ECU CAII: EXAM 4: GI

What are the clinical manifestations or a paralytic ileum?

Absent bowel sounds, abdominal distension, tender abdomen

What are the causes of small bowel obstruction?

Adhesions, hernias, tumors, intussusception, volvulus, foreign bodies, stricture, stenosis, inflammatory bowel disease, diverticulum, ischemia

Therapeutic Management of intussusception

Air enema with or without water-soluble contrast or ultrasound guided hydrostatic (saline) enema IV fluids, NG decompression, antibiotic therapy before hydrostatic reduction is attempted Laparoscopic surgical repair is commonly performed

Pyloric Stenosis: Serum Electrolytes

decreased Cl, Na, K (may be masked by hemoconcentration from extracellular fluid depletion).

what are the complications of food poising

dehydration due to vomiting and electrolyte imbalances

Pyloric Stenosis: barium studies

delayed gastric emptying and narrowing of pyloric channel

describe the nnipples on bottles used to feed babies with cleft lip

large holed, soft nipples

What are some causes of a paralytic ileum?

neurogenic or muscular impairment or tissue anoxia or peritoneal irritation due to hemorrhage, peritonitis or perforation of an organ

what position is contraindicated after cleft lip repair

never let them lay on their abdomen

is milk good for a pt. with GERD

no, it may feel good but it causes more acid production

is the infant restrained before repair

no, only after

do you irrigate or reposition a tube in a pt. after nissen fundoplication

no, the stomach is resting

should you move an NG tube after nissen fundoplication

no, there are sutures in the stomach

can a pt. eat after a nissen fundoplication

no, they are NPO and then given clear liquids and eventually advanced to full liquids and a soft diet

Necrotizing enterocolitis sx

o Abdominal distention,Tenderness o Ileus o Diarrhea with frank blood

Obturator sign

pain with internal rotation of flexed right thigh

Psoas sign

pain with right thigh extension

What is a functional/neurogenic obstruction of small bowel?

paralytic ileus

A pt. is vomiting up blood after a esophagogastroduidenoscopy (EDGD), what should you suspect

perforation

Laparoscopy (peritoneoscopy):

performed with a fiberoptic laparoscope that allows direct visualization of: -- organs and structures w/in abdomen - biopsies may be obtained

Cleft Lip: Surgical/Scar revision

precedes closure of cleft palate

Ranson's criteria

prognostic indicators: 5-6 =40% mortality, >7= 100%

don't go to bed with a full stomach sit up for 30 minutes after eating don't overeat wear loose clothes stop smoking lose weight and don't drink are all recommendations for what

pts. with GERD

What are some ways to check placement of an NG tube?

push air in and hear "swoosh", check pH, check gastric residual

how do you care for an infant with a logan bow

remove the guaze before feeding and cleanse after feeding with peroxide and saline

what must the mother do after feeding the baby who has had cleft lip or palate repair

rinse the mouth with water

What type of colostomy is most likely to be permanent?

sigmoid

pain is relieved in which position

sitting and leaning forward

Factors that contribute to gerd

smoking, excess weigth bp meds (beta blockers)

Mesenteric infarct hallmark sx

sudden cramping, pain out of proportion to exam

Pancreatitis caused by what 5 meds?

sulfonimides, thiazide, furosemide, estrogen, azathioprine (Imuran)

What is the treatment for strangulated obstruction of small bowel?

surgical emergency to save bowel and treatment to correct fluid and electrolyte imbalances (IV of 20 gauge or higher in AC to replenish fluids because of vomiting and NG tube to suck out bile and possible feces)

how are cleft lip and palate primarily treated

surgical repair

What is a bowel resection with ostomy formation?

surgically created opening between the intestine and abdominal wall allowing passage of fecal material

after repair of cleft lip is the infant allowed to cry? to breast feed?

the infant should not be allowed to cry- hold to prevent, the infant is not allowed to breast feed bc sucking is not good after the lip repair

what is a cleft lip

the lip is open to the nares

what is a cleft palate

the roof of the mouth is open to the nasopharynx

Peritoneum:

the serious membrane that lines part of the abdominal cavity and viscera

what does a pt. with an hernia do that causes pain

they bend over

what is the concern with fluids and electrolytes after a nissen fundoplication

third space shifting of fluids

TEF: surgical correction

thoracotomy staged (not all in one surgery).

what is the purpose of a logan bow?

to prevent stress on the suture line

What is the procedure of choice for ulcerative colitis?

total colectomy with an ileal pouch-anal anastomosis

what problems can occur with oral cancer and nutrition?

trouble eating malnurishment

what problems can occur with oral cancer and psycosocial?

trouble speaking, depression alters face

what respiratory measures should be included after a nissen fundoplication

turn cough deep breath and incentive spirometer

how many surguries is cleft palate repaired?

two surgeries... one at 12-18 months and the last at 4-5 years

Cleft Lip: First Diagnosis

ultrasonography (14-16 wks.)

gold standard dx choley

ultrasound

cullen's sign

umbilical discoloration

What significant UGI side effect do BISPHOSPHANATES have?

ESOPHAGITIS (potassium tabs are also bad for esophagitis: the big K-dur ones; small micro-K tabs are better for this) Bisphosphanates are taken weekly.

Post-op after ileostomy formation what should the client be most concerned with doing?

Fluid and electrolyte balance (drink plenty of fluids)

Acute Diarrhea (Children)

Leading cause of illness in children younger than 5 years of age Defined as: Sudden increase in frequency and a change in consistency of stools, often caused by an infectious agent in GI tract

The classic triad of intussusception sx are:

abdominal pain, abdominal mass, bloody stools Children may also be seen with screaming, irritability, lethargy, vomiting, diarrhea or constipation, fever dehydration or shock

What is a perforation of the abdomen?

air in the abdomen

Manidbular fractures most common problems

airway clearance dysphagia tongue support is lost

what are main concerns with oral care

airway clearance, aspiriation, and pain

children with cleft lip and palate should be fed in what position

almost upright

How do you treat septic shock?

antibiotics

TEF: complications

areas that have been cut could develop scar tissue & lead to dysphagia, respiratory complications, GER and feeding difficulties.

What types of colostomies can be formed?

ascending, transverse, descending, and sigmoid colostomy

what is the #1 problem with cleft lip/palate

aspiration

What is a bowel assessment?

assess distension, ask client if he/she feels "bloated"; assess bowel sounds in all 4 quads with suction turned off to best hear; assess for flatus; assess for n/v

Post-procedure: Upper GI endoscopy:

- NPO until gag reflex returns (1-2hrs) - monitor for signs of perforation - maintain bedrest of sedated client until alert - (when gag reflex returns) relieve sore throat by: -- lozenges -- saline gargles -- oral analgesics

ERCP is performed via:

- a flexible endoscope inserted - into the esophagus - down to the descending duodenum ---- multiple posistions req to pass endoscope

Lower GI study (barium enema): Desc:

- a fluoroscopic and radiographic examination - of lrg intestine - performed after rectal instillation- barium sulfate - study may be done with or with out air

Gastric Analysis analizes:

- acidity (pH) of gastric contents - appearance of gastric contents - volume of gastric contents

Upper GI tract study (barium swallow) is:

- an examination of the upper GI - under fluoroscopy - client drinks barium sulfate

Pre-procedure: Cholecystography:

- assess for alergies to iodine seafood - admin contrast agents 10-12 hrs(evening b4) - client NPO aft contrast agent is administered --- instruct to report to ER if rash, hives, or diffiuclty in breathing ocurs aft agent admin.

Post-procedure: Fiberoptic colonoscopy:

- bed rest until alert - monitor for signs of bowel perforation/peritonitis - report bleeding to Dr.

Pre-procedure: Fiberoptic colonoscopy:

- cleanseing of the colon as perscribed by Dr. - clear liquid diet started on day b4 test - consult w/physician re: meds to b held b4 test - NPO aft midnight on day b4 test

Pre-procedure: Anoscopy, Proctoscopy and Sigmoidoscopy

- enemas are given until returns are clear

Pre-procedure: Gastric Analysis:

- fasting for 8-12 hrs is required B4 test - tobacco and chewing gum is avoided 6rs b4 tst - meds that stimulate gastric secretions -held for 24-48 hrs

Post-procedure: Gastric Analysis:

-client may resume normal activities -refrigerate gastric samples if not tested w/in 4hr

What is the pre-operative care for clients undergoing a bowel resection surgery?

low residue diet or liquid diet, oral administration of GoLytely or bowel prep, administration of antibiotics 12-24 hours before surgery, blood transfusion if severe anemia is present

Barium enema:

lower GI study

What is a strangulated obstruction of the small bowel?

lumen of bowel is obstructed and blood supply to the affected portion is compromised

What is the post-op care to an esophagogastroduidenoscopy (EDGD)

make sure the gag reflex has returned

is bilirubin elevated?

may be

If a pt. with a mandibular fracture is nauseated what should you do

use an NG tube and put pt. on their side

Pre-procedure: Fiberoptic colonoscopy Meds:

- Midazolam (Versed) IV to provide sedation - Glucagon to relax smooth muscle

Pre-procedure for PTC:

- NPO - sedating meds administered

Pre-procedure: Barium Swallow:

- NPO after midnight B4 day of test

Preprocedure ERCP:

- NPO several hrs b4 - Sedatin is admin b4 procedure

Peritonitis:

- Inflammation of the peritoneum, - typically caused by bacterial infection - either via the blood or - after the rupture of an abdominal organ

Fiberoptic colonoscopy: Description

- fiberoptic endoscopy study - the lining of the lge intestine visually examined - cardiac/resp functions monitored contiunously - performed with client lying on lft side - w/knees drawn up to the chest - position may be changed during the test - to facilitate passing of the scope

Cholecystography assesses the ability of gallbladder to:

- fill - concentrate it's contents - contract - and empty

Upper GI procedure:

- following sedation - endoscope passed down esophagus to view --- gastric wall --- sphincters --- duodenum - tissue specimens can be obtained

Cholecystography detects:

- gallstones

Signs of bowel perforation/peritonitis:

- guarding of abdomen - increased fever/chills - pallor - progressive ab distention - ab pain - restlessness - tachycardia - tachypnea

Signs of perforation/peritonitis:

- guarding of the abdomen - increased fever and chills - pallor - progressive ab distention - progressive ab pain - restlessness - tachycardia - tachypnea

The dye for PTC examination clearly outline the:

- hepatic ducts w/in the liver - entire length of common bile duct - gallbladder

During gastric analysis, what may be administered:

- histamine/pentagastrin - to stimulate gastric secretions - may produce a flushed feeling

PTC is used to:

- identify obstructions in the liver and bile ducts - that slow or stop the flow of bile

Post-procedure: Barium Enema:

- increase oral fluids to help pass barium - administer a mild laxative as perscribed - laxitives facilitate emptying of barium - monitor bowes for signs of passage of barium - NOTIFY: DR IF: --- bowel movement does not occur w/in 2 days

Post-procedure: Cholecystography:

- inform client that dysuria is common - because contrast agent is excreted in urine - normal diet may be resumed - (fatty meal may enhance excretion of contrast agent)

(PTC) Percutaneous transhepatic cholangiography examination involves:

- injectionof dye directly into biliary tree - x-ray test

Post-procedure: Barrium Swallow:

- laxitive may be perscribed - increase oral fluid intake to pass barium - monitor stools for passage of barium - barium can cause bowel obstruction - barium causes stools to be chalky white

Post- procedure PTC meds:

- local anesthesis/conscious sedation is used - administer antibiotics as percribed to - reduce risk of sepsis

Pre-porcedure: Upper GI endoscopy Meds:

- local anesthetic (spray/gargle) admin - meds admin for conscious sedation/relieve anx -- midazolam (Versed) IV just B4 scope inserted - atropine sulfate (may be) admin 2 reduce secretions - glucagon to relax smooth muscle

Pre-procedure: Barium Enema

- low-residue diet for 1-2 days B4 test - clear liquid diet/laxative evening B4 test - NPO after midnight B4 day of test - cleansing enemas on morning of test

Post-procedure: Anoscopy, Proctoscopy/Sigmoidoscopy

- monitor for rectal bleeding - signs of perforation - signs of peritonitis

Post-procedure ERCP:

- monitor vital signs - monitor for the return of the gag reflex - monitor for signs of perforation/peritonitis

Signs of upper GI perforation: (from endoscopy)

- pain - bleeding - unusual difficulty swallowing - elevated temp

Pre-procedure: Upper GI endoscopy

- pt must be NPO for 6-12 hrs B4 test - client positioned on lft side - to facilitate saliva drainage - easy acces of the endoscope - airway patency is monitored during test - pulse ox used to monitor O2 sats - ER equipment readily available

Pre-procedure Paracentesis:

- pt to void b4 start of procedure- empty bladder - to move bladder out of the way of needle - measure ab girth, weight, baseline vitals - note that pt is positioned

Gastric Analysis: Description

- requires the passage of a nasogastric tube - into the stomach to aspirate gastric contents

If meds are admin b4 ERCP procedure, pt is monitored for signs of:

- resp/CNS depression - hypotensioni - oversedation - vomiting

During a gastric analysis:

- the entire gastric contents are aspirated - then specimens collected q15 min for 1 hr

Paracentesis is the:

- transabdominal removal of fluid - from the peritoneal cavity for analysis

PTC procedure:

- transhepatic insertion of needle - injection of radioactive dye - for those who are not candidates for ERCP

Barium swallow:

- upper gastrointestinal tract study

Proctoscopy/sigmoidoscopy: Description

- use flexible scope to examine rectum/sigmoid colon - placed on lft side w/right knee bent - placed anteriorly - biopsies/polypectomies can be performed

Anoscopy: Description

- use rigid scope to examine anal canal - placed in knee to chest position - back inclined at 45degree angle - biopsies/polypectomies can be performed

Post-procedure for PTC monitor:

- vital signs - signs of bleeding - signs of peritonitis - signs of septicemia (report signs of pain immediately)

Cholecystography contrast agents:

--iopanic acid (Telepaque) --iodipamide meglumine (Cholografin) --sodium ipodate (Oragrafin)

Necrotizing enterocolitis progression

-May affect small portion of terminal ileum (and ascending colon), or entire SI intestine -Injury initially mucosal>> (severe) entire bowel wall becomes hemorrhagic, gangrenous o Needs surgical resecetion (Gangrene and perforation are life threatening)

Necrotizing enterocolitis

-Neonates, low birth weight babies -Acute, nectrotizing inflammation of SI and colon d/t combination of 1. fxn immaturity of neonatal gut 2. Colonization and invasion by pathogenic organisms 3. 2° to ischemic injury

Dehydration is classified into three categories on the basis of osmolality and depends primarily on the serum sodium concentration

1)isotonic 2)hypotonic 3)hypertonic

TEF: Diagnostics

1. inability to pass NG or OG tube 2. Radiopaque catheter advanced until obstruction is met. 3. Chest film reveals esophageal patency or blind pouch. 4. Air in stomach d/t connection between trachea and distal esophagus 5. polyhydramnios: >2000 mls. amniotic fluid swallowed, absorbed and excreted by kidneys.

Pyloric Stenosis Post op care

1. maintain fluid balance: may have vomiting 24-48 hrs. 2. monitor response to oral intake: clear, PO fluids Q4-6hrs., small, frequent feedings (15-20 ml/feeding). 3. feed upright 4. observe for vomiting and hematemesis 5. monitor for weight gain 6. Pain relief: avoid pressure of operative site by not lifting legs during diaper change.

TEF: Intervention goals

1. maintain patent airway. 2. prevent pneumonia 3. gastric decompression 4. surgical repair

Cleft Lip: Complications

1. speech & language difficulties 2. dental: malocclusion, abn. tooth eruption, abn. development of mandible & maxilla, excessive dental decay 3. auditory: Chronic OM (esutachian tube dysfunction) --> hearing loss and speech delay.

how long should you boil foods

10 minutes

CL: Post-Op Care (diet, position, bleeding)

1. Avoid prone position to prevent airway obstruction 2. breast feed when child is awake & alert 3. Pain management is important because crying will put stress on suture line 4. avoid use of suction of objects in mouth: tongue depressors, thermometers, spoons, straws. 5. gentle aspiration of mouth and nasopharyngeal secretions to prevent aspiration and respiratory compromise (check with MD). 6. monitor site for bleeding: excessive swallowing may be signs of bleeding.

CL/CP: Impact on feeding

1. CL: can breast feed. 2. CP: unable to generate negative pressure (can't create suction); swallowing is normal. 3. Pump breast milk & feed via special bottle.

Bacterial Enterocolitis Complications

1. Dehydration 2. Sepsis 3. Perforation 4. Death dt massive fluid loss and destruction of intestinal mucosal barrier

Bacterial Enterocolitis Mechanisms

1. Ingestion of contaminated food: - w/ Staph aureus, virbio spp, clostridium perfingens, clostridium botulinum 2. Infected by toxigenic organisms -Proliferate in gut lumen, >> enterotoxin 3. Infection by enteroinvasive organisms -grow, invade, and destroy mucosal epithelial

Symptoms of Bacterial Enterocolitis

1. Ingestion of performed bacterial toxins -Sx within hours :Explosive diarrhea, Acute abd distress -C.Botulinum may produce resp. failure, fatal 2. Infection with enteric pathogens -Incubation of hrs - days -Sx: Secretory organism: Diarrhea, dehydration - Cytotoxin, Enteroinvasive: dystentery - Traveler's diarrhea beings abruptly, subsides 2-3 days 3. Insidious Infection: May mimic Crohn disease -Yersinia, Mycobacterium o All enteroinvasive organisms can mimic or precipitate acute onset of idiopathic IBD

TEF: Interventions (diet,position, meds, secretions)

1. NPO & IV fluids 2. position to facilitate drainage of secretions & decrease risks of aspiration (remember frothy sputum); head upright 3. suction mouth & pharynx 4. continuous low suction, double lumen cath 5. broad spectrum abx

Pyloric Stenosis: Preop Interventions

1. NPO but restore dehydration & electroyte balance: IV glucose & electrolytes (Na & K). 2. Strict I & O 3. Describe character of vomitus (what went down, comes up undigested). 4. number and character of stools 5. stomach decompression to get air out of stomach 6. protect from infection

What 3 medications are given for bleeding varices?

1. PPI (to stabilize clots) 2. Antibiotics (erythromycin) 3. OCTREOTIDE (divert blood away from the GI tract; somatostatin analogue) [50 ug loading and then 50 ug per hour] Also: Metoclopramide ENDOSCOPY Blakemore tube (last resort) Prophylaxis: NATALOL (a non-selective beta-blocker)

CP/CL Discharge Instructions

1. Watch car seat restraints (for piece that comes across the chest).

CP: Post Op care (diet, position)

1. allowed to lie on abdomen (elbow restraints). 2. resume feedings: breast, bottle, or cup. 3. small, wide spoon allowable. 4. assist palatal function: speech, chewing, frequent swallowing exercise throat and palatine muscles. 5. Diet: soft diet (older child); avoid hard foods (toast, hard cookies, potato chips).

TEF: Clinical Manifestations

1. drooling that is frequently accompanied by choking, coughing and sneezing. When fed, infants swallow normally but begin to cough and struggle as the fluid returns through the nose and mouth. The infant may become cyanotic (turn bluish due to lack of oxygen) and may stop breathing as the overflow of fluid from the blind pouch is aspirated into the trachea. The cyanosis is a result of laryngospasm (a protective mechanism that the body has to prevent aspiration into the trachea). 2. frothy sputum

Pyloric Stenosis: Abdominal Ultrasound

1. first line diagnostic study 2. hypertrophy and hyperplagia of pyloric sphincter.

Post-op after ileostomy what temperature should be reported to the HCP?

101 degrees F

Longest time formula can remain in open system

12 hours

What is an ileal pouch with an anal anastomosis (IPAA)?

