Adult health

Infection with Helicobacter pylori

A client presents to the clinic reporting vomiting and burning in the mid-epigastrium. Which causative factor will the nurse identify may be the cause of these symptoms?

Report of extreme hunger 3 hours after eating Sudden onset of extreme shakiness and fatigue

A client recovering from surgery to resect a gastric tumor reports abdominal cramping and diarrhea after eating. Which additional symptoms will the nurse use to determine if the client is experiencing dumping syndrome? Select all that apply.

Tachycardia Hypotension Tachypnea

A client who experienced an upper gastrointestinal (GI) bleed due to peptic ulcer disease has had the bleeding controlled and is now in stable condition. Which assessment finding(s) would the nurse identify that indicate recurrence? Select all that apply.

The appendix is in the right lower quadrant.

A nurse is assisting with preoperative care for a client who requires an appendectomy. The nurse is aware that the surgery will involve which abdominal quadrant? Mark the correct area.

drink liquids only between meals.

A nurse is caring for a client who underwent a subtotal gastrectomy. To manage dumping syndrome, the nurse should advise the client to:

Acetaminophen

An important message for any nurse to communicate is that drug-induced hepatitis is a major cause of acute liver failure. The medication that is the leading cause is:

Pancakes with butter and honey, and orange juice

The nurse is teaching a client who was admitted to the hospital with acute hepatic encephalopathy and ascites about an appropriate diet. The nurse determines that the teaching has been effective when the client chooses which food choice from the menu?

Increase in the amount of fluids

The nurse is working on a general medical unit. A client is scheduled for an upper gastrointestinal series. Upon returning to the nursing unit, what does the nurse identify as the client goal?

pain 2 to 3 hours after a meal.

The nurse recognizes that the client diagnosed with a duodenal ulcer will likely experience

small bowel enteroscopy

Which procedure is performed to examine and visualize the lumen of the small bowel?

Increased peristalsis

Which response is a parasympathetic response in the GI tract?

Risk for infection

A client with a cyst has been brought for care. The nurse who is contributing to the client's care knows that treatment will be chosen based on what risk?

Administering morphine I.V. as ordered

A client with a history of alcohol abuse comes to the emergency department and complains of abdominal pain. Laboratory studies help confirm a diagnosis of acute pancreatitis. The client's vital signs are stable, but the client's pain is worsening and radiating to his back. Which intervention takes priority for this client?

A regimen of antiviral medications

A client with a history of injection drug use has been diagnosed with hepatitis C. When collaborating with the care team to plan this client's treatment, the nurse should anticipate what intervention?

"The test is noninvasive."

A client with a recent history of intermittent bleeding is undergoing capsule endoscopy to determine the source of the bleeding. When explaining this diagnostic test to the client, what advantage should the nurse describe?

Glucose metabolism Ammonia conversion Protein metabolism

A nursing student is reviewing for an upcoming anatomy and physiology examination. Which of the following would the student correctly identify as a function of the liver? Select all that apply.

Edema and Inflammation

A patient is diagnosed with mild acute pancreatitis. What does the nurse understand is characteristic of this disorder?

A partial gastrectomy is performed with anastomosis of the stomach segment to the duodenum.

A patient is scheduled for a Billroth I procedure for ulcer management. What does the nurse understand will occur when this procedure is performed?

Jaundice, ascites, clubbing of the fingers

The nurse assesses a patient who is diagnosed with decompensated cirrhosis. Which of the following are clinical indicators consistent with that diagnosis? Select all that apply.

Its course is prolonged and variable

The nurse is comparing Crohn's disease (regional enteritis) with ulcerative colitis. Which of the following describes Crohn's disease? The course of Crohn's disease is prolonged and variable whereas ulcerative colitis follows a pattern of exacerbations and remissions. In Crohn's disease, bleeding usually does not occur but tends to be mild when it does occur; fistulas are common, and diarrhea is less severe than it is with ulcerative colitis.

