Saunders GI Part 2

A generally healthy 63-year-old man is seen in the primary health care provider's office for a routine examination. Which statement made by the client is most important for the nurse to follow up on?

"Everyone in my immediate family has died from gastrointestinal cancer."4

A client is seen in the ambulatory care office for a routine examination. Which statement by the client would be most important for the nurse to follow up?

"I just lost a family member to gastrointestinal cancer."

The nurse evaluates that there is a need for further teaching on bowel elimination when the client makes which statement?

"I need to decrease fiber in my diet."

The nurse has given the client diagnosed with hepatitis instructions about post discharge management during convalescence. The nurse determines a need for further teaching if the client makes which statement?

"I should resume a full activity level within 1 week."

The nurse has been reinforcing dietary teaching for a client diagnosed with gastroesophageal reflux disease (GERD) who has a routine follow-up visit. Which behavior is the best indicator of a successful outcome for this client?

A decrease in sour eructation

A client is receiving bolus feedings via a nasogastric tube. The nurse plans to place the client's head of the bed (HOB) in which optimal position once the feeding is completed?

Elevated 30 to 45 degrees with the client in the right lateral position for 60 minutes

After a client undergoes a liver biopsy, the nurse places the client in the prescribed right-side lying position. The nurse understands that the purpose of this intervention is to accomplish which?

Limit bleeding from the biopsy site

A client with hiatal hernia chronically experiences heartburn after meals. Which would the nurse teach the client to avoid?

Lying recumbent after meals

The nurse is assigned to care for a client receiving total parenteral nutrition via the subclavian vein. The nurse would identify which intervention in the plan of care for the client as the priority?

Monitoring the insertion site for signs of infection

A client has been receiving parenteral nutrition at 125 mL/hr for 5 days. On data collection, the nurse notes bilateral crackles and 2+ pedal edema and that the client has gained 3 pounds in 5 days. Which would be appropriate as the initial nursing action?

Notify the registered nurse of the findings.

A client arrives at the emergency department complaining of severe abdominal pain and is placed on NPO status. During a quick assessment the nurse observes that the client has both Cullen's sign and Grey Turner's sign, and pancreatitis is suspected. The nurse would assist to implement which action first?

Obtain vital signs and draw blood for laboratory analysis.

The nurse is assigned to care for a client who had a Sengstaken-Blakemore tube inserted when more conservative treatment failed to alleviate the condition. The nurse would most likely suspect that the client has which diagnosis?

esophageal varices

A client is admitted to the hospital with a diagnosis of acute viral hepatitis. Which sign/symptom would the nurse expect to observe based on this diagnosis?

fatigue

A client is receiving total parenteral nutrition and has been NPO. The primary health care provider (PHCP) prescribed small amounts of clear liquids today. The nurse's priority is to collect data regarding which criterion before giving the client anything by mouth?

presence of swallow reflex

The nurse is collecting data from a client admitted to the hospital with a diagnosis of suspected gastric ulcer and is asking the client questions about pain. Which statement made by the client would the nurse recognize as best supporting the diagnosis of gastric ulcer?

"My pain comes shortly after I eat, maybe a half hour or so later."

A client has had extensive surgery on the gastrointestinal tract and has been started on total parenteral nutrition (TPN). The client tells the nurse, "I think I'm going crazy. I feel like I'm starving, and yet that bag is supposed to be feeding me." Which is the best response from the nurse?

"That is because the empty stomach sends signals to the brain to stimulate hunger."4

Which statement by the spouse of a client with diagnosed end-stage liver failure indicates the need for further teaching by the multidisciplinary team regarding management of the client's pain?

"This opioid will cause very deep sleep, which is what my husband needs."

A caregiver states that the client eats only about 25% of the food that is offered and is losing weight. The caregiver asks the nurse about feeding the client by a tube into the stomach. Which initial response by the nurse would be appropriate?

"Tube feedings can provide adequate amounts of required nutrients."

An older client complains of chronic constipation. Which instructions would the nurse reinforce with the client? Select all that apply.

- Increase fluids to at least 8 glasses a day. - Respond in a timely manner to the urge to defecate.

The nurse is caring for a client that received a new diet prescription from the primary health care provider (PHCP) for nothing-by-mouth (NPO) except ice chips. Which actions would the nurse take to alleviate the effects of dehydration? Select all that apply.

