GI

A client is scheduled for an abdominal surgery. What is the priority preoperative nursing objective when caring for this client?

Alleviating the client's anxiety

The nurse has taught a client about a low-sodium diet. Which food choice by the client indicates successful learning?

Banana

A client who had a laparoscopic cholecystectomy reports pain in the shoulder. In what position should the nurse place the client?

Left Sims

Which statement by an older adult most strongly supports the nurse's conclusion that the client is impacted with stool?

"I feel like I have to go, but I just seep." rationale: A client with a fecal impaction has the urge to defecate but is unable to do so, and liquid stool seeps around the impaction. Flatulence may occur as a result of immobility, not just obstruction. Anorexia may occur with an impaction but also may be caused by other conditions. The frequency of bowel movements varies for individuals; it may be normal for this individual not to have a bowel movement for several days.

A client had surgery for a strangulated hernia. One hour after surgery the client's blood pressure drops from 134/80 to 114/76 mm Hg. Assessment reveals that the client does not have postoperative bleeding. What action should the nurse take?

Instruct the client to move both legs. rationale: The lowered blood pressure may be caused by pooling of blood in peripheral vessels; moving the legs will aid venous return. Turning the client onto the left side will not increase the blood pressure; this intervention is used for pregnant women to move the gravid uterus off the vena cava, which increases placental perfusion.

A nurse is assisting a healthcare provider to perform a sigmoidoscopy. In which position should the nurse place the client for this procedure?

Knee-chest Knee-chest position maximally exposes the rectal area and facilitates entry of the sigmoidoscope. The Sims position does not expose the rectal area to the same extent as does the knee-chest position; it can be used for a sigmoidoscopy if a client is unable to maintain the knee-chest position.

A nurse is teaching a client about a diet that permits 200 g of carbohydrates, 90 g of fat, and 110 g of protein. How many calories per day should the client eat? Record your answer using a whole number. ____ calories per day

2050 Each gram of fat contains 9 calories, and each gram of carbohydrate and protein contains 4 calories. 800 + 810 + 440 = 2050

A nurse is taking care of a client with cirrhosis of the liver. Which clinical manifestations should the nurse assess in the client? Select all that apply.

ascites puritus jaundice rationale: Ascites is a result of portal hypertension that occurs with cirrhosis. Pruritus is common because bile pigments seep into the skin from the bloodstream. Jaundice occurs because the bile duct becomes obstructed and bile enters the bloodstream. The appetite decreases because of the pressure on the abdominal organs from the ascites and the liver's decreased ability to metabolize food.

After taking spironolactone, the client inquires about foods and fluids that contain potassium. Which juice should the nurse recommend?

cranberry juice rationale: Spironolactone is a potassium-sparing diuretic, and foods high in potassium should be avoided. Cranberry juice should be recommended because it contains the least amount of potassium. Prune, orange, and tomato juice are all high in potassium.

A client with Crohn disease is admitted to the hospital with a history of chronic, bloody diarrhea, weight loss, and signs of general malnutrition. The client has anemia, a low serum albumin level, and signs of negative nitrogen balance. The nurse concludes that the client's health status is related to what major deficiency?

protein

A client has a low hemoglobin level that is attributed to a nutritional deficiency. Which foods should the nurse teach the client to increase in the diet? Select all that apply.

liver spinach Liver and spinach are high in iron. The client needs iron for red blood cell production and hemoglobin; a low hemoglobin indicates the client is anemic. Apples are high in fiber. Carrots are high in Vitamin A. Cheese is high in calcium. Apples, carrots, and cheese are low in iron.

A client who is having presurgical testing before a colon resection and possible colostomy says to the nurse, "If I have to have this surgery, I know my partner will never come near me." What would be the nurse's best initial response?

"You seem worried that the surgery will change how your partner sees you."

A client is admitted with a diagnosis of a gastric peptic ulcer. Place an X over the area that the client would indicate is the site of pain associated with this disorder.

