GI practice questions

The nurse has been assigned to care for a client diagnosed with PUD. Which assessment data require further intervention?

A decrease in systolic BP of 20mmhg from lying to sitting. This is a sign of orthostatic hypotension This could indicate that the client is bleeding.

The nurse is administering morning medications at 0730. Which medication should have priority?

A mucousal barrier agent. This med must be administered on an empty stomach for the med to coat with the stomach.

The nurse is caring for an adult client diagnosed with GERD. Which condition is the most common comorbid disease associated with GERD?

Adult-onset asthma.

Drugs for Ulcerative colitis

Aminosalicylates (antiinflammatory) such as sulfasalazine Glucocorticoid (during exacerbations) given PO or IV such as prednisone, and you can give steroid enemas or steroid rectal form Immunosuppressive (used in combo with steroids) Anti-diarrheal (use cautiosuly) such as atropine sulfate or loperamide.

Which physical examination should the nurse implement first when assessing the client diagnosed with PUD?

Auscultate the client's bowel sounds in all four quadrants

The nurse closely monitors the client with acute pancreatitis for which complication? a) duodenal ulcer b) infection c) pneumonia d) heart failure

C

Which foods will the nurse teach the client with chronic pancreatitis to avoid? SELECT ALL THAT APPLY. a) blueberries b) green beans c) bacon d) baked fish e) fried potatoes

C and E

The nurse is preparing a client diagnosed with GERD surgery. Which info warrants notifying the HCP? a) The clients Bernsteins esophageal test was positive b) The client's abdominal x ray shows a hiatal hernia c) The client's WBC count is 14,000 d) The clients hemoglobin is 13.8

C.

A client just had an ileostomy. What is a complication of this?

Fluid/electrolyte imbalance

The nurse is preparing a client diagnosed with GERD for discharge following an esophagastroduodenoscopy. Which statement indicates the client understands the discharge instructions?

I should avoid orange juice and eating tomatoes until my esophagus heals.

A nurse is monitoring a client recovering from moderate sedation that was administered during a colonoscopy. Which finding requires the nurse's immediate attention?

Oxygen saturation (SaO2) of 89% Normal SaO2 is 95% to 100%. Oxygen saturation below 94% indicates inadequate oxygenation, which may be a consequence of the moderate sedation. Appropriate nursing actions include rousing the client, if necessary, assisting the client with coughing and deep breathing, and evaluating the need for additional oxygen. A heart rate of 84 beats/minute is within normal limits. Colonoscopy doesn't affect cough and gag reflexes, although these reflexes may be slightly decreased from the administration of sedation. These findings don't require immediate intervention. Blood-tinged stools are a normal finding after colonoscopy, especially if the client had a biopsy.

The nurse writes the problem "imbalanced nutrition: less than body requirements" for the client diagnosed with hepatitis. Which intervention should the nurse include in the plan of care?

Provide high calorie diet

The nurse is performing an admission assessment on a client diagnosed with GERD. Which signs and symptoms would indicate GERD?

Pyrosis (heartburn), water brash and flatulence.

A patient with ulcerative colitis is scheduled for ileoanal anastomosis (J-Pouch) surgery. You know that this procedure:

Removes the colon and rectum which allows a pouch to be created that will attach to the ileum. This will allow stool to pass from the small intestine to the anus.

What type of precautions should the nurse implement to protect from being exposed to any of the hepatitis virus?

Standard precautions

Drugs for crohns disease

TNF (Tumor necrosis factor "mab".) Antibiotics- metronidazole (for the fistulas) TPN If fistula develops, the pt needs increased nutritional needs (3,000cal/day).

A client is admitted to the hospital for diagnostic testing to rule out colorectal cancer. Which intervention should the nurse include on the plan of care?

Test all stools for occult blood. Blood in the stools is one of the warning signs of colorectal cancer. The nurse should plan on checking all stools for both frank and occult blood. The blood in the stool is coming from the colon or rectum; administering an ointment wouldn't help decrease the bleeding. Preparing a client for a gastrostomy tube isn't appropriate when diagnosing colorectal cancer. Colorectal cancer is usually painless; administering opioid pain medication isn't needed

A patient with late-stage cirrhosis develops portal hypertension. Which of the following options below are complications that can develop from this condition? Select all that apply: A. Increase albumin levels B. Ascites C. Splenomegaly D. Fluid volume deficient E. Esophageal varices

The answer are B, C, and E. Portal Hypertension is where the portal vein becomes narrow due to scar tissue in the liver, which is restricting the flow of blood to the liver. Therefore, pressure becomes increased in the portal vein and affects the organs connected via the vein to the liver. The patient may experience ascites, enlarged spleen "splenomegaly", and esophageal varices etc.

A patient is admitted with hepatic encephalopathy secondary to cirrhosis. Which meal option selection below should be avoided with this patient? A. Beef tips and broccoli rabe B. Pasta noodles and bread C. Cucumber sandwich with a side of grapes D. Fresh salad with chopped water chestnuts

The answer is A. Patients who are experiencing hepatic encephalopathy are having issues with toxin build up in the body, specifically ammonia. Remember that ammonia is the byproduct of protein breakdown, and normally the liver can take the ammonia from the protein breakdown and turn it into urea (but if the cirrhosis is severe enough this can't happen). Therefore, the patient should consume foods LOW in protein until the encephalopathy subsides. Option A is very high in protein while the others are low in protein. Remember meats, legumes, eggs, broccoli rabe, certain grains etc. are high in protein.

