GI Final Exam

Characteristics of suspected cholecystitis

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

Abdominoperineal resection - 3 incisions will be present:

1. On the abdomen 2. Colostomy 3. Perineum

An older adult client is admitted to an acute care facility for treatment of an acute flare-up of a chronic gastrointestinal condition. In addition to assessing the client for complications of the current illness, the nurse monitors for age-related changes in the gastrointestinal tract. Which age-related change increases the risk of anemia? a) Atrophy of the gastric mucosa B) Decrease in intestinal flora C) Increase in bile secretion D) Dulling of nerve impulses

A) Atrophy of the gastric mucosa Reduces the hydrochloric acid secretions, this in turn impairs absorption of iron and vit. B12 increasing the risk of anemia as a person ages.

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

ANS: B The T-tube is placed below the level of the common bile duct to prevent the reflux of bile. The bag must be positioned so the tube is not kinked, or bile cannot drain from the liver. Normally T-tubes are not irrigated.

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

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

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

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

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

ANS: C Because of the close proximity of the esophagus and trachea, any upward movement of the tube could cause airway obstruction.

Which of the following is a classic symptom of cholecystitis? a. Substernal, radiating to the left shoulder and arm b. Epigastric, radiating to the back c. Right upper abdomen, radiating to the back or right scapula d. Left upper abdomen, radiating to the jaw and neck

ANS: C It localizes in the right upper quadrant epigastric region. The pain radiates around the mid torso to the right scapular area.

What should the nurse expect of a patient with a malabsorption of vitamin K? a. Lowered hemoglobin b. Elevated hematocrit c. Increased prothrombin time d. Diminished white blood cell count

ANS: C Prothrombin times are increased because malabsorption of vitamin K or inability to produce the clotting factors VII, IX, and X cause the patient to have bleeding tendencies.

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

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

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

ANS: D Taking care not to overeat is the best defense again pyrosis (heartburn) for the person with a hiatal hernia.

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

ANS: D The rich TPN solution is rapidly diluted in the larger vessel, preventing phlebitis.

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

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

Which food should be included in a client's diet during the first 6 to 8 weeks after ileostomy surgery?

Banana 🍌 Bananas are considered one of the most nutritional foods and are low in fiber. High fiber foods such as fresh corn, celery, and bran cereal should be avoided during The first 6 to 8 weeks after placement of an Ileostomy.

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

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

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

Cigarette smokers and people with diabetes mellitus

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

Flex her legs when moving to a sitting position. Explanation: Flexing the legs when moving to a sitting position reduces the tension on the abdomen and the pain associated with moving. The bed should be placed in the sitting position, rather than flat. The client should be encouraged to stand erect when walking, not flexed at the waist. The buttock muscles should be tightened so that the act of moving uses the leg and buttock muscles rather than the abdominal muscles.

What should a nurse in the discharge teaching for a patient after laparoscopic procedure for cholelithiasis?

Follow up low fat diet and take fat soluble vitamins

Which is the recommended order for performing an abdominal examination?

Inspection auscultation percussion palpation

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

Making sure the client's bladder is empty before auscultating a full bladder may interfere with bowel sounds

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

Metabolism and excretion

Why is morphine contraindicated in the patient with pancreatitis?

Morphine may cause spasms of the sphincter of Oddi. Explanation: A common complaint is constant severe pain. In such cases, Meperidine (Demerol) PCA aid often administered.

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

Pain and distention after eating

A nurse administers promethazine (phenergan) for nausea.Which extra precautionary action should the nurse implement because of the common side effect of antiemetic medications?

Put up side rails to prevent falls. Explanation: Antimetic medications cause drowsiness because of their effect on the CNS resulting in dizziness and confusion.

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

a) Make sure informed consent was obtained. b) Explain the procedure to the client. d) Instruct the client to void. (to minimize the risk of accidental bladder injury from the needle or trocar and cannula)

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

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

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

a) addition of whole grain cereal. b) cessation of laxative use. c) increase in liquid intake. e) eating fresh vegetables.

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

a. Administering I.V. fluids I.V. infusions containing normal saline solution and potassium should be given first to maintain fluid and electrolyte balance.

When caring for a client with hepatitis B, the nurse should monitor closely for the development of which finding associated with a decrease in hepatic function? a) Fatigue during ambulation b) Irritability and drowsiness c) Jaundice d) Pruritus of the arms and legs

b) Irritability and drowsiness

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

b. Excessive flatulence c. Cachexia d. Cramps e. Rectal bleeding f. Anemia

A nurse is assessing a client who is receiving total parenteral nutrition (TPN). Which finding suggests that the client has developed hyperglycemia? a. Cheyne-Stokes respirations b. Increased urine output c. Decreased appetite d. Diaphoresis

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

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

c. Anticoagulants Ginger roots is effective in calming the upset stomach reducing flatulence, and preventing motion sickness. It enhances the action of anticoagulants and antiplatelet agents.

A client with hepatitis C develops liver failure and GI hemorrhage. The blood products that most likely bring about hemostasis in the client are: a) fresh frozen plasma and whole blood. b) whole blood and albumin. c) platelets and packed red blood cells. d) cryoprecipitate and fresh frozen plasma.

d) cryoprecipitate and fresh frozen plasma. Explanation: The liver is vital in the synthesis of clotting factors, so when its diseased or dysfunctional as in hepatitis C, bleeding occurs. The treatment consisted of administering blood products that aid clotting. These blood products include fresh frozen plasma containing fibrinogen, and cryoprecipitate which have the most of the clotting factors.

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

d. Evidence of cardiac ischemia

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

d. Peptic ulcer

A client with cholecystitis is receiving propantheline bromide (Probantine). The client is given this medication because it:

inhibits contraction of the bile duct and gallbladder.

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

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

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

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

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

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