Pain associated with a gastric peptic ulcer usually is located slightly left of the midline of the abdomen between the umbilicus and the xiphoid process. It often is described as sharp, burning, or gnawing in nature. Pain associated with a duodenal peptic ulcer usually is located slightly right of the midline of the abdomen between the umbilicus and the xiphoid process.

After an acute episode of upper gastrointestinal (GI) bleeding, a client vomits undigested antacids and reports having severe epigastric pain. The nursing assessment reveals an absence of bowel sounds, a pulse rate of 134, and shallow respirations of 32 per minute. In addition to calling the healthcare provider, what is the priority nursing action?

Prepare the client for surgery.

A client has a surgical creation of a colostomy for cancer of the rectum. The client asks, "What's the difference between irrigating a colostomy and having an enema?" Which information should the nurse share with the client?

Colostomy irrigation instillation uses a cone-shaped tip catheter.

A nurse teaches a client with calcium-based renal calculi about foods that can be eaten on a low-calcium diet. The nurse concludes that the teaching is effective when the client selects which food items from the menu? Select all that apply.

Baked chicken Roast beef with mashed potato rationale Baked chicken is relatively low in calcium. Roast beef and mashed potato have moderate amounts of calcium. Pudding is made with milk and is high in calcium. Cheese is high in calcium. Ice cream is made with milk and is high in calcium.

A client is admitted to the hospital for a needle biopsy of the liver. A diagnosis of cancer of the liver is suspected. What should the nurse include in the client's preoperative teaching plan?

Bed rest must be maintained after the procedure rationale: Bed rest in the right side-lying position for two hours after the procedure applies pressure to the insertion site and reduces the risk of bleeding. A needle biopsy requires a stab wound over the liver, not an abdominal incision. A liver biopsy is done with local anesthesia. The supine position is contraindicated. The client should be positioned in the right side-lying position for two hours after the procedure because this applies pressure to the insertion site and reduces the risk of bleeding.

An obese client has had an abdominal cholecystectomy. How does the nurse plan to alleviate tension on the surgical wound after surgery?

Maintaining nasogastric tube patency rationale: Maintaining nasogastric tube patency ensures gastric decompression, thus preventing abdominal distention, which places tension on the incision. Deep breathing should be encouraged to prevent respiratory complications. Maintaining T-tube patency only ensures a portal of exit for bile drainage; the tube is not irrigated, and an obstruction will lead to jaundice rather than tension on the surgical wound. The right side-lying position after a cholecystectomy can increase, not decrease, tension in the operative area.

A client is scheduled for a sigmoidoscopy. What instruction should the nurse provide the client in preparation for this diagnostic procedure?

Have an enema the morning of the test. rationale: To permit adequate visualization of the mucosa during the sigmoidoscopy, the bowel must be cleansed with a nonirritating enema before examination. The client does not drink a chalklike substance in preparation for a sigmoidoscopy. Because only the lower bowel is being visualized, withholding food is unnecessary; a laxative may be given the day before to limit fecal residue. Collecting a stool specimen is not part of the procedure for a sigmoidoscopy.

A client is diagnosed with celiac disease. Which foods should the nurse teach the client to avoid? Select all that apply.

Oatmeal Rye bread Gluten is found in rye, oats, wheat, and barley, which should be avoided because gluten in these grains is irritating to the gastrointestinal mucosa in clients with celiac disease. Gluten is found in oatmeal and rye bread and should be avoided. Gluten is not found in corn. Gluten is not found in milk and dairy products. Gluten is not found in fruit.

A client has circumgastric banding, a bariatric surgical procedure. The nurse provides discharge teaching about signs and symptoms of dumping syndrome and includes what physiologic response?

Palpitations rationale: Dumping syndrome is caused by a rapid emptying of gastric contents into the small intestine, resulting in a constellation of vasomotor responses, including tachycardia, vertigo, syncope, diaphoresis, and pallor. Fever is a sign of infection, not dumping syndrome. Vomiting is not a sign of dumping syndrome; excessive food intake may result in nausea and vomiting. Diarrhea and abdominal cramping occur, not constipation.