A temporary or loop ileostomy may be formed to eliminate feces and allow tissue healing for 2-3 months following a total colectomy with IPAA

The client asks the nurse whether he will need surgery to correct his hiatal hernia. Which reply by the nurse would be most accurate? 1. "Surgery is usually required, although medical treatment is attempted first." 2. "Hiatal hernia symptoms can usually be successfully managed with diet modifications, medications, and lifestyle changes." 3. "Surgery is not performed for this type of hernia." 4. "A minor surgical procedure to reduce the size of the diaphragmatic opening will probably be planned."

2. Most clients can be treated successfully with a combination of diet restrictions, medications, weight control, and lifestyle modifications. Surgery to correct a hiatal hernia, which commonly produces complications, is performed only when medical therapy fails to control the symptoms.

A client who has been diagnosed with gastroesophageal reflux disease (GERD) complains of heartburn. To decrease the heartburn, the nurse should instruct the client to eliminate which of the following items from the diet? 1. Lean beef. 2. Air-popped popcorn. 3. Hot chocolate. 4. Raw vegetables.

3. With GERD, eating substances that decrease lower esophageal sphincter pressure causes heartburn. A decrease in the lower esophageal sphincter pressure allows gastric contents to reflux into the lower end of the esophagus. Foods that can cause a decrease in esophageal sphincter pressure include fatty foods, chocolate, caffeinated beverages, peppermint, and alcohol. A diet high in protein and low in fat is recommended for clients with GERD. Lean beef, popcorn, and raw vegetables would be acceptable.

Average fluid needs for an adult

30-35 mls/kg

sliding hiatal hernia

A hernia in which the stomach and a section of esophagus which joins the stomach slide up into the chest through what is called the hiatus (gap/passage).

What is a colectomy?

A resection and removal of the colon where a pouch is formed from the terminal ileum and pouch brought up into the pelvis and anastomosed to anal canal

A client is admitted to the hospital after vomiting bright red blood and is diagnosed with a bleeding duodenal ulcer. The client develops a sudden, sharp pain in the midepigastric region along with a rigid, boardlike abdomen. These clinical manifestations most likely indicate which of the following? 1. An intestinal obstruction has developed. 2. Additional ulcers have developed. 3. The esophagus has become inflamed. 4. The ulcer has perforated.

4. The body reacts to perforation of an ulcer by immobilizing the area as much as possible. This results in boardlike abdominal rigidity, usually with extreme pain. Perforation is a medical emergency requiring immediate surgical intervention because peritonitis develops quickly after perforation. An intestinal obstruction would not cause midepigastric pain. The development of additional ulcers or esophageal inflammation would not cause a rigid, boardlike abdomen.

What is a kock pouch?

A reservoir or pouch is constructed from the distal of ileum allowing stool to be stored until it is drained through a nipple valve

What is a colostomy?

A surgical ostomy made in the colon for diversion of fecal contents

A nurse teaches a client experiencing heartburn to take 1 ½ oz of Maalox when symptoms appear. How many milliliters should the client take? ________________________ mL

45 mL

What % of UGI bleeds stop on their own? 20%? 60%? 80%?

80%

Minimum length for tube feeding under Medicare guidelines

90 days

Number of US patients receiving home tube feeding

> 700,000

The nurse is to obtain a stool specimen from a client who reported that he is taking iron supplements. The nurse would expect the stool to be which color? a) Black b) Red c) Dark brown d) Green

A) Black Ingestion of iron can cause the stool to turn black. Meat protein causes stool to appear dark brown. Ingestion of large amounts of spinach may turn stool green while ingestion of carrots and beets may cause stool to turn red.

The nurse is checking the residual content for a client who is receiving intermittent feedings. Which residual content, if obtained, would lead the nurse to delay the feeding? a) 120 mL b) 60 mL c) 30 mL d) 90 mL

A) 120 mL Feedings typically are delayed if the residual content measures more than 100 mL for intermittent feedings or 10% to 20% of the hourly amount of a continuous feeding. Thus a residual content of 120 mL would require the nurse to delay the feeding.

A client with liver and renal failure has severe ascites. On initial shift rounds, his primary nurse finds his indwelling urinary catheter collection bag too full to store more urine. The nurse empties more than 2,000 ml from the collection bag. One hour later, she finds the collection bag full again. The nurse notifies the physician, who suspects that a bladder rupture is allowing the drainage of peritoneal fluid. The physician orders a urinalysis to be obtained immediately. The presence of which substance is considered abnormal? a) Albumin b) Chloride c) Creatinine d) Urobilinogen

A) Albumin Albumin is an abnormal finding in a routine urine specimen. Ascites present in liver failure contain albumin; therefore, if the bladder ruptured, ascites containing albumin would drain from the indwelling urinary catheter because the catheter is no longer contained in the bladder. Creatinine, urobilinogen, and chloride are normally found in urine.

A client with liver and renal failure has severe ascites. On initial shift rounds, his primary nurse finds his indwelling urinary catheter collection bag too full to store more urine. The nurse empties more than 2,000 ml from the collection bag. One hour later, she finds the collection bag full again. The nurse notifies the physician, who suspects that a bladder rupture is allowing the drainage of peritoneal fluid. The physician orders a urinalysis to be obtained immediately. The presence of which substance is considered abnormal? a) Albumin b) Chloride c) Urobilinogen d) Creatinine

A) Albumin Albumin is an abnormal finding in a routine urine specimen. Ascites present in liver failure contain albumin; therefore, if the bladder ruptured, ascites containing albumin would drain from the indwelling urinary catheter because the catheter is no longer contained in the bladder. Creatinine, urobilinogen, and chloride are normally found in urine.

When caring for a client with an acute exacerbation of a peptic ulcer, the nurse finds the client doubled up in bed with severe pain to his right shoulder. The intial appropriate action by the nurse is to a) Assess the client's abdomen and vital signs. b) Irrigate the client's NG tube. c) Place the client in the high-Fowler's position. d) Notify the health care provider.

A) Assess the client's abdomen and vital signs Signs and symptoms of perforation includes sudden, severe upper abdominal pain (persisting and increasing in intensity); pain may be referred to the shoulders, especially the right shoulder, because of irritation of the phrenic nerve in the diaphragm. The nurse should assess the vital signs and abdomen prior to notifying the physician. Irrigation of the NG tube should not be performed because the additional fluid may be spilled into the peritoneal cavity, and the client should be placed in a position of comfort, usually on the side with the head slightly elevated.

Which of the following is an accurate statement regarding cancer of the esophagus? a) Chronic irritation of the esophagus is a known risk factor. b) It is three times more common in women in the U.S. than men. c) It is seen more frequently in Caucasian Americans than in African Americans. d) It usually occurs in the fourth decade of life.

A) Chronic irritation of the esophagus is a known risk factor In the United States, cancer of the esophagus has been associated with the ingestion of alcohol and the use of tobacco. In the United States, carcinoma of the esophagus occurs more than three times more often in men as in women. It is seen more frequently in African Americans than in Caucasian Americans. It usually occurs in the fifth decade of life

A client is admitted for suspected GI disease. Assessment data reveal muscle wasting, a decrease in chest and axillary hair, and increased bleeding tendency. The nurse suspects the client has: a) cirrhosis. b) cholelithiasis. c) appendicitis. d) peptic ulcer disease.

A) Cirrhosis Muscle wasting, a decrease in chest and axillary hair, and increased bleeding tendencies are all symptoms of cirrhosis. The client may also have mild fever, edema, abdominal pain, and an enlarged liver. Clients with peptic ulcer disease complain of a dull, gnawing epigastric pain that's relieved by eating. Appendicitis is characterized by a periumbilical pain that moves to the right lower quadrant and rebound tenderness. Cholelithiasis is characterized by severe abdominal pain that presents several hours after a large meal.

A nurse is reviewing the history and physical of a client admitted for a hemorrhoidectomy. Which predisposing condition does the nurse expect to see? a) Constipation b) Hypoglycemia c) Lactic acidosis d) Hyperkalemia

A) Constipation Orthostatic hypertension and other conditions associated with persistently high intra-abdominal pressure (such as pregnancy) can lead to hemorrhoids. The passing of hard stools, not diarrhea, can aggravate hemorrhoids. Diverticulosis has no relationship to hemorrhoids. Rectal bleeding is a symptom of hemorrhoids, not a predisposing condition.

Which of the following is the primary symptom of achalasia? a) Difficulty swallowing b) Pulmonary symptoms c) Chest pain d) Heartburn

A) Difficulty swallowing The primary symptom of achalasia is difficulty in swallowing both liquids and solids. The patient may also report chest pain and heartburn that may or may not be associated with eating. Secondary pulmonary complications may result from aspiration of gastric contents.

The client cannot tolerate oral feedings due to an intestinal obstruction and is NPO. A central line has been inserted, and the client is being started on parenteral nutrition (PN). The nurse performs the following actions while the client receives PN (select all that apply): a) Document intake and output. b) Use clean technique for all catheter dressing changes. c) Weigh the client every day. d) Cover insertion site with a transparent dressing that is changed daily. e) Check blood glucose level every 6 hours.

A) Document intake and output; C) Weigh the client every day; E) Check blood glucose level every 6 hours When a client is receiving PN through a central line, the nurse weighs the client daily, checks blood glucose level every 6 hours, and documents intake and output. These actions are to ensure the client is receiving optimal nutrition. The nurse also performs activities to prevent infection, such as covering the insertion site with a transparent dressing that is changed weekly and/or prn and using sterile technique during catheter site dressing changes.

After administering a dose of promethazine (Phenergan) to a patient with nausea and vomiting, the nurse explains that which of the following may be experienced as a common temporary adverse effect of the medication? A) Drowsiness B) Reduced hearing C) Sensation of falling D) Photosensitivity

A) Drowsiness Although being given to this patient as an antiemetic, promethazine also has sedative and amnesic properties. For this reason, the patient is likely to experience drowsiness as an adverse effect of the medication.

A nurse is preparing a client with Crohn's disease for a barium enema. What should the nurse do the day before the test? a) Encourage plenty of fluids. b) Order a high-fiber diet. c) Serve dairy products. d) Serve the client his usual diet.

A) Encourage plenty of fluids The nurse should encourage plenty of fluids because adequate fluid intake is necessary to avoid dehydration that may be caused by the bowel preparation and to prevent fecal impaction after the procedure. The client may be placed on a low-residue diet 1 to 2 days before the procedure to reduce the contents in the GI tract. Fiber intake is limited in a low-residue diet. Because dairy products leave a residue, they aren't allowed the evening before the test. Clear liquids only are allowed the evening before the test.

Diet therapy for patients diagnosed with IBS include which of the following? a) High-fiber diet b) Fluids with meals c) Caffeinated products d) Spicy foods

A) High fiber diet A high-fiber diet is prescribed to help control diarrhea and constipation. Foods that are possible irritants such as caffeine, spicy foods, lactose, beans, fried foods, corn, wheat, alcohol should be avoided. Fluids should not be taken with meals because this results in abdominal distention.

Patients diagnosed with esophageal varices are at risk for hemorrhagic shock. Which of the following is a sign of potential hypovolemia? a) Hypotension b) Bradycardia c) Polyuria d) Warm moist skin

A) Hypotension Signs of potential hypovolemia include cool, clammy skin, tachycardia, decreased blood pressure, and decreased urine output.

A physician plans to send a client home with supplies to complete a hemoccult test on all stools for 3 days. During the client education, the nurse informs the client to avoid which of the following medications while collecting stool for the test? a) ibuprofen (Advil) b) ciprofloxacin (Cipro XR) c) docusate sodium (Colace) d) acetaminophen (Tylenol)

A) Ibprofen (Advil) Fecal occult blood testing (FOBT) is one of the most commonly performed stool tests. FOBT can be done at the bedside, in the physician's office, or at home. The client is taught to avoid aspirin, red meats, nonsteroidal antiinflammatory agents, and horseradish for 72 hours prior to the examination. Advil is an anti-inflammatory drug and should be avoided with FOBT.

Two days following a colectomy for an abdominal mass, a patient reports gas pains and abdominal distention. The nurse plans care for the patient based on the knowledge that the symptoms occur as a result of which of the following? A) Impaired peristalsis B) Irritation of the bowel C) Nasogastric suctioning D) Anastomosis site inflammation

A) Impaired peristalsis Until peristalsis returns to normal following anesthesia, the patient may experience slowed gastrointestinal motility leading to gas pains and abdominal distention.

A nursing instructor tells the class that review of oral hygiene is an important component during assessment of the gastrointestinal system. One of the students questions this statement. Which of the following explanations from the nurse educator is most appropriate? a) "Injury to oral mucosa or tooth decay can lead to difficulty in chewing food." b) "Mouth sores are caused by bacteria that can thin the villi of the small intestine." c) "Decaying teeth secrete toxins that decrease the absorption of nutrients." d) "Bad breath will encourage ingestion of fatty foods to mask odor."

A) Injury to the oral mucosa or tooth decay can lead to difficulty in chewing food Poor oral hygiene can result in injury to the oral mucosa, lip, or palate; tooth decay; or loss of teeth. Such problems may lead to disruption in the digestive system. The ability to chew food or even swallow may be hindered.

After 20 seconds of auscultating for bowel sounds on a client recovering from abdominal surgery, the nurse hears nothing. Which of the following should the nurse do based on the assessment findings? a) Listen longer for the sounds. b) Call the physician to report absent bowel sounds. c) Document that the client is constipated. d) Return in 1 hour and listen again to confirm findings.

A) Listen longer for sounds Auscultation is used to determine the character, location, and frequency of bowel sounds. The frequency and character of sounds are usually heard as clicks and gurgles that occur irregularly and range from 5 to 35 per minutes. Normal sounds are heard about every 5 to 20 seconds, whereas hypoactive sounds can be one or two sounds in 2 minutes. Postoperatively, it is common for sounds to be reduced; therefore, the nurse needs to listen at least 3 to 5 minutes to verify absent or no bowel sounds.

A physician orders spironolactone (Aldactone), 50 mg by mouth four times daily, for a client with fluid retention caused by cirrhosis. Which finding indicates that the drug is producing a therapeutic effect? a) Loss of 2.2 lb (1 kg) in 24 hours b) Serum potassium level of 3.5 mEq/L c) Blood pH of 7.25 d) Serum sodium level of 135 mEq/L

A) Loss of 2.2 lb (1 kg) in 24 hours Daily weight measurement is the most accurate indicator of fluid status; a loss of 2.2 lb (1 kg) indicates loss of 1 L of fluid. Because spironolactone is a diuretic, weight loss is the best indicator of its effectiveness. This client's serum potassium and sodium levels are normal. A blood pH of 7.25 indicates acidosis, an adverse reaction to spironolactone.

The nurse is caring for a 68-year-old patient admitted with abdominal pain, nausea, and vomiting. The patient has an abdominal mass and a bowel obstruction is suspected. The nurse auscultating the abdomen listens for which of the following types of bowel sounds that is consistent with the patient's clinical picture? A) Low pitched and rumbling above the area of obstruction B) High pitched and hypoactive below the area of obstruction C) Low pitched and hyperactive below the area of obstruction D) High pitched and hyperactive above the area of obstruction

A) Low pitched and rumbling above the area of obstruction Early in intestinal obstruction, the patient's bowel sounds are hyperactive and high pitched, sometimes referred to as "tinkling" above the level of the obstruction. This occurs because peristaltic action increases to "push past" the area of obstruction. As the obstruction becomes complete, bowel sounds decrease and finally become absent.

A physician has ordered a liver biopsy for a client whose condition is deteriorating. Which of the following places the client at high risk due to her altered liver function during the biopsy? a) Low platelet count b) Low hemoglobin c) Decreased prothrombin time d) Low sodium level

A) Low platelet count Certain blood tests provide information about liver function. Prolonged prothrombin time (PT) and low platelet count place the client at high risk for hemorrhage. The client may receive intravenous (IV) administration of vitamin K or infusions of platelets before liver biopsy to reduce the risk of bleeding.

The nurse is conducting discharge teaching for a patient with metastatic lung cancer who was admitted with a bowel impaction. Which of the following instructions would be most helpful to prevent further episodes of constipation? A) Maintain a high intake of fluid and fiber in the diet. B) Reduce intake of medications causing constipation. C) Eat several small meals per day to maintain bowel motility. D) Sit upright during meals to increase bowel motility by gravity.

A) Maintain a high intake of fluid and fiber int he diet Increased fluid intake and a high-fiber diet reduce the incidence of constipation caused by immobility, medications, and other factors. Fluid and fiber provide bulk that in turn increases peristalsis and bowel motility.

A patient with type 2 diabetes and cirrhosis asks the nurse if it would be okay to take silymarin (milk thistle) to help minimize liver damage. The nurse responds based on knowledge that A) Milk thistle may affect liver enzymes and thus alter drug metabolism. B) Milk thistle is generally safe in recommended doses for up to 10 years. C) There is unclear scientific evidence for the use of milk thistle in treating cirrhosis. D) Milk thistle may elevate the serum glucose levels and is thus contraindicated in diabetes.

A) Milk thistle may affect liver enzymes and thus alter drug metabolism There is good scientific evidence for the use of milk thistle as an antioxidant to protect the liver cells from toxic damage in the treatment of cirrhosis. It is noted to be safe for up to 6 years, not 10 years, and it may lower, not elevate, blood glucose levels. It does affect liver enzymes and thus could alter drug metabolism. Therefore patients will need to be monitored for drug interactions.

A client recovering from gastric bypass surgery accidentally removes the nasogastric tube. It is best for the nurse to a) Notify the surgeon about the tube's removal. b) Reinsert the nasogastric tube to the stomach. c) Document the discontinuation of the nasogastric tube. d) Place the nasogastric tube to the level of the esophagus.

A) Notify the surgeon about the tube's removal If the nasogastric tube is removed accidently in a client who has undergone esophageal or gastric surgery, it is usually replaced by the physician. Care is taken to avoid trauma to the suture line. The nurse will not insert the tube to the esophagus or to the stomach in this situation. The nurse needs to do more than just document its removal. The nurse needs to notify the physician who will make a determination of leaving out or inserting a new nasogastric tube.

Which of the following is caused by improper catheter placement and inadvertent puncture of the pleura? a) Pneumothorax b) Sepsis c) Fluid overload d) Air embolism

A) 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.

A nurse is interviewing a client about his past medical history. Which preexisting condition may lead the nurse to suspect that a client has colorectal cancer? a) Polyps b) Weight gain c) Hemorrhoids d) Duodenal ulcers

A) Polyps Colorectal polyps are common with colon cancer. Duodenal ulcers and hemorrhoids aren't preexisting conditions of colorectal cancer. Weight loss — not gain — is an indication of colorectal cancer.

The most common cause of esophageal varices includes which of the following? a) Portal hypertension b) Asterixis c) Jaundice d) Ascites

A) Portal hypertension Esophageal varices are almost always caused by portal hypertension, which results from obstruction of the portal circulation within the damaged liver. Jaundice occurs when the bilirubin concentration in the blood is abnormally elevated. Ascites results from circulatory changes within the diseased liver. Asterixis is an involuntary flapping movement of the hands associated with metabolic liver dysfunction.

The nurse observes dry mucous membranes in a client who is receiving tube feedings after an oral surgery. The client also complains of unpleasant tastes and odors. Which of the following measures should be included in the client's plan of care? a) Provide frequent mouth care. b) Keep the feeding formula refrigerated. c) Ensure adequate hydration with additional water. d) Flush the tube with water before adding the feedings.

A) Provide frequent mouth care Frequent mouth care helps to relieve the discomfort from dryness and unpleasant odors and tastes. It can be done with the help of ice chips and analgesic throat lozenges, gargles, or sprays. Adequate hydration is essential. If urine output is less than less than 500 mL/day, formula and additional water can be given as ordered. Keeping the feeding formula refrigerated and unopened until it is ready for use and flushing the tube with water before adding feedings are measures to protect the client from infections.

