CHA 2 Exam 2 GI

A patient drinks a solution and then have x-rays performed to assess for hiatal hernias, strictures, and other structural or anatomic esophageal problems.

Barium swallow test

TRUE OR FALSE When a patient is in the chronic period of pancreatitis the most beneficial intervention is for the patient is to be NPO.

FALSE - during the ACUTE period

TRUE OR FALSE Patients diagnosed with diverticulitis should be placed on laxatives to prevent straining.

FALSE - should avoid laxatives

Identify which of these are NOT complications of ulcerative colitis. Select all that apply a. Nutritional deficiencies / electrolytes b. Perineal sepsis c. Anal fissure/fistula d. Perirectal abscess e. Hemorrhage f. Anemia g. Coagulation defects h. Erythema nodosum on face/arms

NONE - all are complications of ulcerative colitis

TRUE OR FALSE Patients who have laparoscopic colon surgery (MIS) can eat solid foods very soon after the procedure, where patients who have open colectomy typically have a nasogastric tube (NGT) and receive IV PCA for the first 24 to 36 hours. After NGT removal, the diet is slowly progressed from liquids to solid foods as tolerated.

TRUE

TRUE OR FALSE The risk for postoperative pulmonary complications is increased in the patient who has received preoperative radiation.

TRUE

A patient with prolonged prothrombin time values (not related to medication) probably has dysfunction in which organ? a. liver b. pancreas c. spleen d. stomach e. brain f. heart

a

_______________________ is the MOST common symptom of acute pancreatitis? a. abdominal pain b. dental caries c. SOB d. leg cramps

a - In acute pancreatitis, the pancreas is inflamed, which further activates pancreatic enzymes to cause damage to and auto-digest the tissue. One of the most common symptoms as a result is abdominal pain, or mid-epigastric pain that radiates to the back.

A male patient comes into the clinic complaining of the following symptoms: dark, sticky stools, dizziness, lightheadedness, and occasional vomitting (looks like coffee he says). Upon assessment the patient has epigastric pain midline between the umbilicus and xiphoid process. Which diagnosis would these symptoms indicate? a. Peptic ulcer disease b. Encopresis c. Diarrhea d. GI bleed

a - Other S/S Reflux, delayed gastric emptying, bright red or coffee ground vomitus (Hematemesis), Melena (tarry or dark sticky stools), decreased hemoglobin and hematocrit, decreased blood pressure, increased heart rate, weak peripheral pulses, acute confusion, vertigo, dizziness, lightheadedness, syncope, and pain.

Which action is likely to reduce the pancreatic & gastric secretions of a client with pancreatitis? a. Administer anticholinergics b. Keep patient NPO c. Position in fetal position d. Premedication prior to activity

a - block the neural impulses that stimulate the pancreatic/gastric secretions

After esophageal surgery, the nurse recognizes that the patient has developed a fever, fluid accumulation, signs of inflammation, and is tachycardia/ tachypneic). What is the best response by the nurse? a. Respond immediately by reporting any of these findings to the surgeon. b. Place the patient on a nonrebreather mask at max oxygen capabilities. c. Position the patient in Trendelenburg to prevent throwing a thrombus. d. Call a code blue and begin CPR and resuscitation efforts.

a - call a RAPID RESPONSE

Which of these are potential complications of ulcers? Select all that apply a. hemorrhage b. perforation c. pyloric obstruction d. ulcerative colitis

a,b,c - most concerned for hemorrhage

What medications are used to treat an H.Pylori infection? Select all that apply a. Proton pump inhibitors b. Histamine/H2 blockers c. Antacids d. Sucralfate/carafate e. Nitrates f. Amylase inhibitors

a,b,c,d - PPI's which inhibit gastric secretion, H2 or histamine blockers which block gastric secretions, Sucralfate/Carafate, mucosal barrier fortifier that helps the lining of the stomach

A patient is suspected of having GERD which of these diagnostic tests would aid in the diagnosis? Select all that apply a. Esophagogastroduodenoscopy (EGD) b. Barium Swallow Test c. Colonoscopy d. pH Monitoring Examination e. Ultrasound

a,b,d

Which of these are APPROPRTIATE interventions for a patient diagnosed with diverticulitis? Select all that apply a. Temporary colostomy b. Diet modifications c. Opioid use d. Bowel rest e. Antibiotics f. Colonoscopy

a,b,d,e - bowel rest, antibiotics, diet modification, colon resection, percutaneous drainage of abscess, temporary colostomy to drain abscess or rest the colon for 6-8 weeks

