43: Assessment: Gastrointestinal System

The nurse is caring for a patient with an obstructed common bile duct. What condition should the nurse expect?

b. Steatorrhea A common bile duct obstruction will reduce the absorption of fat in the small intestine, leading to fatty stools. Gastrointestinal bleeding is not caused by common bile duct obstruction. Serum cholesterol levels are increased with biliary obstruction. Direct bilirubin level is increased with biliary obstruction.

Which finding by the nurse during abdominal auscultation indicates a need for a focused abdominal assessment?

. Absent bowel sounds Absent bowel sounds are abnormal and require further assessment by the nurse. The other sounds may be heard normally.

A 58-yr-old patient has just returned to the nursing unit after an esophagogastroduodenoscopy (EGD). Which action by unlicensed assistive personnel (UAP) requires that the registered nurse (RN) intervene?

a. Offering the patient a pitcher of water Immediately after EGD, the patient will have a decreased gag reflex and is at risk for aspiration. Assessment for return of the gag reflex should be done by the RN. The other actions by the UAP are appropriate.

A patient is being scheduled for endoscopic retrograde cholangiopancreatography (ERCP) as soon as possible. Which prescribed action should the nurse take first?

a. Place the patient on NPO status. The patient will need to be NPO for 8 hours before the ERCP is done, so the nurse's initial action should be to place the patient on NPO status. The other actions can be done after the patient is NPO.

The nurse receives the following information about a patient who is scheduled for a colonoscopy. Which information should be communicated to the health care provider before sending the patient for the procedure?

a. The patient declined to drink the prescribed laxative solution. If the patient has had inadequate bowel preparation, the colon cannot be visualized and the procedure would be rescheduled. Because contrast solution is not used during colonoscopy, the iodine allergy is not pertinent. A pacemaker is a contraindication to magnetic resonance imaging but not to colonoscopy. The nurse should instruct the patient about the sedation used during the examination to decrease the patient's anxiety about discomfort

The nurse is assessing an alert and independent older adult patient for malnutrition risk. Which is the most appropriate initial question?

b. "Can you tell me the food that you ate yesterday?" This question is the most open-ended and will provide the best overall information about the patient's daily intake and risk for poor nutrition. The other questions may be asked, depending on the patient's response to the first question.

An older patient reports chronic constipation. To promote bowel evacuation, when should the nurse suggest that the patient attempt defecation?

b. After eating breakfast The gastrocolic reflex is most active after the first daily meal. Awakening, the anticipation of eating, and mid-afternoon timing do not stimulate these reflexes

An adult with a body mass index (BMI) of 22 kg/m2 is being admitted to the hospital for elective knee surgery. Which assessment finding should the nurse report to the health care provider?

b. Liver edge 3 cm below the costal margin Normally the lower border of the liver is not palpable below the ribs, so this finding suggests hepatomegaly. Visible aortic pulsations in the epigastrium, active bowel sounds, and abdominal tympany are within normal findings for an adult of normal weight.

Which is the correct technique for the nurse to palpate the liver during a head-to-toe physical assessment?

b. Place one hand on the patient's back and press upward and inward with the other hand below the patient's right costal margin The liver is normally not palpable below the costal margin. The nurse needs to push inward below the right costal margin while lifting the patient's back slightly with the left hand. The other methods will not allow palpation of the liver.

What action should the nurse take after assisting with a needle biopsy of the liver at a patient's bedside?

b. Place the patient on the right side with the bed flat. After a biopsy, the patient lies on the right side with the bed flat to splint the biopsy site. Coagulation studies are checked before the biopsy. A sandbag does not exert adequate pressure to splint the site.

While interviewing a young adult patient, the nurse learns that the patient has a family history of familial adenomatous polyposis (FAP). What area of patient knowledge should the nurse plan to assess?

c. Risk for developing colorectal cancer FAP is a genetic condition that greatly increases the risk for colorectal cancer. Noninfectious hepatitis, use of medications that treat increased gastric pH, and inflammatory bowel disease are not related to FAP.

A patient has just arrived in the recovery area after an upper endoscopy. Which information collected by the nurse is most important to communicate to the health care provider?

c. The oral temperature is 101.4° F. A temperature elevation may indicate that an acute perforation has occurred. The other assessment data are normal immediately after the procedure.

Which information about an 80-yr-old male patient at the senior center is of most concern to the nurse?

c. Unintended weight loss Unintentional weight loss is not a normal finding and may indicate a problem such as cancer or depression. Poor appetite, difficulty in chewing, and indigestion are common in older patients. These will need to be addressed but are not of as much concern as the weight loss

Which statement to the nurse from a patient with jaundice indicates a need for teaching?

d. "I use acetaminophen (Tylenol) every 4 hours for pain." Chronic use of high doses of acetaminophen can be hepatotoxic and may have caused the patient's jaundice. The other patient statements require further assessment by the nurse but do not indicate a need for patient education

What condition should the nurse anticipate when caring for a patient with a history of a total gastrectomy?

d. Cobalamin (vitamin B12) deficiency The patient with a total gastrectomy does not secrete intrinsic factor, which is needed for cobalamin (vitamin B12) absorption. Because the stomach absorbs only small amounts of water and nutrients, the patient is not at higher risk for dehydration, elevated cholesterol, or constipation.

A patient is admitted to the outpatient testing area for an ultrasound of the gallbladder. Which information obtained by the nurse indicates that the ultrasound may need to be rescheduled?

d. The patient ate a low-fat bagel 4 hours ago for breakfast. Food intake can cause the gallbladder to contract and result in a suboptimal study. The patient should be NPO for 8 to 12 hours before the test. A high-fat meal the previous evening, laxative use, or a gastrostomy tube will not affect the results of the study.