Adult Med- Surge GI: Constipation - Surgeries

Care for the postoperative client after gastric resection should focus on which of the following problems? 1. Body image 2. Nutritional needs 3. Skin care 4. Spiritual needs

2. Nutritional needs After gastric resection, a client may require total parenteral nutrition or jejunostomy tube feedings to maintain adequate nutritional status.

During the first few days of recovery from ostomy surgery for ulcerative colitis, which of the following aspects should be the first priority of client care? 1. Body image 2. Ostomy care 3. Sexual concerns 4. Skin care

2. Ostomy care Although all of these are concerns the nurse should address, being able to safely manage the ostomy is crucial for the client before discharge.

This condition is characterized by a board like abdomen, rebound tenderness and treatment includes IV fluids and antibiotics and NG tube to suction. 1. Megacolon 2. Peritonitis "Hot belly" 3. Appendicitis 4. Diverticulitis

2. Peritonitis "Hot Belly" Other clinical manifestations include:Increased pulse, increased BP, dehydration, pain, decreased bowel sounds, fever, N&V, and anorexia.

What are the complications associated with valsalva maneuver? (select all that apply) 1. Increased pressure in chest 2. Hemorrhoids 3. Increased blood pressure 4. Syncope

1, 3, and 4

Which of the following complications is thought to be the most common cause of appendicitis? 1. A fecalith 2. Bowel kinking 3. Internal bowel occlusion 4. Abdominal bowel swelling

1. A fecalith A fecalith is a fecal calculus, or stone, that occludes the lumen of the appendix and is the most common cause of appendicitis. Bowel wall swelling, kinking of the appendix, and external occlusion, not internal occlusion, of the bowel by adhesions can also be causes of appendicitis.

Which of the following terms best describes the pain associated with appendicitis? 1. Aching 2. Fleeting 3. Intermittent 4. Steady

1. A fecalith A fecalith is a fecal calculus, or stone, that occludes the lumen of the appendix and is the most common cause of appendicitis. Bowel wall swelling, kinking of the appendix, and external occlusion, not internal occlusion, of the bowel by adhesions can also be causes of appendicitis.

Which of the following areas is the most common site of fistulas in client's with Crohn's disease? 1. Anorectal 2. Ileum 3. Rectovaginal 4. Transverse colon

1. Anorectal Fistulas occur in all these areas, but the anorectal area is most common because of the relative thinness of the intestinal wall in this area.

The nurse instructs the ileostomy client to do which of the following as a part of essential care of the stoma? 1. Cleanse the peristomal skin meticulously 2. Take in high-fiber foods such as nuts 3. Massage the area below the stoma 4. Limit fluid intake to prevent diarrhea.

1. Cleanse the peristomal skin meticulously The peristomal skin must receive meticulous cleansing because the ileostomy drainage has more enzymes and is more caustic to the skin than colostomy drainage. Foods such as nuts and those with seeds will pass through the ileostomy. The client should be taught that these foods will remain undigested. The area below the ileostomy may be massaged if needed if the ileostomy becomes blocked by high fiber foods. Fluid intake should be maintained to at least six to eight glasses of water per day to prevent dehydration.

Fistulas are most common with which of the following bowel disorders? 1. Crohn's disease 2. Diverticulitis 3. Diverticulosis 4. Ulcerative colitis

1. Crohn's disease The lesions of Crohn's disease are transmural; that is, they involve all thickness of the bowel. These lesions may perforate the bowel wall, forming fistulas with adjacent structures. Fistulas don't develop in diverticulitis or diverticulosis. The ulcers that occur in the submucosal and mucosal layers of the intestine in ulcerative colitis usually don't progress to fistula formation as in Crohn's disease.

What is the location of clinical manifestation for Crohn's Disease? 1. Distal ileum, ascending colon 2. Rectum, descending colon 3. Stomach 4. Small intestine

1. Distal ileum, ascending colon

Which of the following symptoms would a client in the early stages of peritonitis exhibit? 1. Abdominal distention 2. Abdominal pain and rigidity 3. Hyperactive bowel sounds 4. Right upper quadrant pain

2. Abdominal pain and rigidity Abdominal pain causing rigidity of the abdominal muscles is characteristic of peritonitis. Abdominal distention may occur as a late sign but not early on. Bowel sounds may be normal or decreased but not increased. Right upper quadrant pain is characteristic of cholecystitis or hepatitis.

The nurse is preparing to administer all of a patient's medications via feeding tube. The nurse consults the pharmacist and/ or physician when the nurse notes on the patient's medication administration record which of the following types of oral medication? 1. Enteric-coated tablets 2. Buccal or sublingual tablets 3. Simple compressed tablets 4. Soft gelatin capsules filled with liquid

1. Enteric-coated tablets Enteric-coated tablet are meant to be digested in the intestinal tract and may be destroyed by stomach acids. A change in the form of medication is necessary for patients with tube feedings. Simple compressed tablet may be crushed and dissolved in water for patients receiving oral medications by feeding tube. Buccal or sublingual tablets are absorbed by mucous membranes and may be given as intended to the patient undergoing tube feedings. The nurse may make an opening in the capsule and squeeze out contents for administration by feeding tube.