A patient with a history of peptic ulcer disease has presented to the emergency department with complaints of severe abdominal pain and a rigid, boardlike abdomen, prompting the health care team to suspect a perforated ulcer. Which of the following actions should the nurse anticipate? A) Providing IV fluids and inserting a nasogastric tube B) Administering oral bicarbonate and testing the patient's gastric pH level C) Performing a fecal occult blood test and administering IV calcium gluconate D) Starting parenteral nutrition and placing the patient in a high-Fowler's position

A) Providing IV fluids and inserting a NG tube A perforated peptic ulcer requires IV replacement of fluid losses and continued gastric aspiration by NG tube. Nothing is given by mouth and gastric pH testing is not a priority. Calcium gluconate is not a medication directly relevant to the patient's suspected diagnosis and parenteral nutrition is not a priority in the short term.

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? A) RLQ B) RUQ C) LLQ D) LUQ

A) RLQ The appendix is in the right lower quadrant.

A patient scheduled to undergo an abdominal ultrasonography is advised to do which of the following? a) Restrict eating of solid food for 6 to 8 hours before the test. b) Do not consume anything sweet for 24 hours before the test c) Do not undertake any strenuous exercise for 24 hours before the test d) Avoid exposure to sunlight for at least 6 to 8 hours before the test

A) Restrict eating of solid food for 6 to 8 hours before the test For a patient who is scheduled to undergo an abdominal ultrasonography, the patient should restrict herself from solid food for 6 to 8 hours to avoid having images of her test obscured with gas and intestinal contents. Ultrasonography records the reflection of sound waves. Strenuous exercises, the consumption of sweets, and exposure to sunlight do not affect the results of the test in any way.

The nurse is caring for a patient in the emergency department with complaints of acute abdominal pain, nausea, and vomiting. When the nurse palpates the patient's left lower abdominal quadrant, the patient complains of pain in the right lower quadrant. The nurse will document this as which of the following diagnostic signs of appendicitis? A) Rovsing sign B) Referred pain C) Chvostek's sign D) Rebound tenderness

A) Rovsing sign In patients with suspected appendicitis, Rovsing sign may be elicited by palpation of the left lower quadrant, causing pain to be felt in the right lower quadrant.

Blood shed in sufficient quantities into the upper GI tract, produces which color of stool? a) Tarry-black b) Milky white c) Green d) Bright red

A) Tarry-black Blood shed in sufficient quantities into the upper GI tract produces a tarry-black stool. Blood entering the lower portion of the GI tract or passing rapidly through it will appear bright or dark red. A milky white stool is indicative "of" a patient who received barium. A green stool is indicative of a patient who has eaten spinach.

A nurse enters the room of a client who has returned to the unit after having a radical neck dissection. Which assessment finding requires immediate intervention? a) The client lying in a lateral position, with the head of bed flat b) Foley catheter bag containing 500 ml of amber urine c) Serosanguineous drainage on the dressing d) A piggyback infusion of levofloxacin (Levaquin)

A) The client lying in a lateral position, with the head of bed flat A client who has had neck surgery is at risk for neck swelling. To prevent respiratory complications, the head of the bed should be at least at a 30-degree angle. This position gives the lungs room to expand and decreases swelling by promoting venous and lymphatic drainage. This position also minimizes the risk of aspiration. Serosanguineous drainage on the dressing, a Foley bag containing amber urine, and levofloxacin infusing aren't causes for concern.

The nurse is preparing to insert a nasogastric tube into a 68-year-old patient with an abdominal mass and suspected bowel obstruction. The patient asks the nurse why this procedure is necessary. Which of the following responses is most appropriate? A) "The tube will help to drain the stomach contents and prevent further vomiting." B) "The tube will push past the area that is blocked, and thus help to stop the vomiting." C) "The tube is just a standard procedure before many types of surgery to the abdomen." D) "The tube will let us measure your stomach contents, so that we can plan what type of IV fluid replacement would be best."

A) The tube will help drain the stomach contents and prevent further vomiting The nasogastric tube is used to decompress the stomach by draining stomach contents, and thereby prevent further vomiting.

A client with GERD develops espophagitis. Which diagnostic test would the nurse expect the physician to order to confirm the diagnosis? a) Upper endoscopy with biopsy b) Stool testing for occult blood c) 24-hour esophageal pH monitoring d) Barium swallow

A) Upper endoscopy with biopsy Upper endoscopy with biopsy confirms esophagitis. Barium-swallow would reveal inflammation or stricture formation from chronic esophagitis. Tests of stool may show positive findings of blood. Ambulatory 24-hour esophageal pH monitoring allows for observation of the frequency of reflux episodes and their associated symptoms.

The nurse inserts a nasoduodenal tube for feeding of the client. To check best for placement, the nurse a) Verifies location with an abdominal x-ray b) Aspirates contents and checks the color of the aspirate c) Auscultates when injecting air d) Adds 8 to 10 inches of the tube after inserting to the xiphoid process

A) Verifies location with an abdominal x-ray Initially, an x-ray should be used to confirm placement of the nasoduodenal tube. It is the most accurate method to verify tube placement. Adding 8 to 10 inches to the length of the tube after measuring from nose to earlobe to xiphoid process is not supported, because it does not indicate that the tube will be in the correct position. Intestinal aspirate is usually clear and yellow to bile-colored. Gastric aspirate is usually cloudy and green, tan, off-white, or brown. Food particles may be present. The traditional method of injecting air through the tube while auscultating the epigastric area with a stethoscope to detect air insufflation is also an unreliable indicator.

Initially, which diagnostic should be completed following placement of a NG tube? a) X-ray b) Measurement of tube length c) pH measurement of aspirate d) Visual assessment of aspirate

A) X-ray Instead of auscultation, a combination of three methods is recommended: measurement of tube length, visual assessment of aspirate, and pH measurement of aspirate.

When caring for a patient with a biliary obstruction, the nurse will anticipate administering which of the following vitamin supplements (select all that apply)? A) Vitamin A B) Vitamin D C) Vitamin E D) Vitamin K E) Vitamin B

A,B,C,D Biliary obstruction prevents bile from entering the small intestine and thus prevents the absorption of fat-soluble vitamins. Vitamins A, D, E, and K are all fat soluble and thus would need to be supplemented in a patient with biliary obstruction.

When caring for a patient with liver disease, the nurse recognizes the need to prevent bleeding resulting from altered clotting factors and rupture of varices. Which of the following nursing interventions would be appropriate to achieve this outcome (select all that apply)? A) Use smallest gauge possible when giving injections or drawing blood. B) Teach patient to avoid straining at stool, vigorous blowing of nose, and coughing. C) Advise patient to use soft-bristle toothbrush and avoid ingestion of irritating food. D) Apply gentle pressure for the shortest possible time period after performing venipuncture. E) Instruct patient to avoid aspirin and NSAIDs to prevent hemorrhage when varices are present.

A,B,C,E Using the smallest gauge for injections will minimize the risk of bleeding into the tissues. Avoiding straining, nose blowing, and coughing will reduce the risk of hemorrhage at these sites. The use of a soft-bristle toothbrush and avoidance of irritating food will reduce injury to highly vascular mucous membranes. The nurse should apply gentle but prolonged pressure to venipuncture sites to minimize the risk of bleeding.

Severe cases of acute Diarrhea s/sx and how to treat

All signs of moderate plus: rapid, thread pulse, cyanosis, rapid breathing, lethargy, coma THERAPY: IV fluids (ringer's lactate; 0.9 NS), 20ml/kg bolus over 30 minutes and repeat until pulse and LOC return to normal; then fluids w/dextrose and 0.45 NS; add K+ after renal function adequate give 50-100 ml/kg or ORS

What is an incarcerated hernia?

An incarcerated hernia is a closed-loop obstruction with two different portions of bowel lumen obstructed

Which of the following should the nurse do first after noting that a child with Hirschsprung disease has a fever and watery explosive diarrhea? A. Notify the physician immediately B. Administer antidiarrheal medications C. Monitor child ever 30 minutes D Nothing, this is characteristic of Hirschsprung disease

A. Notify the physician immediately For the child with Hirschsprung disease, fever and explosive diarrhea indicate enterocolitis, a life-threatening situation. Therefore, the physicianshould be notified immediately. Generally, becauseof the intestinal obstruction and inadequatepropulsive intestinal movement, antidiarrheals arenot used to treat Hirschsprung disease. The child isacutely ill and requires intervention, with monitoringmore frequently than every 30 minutes.Hirschsprung disease typically presents withchronic constipation.

Labs elevated in cholecystitis

ALT, AST, LDH, alk phosp

What clinical effect does metoclopramide have?

ANTIEMESIS GASTROPROKINESIS Metoclopramide (INN) (pronounced /ˌmɛtəˈklɒprəmaɪd/) is an antiemetic and gastroprokinetic agent. Thus it is primarily used to treat nausea and vomiting, and to facilitate gastric emptying in patients with gastroparesis. It is also a primary treatment for migraine headaches.

A rare and often fatal cause of GI bleed following aortic graft surgery:

AORTO-ENTERIC FISTULA (Entero-aortic fistula)

On an ill child

Assess VS q 15-30 minutes

What is the post-op care for a client who has had bowel resection surgery?

Assess bowel sounds, monitor output, assess stoma, assess abdominal and perineal wounds, monitor vital signs, advance diet as tolerated, decrease cramping, reduce pain, monitor stoma and drainage, prevent thrombophlebitis, give emotional support, educate on stoma care

The results of a patient's recent endoscopy indicate the presence of peptic ulcer disease (PUD). Which of the following teaching points should the nurse provide to the patient in light of his new diagnosis? A) "You'll need to drink at least two to three glasses of milk daily." B) "It would likely be beneficial for you to eliminate drinking alcohol." C) "Many people find that a minced or pureed diet eases their symptoms of PUD." D) "Your medications should allow you to maintain your present diet while minimizing symptoms."

B) "It would likely be beneficial for you to eliminate drinking alcohol" Although there is no specific recommended dietary modification for PUD, most patients find it necessary to make some sort of dietary modifications to minimize symptoms. Milk may exacerbate PUD and alcohol is best avoided because it can delay healing.

A patient who is administering a bisacodyl (Dulcolax) suppository asks the nurse how long it will take to work. The nurse replies that the patient will probably need to use the bedpan or commode within which of the following time frames after administration? A) 2-5 Minutes B) 15-60 Minutes C) 2-4 Hours D) 6-8 Hours

B) 15-60 minutes Bisacodyl suppositories usually are effective within 15 to 60 minutes of administration, so the nurse should plan accordingly to assist the patient to use the bedpan or commode.

A 61-year-old patient with suspected bowel obstruction has had a nasogastric tube inserted at 4:00 am. The nurse shares in the morning report that the day shift staff should check the tube for patency at which of the following times? A) 7:00 am, 10:00 am, and 1:00 pm B) 8:00 am and 12:00 pm C) 9:00 am and 3:00 pm D) 9:00 am, 12:00 pm, and 3:00 pm

B) 8:00 am and 12:00 pm A nasogastric tube should be checked for patency routinely at 4-hour intervals. Thus if the tube were inserted at 4:00 am, it would be due to be checked at 8:00 am and 12:00 pm.

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? a) Anxiety related to unknown outcome of hospitalization b) Acute pain related to biliary spasms c) Imbalanced nutrition: Less than body requirements related to biliary inflammation d) Deficient knowledge related to prevention of disease recurrence

B) Acute pain related to biliary spams The chief symptom of cholecystitis is abdominal pain or biliary colic. Typically, the pain is so severe that the client is restless and changes positions frequently to find relief. Therefore, the nursing diagnosis of Acute pain related to biliary spasms takes highest priority. Until the acute pain is relieved, the client can't learn about prevention, may continue to experience anxiety, and can't address nutritional concerns.

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) Providing mouth care b) Administering morphine I.V. as ordered c) Placing the client in a semi-Fowler's position d) Maintaining nothing-by-mouth (NPO) status

B) Administering morphine IV as ordered The nurse should address the client's pain issues first by administering morphine I.V. as ordered. Placing the client in a Semi-Fowler's position, maintaining NPO status, and providing mouth care don't take priority over addressing the client's pain issues.

A colectomy is scheduled for a 68-year-old woman with an abdominal mass, possible bowel obstruction, and a history of rectal polyps. The nurse should plan to include which of the following prescribed measures in the preoperative preparation of this patient? A) Instruction on irrigating a colostomy B) Administration of a cleansing enema C) A high-fiber diet the day before surgery D) Administration of IV antibiotics for bowel preparation

B) Administration of a cleansing enema Preoperative preparation for bowel surgery typically includes bowel cleansing with antibiotics, such as oral neomycin and cleansing enemas, including Fleet enemas.

A nonresponsive client has a nasogastric tube to low intermittent suction due to gastrointestinal bleeding. It is most important for the nurse to a) Change the nasal tape every 2 to 3 days. b) Auscultate lung sounds every 4 hours. c) Inspect the nose daily for skin irritation. d) Apply water-based lubricant to the nares daily.

B) Auscultate lung sounds every 4 hours Pulmonary complications may occur as a result of nasogastric intubation. It is a high priority according to Maslow's hierarchy of needs and takes a higher priority over assessing the nose, changing nasal tape, or applying a water-based lubricant.

A client with a peptic ulcer is about to begin a therapeutic regimen that includes a bland diet, antacids, and famotidine (Pepcid). Before the client is discharged, the nurse should provide which instruction? a) "Eat three balanced meals every day." b) "Avoid aspirin and products that contain aspirin." c) "Stop taking the drugs when your symptoms subside." d) "Increase your intake of fluids containing caffeine."

B) Avoid aspirin and products that contain aspirin The nurse should instruct the client to avoid aspirin because it's a gastric irritant and should not be taken by clients with peptic ulcer to prevent further erosion of the stomach lining. The client should eat small, frequent meals rather than three large ones. Antacids and ranitidine prevent acid accumulation in the stomach; they should be taken even after symptoms subside. Caffeine should be avoided because it increases acid production in the stomach.

The nurse should administer a prn dose of magnesium hydroxide (MOM) after noting which of the following while reviewing a patient's medical record? A) Abdominal pain and bloating B) No bowel movement for 3 days C) A decrease in appetite by 50% over 24 hours D) Muscle tremors and other signs of hypomagnesemia

B) No bowel movement for 3 days MOM is an osmotic laxative that produces a soft, semisolid stool usually within 15 minutes to 3 hours. This medication would benefit the patient who has not had a bowel movement for 3 days.

Which of the follow statements provide accurate information regarding cancer of the colon and rectum? a) There is no hereditary component to colon cancer. b) Cancer of the colon and rectum is the second most common type of internal cancer in the United States. c) Rectal cancer affects more than twice as many people as colon cancer. d) The incidence of colon and rectal cancer decreases with age.

B) Cancer of the colon and rectum is the second most common type of internal cancer in the US Cancer of the colon and rectum is the second most common type of internal cancer in the United States. Colon cancer affects more than twice as many people as does rectal cancer (94,700 for colon, 34,700 for rectum). The incidence increases with age (the incidence is highest in people older than 85). Colon cancer occurrence is higher in people with a family history of colon cancer.

A client comes into the emergency department with complaints of abdominal pain. Which of the following should the nurse ask first? a) Family history of ruptured appendix b) Characteristics and duration of pain c) Concerns about impending hospital stay d) Medications taken in the last 8 hours

B) Characteristics and duration of pain A focused abdominal assessment begins with a complete history. The nurse must obtain information about abdominal pain. Pain can be a major symptom of gastrointestinal disease. The character, duration, pattern, frequency, location, distribution, and timing of the pain vary but require investigation immediately.

A client is scheduled for several diagnostic tests to evaluate her gastrointestinal function. After teaching the client about these tests, the nurse determines that the client has understood the teaching when she identifies which test as not requiring the use of a contrast medium? a) Computer tomography b) Colonoscopy c) Small bowel series d) Upper GI series

B) Colonoscopy A colonoscopy is a direct visual examination of the entire large intestine. It does not involve the use of a contrast agent. Contrast medium may be used with a small bowel series, computed tomography, and upper GI series.

The nurse is caring for a patient treated with intravenous fluid therapy for severe vomiting. As the patient recovers and begins to tolerate oral intake, the nurse understands that which of the following food choices would be most appropriate? A) Ice tea B) Dry toast C) Warm broth D) Plain hamburger

B) Dry toast Dry toast or crackers may alleviate the feeling of nausea and prevent further vomiting. Extremely hot or cold liquids and fatty foods are generally not well tolerated.

A nurse is preparing a client with Crohn's disease for a barium enema. What should the nurse do the day before the test? a) Serve dairy products. b) Encourage plenty of fluids. c) Serve the client his usual diet. d) Order a high-fiber diet.

B) Encourage plenty of fluids The nurse should encourage plenty of fluids because adequate fluid intake is necessary to avoid dehydration that may be caused by the bowel preparation and to prevent fecal impaction after the procedure. The client may be placed on a low-residue diet 1 to 2 days before the procedure to reduce the contents in the GI tract. Fiber intake is limited in a low-residue diet. Because dairy products leave a residue, they aren't allowed the evening before the test. Clear liquids only are allowed the evening before the test.

Which of the following medications requires the nurse to contact the pharmacist in consultation when the patient receives all oral medications by feeding tube? a) Buccal or sublingual tablets b) Enteric-coated tablets c) Soft gelatin capsules filled with liquid d) Simple compressed tablets

B) Enteric-coated tablets Enteric-coated tablets 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 tablets 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.

The patient who is admitted with a diagnosis of diverticulitis and a history of irritable bowel disease and gastroesophageal reflux disease (GERD) has received a dose of Mylanta 30 ml PO. The nurse would evaluate its effectiveness by questioning the patient as to whether which of the following symptoms has been resolved? A) Diarrhea B) Heartburn C) Constipation D) Lower abdominal pain

B) Heartburn Mylanta is an antacid that contains both aluminum and magnesium. It is indicated for the relief of GI discomfort, such as with heartburn associated with GERD.

The nurse is planning care for a 68-year-old patient with an abdominal mass and suspected bowel obstruction. Which of the following factors in the patient's history increases the patient's risk for colorectal cancer? A) Osteoarthritis B) History of rectal polyps C) History of lactose intolerance D) Use of herbs as dietary supplements

B) History of rectal polyps A history of rectal polyps places this patient at risk for colorectal cancer. This tissue can degenerate over time and become malignant. The other factors identified do not pose additional risk to the patient.

The nurse is preparing to interview a client with cirrhosis. Based on an understanding of this disorder, which question would be most important to include? a) "What type of over-the-counter pain reliever do you use?" b) "How often do you drink alcohol?" c) "Have you had an infection recently?" d) "Does your work expose you to chemicals?"

B) How often do you drink alcohol? The most common type of cirrhosis results from chronic alcohol intake and is frequently associated with poor nutrition. Although it can follow chronic poisoning with chemicals or ingestion of hepatotoxic drugs such as acetaminophen, asking about alcohol intake would be most important. Asking about an infection or exposure to hepatotoxins or industrial chemicals would be important if the client had postnecrotic cirrhosis.

Which of the following would be the highest priority information to include in preoperative teaching for a 68-year-old patient scheduled for a colectomy? A) How to care for the wound B) How to deep breathe and cough C) The location and care of drains after surgery D) What medications will be used during surgery

B) How to deep breathe and cough Because anesthesia, an abdominal incision, and pain can impair the patient's respiratory status in the postoperative period, it is of high priority to teach the patient to cough and deep breathe. Otherwise, the patient could develop atelectasis and pneumonia, which would delay early recovery from surgery and hospital discharge.

An elderly patient diagnosed with diarrhea is taking digoxin (Lanoxin). Which of the following electrolyte imbalances should the nurse be alert to? a) Hyponatremia b) Hypokalemia c) Hypernatremia d) Hyperkalemia

B) Hypokalemia The older person taking digitalis must be aware of how quickly dehydration and hypokalemia can occur with diarrhea. The nurse teaches the patient to recognize the symptoms of hypokalemia because low levels of potassium intensify the action of digitalis, leading to digitalis toxicity.

