generally produces no gastric bleeding

A client with acute pancreatitis is experiencing severe pain. After noting an absence of an analgesic prescription on the health care provider prescription sheet, the nurse should suggest contacting the health care provider to request a prescription for which medication?

Hydromorphone (Dilaudid) Hydromorphone rather than morphine is the medication of choice because morphine can cause spasms in the sphincter of Oddi

The nurse is reinforcing dietary instructions for a client with peptic ulcer disease. Which statement made by the client indicates a need for further teaching?

I will eat a bland diet only. A bland diet is unnecessary. The client should not skip meals, avoid tea and coffee, as they cause an increase in acid production, and discontinue eating spicy foods if they cause pain.

An acutely ill looking client arrives at the emergency department. The client complains of "the worst pain I ever felt in my belly. I can't get comfortable." The client is quiet but with each movement the client cries out in pain. The nurse suspects the client has peritonitis. Which data should the nurse collect to assist in validating this suspicion? Select all that apply.

Inspect the abdomen for rigidity. Check for the presence of hiccups. Inspect the client's mucous membranes.

The nurse who is assisting in the care of a client within the first 24 hours following a total gastrectomy for gastric cancer should avoid which intervention?

Irrigating the nasogastric (NG) tube.

The nurse is caring for a client after a Billroth II (gastrojejunostomy) procedure. On review of the postoperative prescriptions, which should the nurse clarify?

Irrigating the nasogastric (NG) tube. Patency of the NG tube is critical for preventing the retention of gastric secretions. The nurse, however, should never irrigate or reposition the gastric tube after gastric surgery unless specifically prescribed by the health care provider. In this situation, the nurse should clarify the prescription.

The nurse is reinforcing discharge instructions to a client with a hiatal hernia. Which should the nurse include in the teaching session? Select all that apply.

It is advisable to stop smoking cigarettes. Wait at least 1 hour after meals to perform chores. Be sure to elevate the head of the bed during sleep.

The nurse should include which instruction in a teaching plan for a client who has peptic ulcer disease?

Learn to use stress reduction techniques. Identifying and reducing stress are essential to a comprehensive ulcer management plan.

A client in the emergency department reports right lower quadrant abdominal pain. After noting a white blood cell count of 16,500 cells/mm3, the nurse should question which prescriptions? Select all that apply.

Milk of magnesia

A nurse planning care for a client with hepatitis plans to meet the client's safety needs by performing which action?

Monitoring prothrombin and partial thromboplastin values. When liver function is impaired, as in the client with hepatitis, some important body functions do not occur. The liver synthesizes fibrinogen, prothrombin, and factors needed for normal blood clotting.

The nurse is caring for a client with a nasogastric (NG) tube and tests the pH of the aspirate to determine correct placement. The nurse notes that the pH is 5. Which information does this indicate?

Placement of the NG tube is accurate. After the nurse inserts an NG tube into a client, the correct location of the tube must be verified. Testing the pH of the gastric fluid and determining its acidity further verifies that the tube is in the stomach. The stomach contents are acidic, and a pH of 5 should indicate accurate placement.

The nurse provides information to a client following a gastrectomy who is now diagnosed with pernicious anemia. Which instructions about pernicious anemia should the nurse reinforce? Select all that apply.

Provide meticulous and frequent oral hygiene. Use additional lightweight blankets as needed. Check blood serum vitamin B12 levels every 1 to 2 years.

A client with a peptic ulcer is scheduled for a vagotomy, and the client asks the nurse about the purpose of this procedure. The nurse tells the client that a vagotomy serves which purpose?

Reduces the stimulation of acid secretions. A vagotomy, or cutting of the vagus nerve, is done to eliminate parasympathetic stimulation of gastric secretion.

The nurse is reinforcing instructions to a client about insertion of a Sengstaken-Blakemore tube. Which statement by the client indicates an understanding of the teaching?

The tube will be inserted through my nose to my stomach. A Sengstaken-Blakemore tube may be used to control bleeding of esophageal varices when other interventions have been ineffective.

A health care provider asks the nurse to obtain a Salem Sump tube for gastric intubation. The nurse selects which tube from the unit storage area?

Tube with a lumen and an air vent.

The nurse is evaluating the effect of dietary counseling on the client with cholecystitis. The nurse determines that the client understands the instructions given if the client states that which food item is acceptable to include in the diet?

Turkey and lettuce sandwich. The client with cholecystitis should decrease overall intake of dietary fat. Red meats (hamburger and steak) contain fat. Mashed potatoes are usually made with milk and butter. The correct food item that is low in fat is the turkey and lettuce sandwich.

A health care provider is about to perform a paracentesis on a client with abdominal ascites. The nurse should assist the client to assume which position?

Upright. An upright position allows the intestine to float posteriorly and helps prevent intestinal laceration during catheter insertion. Ideally, the client sits upright in a chair, with feet flat on the floor, and with the bladder emptied before the procedure.

