GI - ATI

A community health nurse is planning an educational program about hepatitis A. When preparing the materials, the nurse should identify that which of the following groups is most at risk for developing hepatitis A? a. Children b. Older adults c. Women who are pregnant d. Middle-aged men

a. Children The nurse should apply the safety and risk reduction priority-setting framework. This framework assigns priority to the factor or situation posing the greatest safety risk to the client. When there are several risks to client safety, the one posing the greatest threat is the highest priority. The nurse should use Maslow's Hierarchy of Needs, the ABC priority-setting framework, or nursing knowledge to identify which risk poses the greatest threat to the client. The hepatitis A virus can be contracted from the feces, bile, and blood of infected clients. The usual mode of transmission is the fecal-oral route. Children and young adults are the two groups most often affected by the hepatitis A virus. Typically, a child or young adult acquires the infection at school, through poor hygiene, hand-to-mouth contact, or another form of close contact. b. Older adults are not often affected by or at risk for developing hepatitis A. c. Women who are pregnant are not often affected by or at risk for developing hepatitis A. d. Middle-aged men are not often affected by or at risk for developing hepatitis A.

A nurse is caring for a client who has a history of cirrhosis and is admitted with manifestations of hepatic encephalopathy. The nurse should anticipate a prescription for which of the following laboratory tests to determine the possibility of recent excessive alcohol use? a. Gamma-glutamyl transferase (GGT) b. Alkaline phosphatase (ALP) c. Serum bilirubin d. Alanine aminotransferase (ALT)

a. Gamma-glutamyl transferase (GGT) The GGT laboratory test is specific to the hepatobiliary system in which levels can be raised by alcohol and hepatotoxic drugs. Therefore, it is useful for monitoring drug toxicity and excessive alcohol use. b. ALP is elevated in biliary obstruction and most forms of liver dysfunction. It does not differentiate between alcohol and other causative factors for liver disease. c. The serum bilirubin test is used to detect the function of the liver and its ability to excrete bilirubin. Elevated levels can determine liver disease or biliary tract disease. d. The largest concentration of the enzyme ALT is found in liver tissue. However, it is also present in kidney, heart, and skeletal muscle tissues. Because it is elevated in various types of tissue damage, it is not helpful in identifying excessive alcohol use.

A nurse is caring for a client who is scheduled to undergo a liver biopsy for a suspected malignancy. Which of the following laboratory findings should the nurse monitor prior to the procedure? a. Prothrombin time b. Serum lipase c. Bilirubin d. Calcium

a. Prothrombin time A major complication following a liver biopsy is hemorrhage. Many clients who have liver disease have clotting defects and are at risk for bleeding. Along with the prothrombin time (PT), the activated partial thromboplastin time (aPTT) and the platelet count should be monitored. Liver dysfunction causes the production of blood clotting factors to be reduced, which leads to an increased incidence of bruising, nosebleeds, bleeding from wounds, and gastrointestinal bleeding. This is due to a deficient absorption of vitamin K from the gastrointestinal tract caused by the inability of liver cells to use vitamin K to make prothrombin. b. Serum lipase is monitored to detect pancreatic disease and does not need to be monitored prior to this procedure. c. Bilirubin is monitored to detect biliary obstruction and does not need to be monitored prior to this procedure. d. Calcium is monitored to detect kidney failure or pancreatitis and does not need to be monitored prior to this procedure.

A nurse is caring for a client who is 4 hr postoperative following a laparoscopic cholecystectomy. Which of the following findings should the nurse expect? a. Right shoulder pain b. Urine output 20 mL/hr c. Temperature 38.4° C (101.1° F) d. Oxygen saturation 92%

a. Right shoulder pain The client can experience pain in the right upper shoulder due to gas (carbon dioxide) injected into the abdominal cavity during the laparoscopic procedure, which can irritate the diaphragm and cause referred pain in the shoulder area. The pain disappears in 1 to 2 days. Mild analgesics and a recumbent position can help with client comfort. b. Urine output following surgery should be at least 30 mL/hr. Less than this amount can indicate hypovolemia or renal complications and should be reported to the provider immediately. c. A temperature greater than 38.4° C (101.1 F) can indicate infection and should be reported to the provider immediately. d. An oxygen saturation of less than 95% can indicate an impaired gas exchange following surgery and should be reported to the provider immediately.