Patients diagnosed with esophageal varices are at risk for hemorrhagic shock. Which of the following is a sign of potential hypovolemia? a) Bradycardia b) Hypotension c) Polyuria d) Warm moist skin

B) Hypotension Signs of potential hypovolemia include cool, clammy skin, tachycardia, decreased blood pressure, and decreased urine output.

A client who is recovering from anesthesia following oral surgery for lip cancer is experiencing difficulty breathing deeply and coughing up secretions. Which of the following measures will help ease the client's discomfort? a) Positioning the client flat on the abdomen or side. b) Keeping the head of the bed elevated. c) Turning the client's head to the side. d) Providing a tracheostomy tray near the bed.

B) Keeping the head of the bed elevated It is essential to position the client with the head of the bed elevated because it is easier for the client to breathe deeply and cough up secretions after recovering from the anesthetic. Positioning the client flat either on the abdomen or side with the head turned to the side will facilitate drainage from the mouth. A tracheostomy tray is kept by the bed for respiratory distress or airway obstruction. When mouth irrigation is carried out, the nurse should turn the client's head to the side to allow the solution to run in gently and flow out.

A 74-year-old client is on the hospital unit where you practice nursing. She will be undergoing rhinoplasty and you are completing her admission assessment and paperwork. She reports medications she uses on a daily basis, which you record for her chart. Which of her daily medications will result in constipation? a) Acetaminophen b) Laxative c) NSAIDs d) Multivitamin without iron

B) Laxative Constipation may also result from chronic use of laxatives ("cathartic colon") because such use can cause a loss of normal colonic motility and intestinal tone. Laxatives also dull the gastrocolic reflex.

A nurse is providing dietary instructions to a client with a history of pancreatitis. Which instruction is correct? a) "Maintain a high-sodium, high-calorie diet." b) "Maintain a high-carbohydrate, low-fat diet." c) "Maintain a high-fat, high-carbohydrate diet." d) "Maintain a high-fat diet and drink at least 3 L of fluid a day."

B) Maintain a high carbohydrate, low fat diet A client with a history of pancreatitis should avoid foods and beverages that stimulate the pancreas, such as fatty foods, caffeine, and gas-forming foods; should avoid eating large meals; and should eat plenty of carbohydrates, which are easily metabolized. Therefore, the only correct instruction is to maintain a high-carbohydrate, low-fat diet. An increased sodium or fluid intake isn't necessary because chronic pancreatitis isn't associated with hyponatremia or fluid loss.

If a client has abdominal surgery and a portion of the small intestine is removed, the client is at risk for which of the following? a) Gastric ulcers b) Malabsorption syndrome c) Constipation d) Cirrhosis

B) Malabsorption syndrome Absorption is the primary function of the small intestine. Vitamins and minerals are absorbed essentially unchanged. Nutrients are absorbed at specific locations in the small intestine.

What part of the GI tract begins the digestion of food? a) Stomach b) Mouth c) Duodenum d) Esophagus

B) Mouth Food that contains starch undergoes partial digestion when it mixes with the enzyme salivary amylase, which the salivary glands secrete.

A client is admitted with a diagnosis of acute appendicitis. When assessing the abdomen, the nurse would expect to find rebound tenderness at which location? a) Left upper quadrant b) Right lower quadrant c) Left lower quadrant d) Right upper quadrant

B) Right lower quadrant The pain of acute appendicitis localizes in the right lower quadrant (RLQ) at McBurney's point, an area midway between the umbilicus and the right iliac crest. Often, the pain is worse when manual pressure near the region is suddenly released, a condition called rebound tenderness.

Patients with chronic liver dysfunction have problems with insufficient vitamin intake. Which of the following may occur as a result of vitamin C deficiency? a) Beriberi b) Scurvy c) Night blindness d) Hypoprothrombinemia

B) Scurvy Scurvy may result from a vitamin C deficiency. Night blindness, hypoprothrombinemia, and beriberi do not result from a vitamin C deficiency.

Patients with chronic liver dysfunction have problems with insufficient vitamin intake. Which of the following may occur as a result of vitamin C deficiency? a) Hypoprothrombinemia b) Scurvy c) Beriberi d) Night blindness

B) Scurvy Scurvy may result from a vitamin C deficiency. Night blindness, hypoprothrombinemia, and beriberi do not result from a vitamin C deficiency.

Nursing assessment of a client with peritonitis reveals hypotension, tachycardia, and signs and symptoms of dehydration. The nurse also expects to find: a) tenderness and pain in the right upper abdominal quadrant. b) severe abdominal pain with direct palpation or rebound tenderness. c) jaundice and vomiting. d) rectal bleeding and a change in bowel habits.

B) Severe abdominal pain with direct palpation or rebound tenderness Peritonitis decreases intestinal motility and causes intestinal distention. A classic sign of peritonitis is a sudden, diffuse, severe abdominal pain that intensifies in the area of the underlying causative disorder (such as appendicitis, diverticulitis, ulcerative colitis, or a strangulated obstruction). The client may also have rebound tenderness. Tenderness and pain in the right upper abdominal quadrant suggest cholecystitis. Jaundice and vomiting are signs of cirrhosis of the liver. Rectal bleeding or a change in bowel habits may indicate colorectal cancer.

Which of the following medications would the nurse expect the physician to order for a client with cirrhosis who develops portal hypertension? a) Kanamycin (Kantrex) b) Spironolactone (Aldactone) c) Cyclosporine (Sandimmune) d) Lactulose (Cephulac)

B) Spironlactone (Aldactone) For portal hypertension, a diuretic usually an aldosterone antagonist such as spironolactone (Aldactone) is ordered. Kanamycin (Kantrex) would be used to treat hepatic encephalopathy to destroy intestinal microorganisms and decrease ammonia production. Lactulose would be used to reduce serum ammonia concentration in a client with hepatic encephalopathy. Cyclosporine (Sandimmune) would be used to prevent graft rejection after a transplant.

A client with acute liver failure exhibits confusion, a declining level of consciousness, and slowed respirations. The nurse finds him very difficult to arouse. The diagnostic information which best explains the client's behavior is: a) elevated blood urea nitrogen and creatinine levels and hyperglycemia. b) subnormal serum glucose and elevated serum ammonia levels. c) subnormal clotting factors and platelet count. d) elevated liver enzymes and low serum protein level.

B) Subnormal serum glucose and elevated serum ammonia levels In acute liver failure, serum ammonia levels increase because the liver can't adequately detoxify the ammonia produced in the GI tract. In addition, serum glucose levels decline because the liver isn't capable of releasing stored glucose. Elevated serum ammonia and subnormal serum glucose levels depress the level of a client's consciousness. Elevated liver enzymes, low serum protein level, subnormal clotting factors and platelet count, elevated blood urea nitrogen and creatine levels, and hyperglycemia aren't as directly related to the client's level of consciousness.

The nurse is preparing to examine the abdomen of a client complaining of a change in his bowel pattern. The nurse would place the client in which position? a) Lithotomy b) Supine with knees flexed c) Knee-chest d) Left Sim's lateral

B) Supine with knees flexed When examining the abdomen, the client lies supine with his knees flexed. This position assists in relaxing the abdominal muscles. The lithotomy position commonly is used for a female pelvic examination and to examine the rectum. The knee-chest position can be used for a variety of examinations, most commonly the anus and rectum. The left Sim's lateral position may be used to assess the rectum or vagina and to administer an enema.

A client with appendicitis is experiencing excruciating abdominal pain. An abdominal X-ray film reveals intraperitoneal air. The nurse should prepare the client for: a) colonoscopy. b) surgery. c) nasogastric (NG) tube insertion. d) barium enema.

B) Surgery The client should be prepared for surgery because his signs and symptoms indicate bowel perforation. Appendicitis is the most common cause of bowel perforation in the United States. Because perforation can lead to peritonitis and sepsis, surgery wouldn't be delayed to perform other interventions, such as colonoscopy, NG tube insertion, or a barium enema. These procedures aren't necessary at this point.

Which patient teaching component is important for the nurse to communicate regarding pain management prior to or during diagnostic testing for a disorder of the GI system? a) The patient should not expel gas and test fluids from the bowel when he or she experiences the urge during the procedure. b) The patient should inform the test personnel if he or she experiences pressure or cramping during the instillation of test fluids. c) The patient should take a sedative before the procedure to avoid the possibility of experiencing any discomfort. d) The patient should lie down in a supine position for at least 3 hours before the test to reduce any discomfort during the test.

B) The patient should inform the test personnel if he or she experiences pressure or cramping during instillation of test fluids To ensure that a patient who is to undergo a diagnostic test for a disorder of the gastrointestinal system experiences no or minimal discomfort during the test, the patient should be instructed to inform the test personnel if he or she experiences pressure or cramping during the instillation of test fluids. The test personnel can slow the instillation or take other measures to relieve discomfort. The patient should also be advised to expel gas and test fluids from the bowel when he or she experiences the urge. Ignoring the urge to expel the bowel contents increases pain and discomfort. The patient should be advised not to take any sedative or analgesic before the test, unless prescribed. Lying down in a supine position is not known to have any consequence on the level of discomfort experienced by a patient during a diagnostic test for a GI disorder.

Paul Cavanagh, a 63-year-old retired teacher, had oral cancer and had extensive surgery to excise the malignancy. While is surgery was deemed successful, it was quite disfiguring and incapacitating. What is essential to Mr. Cavanagh and his family? a) Knowing that everything will work out just fine b) Time to mourn, accept, and adjust to the loss c) Not giving in to anger d) Having a courageous attitude

B) Time to mourn, accept, and adjust to the loss The first time family members or clients see the effects of surgery, the experience usually is traumatic. The nurse needs to promote effective coping and therapeutic grieving at this time. Responses may range from crying or extreme sadness and avoiding contact with others to refusing to talk about the surgery or changes in appearance. Allowing the client time to mourn, accept, and adjust to losses is essential.

A client with severe and chronic liver disease is showing manifestations related to inadequate vitamin intake and metabolism. He reports difficulty driving at night because he cannot see well. Which of the following vitamins is most likely deficient for this client? a) Vitamin K b) Vitamin A c) Riboflavin d) Thiamine

B) Vitamin A Problems common to clients with severe chronic liver dysfunction result from inadequate intake of sufficient vitamins. Vitamin A deficiency results in night blindness and eye and skin changes. Thiamine deficiency can lead to beriberi, polyneuritis, and Wernicke-Korsakoff psychosis. Riboflavin deficiency results in characteristic skin and mucous membrane lesions. Vitamin K deficiency can cause hypoprothrombinemia, characterized by spontaneous bleeding and ecchymoses.

A client presented with gastrointestinal bleeding 2 days ago and continues to have problems. The physician has ordered a visualization of the small intestine via a capsule endoscopy. Which of the following will the nurse include in the client education about this procedure? a) "An x-ray machine will use a capsule ray to follow your intestinal tract." b) "You will need to swallow a capsule." c) "The physician will use a scope called a capsule to view your intestine." d) "A capsule will be inserted into your rectum."

B) You will need to swallow a capsule A capsule endoscopy allows for noninvasive visualization of the small intestinal mucosa. The technique consists of the client swallowing a capsule that is embedded with a wireless miniature camera, which is propelled through the intestine by peristalsis. The capsule passes from the rectum in 1 to 2 days.

UGI Bleed Mnemonic: GUM BLEEDING What is the "BLEEDING"?

BILIARY LARGE VARICES ESOPHAGITIS ENTERO-AORTIC FISTULA DIEULAFOY LESION IBD NEOVASCULARIZATION GASTRIC CANCER GUM: GASTRITIS ULCER MALLORY WEISS TEAR

What lab values do you check for renal insufficiency?

BUN, creatinine

Whenever appendicitis is suspected

Be aware of the danger of administering laxatives or enemas or applying heat to the area, such measures stimulate bowel motility and increase the risk of perforation.

Why is a client who has an NG tube NPO?

Because contents are being sucked right back out by suction, it gives the bowel time to rest

What is intestinal obstruction?

Blockage that prevents normal flow of intestinal contents (something blocking intestines so bowel cannot get through)

When fluid loss exceed the body's ability to sustain blood volume and blood pressure, circulation is seriously compromised, what happens in this?

Blood pressure falls This results in tissue hypoxia with accumulation of lactic acid, pyruvate, and acid metabolites

How should a stoma look?

Bright red, pink, and moist

A patient is scheduled to receive "Colace 100 mg PO." The patient asks to take the medication in liquid form, and the nurse obtains an order for the interchange. Available is a syrup that contains 150 mg/15 ml. How many milliliters does the nurse administer? A) 3 B) 5 C) 10 D) 12

C) 10 mL The concentration of the syrup is 10 mg/ml. Therefore, a 100-mg dose necessitates 10 ml.

A nurse is receiving report from the emergency room regarding a new client being admitted to the medical-surgical unit with a diagnosis of peptic ulcer disease. The nurse expects the age of the client will be between a) 20 and 30 years b) 15 and 25 years c) 40 and 60 years d) 60 and 80 years

C) 40 to 60 years Peptic ulcer disease occurs with the greatest frequency in people 40 to 60 years old. It is relatively uncommon in women of childbearing age, but it has been observed in children and even in infants.

A 24-year-old athlete is admitted to the trauma unit following a motor-vehicle collision. The client is comatose and has developed ascites as a result of the accident. You are explaining the client's condition to his parents. In your education, what do you indicate is the primary function of the small intestine? a) Digest proteins b) Digest fats c) Absorb nutrients d) Absorb water

C) Absorb nutrients The primary function of the small intestine is to absorb nutrients from the chyme.

A 54-year-old patient admitted with diabetes mellitus, malnutrition, osteomyelitis, and alcohol abuse has a serum amylase level of 280 U/L and a serum lipase level of 310 U/L. To which of the following diagnoses does the nurse attribute these findings? A) Malnutrition B) Osteomyelitis C) Alcohol abuse D) Diabetes mellitus

C) Alcohol Abuse The patient with alcohol abuse could develop pancreatitis as a complication, which would increase the serum amylase (normal 30-122 U/L) and serum lipase (normal 31-186 U/L) levels as shown.

A longitudinal tear or ulceration in the lining of the anal canal is termed a (an) a) anorectal abscess. b) anal fistula. c) anal fissure. d) hemorrhoid.

C) Anal fissure Fissures are usually caused by the trauma of passing a large, firm stool or from persistent tightening of the anal canal secondary to stress or anxiety (leading to constipation). An anorectal abscess is an infection in the pararectal spaces. An anal fistula is a tiny, tubular, fibrous tract that extends into the anal canal from an opening located beside the anus. A hemorrhoid is a dilated portion of vein in the anal canal.

A client is prescribed tetracycline to treat peptic ulcer disease. Which of the following instructions would the nurse give the client? a) "Take the medication with milk." b) "Do not drive when taking this medication." c) "Be sure to wear sunscreen while taking this medicine." d) "Expect a metallic taste when taking this medicine, which is normal."

C) Be sure to wear sunscreen while taking this medicine Tetracycline may cause a photosensitivity reaction in clients. The nurse should caution the client to use sunscreen when taking this drug. Dairy products can reduce the effectiveness of tetracycline, so the nurse should not advise him or her to take the medication with milk. A metallic taste accompanies administration of metronidazole (Flagyl). Administration of tetracycline does not necessitate driving restrictions.

The nurse is to obtain a stool specimen from a client who reported that he is taking iron supplements. The nurse would expect the stool to be which color? a) Dark brown b) Red c) Black d) Green

C) Black Ingestion of iron can cause the stool to turn black. Meat protein causes stool to appear dark brown. Ingestion of large amounts of spinach may turn stool green while ingestion of carrots and beets may cause stool to turn red.

A client is admitted to the healthcare facility suspected of having acute pancreatitis and undergoes laboratory testing. Which of the following would the nurse expect to find? a) Decreased white blood cell count b) Decreased liver enzyme levels c) Elevated urine amylase levels d) Increased serum calcium levels

C) Elevated urine amylase levels Elevated serum and urine amylase, lipase, and liver enzyme levels accompany significant pancreatitis. If the common bile duct is obstructed, the bilirubin level is above normal. Blood glucose levels and white blood cell counts can be elevated. Serum electrolyte levels (calcium, potassium, and magnesium) are low.

The nurse determines that a patient has experienced the beneficial effects of medication therapy with famotidine (Pepcid) when which of the following symptoms is relieved? A) Nausea B) Belching C) Epigastric pain D) Difficulty swallowing

C) Epigastric Pain Famotidine is an H2-receptor antagonist that inhibits parietal cell output of HCl acid and minimizes damage to gastric mucosa related to hyperacidity, thus relieving epigastric pain.

A nurse is preparing a client for surgery. During preoperative teaching, the client asks where is bile stored. The nurse knows that bile is stored in the: a) Cystic duct b) Duodenum c) Gallbladder d) Common bile duct

C) Gallbladder The gallbladder functions as a storage depot for bile.

Which of the following surgical procedures for obesity utilizes a prosthetic device to restrict oral intake? a) Vertical-banded gastroplasty b) Roux-en-Y gastric bypass c) Gastric banding d) Biliopancreatic diversion with duodenal switch

C) Gastric banding In gastric banding, a prosthetic device is used to restrict oral intake by creating a small pouch of 10 to 15 milliliters that empties through the narrow outlet into the remainder of the stomach. Roux-en-Y gastric bypass uses a horizontal row of staples across the fundus of the stomach to create a pouch with a capacity of 20 to 30 mL. Vertical-banded gastroplasty involves placement of a vertical row of staples along the lesser curvature of the stomach, creating a new, small gastric pouch. Biliopancreatic diversion with duodenal switch combines gastric restriction with intestinal malabsorption.

The nurse is caring for a man who has experienced a spinal cord injury. Throughout his recovery, the client expects to gain control of his bowels. The nurse's best response to this client would be which of the following? a) "Over time, the nerve fibers will regrow new tracts, and you can have bowel movements again." b) "Wearing an undergarment will become more comfortable over time." c) "Having a bowel movement is a spinal reflex requiring intact nerve fibers. Yours are not intact." d) "It is not going to happen. Your nerve cells are too damaged."

C) Having a bowel movement is a spinal reflex requiring intact nerve fibers. Yours are not intact The act of defecation is a spinal reflex involving the parasympathetic nerve fibers. Normally, the external anal sphincter is maintained in a state of tonic contraction. With a spinal cord injury, the client no longer has this nervous system control and is often incontinent.

When reviewing the history of a client with pancreatic cancer, the nurse would identify which of the following as a possible risk factor? a) Ingestion of caffeinated coffee b) Ingestion of a low-fat diet c) History of pancreatitis d) One-time exposure to petrochemicals

C) History of pancreatitis Pancreatitis is associated with the development of pancreatic cancer. Other factors that correlate with pancreatic cancer include diabetes mellitus, a high-fat diet, and chronic exposure to carcinogenic substances (i.e., petrochemicals). Although data are inconclusive, a relationship may exist between cigarette smoking and high coffee consumption (especially decaffeinated coffee) and the development of pancreatic carcinoma.

A client is diagnosed with a hiatal hernia. Which statement indicates effective client teaching about hiatal hernia and its treatment? a) "I'll lie down immediately after a meal." b) "I'll eat three large meals every day without any food restrictions." c) "I'll eat frequent, small, bland meals that are high in fiber." d) "I'll gradually increase the amount of heavy lifting I do."

C) I'll eat frequent, small, bland meals that are high in fiber In hiatal hernia, the upper portion of the stomach protrudes into the chest when intra-abdominal pressure increases. To minimize intra-abdominal pressure and decrease gastric reflux, the client should eat frequent, small, bland meals that can pass easily through the esophagus. Meals should be high in fiber to prevent constipation and minimize straining on defecation (which may increase intra-abdominal pressure from the Valsalva maneuver). Eating three large meals daily would increase intra-abdominal pressure, possibly worsening the hiatal hernia. The client should avoid spicy foods, alcohol, and tobacco because they increase gastric acidity and promote gastric reflux. To minimize intra-abdominal pressure, the client shouldn't recline after meals, lift heavy objects, or bend.