Patients with H. pylori are at an increased risk for developing which of the following? Select all that apply a. GI bleed b. peptic ulcers c. hernia d. gastric cancer

a,d

Which of these symptoms are expected in a person with known ulcerative colitis? Select all that apply a. Pale skin b. Cramping/abdominal pain c. Mucosal discharge d. Recurrent/bloody diarrhea e. Weight gain f. Bradycardia

b,c,d - weight loss, and tachycardia

Illicit IV drug needle sharing is the most common cause of which type of hepatitis? a. A b. B c. C d. D e. E

c

Which intervention will provide the most symptom relief for a patient with acute pancreatitis? a. NG insertion b. Resting in Trendelenburg c. NPO d. NSAID administration

c - NPO Is the best intervention, fetal position also helps, and OPIOIDS

Which diagnostic test would be most appropriate when trying to diagnosis pancreatic cancer? a. Chest x-ray b. Colonoscopy c. Spinal tap d. Abdominal CT scan

d - ERCP may also be used

The student nurse is teaching her fellow classmates about the complications of hepatitis. What answer should the nursing instructor correct? a. Cirrhosis b. Liver cancer c. Liver failure d. Portal hypertension -> ascites e. GI hemorrhage

e

A patient with acute pancreatitis is admitted to the med/surg floor what S/S the nurse should watch for? Select all that apply a. jaundice b. intermittent hyperglycemia c. left lung pleural effusions d. atelectasis e. pneumonia f. pulmonary edema

ALL

Which of these are appropriate post assessments after a paracentesis? Select all that apply a. Record weight from before and after the paracentesis b. Measure the drainage and record, label and send drainage to the laboratory for analysis c. Apply dressing to the site after draining fluid d. Monitor for leakage e. Respiratory and Gastrointestinal assessment

ALL

Which of these foods should a person with diverticulitis NOT eat? Select all that apply a. nuts b. corn c. popcorn d. seeded cucumbers e. tomatoes f. figs g. strawberries

ALL - blocks the diverticulum and causes inflammation

Identify which of these DO NOT predispose adults to decreased lower esophageal sphincter pressure and lead to reflux. a. Caffeinated beverages, such as tea, coffee, and soda b. Chocolate c. Citrus fruits d. Tomatoes/tomato products e. Smoking and use of other tobacco products f. Calcium channel blockers g. Nitrates h. Peppermint, spearmint i. Alcohol j. Anticholinergic drugs k. High levels of estrogen and progesterone l. Nasogastric tube placement

NONE - all of these increase the risk of reflux

True or false No specific blood tests diagnose pancreatic cancer.

TRUE

Why does pancreatic cancer have such a high mortality rate?

The organ is hidden by other organs and needs to be visualized with a CT (contrast preferred) The S/S are vague until the disease is progressed. There is not specific screening.

A patient on the med/surg floor with diagnosed encopresis asks when they can go home. The nurse should say which statement? a. The goal is to have 2-3 soft stools/day with no pain when having a BM. b. We want you to be able to tolerate a select list of foods. c. We have a policy to keep patients with encopresis for at least 3 days. d. When your electrolytes have been corrected you may go home.

a

Can a patient drive home after an EGD? a. YES - when a patient has conscious sedation after resting in PACU for a while they should be able to drive home - be sure to rest. b. NO - an EGD qualifies for general anesthesia - having a driver is highly recommended

a

Repeated constipation that leads to impaction and the involuntary loss of stool is called what? a. encopresis b. stool impaction c. small bowel obstruction d. irritable bowel syndrome

a

The nurse administers 2 units of salt-poor albumin to a client with portal hypertension & ascites. Which information would the nurse share with the client regarding the purpose of the albumin? a. albumin pulls fluid into the circulation b. albumin decreases the salt in the body c. albumin causes diuresis of the water in the body d. all of the above

a

Which assessment finding would the nurse expect in a patient admitted for a Crohn's disease exacerbation? a. High-pitched, rushing bowel sounds in the right lower quadrant b. Low-pitched distant bowel sounds in the right lower quadrant c. Normoactive audible bowel sounds in all quadrants d. Hypoactive - sluggish bowel sounds in the left lower/upper quadrants

a

Which of the statement is correct regarding acute pancreatitis pathophysiology? a. autodigestion and fibrosis of the pancreas b. decreased production of pancreatic enzymes c. pancreatic cell degeneration d. fat globules clogging up the ducts

a

Which of these interventions would be most appropriate for a patient going to have a paracentesis? a. Ask the patient to void before the procedure to prevent injury to the bladder b. Keep the patient NPO for up to 4 hours afterwards to prevent aspiration c. Place the patient in Trendelenburg position, with SCD's on legs. d. Remove all unnecessary wire and metal objects from the room.

a

Which vital sign does the nurse need to monitor immediately following a paracentesis? a. blood pressure b. respirations c. temperature d. pain

a - Hypovolemia due to decrease in abdominal pressure so the patient will have s/sx of hypotension