Peptic ulcers

The nurse is conducting a community education class on gastritis. The nurse includes that chronic gastritis caused by Helicobacter pylori is implicated in which disease/condition?

ulcerative colitis

The nurse is conducting a gastrointestinal assessment. When the client reports the presence of mucus and pus in the stool, the nurse assesses for additional signs/symptoms of which disease/condition?

Epigastric area and consider possible radiation of pain to the right subscapular region

The nurse is investigating a client's report of pain in the duodenal area. Where should the nurse perform the assessment?

Rigidity of the abdomen

A client who had surgery for gallbladder disease has just returned to the postsurgical unit from postanesthetic recovery. The nurse caring for this client knows to immediately report what assessment finding to the health care provider?

The client will take immunosuppressive agents as required.

A client who has undergone liver transplantation is ready to be discharged home. Which outcome of health education should the nurse prioritize?

Crohn disease (Crohn's)

A client with a 10-year history of Crohn disease is seeing the physician due to increased diarrhea and fatigue. Additionally, the client has developed arthritis and conjunctivitis. What is the most likely cause of the latest symptoms? The systemic nature of Crohn disease is evidenced by symptoms outside the GI tract, referred to as extraintestinal manifestations of IBD. They include arthritis, arthralgias, skin lesions, eye inflammation (uveitis, conjunctivitis, and iritis), and disorders of the liver and gallbladder.

weight loss

A client with chronic pancreatitis is treated for uncontrolled pain. Which complication does the nurse recognize is most common in the client with chronic pancreatitis?

The client will be monitored closely to detect malignant changes.

A client with gastroesophageal reflux disease (GERD) has a diagnosis of Barrett esophagus with minor cell changes. What principle should be integrated into the client's subsequent care?

Spironolactone

A client with liver cirrhosis develops ascites. Which medication will the nurse prepare teaching for this client?

Reduction in sodium intake

A client with liver disease has developed ascites; the nurse is collaborating with the client to develop a nutritional plan. The nurse should prioritize which of the following in the client's plan?

increased bilirubin

A client's abdominal ultrasound indicates cholelithiasis. When the nurse is reviewing the client's laboratory studies, what finding is most closely associated with this diagnosis?

Disposing of sharps appropriately and not recapping needles

A group of nurses attended an inservice on the prevention of occupationally acquired diseases that affect health care providers. What action has the greatest potential to reduce a nurse's risk of acquiring hepatitis C (HCV ) in the workplace?

Multiparous Obese Older than 40 years old History of diabetes mellitus

A nurse admits a woman reporting severe right upper quadrant pain after eating dinner. What client risk factors lead the nurse to suspect gallbladder disease? Select all that apply.

To reduce intestinal bacteria levels

A nurse caring for a patient with colorectal cancer is preparing the patient for upcoming surgery. The nurse administers cephalexin (Keflex) to the patient and explains what rationale?

Infection typically occurs due to ingestion of contaminated food and water.

A nurse is assessing a client who has peptic ulcer disease. The client requests more information about the typical causes of Helicobacter pylori infection. What would it be appropriate for the nurse to instruct the client?

Report possible signs of aspiration pneumonia to the primary provider.

A nurse is caring for a client with a nasogastric tube for feeding. During shift assessment, the nurse auscultates a new onset of bilateral lung crackles and notes a respiratory rate of 30 breaths per minute. The client's oxygen saturation is 89% by pulse oximetry. After ensuring the client's immediate safety, what is the nurse's most appropriate action?

Clay color stool

A nurse is caring for a client with cholelithiasis. Which sign indicates obstructive jaundice? Obstructive jaundice develops when a stone obstructs the flow of bile in the common bile duct. When the flow of bile to the duodenum is blocked, the lack of bile pigments results in a clay-colored stool. In obstructive jaundice, urine tends to be dark amber (not straw-colored) as a result of soluble bilirubin in the urine. Hematocrit levels aren't affected by obstructive jaundice. Because obstructive jaundice prevents bilirubin from reaching the intestine (where it's converted to urobilinogen), the urine contains no urobilinogen.

