GI, Liver and pancreas questions in ppt

GI bleeding as a result of a Mallory-Weiss tear often presents with which manifestation? A) hematemesis B) hematochezia C) melena D) pain

A

How is volume resuscitation generally accomplished in the client with an acute GI bleed? A) intravenous crystalloid infusion B) vasoconstricting drugs C) blood transfusion D) normal saline via NG tube

A

Which diagnostic test would be used first to evaluate a client with upper GI bleeding? A) endoscopy B) upper GI series C) hemoglobin (Hb) and hematocrit D) arteriography

A Endoscopy permits direct evaluation of the upper GI tract and can detect 90% of bleeding lesions. An upper GI series, or barium study, usually isn't the diagnostic method of choice, especially in a client with acute active bleeding who's vomiting and unstable. An upper GI series is also less accurate than endoscopy. Although an upper GI series might confirm the presence of a lesion, it wouldn't necessarily reveal whether the lesion is bleeding. Hb levels and HCT, which indicate loss of blood volume, aren't always reliable indicators of GI bleeding because a decrease in these values may not be seen for several hours. Arteriography is an invasive study associated with life-threatening complications and wouldn't be used for an initial evaluation.

Lactulose (Cephulac) is administered to a patient diagnosed with hepatic encephalopathy to reduce which of the following? A) ammonia B) calcium C) bicarbonate D) alcohol

A Lactulose (Cephulac) is administered to reduce serum ammonia levels. Cephulac does not influence calcium, bicarbonate, or alcohol levels.

If a client with a small bowel obstruction develops rebound tenderness with a board like distention, what should the nurse suspect? A) constipation B) peroration C) olgilvie syndrome D) retroperitoneal bleeding

B

To assess the severity of blood loss, what should the nurse determine? A) respiratory status B) hemodynamic status C) level of consciousness D) degree impairment

B

When evaluating a male client for complications of acute pancreatitis, the nurse would observe for: A) increased ICP B) decreased urine output C) bradycardia D) hypertension

B Acute pancreatitis can cause decreased urine output, which results from the renal failure that sometimes accompanies this condition. Intracranial pressure neither increases nor decreases in a client with pancreatitis. Tachycardia, not bradycardia, usually is associated with pulmonary or hypovolemic complications of pancreatitis. Hypotension can be caused by a hypovolemic complication, but hypertension usually isn't related to acute pancreatitis.

The nurse is caring for a 78 year old patient who has severe ascites due to chronic liver failure. An order to administer a colloidal solution for a patient who is experiencing hypovolemic shock is given. What common colloidal solution will the nurse most likely administer? A) Packed red blood cells B) 5% albumin C) dextrose D) mannitol

B Typically, if colloids are used to treat tissue hypoperfusion, albumin is the agent prescribed. Albumin is a plasma protein; an albumin solution is prepared from human plasma and is heated during production to reduce its potential to transmit disease. The disadvantage of albumin is its high cost compared to crystalloid solutions. Dextran solutions are not indicated for fluid administration because these agents interfere with platelet aggregation. Blood products are not indicated in this situation. There is no mention of hemorrhage Mannitol diuretic used for HE

A 35 year old male is diagnosed with PUD. His father had a gastric Ulcer. He smokes one pack of cigarettes per day, takes a diuretic to treat hypertension, and is obese. He takes aspirin every day for this arthritis. How many risk factors for PUD does this person have? A) Two B) Three C) Four D) Five

B- three

The nurse is caring for a male client with cirrhosis. Which assessment findings indicate that the client has deficient vitamin K absorption caused by his hepatic disease? A) dyspnea and fatigue B) ascites and orthopnea C) purpura and petechiae D) gynecomastia and testicular atrophy

C A hepatic disorder, such as cirrhosis, may disrupt the liver's normal use of vitamin K to produce prothrombin (a clotting factor). Consequently, the nurse should monitor the client for signs of bleeding, including purpura and petechiae. Dyspnea and fatigue suggest anemia. Ascites and orthopnea are unrelated to vitamin K absorption. Gynecomastia and testicular atrophy result from decreased estrogen metabolism by the diseased liver.

The nurse is caring for a female client with active upper GI bleeding. What is the appropriate diet for this client during the first 24 hours after admission? A) regular diet B) skim milk C) NPO D) clear liquids

C Shock and bleeding must be controlled before oral intake, so the client should receive nothing by mouth. A regular diet is incorrect. When the bleeding is controlled, the diet is gradually increased, starting with ice chips and then clear liquids. Skim milk shouldn't be given because it increases gastric acid production, which could prolong bleeding. A liquid diet is the first diet offered after bleeding and shock are controlled.

The nurse is caring for a patient who has ascites as a result of hepatic dysfunction. What intervention can the nurse provide to determine if the ascites is increasing? (select all that apply) A) measure urine output every 8 hours B) assess and document vital signs every 4 hours C) measure abdominal girth daily D) perform daily weights E) monitor the number of BM per day

C,D . Increased abdominal girth and rapid weight gain are common presenting symptoms of ascites. If a patient with ascites from liver dysfunction is hospitalized, nursing measures include assessment and documentation of intake and output (I&O;), abdominal girth, and daily weight to assess fluid status. The nurse also closely monitors the respiratory status because large volumes of ascites can compress the thoracic cavity and inhibit adequate lung expansion. The nurse monitors serum ammonia, creatinine, and electrolyte levels to assess electrolyte balance, response to therapy, and indications of encephalopathy.

Clients with occult GI bleeding often present with which manifestations? A) nausea and vomiting B) mental status changes C) headache and abdominal pain D) fatigue and syncope

D Anemia, fatigue, dyspnea, lightheadedness or syncope low rbc and hemoglobin, iron deficient pg 594

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 NG tube D) administering IV fluids

D I.V. infusions containing normal saline solution and potassium should be given first to maintain fluid and electrolyte balance. For the client's comfort and to assist in bowel decompression, the nurse should prepare to insert an NG tube next. A blood sample is then obtained for laboratory studies to aid in the diagnosis of bowel obstruction and guide treatment. Blood studies usually include a complete blood count, serum electrolyte levels, and blood urea nitrogen level. Pain medication often is withheld until obstruction is diagnosed because analgesics can decrease intestinal motility.