A client had an open partial colectomy and colostomy placement 6 hours ago. Which assessment would concern the nurse? A. Purple, moist stoma B. Stoma edema C. Liquid stool collecting in the drainage bag D. Serosanguineous fluid draining from the drain(s)

a - stoma should be red and beefy other things to report to the surgeon include: • Stoma ischemia and necrosis (dark red, purplish, or black color; dry) • Continuous heavy bleeding • Mucocutaneous separation (breakdown of the suture line securing the stoma to the abdominal wall)

H.Pylori is diagnosed with which of the following serological tests? (Pick 2) a. urea breath test b. urine culture c. stool antigen d. CBC e. blood cultures

a, c

For a patient experiencing acute pancreatitis which lab results are expected to decrease? Select all that apply a. calcium b. CRP c. elastase d. trypsin e. magnesium f. amylase g. lipase h. bilirubin i. leukocytes j. AST & ALT

a, e - Others are expected to be increased Elevated amylase Elevated lipase Elevated trypsin Elevated elastase Elevated bilirubin Elevated AST and ALT Elevated CRP Elevated leukocytes Decreased calcium and magnesium

Chronic carriers of hepatitis B are at an increased risk of which of the following? Select all that apply a. cirrhosis b. liver failure c. splenomegaly d. portal hypertension e. pancreatitis f. colon cancer g. ulcerative colitits

a,b

Which forms of Hepatitis are preventable via vaccine? Select all that apply a. Hepatitis A b. Hepatitis B c. Hepatitis C d. Hepatitis D e. Hepatitis E

a,b - Hepatitis A (acute infection)- supportive treatment; educate on adequate hand hygiene to prevent spread; people can receive immunoglobulin within 14 days if exposed to virus; Prevent with HAV vaccine Hepatitis B (acute & chronic infection)- antiviral drugs for chronic infection; always hand hygiene; people can receive immunoglobulin within 24 hours of virus exposure; Prevent with HBV vaccine Hepatitis C (acute & chronic infection)- antiviral drugs; NO vaccine or immunoglobulin; implement strict blood & organ donor screening Hepatitis D (acute & chronic infection)- prevent HBV Hepatitis E (acute infection)- supportive treatment; NO vaccine

A client was admitted to the hospital with blunt trauma to the abdomen. During the recovery period, the nurse should monitor the client for which indications of peritonitis? Select all that apply a. boardlike abdomen b. abdominal tenderness c. decreased bowel sounds d. diarrhea e. jaundice

a,b,c

The nurse is caring for a client with ascites secondary to liver failure. Which interventions are appropriate to include in the client's care? Select all that apply a. Daily paracentesis' b. Daily weight c. Low sodium diet d. Daily abdominal girth measurements e. Q4 hour oral checks

a,b,c,d

A patient going to have a esophagogastrostomy asks what they need to know about this procedure. What should the nurse include in the teaching? Select all that apply a. Stop taking anticoagulants, aspirin or NSAIDs several days before the procedure. b. Remain NPO for 8 hours before. c. The procedure will take 20-30 minutes and it consists of a flexible tube being passed through the mouth, into the esophagus. d. You will be sedated for the procedure and will need someone to drive them home because you will not be able to drive for 12-18 hours after receiving sedation. e. Please report to your provider if you have a hoarse/sore throat after the procedure as this is unexpected.

a,b,c,d - hoarse sore throat is expected for several days and to use throat lozenges to relieve discomfort.

An elderly patient comes into the ER with 6 days of diarrhea. Upon assessment she appears weak and fatigued, her BP is low, and her skin stays tented. What are the priority nursing interventions for this patient? Select all that apply a. Proper hand washing b. Culture stool c. Administer antidiarrheal's as appropriate d. IV and oral fluid intake increase e. Increase salt intake f. Keep the patient in the bed

a,b,c,d - most common complication from diarrhea is dehydration which can cause electrolyte imbalances

Which of these are potential complications of an esophagectomy? Select all that apply a. mediastinitis b. wound dehiscence c. pneumonia d. atelectasis e. myocardial infarction

a,b,c,d - respiratory and wound management

Which of these are factors that can lead to the development of GERD in infants? Select all that apply a. Neurological impairments (cerebral palsy, Down syndrome, head injury) b. Partial/incomplete swallowing dysfunction c. Medications (theophylline, caffeine) d. Increased intraabdominal pressure from straining, crying, coughing, or slumping e. Obesity f. Hiatal hernias g. Shaken Baby syndrome

a,b,c,d,e,f

Which of the following medications aid in the treatment of cirrhosis? Select all that apply a. lactulose b. potassium c. propranolol d. nitroglycerin e. diuretic's f. remdisivir

a,b,c,e Diuretic: to reduce fluid accumulation and prevent cardiac/respiratory problems. SE= electrolyte imbalances, kidney function changes and dehydration. Propranolol: decrease blood pressure to prevent bleeding. IV potassium supplement: may be prescribed with diuretic (depending on diuretic selected). SE= hyperkalemia. Cephalosporins/Fluoroquinolones: treatments for spontaneous bacterial peritonitis. SE= nausea, vomiting, abdominal pain and decreased appetite. Lactulose: promote excretion of ammonia in stool. SE=soft stools and dehydration.