Which of the following aspects is the priority focus of nursing management for a client with peritonitis? 1. Fluid and electrolyte balance 2. Gastric irrigation 3. Pain management 4. Psychosocial issues

1. Fluid and electrolyte balance Peritonitis can advance to shock and circulatory failure, so fluid and electrolyte balance is the priority focus of nursing management. Gastric irrigation may be needed periodically to ensure patency of the nasogastric tube. Although pain management is important for comfort and psychosocial care will address concerns such as anxiety, focusing on fluid and electrolyte imbalance will maintain hemodynamic stability.

Other than patient hx and physical exams how else can constipation be diagnosed? (select all that apply) 1. Kidney Ureter Bladder X- ray 2. Upper endoscopy 3. barium enema 4. sigmoidoscopy

1. Kidney Ureter Bladder X- ray= to look at bowels 3. barium enema 4. sigmoidoscopy

Which of the following types of diets is implicated in the development of diverticulosis? 1. Low-fiber diet 2. High-fiber diet 3. High-protein diet 4. Low-carbohydrate diet

1. Low-fiber diet Low-fiber diets have been implicated in the development of diverticula because these diets decrease the bulk in the stool and predispose the person to the development of constipation. A high-fiber diet is recommended to help prevent diverticulosis. A high-protein or low-carbohydrate diet has no effect on the development of diverticulosis.

The client with Crohn's disease has a nursing diagnosis of acute pain. The nurse would teach the client to avoid which of the following in managing this problem? 1. Lying supine with the legs straight 2. Massaging the abdomen 3. Using antispasmodic medication 4. Using relaxation techniques

1. Lying supine with the legs straight The pain associated with Crohn's disease is alleviated by the use of analgesics and antispasmodics and also is reduced by having the client practice relaxation techniques, applying local cold or heat to the abdomen, massaging the abdomen, and lying with the legs flexed. Lying with the legs extended is not useful because it increases the muscle tension in the abdomen, which could aggravate the inflamed intestinal tissues as the abdominal muscles are stretched.

Which of the following symptoms indicated diverticulosis? 1. No symptoms exist 2. Change in bowel habits 3. Anorexia with low-grade fever 4. Episodic, dull, or steady midabdominal pain

1. No symptoms exist Diverticulosis is an asymptomatic condition. The other choices are signs and symptoms of diverticulitis.

You are taking care of a client with appendicitis and suddenly the client states the pain is gone. What does the nurse know has caused this pain relief? 1. Ruptured appendix 2. Endorphins 3. Sepsis 4. Neuropathy

1. Ruptured appendix

A client has a percutaneous endoscopic gastrostomy tube inserted for tube feedings. Before starting a continuous feeding, the nurse should place the client in which position? 1. Semi-Fowlers 2. Supine 3. Reverse Trendelenburg 4. High Fowler's

1. Semi-Fowlers To prevent aspiration of stomach contents, the nurse should place the client in semi-Fowler's position. High Fowler's position isn't necessary and may not be tolerated as well as semi-Fowler's.

The client with a new colostomy is concerned about the odor from the stool in the ostomy drainage bag. The nurse teaches the client to include which of the following foods in the diet to reduce odor? 1. Yogurt 2. Broccoli 3. Cucumbers 4. Eggs

1. Yogurt The client should be taught to include deodorizing foods in the diet, such a beet greens, parsley, buttermilk, and yogurt. Spinach also reduces odor but is a gas forming food as well. Broccoli, cucumbers, and eggs are gas forming foods.

The patient complains that they have abdominal distention, pain and pressure, decreased appetite, headache, fatigue, indigestion, sensation of incomplete evacuation of stools. What questions should the nurse ask next? (select all that apply) 1. Have you traveled outside of the country lately? 2. When is the last time you had a BM, how much, and what did it look like? 3. What type of laxative would your prefer? 4. What is your normal BM pattern?

2 and 4 The nurse suspects the client is constipated. Will need to know the clients normal bm pattern and also the characteristics of the bm to determine if the patient is indeed constipated.

What patient education is important for the nurse to include about preventing constipation? 1. Take go lytely daily 2. Drink at least 8 glasses of water a day 3. Eat a diet high in fiber 4. Exercise 30 minutes a day 5 days a week

2, 3, 4

When planning care for a client with ulcerative colitis who is experiencing symptoms, which client care activities can the nurse appropriately delegate to a unlicensed assistant? Select all that apply. 1. Assessing the client's bowel sounds 2. Providing skin care following bowel movements 3. Evaluating the client's response to antidiarrheal medications 4. Maintaining intake and output records 5. Obtaining the client's weight.

2, 4, and 5. The nurse can delegate the following basic care activities to the unlicensed assistant: providing skin care following bowel movements, maintaining intake and output records, and obtaining the client's weight. Assessing the client's bowel sounds and evaluating the client's response to medication are registered nurse activities that cannot be delegated.