A client has been diagnosed with chronic gastritis and has been told that there is too little intrinsic factor being produced. The nurse tells the client that which therapy will be prescribed to treat the problem?

Vitamin B12 injections Insufficient intrinsic factor results in the inability to absorb vitamin B12, which must then be supplemented by the parenteral route.

The nurse is caring for a client with a diagnosis of chronic gastritis. The nurse anticipates that the client is at risk for which vitamin deficiency?

Vitamin B12. Deterioration and atrophy of the lining of the stomach lead to the loss of function of the parietal cells. When the acid secretion decreases, the source of the intrinsic factor is lost, which results in the inability to absorb vitamin B12.

Which statement by the spouse of a client with end-stage liver failure indicates the need for further teaching by the multidisciplinary team regarding the management of pain?

"This opioid will cause very deep sleep, which is what my husband needs." Changes in level of consciousness are an indicator of potential opioid overdose, as well as indicative of numerous fluid, electrolyte, and oxygenation deficits. It is important for the spouse to understand the differences in sleep related to the relief of pain and changes in neurological status related to overdose or deficits.

A client is admitted to an acute care facility with complications of celiac disease. Which question should be helpful initially in obtaining information for the nursing care plan?

"What is your understanding of celiac disease?" Celiac disease is also known as "gluten-induced enteropathy." It causes diseased intestinal villi, which results in decreased absorptive surfaces and malabsorption syndrome. Clients with celiac disease must maintain a gluten-free diet, which eliminates all products made from wheat, rye, oats, barley, buckwheat, or graham. Many products may contain gluten without the client's knowledge. Beer, pasta, crackers, cereals, and many more substances contain gluten.

The nurse is checking a client for the correct placement of a nasogastric (NG) tube. The nurse aspirates the client's stomach contents and checks its pH level. Which pH value indicates the correct placement of the tube?

3.5 If the NG tube is in the stomach, the pH of the contents will be acidic.

A client with Crohn's disease has a prescription to begin taking antispasmodic medication. The nurse should time the medication so that each dose is taken at which time?

30 minutes before meals. o be effective in decreasing bowel motility, antispasmodic medications should be administered 30 minutes before mealtime.

After a liver biopsy, the nurse should place the client in which position?

A right side-lying position with a small pillow or folded towel under the puncture site. assuming a right side-lying position with a small pillow or folded towel under the puncture site for at least 3 hours.

A client arrives at the emergency department and complains of severe abdominal pain. The initial diagnosis is acute abdomen, and an x-ray and an abdominal ultrasonogram are prescribed to be obtained immediately. The nurse prepares the client for these diagnostic tests and reviews the health care provider's prescriptions. Which prescription should the nurse question if written on the health care provider's prescription form?

Administration of an opioid analgesic. Until a differential diagnosis is determined and a decision about the need for surgery is made, the nurse should question a prescription to give an opioid analgesic because it could mask the client's symptoms.

A client is admitted to the hospital with a diagnosis of acute pancreatitis. The nurse plans care, knowing that which problem occurs with this disorder?

Alteration in comfort related to abdominal pain. Abdominal pain is the predominant symptom of acute pancreatitis. Shock and hypovolemia may occur from hemorrhage, toxemia, or loss of fluid into the peritoneal space. Potassium and sodium may be lost due to gastric suction and frequent vomiting. Hyperglycemia may result from impaired carbohydrate metabolism.

The nurse notes that the medical record of a client with cirrhosis states that the client has asterixis. To verify this information the nurse should take which action?

Ask the client to extend the arms. Asterixis is irregular flapping movements of the fingers and wrists when the hands and arms are outstretched, with the palms down, wrists bent up, and fingers spread. It is the most common and reliable sign that hepatic encephalopathy is developing.

The nurse observes that a client's nasogastric tube has suddenly stopped draining. The tube is connected to suction, the machine is on and functioning and all connections are snug. The tube is secured properly and does not appear to have been dislodged. After checking placement, the nurse gently flushes the tube with 30 mL of normal saline, but the tube still is not draining. The nurse analyzes this problem as which?

Channels of gastric secretions may be bypassing the holes in the tube; turning the client will promote stomach emptying.

A client has undergone esophagogastroduodenoscopy (EGD). The nurse places highest priority on which action as part of the client's care plan?

Checking for return of a gag reflex The nurse places highest priority on managing the client's airway.

The nurse is reinforcing medication instructions to a client with peptic ulcer disease. Which represents correct information given by the nurse?

Cimetidine (Tagamet) results in decreased secretion of stomach acid. Cimetidine and other histamine H2-receptor antagonists decrease the secretion of gastric acid in the stomach.

A client with possible hiatal hernia complains of frequent heartburn and regurgitation. The nurse should gather further information about the presence of which sign or symptom?

Difficulty swallowing Although many clients with hiatal hernia are asymptomatic, those with symptoms usually have difficulty swallowing, along with heartburn and reflux.