- Observe mucous membranes for drynessisinterest - Provide frequent oral care with moist swabs -Apply lubricant to the lips and oral mucous membranes

The client arrives at the clinic complaining of dyspepsia and pain that occurs about 90 minutes after eating. The client also reports that the pain became worse this afternoon about 3 hours after eating a large bowl of spaghetti with tomato sauce. Laboratory tests reveal the presence of Helicobacter pylori (H. pylori). The nurse anticipates that the primary health care provider would prescribe which medications? Select all that apply.

- esomeprazole - metronidazole - clarithromycin

The nurse is collecting data during an assessment on a client. Which of the following assessment findings are typical for a malnourished client? Select all that apply.

-Glossitis - Cheilosis -Bleeding gums

The nurse has assisted with the insertion of a Levin tube for gastrointestinal (GI) decompression in a client with a bowel obstruction. Which settings would the nurse anticipate to be prescribed by the primary health care provider? Select all that apply.

-low - intermittent

The nurse reviewing a client's medical record would recognize which conditions as risk factors for nonalcoholic fatty liver disease (NAFLD)? Select all that apply.

-obesity - diabtes - hyperlipidemia

The nurse is caring for a client diagnosed with esophageal varices who is going to have a Sengstaken-Blakemore tube inserted. The nurse brings which priority item to the bedside so that it is available at all times?

An irrigation set

A client has undergone esophagogastroduodenoscopy (EGD). The nurse would place highest priority on which action as part of the client's care plan?

Checking for return of a gag reflex

The nurse is reinforcing medication instructions to a client with peptic ulcer disease. Which represents correct information given by the nurse?

Cimetidine results in decreased secretion of stomach acid

A client is admitted to a long-term care facility with the diagnosis of weight loss secondary to anorexia. The primary health care provider inserts a nasogastric tube and prescribes a tube feeding of a standard formula feeding to run at 50 mL/hr. The nurse plans care, knowing that which is true regarding enteral feedings?

Enteral feedings require the normal digestive capabilities of the gastrointestinal (GI) tract.

The nurse is assigned to assist in caring for a client who is receiving parenteral nutrition with fat emulsion. The nurse is instructed to monitor the client for signs of fat overload. The nurse monitors for which signs and symptoms of this complication?

Fever and pruritic urticaria

A licensed practical nurse (LPN) is assisting in the insertion of a nasogastric (NG) tube for an adult client. The LPN helps determine the correct length to insert the tube by performing which measurement?

From the tip of the client's nose to the earlobe and then down to the xiphoid process

The nurse is caring for a client with a history of peptic ulcer disease admitted to the medical-surgical unit with abdominal pain that is worse towards the end of the day. The client tells the nurse that he has had a bowel perforation in the past that healed on its own. Given the client's history, which condition would the nurse suspect?

Gastric outlet obstruction

The nurse is reviewing the medication record of a client with a diagnosis of acute gastritis. Which medication noted on the client's record would the nurse most likely question?

Ibuprofen

The nurse caring for a client diagnosed with acute pancreatitis and has a history of alcoholism is monitoring the client for complications. The nurse determines that which data collected is most likely indicative of paralytic ileus?

Inability to pass flatus

A client with a diagnosis of viral hepatitis has no appetite, and food makes the client nauseated. The nurse would conclude that which intervention is most appropriate?

Offer small, frequent meals.

A client that is postgastrectomy is at high risk for hyperglycemia related to uncontrolled gastric emptying of fluid and food into the small intestine (dumping syndrome). Because of this risk, the nurse would plan to monitor which data?

Postprandial blood glucose readings

The nurse is caring for a client diagnosed with a resolved intestinal obstruction who has a nasogastric tube in place. The primary health care provider has now prescribed the nasogastric tube to be discontinued. To best determine the client's readiness for discontinuation of the nasogastric tube, which measure would the nurse check?

Presence of bowel sounds in all four quadrants

The nurse is reviewing the chart for a client with Clostridium difficile (C. difficile) infection. The nurse would contact the primary health care provider (PHCP) regarding which priority finding?

Serum potassium 2.9 mEq/L (2.9 mmol/L)

A client calls the clinic and asks the nurse about measures to minimize pain and swelling for hemorrhoids. What is the correct response by the nurse?

Sitz baths for 15 to 20 minutes 2 to 3 times a day

A client has undergone subtotal gastrectomy, and the nurse is preparing the client for discharge. Which item would be included when reinforcing instructions to the client about ongoing self-management?