The client's hepatic function is decreasing

A nurse is caring for a client with cirrhosis. The nurse assesses the client at noon and discovers that the client is difficult to arouse and has an elevated serum ammonia level. The nurse should suspect which situation?

Erosion of the lining of the stomach or intestine

A nurse is preparing to discharge a client after recovery from gastric surgery. What is an appropriate discharge outcome for this client?

Engage the client in dialogue about the implications of having the colostomy.

A nurse is providing care for a client whose recent colostomy has contributed to a nursing diagnosis of Disturbed Body Image Related to Colostomy. What intervention best addresses this diagnosis?

Self-digestion of the pancreas by its own proteolytic enzymes

A nurse is teaching a client about the cause of acute pancreatitis. The nurse evaluates the teaching as effective when the client correctly identifies which condition as a cause of acute pancreatitis?

hypoactive

A nursing student has auscultated a client's abdomen and noted two bowel sounds in a 1-minute period of time. How would you tell the student to document the client's bowel sounds? Sounds like gurgles and normally occurs every 5-20 seconds Hypoactive- one or two sounds in 2minutes five to six sounds in under 30 seconds 5-30 bowel sounds per minute (about 2 sounds every 5 seconds).normal (5 to 34 sounds heard per minute)

gastroesophageal reflux disease (GERD)

A patient describes a burning sensation in the esophagus, pain when swallowing, and frequent indigestion. What does the nurse suspect that these clinical manifestations indicate? Symptoms may include pyrosis (burning sensation in the esophagus), dyspepsia (indigestion), regurgitation, dysphagia or odynophagia (pain on swallowing), hypersalivation, and esophagitis.

bowel perforation

A patient is admitted to the hospital after not having had a bowel movement in several days. The nurse observes the patient is having small liquid stools, a grossly distended abdomen, and abdominal cramping. What complication can this patient develop related to this problem?

low platelet count

A physician has ordered a liver biopsy for a client with cirrhosis whose condition has recently deteriorated. The nurse reviews the client's recent laboratory findings and recognizes that the client is at risk for complications due to:

Decompression

A preoperative client scheduled to have an open cholecystectomy says to the nurse, "The doctor said that after surgery, I will have a tube in my nose that goes into my stomach. Why do I need that?" What most common reason for a client having a nasogastric tube in place after abdominal surgery should the nurse include in a response?

"You must have the second one in 1 month and the third in 6 months."

A student accepted into a nursing program must begin receiving the hepatitis B series of injections. The student asks when the next two injections should be administered. What is the best response by the instructor?

Awaiting the results of a pregnancy test

A young adult client is prescribed misoprostol to prevent gastric ulcers caused by frequent use of nonsteroidal anti-inflammatory agents for an autoimmune disorder. For which reason will the nurse question giving the client a dose of this medication?

Decreased mucus secretion Decreased tone of internal anal sphincter

The nurse is performing an abdominal assessment of an older adult client. Which age-related change(s) in gastrointestinal structure and function will the nurse include in the assessment? Select all that apply.

Vasopressin

Which medication is used to decrease portal pressure, halting bleeding of esophageal varices?

pancreatitis

Which of the following conditions is most likely to involve a nursing diagnosis of fluid volume deficit?

Long term use of alcohol

Which of the following is commonly associated with acute episodes of pancreatitis?

removal of tumor

Which of the following is the most successful treatment for gastric cancer?

Asterixis

Which of the following would the nurse expect to assess in a conscious client with hepatic encephalopathy?

The bed automatically moves, so she's less likely to develop pressure sores while she's in bed."

The family of a client in the ICU diagnosed with acute pancreatitis asks the nurse why the client has been moved to an air bed. What would be the nurse's best response?

Fluids must be increased to facilitate the evacuation of the stool.

An adult client is scheduled for an upper GI series that will use a barium swallow. What teaching should the nurse include about what the client should expect after the test is completed?

Have the client refrain from food and fluids after midnight.