A client had a laparoscopic cholecystectomy. Postoperatively the client experiences nausea and vomiting and is admitted overnight for observation and hydration. What should the nurse include in the teaching plan when preparing this client for discharge? Select all that apply.

- Call the healthcare provider if you have a fever of 100o F (37.8oC) or more for two days. - Check the puncture sites daily for redness, tenderness, swelling, heat, or drainage. rationale: A fever of 100o F (37.8o C) or more for two days is the sign of an infection that should be reported to the healthcare provider. Redness, tenderness, swelling, heat, and drainage are physical responses associated with an infection or a problem with healing. The puncture sites should be washed gently with mild soap and warm water. Tape-strips should be allowed to fall off; they should not be pulled off because they reinforce closure of the incision. A heating pad 20 minutes hourly is recommended to relieve discomfort in the right, not left, shoulder as a result of phrenic nerve irritation because of retention of carbon dioxide gas insufflated into the abdomen during surgery.

A client with a history of Crohn disease develops an intestinal obstruction. A nasogastric tube is inserted and connected to low continuous suction. The nurse monitors the client for fluid volume deficit. What clinical finding does the nurse expect if the client becomes dehydrated?

Inelastic skin turgor

Following a major abdominal surgery, a client has a nasogastric tube attached to continuous low suction. The nurse caring for the client postoperatively monitors the client for what signs of hypokalemia? Select all that apply.

Short-term irritability Dysrhythmias Muscle weakness rationale: Dysrhythmias are a sign of potassium depletion in cardiac muscles. Other cardiovascular effects include irregular, rapid, weak pulse; decreased blood pressure; flattened and inverted T waves; prominent U waves; depressed ST segments; peaked P waves; and prolonged QT intervals. Muscle weakness is a symptom of potassium depletion in skeletal muscles; potassium facilitates the conduction of nerve impulses and muscle activity. Neurologic changes from hypokalemia include altered mental status; the patient may have short-term irritability and anxiety followed by lethargy that progresses to acute confusion and coma as hypokalemia worsens.

A client is diagnosed with hepatitis A. The nurse takes the client's history. Which employment history is most likely linked to the development of hepatitis A?

Works at a plumbing business rationale: Hepatitis A primarily is spread via a fecal-oral route; sewage-polluted water may harbor the virus. Working at a hemodialysis unit is closely linked to hepatitis types B, C, and D; these types are more often spread via the blood-borne route. Using disposable equipment and proper handling of syringes decreases the risk of spreading the virus. Working as a dishwasher at a local restaurant does not increase the risk of developing the disease, but it will increase the risk of an infected individual spreading the disease to others.

What information from a client's history should the nurse identify as risk factors for the development of colon cancer? Select all that apply.

increased age ulcerative colitis rationale: A slower fecal transit time, which occurs with aging, may increase the risk for colon cancer. Chronic irritation of the intestinal mucosa, such as occurs in ulcerative colitis, increases the risk for colon cancer.

A nurse is admitting a client with the diagnosis of celiac disease to the medical unit at lunchtime. Which foods can be included on the client's prescribed diet?

Cheese omelet with chopped spinach rationale: Cheese omelet (dairy) and spinach do not contain gluten, and they are permitted in a diet for a client with celiac disease.

A client with Laënnec cirrhosis has a Sengstaken-Blakemore tube in place. The client becomes increasingly confused and tries to climb out of bed. The client's breath becomes fetid. What is the nursing priority?

Implement fall precautions/prevention measures

A client returns from surgery after an abdominal cholecystectomy for a gangrenous gallbladder. For which postoperative complication, associated with the location of the surgical site, should the nurse assess the client?

Atelectasis rationale: Subcostal incisional pain causes the client to splint and avoid deep breathing, which impedes air exchange in the alveoli. The location of the incision does not increase the risk of hemorrhage. Paralytic ileus can be a postoperative problem, but it is unrelated to the site of the incision. The subcostal incision site is not specifically vulnerable to infection.