Smaller, more frequent meals should be eaten.

The nurse is performing colostomy irrigation on a client. During the irrigation, the client begins to complain of abdominal cramps. The nurse would take which appropriate action?

Stop the irrigation temporarily.

A licensed practical nurse (LPN) is helping a registered nurse (RN) conduct an abdominal assessment. The LPN would assist the client into which most appropriate position?

Supine with the head raised slightly and the knees slightly flexed

A postoperative client has regained bowel sounds and is ready to start a clear liquid diet. The nurse is told that the primary health care provider has written a prescription to remove the nasogastric (NG) tube. The nurse assists in the procedure and would ask the client to do which during tube removal?

Take a breath and hold it until the tube is out.

A client presents to the urgent care center with complaints of abdominal pain. Suddenly the client vomits bright red blood. The nurse would take which immediate action?

Take the client's vital signs.

A client had a Miller-Abbott tube inserted 24 hours ago. The nurse is asked to check the client to determine whether the tube is in the appropriate location at this time. Which data finding best indicates adequate location of the tube?

The aspirate from the tube has a pH of 7.45.

The nurse is` caring for a client with fatty liver disease who is scheduled for a paracentesis to treat ascites. The client has an indwelling urinary catheter in place to aid in the healing of a sacral pressure injury. The nurse assesses the client and would notify the registered nurse regarding which priority finding?

The client has pink-tinged urine in the indwelling urinary drainage bag.

The nurse would reinforce instructions to a client that has had a gastrectomy about the signs and symptoms of pernicious anemia, knowing what information?

The nurse would reinforce instructions to a client that has had a gastrectomy about the signs and symptoms of pernicious anemia, knowing what information?

The nurse is collecting data about how well a client diagnosed with a gastrointestinal (GI) disorder is able to absorb food. While doing this, the nurse recalls that absorption is most concerned with which bodily function?

The transfer of digested food molecules from the GI tract into the bloodstream

A client with a history of gastrointestinal upset has been diagnosed with acute diverticulitis. To aid the client in symptom management, the nurse would most appropriately suggest which diet during the acute phase?

a low fiber diet

A client is admitted to the hospital with a diagnosis of acute pancreatitis. The nurse would plan care knowing that most likely, which problem will occur with this disorder?

alteration in comfort related to abdominal pain

A client with cirrhosis admitted to the hospital diagnosed with severe jaundice is having diagnostic testing. Because the client has no complaints of fatigue, the client is encouraged to ambulate in the hall to maintain muscle strength. The client paces around the room but will not enter the hall. The nurse would determine which concern is most likely the reason for the client's reluctance to walk in the hall?

feeling self conscious about appearance

A client with Crohns's disease has just had surgery to create an ileostomy. The nurse assesses the client in the postoperative period for which most frequent complication of this type of surgery?

fluid and electrolyte imbalance

It has been determined that a client with hepatitis has contracted the infection from contaminated food. Which type of hepatitis is this client most likely experiencing?

hepatitis A

A client has a diagnosis of asymptomatic diverticular disease. Which type of diet would the nurse anticipate being prescribed?

high fiber diet

The nurse is assisting with the insertion of a nasogastric tube into a client. The nurse would place the client in which position for insertion?

high fowlers

A client that is postgastrectomy being discharged from the hospital tells the nurse, "I hope my stomach problems are over. I need to get back to work right away. I've missed a lot of work, and I may lose my job." Based on the client's statement, the nurse would determine that at this time, it is most appropriate to discuss which topic?

reducing stressors in life

A primary health care provider asks the licensed practical nurse (LPN) to reinforce preprocedure instructions to a client who will undergo a barium swallow (esophagography) in a few days. The LPN would include which instruction in this discussion?

remove all metal and jewelry before the test

The nurse would recognize that which type of enema has the highest risk of water intoxication?

tap water

A primary health care provider asks the nurse to obtain a Salem sump tube for gastric intubation for a client with a bowel obstruction. The nurse would select which tube from the unit storage area?

tube with a lumen and an air vent

The nurse working in an outpatient clinic is providing teaching to a client on preventive measures for hemorrhoids. Which statement, if made by the client, indicates a need for further teaching?

"I will sit or lie down throughout the day as much as I can."