A nurse is caring for a client who has celiac disease. Which of the following foods should the nurse remove from the client's meal tray? a. Wheat toast b. Tapioca pudding c. Hard-boiled egg d. Mashed potatoes

a. Wheat toast Celiac disease is an autoimmune disorder characterized by a permanent intolerance to wheat, barley, and rye. Wheat toast contains gluten and should be removed from the client's tray. b. Tapioca pudding is rich in dairy and does not contain gluten. Therefore, it is an acceptable food to include in the client's diet. c. A hard-boiled egg does not contain gluten and is a good source of protein. Therefore, it is an acceptable food to include in the client's diet. d. Mashed potatoes do not contain gluten are a good source of protein and potassium. Therefore, mashed potatoes are an acceptable food to include in the client's diet.

A nurse is preparing a community education program about hepatitis B. Which of the following statements should the nurse include in the teaching? a. "A hepatitis B immunization is recommended for those who travel, especially military personnel." b. "A hepatitis B immunization is given to infants and children." c. "Hepatitis B is acquired by eating foods that are contaminated during handling." d. "Hepatitis B can be prevented by using good personal hygiene habits and proper sanitation."

b. "A hepatitis B immunization is given to infants and children." Hepatitis B immune globulin is given as part of the standard childhood immunizations. It can be administered as early as birth, especially in infants born to hepatitis B surface antigen (HBsAg) negative mothers. These infants should receive the second dose between 1 and 4 months of age. a. The hepatitis A vaccine is recommended for those who travel, especially military personnel. It is also recommended for other at-risk groups. c. Hepatitis A is acquired by eating fruits, vegetables, shellfish, or other foods that are contaminated during handling. Hepatitis B is acquired by exposure to blood or body fluids from an infected person. d. Good personal hygiene habits and proper sanitation can help prevent the spread of hepatitis A.

A nurse is teaching a client who has Barrett's esophagus and is scheduled to undergo an esophagogastroduodenoscopy (EGD). Which of the following statements should the nurse include in the teaching? a. "This procedure is performed to measure the presence of acid in your esophagus." b. "This procedure can determine how well the lower part of your esophagus works." c. "This procedure is performed while you are under general anesthesia." d. "This procedure can determine if you have colon cancer."

b. "This procedure can determine how well the lower part of your esophagus works." An EGD is useful in determining the function of the esophageal lining and the extent of inflammation, potential scarring, and strictures. a. A pH probe study, which involves the insertion of a specially designed probe into the distal esophagus, is performed to monitor for the presence of acid in the normally alkaline esophagus. c. An EGD is performed while the client receives moderate sedation. d. A colonoscopy is performed to detect colon cancer.

A nurse is assessing a client who is in the early stages of hepatitis A. Which of the following manifestations should the nurse expect? a. Jaundice b. Anorexia c. Dark urine d. Pale feces

b. Anorexia Anorexia is an early manifestation of hepatitis A and is often severe. It is thought to result from the release of a toxin by the damaged liver or by the failure of the damaged liver cells to detoxify an abnormal product. a. Jaundice is a late manifestation of hepatitis A. c. Dark urine is a late manifestation of hepatitis A. d. Pale feces is a late manifestation of hepatitis A.