A 66 year old female had her stomach removed via a gastrectomy. She is preparing to discharge after a night of observation. What patient education should the nurse include? Select all that apply a. Monitor your incision for signs of infection including (redness, extreme pain, and drainage). b. Prevention of dumping syndrome by eliminating liquids with meals c. Low carbohydrate diet that's high in good fats and protein d. Eat three large meals per day e. Importance of taking vitamin B12, folic acid, and iron supplements.

a,b,c,e - eat small meals

A patient is post op after a Stretta procedure. What education should the nurse provide the patient? Select all that apply a. Remain on clear liquids for 24 hours after the procedure. b. After the first day, consume a soft diet, such as custard, pureed vegetables, mashed potatoes, and applesauce. c. Avoid NSAIDs and aspirin for 10 days. d. Increase intake of acidic foods to balance the stomach's pH. e. Use liquid medications whenever possible. f. Do not allow nasogastric tubes to be inserted for at least 1 month because the esophagus could be perforated.

a,b,c,e,f

Chronic cholecystitits patients would have which S/S? Select all that apply a. Jaundice b. Clay-colored stools c. Dark urine d. Steatorrhea e. Absent bowel sounds f. Pruritus

a,b,c,e,f

What are the nursing priorities for a patient that has peptic ulcer disease and has just vomited blood? Select all that apply a. Monitor vital signs b. Maintain a patent airway. c. Replace lost volume with isotonic solutions immediately. d. Blood product administration prior to labs e. NGT placement and lavage is one treatment, in addition to an EGD f. Monitor patient's intake and output g. Monitor electrolyte levels

a,b,c,e,f,g - monitor for hypovolemia

A patient comes out of surgery after receiving a esophagectomy for esophageal cancer. What postoperative interventions should the nurse implement? Select all that apply a. Ensure patency of chest tube system b. Monitor for changes in volume or color of drainage c. Keep patient in semi/high fowler position d. Reduce IV rate to prevent fluid overload

a,b,c- Remind all staff to keep the patient in a semi-Fowler or high-Fowler position to support ventilation and prevent reflux.

A patient with known Chron's disease comes into the ER. This patient is admitted to the Med/Surg floor. What are the priority nursing interventions? Select all that apply a. Managing diarrhea b. Relief off symptoms c. NG tube management d. Reduce intestinal motility e. Decrease inflammation f. Promote intestinal healing

a,b,d,e,f

Chron's patients are at increased risk of developing which of these? Select all that apply a. toxic megacolon b. intestinal malabsorption c. anemia d. nonmechanical bowel obstruction e. fistulas f. colorectal cancer g. osteoporosis

a,b,d,e,f,g

Which of these are common S/S seen with patients experiencing appendicitis? Select all that apply a. Abdominal pain b. N/V c. Flank pain d. Pain with right leg extension & movement of hip e. Facial twitching f. Rebound tenderness g. Fever

a,b,d,f,g

A patient had recently been diagnosed with peptic ulcer disease. A student nurse volunteers to do the teaching. What statement should the nursing instructor correct? a. "Avoid the use of NSAIDS and aspirin." b. "Increase intake of protein and carbohydrates." c. "Avoid or limit your intake of caffeine which includes coffee, tea, and cola." d. "Continue to take your prescribed medications even if you begin to feel better. If you stop your symptoms will resume." e. "Seek medical attention if you if have blood in your vomit, blood in your stool or tarry or black stools, severe abdominal pain, pain in one or both your shoulders."