Which of the following definitions best describes diverticulosis? 1. An inflamed outpouching of the intestine 2. A noninflamed outpouching of the intestine 3. The partial impairment of the forward flow of intestinal contents 4. An abnormal protrusion of an organ through the structure that usually holds it.

2. A noninflamed outpouching of the intestine Diverticulosis involves a noninflamed outpouching of the intestine. Diverticulitis involves an inflamed outpouching. The partial impairment of forward flow of the intestine is an obstruction; abnormal protrusion of an organ is a hernia.

Which of the following factors is believed to cause ulcerative colitis? 1. Acidic diet 2. Altered immunity 3. Chronic constipation 4. Emotional stress

2. Altered immunity Several theories exist regarding the cause of ulcerative colitis. One suggests altered immunity as the cause based on the extraintestinal characteristics of the disease, such as peripheral arthritis and cholangitis. Diet and constipation have no effect on the development of ulcerative colitis. Emotional stress can exacerbate the attacks but isn't believed to be the primary cause.

A diverticulitis patient is being admitted to the hospital for acute inflammation. What will the nurse anticipate to be part of this patients treatment? (select all that apply) 1. Patient will be on a clear liquid diet, rest, analgeiscs, and anti-spasmodics 2. Antibiotics for 7-10 days 3. Patient will be NPO until sx subside, IV fluids, opioid analgesics, anti-spasmodics 4. Bulk forming laxatives, high fiber then low fat diet

2. Antibiotics for 7-10 days 3. Patient will be NPO until sx subside, IV fluids, opioid analgesics, anti-spasmodics Acute cases that require hospitalization the treatment is generally an IV based treatment and client will be in the hospital 3-4 days

Which of the following tests should be administered to a client suspected of having diverticulosis? 1. Abdominal ultrasound 2. Barium enema 3. Barium swallow 4. Gastroscopy

2. Barium enema A barium enema will cause diverticula to fill with barium and be easily seen on x-ray. An abdominal US can tell more about structures, such as the gallbladder, liver, and spleen, than the intestine. A barium swallow and gastroscopy view upper GI structures.

An older patient explains to the nurse that they have not had a bowel movement in two days and that they need a prescription for a laxative to get things moving again. What is the patient experiencing? 1. Constipation 2. Bowel Movement Pattern Change 3. Crohn's Disease 4. Megacolon

2. Bowel Movement Pattern Change Older adults often mistake BM pattern changes as constipation. Constipation is fewer than 3 BM per week, abdominal distention, pain and pressure, straining at stool, and elimination of small volume lumpy hard dry stools

The nurse is reviewing the record of a client with Crohn's disease. Which of the following stool characteristics would the nurse expect to note documented on the client's record? 1. Chronic constipation 2. Diarrhea 3. Constipation alternating with diarrhea 4. Stool constantly oozing from the rectum

2. 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. The other options are not associated with diarrhea.

A sac- like herniation of the lining of the bowel that extend through a defect in the muscle layer: 1. appendicitis 2. Diverticular disease 3. Peritonitis 4. Bowel obstruction

2. Diverticular disease

Which of the following complications of gastric resection should the nurse teach the client to watch for? 1. Constipation 2. Dumping syndrome 3. Gastric spasm 4. Intestinal spasms

2. Dumping syndrome Dumping syndrome is a problem that occurs postprandially after gastric resection because ingested food rapidly enters the jejunum without proper mixing and without the normal duodenal digestive processing. Diarrhea, not constipation, may also be a symptom. Gastric or intestinal spasms don't occur, but antispasmodics may be given to slow gastric emptying.

The client has just had surgery to create an ileostomy. The nurse assesses the client in the immediate post-op period for which of the following most frequent complications of this type of surgery? 1. Intestinal obstruction 2. Fluid and electrolyte imbalance 3. Malabsorption of fat 4. Folate deficiency

2. Fluid and electrolyte imbalance A major complication that occurs most frequent following an ileostomy is fluid and electrolyte imbalance. The client requires constant monitoring of intake and output to prevent this from happening. Losses require replacement by intravenous infusion until the client can tolerate a diet orally. Intestinal obstruction is a less frequent complication. Fat malabsorption and folate deficiency are complications that could occur later in the postoperative period.

A client with irritable bowel syndrome is being prepared for discharge. Which of the following meal plans should the nurse give the client? 1. Low fiber, low-fat 2. High fiber, low-fat 3. Low fiber, high-fat 4. High-fiber, high-fat

2. High-fiber, low-fat The client with irritable bowel syndrome needs to be on a diet that contains at least 25 grams of fiber per day. Fatty foods are to be avoided because they may precipitate symptoms.