The nurse has assisted in the insertion of a Levin tube for gastrointestinal (GI) decompression. The nurse would anticipate a prescription to set the suction to which pressure?

low and intermittent

A client has been diagnosed with acute gastroenteritis. Which diet would the nurse anticipate to be prescribed for the client?

low fiber

Psyllium is prescribed for the client diagnosed with a cardiac disorder to facilitate defecation and prevent straining with bowel movements. The nurse reinforces instructions to the client regarding administration of the medication. Which statement by the client indicates an understanding of the use of the medication?

"I should mix the medication with a full glass of water."

The nurse is providing instructions to a client that has an esophagogastroduodenoscopy (EGD) ordered to confirm the diagnosis of esophageal stricture. Which statement by the client indicates a need for further teaching?

"I should stop taking my daily aspirin several days before the exam."

The nurse is caring for a client with a neurogenic bowel due to a lower motor neuron spinal cord injury below T12 resulting in flaccid functionality. Besides triggering or facilitating techniques for defecation, what are some of the strategies the nurse needs to address to reestablish defecation patterns? Select all that apply.

- Suppository use - Manual disimpaction - Consistent toileting schedule

The nurse is assessing a client with a suspected Clostridium difficile infection. The nurse notes that which clinical manifestations are consistent with this diagnosis? Select all that apply.

- The client's temperature is 101.7°F (38.2°C). - The client is having watery bowel movements. - The client grimaces while the nurse palpates the abdomen.

The nurse is caring for a client in the emergency department who has right lower quadrant abdominal pain. After noting a white blood cell count of 16,500 cells/mm3, the nurse would question which prescription?

milk of magnesia

The nurse is reviewing the client's medical records for the shift and notes that which clients are at risk for dehydration? Select all that apply.

-the client with dementia - client with c.diff - client in acute heart failure exacerbation taking furosemide

Atropine sulfate is prescribed for the client diagnosed with gastrointestinal hypermotility, and the nurse reviews the client's record before administering the medication. Which finding, if noted on the client's record, most indicates the need to contact the primary health care provider before administering the medication?

narrow- angle galucoma

Implemented treatment measures for a client with a diagnosis of bleeding esophageal varices have been unsuccessful. The primary health care provider states that a Sengstaken-Blakemore tube will be used to control the resulting hemorrhage. The nurse would prepare for insertion of this tube via which route?

nasogastric

The nurse is caring for a client with a diagnosis of acute appendicitis. Which physical assessment finding consistent with this diagnosis would the nurse expect to be documented in the client's medical record?

pain at mcburneys point

The nurse is caring for a postoperative client who had a colon resection for colon cancer. Which complication is most likely to occur after this procedure?

paralytic ileus

The nurse is collecting data on a client admitted to the hospital with a diagnosis of hepatitis. The nurse would determine which data indicates the client may have liver damage?

pruritis

A primary health care provider is about to perform a paracentesis on a client diagnosed with abdominal ascites. The nurse would assist the client to assume which position?

upright

The nurse is caring for a client with a diagnosis of pneumonia and a history of bleeding esophageal varices. Based on this information, the nurse would plan care knowing that which could most result in a potential complication?

vigorous coughing

The nurse is caring for a client with a diagnosis of chronic gastritis. The nurse anticipates that the client is at risk for which vitamin deficiency?

vitamin b12

A client diagnosed with pernicious anemia asks the nurse what caused the deficiency. The nurse replies that it is most likely a result of which condition that is part of the client's health history?

Hemigastrectomy

The nurse is evaluating the effect of dietary counseling on the client diagnosed with cholecystitis. The nurse determines the client understands the instructions given if the client states that which food item is most appropriate to include in the diet?

Turkey and lettuce sandwich

The nurse is preparing to administer an intermittent tube feeding to a client. The nurse aspirates and is unable to obtain any residual tube feeding. Which action would the nurse take next?

Turn the client to the side and attempt to aspirate again.

The nurse is assisting in planning stress management strategies for the client diagnosed with irritable bowel syndrome. Which suggestion is most appropriate for the nurse to give to the client?

Learn measures such as biofeedback or progressive relaxation.

The nurse understands that the client with a Clostridium difficile (C. difficile) infection is at increased risk for which acid-base imbalance?

Metabolic acidosis

The nurse caring for a client with a small bowel obstruction monitors for complications of this condition. Which acid-base imbalance would the nurse most likely expect to occur in this condition?

Metabolic alkalosis

The nurse will be providing postprocedure care to a client who has undergone esophagogastroduodenoscopy (EGD). Based on the procedure done, the nurse would plan to do which action first?