A nurse is completing a history and physical assessment for a client who has chronic pancreatitis. Which of the following findings should the nurse identify as a likely cause of the client's condition? a. High-calorie diet b. Prior gastrointestinal illnesses c. Tobacco use d. Alcohol use

d. Alcohol use Alcohol consumption is one of the major causes of chronic pancreatitis in the U.S. Long-term alcohol use disorder produces hypersecretion of protein in pancreatic secretions. The result is protein plugs and calculi within the pancreatic ducts. Alcohol also has a direct toxic effect on the cells of the pancreas. Damage to these cells is more likely to occur and to be more severe in clients whose diets are poor in protein content and either very high or very low in fat. a. A high-calorie diet can contribute to heart disease and obesity, but it does not cause chronic pancreatitis. b. A prior gastrointestinal illness does not cause or contribute to chronic pancreatitis c. Tobacco use can contribute to heart disease and increases the risk of cancer development, but it does not cause chronic pancreatitis.

A nurse is caring for a client who has a percutaneous endoscopic gastrostomy (PEG) tube and is receiving intermittent feedings. Prior to initiating the feeding, which of the following actions should the nurse take first? a. Flush the tube with water. b. Place the client in semi-Fowler's position. c. Cleanse the skin around the tube site. d. Aspirate the tube for residual contents.

b. Place the client in semi-Fowler's position. The nurse should apply the ABC priority-setting framework. This framework emphasizes the basic core of human functioning: having an open airway, being able to breathe in adequate amounts of oxygen, and circulating oxygen to the body's organs via the blood. An alteration in any of these can indicate a threat to life and is therefore the nurse's priority concern. When applying the ABC priority-setting framework, airway is always the highest priority because the airway must be clear and open for oxygen exchange to occur. Breathing is the second priority in the ABC priority-setting framework because adequate ventilatory effort is essential for oxygen exchange to occur. Circulation is the third priority in the ABC priority-setting framework because delivery of oxygen to critical organs only occurs if the heart and blood vessels are capable of efficiently carrying oxygen to them. A client who is receiving PEG tube feedings should be positioned with the head of the bed elevated at least 30° during and after feedings to decrease the risk of aspiration. Therefore, this is the priority action by the nurse. a. A client receiving PEG tube feedings should have the tube thoroughly flushed. However, there is another action the nurse should take first. c. A client who has a PEG tube requires frequent observation and good skin hygiene at the insertion site to prevent breakdown and irritation. However, there is another action the nurse should take first. d. Prior to each feeding, the PEG tube should be aspirated for residual gastric contents from the previous feeding. However, there is another action the nurse should take first.

A nurse is caring for a client who is scheduled to undergo an esophagogastroduodenoscopy (EGD). The nurse should identify that this procedure is used to do which of the following? a. To visualize polyps in the colon b. To detect an ulceration in the stomach c. To identify an obstruction in the biliary tract d. To determine the presence of free air in the abdomen

b. To detect an ulceration in the stomach An EGD is used to visualize the esophagus, stomach, and duodenum with a lighted tube to detect a tumor, ulceration, or obstruction. a. A sigmoidoscopy or barium enema is used to visualize the lower gastrointestinal tract, where polyps are found. c. Identifying an obstruction in the biliary tract is performed during endoscopic retrograde cholangiopancreatography (ERCP). d. The measurement of free air, which is a gas, is obtained using fluoroscopy or an x-ray, not an EGD.

A nurse is caring for a client who has acute pancreatitis. Which of the following serum laboratory values should the nurse anticipate returning to the expected reference range within 72 hr after treatment begins? a. Aldolase b. Lipase c. Amylase d. Lactic dehydrogenase

c. Amylase Pancreatitis is the most common diagnosis for marked elevations in serum amylase. Serum amylase begins to increase about 3 to 6 hr following the onset of acute pancreatitis. The amylase level peaks in 20 to 30 hr and returns to the expected reference range within 2 to 3 days. a. Elevated aldolase levels are caused by inflammation of the muscles, also known as myositis. The levels of aldolase are not affected by pancreatic disorders. b. Lipase levels in clients who have pancreatitis increase after a rise in serum amylase and stay elevated for up to 14 days longer than amylase. d. Lactic dehydrogenase (LDH) increases are typically seen in clients who have anemia, leukemia, or liver damage.