What is the preferred method of removal of the appendix? 1. Open appendectomy 2. Laproscopic appendectomy 3. Aspiration appendectomy 4. Pharmacologic lysis of appendix

2. Laproscopic appendectomy

What type of diet and patient is associated with diverticular disease? 1. High fiber diet, vegans 2. Low fiber diet, older adults 3. High meat diet, older men 4. High sugar diet, children

2. Low fiber diet, older adults Because food moves more slowly providing more opportunity to get food stuck

Which goal of the client's care should take priority during the first days of hospitalization for an exacerbation of ulcerative colitis? 1. Promoting self-care and independence 2. Managing diarrhea 3. Maintaining adequate nutrition 4. Promoting rest and comfort

2. Managing diarrhea Diarrhea is the primary symptom in an exacerbation of ulcerative colitis, and decreasing the frequency of stools is the first goal of treatment. The other goals are ongoing and will be best achieved by halting the exacerbation. The client may receive antidiarrheal medications, antispasmodic agents, bulk hydrophilic agents, or anti-inflammatory drugs.

A nurse is monitoring a client admitted to the hospital with a diagnosis of appendicitis. The client is scheduled for surgery in 2 hours. The client begins to complain of increased abdominal pain and begins to vomit. On assessment the nurse notes that the abdomen is distended and the bowel sounds are diminished. Which of the following is the most appropriate nursing intervention? 1. Administer dilaudid 2. Notify the physician 3. Call and ask the operating room team to perform the surgery as soon as possible 4. Reposition the client and apply a heating pad on a warm setting to the client's abdomen.

2. Notify the physician Based on the signs and symptoms presented in the question, the nurse should suspect peritonitis and should notify the physician. Administering pain medication is not an appropriate intervention. Heat should never be applied to the abdomen of a client with suspected appendicitis. Scheduling surgical time is not within the scope of nursing practice, although the physician probably would perform the surgery earlier than the prescheduled time.

Which of the following is caused by improper catheter placement and inadvertent puncture of the pleura? 1. Air embolism 2. Pneumothorax 3. Sepsis 4. Fluid overload

2. Pneumothorax A pneumothorax is caused by improper catheter placement and inadvertent puncture of the pleura. Air embolism can occur from a missing cap on a port. Sepsis can be caused by the separation of dressings. Fluid overload is caused by fluids infusing too rapidly.

Which of the following symptoms is associated with ulcerative colitis? 1. Dumping syndrome 2. Rectal bleeding 3. Soft stools 4. Fistulas

2. Rectal bleeding In ulcerative colitis, rectal bleeding is the predominant symptom. Soft stools are more commonly associated with Crohn's disease, in which malabsorption is more of a problem. Dumping syndrome occurs after gastric surgeries. Fistulas are associated with Crohn's disease.

What is the location of clinical manifestation for Ulcerative Colitis? 1. Distal ileum, ascending colon 2. Rectum, descending colon 3. Stomach 4. Small intestine

2. Rectum, descending colon

The nurse evaluates the client's stoma during the initial post-op period. Which of the following observations should be reported immediately to the physician? 1. The stoma is slightly edematous 2. The stoma is dark red to purple 3. The stoma oozes a small amount of blood 4. The stoma does not expel stool

2. The stoma is dark red to purple A dark red to purple stoma indicates inadequate blood supply. Mild edema and slight oozing of blood are normal in the early post-op period. The colostomy would typically not begin functioning until 2-4 days after surgery.

Medical management of the client with diverticulitis should include which of the following treatments? 1. Reduced fluid intake 2. Increased fiber in diet 3. Administration of antibiotics 4. Exercises to increase intra-abdominal pressure

3. Administration of antibiotics Antibiotics are used to reduce the inflammation. The client isn't typically isn't allowed anything orally until the acute episode subsides. Parenteral fluids are given until the client feels better; then it's recommended that the client drink eight 8-ounce glasses of water per day and gradually increase fiber in the diet to improve intestinal motility. During the acute phase, activities that increase intra-abdominal pressure should be avoided to decrease pain and the chance of intestinal obstruction.

A client with ulcerative colitis has an order to begin salicylate medication to reduce inflammation. The nurse instructs the client to take the medication: 1. 30 minutes before meals 2. On an empty stomach 3. After meals 4. On arising

3. After meals Salicylate compounds act by inhibiting prostaglandin synthesis and reducing inflammation. The nurse teaches the client to take the medication with a full glass of water and to increase fluid intake throughout the day. This medication needs to be taken after meals to reduce GI irritation.

The nurse has given instructions to the client with an ileostomy about foods to eat to thicken the stool. The nurse determines that the client needs further instructions if the client stated to eat which of the following foods to make the stools less watery? 1. Pasta 2. Boiled rice 3. Bran 4. Low-fat cheese

3. Bran Foods that help thicken the stool of the client with an ileostomy include pasta, boiled rice, and low-fat cheese. Bran is high in dietary fiber and thus will increase output of watery stool by increasing propulsion through the bowel. Ileostomy output is liquid. Addition or elimination of various foods can help thicken or loosen this liquid drainage.

How is diverticular disease usually dx? 1. Ultrasound 2. Barium enema 3. Colonoscopy 4. Upper endoscopy

3. Colonoscopy

In a client with Crohn's disease, which of the following symptoms should not be a direct result of antibiotic therapy? 1. Decrease in bleeding 2. Decrease in temperature 3. Decrease in body weight 4. Decrease in the number of stools

3. Decrease in body weight A decrease in body weight may occur during therapy due to inadequate dietary intake, but isn't related to antibiotic therapy. Effective antibiotic therapy will be noted by a decrease in temperature, number of stools, and bleeding.