Monitor for return of the gag reflex.

The nurse is reviewing the medical record for a client with peritonitis. Which prescription would prompt the nurse to contact the registered nurse to seek clarification from the gastroenterologist?

clear liquid diet

A client who is receiving total parenteral nutrition (TPN) complains of a headache. The nurse notes that the client has an increased blood pressure and a bounding pulse. The nurse reports the findings, knowing that these signs/symptoms are indicative of which complication of this therapy?

fluid overload

The nurse is reinforcing discharge instructions to a client after a gastrectomy. Which measure would the nurse include during client teaching to help prevent dumping syndrome?

limit the fluids taken with meals

Which information would the nurse include when reinforcing client teaching regarding ostomy care? Select all that apply.

- empty pouch when 1/3 to 1/2 full - stoma should be moist and pink to red - skin barrier should be within 1/16 to 1/8 inch of the stoma - change the appliance about every 3 days or sooner if its leaking

A morbidly obese client, 3 days postoperative gastric bypass surgery, comes to the clinic complaining of pain. The nurse suspects that the client has an anastomotic leak requiring hospitalization. The nurse would determine that which findings best validate this suspicion? Select all that apply.

- oliguria - restlessness - abdominal pain - unexplained tachycardia

The client arrives at an emergency department complaining of severe abdominal pain. The initial diagnosis is acute abdomen, and an x-ray and an abdominal ultrasonogram are prescribed to be obtained immediately. The nurse prepares the client for these diagnostic tests and reviews the primary health care provider's prescriptions. Which prescription would the nurse most likely question if written on the primary health care provider's prescription form?

Administration of an opioid analgesic4

A client with a diagnosis of acute pancreatitis is experiencing severe pain. After noting an absence of an analgesic prescription on the primary health care provider prescription sheet, the nurse would suggest contacting the primary health care provider to request a prescription for which medication?

hydromorphone

The client admitted to the hospital with a diagnosis of viral hepatitis is complaining of a loss of appetite. In order to provide adequate nutrition, which action would the nurse encourage the client to take?

increase intake of fluids

The nurse is monitoring a client for the early signs and symptoms of dumping syndrome. Which findings indicate this occurrence?

sweating and pallor

The nurse is collecting assessment data on an assigned client. Which assessment findings support that the client is experiencing dehydration? Select all that apply.

- dark urine - cracked lips -UOP of 20ml in the past hour

The nurse who is reinforcing instructions to a client who has had a gastric resection would include which considerations? Select all that apply.

- eat small frequent meals - take action to prevent dumping syndrome

The nurse is assisting in assessing a client who was in a motor vehicle crash and experienced blunt trauma to the abdomen. The nurse is told that on auscultation of the abdomen, a bruit is heard. Which complication would the nurse suspect?

aortic aneurysm

The nurse is caring for a client following an esophagogastroduodenoscopy (EGD) done to confirm the diagnosis of esophageal stricture. Which assessment is priority after this procedure to promote client safety?

gag reflex

The nurse is assisting in caring for a client with a large penetrating wound to the abdomen and several smaller wounds containing shrapnel. The nurse plans for which appropriate nursing interventions? Select all that apply.

- apply pressure to bleeding wounds - obtain blood for a type and crossmatch - apply supplement oxygen as ordered - establish IUV access with 2 large bore catheters

The nurse is reviewing the primary health care provider's (PHCP'S) prescriptions written for a client admitted with acute pancreatitis. Which PHCP prescription would the nurse verify if noted in the client's chart?

supine and flat client positioning

The nurse is reviewing the prescriptions of a client admitted to the hospital with a diagnosis of acute pancreatitis. Which interventions would the nurse expect to be prescribed? Select all that apply.

- administer antacids as prescribed - encourage coughing and deep breathing - administer anticholinergics, as prescribed

The client in an emergency department reports right lower quadrant abdominal pain. After noting a white blood cell count of 16,500 cells/mm3, the nurse should question which prescriptions? Select all that apply.

- mom - heat pad to the abdomen

The nurse is assisting with admitting a client to the hospital for the treatment of diagnosed dehydration. The client reports nausea, vomiting, diarrhea, and cramping for the past week. The nurse asks the client about medications being taken. The client denies taking prescription medications but states he has been taking some herbs given to him by a cousin. The nurse would alert the registered nurse when the client states he has been taking which herb?

senna