GI questions

The nurse is caring for a male client postoperatively following creation of a colostomy. Which nursing diagnosis should the nurse include in the plan of care? a. Sexual dysfunction b. Body image, disturbed c. Fear related to poor prognosis d. Nutrition: more than body requirements, imbalanced

b. Body image, disturbed Body image, disturbed relates to loss of bowel control, the presence of a stoma, the release of fecal material onto the abdomen, the passage of flatus, odor, and the need for an appliance (external pouch). No data in the question support options A and C. Nutrition: less than body requirements, imbalanced is the more likely nursing diagnosis.

A female client being seen in a physician's office has just been scheduled for a barium swallow the next day. The nurse writes down which instruction for the client to follow before the test? a. Fast for 8 hours before the test b. Eat a regular supper and breakfast c. Continue to take all oral medications as scheduled d. Monitor own bowel movement pattern for constipation

a. Fast for 8 hours before the test A barium swallow is an x-ray study that uses a substance called barium for contrast to highlight abnormalities in the gastrointestinal tract. The client should fast for 8 to 12 hours before the test, depending on physician instructions. Most oral medications also are withheld before the test. After the procedure, the nurse must monitor for constipation, which can occur as a result of the presence of barium in the gastrointestinal tract.

The nurse is providing discharge instructions to a male client following gastrectomy and instructs the client to take which measure to assist in preventing dumping syndrome? a. Ambulate following a meal b. Eat high carbohydrate foods c. Limit the fluid taken with meal d. Sit in a high-Fowler's position during meals

c. Limit the fluid taken with meal

The nurse is caring for a hospitalized female client with a diagnosis of ulcerative colitis. Which finding, if noted on assessment of the client, would the nurse report to the physician? a. Hypotension b. Bloody diarrhea c. Rebound tenderness d. A hemoglobin level of 12 mg/dL

c. Rebound tenderness Rebound tenderness may indicate peritonitis. Bloody diarrhea is expected to occur in ulcerative colitis. Because of the blood loss, the client may be hypotensive and the hemoglobin level may be lower than normal. Signs of peritonitis must be reported to the physician.

The nurse is monitoring a female client with a diagnosis of peptic ulcer. Which assessment findings would most likely indicate perforation of the ulcer? a. Bradycardia b. Numbness in the legs c. Nausea and vomiting d. A rigid, board-like abdomen

d. A rigid, board-like abdomen Perforation of an ulcer is a surgical emergency and is characterized by sudden, sharp, intolerable severe pain beginning in the midepigastric area and spreading over the abdomen, which becomes rigid and board-like. Nausea and vomiting may occur. Tachycardia may occur as hypovolemic shock develops. Numbness in the legs is not an associated finding.

Polyethylene glycol-electrlyte solution (GoLYTELY) is prescribed for the female client scheduled for a colonoscopy. The client begins to experience diarrhea following administration of the solution. What action by the nurse is appropriate? a. Start an IV infusion b. Administer an enema c. Cancel the diagnostic test d. Explain that diarrhea is expected

d. Explain that diarrhea is expected The solution GoLYTELY is a bowel evacuant used to prepare a client for a colonoscopy by cleansing the bowel. The solution is expected to cause a mild diarrhea and will clear the bowel in 4 to 5 hours. Options A, B, and C are inappropriate actions.

A client is experiencing an acute episode of ulcerative colitis. Which of the following is the most important nursing action for this client? A. Replace lost fluid and sodium. B. Monitor for increased serum glucose level from steroid therapy. C. Restrict the dietary intake of foods high in potassium. D. Note any change in the color and consistency of stools.

A. Replace lost fluid and sodium. Diarrhea due to an acute episode of ulcerative colitis leads to fluid and electrolyte losses, so fluid and sodium replacement is necessary. There is no need to restrict foods high in potassium, but potassium may need to be replaced. If the client is taking steroid medications, the nurse should monitor his glucose levels, but this isn't the highest priority. Noting changes in stool consistency is important, but fluid replacement takes priority.

A client admitted with peritonitis is under a nothing-by-mouth order. The client is complaining of dry mouth and thirst. Which of the following actions by the nurse is most appropriate? A. Increase the I.V. infusion rate. B. Use diversion activities. C. Provide frequent mouth care. D. Give ice chips every 15 minutes.

C. Provide frequent mouth care. Frequent mouth care, such as swabbing the mouth with moist sponge swabs and rinsing the mouth, helps relieve dry mouth and the sensation of thirst. Increasing the I.V. infusion rate isn't appropriate to relieve dry mouth and may cause fluid overload. Diversion activities aren't specific and are not likely to distract a person from feeling thirst. Because the client has a nothing-by-mouth order, she can't have ice chips, which are a form of liquid.

A client with a history of long-term use of non-steroidal anti-inflammatory drugs (NSAIDs) has dark, tarry and sometimes foul-smelling stools. The nurse knows that this may indicate bleeding in which part of the gastrointestinal tract? A. Upper colon (ascending and transverse). B. Lower colon (descending). C. Stomach or proximal part of small intestine. D. Distal part of small intestine.