A health care provider places a Miller-Abbott tube in a client who has a bowel obstruction. Six hours later, the nurse measures the length of the tube outside of the nares and notes that the tube has advanced 6 cm since it was first placed. Based on this finding, which action should the nurse take next?

Document the finding in the client's record. The Miller-Abbott tube is a nasoenteric tube, which is used to decompress the intestine and correct a bowel obstruction. Initial insertion of the tube is a health care provider's responsibility. The tube is weighted by a special substance and either advances by gravity or may be advanced manually. Advancement of the tube can be monitored by measuring the tube and by taking serial x-rays.

The nurse is assisting with the insertion of a nasogastric tube into a client. The nurse should place the client in which position for insertion?

High-Fowler's position. During the insertion of a nasogastric tube, the client is placed in a sitting or high-Fowler's position to reduce the risk of pulmonary aspiration if the client should vomit.

The nurse is reinforcing discharge instructions to a client after a gastrectomy. Which measure should the nurse include in client teaching to help prevent dumping syndrome?

Limit the fluids taken with meals. The client should be instructed to decrease the amount of fluid taken at meals. The client should also be instructed to avoid high-carbohydrate foods, including fluids such as fruit nectars; assume a low-Fowler's position during meals; lie down for 30 minutes after eating to delay gastric emptying; and take antispasmodics as prescribed

The nurse has assisted with the insertion of a Levin tube for gastrointestinal (GI) decompression. Which settings will the health care provider prescribe? Select all that apply.

Low, Intermittent. A Levin tube has no air vent, and the suction must be placed on a low and intermittent setting to prevent trauma to the gastric mucosa.

The nurse will be providing postprocedure care to a client who has undergone esophagogastroduodenoscopy (EGD). The nurse should plan to do which action first?

Monitor for return of the gag reflex. The nurse should place highest priority on monitoring for return of the gag reflex, which is part of managing the client's airway. The client's vital signs should be monitored next; a sudden, sharp increase in temperature could indicate perforation of the gastrointestinal tract.

A morbidly obese client, 3 days postoperative gastric bypass surgery, comes to the clinic complaining of pain. The nurse suspects that the client has an anastomotic leak requiring hospitalization. Which findings validate this suspicion? Select all that apply.

Oliguria Restlessness Abdominal pain Unexplained tachycardia

The nurse is caring for a client with a resolved intestinal obstruction who has a nasogastric tube in place. The health care provider has now prescribed the nasogastric tube to be discontinued. To determine the client's readiness for discontinuation of the nasogastric tube, which measure should the nurse check?

Presence of bowel sounds in all four quadrants. Distention, vomiting, and abdominal pain are a few of the symptoms associated with intestinal obstruction, and a nasogastric tube may be used to empty the stomach and relieve distention and vomiting. Bowel sounds return to normal as the obstruction is relieved and normal bowel function is restored.

The nurse is collecting data on a client admitted to the hospital with hepatitis. Which data indicate that the client may have liver damage?

Pruritus When bilirubin is not metabolized by the liver, it accumulates in the circulation and is minimally excreted by the skin, causing jaundice and pruritus. It is also eliminated unchanged by the kidneys, causing urine to become dark amber or brown.

The nurse reinforces instructions to a client following a gastrectomy about the signs and symptoms of pernicious anemia, knowing what information?

Regular monthly injections of vitamin B12 will prevent this complication. Deficiency occurs from the lack of intrinsic factor normally secreted by specialized cells in the gastric mucosa.

A health care provider asks the licensed practical nurse (LPN) to reinforce preprocedure instructions to a client who will undergo a barium swallow (esophagography) in a few days. The LPN should include which instruction in this discussion?

Remove all metal and jewelry before the test. A barium swallow, or esophagography, is an x-ray that uses a substance called barium for contrast to highlight abnormalities in the gastrointestinal (GI) tract. The client is told to remove all jewelry before the test so it won't interfere with x-ray visualization of the field. The client should fast for 8 to 12 hours before the test, depending on health care provider instructions.

The nurse has assisted the health care provider with a liver biopsy, which was done at the bedside. Upon completion of the procedure, the nurse assists the client into which position?

Right side-lying with a small pillow or towel under the puncture site. Following a liver biopsy, the client is assisted to assume a right side-lying position with a small pillow or folded towel under the puncture site for at least 3 hours. This helps immobilize the area and provides pressure to minimize bleeding in this vascular organ.

A client has undergone subtotal gastrectomy and the nurse is preparing the client for discharge. Which item should be included when reinforcing instructions to the client about ongoing self-management?

Smaller, more frequent meals should be eaten. Following gastric surgery, the client should eat smaller, more frequent meals to facilitate digestion.

The nurse is monitoring a client for the early signs and symptoms of dumping syndrome. Which indicates this occurrence?