Hypertonic

More water loss than electrolyte loss This type is the MOST dangerous and requires more specific fluid therapy. This may occur when infants are given fluids by mouth that contain large amounts of solute or high-protein NG feedings NA+ is more than 150 meq/L CNS distrubances, LOC alteration, lethargy, increased muscle tone with hyperreflexia, hyperirritability to stimuli

The client is receiving a 25% dextrose solution of parenteral nutrition. The infusion machine is beeping, and the nurse determines the intravenous (IV) bag is empty. The nurse finds there is no available bag to administer. It is most important for the nurse to a) Request a new bag from the pharmacy department. b) Flush the line with 10 mL of sterile saline. c) Infuse a solution containing 10% dextrose and water. d) Catch up with the next bag when it arrives.

C) Infuse a solution containing 10% dextrose and water If the parenteral nutrition solution runs out, a solution of 10% dextrose and water is infused to prevent hypoglycemia. The nurse would then order the next parenteral nutrition bag from the pharmacy. Flushing a peripherally inserted catheter is usually prescribed every 8 hours or per hospital established protocols. It is not the most important activity at this moment. The infusion rate should not be increased to compensate for fluids that were not infused, because hyperglycemia and hyperosmolar diuresis could occur.

When assisting with the plan of care for a client receiving tube feedings, which of the following would the nurse include to reduce the client's risk for aspiration? a) Administering 15 to 30 mL of water every 4 hours. b) Aspirating for residual contents every 4 to 8 hours. c) Keeping the client in a semi-Fowler's position at all times. d) Giving the feedings at room temperature.

C) Keeping the client in a semi Fowler's position at all times With continuous tube feedings, the nurse needs to keep the client in a semi-Fowler's position at all times to reduce regurgitation and the risk for aspiration. Aspirating for residual contents helps to ensure adequate nutrition and prevent overfeeding. Administering 15 to 30 mL of water every 4 hours helps to maintain tube patency. Giving the feedings at room temperature reduces the risk for diarrhea.

While palpating a client's right upper quadrant (RUQ), the nurse would expect to find which structure? a) Spleen b) Appendix c) Liver d) Sigmoid colon

C) Liver The RUQ contains the liver, gallbladder, duodenum, head of the pancreas, hepatic flexure of the colon, portions of the ascending and transverse colon, and a portion of the right kidney. The sigmoid colon is located in the left lower quadrant; the appendix, in the right lower quadrant; and the spleen, in the left upper quadrant.

The patient receiving chemotherapy rings the call bell and reports an onset of nausea. The nurse should prepare a prn dose of which of the following medications? A) Morphine sulfate B) Zolpidem (Ambien) C) Ondansetron (Zofran) D) Dexamethasone (Decadron)

C) Ondansetron (Zofran) Ondansetron is a 5-HT3 receptor antagonist antiemetic that is especially effective in reducing cancer chemotherapy-induced nausea and vomiting.

The nurse recognizes that the patient diagnosed with a duodenal ulcer will likely experience a) weight loss. b) vomiting. c) pain 2 to 3 hours after a meal. d) hemorrhage.

C) Pain 2 to 3 hours after a meal The patient with a gastric ulcer often awakens between 1 to 2 with pain, and ingestion of food brings relief. Vomiting is uncommon in the patient with duodenal ulcer. Hemorrhage is less likely in the patient with duodenal ulcer than the patient with gastric ulcer. The patient with a duodenal ulcer may experience weight gain.

When caring for a client with acute pancreatitis, the nurse should use which comfort measure? a) Encouraging frequent visits from family and friends b) Administering frequent oral feedings c) Positioning the client on the side with the knees flexed d) Administering an analgesic once per shift, as ordered, to prevent drug addiction

C) Postitioning the client on the side with the knees flexed The nurse should place the client with acute pancreatitis in a side-lying position with knees flexed; this position promotes comfort by decreasing pressure on the abdominal muscles. The nurse should administer an analgesic, as needed and ordered, before pain becomes severe, rather than once each shift. Because the client needs a quiet, restful environment during the acute disease stage, the nurse should discourage frequent visits from family and friends. Frequent oral feedings are contraindicated during the acute stage to allow the pancreas to rest.

A client is being treated for prolonged diarrhea. Which of the following foods should the nurse encourage the client to consume? a) Protein-rich foods b) High-fiber foods c) Potassium-rich foods d) High-fat foods

C) Potassium rich foods The nurse should encourage the client with diarrhea to consume potassium-rich foods. Excessive diarrhea causes severe loss of potassium. The nurse should also instruct the client to avoid high-fiber or fatty foods because these foods stimulate gastrointestinal motility. The intake of protein foods may or may not be appropriate depending on the client's status.

A client presents with complaints of blood in her stools. Upon inspection, the nurse notes streaks of bright red blood visible on the outer surface of formed stool. Which of the following will the nurse further investigate with this client? a) Ingestion of cherry soda b) Ingestion of cocoa c) Presence or history of hemorrhoids d) Recent barium studies

C) Presence or history of hemorrhoids Stool is normally light to dark brown. Blood in the stool can present in various ways and must be investigated. Lower rectal or anal bleeding is suspected if there is streaking of blood on the surface of the stool or blood is noted on toilet tissue.

The nurse observes dry mucous membranes in a client who is receiving tube feedings after an oral surgery. The client also complains of unpleasant tastes and odors. Which of the following measures should be included in the client's plan of care? a) Ensure adequate hydration with additional water. b) Keep the feeding formula refrigerated. c) Provide frequent mouth care. d) Flush the tube with water before adding the feedings.

C) Provide frequent mouth care Frequent mouth care helps to relieve the discomfort from dryness and unpleasant odors and tastes. It can be done with the help of ice chips and analgesic throat lozenges, gargles, or sprays. Adequate hydration is essential. If urine output is less than less than 500 mL/day, formula and additional water can be given as ordered. Keeping the feeding formula refrigerated and unopened until it is ready for use and flushing the tube with water before adding feedings are measures to protect the client from infections.

The nurse is caring for a client with cirrhosis. Which assessment findings indicate that the client has deficient vitamin K absorption caused by this hepatic disease? a) Ascites and orthopnea b) Gynecomastia and testicular atrophy c) Purpura and petechiae d) Dyspnea and fatigue

C) Purpura and petechiae A hepatic disorder, such as cirrhosis, may disrupt the liver's normal use of vitamin K to produce prothrombin (a clotting factor). Consequently, the nurse should monitor the client for signs of bleeding, including purpura and petechiae. Dyspnea and fatigue suggest anemia. Ascites and orthopnea are unrelated to vitamin K absorption. Gynecomastia and testicular atrophy result from decreased estrogen metabolism by the diseased liver.

Following administration of a dose of metoclopramide (Reglan) to the patient, the nurse determines that the medication has been effective when which of the following is noted? A) Decreased blood pressure B) Absence of muscle tremors C) Relief of nausea and vomiting D) No further episodes of diarrhea

C) Relief of nausea and vomiting Metoclopramide is classified as a prokinetic and antiemetic medication. If it is effective, the patient's nausea and vomiting should resolve.

Intussusception

Most common cause of intestinal obstruction in children between ages of 3 months and 3 years More common in boys More common in children with cystic fibrosis

A client is admitted to the health care facility with abdominal pain, a low-grade fever, abdominal distention, and weight loss. The physician diagnoses acute pancreatitis. What is the primary goal of nursing care for this client? a) Maintaining adequate nutritional status b) Preventing fluid volume overload c) Relieving abdominal pain d) Teaching about the disease and its treatment

C) Relieving abdominal pain The predominant clinical feature of acute pancreatitis is abdominal pain, which usually reaches peak intensity several hours after onset of the illness. Therefore, relieving abdominal pain is the nurse's primary goal. Because acute pancreatitis causes nausea and vomiting, the nurse should try to prevent fluid volume deficit, not overload. The nurse can't help the client achieve adequate nutrition or understand the disease and its treatment until the client is comfortable and no longer in pain.

Following bowel resection, a patient has a nasogastric tube to suction, but complains of nausea and abdominal distention. The nurse irrigates the tube prn as ordered, but the irrigating fluid does not return. Which of the following should be the priority action by the nurse? A) Notify the physician. B) Auscultate for bowel sounds. C) Reposition the tube and check for placement. D) Remove the tube and replace it with a new one.

C) Reposition the tube and check for placement The tube may be resting against the stomach wall. The first action by the nurse, since this intestinal surgery (not gastric surgery), is to reposition the tube and check it again for placement.

The nurse is assessing a client for constipation. Which of the following is the first review that the nurse should conduct in order to identify the cause of constipation? Choose the correct option. a) Review the client's current medications b) Review the client's alcohol consumption c) Review the client's usual pattern of elimination d) Review the client's activity levels

C) Review the client's usual pattern of elimination Constipation has many possible reasons; assessing the client's usual pattern of elimination is the first step in identifying the cause.

A client with hepatitis who has not responded to medical treatment is scheduled for a liver transplant. Which of the following most likely would be ordered? a) Chenodiol b) Ursodiol c) Tacrolimus d) Interferon alfa-2b, recombinant

C) Tacrolimus In preparation for a liver transplant, a client receives immunosuppressants to reduce the risk for organ rejection. Tacrolimus or cyclosporine are two immunosuppresants that may be used. Chenodiol and ursodiol are agents used to dissolve gall stones. Recombinant interferon alfa-2b is used to treat chronic hepatitis B, C, and D to force the virus into remission.

An elderly client asks the nurse how to treat chronic constipation. What is the best recommendation the nurse can make? a) Administer a tap-water enema weekly. b) Take a mild laxative such as magnesium citrate when necessary. c) Take a stool softener such as docusate sodium (Colace) daily. d) Administer a phospho-soda (Fleet) enema when necessary.

C) Take a stool softener such as docusate sodium (Colace) daily Stool softeners taken daily promote absorption of liquid into the stool, creating a softer mass. They may be taken on a daily basis without developing a dependence. Dependence is an adverse effect of daily laxative use. Enemas used daily or on a frequent basis can also lead to dependence of the bowel on an external source of stimulation.

what sign is present?

Murphy's

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? a) Prepare the client for a gastrostomy tube placement. b) Administer morphine (Duramorph PF) routinely, as ordered. c) Test all stools for occult blood. d) Administer topical ointment to the rectal area to decrease bleeding.

C) Test all stools for occult blood Blood in the stools is one of the warning signs of colorectal cancer. The nurse should plan on checking all stools for both frank and occult blood. The blood in the stool is coming from the colon or rectum; administering an ointment wouldn't help decrease the bleeding. Preparing a client for a gastrostomy tube isn't appropriate when diagnosing colorectal cancer. Colorectal cancer is usually painless; administering opioid pain medication isn't needed.

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? a) The client didn't take his morning dose of lactulose (Cephulac). b) The client is relaxed and not in pain. c) The client's hepatic function is decreasing. d) The client is avoiding the nurse.

C) The client's hepatic function is decreasing The decreased level of consciousness caused by an increased serum ammonia level indicates hepatic disfunction. If the client didn't take his morning dose of lactulose, he wouldn't have elevated ammonia levels and decreased level of consciousness this soon. These assessment findings don't indicate that the client is relaxed or avoiding the nurse.

Which of the following indicates an overdose of lactulose? a) Hypoactive bowel sounds b) Constipation c) Watery diarrhea d) Fecal impaction

C) Watery diarrhea The patient receiving lactulose is monitored closely for the development of watery diarrheal stool, which indicates a medication overdose.

Which of the following is the best method for determining nasogastric tube placement? a) Placement of external end of tube under water b) Testing of pH of gastric aspirate c) X-ray d) Observation of gastric aspirate

C) X-ray Radiologic identification of tube placement in the stomach is the most reliable method. Gastric fluid may be grassy green, brown, clear, or odorless while an aspirate from the lungs may be off-white or tan. Hence, checking aspirate is not the best method of determining nasogastric tube placement in the stomach. Gastric pH values are typically lower or more acidic than that of the intestinal or respiratory tract, but not always. Placement of external end of tube under water and watching for air bubbles is not a reliable method for determining nasogastric tube placement in the stomach.

What is bowel decompression?

NG tube of long intestinal tube connected to low suction until peristalsis resumes or the obstruction is relieved

What blood work (labs) should be done for a UGI bleed?

CBC Cross & Type PTT, PT Lytes, BUN, Cr LFTs

Dx test

CT

What should you do if you see a stoma appears dark and dusky?

Call HCP immediately

How can tumors cause small bowel obstruction?

Can be intrinsic or extrinsic and can progressively occlude bowel lumen

Main medical condition for home tube feeding

Cancer

Acute-infectious diarrhea

Cause by a variety of viral, bacterial and parasitic pathogens

Norwalk-like Organisms

Cause- Fecal-oral; contaminated water Characteristics: Abdominal cramps, N/V, malaise, low-grade fever, watery diarrhea without blood, duration 2-3 days; tends to resemble food poisoning with Nausea predominating Affects all ages

Escherichia Coli

Cause- enterotoxin production, adherence, or invasion Foodborne pathogen, Traveler's diarrhea Characteristics: Watery Diarrhea 1-2 days, then severe abdominal cramping and bloody diarrhea Can progress to hemolytic uremic syndrome, shock Highest incidence is Summertime Antibiotics may worsen course Avoid anti-mobility agents and opioids

Clostridium difficule (C-dif)

Cause: Alteration of normal flora Characteristics: Mostly mild watery diarrhea lasting a few days May cause pseudomembranous colitis Treatment: Metronidazole in mild to moderate/ if they don't respond to that- Vancomycin

Rotavirus

Cause: fecal-oral; contaminated water Characteristics: Mild to moderate fever, vomiting followed by onset of foul-smelling watery stools, fever and vomiting abate w/in days, but diarrhea persists 5-7 days Most common cause of diarrhea in children under 5 Most vulnerable in 6-12 months Occurs more in winter Important cause of nosocomial infections Two preventative vaccines are available: Rotarix and Rota Teq

H2 Receptor Blockers

Cimetidine, Ranitidine, famotidine, Nizatidine (OTC; all end with -dine) Block what you dine with... Block the action of histamine on the H2 receptors and thus reduce HCl acid secretion. This action decreases the conversion of pepsinogen to pepsin and reduces irritation of the esophageal mucosa.

Tx diverticulitis

NPO hydration

What are some examples of inflammatory bowel disease?

Crohn's disease and ulcerative colitis (very common)

Which of the following is an outcome of histamine 2 (H2)-receptor antagonists blocking the action of histamine in the stomach? a) Blood phosphate levels are elevated. b) Symptoms of gastroesophageal reflux are relieved. c) Acid indigestion is relieved. d) Acid secretion is reduced.

D) Acid secretion is reduced H2-receptor antagonists decrease the amount of hydrochloric acid that the stomach produces by blocking the action of histamine on histamine receptors of potential cells in the stomach.

Preferred tube for patient in hospital who will be NPO for 10 days

Nasoenteric tube

What clinical manifestations are seen with HD

Neonates = usually is seen with distended abdomen, feeding intolerance, bilious vomiting, delay in passing of meconium.

What indicates bacterial gastroenteritis or IBD?

Neutrophils or RBC in stools

Will you hear bowel sounds with a paralytic ileum? Why or why not?

No because nothing is moving into intestines

The nurse who inserted a nasogastric tube for a 68-year-old patient with suspected bowel obstruction should write which of the following priority nursing diagnoses on the patient's problem list? A) Anxiety related to nasogastric tube placement B) Abdominal pain related to nasogastric tube placement C) Risk for deficient knowledge related to nasogastric tube placement D) Altered oral mucous membrane related to nasogastric tube placement

D) Altered oral mucous membrane related to nasogastric tube placement With nasogastric tube placement, the patient is likely to breathe through the mouth and may experience irritation in the affected nares. For this reason, the nurse should plan preventive measures based on this nursing diagnosis.

The family of a patient newly diagnosed with hepatitis A asks the nurse what they can do to prevent becoming ill themselves. Which of the following responses by the nurse is most appropriate? A) "The hepatitis vaccine will provide immunity from this exposure and future exposures." B) "I am afraid there is nothing you can do since the patient was infectious before admission." C) "You will need to be tested first to make sure you don't have the virus before we can treat you." D) "An injection of immunoglobulin will need to be given to prevent or minimize the effects from this exposure."

D) An injection of immunoglobulin will need to be given to prevent or minimize the effects from this exposure Immunoglobulin provides temporary (1-2 months) passive immunity and is effective for preventing hepatitis A if given within 2 weeks after exposure. It may not prevent infection in all persons, but it will at least modify the illness to a subclinical infection. The hepatitis vaccine is only used for preexposure prophylaxis.

Which of the following would a nurse expect to assess in a client with peritonitis? a) Decreased pulse rate b) Deep slow respirations c) Hyperactive bowel sounds d) Board-like abdomen

D) Board-like abdomen The client with peritonitis would typically exhibit a rigid, board-like abdomen, with absent bowel sounds, elevated pulse rate, and rapid, shallow respirations.

The nurse is preparing to administer a scheduled dose of docusate sodium (Colace) when the patient complains of an episode of loose stool and does not want to take the medication. Which of the following is the appropriate action by the nurse? A) Write an incident report about this untoward event. B) Attempt to have the family convince the patient to take the ordered dose. C) Withhold the medication at this time and try to administer it later in the day. D) Chart the dose as not given on the medical record and explain in the nursing progress notes.

D) Chart the dose as not given on the medical record and explain in the nursing progress notes. Whenever a patient refuses medication, the dose should be charted as not given. An explanation of the reason should then be documented in the nursing progress notes. In this instance, the refusal indicates good judgment by the patient.

To ensure patency of central venous line ports, diluted heparin flushes are used in which of the following situations? a) Before drawing blood b) With continuous infusions c) When the line is discontinued d) Daily when not in use

D) Daily when not in use Daily instillation of dilute heparin flush when a port is not in use will maintain the port. Continuous infusion maintains the patency of each port. Heparin flushes are used after each intermittent infusion. Heparin flushes are used after blood drawing in order to prevent clotting of blood within the port. Heparin flush of ports is not necessary if a line is to be discontinued.

The health care provider orders lactulose for a patient with hepatic encephalopathy. The nurse will monitor for effectiveness of this medication for this patient by assessing which of the following? A) Relief of constipation B) Relief of abdominal pain C) Decreased liver enzymes D) Decreased ammonia levels

D) Decreased ammonia levels Hepatic encephalopathy is a complication of liver disease and is associated with elevated serum ammonia levels. Lactulose traps ammonia in the intestinal tract. Its laxative effect then expels the ammonia from the colon, resulting in decreased serum ammonia levels and correction of hepatic encephalopathy.

What foods are allowed in a client who is NPO?

Nothing allowed

The nurse asks a 68-year-old patient scheduled for colectomy to sign the operative permit as directed in the physician's preoperative orders. The patient states that the physician has not really explained well what is involved in the surgical procedure. Which of the following is the most appropriate action by the nurse? A) Ask family members whether they have discussed the surgical procedure with the physician. B) Have the patient sign the form and state the physician will visit to explain the procedure before surgery. C) Explain the planned surgical procedure as well as possible, and have the patient sign the consent form. D) Delay the patient's signature on the consent and notify the physician about the conversation with the patient.

D) Delay the patient's signature on the consent and notify the physician about the conversation with the patient. The patient should not be asked to sign a consent form unless the procedure has been explained to the satisfaction of the patient. The nurse should notify the physician, who has the responsibility for obtaining consent.

The most common symptom of esophageal disease is a) nausea. b) odynophagia. c) vomiting. d) dysphagia.

D) Dysphagia This symptom may vary from an uncomfortable feeling that a bolus of food is caught in the upper esophagus to acute pain on swallowing. Nausea is the most common symptom of gastrointestinal problems in general. Vomiting is a nonspecific symptom that may have a variety of causes. Odynophagia refers specifically to acute pain on swallowing.