a,c,d,e

A patient comes in with extreme jaundice and is diagnosed with cirrhosis of the liver. What are all possible causes of cirrhosis? Select all that apply a. viral hepatitis b. lung disease c. autoimmune hepatitis d. steatohepatitis e. gallbladder disease f. cardiovascular disease g. barrett's epithelium

a,c,d,e,f - most common is alcohol

What patient education should be given to a gastrectomy patient who is asking about prevention of dumping syndrome? Select all that apply a. Eating small meals b. Drinking room temperature water c. Eliminating liquids with meals d. Wearing an abdominal binder when not eating e. Having a low-moderate carb diet that's high in good fats and good protein

a,c,e

For which clinical indicators would the RN monitor when caring for a client with cholelithiasis & obstructive jaundice? Select all that apply a. Dark urine b. Gallstones c. Coffee emesis d. Clay stool e. Yellow skin f. Dry mucous membranes

a,d,e

Match the term to its definition. a. dyspepsia b. globus c. water brash d. odynophagia e. pyrosis 1. Painful swallowing 2. Feeling of something in the back of the throat 3. Hypersalivation 4. Indigestion 5. Heartburn

a4, b2, c3, d1, e5

Match the Hepatitis to its correct infection route. a. Hepatitis A b. Hepatitis B c. Hepatitis C d. Hepatitis D e. Hepatitis E 1. fecal-oral route (consuming contaminated food and water or undercooked pork) 2. blood/body fluids (only occurs with Hepatitis B) 3. blood/body fluids (IV drugs & blood products) 4. blood/body fluids (sex, IV drugs, & birth) 5. fecal-oral route (consuming contaminated food and water)

a5,b4,c3,d2,e1 Hepatitis A- fecal-oral route (consuming contaminated food and water) Hepatitis B- blood/body fluids (sex, IV drugs, & birth) Hepatitis C- blood/body fluids (IV drugs & blood products) Hepatitis D- blood/body fluids (only occurs with Hepatitis B) Hepatitis E- fecal-oral route (consuming contaminated food and water or undercooked pork)

1 day after a colonoscopy/biopsy, a spot of bright red blood is present after wiping. How should the nurse respond? a. Ask provider for STAT hemoglobin test b. Remind patient a small amount of blood it is to be expected c. Administer one unit of precautionary blood d. Assess the patient for hypovolemia

b

A patient had an open traditional Whipple procedure this morning. For what priority complication would the nurse assess? a. GI bleeding b. Fluid/electrolyte imbalances c. Infection d. Confusion - decreased LOC

b

A patient with a hx of cirrhosis of the liver comes into the clinic with a sudden decrease in urinary flow. The nurse practitioner orders labs that show an elevated BUN, elevated creatinine level, and increased urine osmolarity. What complication is most likely happening? a. Hepatitis B or C b. Hepatorenal syndrome c. Superior vena cava syndrome d. Hepatic obstruction

b

When a break in the mucosal barrier occurs (such as that caused by H. pylori infection ), hydrochloric acid injures the epithelium. _______________________ may then result from back-diffusion of acid or dysfunction of the pyloric sphincter. Without normal functioning of the pyloric sphincter, bile refluxes (backs up) into the stomach. a. duodenal ulcers b. gastric ulcers c. stress ulcers d. esophageal ulcers

b

__________________ pancreatitis is an inflammatory process is caused by a premature activation of excessive pancreatic enzymes that destroy ductal tissue and pancreatic cells, resulting in autodigestion and fibrosis of the pancreas. a. chronic b. acute c. traumatic d. none

b

Ulcerative colitis is a what? a. acute torsion of the colon causing ischemia b. chronic inflammatory disorder of the colonic mucosa c. perforation of the colon - medical emergency d. pocket in the colon that can become inflamed

b - inflammatory bowel disease UNKNOWN cause

Which of the assessments would be MOST beneficial for assessing effectiveness of treatment in a patient with ascites d/t cirrhosis of the liver? a. monitoring hemoglobin b. measure abdominal girth c. assessment of LOC d. check potassium level e. strict I&O monitoring

b - physical assessment of whether or not fluid in the body has decreased

Which of these diagnosis' are characterized by pockets that develop in the colon, and bulge out of weak spots in the colon? a. appendicitis b. diverticulosis c. diverticulitis d. colon cancer e. ulcerative colitis

b - pockets = diverticula

______________________________ gram negative bacteria that infects the stomach and duodenum. It penetrates the mucosal gel lining of the gastric epithelium, which decreases the protective defenses of the mucosal lining and can open sores called peptic ulcers. a. C-difficile b. H. Pylori c. E. Coli d. Pseudomonas aeruginosa e. Klebsiella

b - the epithelium is no longer protected from acid and pepsin

Which of these statements is true regarding Barrett's epithelium? Select all that apply a. When the body begins to heal the esophagus after exposure it replaces the normal columnar epithelium for Barrett's epithelium which is squamous cell epithelium. b. Columnar epithelium is more resistant to acid and supports esophageal healing. c. Barrett's epithelium is considered premalignant and increases the patients risk for cancer. d. The fibrosis and scarring that accompany the healing process can produce esophageal stricture which leads to progressive difficulty swallowing.

b,c,d - Barrett's epithelium replaces squamous cell (normal) with columnar.