Five days after undergoing surgery, a client develops a small-bowel obstruction. A Miller-Abbott tube is inserted for bowel decompression. Which nursing diagnosis takes priority? 1. Imbalanced nutrition: Less than body requirements 2. Acute pain 3. Deficient fluid volume 4. Excess fluid volume

3. Deficient fluid volume Fluid shifts to the site of the bowel obstruction, causing a fluid deficit in the intravascular spaces. If the obstruction isn't resolved immediately, the client may experience an imbalanced nutritional status (less than body requirements); however, deficient fluid volume takes priority. The client may also experience pain, but that nursing diagnosis is also of lower priority than deficient fluid volume.

A patient that is recieving Golytely is at risk for the following complications? 1. Constipation 2. Hypertension 3. Electrolyte imbalance 4. Syncope

3. Electrolyte imbalance Golytely is a aggressive laxative. Pt that get this will have a massive amount of stool loss.

Which of the following factors is believed to be linked to Crohn's disease? 1. Constipation 2. Diet 3. Hereditary 4. Lack of exercise

3. Hereditary Although the definite cause of Crohn's disease is unknown, it's thought to be associated with infectious, immune, or psychological factors. Because it has a higher incidence in siblings, it may have a genetic cause.

A client's ulcerative colitis symptoms have been present for longer than 1 week. The nurse recognizes that the client should be assessed carefully for signs of which of the following complications? 1. Heart failure 2. DVT 3. Hypokalemia 4. Hypocalcemia

3. Hypokalemia Excessive diarrhea causes significant depletion of the body's stores of sodium and potassium as well as fluid. The client should be closely monitored for hypokalemia and hyponatremia. Ulcerative colitis does not place the client at risk for heart failure, DVT, or hypocalcemia.

Crohn's disease can be described as a chronic relapsing disease. Which of the following areas in the GI system may be involved with this disease? 1. The entire length of the large colon 2. Only the sigmoid area 3. The entire large colon through the layers of mucosa and submucosa 4. The small intestine and colon; affecting the entire thickness of the bowel

4. The small intestine and colon; affecting the entire thickness of the bowel Crohn's disease can involve any segment of the small intestine, the colon, or both, affecting the entire thickness of the bowel. Answers 1 and 3 describe ulcerative colitis, answer 2 is too specific and therefore, not likely.

A client who has ulcerative colitis has persistent diarrhea. He is thin and has lost 12 pounds since the exacerbation of his ulcerative colitis. The nurse should anticipate that the physician will order which of the following treatment approaches to help the client meet his nutritional needs? 1. Initiate continuous enteral feedings 2. Encourage a high protein, high-calorie diet 3. Implement total parenteral nutrition 4. Provide six small meals a day.

3. Implement total parenteral nutrition Food will be withheld from the client with severe symptoms of ulcerative colitis to rest the bowel. To maintain the client's nutritional status, the client will be started on TPN. Enteral feedings or dividing the diet into 6 small meals does not allow the bowel to rest. A high-calorie, high-protein diet will worsen the client's symptoms.

Which of the following definitions best describes gastritis? 1. Erosion of the gastric mucosa 2. Inflammation of a diverticulum 3. Inflammation of the gastric mucosa 4. Reflux of stomach acid into the esophagus

3. Inflammation of the gastric mucosa Gastritis is an inflammation of the gastric mucosa that may be acute (often resulting from exposure to local irritants) or chronic (associated with autoimmune infections or atrophic disorders of the stomach). Erosion of the mucosa results in ulceration. Inflammation of a diverticulum is called diverticulitis; reflux of stomach acid is known as gastroesophageal disease.

You are working in the ED and a 16 year old girl is complaining of the following sx: Periumbical pain that progresses to RLQ pian, N/V, and loss of appetite. After assessing the patient you document that the patient has a low grade fever, rebound tenderness and tenderness at McBurney's point. You suspect the pt has appendicitis and anticipate the physician to make the following orders: (select all that apply) 1. Emergent appendectomy 2. Aggressive antibiotics 3. Labs 4. CT scan

3. Labs= to check WBC and platelet elevation 4. CT scan to DX or rule out appendicitis

Which of the following associated disorders may the client with Crohn's disease exhibit? 1. Ankylosing spondylitis 2. Colon cancer 3. Malabsorption 4. Lactase deficiency

3. Malabsorption Because of the transmural nature of Crohn's disease lesions, malabsorption may occur with Crohn's disease. Ankylosing spondylitis and colon cancer are more commonly associated with ulcerative colitis. Lactase deficiency is caused by a congenital defect in which an enzyme isn't present.