Sweating and pallor. Early manifestations occur 5 to 30 minutes after eating. Symptoms include vertigo, tachycardia, syncope, sweating, pallor, palpitations, and the desire to lie down.

A licensed practical nurse (LPN) is preparing to assist a registered nurse (RN) with removing a nasogastric (NG) tube from the client. The LPN should reinforce instructing the client to perform which action?

Take and hold a deep breath. When the NG tube is removed, the client is instructed to take and hold a deep breath. This will close the epiglottis, and the airway will be temporarily obstructed during the tube removal. This allows for the easy withdrawal of the tube through the esophagus into the nose. The tube is removed with one very smooth, continuous pull.

The nurse is teaching a client who is newly diagnosed with a hiatal hernia about measures to prevent recurrence of symptoms. The nurse should make which accurate statement to the client?

"Be sure to sleep with your head elevated in bed." Most clients with hiatal hernia can be managed by conservative measures, which include a low-fat diet, avoiding lying down for an hour after eating, and keeping the head of the bed elevated.

A generally healthy 63-year-old man is seen in the health care provider's office for a routine examination. Which statement made by the client is important for the nurse to follow up on?

"Everyone in my immediate family has died from gastrointestinal cancer." The nurse should follow up on the statement about familial cancer. The client may have some anxiety that this will ultimately occur to him, and the nurse should gather further data to understand the client's situation and to identify additional risk factors.

The nurse has been reinforcing dietary teaching for a client with gastroesophageal reflux disease (GERD) who has a routine follow-up visit. Which behavior is the best indicator of a successful outcome for this client?

A decrease in sour eructation A decrease in sour eructation (burping) represents a change in the client's health status and is an effective indicator of a successful outcome.

A client who has undergone a colostomy several days ago is reluctant to leave the hospital and has not yet looked at the ostomy site. Which measures are most likely to promote coping? Select all that apply

Ask a member of the local ostomy club to visit with the client before discharge. Ask the enterostomal nurse specialist to consult with the client before discharge. Ask the client to begin doing one part of the ostomy care and increase tasks daily.

The nurse is collecting data about how well a client with a gastrointestinal (GI) disorder is able to digest food. Which processes are involved in the complete digestive process? Select all that apply.

Chemical, Absorption, Mechanical, Active transport. Digestion is the mechanical and chemical process involving the breakdown of foods. Absorption is the transfer of digested food elements into the bloodstream. The blood then carries nutrients to the cells. Active transport is the process used to transfer nutrients into the cells

The nurse has a prescription to give 30 mL of an antacid to a client through a nasogastric (NG) tube that is connected to wall suction. The nurse should do which action to perform this procedure correctly?

Clamp the NG tube for 30 minutes following administration of the medication. If a client has an NG tube connected to suction, the nurse clamps the tube and waits 20 to 30 minutes before reconnecting the tube to the suction. This allows adequate time for medication absorption.

The nurse documents that a client with a hiatal hernia is implementing effective health maintenance measures after the client reports doing which action?

Eating low-fat or nonfat foods Is recommended to reduce gastric pressure and prevent sliding of the hernia through the cardiac sphincter. The client should also elevate the head of the bed during sleep, and wait at least 1 hour after meals to perform chores.

A client complains of stomach pain 30 minutes to 1 hour after eating. The pain is not relieved by further intake of food, although it is relieved by vomiting, and a gastric ulcer is suspected. The nurse should gather which additional supportive data from the client for this diagnosis?

History of alcohol use, smoking, and weight loss. Alcohol use, smoking, and weight loss are most commonly associated with gastric ulcers. The other options do not identify risk factors commonly associated with this disorder.

A client in the emergency department reports right lower quadrant abdominal pain. After noting a white blood cell count of 16,500 cells/mm3, the nurse should question which prescriptions? Select all that apply.

Milk of magnesia Heat pad to the abdomen. A client with right lower quadrant abdominal pain may have appendicitis. This client would be NPO and given intravenous (IV) fluids for hydration. Cold packs may provide comfort. Laxatives are not prescribed; heat might bring enough blood and fluid to the appendix to cause it to rupture and cause peritonitis, therefore, the nurse would question the cathartic prescription and heat application.

A client with viral hepatitis has no appetite, and food makes the client nauseated. Which nursing intervention should be appropriate?

Offer small, frequent meals. If nausea persists, the client will need to be assessed for fluid and electrolyte imbalances. It is important to explain to the client that the majority of calories should be eaten in the morning hours because nausea most often occurs in the afternoon and evening.

The nurse is participating in a health screening clinic and is preparing materials about colorectal cancer. The nurse plans to include which risk factor for colorectal cancer in the material?

Personal history of ulcerative colitis or gastrointestinal (GI) polyps Common risk factors for colorectal cancer include age over 40 years; first-degree relative with colorectal cancer; high-fat, low-fiber diet; and history of bowel problems such as ulcerative colitis or familial polyposis.