A nurse is providing dietary teaching to a client who has diverticulitis about preventing acute attacks. Which of the following foods should the nurse recommend? a. Foods high in vitamin C b. Foods low in fat c. Foods high in fiber d. Foods low in calories

c. Foods high in fiber The result of long-term, low-fiber eating habits along with increased intracolonic pressure lead to straining during bowel movements, causing the development of diverticula. High-fiber foods help strengthen and maintain active motility of the gastrointestinal tract. a. Vitamin C functions as an antioxidant as well as a coenzyme. It can be associated with prevention of cancer of the stomach, esophagus, and colon. However, it does not improve or prevent acute diverticulitis attacks. b. Low-fat foods do not improve or prevent acute diverticulitis attacks. d. Low-calorie foods do not improve or prevent acute diverticulitis attacks.

A nurse is caring for a client who has fulminant hepatic failure. Which of the following procedures should the nurse anticipate for this client? a. Endoscopic sclerotherapy b. Liver lobectomy c. Liver transplant d. Transjugular intrahepatic portal-systemic shunt placement

c. Liver transplant Fulminant hepatic failure, most often caused by viral hepatitis, is characterized by the development of hepatic encephalopathy within weeks of the onset of disease in a client without prior evidence of hepatic dysfunction. Mortality remains high, even with treatment modalities such as blood or plasma exchanges, charcoal hemoperfusion, and corticosteroids. Consequently, liver transplantation has become the treatment of choice for these clients. a. Endoscopic sclerotherapy is the injection of a sclerotherapy agent during endoscopy to target esophageal varices that are actively bleeding. This promotes thrombosis, which eventually leads to sclerosis. b. A liver lobectomy is used for a client who has localized cancer of a lobe of the liver. This is not appropriate for a client experiencing rapidly progressive liver failure. d. A transjugular intrahepatic portal-systemic shunt is placed to treat esophageal varices through placement of a stent into the portal vein. The stent serves as a shunt between the portal circulation and the hepatic vein, thereby reducing portal hypertension. It is not used for fulminant hepatic failure.

A nurse is assessing a client who was admitted with a bowel obstruction. The client reports severe abdominal pain. Which of the following findings should indicate to the nurse that a possible bowel perforation has occurred? a. Elevated blood pressure b. Bowel sounds increased in frequency and pitch c. Rigid abdomen d. Emesis of undigested food

c. Rigid abdomen Abdominal tenderness and rigidity occur with a bowel perforation. As fluid escapes into the peritoneal cavity, there is a reduction in circulating blood volume and a lowered blood pressure, or hypotension, results. a. A client who has experienced a bowel perforation will not display an elevated blood pressure. However, hypotension or shock can be present. b. Intestinal peristalsis increases in frequency and intensity as the bowel attempts to move intestinal contents past the obstructed area. Bowel sounds are silent with a bowel perforation d. Vomiting is frequent and copious with a small bowel obstruction. This does not indicate a bowel perforation.

A nurse in the emergency department is caring for a client who has bleeding esophageal varices. The nurse should anticipate a prescription for which of the following medications? a. Famotidine b. Esomeprazole c. Vasopressin d. Omeprazole

c. Vasopressin Vasopressin constricts the splanchnic bed and decreases portal pressure. Vasopressin also constricts the distal esophageal and proximal gastric veins, which reduces inflow into the portal system and is used to treat bleeding varices. a. Famotidine is an H2 receptor antagonist used to treat stress ulcers. b. Esomeprazole is a proton pump inhibitor used to treat gastrointestinal reflux disease. d. Omeprazole is a proton pump inhibitor used to treat duodenal and gastric ulcers.