The client is experiencing swallowing difficulties and is now scheduled to receive a gastric feeding. She has the following oral medications prescribed: furosemide (Lasix), digoxin, enteric coated aspirin (Ecotrin), and vitamin E. The nurse withholds a) furosemide b) digoxin c) vitamin E d) enteric coated aspirin

D) Enteric coated aspirin Simple compressed tablets (furosemide, digoxin) may be crushed and dissolved in water. Soft gelatin capsules filled with liquid (vitamin E) may be opened, and the contents squeezed out. Enteric coated tablets (enteric coated aspirin) are not to be crushed and a change in the form of the medications is required.

A client has a gastrointestinal tube that enters the stomach through a surgically created opening in the abdominal wall. The nurse documents this as which of the following? a) Jejunostomy tube b) Nasogastric tube c) Orogastric tube d) Gastrostomy tube

D) Gastrostomy tube A gastrostomy tube enters the stomach through a surgically created opening into the abdominal wall. A jejunostomy tube enters jejunum or small intestine through a surgically created opening into the abdominal wall. A nasogastric tube passes through the nose into the stomach via the esophagus. An orogastric tube passes through the mouth into the stomach.

A nurse is applying an ostomy appliance to the ileostomy of a client with ulcerative colitis. Which action is appropriate? a) Maintaining wrinkles in the faceplate so it doesn't irritate the skin b) Scrubbing fecal material from the skin surrounding the stoma c) Cutting the faceplate opening no more than 2? larger than the stoma d) Gently washing the area surrounding the stoma using a facecloth and mild soap

D) Gently washing the area surrounding the stoma using a facecloth and mild soap For a client with an ostomy, maintaining skin integrity is a priority. The nurse should gently wash the area surrounding the stoma using a facecloth and mild soap. Scrubbing the area around the stoma can damage the skin and cause bleeding. The faceplate opening should be no more than 1/8? to 1/6? larger than the stoma. This size protects the skin from exposure to irritating fecal material. The nurse can create an adequate seal and prevent leakage of fecal material from under the faceplate by applying a thin layer of skin barrier and smoothing out wrinkles in the faceplate. Eliminating wrinkles in the faceplate also protects the skin surrounding the stoma from pressure.

The nurse would question the use of which of the following cathartic agents in a patient with renal insufficiency? A) Bisacodyl B) Lubiprostone C) Cascara sagrada D) Milk of magnesia

D) Milk of Magnesia Milk of magnesia may cause hypermagnesemia in patients with renal insufficiency. The nurse should question this order with the health care provider before administration.

When reviewing the history of a client with pancreatic cancer, the nurse would identify which of the following as a possible risk factor? a) Ingestion of a low-fat diet b) One-time exposure to petrochemicals c) Ingestion of caffeinated coffee d) History of pancreatitis

D) History of pancreatitis Pancreatitis is associated with the development of pancreatic cancer. Other factors that correlate with pancreatic cancer include diabetes mellitus, a high-fat diet, and chronic exposure to carcinogenic substances (i.e., petrochemicals). Although data are inconclusive, a relationship may exist between cigarette smoking and high coffee consumption (especially decaffeinated coffee) and the development of pancreatic carcinoma.

A home care nurse is caring for a client with complaints of epigastric discomfort who is scheduled for a barium swallow. Which statement by the client indicates an understanding of the test? a) "I'll drink full liquids the day before the test." b) "There is no need for special preparation before the test." c) "I'll take a laxative to clear my bowels before the test." d) "I'll avoid eating or drinking anything 6 to 8 hours before the test."

D) I'll avoid eating or drinking anything 6 to 8 hours before the test The client demonstrates understanding of a barium swallow when he states that he must refrain from eating or drinking for 6 to 8 hours before the test. No other preparation is needed. Before a lower GI series, the client should eat a low-residue or clear liquid diet for 2 days and take a potent laxative and an oral liquid preparation.

Which of the following is a parasympathetic response in the GI tract? a) Blood vessel constriction b) Decreased gastric secretion c) Decreased motility d) Increased peristalsis

D) Increased peristalsis Increased peristalsis is a parasympathetic response in the GI tract. Decreased gastric secretion, blood vessel constriction, and decreased motility are sympathetic responses in the GI tract.

The nurse is preparing to administer a dose of bisacodyl (Dulcolax). In explaining the medication to the patient, the nurse would state that it acts in which of the following ways? A) Increases bulk in the stool B) Lubricates the intestinal tract to soften feces C) Increases fluid retention in the intestinal tract D) Increases peristalsis by stimulating nerves in the colon wall

D) Increases peristalsis by stimulating nerves in the colon wall Bisacodyl is a stimulant laxative that aids in producing a bowel movement by irritating the colon wall and stimulating enteric nerves. It is available in oral and suppository forms.

When planning care for a patient with cirrhosis, the nurse will give highest priority to which of the following nursing diagnoses? A) Imbalanced nutrition: less than body requirements B) Impaired skin integrity related to edema, ascites, and pruritus C) Excess fluid volume related to portal hypertension and hyperaldosteronism D) Ineffective breathing pattern related to pressure on diaphragm and reduced lung volume

D) Ineffective breathing pattern related to pressure on diaphragm and reduced lung volume Although all of these nursing diagnoses are appropriate and important in the care of a patient with cirrhosis, airway and breathing are always the highest priorities.

Which of the following terms describes a gastric secretion that combines with vitamin B12 so that it can be absorbed? a) Amylase b) Trypsin c) Pepsin d) Intrinsic factor

D) Intrinsic factor Intrinsic factor, secreted by the gastric mucosa, combines with dietary vitamin B12 so that the vitamin can be absorbed in the ileum. In the absence of intrinsic factor, vitamin B12 cannot be absorbed and pernicious anemia results. Amylase is an enzyme that aids in the digestion of starch. Pepsin, an important enzyme for protein digestion, is the end product of the conversion of pepsinogen from the chief cells. Digestive enzymes secreted by the pancreas include trypsin, which aids in digesting protein.

A nurse is preparing a client for a protcosigmoidoscopy. Identify the quadrant on which this diagnostic test will focus. A) RUQ B) RLQ C) LUQ D) LLQ

D) LLQ The sigmoid colon is in the left lower quadrant. Proctosigmoidoscopy is examination of the rectum and sigmoid colon using a rigid endoscope inserted anally about 10 inches.

A physician has ordered a liver biopsy for a client whose condition is deteriorating. Which of the following places the client at high risk due to her altered liver function during the biopsy? a) Low hemoglobin b) Decreased prothrombin time c) Low sodium level d) Low platelet count

D) Low platelet count Certain blood tests provide information about liver function. Prolonged prothrombin time (PT) and low platelet count place the client at high risk for hemorrhage. The client may receive intravenous (IV) administration of vitamin K or infusions of platelets before liver biopsy to reduce the risk of bleeding.

Regarding oral cancer, the nurse provides health teaching to inform the patient that a) most oral cancers are painful at the outset. b) blood testing is used to diagnose oral cancer. c) a typical lesion is soft and craterlike. d) many oral cancers produce no symptoms in the early stages.

D) Many oral cancers produce no symptoms in the early stages The most frequent symptom of oral cancer is a painless sore that does not heal. The patient may complain of tenderness, and difficulty with chewing, swallowing, or speaking as the cancer progresses. Biopsy is used to diagnose oral cancer. A typical lesion in oral cancer is a painless hardened ulcer with raised edges.

Two signs that are less prominent in hypernatremia of dehydration?

Dry mucous membranes and cap refill

A patient reports having dry mouth and asks for some liquid to drink. The nurse reasons that this symptom can most likely be attributed to a common adverse effect of which of the following medications? A) Digoxin (Lanoxin) B) Cefotetan (Cefotan) C) Famotidine (Pepcid) D) Promethazine (Phenergan)

D) Promethazine (Phenergan) A common adverse effect of promethazine, an antihistamine antiemetic agent, is dry mouth; another is blurred vision.

A client being treated for pancreatitis faces the risk of atelectasis. Which of the following interventions would be important to implement to minimize this risk? a) Withhold oral feedings for the client. b) Instruct the client to avoid coughing. c) Monitor pulse oximetry every hour. d) Reposition the client every 2 hours.

D) Reposition the client every 2 hours Repositioning the client every 2 hours minimizes the risk of atelectasis in a client who is being treated for pancreatitis. The client should be instructed to cough every 2 hours to reduce atelectasis. Monitoring the pulse oximetry helps show changes in respiratory status and promote early intervention, but it would do little to minimize the risk of atelectasis. Withholding oral feedings limits the reflux of bile and duodenal contents into the pancreatic duct.

The nurse is providing care to a client who has had a percutaneous liver biopsy. The nurse would monitor the client for which of the following? a) Intake and output b) Passage of stool c) Return of the gag reflex d) Signs and symptoms of bleeding

D) Signs and symptoms of bleeding A major complication after a liver biopsy is bleeding so it would be important for the nurse to monitor the client for signs and symptoms of bleeding. Return of the gag reflex would be important for the client who had an esophagogastroduodenoscopy to prevent aspiration. Monitoring the passage of stool would be important for a client who had a barium enema or colonoscopy. Monitoring intake and output is a general measure indicated for any client. It is not specific to a liver biopsy.

After teaching a group of students about the various organs of the upper gastrointestinal tract and possible disorders, the instructor determines that the teaching was successful when the students identify which of the following structures as possibly being affected? a) Large intestine b) Ileum c) Liver d) Stomach

D) Stomach The upper gastrointestinal (GI) tract begins at the mouth and ends at the jejunum. Therefore, the stomach would be a component of the upper GI tract. The lower GI tract begins at the ileum and ends at the anus. The liver is considered an accessory structure.

An elderly client asks the nurse how to treat chronic constipation. What is the best recommendation the nurse can make? a) Take a mild laxative such as magnesium citrate when necessary. b) Administer a tap-water enema weekly. c) Administer a phospho-soda (Fleet) enema when necessary. d) Take a stool softener such as docusate sodium (Colace) daily.

D) Take a stool softener such as docuaste sodium (Colace) daily. Stool softeners taken daily promote absorption of liquid into the stool, creating a softer mass. They may be taken on a daily basis without developing a dependence. Dependence is an adverse effect of daily laxative use. Enemas used daily or on a frequent basis can also lead to dependence of the bowel on an external source of stimulation.

The nurse would instruct the patient to do which of the following to best enhance the effectiveness of a daily dose of docusate sodium (Colace)? A) Take a dose of mineral oil at the same time. B) Add extra salt to food on at least one meal tray. C) Ensure dietary intake of 10 g of fiber each day. D) Take each dose with a full glass of water or other liquid.

D) Take each dose with a full glass of water or other liquid Docusate lowers the surface tension of stool, permitting water and fats to penetrate and soften the stool for easier passage. The patient should take the dose with a full glass of water and should increase overall fluid intake, if able, to enhance effectiveness of the medication. Dietary fiber intake should be a minimum of 20 g daily to prevent constipation.

A client with an esophageal stricture is about to undergo esophageal dilatation. As the bougies are passed down the esophagus, the nurse should instruct the client to do which action to minimize the vomiting urge? a) Hold his breath b) Bear down as if having a bowel movement c) Pant like a dog d) Take long, slow breaths

D) Take long, slow breaths During passage of the bougies used to dilate the esophagus, the client should take long, slow breaths to minimize the vomiting urge. Having the client hold the breath, bear down as if having a bowel movement, or pant like a dog is neither required nor helpful.

A client with diabetes begins to have digestive problems and is told by the physician that they are a complication of the diabetes. Which of the following explanations from the nurse is most accurate? a) Insulin has an adverse effect of constipation. b) The nerve fibers of the intestinal lining are experiencing neuropathy. c) Elevated glucose levels cause bacteria overgrowth in the large intestine. d) The pancreas secretes digestive enzymes.

D) The pancreas secretes digestive enzymes While the pancreas has the well-known function of secreting insulin, it also secretes digestive enzymes. These enzymes include trypsin, amylase, and lipase. If the secretion of these enzymes are affected by a diseased pancreas as foundi with diabetes, the digestive functioning may be impaired.

The nurse is caring for a postoperative patient with a colostomy. The nurse is preparing to administer a dose of famotidine (Pepcid) when the patient asks why the medication was ordered since the patient does not have a history of heartburn or gastroesophageal reflux disease (GERD). Which of the following would be the most appropriate response by the nurse? A) "This will prevent air from accumulating in the stomach, causing gas pains." B) "This will prevent the heartburn that occurs as a side effect of general anesthesia." C) "The stress of surgery is likely to cause stomach bleeding if you do not receive it." D) "This will reduce the amount of HCl in the stomach until the nasogastric tube is removed, and you can eat a regular diet again."

D) This will reduce the amount of HCl in the stomach until the nasogastric tube is removed, and you can eat a regular diet again Famotidine is an H2-receptor antagonist that inhibits gastric HCl secretion and thus minimizes damage to gastric mucosa while the patient is not eating a regular diet after surgery.

Which of the following symptoms characterizes regional enteritis? a) Severe diarrhea b) Diffuse involvement c) Exacerbations and remissions d) Transmural thickening

D) Transmural thickening Transmural thickening is an early pathologic change of Crohn's disease. Later pathology results in deep, penetrating granulomas. Regional enteritis is characterized by regional discontinuous lesions. Severe diarrhea is characteristic of ulcerative colitis while diarrhea in regional enteritis is less severe. Regional enteritis is characterized by a prolonged and variable course while ulcerative colitis is characterized by exacerbations and remissions.

A client with complaints of right lower quadrant pain is admitted to the emergency department. Blood specimens are drawn and sent to the laboratory. Which laboratory finding should be reported to the physician immediately? a) Hematocrit 42% b) Serum potassium 4.2 mEq/L c) Serum sodium 135 mEq/L d) White blood cell (WBC) count 22.8/mm3

D) White blood cell (WBC) count 22.8/mm3 The nurse should report the elevated WBC count. This finding, which is a sign of infection, indicates that the client's appendix might have ruptured. Hematocrit of 42%, serum potassium of 4.2 mEq/L, and serum sodium of 135 mEq/L are within normal limits. Alterations in these levels don't indicate appendicitis.

A large tortuous arteriole in the stomach wall that erodes and bleeds: ? (relatively uncommon)

DIELAFOY LESION WIKI: Dieulafoy's Lesions are characterized by a single large tortuous arteriole in the submucosa which does not undergo normal branching or a branch with caliber of 1-5 mm (more than 10 times the normal diameter of mucosal capillaries). The lesion bleeds into the gastrointestinal tract through a minute defect in the mucosa which is not a primary ulcer of the mucosa but an erosion likely caused in the submucosal surface by protrusion of the pulsatile arteriole. Approximately 75% of Dieulafoy's lesions occur in the upper part of the stomach within 6 cm of the gastroesophageal junction, most commonly in the lesser curvature.

Dehydration:

Dehydration!!

Salmonella complications

Diarrhea, N/V, abdominal cramps, fever and chills

Enterocolitis

Diarrheal Disease -Many d/t microbial agents, malabroptive d/o and, idiopathic IBD -Increase in stool mass, frequency, fluidity > 250 mg, 70-95% water -Associated Sx: Pain, Urgency, Perianal discomfort and Incontinence -Dysentry: low volume, painful, bloody diarrhea

Hypotonic

Electrolyte defecti exceeds the water defecit Shock is frequent finding Serum NA+ is less than 130

A nurse is assisting with a percutaneous liver biopsy. Place the steps involved in care in the correct sequence from first to last. Ensure that the biopsy equipment is assembled and in order. Help the client assume a supine position. Make sure that the specimen container is labeled and delivered to the laboratory. While the physician inserts the needle, instruct the client to take a deep breath and hold it to keep the liver as near to the abdominal wall as possible. Place a rolled towel beneath the client's right lower ribs.

Ensure that the biopsy equipment is assembled and in order. Help the client assume a supine position. Place a rolled towel beneath the client's right lower ribs. While the physician inserts the needle, instruct the client to take a deep breath and hold it to keep the liver as near to the abdominal wall as possible. Make sure that the specimen container is labeled and delivered to the laboratory. When assisting with a percutaneous liver biopsy, the nurse ensures that the biopsy equipment is assembled and in order. He or she helps the client assume a supine position with a rolled towel beneath the right lower ribs. Before the physician inserts the needle, the nurse instructs the client to take a deep breath and hold it to keep the liver as near to the abdominal wall as possible. After specimen cells are obtained, they are placed in a preservative. The nurse makes sure that the specimen container is labeled and delivered to the laboratory.

The most serious complication of HD is

Enterocolitis

What indicates a parasitic infection or protein intolerance?

Eosinophils in stools

TEF: Type C

Esophageal Atresia where the lower esophageal pouch makes an abnormal connection with the trachea (fistula). The upper esophageal pouch ends blindly.

Complications of GER

Esophagitis Esophageal stricture Laryngitis Recurrent pneumonia Anemia Barrett esophagus

What are the three stages of Parenteral rehydration therapy?

Expand ECF volume quickly Replace defecits, meet maintenance water and electrolyte requirements Allow patient to return to normal and begin oral feedings

True or False? A drug that clocks the release of secretions from the stomach's chief cells will decrease gastric acidity.

False A drug that clocks the release of secretions from the stomach's parietal cells will decrease gastric acidity.

True or False? Obsruction of the biliary tract is indicated by increased unconjugated (indirect) bilirubin levels in the blood.

False Obsruction of the biliary tract is indicated by increased conjugated (direct) bilirubin levels in the blood.

True or False? The structure that prevents reflux of stomach contents into the esophagus is the upper esophageal sphincter.

False The structure that prevents reflux of stomach contents into the esophagus is the lower esophageal sphincter.

What is essential for detection and therapeutic management of dehydration?

Nursing observation and intervention

UGI Bleed Mnemonic: GUM BLEEDING What is the GUM?

GASTRITIS ULCER MALLORY WEISS TEAR

What is the purpose of an NG tube insertion?

GI decompression, aspiration, irrigation, feedings, medications

MNEMONIC for UGI bleed: ?

GUM BLEEDING GASTRITIS ULCER Mallory Weiss Tear Biliary (Haemobilia: usually post procedure) LARGE VARICES ESOPHAGITIS (Bisphosphanates) Entero-Aortic Fistula (e.g. after AAA surgery) Dieulafoy lesion IBD Neovascularization Gastric Cancer Rx: 2 large bore IVs (14 gauge) in antecubital fossae - Blood (Cross-matched; O neg for women if possible) - Speed: as fast as it will go in

Cleft Lip: Causes

Genetics, Fetal exposure to cigarette smoke, alcohol, certain medications, illicit drugs, certain viruses, nutritional deficiencies in mother (lack of folate).

George Washington got lazy after.....

Greater than 55 Wbc > 16,000 Glucose >200 Lazy- LDH > 350 AST >250

LGI Bleed Mnemonic: H-DRAIN = ?

HEMORRHOIDS DIVERTICULOSIS (ITIS) RADIATION AVM IBD / Infection / Ischemia NEOPLASM

what position should a pt with GERD be in

HOB at 30 degrees

He Broke C-A-B-E

Hct drop >10 BUN up >5 Calcium <8 Art. O2 <60 Base deficit >4 Est fluid seqeustred >6,000 ml

Clinical manifestations of GER in Children

Heartburn Abdominal pain Non cardiac chest pain chronic cough dysphagia nocturnal asthma recurrent pneumonia

Why do we educate clients who are getting an NG inserted?

Helps client cooperation and compliance

What on the CBC will be elevated in Acute diarrhea in children?

Hemoglobin, Hematocrit, creatinine, and BUN

What lab values do you assess for to determine anemia?

Hgb and Hct

Rapid fluid replacement is contraindicated for what type of dehydration and why?

Hypertonic Risk of water intoxication (Pontine cells in brain)

Complications of Peritonitis

Hypovelmic shock Sepsis Intrabdominal abcess formation paralytic ileus acute respiratory distress syndrome

Nursing care of GER is directed at:

Identifying children with symptoms Educating parents regarding home care, feeding, positioning, meds caring for the child undergoing surgical interventions

What are the complications of a large bowel obstruction?