The nurse is performing an abdominal assessment on a client. The nurse interprets that which finding is abnormal and should be reported to the registered nurse (RN) or health care provider?

Pulsation between the umbilicus and pubis. The umbilicus should be in the midline with a concave appearance. The presence of pulsation between the umbilicus and the pubis could indicate an abdominal aortic aneurysm and should be reported

The nurse is performing colostomy irrigation on a client. During the irrigation, the client begins to complain of abdominal cramps. Which is the appropriate nursing action?

Stop the irrigation temporarily. f cramping occurs during colostomy irrigation, the irrigation flow is stopped temporarily and the client is allowed to rest. Cramping may occur from infusion that is too rapid or is causing too much pressure. Increasing the height of the irrigation will cause further discomfort.

The nurse observes that a client with a nasogastric tube connected to continuous gastric suction is mouth breathing, has dry mucous membranes, and has a foul breath odor. In planning care, which nursing intervention would be best to maintain the integrity of this client's oral mucosa?

Use diluted mouthwash and water to rinse the mouth after brushing teeth. After the nasogastric tube is in place, mouth care is extremely important. With one naris occluded, the client tends to mouth breathe, drying the mucous membranes. Frequent oral hygiene may be required to prevent or care for dry, irritated mucous membranes.

A client is seen in the ambulatory care office for a routine examination. Which statement by the client would be important for the nurse to follow up?

"I just lost a family member to gastrointestinal cancer." The nurse should recognize and follow up on the statement about familial cancer. The client may have some anxiety that this will ultimately occur to him, and the nurse should gather further data to understand the client's situation. Gathering data about the types of cancer, age, and sex of affected family members, and the presence of other risk factors provides the needed information to initiate preventive education.

The nurse is reviewing the medication record of a client with acute gastritis. Which medication noted on the client's record should the nurse question?

Ibuprofen (Motrin) Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) and can cause ulceration of the esophagus, stomach, duodenum, or small intestine. It is contraindicated in a client with a gastrointestinal disorder.

The nurse is working with a client diagnosed with anorexia nervosa. The nurse plans care, focusing on which as the primary problem?

Impaired nutritional status. A client with anorexia nervosa has a decreased appetite, which can be a result of any number of causes. The plan of care primarily focuses on the risk of impaired nutritional status.

A postgastrectomy client is at high risk for hyperglycemia related to uncontrolled gastric emptying of fluid and food into the small intestine (dumping syndrome). Because of this risk, the nurse plans to monitor which data?

Postprandial blood glucose readings ate symptoms of dumping syndrome following a gastrectomy occur 2 to 3 hours after eating and result from a rapid entry of increased carbohydrate food into the jejunum, a rise in blood glucose levels, and excessive insulin secretion. To monitor this, the nurse checks the blood glucose level 2 hours after meals.

The nurse is reinforcing home care instructions to a client following a gastric resection. The nurse should include which instruction?

Take actions to prevent dumping syndrome. Dumping syndrome can occur in clients after gastric surgery and may occur as an early or late complication. Upper rather than lower gastrointestinal hemorrhage may also occur.

The nurse is caring for a client with a nasogastric tube. Which observation is most reliable in determining that the tube is correctly placed?

The pH of the aspirate is 5. After the nurse inserts a nasogastric tube into a client, the correct location of the tube must be verified. The nurse follows the approved procedure for inserting a nasogastric tube, including correct measurement and aspirating fluid with the visible characteristics of gastric fluid.

The nurse is collecting data about how well a client with a gastrointestinal (GI) disorder is able to absorb food. While carrying out this function, the nurse recalls that absorption is defined as which?

The transfer of digested food molecules from the GI tract into the bloodstream Absorption is the transfer of digested food elements into the bloodstream. The blood then carries nutrients to the cells. Active transport is the process used to transfer nutrients into the cells.

The nurse is preparing to administer a soapsuds enema to a client. Into which position does the nurse place the client to administer the enema? Refer to figure.

To administer an enema, the nurse assists the client into the left side-lying (Sims') position with the right knee flexed. This position allows the enema solution to flow downward by gravity along the natural curve of the sigmoid colon and rectum, thus improving the retention of solution.

The nurse is caring for a client with pneumonia with a history of bleeding esophageal varices. Based on this information, the nurse plans care, knowing that which could result in a potential complication?

Vigorous coughing. Increased intrathoracic pressure contributes to rupturing of varices. Straining at stool, coughing, and vomiting all increase intrathoracic pressure. The nurse needs to implement measures that will prevent increased intrathoracic pressure.

The nurse is reinforcing discharge instructions to a client who has had a total gastrectomy. The nurse tells the client about the importance of returning to the health care clinic as scheduled for which priority assessment

Vitamin B12 and folic acid studies. This may result from a deficiency of an intrinsic factor and/or inadequate absorption because food enters the bowel too quickly.

A client has had a partial gastrectomy and the nurse is reinforcing discharge instructions. The nurse should tell the client about the need for which? Select all that apply.