During the assessment of a client's mouth, the nurse notes the absence of saliva. The client is also complaining of pain near the area of the ear. The client has been NPO for several days because of the insertion of a NG tube. Based on these findings, the nurse suspects that the client is developing which of the following mouth conditions? 1. Stomatitis 2. Oral candidiasis 3. Parotitis 4. Gingivitis

3. Parotitis The lack of saliva, pain near the area of the ear, and the prolonged NPO status of the client should lead the nurse to suspect the development of parotitis, or inflammation of the parotid gland. Parotitis usually develops in cases of dehydration combined with poor oral hygiene or when clients have been NPO for an extended period. Preventative measures include the use of sugarless hard candy or gum to stimulate saliva production, adequate hydration, and frequent mouth care. Stomatitis (inflammation of the mouth) produces excessive salivation and a sore mouth.

Which of the following conditions is most likely to directly cause peritonitis? 1. Cholelithiasis 2. Gastritis 3. Perforated ulcer 4. Incarcerated hernia

3. Perforated ulcer The most common cause of peritonitis is a perforated ulcer, which can pour contaminates into the peritoneal cavity, causing inflammation and infection within the cavity. The other conditions don't by themselves cause peritonitis. However, if cholelithiasis leads to rupture of the gallbladder, gastritis leads to erosion of the stomach wall, or an incarcerated hernia leads to rupture of the intestines, peritonitis may develop.

Which of the following medications is most effective for treating the pain associated with irritable bowel disease? 1. Acetaminophen 2. Opiates 3. Steroids 4. Stool softeners

3. Steroids The pain with irritable bowel disease is caused by inflammation, which steroids can reduce. Stool softeners aren't necessary. Acetaminophen has little effect on the pain, and opiate narcotics won't treat its underlying cause.

Which of the following interventions should be included in the medical management of Crohn's disease? 1. Increasing oral intake of fiber 2. Administering laxatives 3. Using long-term steroid therapy 4. Increasing physical activity

3. Using long-term steroid therapy Management of Crohn's disease may include long-term steroid therapy to reduce the inflammation associated with the deeper layers of the bowel wall. Other management focuses on bowel rest (not increasing oral intake) and reducing diarrhea with medications (not giving laxatives). The pain associated with Crohn's disease may require bed rest, not an increase in physical activity.

A patient has just had a nasogastic (NG) tube inserted and the nurse is waiting for verification of placement of the tube prior to starting tube feedings. Which is the best method of verification the nurse should use for determining new NG tube placement? 1. Gastric aspirate pH testing 2. Observing gastric aspirate 3. X-ray confirmation 4. Air auscultation

3. X-ray confirmation Raidologic identification of tube placement in the stomach is the most reliable method. Gastric fluid may be grassy green, brown, clear, or odorless, whereas an aspirate from the lungs may be off white or tan. Hence, checking aspirate is not the best method of determining NG tube placement in the stomach. Gastric pH values are typically lower and more acidic than that of the intestinal or respiratory tract, but not always. Air auscultation is not a reliable method for determining NG tube placement in the stomach when used alone.

Identify the mildest form of laxative followed by stronger formulations? 1. magnesium citrate 2. Golytely 3. Senokot 4. Colace

4, 3, 1, 2

When teaching an elderly client how to prevent constipation, which of the following instructions should the nurse include? 1. "Drink 6 glasses of fluid each day." 2. "Avoid grain products and nuts." 3. "Add at least 4 grams of bran to your cereal each morning." 4. "Be sure to get regular exercise."

4. "Be sure to get regular exercise." Exercise helps prevent constipation. Fluids and dietary fiber promote normal bowel function. The client should drink eight to ten glasses of fluid each day. Although adding bran to cereal helps prevent constipation by increasing dietary fiber, the client should start with a small amount and gradually increase the amount as tolerated to a maximum of 2 grams a day.

Which of the following nursing interventions should be implemented to manage a client with appendicitis? 1. Assessing for pain 2. Encouraging oral intake of clear fluids 3. Providing discharge teaching 4. Assessing for symptoms of peritonitis

4. Assessing for symptoms of peritonitis The focus of care is to assess for peritonitis, or inflammation of the peritoneal cavity. Peritonitis is most commonly caused by appendix rupture and invasion of bacteria, which could be lethal. The client with appendicitis will have pain that should be controlled with analgesia. The nurse should discourage oral intake in preparation for surgery. Discharge teaching is important; however, in the acute phase, management should focus on minimizing preoperative complications and recognizing when such may be occurring.

Complications or diverticular disease include: peritonitis (ruptured diverticulas), abscess (pockets of infection), fistulas, and bleeding. What is the possible surgical treatment? 1. Colostomy 2. Illeostomy 3. Bowel Decompression 4. Bowel Resection

4. Bowel Resection

Surgical management of ulcerative colitis may be performed to treat which of the following complications? 1. Gastritis 2. Bowel herniation 3. Bowel outpouching 4. Bowel perforation

4. Bowel perforation Perforation, obstruction, hemorrhage, and toxic megacolon are common complications of ulcerative colitis that may require surgery. Herniation and gastritis aren't associated with irritable bowel diseases, and outpouching of the bowel is diverticulosis.