If obstruction is not corrected can lead to increasing pressure which impairs circulation to bowel wall causing ischemia. Also gangrene and perforation

Diagnostic Evaluation on Children

If they have: Watery, explosive diarrhea = Glucose intolerance Foul-smelling, greasy, bulky stools = Fat malabsorption Cow's milk, fruits or cereal = Enzyme deficiency or protein intolerance

What differentiates septic shock from any other shock?

Increased temperature along with increased HR and decreased BP

Peritonitis

Inflammation spreads rapidly throughout the stomach Occurs when blood-borne organisms enter the peritoneal cavity

What is the correct way to assess the abdomen?

Inspect, auscultate, then palpate--start at lower left quadrant because that is where bowel sounds are first heard

Initial phase of fluid replacement is rapid in which types of dehydration?

Isotonic and Hypotonic

Why is an NG tube inserted in clients who have had a GI surgery?

It allows the bowel to rest

How does ischemia cause small bowel obstruction?

It decreases supply of oxygenated blood to the bowel meaning something is dying; it is non-viable; requires emergency surgery

Hirschsprung Disease (Peds, Wongs)

It is a congenital anomaly that results in mechanical obstruction from inadequate motility of the intestine. R/T absence of ganglion cells

What is an ileostomy?

It is made in the ileum of the small intestine

Why is a colectomy performed?

It is performed in clients who have extensive chronic ulcerative colitis, and done in clients who have a high risk of developing colon cancer

Why do we as nurses never reposition an NG tube if put in during surgery?

It is placed where the doctor wants it

What is a paralytic ileus?

It is when peristalsis stops (nothing moving) due to either neurogenic or muscular impairment. The bowel lumen remains patent but the contents are not propelled forward causing it to back up.

What do we want to educate our clients who are getting an NG tube about?

It will be very uncomfortable, chew ice chips while inserting or suck on rag

A nurse is reviewing laboratory test results from a client. The report indicates that the client has jaundice. What serum bilirubin level must the client's finding exceed? Enter the correct number only.

Jaundice becomes clinically evident when the serum bilirubin level exceeds 2.5 mg/dL (43 fmol/L).

Labs elevated are?

LDH, AST, amylase, lipase

75% of GI bleeds are UGI: UGI location is proximal to _______? (anatomy)

LIGAMENT OF TREITZ

pain of diverticulitis is located?

LLQ

Moderate cases of acute Diarrhea s/sx and how to treat

Loss of skin turgor, dry buccal, mucous membranes, sunken eyes and sunken fontanel THERAPY: ORS, 100 ml/kg w/in 4 hrs

What can be done to prevent thrombophlebitis?

Lovenox is administered in abdomen, STD and TED hose

Common causes of constipation

Low fluid intake, lack of fiber, medications

Most likely Dx: Hematemesis following a night of drinking and retching.

MALLORY-WEISS TEAR 90% stop spontaneously. If persistent: Endoscopic treatment (+/- clips or surgery)

What is bowel prep for bowel resection surgery?

Makes client go to the bathroom to get rid of all things in the intestines

Is amylase elevated?

May be

The most intense sign of pain in Appendicitis is:

McBurney Point: located at a point midway between the anterior superior iliac crest and the umbilicus DO not perform rebound tenderness on a child

Intervention of HD for the nurse is to

Measure progressive distention of the abdomen circumference with a tape measurer, mark with a pen

Bacterial Enterocolitis

More severe than viral disease 1.E. Coli: from food and water >>traveler's diarrhea 2. Salmonella: milk, beef, eggs, poultry >>fever, pain, bacteremia, common outbreaks 3. Shigella: person-person >> fever, pain, dysentry, epidemic spread 4. Campylobacter:milk, poultry, animal contact >> fever, pain, food sources, animal reservious

What is the most common reason for small bowel surgery?

Obstruction

Pathophysiology of Intussusception

One segment of the bowel telescopes into another segment, pulling the mesentery with it.

Are ice chips allowed in a client who is NPO?

Only if the doctor ordered ice chips

Stool cultures should be performed, when? (peds)

Only when blood, mucus, or polymorphonuclear leukocytes are present in stool, sx are severe, history of traveling to developing country, specific pathogen is suspencted.

Infants and children with acute diarrhea and dehydration should first be treated with?

Oral rehydration therapy (ORT)

Salmonella

Organisms enter the body by eating contaminated food like undercooked eggs and chicken or drinking contaminated water. Infection can be transmited via fecal-oral route

Tube feeding is covered under Medicare as

Part B, Prosthetic Device Benefit

A sign that the intussusception has reduced itself is:

Passing of a normal brown stool Immediately report this to PCP they may choose to alter the diagnostic and therapeutic care plan

PEG

Percutaneous Endoscopically placed Gastric Tube

Etiology of peritonitis

Perforated peptic ulcers Ruptured diverticuli Ruptured appendix Intestinal perforation

What dx exam on all pts?

Plain abd films to r/o free air

Infants who are prone to develop GER are:

Premature infants and Broncho pulmonary dysplasia

The best intervention for diarrhea is?

Prevention

What do NG tubes help prevent or maintain?

Prevents nausea/vomiting, prevents/resolves abdominal distension, prevents incision pain, helps maintain accurate I&O of gastric contents

Isotonic

Primary form of dehydration in children Water and Sodium are lost in = amounts Shock is greatest threat Display sx of hypovelmic shock Plasma sodium remains w/in normal limits

What is mechanical obstruction?

Problems OUTSIDE the intestine such as scar tissue or hernias or problems WITHIN the intestine such as tumors or inflammatory bowel disease

What is intussusception?

Prolapse of one segment of bowel into the lumen of another segment (rare in adults)

Positive Rovsing's

RLQ when pressure is applied to LLQ

A client diagnosed with acute pancreatitis is being transferred to another facility. The nurse caring for the client completes the transfer summary, which includes information about the client's drinking history and other assessment findings. Which assessment findings confirm his diagnosis? a) Recent weight loss and temperature elevation b) Presence of easy bruising and bradycardia c) Adventitious breath sounds and hypertension d) Presence of blood in the client's stool and recent hypertension

Recent weight loss and temperature elevation Assessment findings associated with pancreatitis include recent weight loss and temperature elevation. Inflammation of the pancreas causes a response that elevates temperature and leads to abdominal pain that typically occurs with eating. Nausea and vomiting may occur as a result of pancreatic tissue damage that's caused by the activation of pancreatic enzymes. The client may experience weight loss because of the lost desire to eat. Blood in stools and recent hypertension aren't associated with pancreatitis; fatty diarrhea and hypotension are usually present. Presence of easy bruising and bradycardia aren't found with pancreatitis; the client typically experiences tachycardia, not bradycardia. Adventitious breath sounds and hypertension aren't associated with pancreatitis.

Therapeutic Management for HD

Requires a pull through surgery (temporary colostomy) rather than frequent enemas

The first priority to dehydration is?

Restoration of circulation by rapid expansion of the ECF volume to treat or prevent shock

Appendicitis Clinical Manifestations

Right lower quadrant abdominal pain Fever Right abdomen Decreased or absent bowel sounds Vomiting Constipation or diarrhea Anorexia Tachycardia Rapid, shallow breathingPallor lethargy irritability stooped posture

What is a volvulus?

Rotation of the loops of bowel about a fixed point

Why is IV PPI given for UGI bleed? - Stabilize Clot? - Accelerate ulcer healing?

STABILIZE CLOT Also give Octreotide if Variceal bleed.

An indication for tube feeding

Should not or cannot eat adequately to maintain nutritional stores

Where is a large bowel obstruction more commonly to occur?

Sigmoid colon

What is the chief solute in ECF and is the primary determinant of ECF volume?

Sodium

Clinical manifestations of GER in Infants

Spitting up regurgitation vomiting (forceful) Silent Weight loss, growth failure Respiratory problems Hematemesis

Cleft Lip: Definition

Split in the upper lip, palate or both. Occurs the first three prenatal months.

If bacteria and viral culture results are negative, but diarrhea still persists. What do you do?

Stools should be examined for ova and parasites

Nursing Care of Peritonitis

Surgery is usually indicated to locate the cause of the inflammation, drain purulent fluid, and repair the damage

Salmonella treatment

Symptomatic, fluid and electrolyte replacement

What is the nurse supposed to educate the client about post-op after a bowel resection surgery?

TCDB, discuss body disturbance, and sexual activity

The earliest detectable sign is usually of dehydration?

Tachycardia followed by Dry Skin and mucous membranes, sunken fontanels, circulatory failure (coolnesss/mottling), loss of skin elasticity, and prolonged cap refill

What should you teach the client who has a ostomy about bodily appearance?

Teach to wear loose fitting clothing, still can be sexually active, swim and do anything he/she wants to do.

Cancer may occur in the mouth as a sore that does not heal.

men after age 40, tobacco, etoh family HX, tanning viral infections HPV cancer in teh mouth looks like a rough spot, it may be white or red patches, they may have ear pain or hoarseness. Any sore that does not heal within 2 weeks should be looked at

What is a total proctoclectomy?

The colon, rectum, and anus are completely removed. The anal canal is closed, and the end of the terminal ileum is brought to the body surface through the abdominal wall to form a permanent stoma

What does the sphincter do/not do in HD?

The internal sphincter does not relax

The best position of sleeping for a child with GER is:

The supine position

Why are narcotics not used often when have an intestinal obstruction?

They can mask the signs and symptoms of intestinal obstruction

What is the importance to monitor vital signs post-op after a bowel resection surgery?

To determine if client has hypovolemia or going into shock

GER Infant

Transfer of gastric contents into the esophagus; more frequently after meals or at night GERD (different than GER; tissue damage)

Special orders of tube feeding or patient caloric needs exceed 2,000 kcal will need extra documentation.

True

True or False? The nurse encourages that patient with chronic constipation to attempt defecation after the first meal of the day because gastrocolic and duodenocolic reflexes increase colon peristalsis at that time.

True

True or False? The secretion of hydrochloric acid and pepsinogen is stimulated by the sight, smell, and taste of food.

True

Sandifer syndrome

Uncommon condition, usually occurring in young children, characterized by repetitive stretching and arching of the head and neck that can be mistaken for a seizure disorder

Acute Diarrhea

Usually Self-limited ( <14 days' duration)

Cleft Palate: Possible areas affected

Uvula, soft/hard palate

Infectious Enterocolitis

Viral, Bacterial, Protozoal > 3 million deaths WW: ½ kids < 5 y.o -Diarrhea is MC amongst travelers -Offenders: Rotavirus, Calcivirus and Enterotoxigenic E. Coli -Offenders vary w/ age, nutrition, immune status, environment, special predispositions -foreign travel: exposure to more virulent organisms while hospitalized, wartime dislocation...

labs elevated are:

WBC, amylase (not lipase)

What is the most important determinant of the % of TBF loss in infants and younger children?

WEIGHT (However, pre-illness weight is usually unknown)

what will be used to feed the infant after cleft lip repair

a dropper/syringe with rubber tip to discourage sucking

after a cleft lip repair, what device will the baby wear

a logan bow

What is done to decrease cramping post-op after a bowel resection surgery?

a rectal tube is inserted to excrete bowel

S/Sx of peritonitis

abdominal pain most common, tenderness over involved area, rebound tenderness, muscular rigidity, and spasm are major signs of irritation. Could have abdominal distention or ascites, fever, tachycardia, tachypnea, N/V, altered bowel habits

for a barium swallow a pt. should be NPO for how long?

midnight before the test

What are adhesions?

bands of scar tissue following abdominal surgery or inflammatory processes that causes simple obstruction or single blockage in one portion of intestine

Upper GI study:

barium swallow

why is the final repair delayed till 4-5 years

because earlier surgery would interfere with tooth development

when will the cleft palate be repaired?

between 1 and 5 years of age

when will the cleft lip be repaired?

between 10 weeks and 6 months

What are the diagnostic studies done to diagnose intestinal obstruction?

bowel assessment, abdominal x-rays, CT of abdomen, serum electrolytes and CBC, gastrografin

What is the treatment for intestinal obstruction?

bowel decompression, Fluid and electrolyte replacement, surgery

What types of surgery can be performed to treat intestinal obstruction?

bowel resection with ostomy formation, ileostomy, ileal pouch anal anastomosis

IV abx cholecystistis

broad spectrum eg piperacilin

DX for cancer of the mouth

brush biopsy

the infant with cleft lip/cleft palate needs more frequent ______

burping

nissen fundoplication

most frequently used surgery, abdominal approach to suture the fundus around the esophagus, increase in pressure or volume in stomach closes the cardia and blocks reflux into the esophagus

A client is admitted to the healthcare facility suspected of having acute pancreatitis and undergoes laboratory testing. Which of the following would the nurse expect to find? a) Decreased white blood cell count b) Increased serum calcium levels c) Elevated urine amylase levels d) Decreased liver enzyme levels

c) Elevated urine amylase levels Elevated serum and urine amylase, lipase, and liver enzyme levels accompany significant pancreatitis. If the common bile duct is obstructed, the bilirubin level is above normal. Blood glucose levels and white blood cell counts can be elevated. Serum electrolyte levels (calcium, potassium, and magnesium) are low.

A patient receives atropine, an anticholinergic drug, in preparation for surgery. The nurse expects this drug to affect the GI tract by: a) increasing gastric emptying b) relaxing pyloric and ileocecal sphincters c) decreasing secretions and peristaltic action d) stimulating the nervous system of the GI tract

c) decreasing secretions and peristaltic action The parasympathetic nervous system increasing motility and secretions and relaxing sphincters to promote movement of contents. A drug that blocks this activity decreases secretions and peristalsis, slows gastric emptying, and contracts sphincters. The enteric nervous system of the GI tract is modulated by sympathetic and parasympathetic influence

When caring for a patient who has had most of the stomach surgically removed, the nurse plans to teach the client a) that extra iron will need to be taken to prevent anemia b) to avoid foods with lactose to prevent diarrhea and bloating c) that lifelong supplementation of cobalamin will be needed d) that, because of the absence of digestive enzymes, protein malnurition is likely

c) that lifelong supplementation of cobalamin will be needed The stomach secretes intrinsic factor necessary for cobalamin absorption in the intestine. In removal of part or all of the stomach, cobalamin must be supplemented for life.

What is usually the cause of a large bowel obstruction?

cancer

What are the nursing responsibilities concerning an NG tube?

check placement FIRST and prior to each instillation, check residual prior to each feeding; maintain fluid balance

How do you know that peristalsis has returned after a bowel decompression?

client will be hungry, pass flatulence, and you will hear bowel sounds

What is the pre-op prior to an esophagogastroduidenoscopy (EDGD)

consent numb the throat iv lines NPO for 6 - 8 hours prior heart monitor

What are the clinical manifestations of a large bowel obstruction?

constipation from impaction, abdominal pain, cramping, distention with high pitched, tinkling bowel sounds with rushes and gurgles, and localized tenderness/mass on palpation

A client is to have an upper GI procedure with barium ingestion and abdominal ultrasonography. While scheduling these diagnostic tests, the nurse must consider which factor? a) The client may eat a light meal before either test. b) Both tests need to be done before breakfast. c) The upper GI should be scheduled before the ultrasonography. d) The ultrasonography should be scheduled before the GI procedure.

d) The ultrasonography should be scheduled before the GI procedure Both an upper GI procedure with barium ingestion and an ultrasonography may be completed on the same day. The ultrasonography test should be completed first, because the barium solution could interfere with the transmission of the sound waves. The ultrasonography test uses sound waves that are passed into internal body structures, and the echoes are recorded as they strike tissues. Fluid in the abdomen prevents transmission of ultrasound.

After eating, a patient with an inflamed gallbladder experiences pain caused by contraction of the gallbladdder. The mechanism responsible for this action is a) production of bile by the liver b) production of secretin by the duodenum c) release of gastrin from the stomach antrum d) production of cholecystokinin by the duodenum

d) production of cholecystokinin by the duodenum Cholecystokinin is secreted by the duodenal mucosa when fats and amino acids enter the duodenum and stimulates the gallbladder to release bile and emulsify the fats for digestion. The bile is produced by the liver but stored in the gallbladder. Secretin is responsible for stimulating pancreatic bicarbonate secretion, and gastrin increases gastric motility and acid secretion.

Bacteria replicates in gut

depends on: 1. Ability to adhere to mucosal epithelial cells -plasmid coded adhesins- prevents swept away by fluids 2. Ability to elaborate enterotoxins: produce polypeptides that cause diarrhea - Secretagogues: activate secretion w/out damaging cell -or Cytotoxins>>direct epithelial cell necrosis 3. Capacity to invade: Followed by intracellular proliferation, cell lysis, cell-cell spread -S. Flexneri is major cause of diarrhea in areas of poor hygiene, devloping countries -Salmonella causes > ½ million cases of food poisoning in US -Contaminated eggs, chicken, beef (not properly washed)

Is calcium up or down

down

What should a pt. do after a barium swallow test

drink lots of liquids to clear out barrium

What are the clinical manifestations of strangulated obstruction?

edema, cyanosis, and gangrene of affected loop of bowel

with what device will the infant be restrained after repair

elbow restraints

Upper GI endoscopy AKA:

esophagogastroduodenoscopy

Endoscopic retrograde cholangiopancreatography (ERCP) used for:

examination of the hepatobiliary system

Ptyalism = ?

excessive salivation

Tracheoesophageal Fistula (TEF) : Definition

failure of esophagus to develop as a continuous passage and failure of the trachea & esophagus to separate into distinct structures.

The biggest risk factor for cleft lip

family history

Cleft Lip: Clinical Manifestations

feeding difficulties, complete (through nares), incomplete (part of the lip), nasal distortion

why is the cleft lip repaired early? 2 reasons

feeding is easier and appearance after repair is more acceptable to the parents

IV abx diverticulitis

flagyl, cipro, fortaz, cleocin, amp, etc

Grey Turner's sign

flank discoloration

What are the non-GI manifestations of a small bowel obstruction?

fluid and electrolyte imbalance (hypovolemia and dehydration), renal insufficiency, respiratory problems

Child who is vomiting should be given ORS when?

frequent intervals, small amounts 5-10 ml q 1-5 minutes

what problems can occur with oral cancer and mouthcare

halitosis and thrush

children with cleft lip and cleft palate have long term problems with _______ and _______ and ______

hearing, speech, teeth

hiatal hernia

hernia resulting from the protrusion of part of the stomach through the diaphragm

what type of food should you not give an infant until they are at least one yr.

honey

Pyloric Stenosis: Urine Sp. Gravity

increased BUN --> dehydration

What are the signs of hypovolemia and shock?

increased heart rate and decreased blood pressure

Pyloric Stenosis: CBC

increased hg & hct because of hemoconcentration (not enough blood, more fluid)

Cholangitis:

infected bile

Viral Gastroenteritis

infection of superficial epithelium in small intestine destroys cells and absorptive fxn -Repopulation of immature enterocytes and relative preservation of crypt secretory cells >> net secretin of water and electrolytes o Sx disease caused by several viruses 1. Rotavirus: 2. Calicivirusus

What causes fecal material to "back up"?

intestinal obstruction

What are the clinical manifestations of a small bowel obstruction?

vary depending on level of obstruction and how rapidly it develops but will see--abdominal distension, cramping or colicky abdominal pain, vomiting, peristaltic waves in distended loops of bowel in thin clients, later on will have totally absent bowel sounds

esophagogastroduidenoscopy (EGD)

visual examination of the esophagus, stomach and duodenum

What can cause a strangulated obstruction of the small bowel?

volvulus and incarcerated hernia

what stools are normal for a few days after a barium swallow test

white stools

what must always be at the bedside for a pt. with a jaw that is wired shut

wire cutters

can these babes sleep on their backs

yes

should children with cleft palate before surgery be allowed to cry or breast feed

yes the can cry, may breast feed with simple cleft lip however palate interferes with feeding

should a pt. ambulate shortly after a nissen fundoplication

yes to prevent clots

is it possible to have only one? cleft lip or cleft palate?

yes, you can have one or the other or both

A client with a peptic ulcer reports epigastric pain that frequently awakens her during the night. The nurse should instruct the client to do which activities? Select all that apply. 1. Obtain adequate rest to reduce stimulation. 2. Eat small, frequent meals throughout the day. 3. Take all medications on time as ordered. 4. Sit up for one hour when awakened at night. 5. Stay away from crowded areas.