A nurse is assessing a client who is experiencing perforation of a peptic ulcer. Which of the following manifestations should the nurse expect? a. Increased blood pressure b. Decreased heart rate c. Yellowing of the skin d. Boardlike abdomen

d. Boardlike abdomen The nurse should expect the client who is experiencing perforation of a peptic ulcer to exhibit manifestations of a boardlike abdomen and severe pain in the abdomen or back that radiates to the right shoulder. Vomiting of blood and shock can occur if the perforation causes hemorrhaging. a. The nurse should expect the client who is experiencing perforation of a peptic ulcer to exhibit manifestations of shock, including hypotension. b. The nurse should expect the client who is experiencing perforation of a peptic ulcer to exhibit manifestations of shock, including tachycardia. c. The nurse should expect a client who has liver disease to exhibit jaundice, or yellowing of the skin.

A nurse is caring for a client who is 2 days postoperative following a gastric bypass. The nurse notes that bowel sounds are present. Which of the following foods should the nurse provide at the initial feeding? a. Vanilla pudding b. Apple juice c. Diet ginger ale d. Clear liquids

d. Clear liquids Clear liquids, such as water or broth, can be given for the first oral feedings, but should be limited to only 30 mL (1 oz) per feeding. Water does not contain sugar, which could cause diarrhea due to hyperosmolarity. a. Vanilla pudding contains sugar, which can cause diarrhea due to hyperosmolarity. Clear liquids should be given as the first oral feeding. b. The sugar content of apple juice can cause diarrhea due to hyperosmolarity. Clear liquids should be given as the first oral feeding. c. The client should avoid carbonated beverages because they can distend the stomach, causing pressure on the internal sutures or staples. Pressure can cause leaking into the peritoneum resulting in peritonitis.

A nurse is caring for a client who is receiving total parenteral nutrition (TPN) therapy and has just returned to the room following physical therapy. The nurse notes that the infusion pump for the client's TPN is turned off. After restarting the infusion pump, the nurse should monitor the client for which of the following findings? a. Hypertension b. Excessive thirst c. Fever d. Diaphoresis

d. Diaphoresis The nurse should recognize that the client has the potential for the development of hypoglycemia due to the sudden withdrawal of the TPN solution. In addition to diaphoresis, other potential manifestations of hypoglycemia can include weakness, anxiety, confusion, and hunger. a. A client experiencing fluid volume overload will exhibit hypertension. b. A client experiencing hyperglycemia will exhibit excessive thirst. c. A client who has an infection will have an increased temperature.

A nurse is caring for a client who is dehydrated and is receiving continuous tube feeding through a pump at 75 mL/hr. When the nurse assesses the client at 0800, which of the following findings requires intervention by the nurse? a. A full pitcher of water is sitting on the client's bedside table within the client's reach. b. The disposable feeding bag is from the previous day at 1000 and contains 200 mL of feeding. c. The client is lying on the right side with a visible dependent loop in the feeding tube. d. The head of the bed is elevated 20°.

d. The head of the bed is elevated 20°. The head of the bed should be elevated at least 30° (semi-Fowler's position) while the tube feeding is administered. This position uses gravity to help the feeding move down through the digestive system and lessens the possibility of regurgitation. a. The nurse should monitor the client's intake and output and should observe the client for manifestations of dehydration, such as dry mucous membranes, thirst, and decreased urinary output. A pitcher of water at the client's bedside does not require intervention by the nurse. b. The client's feeding bag should be changed every 24 hr. The 200 mL remaining in the bag is sufficient to last until the bag needs to be changed. Because the rate is 75 mL/hr, the nurse will need 150 mL to cover the 2 hr until the bag needs to be changed. The 50 mL left in the bag will ensure that the bag does not run dry, causing air to enter the client's stomach. c. This observation does not require intervention because the feeding is not by gravity, but by a pump, and is set at a constant rate. The client's side-lying position will not affect the pump's rate of flow unless the client is lying on the tubing.