What are priority nursing concerns for patients diagnosed with hepatitis? Select all that apply a. Aspiration risk b. Infection risk c. Weakness/fatigue d. Weight loss

b,c,d - Weight loss- promote nutrition by encouraging the patient to eat small, frequent meals high in carbohydrates and with moderate fat and protein content; Ask the patient about foods they want to eat; Encourage high-calorie snacks Fatigue- encourage lots of rest with periods of activity Infection risk- education on adequate hand hygiene and implementation of isolation precautions; Monitor for a fever and/or WBC value changes

A 78 year old patient in the ER is diagnosed with norovirus which causes vomitting. What are the priority nursing concerns that should be addressed? Select all that apply a. Risk for infection b. Risk for aspiration c. Fluid/electrolyte imbalances d. Malnutrition

b,c,d - possible complications: Metabolic Alkalosis and Nutrition deficiency

A patient on the Med/surg floor is getting ready to discharge after a 3 day hospital stay ending in a diagnosis of Chron's disease. What are the priority education topics that the nurse should teach this patient? Select all that apply a. Sitting upright for at least 1 hour after eating b. Ways to control the disease and manage nutrition c. Discuss importance of making arrangements to have easy access to restrooms d. Education on usual course of disease, symptoms of complications and to notify the healthcare provider e. Importance of rest periods

b,c,d,e

Which of the nursing concerns apply to a patient with cirrhosis of the liver experiencing serve fluid retention and ascites? Select all that apply a. Prevention and management of infection b. Prevention and management of confusion c. Prevention or management of hemorrhage d. Management of fluid volume status e. Management of pruritus

b,c,d,e Manage Fluid Volume: Monitor the effect of diuretic therapy by weighing patients daily, monitoring I/O, measuring abdominal girth, documenting peripheral edema and assessing electrolyte levels. Preventing or Managing Hemorrhage: Assess for signs and symptoms of bleeding. (check gums and monitor labs) Preventing or Managing Confusion: Assess the patient's neurological status and monitor during treatments. Observe the response of lactulose. Monitor for dehydration and hypokalemia. Managing Pruritus: Perform comfort measures such as cool compresses and/or corticosteroids creams.

A patient diagnosed with a peptic ulcer caused by a H. Pylori infection asks how she might have contracted this bacteria. The nurses educates her that H. Pylori can be found where? Select all that apply a. Excessive alcohol intake b. Excessive NSAID use c. Contaminated food or water d. stool e. vomit f. saliva

b,c,d,e,f - NSAIDs can irritate the lining of your stomach so that an ulcer (a small erosion) forms

A patient comes in with suspected appendicitis. Which of these assessments should the nurse perform? Select all that apply a. Respiratory - ask about sore throat, cough b. Abdominal - listen and palpate c. Pain - watch for guarding, RLQ pain d. GI - ask about N/V, cramping, abd pain e. GU - ask about hematuria, dysuria f. Musculoskeletal - extend the right thigh watching for pain

b,c,d,f - Pain assessment: (RLQ,"McBurney point), abd pain that increases with cough/movement, guarding upon palpation, rebound tenderness, muscle rigidity, extend the right thigh (obturators sign, psoas sign) GI assessment: NV, severe abd pain, cramping, anorexia

A 55 year old patient had an esophagectomy 20 hours ago and is being extubated. What are the PRIORIOTY nursing interventions for this patient? Select all that apply a. No bending over or fast head turning to prevent increased ICP. b. Deep breathing, turning, and coughing every 1 to 2 hours. c. Assess the patient for decreased breath sounds and shortness of breath every 1 to 2 hours. d. Take orthostatic blood pressures every 2-3 hours for 12 hours post intubation. e. Provide incisional support and adequate analgesia to enhance effective coughing.

b,c,e

Which of these are non-pharmacological interventions that should be implemented on patients with pancreatitis? select all that apply a. opioids b. NPO c. fetal position d. IV fluids e. distraction

b,c,e - reduce anxiety

A patient is newly diagnosed with diverticulitis. What patient education does the nurse need to teach the patient prior to discharge? Select all that apply a. High fiber during exacerbation and low fiber diet otherwise b. Increase fluid intake c. Decrease alcohol e. Eat foods that can block diverticulum f. Decrease dietary fat

b,c,f - Low fiber during exacerbation and high fiber diet otherwise, DO NOT EAT foods that can block diverticulum (nuts, corn, popcorn, seeded cucumbers, tomatoes, figs, strawberries)