C. Stomach or proximal part of small intestine. Melena is the passage of dark, tarry stools that contain a large amount of digested blood. It occurs with bleeding from the upper GI tract (stomach or proximal part of the small intestine). Passage of dark red blood from the rectum indicates lower GI (distal small intestine, colon, and rectum) bleeding. Bleeding in the lower colon or rectum would cause bright red blood in the stool.

A client underwent a colostomy for a ruptured diverticulum. He did well throughout the surgery and returned to the medical-surgical floor in stable condition. The nurse assesses the client's colostomy stoma 2 days after surgery. Which assessment finding should the nurse report immediately to the physician? A. Blanched stoma. B. Edematous stoma. C. Reddish-pink stoma. D. Brownish-black stoma.

D. Brownish-black stoma. A brownish-black stoma indicates a lack of blood flow to the stoma, and necrosis is likely. Two days postoperatively, the stoma should still be edematous and reddish-pink in color. A blanched or pale stoma indicates possible decreased blood flow and should be assessed regularly. Stomas should be assessed for color, size, characteristics (mucosa should be moist), shape, and protrusion (should be slightly above skin level).

The nurse is reviewing the record of a female client with Crohn's disease. Which stool characteristics should the nurse expect to note documented in the client's record? a. Diarrhea b. Chronic constipation c. Constipation alternating with diarrhea d. Stools constantly oozing form the rectum

a. Diarrhea Crohn's disease is characterized by nonbloody diarrhea of usually not more than four to five stools daily. Over time, the diarrhea episodes increase in frequency, duration, and severity. Options B, C, and D are not characteristics of Crohn's disease.

The nurse is monitoring a female client for the early signs and symptoms of dumping syndrome. Which of the following indicate this occurrence? a. Sweating and pallor b. Bradycardia and indigestion c. Double vision and chest pain d. Abdominal cramping and pain

a. Sweating and pallor Early manifestations of dumping syndrome occur 5 to 30 minutes after eating. Symptoms include vertigo, tachycardia, syncope, sweating, pallor, palpitations, and the desire to lie down.

The nurse is caring for a male client with a diagnosis of chronic gastritis. The nurse monitors the client knowing that this client is at risk for which vitamin deficiency? a. Vitamin A b. Vitamin B12 c. Vitamin C d. Vitamin E

b. Vitamin B12 Chronic gastritis causes deterioration and atrophy of the lining of the stomach, leading to the loss of the function of the parietal cells. The source of the intrinsic factor is lost, which results in the inability to absorb vitamin B12. This leads to the development of pernicious anemia. The client is not at risk for vitamin A, C, or E deficiency.

The nurse is reviewing the medication record of a female client with acute gastritis. Which medication, if noted on the client's record, would the nurse question? a. Digoxin (Lanoxin) b. Furosemide (Lasix) c. Indomethacin (Indocin) d. Propranolol hydrochloride (Inderal)

c. Indomethacin (Indocin) Indomethacin (Indocin) is a nonsteroidal anti-inflammatory drug and can cause ulceration of the esophagus, stomach, or small intestine. Indomethacin is contraindicated in a client with gastrointestinal disorders. Furosemide (Lasix) is a loop diuretic. Digoxin is a cardiac medication. Propranolol (Inderal) is a β-adrenergic blocker. Furosemide, digoxin, and propranolol are not contraindicated in clients with gastric disorders.

The nurse is caring for a female client following a Billroth II procedure. Which postoperative order should the nurse question and verify? a. Leg exercises b. Early ambulation c. Irrigating the nasogastric tube d. Coughing and deep-breathing exercises

c. Irrigating the nasogastric tube In a Billroth II procedure, the proximal remnant of the stomach is anastomosed to the proximal jejunum. Patency of the nasogastric tube is critical for preventing the retention of gastric secretions. The nurse should never irrigate or reposition the gastric tube after gastric surgery, unless specifically ordered by the physician. In this situation, the nurse should clarify the order. Options A, B, and D are appropriate postoperative interventions.

The nurse is performing an abdominal assessment and inspects the skin of the abdomen. The nurse performs which assessment technique next? a. Palpates the abdomen for size b. Palpates the liver at the right rib margin c. Listens to bowel sounds in all four quadrants d. Percusses the right lower abdominal quadrant

c. Listens to bowel sounds in all four quadrants The appropriate sequence for abdominal examination is inspection, auscultation, percussion, and palpation. Auscultation is performed after inspection to ensure that the motility of the bowel and bowel sounds are not altered by percussion or palpation. Therefore, after inspecting the skin on the abdomen, the nurse should listen for bowel sounds.

A male client with a peptic ulcer is scheduled for a vagotomy and the client asks the nurse about the purpose of this procedure. Which response by the nurse best describes the purpose of a vagotomy? a. Halts stress reactions b. Heals the gastric mucosa c. Reduces the stimulus to acid secretions d. Decreases food absorption in the stomach

c. Reduces the stimulus to acid secretions A vagotomy, or cutting of the vagus nerve, is done to eliminate parasympathetic stimulation of gastric secretion. Options A, B, and D are incorrect descriptions of a vagotomy.