If a client had irritable bowel syndrome, which of the following diagnostic tests would determine if the diagnosis is Crohn's disease or ulcerative colitis? 1. Abdominal computed tomography (CT) scan 2. Abdominal x-ray 3. Barium swallow 4. Colonoscopy with biopsy

4. Colonoscopy with biopsy A colonoscopy with biopsy can be performed to determine the state of the colon's mucosal layers, presence of ulcerations, and level of cytologic development. An abdominal x-ray or CT scan wouldn't provide the cytologic information necessary to diagnose which disease it is. A barium swallow doesn't involve the intestine.

A client presents to the emergency room, reporting that he has been vomiting every 30 to 40 minutes for the past 8 hours. Frequent vomiting puts him at risk for which of the following? 1. Metabolic acidosis with hyperkalemia 2. Metabolic acidosis with hypokalemia 3. Metabolic alkalosis with hyperkalemia 4. Metabolic alkalosis with hypokalemia

4. Metabolic alkalosis with hypokalemia Gastric acid contains large amounts of potassium, chloride, and hydrogen ions. Excessive loss of these substances, such as from vomiting, can lead to metabolic alkalosis and hypokalemia.

Which of the following substances is most likely to cause gastritis? 1. Milk 2. Bicarbonate of soda, or baking soda 3. Enteric coated aspirin 4. Nonsteriodal anti-imflammatory drugs

4. Nonsteroidal anti-inflammatory drugs NSAIDS are a common cause of gastritis because they inhibit prostaglandin synthesis. Milk, once thought to help gastritis, has little effect on the stomach mucosa. Bicarbonate of soda, or baking soda, may be used to neutralize stomach acid, but it should be used cautiously because it may lead to metabolic acidosis. ASA with enteric coating shouldn't contribute significantly to gastritis because the coating limits the aspirin's effect on the gastric mucosa.

Tube feedings are given to a patient after an oral surgery. The nurse manages tube feedings to minimize the risk of aspiration. Which of the following measures should the nurse include in the plan of care to reduce the risk of aspiration? 1. Change tube feeding container and tubing. 2. Administer 15 to 30 mL of water before and after medications. 3. Avoid cessation of feedings. 4. Place patient in semi- fowler's position during, and 60 minutes after, an intermittent feeding.

4. Place patient in semi- fowler's position during, and 60 minutes after, an intermittent feeding.

The client who has undergone creation of a colostomy has a nursing diagnosis of Disturbed body image. The nurse would evaluate that the client is making the most significant progress toward identified goals if the client: 1. Watches the nurse empty the colostomy bag 2. Looks at the ostomy site 3. Reads the ostomy product literature 4. Practices cutting the ostomy appliance

4. Practices cutting the ostomy appliance The client is expected to have a body image disturbance after colostomy. The client progresses through normal grieving stages to adjust to this change. The client demonstrates the greatest deal of acceptance when the client participates in the actual colostomy care. Each of the incorrect options represents an interest in colostomy care but is a passive activity. The correct option shows the client is participating in self-care.

The nurse is caring for a hospitalized client with a diagnosis of ulcerative colitis. Which finding, if noted on assessment of the client, would the nurse report to the physician? 1. Bloody diarrhea 2. Hypotension 3. A hemoglobin of 12 mg/dL 4. Rebound tenderness

4. Rebound tenderness Rebound tenderness may indicate peritonitis. Blood 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.

Which of the following therapies is not included in the medical management of a client with peritonitis? 1. Broad-spectrum antibiotics 2. Electrolyte replacement 3. I.V. fluids 4. Regular diet

4. Regular diet The client with peritonitis usually isn't allowed anything orally until the source of peritonitis is confirmed and treated. The client also requires broad-spectrum antibiotics to combat the infection. I.V. fluids are given to maintain hydration and hemodynamic stability and to replace electrolytes.

Where is diverticular disease most commonly found in the intestine? 1. Cecum 2. Transverse Colon 3. Descending Colon 4. Sigmoid Colon

4. Sigmoid Colon Diverticular disease may occur anywhere in the intestine but are most common in the sigmoid colon.

Which of the following symptoms may be exhibited by a client with Crohn's disease? 1. Bloody diarrhea 2. Narrow stools 3. N/V 4. Steatorrhea

4. Steatorrhea Steatorrhea from malabsorption can occur with Crohn's disease. N/V, and bloody diarrhea are symptoms of ulcerative colitis. Narrow stools are associated with diverticular disease.

Which area of the alimentary canal is the most common location for Crohn's disease? 1. Ascending colon 2. Descending colon 3. Sigmoid colon 4. Terminal ileum

4. Terminal ileum Studies have shown that the terminal ileum is the most common site for recurrence in clients with Crohn's disease. The other areas may be involved but aren't as common.

Which of the following associated disorders may a client with ulcerative colitis exhibit? 1. Gallstones 2. Hydronephrosis 3. Nephrolithiasis 4. Toxic megacolon

4. Toxic megacolon Toxic megacolon is extreme dilation of a segment of the diseased colon caused by paralysis of the colon, resulting in complete obstruction. This disorder is associated with both Crohn's disease and ulcerative colitis. The other disorders are more commonly associated with Crohn's disease.