The nurse is caring for a client who has late-stage (advanced) cirrhosis. What are expected assessment findings? Select one or more answers! a. abdominal fullness b. jaundice c. shortness of breath d. icterus e. sore throat f. petechiae g. dark urine

b,d,f,g

The nurse prepares to administer albumin to a client with ascites. Which effect would the nurse anticipate? a. Increase of fluid in the body b. Lymphatic fluid circulation increase c. Intravascular fluid volume will increase d. Extracellular fluid volume decrease

c

To promote comfort and the passage of flatus after a colonoscopy, in what position does the nurse place the patient? a. trendelenburg b. semi-fowlers c. left side d. right side

c

What is the first sign of liver dysfunction? a. pancytopenia b. anemia c. thrombocytopenia d. leukocytosis

c

What is the post-procedure nursing intervention for patients that have an EGD? a. Electrolyte assessment b. Fluid replacement c. Assess gag reflex d. Cardiac monitoring

c

______________ is the primary site of ethanol metabolism. a. stomach b. pancreas c. liver d. small intestine e. spleen

c

_________________ is the most common cause of increased amounts of secretions that can block the small pancreatic ducts. This leads to an early activation of lysosomal enzymes and digestive enzymes. a. Nitrates b. Acidic foods c. Alcohol d. Tobacco

c

Famotadine is typically administered when? a. morning b. 2 hours before meals c. bedtime d. lunch time e. 2 hours after meals

c - H2 agonist blocker = Decrease gastric acid secretions by blocking histamine receptors in parietal cells.

A nurse assesses a patient who has ulcerative colitis and severe diarrhea. Which assessment would the nurse do first? a. Oral mucosa inspection b. Abdominal percussion c. Heart rate and rhythm d. Cognitive function

c - The patient would have electrolyte levels monitored, and electrolyte replacement may be necessary. Oral mucosa inspection, dietary intake, and abdominal percussion are important parts of physical assessment but are lower priority for this patient.

What diet is recommended for ascites related to cirrhosis? a. High fat diet b. Low fiber diet c. Low sodium diet d. Balanced diet

c - ascites = fluid, less salt = less fluid

What is the PPI-triple therapy? a. 1 PPI, 1 antibiotic, and 1 antacid b. 2 antibiotics and 1 PPI c. 2 PPI's and 1 antibiotics d. none of the above

c - common regimen to treat H. pylori which combines a proton pump inhibitor such as lansoprazole and two antibiotics for 10-14 days.

What would be a priority intervention for a patient experiencing hepatorenal syndrome? a. focused respiratory assessment Q4 b. neuro checks Qshift c. intake and output/weight Q shift d. NPO until pain subsides e. fetal position when in bed

c - d/t the SUDDEN decrease in urine output typically seen in these patients

A client with ascites is scheduled to receive albumin. To have the greatest therapeutic effect, the nurse expects which infusion rate & which oral fluid intake? (Select 2) a. Increase oral intake b. Increase IV rate to 999 mL/hr c. Decrease IV rate d. Fluid restriction

c,d

What are the nursing priorities for a patient that has peptic ulcer disease anyone has just vomited blood? Select all that apply a. Assess lab values - hemoglobin! d. Abdominal assessment c. Maintain a patent airway d. Replace lost volume with isotonic solutions immediately

c,d

Which laboratory values would be elevated in a patient with cirrhosis of the liver? a. albumin b. serum protein c. AST d. ALT e. bilirubin f. ammonia g. amylase

c,d,e,f - ALT, AST elevated initially due to hepatic inflammation and then normal when the liver cells are no longer able to create an inflammatory response. total serum protein and albumin decreased and low platelet count.

Which of these are risk factors for developing diverticulosis? Select all that apply a. Anxiety b. Too much iron intake c. Lack of fiber in the diet d. Constipation e. Smoking f. Obesity g. Sedentary lifestyle

c,d,e,f,g

Identify which of these lab values are elevated for a patient with cirrhosis. a. Albumin b. Platelet c. Prothrombin time d. AST/ALT e. Ammonia f. Sodium g. Bilirubin h. Creatinine

c,d,e,g,h Labs: Elevated= AST, ALT, LDH, Bilirubin, PT/INR, Ammonia and Creatinine. Decreased= Protein, Albumin, Platelet, RBC/Hgb/Hct, Sodium

A patient has dumping syndrome. What menu selections indicates understanding of correct diet for this condition? Select all that apply a. Coffee cake b. Coca-cola c. Apricots d. Broccoli e. Potato soup f. Baked beans

c,e - Apricots and potato soup are appropriate selections as they are part of a high-protein, high-fat, and low- to moderate-carbohydratediet. Coffee cake, other sweet treats, sweet drinks, and gas-forming foods need to be avoided.