Iron supplements. Calcium supplements Vitamin B12 injections The absorption of vitamin B12, folic acid, iron, calcium, and vitamin D may be impaired, so supplements will be needed. Insufficient intrinsic factor results in the inability to absorb vitamin B12, which must then be supplemented by the parenteral route.

A client has asymptomatic diverticular disease. Which type of diet should the nurse anticipate being prescribed?

A high-fiber diet is the diet of choice for asymptomatic diverticular disease to help prevent straining from constipation.

A client with a history of gastrointestinal upset has been diagnosed with acute diverticulitis. To aid the client in symptom management, the nurse suggests which diet?

A low-fiber diet A low-fiber diet places less strain on the intestines because this type of diet is easier to digest. This diet is used for acute diverticulitis, ulcerative colitis, and irritable bowel syndrome.

A client has been diagnosed with acute gastroenteritis. Which diet should the nurse anticipate to be prescribed for the client?

A low-fiber diet. Places less strain on the intestines because this type of diet is easier to digest. This diet is prescribed for clients with inflammatory bowel disease, ileostomy, colostomy, partial obstructions of the intestinal tract, acute gastroenteritis, or diarrhea.

A client with peptic ulcer disease is scheduled for a pyloroplasty, and the client asks the nurse about the procedure. The nurse bases the response on which information?

A pyloroplasty involves an incision and resuturing of the pylorus to relax the muscle and enlarge the opening from the stomach to the duodenum.

A health care provider asks the nurse to obtain a Salem Sump tube for gastric intubation. The nurse should correctly select which tube from the unit storage area?

A tube with a larger lumen and an air vent. A Salem Sump tube is used commonly for gastric intubation and has a larger suction lumen and an air vent

The nurse is reviewing the prescriptions of a client admitted to the hospital with a diagnosis of acute pancreatitis. Which interventions should the nurse expect to note? Select all that apply.

Administer antacids, as prescribed. Encourage coughing and deep breathing. Administer anticholinergics, as prescribed.

The nurse is getting a client who underwent umbilical hernia repair ready for discharge. The nurse tells the client that it is important to continue to do which action after discharge?

Avoid coughing. Coughing is avoided to prevent disruption of the sutured tissue, which could occur because of the location of this surgical procedure. Frequent deep breathing exercises are important, though.

A client receiving a high cleansing enema complains of pain and cramping. The nurse should take which corrective action?

Clamp the tubing for 30 seconds and restart the flow at a slower rate. enema fluid should be administered slowly. If the client complains of fullness or pain, the flow is stopped for approximately 30 seconds and restarted at a slower rate.

The nurse is caring for a client with acute pancreatitis and a history of alcoholism and is monitoring the client for complications. Which data should be indicative of paralytic ileus?

Inability to pass flatus. An inflammatory reaction, such as acute pancreatitis, can cause paralytic ileus, the most common form of nonmechanical obstruction. Inability to pass flatus is a sign/symptom of paralytic ileus

The nurse is reviewing the record of a client with Crohn's disease. Which stool characteristic should the nurse expect to see documented in the record?

Diarrhea. Crohn's disease is characterized by nonbloody diarrhea of usually not more than four or five stools daily. Over time, the diarrhea episodes increase in frequency, duration, and severity.

A client is resuming a diet after partial gastrectomy. To minimize complications, the nurse should tell the client to avoid which practice?

Drinking liquids with meals. The client who has had a hemigastrectomy is at risk for dumping syndrome. This client should be placed on a diet that is high in protein, moderate in fat, and high in calories. The client should avoid drinking liquids with meals. Frequent small meals are encouraged, and the client should avoid concentrated sweets.

The nurse is reinforcing dietary instructions for a client with peptic ulcer disease. Which action does the nurse encourage the client to do?

Eat anything as long as it does not aggravate or cause pain. The client may eat foods as long as they do not aggravate or cause pain.

The nurse who is reinforcing instructions to a client following gastric resection should include which suggestions? Select all that apply.

Eat small frequent meals. Take action to prevent dumping syndrome. Dumping syndrome occurs in many clients after GI surgery and may occur as an early or late complication. Upper GI hemorrhage also may occur. A diet high in vitamin B12 will not prevent pernicious anemia because the client lacks the intrinsic factor needed for absorption. Instead the client requires injection to supplement this vitamin. Iron supplements are necessary to help absorption of parenteral vitamin B12.

Before administering an intermittent tube feeding through a nasogastric tube, the nurse checks for gastric residual volume. Which is the best rationale for checking gastric residual volume before administering the tube feeding?

Evaluate absorption of the last feeding. All the stomach contents are aspirated and measured before administering a tube feeding. The gastric residual volume is checked to confirm whether undigested formula from a previous feeding remains and thereby evaluates the absorption of the last feeding. It is important to check the gastric residual before administration of a tube feeding.