A client has been scheduled for an ultrasound of the gallbladder the following morning. What should the nurse do in preparation for this diagnostic study?

colonoscopy

A client has come to the outpatient radiology department for diagnostic testing that will allow the care team to evaluate and remove polyps. The nurse should prepare the client for what procedure?

Anorexia , nausea and vomiting

A client has just been diagnosed with hepatitis A. On assessment, the nurse expects to note:

Streaks of blood present in the stool

A client has returned to the medical unit after a barium enema. When assessing the client's subsequent bowel patterns and stools, what finding would warrant reporting to the health care provider?

"Do not take any NSAIDs within 72 hours of the test."

A client has sought care because of recent dark-colored stools. As a result, a fecal occult blood test has been ordered. The nurse should give what instructions to the client?

On the right side

A client has undergone a liver biopsy. After the procedure, the nurse should place the client in which position?

Test all stools for occult blood.

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?

Persistently low hemoglobin An abnormally low hematocrit

A client is assessed for a suspected deficit in intrinsic factor synthesis. Which diagnostic or assessment finding(s) is/are the most likely rationale(s) for this examination?

Scurvy

Clients with chronic liver dysfunction have problems with insufficient vitamin intake. Which may occur as a result of vitamin C deficiency?

hemorrhoids

A client asks the nursing assistant for a bedpan. When the client is finished, the nursing assistant notifies the nurse that the client has bright red streaking of blood in the stool. The nurse's assessment should focus on what potential cause?

"The pain stopped so I stopped taking the medications."

A client being treated for a peptic ulcer seeks medical attention for vomiting blood. Which statement indicates to the nurse the reason for the client developing hematemesis?

Place hand under right lower rib cage and press down lightly with the other hand.

A nurse is performing an admission assessment of a client with a diagnosis of cirrhosis. What technique should the nurse use to palpate the client's liver?

"It indicates if a cancer is present."

A client asks the nurse why the physician ordered the blood test carcinoembryonic antigen (CEA). The nurse answers:

duodenum

Cystic fibrosis, a genetic disorder characterized by pulmonary and pancreatic dysfunction, usually appears in young children but can also affect adults. If the pancreas was functioning correctly, where would the bile and pancreatic enzymes enter the GI system?

Medulla oblongata V cranial nerve (CN) VII cranial nerve (CN)

Damage to what structure(s) most affects the client's ability to swallow? Select all that apply.

The possibility of surgery, chemotherapy and radiotherapy

Diagnostic testing of a client with a history of dyspepsia and abdominal pain has resulted in a diagnosis of gastric cancer. The nurse's anticipatory guidance should include what information?

"Hydrochloric acid is secreted by glands in the stomach in response to the actual or anticipated presence of food."

How would the nurse explain the formation and role of acid in the stomach?

23 feet

In client education with a client who has a lower GI study scheduled, the nurse describes the organs involved and their characteristics. Approximately how long are the jejunum and the ileum if their lengths are combined?

To relax colonic musculature and reduce spasm.

The nurse is assisting the health care provider with a colonoscopy for a client with rectal bleeding. The health care provider requests the nurse to administer glucagon during the procedure. Why is the nurse administering this medication during the procedure?

abdominal cramps

The nurse is caring for a client recovering from a colonoscopy. Which assessment finding will the nurse expect in the client after the procedure?

7 months

Ursodeoxycholic acid (UDCA) has been used to dissolve small, radiolucent gallstones. Which duration of therapy is required to dissolve the stones?

Increased abdominal girth Rapid weight gain Stretch marks Visible distended veins

What does the nurse recognize as clinical manifestations consistent with ascites? Select all that apply.

Pad the side rails on the bed

What initial measure can the nurse implement to reduce risk of injury for a client with liver disease?

Albumin infusion

What intervention does the nurse anticipate providing for the patient with ascites that will help correct the decrease in effective arterial blood volume that leads to sodium retention?

adhesions

What is the most common cause of small-bowel obstruction?

Low fat diet

What is the recommended dietary treatment for a client with chronic cholecystitis?