Which 2 labs cause ascites in a patient with cirrhosis when they decrease? a. AST b. Ammonia c. Protein d. INR e. Albumin f. Bilirubin g. Sodium

c,e - fluid shift (low sodium can INCREASE ascites)

A patient comes in with LLQ pain, nausea, vomiting, fever, tachycardia, and abdominal distention. CT scan shows inflammation of pockets in the colon. What is the most likely diagnosis? a. Need more information to make a diagnosis b. Ulcerative colitis c. Appendicitis - needing surgery ASAP d. Diverticulitis

d

A patient is recovering from an EGD and requests something to drink. What action by the nurse is appropriate? a. Take their blood pressure b. Have them walk to the bathroom c. Ask them if they can pee d. Assess gag reflux e. Focused GI assessment

d

Chronic and excessive alcohol use causes an inflammation of the liver tissue which results in extensive what? a. underproduction on enzymes that cause inflammation and auto digestion of the liver tissues. b. lysis of the hepatic enzymes that protect the liver from degeneration c. overproduction of glucose causing obstruction of the liver tissues d. degeneration and destruction of hepatocytes and liver will develop fibrosis which progresses to cirrhosis.

d

Risk factors for pancreatitis include all of the following except what? a. hyperlipidemia b. hyperparathyroidism c. hypercalcemia d. hypokalemia e. Penetrating gastric or duodenal ulcers, resulting in peritonitis f. Viral Infections (HIV) g. Alcoholism h. Drug toxicities i. Smoking j. Cystic Fibrosis k. Gallstones

d

Which of these is a post-procedure nursing intervention for patients that have had an EGD? a. Monitor ECG for P wave changes b. Induce vomitting to reduce post discharge vomitting c. Administer one unit of blood d. Assess gag reflex e. Monitor deep tendon reflexes

d

A 6 month old patient presents to the ER with his mother. The mother states that he has been vomitting after all meals, having reoccurring ear infections, unexplained weight loss, and increasingly irritable. Upon assessment the patient is wheezing and is bradycardiac. Which diagnosis would be mostly likely? a. pancreatitis b. testicular torsion c. ulcerative colitis d. GERD

d The otis media is d/t pooled secretion's in the nasopharynx Other physical manifestations include: abdominal pain, hiccupping, coughing, chocking, asthma, pneumonia, apnea, and failure to thrive

Following an EGD with midazolam, the patient has a RR of 8 BPM. What action by the nurse is most appropriate? a. Administer naloxone b. Rapid response should be initiated c. Intubation and management of airway d. Provide physical stimulation - sternal rub

d - For an EGD, patients are given mild sedation. For shallow or slow respirations after the sedation is given, the nurse's most appropriate action is to provide a physical stimulation such as a sternal rub and directions to breathe deeply.

_________________ care is the highest postoperative priority for patients having an esophagectomy. WHY? a. cardiovascular b. musculoskeletal c. gastrointestinal d. respiratory

d - For those who had traditional surgery, intubation with mechanical ventilation is necessary for at least the first 16 to 24 hours.

A patient who has been newly diagnosed with cirrhosis is getting ready to discharge home from the hospital. The nursing student asks if she can do the discharge teaching. Which statement made by the nursing student should be corrected by her instructor? a. "Be sure to avoid NSAIDS, hepatic toxic herbs, vitamins & minerals." b. "Constipation, bleeding, and infection can increase your risk of developing encephalopathy. " c. "Eat many small meals throughout the day." d. "You can still have ONE drink worth of alcohol per day." e. "Notify your provider is you have any S/S of GI bleeding." f. "Your diet will need to change a little bit, starting with decreasing your sodium intake."

d - NO ALCOHOL intake

A patient with a history of cirrhosis comes into the ER with abdominal pain, jaundice, hypotension, and serious ascites. Which procedure would be performed to relieve the ascites? a. thoracentesis b. ERCP c. EGD d. paracentesis e. NG insertion

d - invasive procedure performed to remove abdominal fluid

What are the most common skin complications from colostomy bags? a. irritant dermatitis (from fecal content) b. skin stripping (from the adhesive barrier or wafer) c. candidiasis (fungal infection under the barrier or wafer) d. none of the above e. All of the above

e

Cholecystitis is an inflammation of the ______________________. a. liver b. colon c. stomach d. pancreas e. spleen f. gallbladder

f - It is most often caused by gallstones obstructing the cystic and /or common bile.

Serum amylase and lipase are typically (increased/decreased) in a patient with acute pancreatitis.

increased - usually increase within 12-24 hours, and remain elevated for 2-3 days. Will also see ↑ WBCs, ESR, and glucose levels. ↑ ALT - with biliary obstruction in acute pancreatitis

Famotidine is prescribed for a client with PUD, what is the mechanism of action?

inhibits gastric acid secretion

esophagectomy

is the removal of all or part of the esophagus, and is usually selected as the initial surgical approach to esophageal cancer

A mixture of bile and secretions made to digest food

stomach acid

True or false The pancreas is unusual in that it functions as both an exocrine gland and an endocrine gland.

true