A licensed practical nurse (LPN) is assisting in the insertion of a nasogastric (NG) tube for an adult client. The LPN helps determine the correct length to insert the tube by performing which measurement?

From the tip of the client's nose to the earlobe and then down to the xiphoid process. The correct method for measuring the length of tube is to place the tube at the tip of the client's nose and measure by extending the tube to the earlobe and then down to the xiphoid process. The average length for an adult is about 22 to 26 inches.

A client with a possible hiatal hernia complains of difficulty swallowing. Which other sign/symptom is associated with a hiatal hernia?

Heartburn and regurgitation. Although many clients with a hiatal hernia are asymptomatic, those with symptoms usually have difficulty swallowing along with heartburn and reflux.

The health care provider arrives on the nursing unit and deflates the esophageal balloon. Following deflation of the balloon, the nurse should monitor the client closely for which?

Hematemesis. The esophageal balloon exerts pressure on the ruptured esophageal varices and stops the bleeding. The pressure of the esophageal balloon is released at intervals to decrease the risk of trauma to esophageal tissues, including esophageal rupture or necrosis. When the balloon is deflated, the client may begin to bleed again from the esophageal varices, noted by vomiting of blood (hematemesis).

Which infection control method should be the priority to include in the plan of care to prevent hepatitis B in a client considered to be at high risk for exposure?

Hepatitis B vaccine. Immunization is the most effective method of preventing hepatitis B infection. Other general measures include hand washing.

The nurse is caring for a client in the emergency department who has right lower quadrant abdominal pain. After noting a white blood cell count of 16,500 cells/mm3, the nurse should question which prescription?

Milk of magnesia. A client with right lower quadrant pain may have appendicitis. This client should be NPO and given IV fluids for hydration. Cold packs may provide comfort. Laxatives are not prescribed; therefore, the nurse should question this prescription.

A client arrives at the emergency department complaining of severe abdominal pain and is placed on NPO status. During a quick assessment the nurse observes that the client has both Cullen's sign and Grey Turner's sign and pancreatitis is suspected. The nurse should perform the following actions/prescriptions in which priority order?

Obtain vital signs and draw blood for laboratory analysis. Ensure the client receives intravenous pain medication. Hydrate the client with intravenous fluids. Place a nasogastric tube. Client is NPO (nothing by mouth). Inquire about when pain occurs and previous history including medications and alcohol.

A postgastrectomy client who is being discharged from the hospital tells the nurse, "I hope my stomach problems are over. I need to get back to work right away. I've missed a lot of work, and I'm really behind. If I don't get my act together, I may lose my job." Based on the client's statement, the nurse determines that at this time, it is appropriate to discuss which topic?

Reducing stressors in life. Some clients need help reducing stressors in their lives. This may be extremely important for recovery. Clients may expect a rapid recovery and are disappointed when this does not occur. The client's statement provides an opportunity for the nurse to discuss stress and its relationship to gastrointestinal disorders.

The nurse assigned to care for a client with cirrhosis reviews the medical record and notes that the client has difficulty maintaining an effective breathing pattern due to pressure on the diaphragm. The nurse plans care knowing that which client position will best assist in facilitating breathing?

Semi-Fowler's The client experiencing difficulty maintaining an effective breathing pattern due to pressure on the diaphragm should be placed in a semi-Fowler's or Fowler's position. The nurse should support the client's arms and chest with pillows to facilitate breathing by relieving pressure on the diaphragm.

The nurse is reviewing the health care record of a client with a diagnosis of chronic pancreatitis. Which data noted in the record indicate poor absorption of dietary fats?

Steatorrhea. The pancreas makes digestive enzymes that aid absorption. Chronic pancreatitis interferes with the absorption of nutrients. Fat absorption is limited because of the lack of pancreatic lipase. Steatorrhea by definition is excess fat in stools often caused by malabsorption problems.

A licensed practical nurse (LPN) is helping a registered nurse (RN) conduct an abdominal assessment. The LPN assists the client into which position?

Supine with the head raised slightly and the knees slightly flexed. To perform an abdominal assessment, the client is placed in the supine position with the head raised slightly and the knees slightly flexed. This position will relax the abdominal muscles.

A client presents to the urgent care center with complaints of abdominal pain. Suddenly the client vomits bright red blood. The nurse takes which immediate action?

Takes the client's vital signs. The nurse should take the client's vital signs first to determine if the client is hypovolemic or in shock from blood loss; this also provides a baseline blood pressure and pulse by which to gauge the effectiveness of treatment. Signs and symptoms of shock include low blood pressure; rapid, weak pulse; increased thirst; cold, clammy skin; and restlessness.

The nurse is assigned to care for a client who had a Sengstaken-Blakemore tube inserted when more conservative treatment failed to alleviate the condition. The nurse should suspect that the client has which diagnosis?