Checking if the mucus membranes are dry

When examining the skin of a client who is dehydrated due to fluid losses from the gastrointestinal tract, which of the following would be most important?

Lying on the left side with legs drawn toward the chest

When providing health education to a client scheduled for a colonoscopy the nurse should explain that they will be placed in what position during this diagnostic test?

fissure

fissure

ineffective breathing pattern

he assessment of a client admitted with increased ascites related to cirrhosis reveals the following: pulse 86 beats per minute and weak, respirations 28 breaths per minute, blood pressure 130/88 mm Hg, and pulse oximetry 90%. Which nursing diagnosis should receive top priority?

IV hydromorphone

A client has been diagnosed with acute pancreatitis. The nurse is addressing the client's acute pain. What pharmacologic intervention is most likely to be ordered for this client?

drug-drug interactions

A client has been prescribed cimetidine for the treatment of peptic ulcer disease. When providing relevant health education for this client, the nurse should ensure the client is aware of what potential outcome?

Hepatic encephalopathy

A client has an elevated serum ammonia concentration and is exhibiting changes in mental status. The nurse should suspect which condition?

Interact with the client in a relaxed manner. Help identify the client's current stressors. Discuss potential coping techniques with the client. Offer information about relaxation methods.

A client diagnosed with a peptic ulcer says, "Now I have something else I have to worry about." Which actions will the nurse take to help reduce the client's anxiety? Select all that apply.

Frequent screening for osteoporosis

A client experiencing disturbing gastrointestinal (GI) symptoms that have been worsening in severity has been diagnosed with lactose intolerance. The nurse should recognize an increased need for what form of health promotion?

Hemorrhoids, enlarged liver, ascites.

A client is given a diagnosis of hepatic cirrhosis. The client asks the nurse what findings led to this determination. Which of the following clinical manifestations would the nurse correctly identify? Select all that apply.

Provide cleansing enemas until clear Maintain nothing by mouth until after the test

A client is scheduled for a barium enema later in the day. Which actions will the nurse take to prepare the client on the morning of the test? Select all that apply.

Ingest nothing by mouth after midnight

A client is scheduled for an upper gastrointestinal barium study. Which teaching will the nurse provide for the client to prepare for this diagnostic test?

Reduced or absent bile as a result of obstruction impacts digestion.

A client is treated for gastrointestinal problems related to chronic cholecystitis. What pathophysiological process related to cholecystitis does the nurse understand is the reason behind the client's GI problems?

An abnormal glucose tolerance Glucosuria Hyperglycemia

A patient is suspected to have pancreatic carcinoma and is having diagnostic testing to determine insulin deficiency. What would the nurse determine is an indicator for insulin deficiency in this patient? (Select all that apply).

"This medication will reduce the amount of acid secreted in your stomach."

A patient with a diagnosis of peptic ulcer disease has just been prescribed omeprazole (Prilosec). How should the nurse best describe this medication's therapeutic action?

Alanine aminotransferase (ALT) Gamma-glutamyl transferase (GGT) Aspartate aminotransferase (AST)

A patient's physician has ordered a "liver panel" in response to the patient's development of jaundice. When reviewing the results of this laboratory testing, the nurse should expect to review what blood tests? Select all that apply.

Loss of teeth Weakened gag reflex Atrophy of taste buds Reduced saliva production Less ptyalin and amylase in saliva

An older client reports difficulty chewing and swallowing. Which age-related changes will the nurse suspect as the reasons for the client's symptoms? Select all that apply.

10 inches

It is suspected that a client might have a problem in the duodenum and the client is scheduled to have GI studies done in the morning. In client education, the nurse describes the procedure and includes basic information about anatomy and the function of the organs involved. The client asks how long the duodenum is. What is the nurse's best response?

Avoid bismuth subsalicylate before the test. Do not take proton pump inhibitors before the test.

The nurse is caring for a client who is scheduled for a urea breath test to detect for Helicobacter pylori as a reason for gastric distress. Which instruction(s) will the nurse provide to the client to prepare for this test? Select all that apply.