Colon cancer is most closely associated with which of the following conditions? 1. Appendicitis 2. Hemorrhoids 3. Hiatal hernia 4. Ulcerative colitis

4. Ulcerative colitis Chronic ulcerative colitis, granulomas, and familial polyposis seem to increase a person's chance of developing colon cancer. The other conditions listed have no known effect on colon cancer risk.

Which of the following mechanisms can facilitate the development of diverticulosis into diverticulitis? 1. Treating constipation with chronic laxative use, leading to dependence on laxatives 2. Chronic constipation causing an obstruction, reducing forward flow of intestinal contents 3. Herniation of the intestinal mucosa, rupturing the wall of the intestine 4. Undigested food blocking the diverticulum, predisposing the area to bacterial invasion.

4. Undigested food blocking the diverticulum, predisposing the area to bacterial invasion. Undigested food can block the diverticulum, decreasing blood supply to the area and predisposing the area to invasion of bacteria. Chronic laxative use is a common problem in elderly clients, but it doesn't cause diverticulitis. Chronic constipation can cause an obstruction—not diverticulitis. Herniation of the intestinal mucosa causes an intestinal perforation.

Which of the following laboratory results would be expected in a client with peritonitis? 1. Partial thromboplastin time above 100 seconds 2. Hemoglobin level below 10 mg/dL 3. Potassium level above 5.5 mEq/L 4. White blood cell count above 15,000

4. White blood cell count above 15,000 Because of infection, the client's WBC count will be elevated. A hemoglobin level below 10 mg/dl may occur from hemorrhage. A PT time longer than 100 seconds may suggest disseminated intravascular coagulation, a serious complication of septic shock. A potassium level above 5.5 mEq/L may indicate renal failure.

A patient has become very depressed postoperatively after receiving colostomy for GI cancer. He does not participate in his colostomy care or look at the stoma. An appropriate nursing diagnosis for this situation is: A. Ineffective Individual Coping B. Knowledge Deficit C. Impaired Adjustment D. Anxiety

A. Ineffective Individual Coping The patient is dealing with a disturbance in self-concept and difficulty coping with the newly established stoma.

A patient is dx with a ruptured appendix. What should the nurse anticipate will be done next?

Aggressive antibiotics and then laproscopic appendectomy after infection is controlled.

What pharmacological intervention is used to manage inflammation in inflammatory bowel disease?

Aminosalicylates

What are some risk factors for peritonitis?

Any external or internal trauma that results in the leakage of contents from abdominal organs into the abdominal cavity, bacterial proliferation occurs, leads to tissue edema and exudation of fluid. Examples: stabbing, trauma, ulcer, appendix, diverticulum,

The correct sequence for abdominal assessment is: A. inspection, percussion, palpation, auscultation. B. inspection, auscultation, palpation, percussion. C. inspection, palpation, auscultation, percussion. D. inspection, percussion, auscultation, palpation

B. inspection, auscultation, palpation, percussion Auscultation is done before palpation to avoid stimulating peristaltic movements and distorting auscultatory sounds.

What is a risk associated with megacolon?

Colon can rupture, perforate and cause peritonitis.

What pharmacological intervention is used to manage sx's of inflammatory bowel diseases?

Corticosteroids

Which inflammatory bowel disease commonly includes fistulas, fissures, and abscesses?

Crohn's Disease

Which inflammatory bowel disease extends through all layers of GI tract wall?

Crohn's Disease

Which inflammatory bowel disease primarily effects ages 15- 40 year olds?

Crohn's Disease

Peritonitis can occur as a complication of: A. septicemia B. multiple organ failure C. hypovolemic shock D. peptic ulcer disease

D. peptic ulcer disease Perforation is a life-threatening complication of peptic ulcer disease and can result in peritonitis.

During initial assessment of a patient post-endoscopy, the nurse notes absent bowel sounds, tachycardia, and abdominal distention. The nurse would anticipate: A. ischemic bowel B. peritonitis C. hypovolemic shock D. perforated bowel

D. perforated bowel Invasive diagnostic testing can cause perforated bowel. Ischemic bowel (Choice A) is usually not related. Peritonitis (Choice B) can be a complication after initial perforation. Hypovolemic shock (Choice C) can occur if peritonitis is allowed to continue.

What complications are associated with straining to void stools?

Hemorrhoids and anal fissures

What pharmacological intervention is used to manage the body's response to Crohn's and Ulcerative Colitis?

Immunomodulators

A patient is dx with appendicitis. What should the nurse do next?

Make pt NPO, get to OR, IV fluids, and pain meds.

What constipation complication is associated with the upper portion of the colon is completely blocked?

Megacolon

What is the difference between megacolon and fecal impaction?

Megacolon= upper portion of the colon is completely blocked Fecal impaction= end of GI tract is blocked

Why is peritonitis a big deal infection?

This infection leads to sepsis and sepsis leads to death.

Which inflammatory bowel disease affects the mucuosal and submucosal layers of the GI tract?

Ulcerative Colitis

Which inflammatory bowel disease commonly includes severe bloody diarrhea?

Ulcerative Colitis

Which inflammatory bowel disease primarily effects the older population?

Ulcerative Colitis