Esophageal varices A Sengstaken-Blakemore tube is inserted in a client with a diagnosis of cirrhosis with ruptured esophageal varices when other measures used to treat the varices are unsuccessful or contraindicated for the client

The nurse is assisting in planning stress management strategies for the client with irritable bowel syndrome. Which suggestion should the nurse give to the client?

Learn measures such as biofeedback or progressive relaxation. The client should also learn to limit responsibilities. Other measures include increased fluid and fiber in the diet as prescribed and antispasmodic or sedative medications as needed.

A postoperative client has regained bowel sounds and is ready to start a clear liquid diet. The nurse is told that the health care provider has written a prescription to remove the nasogastric (NG) tube. The nurse assists in the procedure and asks the client to do which during tube removal?

Take a breath and hold it until the tube is out. When the nurse removes an NG tube, the client is instructed to take a breath and hold it until the tube is out. This will close the epiglottis and prevent aspiration of any secretions. The nurse removes the tube with one very smooth continuous pull.

A client had a Miller-Abbott tube inserted 24 hours ago. The nurse is asked to check the client to determine whether the tube is in the appropriate location at this time. Which finding would indicate adequate location of the tube?

The aspirate from the tube has a pH of 7.45. The Miller-Abbott tube is a nasoenteric tube that is used to decompress the intestine (to correct a bowel obstruction). The end of the tube should be located in the intestine. The pH of the gastric fluid is acidic, and the pH of the intestinal fluid is 7 or higher if the tube is adequately located. Location of the tube can also be determined by x-ray.

The nurse should include which information when reinforcing home care instructions for a client who has peptic ulcer disease?

Learn to use stress reduction techniques. Identifying and reducing stress is essential to a comprehensive ulcer management plan.

A client diagnosed with pernicious anemia asks the nurse what caused the deficiency. The nurse replies that it is likely a result of which condition that is part of the client's health history?

Hemigastrectomy. The client who has had surgical resection of the stomach or small intestine may develop pernicious anemia as a complication. This results from decreased production of intrinsic factor (gastrectomy) or decreased surface area for vitamin B12 absorption (intestinal resection). The client then requires vitamin B12 injections for life.

A client complains of stomach pain 30 minutes to 1 hour after eating. The pain is not relieved by further intake of food, although it is relieved by vomiting. A gastric ulcer is suspected. Which data would further support this diagnosis?

History of chronic obstructive pulmonary disease with weight loss. History of chronic obstructive pulmonary disease is commonly associated with gastric ulcers, because this disease increases gastric acid secretion. Weight loss is also associated with gastric ulcer disease.

A client is admitted to the hospital with viral hepatitis and is complaining of a loss of appetite. In order to provide adequate nutrition, which action does the nurse encourage the client to take?

Increase intake of fluids. it is generally recommended that clients have a diet with low-fat content because fat may be poorly tolerated due to decreased bile production. Small, frequent meals are preferable and may even prevent nausea. Often times, the appetite is better in the morning, so it is easier to eat a healthy breakfast.

The nurse is reinforcing instructions to a client and his family about alcohol abuse and chronic cirrhosis. The nurse knows to include which essential elements in the discharge teaching guide? Select all that apply.

Avoid potentially hepatotoxic over-the-counter drugs. Teach symptoms of complications and when to seek prompt medical attention. Explain that cirrhosis of the liver is a chronic illness and the importance of continuous health care. Avoid spicy and rough foods and activities that increase portal pressure such as straining at stool, coughing, sneezing and vomiting.

The nurse is reinforcing discharge instructions to a client who has had a total gastrectomy. The nurse tells the client about the importance of returning to the health care clinic as scheduled for which priority assessment

Vitamin B12 and folic acid studies.

The nurse is caring for a client within the first 24 hours following a total gastrectomy for gastric cancer. During this time frame, on which intervention should the nurse focus?

Maintaining a patent nasogastric (NG) tube. An NG tube is inserted during surgery and is left in place for 24 to 48 hours to decompress the gastrointestinal tract, which enhances sealing of the suture line. It is essential that the NG tube does not become occluded because this could disrupt the suture lines if distention occurs.

A client with acute pancreatitis is experiencing severe pain from the disorder. The nurse tells the client to avoid which position that could aggravate the pain?

Lying flat. Positions such as sitting up, leaning forward, and flexing the legs (especially the left leg) may alleviate some of the pain associated with pancreatitis. This is because the pancreas is located retroperitoneally, and the edema and inflammation intensify the irritation of theposterior peritoneal wall with these positions.

A calcium supplement is prescribed for a client with hypoparathyroidism in the management of hypocalcemia. The client arrives at the clinic for a follow-up visit and complains of chronic constipation, and the nurse reinforces instructions to the client about measures to alleviate the constipation. Which comment by the client would indicate a need for further teaching?

"I need to add 0.5 ounce of mineral oil to my daily diet." Clients taking antihypocalcemic medications should be instructed to avoid the use of mineral oil as a laxative because it decreases vitamin D absorption, and vitamin D is needed to assist in the absorption of calcium.