Bring the connection tubing if going to the hospital.

The nurse is caring for a client who had a low-profile gastrostomy device placed. Which instruction should the nurse give the client and family?

carbohydrate digestion

The nurse is caring for a client with a biliary disorder who has an elevated amylase level. If this elevation correlates to dysfunction, which body process does the nurse recognize may be impaired?

hyperactive

The nurse auscultates the abdomen to assess bowel sounds. She documents five to six sounds heard in less than 30 seconds. How does the nurse document the bowel sounds?

watery diarrhea

The nurse is administering Cephulac (lactulose) to decrease the ammonia level in a patient who has hepatic encephalopathy. What should the nurse carefully monitor for that may indicate a medication overdose?

How much alcohol do you consume in a day?

The nurse is assessing a client admited with suspected pancreatitis. Which question will the nurse prioritize when assessing this client?

Pentagastrin

The nurse is assisting the health care provider with a gastric acid stimulation test for a client. What medication should the nurse prepare to administer subcutaneously to stimulate gastric secretions?

Gastroesophageal sphincter is intact, lessening the possibility of regurgitation.

The nurse is caring for a comatose patient and administering gastrostomy feedings. What does the nurse understand is the reason that gastrostomy feedings are preferred to nasogastric (NG) feedings in the comatose patient?

Measure abdominal girth daily. Perform daily weights.

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.)

The client's hands flap back and forth when the arms are extended.

The nurse is completing a morning assessment of a client with cirrhosis. Which information obtained by the nurse will be of most concern?

cannot tolerate a high glucose concentration.

Total parental nutrition (TPN) should be used cautiously in clients with pancreatitis because they

watery diarrhea

Which condition indicates an overdose of lactulose?

Bisacodyl

Which drug is considered a stimulant laxative?

Clay-colored stools

Which is a clinical manifestation of cholelithiasis?

dirrhea

Which is one of the primary symptoms of irritable bowel syndrome (IBS)?

portal hypertension

Which is the most common cause of esophageal varices?

Gastric ulcer Gastric cancer Duodenal ulcer pernicious anemia

A client is being scheduled for a gastric analysis test. The nurse knows that which conditions can be diagnosed from this type of test? Select all that apply.

Maintain the client in a semi-Fowler position whenever possible.

A client is being treated on the acute medical unit for acute pancreatitis. The nurse has identified an ineffective breathing pattern in the client related to pain. What intervention should the nurse perform to best address this?

Acute pain related to biliary spasms

A client is evaluated for severe pain in the right upper abdominal quadrant, which is accompanied by nausea and vomiting. The physician diagnoses acute cholecystitis and cholelithiasis. For this client, which nursing diagnosis takes top priority?

The client's hepatic function is decreasing.

A nurse is caring for a client with cirrhosis. The nurse assesses the client at noon and discovers that the client is difficult to arouse and has an elevated serum ammonia level. The nurse should suspect which situation?

Stomach emptying takes place more slowly.

A nurse is caring for an 83-year-old client who is being assessed for recurrent and intractable nausea. What age-related change to the gastrointestinal (GI) system may be a contributor to the client's health complaint?

The family's ability to provide emotional support

A nurse is planning discharge teaching for a 21-year-old client with a new diagnosis of ulcerative colitis. When planning family assessment, the nurse should recognize that which of the following factors will likely have the greatest impact on the client's coping after discharge?

Metoclopramide

The nurse is providing discharge instructions for a slightly overweight client seen in the Emergency Department with gastroesophageal reflux disease (GERD). The nurse notes in the client's record that the client is taking carbidopa/levodopa. Which order for the client by the health care provider should the nurse question?

The client must fast for 8 hours before the examination. The throat will be sprayed with a local anesthetic. After gastroscopy, the client cannot eat or drink until the gag reflex returns (1 to 2

The nurse is providing instructions to a client scheduled for a gastroscopy. What should the nurse be sure to include in the instructions? Select all that apply.