The liver receives it blood supply from two sources. One of these sources is called the _________________, which is a vessel network that delivers blood _____________ in nutrients but ________ in oxygen. A. hepatic artery, low, high B. hepatic portal vein, high, low C. hepatic lobule, high, low D. hepatic vein, low, high

The answer is B. Majority of the blood flow to the liver comes from the hepatic portal vein. This vessel network delivers blood HIGH in nutrients (lipids, proteins, carbs etc.) from organs that aid in the digestion of food, but the blood is POOR in oxygen. The organs connected to the hepatic portal vein are: small/large intestine, pancreas, spleen, stomach. Rich oxygenated blood comes from the hepatic artery to the liver.

During your morning assessment of a patient with cirrhosis, you note the patient is disoriented to person and place. In addition while assessing the upper extremities, the patient's hands demonstrate a flapping motion. What lab result would explain these abnormal assessment findings? A. Decreased magnesium level B. Increased calcium level C. Increased ammonia level D. Increased creatinine level

The answer is C. Based on the assessment findings and the fact the patient has cirrhosis, the patient is experiencing hepatic encephalopathy. This is due to the buildup of toxins in the blood, specifically ammonia. The flapping motion of the hands is called "asterixis". Therefore, an increased ammonia level would confirm these abnormal assessment findings.

your patient with cirrhosis has severe splenomegaly. As the nurse you will make it priority to monitor the patient for signs and symptoms of? Select all that apply: A. Thrombocytopenia B. Vision changes C. Increased PT/INR D. Leukopenia

The answers are A, C, and D. A patient with an enlarged spleen (splenomegaly) due to cirrhosis can experience thrombocytopenia (low platelet count), increased PT/INR (means it takes the patient a long time to stop bleeding), and leukopenia (low white blood cells). The spleen stores platelets and WBCs. An enlarged spleen can develop due to portal hypertension, which causes the platelets and WBCs to become stuck inside the spleen due to the increased pressure in the hepatic vein (hence lowering the count and the body's access to these important cells for survival).

You're providing an in-service to new nurse graduates about esophageal varices in patients with cirrhosis. You ask the graduates to list activities that should be avoided by a patient with this condition. Which activities listed are correct: Select all that apply A. Excessive coughing B. Sleeping on the back C. Drinking juice D. Alcohol consumption E. Straining during a bowel movement F. Vomiting

The answers are A, D, E, and F. Esophageal varices are dilated vessels that are connected from the throat to the stomach. They can become enlarged due to portal hypertension in cirrhosis and can rupture (this is a medical emergency). The patient should avoid activities that could rupture these vessels, such as excessive cough, vomiting, drinking alcohol, and constipation (straining increases thoracic pressure.)

A nurse is caring for a client in the emergency department who is complaining of severe abdominal pain. The client is diagnosed with acute pancreatitis. Which laboratory value requires immediate intervention?

Troponin of 2.3 mcg/L An elevated troponin level indicates myocardial damage and needs immediate further investigation. Hyperglycemia [evidenced by a serum glucose of 240 mg/dl (50 mmol/L)], an elevated WBC count, and hypocalcemia [evidenced by a calcium level of 7.8 mg/dl (0.9 mmol/L)], although commonly seen in pancreatitis, don't require immediate action.

Ulcerative colitis and crohns disease

Ulcerative colitis- down to up Crohns disease- up to down

Which intervention will the nurse include in the plan of care for a client with severe liver disease? a) Encourage the client to eat a low protein, high carb diet b) Administer Kayexalate enemas c) Instruct the client to consume high protein, low carb diets d) Teach the client to particpate in frequent, vigorous physical activities.

a

A client previously diagnosed with liver cirrhosis visits the medical clinic. What assessment findings does the nurse expect in this client? a) ecchymosis b) soft abdomen c) moist, clammy skin d) jaundice e) ankle edema f) fever

a, d, e

A client is scheduled for oral cholecystography. Prior to the test, the nurse should:

ask the client about possible allergies to iodine or shellfish.

The nurse is providing discharge instructions for a client who has undergone a laparoscopic cholecystectomy. Which instructions will the nurse include in the discharge teaching? a) Keep dressing in place for 4 weeks b) Report bile-colored drainage from any of the incisions c) expect dark, tarry stools after surgery d) be aware that no dietary changes will be necessary

b

The nurse is providing teaching for a client scheduled for a paracentesis. Which statement by the client indicates the teaching has been successful? a) I must not use the bathroom prior to the procedure b) I will lie on my stomach while the procedure is performed. c) I will not be allowed to eat or drink anything the night before the procedure d) The physician will likely remove 2-3 liters of fluid from my abdomen.

d

The client is in the preicteric phase of hepatitis. Which signs/symptoms should the nurse expect to exhibit during this phase? a) Clay-colored stool and jaundice b) normal appetite and pruitis c) being afebrile and left upper quadrant pain d) complaints of fatigue and diarrhea.

d. Flu like symptoms is the first sign.

What instruction should the nurse teach the client when in icteric phase of hep. c?

encourage rest periods for optimum immune function.

A male client with pancreatitis complains of pain. The nurse expects the physician to prescribe meperidine (Demerol) instead of morphine to relieve pain because:

morphine may cause spasms of oddi's sphincter

Which condition is most likely to have a nursing diagnosis of fluid volume deficit?

pancreatitis

What does stoma prolapse mean?

protruding stoma

During preparation for bowel surgery, a male client receives an antibiotic to reduce intestinal bacteria. Antibiotic therapy may interfere with synthesis of which vitamin and may lead to hypoprothrombinemia?

vitamin k

Which finding is normal for a client during the icteric phase of hepatitis A?

yellowed sclera Liver inflammation and obstruction block the normal flow of bile. Excess bilirubin turns the skin and sclera yellow and the urine dark and frothy. Profound anorexia is also common. Tarry stools are indicative of gastrointestinal bleeding and would not be expected in hepatitis. Light- or clay-colored stools may occur in hepatitis owing to bile duct obstruction. Shortness of breath would be unexpected.