1, 2, 3, 4. The nurse should encourage the client to reduce stimulation that may enhance gastric secretion. The nurse can also advise the client to utilize health practices that will prevent recurrences of ulcer pain, such as avoiding fatigue and elimination of smoking. Eating small, frequent meals helps to prevent gastric distention if not actively bleeding and decreases distension and release of gastrin. Medications should be administered promptly to maintain optimum levels. After awakening during the night, the client should eat a small snack and return to bed, keeping the head of the bed elevated for an hour after eating. It is not necessary to stay away from crowded areas.

The client attends two sessions with the dietitian to learn about diet modifications to minimize gastroesophageal reflux. The teaching would be considered successful if the client says that she will decrease her intake of which of the following foods? 1. Fats. 2. High-sodium foods. 3. Carbohydrates. 4. High-calcium foods.

1. Fats are associated with decreased esophageal sphincter tone, which increases reflux. Obesity contributes to the development of hiatal hernia, and a low-fat diet might also aid in weight loss. Carbohydrates and foods high in sodium or calcium do not affect gastroesophageal reflux.

The nurse instructs the client on health maintenance activities to help control symptoms from her hiatal hernia. Which of the following statements would indicate that the client has understood the instructions? 1. "I'll avoid lying down after a meal." 2. "I can still enjoy my potato chips and cola at bedtime." 3. "I wish I didn't have to give up swimming." 4. "If I wear a girdle, I'll have more support for my stomach."

1. A client with a hiatal hernia should avoid the recumbent position immediately after meals to minimize gastric reflux. Bedtime snacks, as well as high-fat foods and carbonated beverages, should be avoided. Excessive vigorous exercise also should be avoided, especially after meals, but there is no reason why the client must give up swimming. Wearing tight, constrictive clothing such as a girdle can increase intra-abdominal pressure and thus lead to reflux of gastric juices.

The nurse is caring for a client who has just had an upper GI endoscopy. The client's vital signs must be taken every 30 minutes for 2 hours after the procedure. The nurse assigns an unlicensed nursing personnel (UAP) to take the vital signs. One hour later, the UAP reports the client, who was previously afebrile, has developed a temperature of 101.8 ° F (38.8 ° C). What should the nurse do in response to this reported assessment data? 1. Promptly assess the client for potential perforation. 2. Tell the assistant to change thermometers and retake the temperature. 3. Plan to give the client acetaminophen (Tylenol) to lower the temperature. 4. Ask the assistant to bathe the client with tepid water.

1. A sudden spike in temperature following an endoscopic procedure may indicate perforation of the GI tract. The nurse should promptly conduct a further assessment of the client, looking for further indicators of perforation, such as a sudden onset of acute upper abdominal pain; a rigid, boardlike abdomen; and developing signs of shock. Telling the assistant to change thermometers is not an appropriate action and only further delays the appropriate action of assessing the client. The nurse would not administer acetaminophen without further assessment of the client or without a physician's order; a suspected perforation would require that the client be placed on nothing-by-mouth status. Asking the assistant to bathe the client before any assessment by the nurse is inappropriate.

Which of the following dietary measures would be useful in preventing esophageal reflux? 1. Eating small, frequent meals. 2. Increasing fluid intake. 3. Avoiding air swallowing with meals. 4. Adding a bedtime snack to the dietary plan.

1. Esophageal reflux worsens when the stomach is overdistended with food. Therefore, an important measure is to eat small, frequent meals. Fluid intake should be decreased during meals to reduce abdominal distention. Avoiding air swallowing does not prevent esophageal reflux. Food intake in the evening should be strictly limited to reduce the incidence of nighttime reflux, so bedtime snacks are not recommended.

The nurse is obtaining a health history from a client who has a sliding hiatal hernia associated with reflux. The nurse should ask the client about the presence of which of the following symptoms? 1. Heartburn. 2. Jaundice. 3. Anorexia. 4. Stomatitis.

1. Heartburn, the most common symptom of a sliding hiatal hernia, results from reflux of gastric secretions into the esophagus. Regurgitation of gastric contents and dysphagia are other common symptoms. Jaundice, which results from a high concentration of bilirubin in the blood, is not associated with hiatal hernia. Anorexia is not a typical symptom of hiatal hernia. Stomatitis is inflammation of the mouth.

The physician prescribes metoclopramide hydrochloride (Reglan) for the client with hiatal hernia. The nurse plans to instruct the client that this drug is used in hiatal hernia therapy to accomplish which of the following objectives? 1. Increase tone of the esophageal sphincter. 2. Neutralize gastric secretions. 3. Delay gastric emptying. 4. Reduce secretion of digestive juices.

1. Metoclopramide hydrochloride (Reglan) increases esophageal sphincter tone and facilitates gastric emptying; both actions reduce the incidence of reflux. Other drugs, such as antacids or histamine receptor antagonists, may also be prescribed to help control reflux and esophagitis and to decrease or neutralize gastric secretions. Reglan is not effective in decreasing or neutralizing gastric secretions.

The nurse is developing standards of care for a client with gastroesophageal reflux disease and wants to review current evidence for practice. Which one of the following resources will provide the most helpful information? 1. A review in the Cochrane Library. 2. A literature search in a database, such as the Cumulative Index to Nursing and Allied Health Literature (CINHAL). 3. An online nursing textbook. 4. The online policy and procedure manual at the health care agency.

1. The Cochrane Library provides systematic reviews of health care interventions and will provide the best resource for evidence for nursing care. CINHAL offers key word searches to published articles in nursing and allied health literature, but not reviews. A nursing textbook has information about nursing care which may include evidence-based practices, but textbooks may not have the most up-to-date information. While the policy and procedure manual may be based on evidence-based practices, the most current practices will be found in evidence-based reviews of literature.

The client is scheduled to have an upper gastrointestinal tract series of x-rays. Following the x-rays, the nurse should instruct the client to: 1. Take a laxative. 2. Follow a clear liquid diet. 3. Administer an enema. 4. Take an antiemetic.

1. The client should take a laxative after an upper gastrointestinal series to stimulate a bowel movement. This examination involves the administration of barium, which must be promptly eliminated from the body because it may harden and cause an obstruction. A clear liquid diet would have no effect on stimulating removal of the barium. The client should not have nausea and an antiemetic would not be necessary; additionally, the antiemetic will decrease peristalsis and increase the likelihood of eliminating the barium. An enema would be ineffective because the barium is too high in the gastrointestinal tract.

A client with peptic ulcer disease reports that he has been nauseated most of the day and is now feeling light-headed and dizzy. Based upon these findings, which nursing actions would be most appropriate for the nurse to take? Select all that apply. 1. Administering an antacid hourly until nausea subsides. 2. Monitoring the client's vital signs. 3. Notifying the physician of the client's symptoms. 4. Initiating oxygen therapy. 5. Reassessing the client in an hour.

2, 3. The symptoms of nausea and dizziness in a client with peptic ulcer disease may be indicative of hemorrhage and should not be ignored. The appropriate nursing actions at this time are for the nurse to monitor the client's vital signs and notify the physician of the client's symptoms. To administer an antacid hourly or to wait 1 hour to reassess the client would be inappropriate; prompt intervention is essential in a client who is potentially experiencing a gastrointestinal hemorrhage. The nurse would notify the physician of assessment findings and then initiate oxygen therapy if ordered by the physician.

The nurse is caring for a client who has had a gastroscopy. Which of the following signs and symptoms may indicate that the client is developing a complication related to the procedure? Select all that apply. 1. The client has a sore throat. 2. The client has a temperature of 100 ° F (37.8 ° C). 3. The client appears drowsy following the procedure. 4. The client has epigastric pain. 5. The client experiences hematemesis.

2, 4, 5. Following a gastroscopy, the nurse should monitor the client for complications, which include perforation and the potential for aspiration. An elevated temperature, complaints of epigastric pain, or the vomiting of blood (hematemesis) are all indications of a possible perforation and should be reported promptly. A sore throat is a common occurrence following a gastroscopy. Clients are usually sedated to decrease anxiety and the nurse would anticipate that the client will be drowsy following the procedure.

The nurse finds a client who has been diagnosed with a peptic ulcer surrounded by papers from his briefcase and arguing on the telephone with a coworker. The nurse's response to observing these actions should be based on knowledge that: 1. Involvement with his job will keep the client from becoming bored. 2. A relaxed environment will promote ulcer healing. 3. Not keeping up with his job will increase the client's stress level. 4. Setting limits on the client's behavior is an important nursing responsibility.

2. A relaxed environment is an essential component of ulcer healing. Nurses can help clients understand the importance of relaxation and explore with them ways to balance work and family demands to promote healing. Being involved with his work may prevent boredom; however, this client is upset and argumentative. Not keeping up with his job will probably increase the client's stress level, but the nurse's response is best if it is based on the fact that a relaxed environment is an essential component of ulcer healing. Nurses cannot set limits on a client's behavior; clients must make the decision to make lifestyle changes.

Which of the following would be an expected outcome for a client with peptic ulcer disease? The client will: 1. Demonstrate appropriate use of analgesics to control pain. 2. Explain the rationale for eliminating alcohol from the diet. 3. Verbalize the importance of monitoring hemoglobin and hematocrit every 3 months. 4. Eliminate contact sports from his or her lifestyle.

2. Alcohol is a gastric irritant that should be eliminated from the intake of the client with peptic ulcer disease. Analgesics are not used to control ulcer pain; many analgesics are gastric irritants. The client's hemoglobin and hematocrit typically do not need to be monitored every 3 months, unless gastrointestinal bleeding is suspected. The client can maintain an active lifestyle and does not need to eliminate contact sports as long as they are not stress-inducing.

Which of the following factors would most likely contribute to the development of a client's hiatal hernia? 1. Having a sedentary desk job. 2. Being 5 feet, 3 inches tall and weighing 190 lb. 3. Using laxatives frequently. 4. Being 40 years old.

2. Any factor that increases intra-abdominal pressure, such as obesity, can contribute to the development of hiatal hernia. Other factors include abdominal straining, frequent heavy lifting, and pregnancy. Hiatal hernia is also associated with older age and occurs in women more frequently than in men. Having a sedentary desk job, using laxatives frequently, or being 40 years old is not likely to be a contributing factor in development of a hiatal hernia.

In developing a teaching plan for the client with a hiatal hernia, the nurse's assessment of which work-related factors would be most useful? 1. Number and length of breaks. 2. Body mechanics used in lifting. 3. Temperature in the work area. 4. Cleaning solvents used.

2. Bending, especially after eating, can cause gastroesophageal reflux. Lifting heavy objects increases intra-abdominal pressure. Assessing the client's lifting techniques enables the nurse to evaluate the client's knowledge of factors contributing to hiatal hernia and how to prevent complications. Number and length of breaks, temperature in the work area, and cleaning solvents used are not directly related to treatment of hiatal hernia.

Bethanechol (Urecholine) has been ordered for a client with gastroesophageal reflux disease (GERD). The nurse should assess the client for which of the following adverse effects? 1. Constipation. 2. Urinary urgency. 3. Hypertension. 4. Dry oral mucosa.

2. Bethanechol (Urecholine), a cholinergic drug, may be used in GERD to increase lower esophageal sphincter pressure and facilitate gastric emptying. Cholinergic adverse effects may include urinary urgency, diarrhea, abdominal cramping, hypotension, and increased salivation. To avoid these adverse effects, the client should be closely monitored to establish the minimum effective dose.

A client with peptic ulcer disease tells the nurse that he has black stools, which he has not reported to his physician. Based on this information, which nursing diagnosis would be appropriate for this client? 1. Ineffective coping related to fear of diagnosis of chronic illness. 2. Deficient knowledge related to unfamiliarity with significant signs and symptoms. 3. Constipation related to decreased gastric motility. 4. Imbalanced nutrition: Less than body requirements related to gastric bleeding.

2. Black, tarry stools are an important warning sign of bleeding in peptic ulcer disease. Digested blood in the stool causes it to be black. The odor of the stool is very offensive. Clients with peptic ulcer disease should be instructed to report the incidence of black stools promptly to their primary health care provider. The data do not support the other diagnoses.

Which of the following lifestyle modifications should the nurse encourage the client with a hiatal hernia to include in activities of daily living? 1. Daily aerobic exercise. 2. Eliminating smoking and alcohol use. 3. Balancing activity and rest. 4. Avoiding high-stress situations.

2. Smoking and alcohol use both reduce esophageal sphincter tone and can result in reflux. They therefore should be avoided by clients with hiatal hernia. Daily aerobic exercise, balancing activity and rest, and avoiding high-stress situations may increase the client's general health and well-being, but they are not directly associated with hiatal hernia.

Which of the following instructions should the nurse include in the teaching plan for a client who is experiencing gastroesophageal reflux disease (GERD)? 1. Limit caffeine intake to two cups of coffee per day. 2. Do not lie down for 2 hours after eating. 3. Follow a low-protein diet. 4. Take medications with milk to decrease irritation.

2. The nurse should instruct the client to not lie down for about 2 hours after eating to prevent reflux. Caffeinated beverages decrease pressure in the lower esophageal sphincter and milk increases gastric acid secretion, so these beverages should be avoided. The client is encouraged to follow a high-protein, low-fat diet, and avoid foods that are irritating.

The nurse has been assigned to provide care for four clients at the beginning of the day shift. In what order should the nurse assess these clients? 1. The client awaiting hiatal hernia repair at 11 am. 2. A client with suspected gastric cancer who is on nothing-by-mouth (NPO) status for tests. 3. A client with peptic ulcer disease experiencing sudden onset of acute stomach pain. 4. A client who is requesting pain medication 2 days after surgery to repair a fractured jaw.

3, 4, 2, 1 The client with peptic ulcer disease who is experiencing a sudden onset of acute stomach pain should be assessed first by the nurse. The sudden onset of stomach pain could be indicative of a perforated ulcer, which would require immediate medical attention. It is also important for the nurse to thoroughly assess the nature of the client's pain. The client with the fractured jaw is experiencing pain and should be assessed next. The nurse should then assess the client who is NPO for tests to ensure NPO status and comfort. Last, the nurse can assess the client before surgery.

When obtaining a nursing history on a client with a suspected gastric ulcer, which signs and symptoms should the nurse expect to assess? Select all that apply. 1. Epigastric pain at night. 2. Relief of epigastric pain after eating. 3. Vomiting. 4. Weight loss. 5. Melena.

3, 4, 5. Vomiting and weight loss are common with gastric ulcers. The client may also have blood in the stools (melena) from gastric bleeding. Clients with a gastric ulcer are most likely to complain of a burning epigastric pain that occurs about 1 hour after eating. Eating frequently aggravates the pain. Clients with duodenal ulcers are more likely to complain about pain that occurs during the night and is frequently relieved by eating.

Cimetidine (Tagamet) may also be used to treat hiatal hernia. The nurse should understand that this drug is used to prevent which of the following? 1. Esophageal reflux. 2. Dysphagia. 3. Esophagitis. 4. Ulcer formation.

3. Cimetidine (Tagamet) is a histamine receptor antagonist that decreases the quantity of gastric secretions. It may be used in hiatal hernia therapy to prevent or treat the esophagitis and heartburn associated with reflux. Cimetidine is not used to prevent reflux, dysphagia, or ulcer development.

The nurse is preparing to teach a client with a peptic ulcer about the diet that should be followed after discharge. The nurse should explain that the diet will most likely consist of which of the following? 1. Bland foods. 2. High-protein foods. 3. Any foods that are tolerated. 4. Large amounts of milk.

3. Diet therapy for ulcer disease is a controversial issue. There is no scientific evidence that diet therapy promotes healing. Most clients are instructed to follow a diet that they can tolerate. There is no need for the client to ingest only a bland or high-protein diet. Milk may be included in the diet, but it is not recommended in excessive amounts.

A client has been taking aluminum hydroxide (Amphojel) 30 mL six times per day at home to treat his peptic ulcer. He tells the nurse that he has been unable to have a bowel movement for 3 days. Based on this information, the nurse would determine that which of the following is the most likely cause of the client's constipation? 1. The client has not been including enough fiber in his diet. 2. The client needs to increase his daily exercise. 3. The client is experiencing an adverse effect of the aluminum hydroxide. 4. The client has developed a gastrointestinal obstruction.

3. It is most likely that the client is experiencing an adverse effect of the antacid. Antacids with aluminum salt products, such as aluminum hydroxide, form insoluble salts in the body. These precipitate and accumulate in the intestines, causing constipation. Increasing dietary fiber intake or daily exercise may be a beneficial lifestyle change for the client but is not likely to relieve the constipation caused by the aluminum hydroxide. Constipation, in isolation from other symptoms, is not a sign of a bowel obstruction.

A client is to take one daily dose of ranitidine (Zantac) at home to treat her peptic ulcer. The client understands proper drug administration of ranitidine when she says that she will take the drug at which of the following times? 1. Before meals. 2. With meals. 3. At bedtime. 4. When pain occurs.

3. Ranitidine blocks secretion of hydrochloric acid. Clients who take only one daily dose of ranitidine are usually advised to take it at bedtime to inhibit nocturnal secretion of acid. Clients who take the drug twice a day are advised to take it in the morning and at bedtime. It is not necessary to take the drug before meals. The client should take the drug regularly, not just when pain occurs.

Which of the following nursing interventions would most likely promote self-care behaviors in the client with a hiatal hernia? 1. Introduce the client to other people who are successfully managing their care. 2. Include the client's daughter in the teaching so that she can help implement the plan. 3. Ask the client to identify other situations in which he demonstrated responsibility for himself. 4. Reassure the client that he will be able to implement all aspects of the plan successfully.

3. Self-responsibility is the key to individual health maintenance. Using examples of situations in which the client has demonstrated self-responsibility can be reinforcing and supporting. The client has ultimate responsibility for his personal health habits. Meeting other people who are managing their care and involving family members can be helpful, but individual motivation is more important. Reassurance can be helpful but is less important than individualization of care.

The client has been taking magnesium hydroxide (milk of magnesia) at home in an attempt to control hiatal hernia symptoms. The nurse should assess the client for which of the following conditions most commonly associated with the ongoing use of magnesium-based antacids? 1. Anorexia. 2. Weight gain. 3. Diarrhea. 4. Constipation.

3. The magnesium salts in magnesium hydroxide are related to those found in laxatives and may cause diarrhea. Aluminum salt products can cause constipation. Many clients find that a combination product is required to maintain normal bowel elimination. The use of magnesium hydroxide does not cause anorexia or weight gain.

A client is taking an antacid for treatment of a peptic ulcer. Which of the following statements best indicates that the client understands how to correctly take the antacid? 1. "I should take my antacid before I take my other medications." 2. "I need to decrease my intake of fluids so that I don't dilute the effects of my antacid." 3. "My antacid will be most effective if I take it whenever I experience stomach pains." 4. "It is best for me to take my antacid 1 to 3 hours after meals."

4. Antacids are most effective if taken 1 to 3 hours after meals and at bedtime. When an antacid is taken on an empty stomach, the duration of the drug's action is greatly decreased. Taking antacids 1 to 3 hours after a meal lengthens the duration of action, thus increasing the therapeutic action of the drug. Antacids should be administered about 2 hours after other medications to decrease the chance of drug interactions. It is not necessary to decrease fluid intake when taking antacids. If antacids are taken more frequently than recommended, the likelihood of developing adverse effects increases. Therefore, the client should not take antacids as often as desired to control pain.

The client with gastroesophageal reflux disease (GERD) complains of a chronic cough. The nurse understands that in a client with GERD this symptom may be indicative of which of the following conditions? 1. Development of laryngeal cancer. 2. Irritation of the esophagus. 3. Esophageal scar tissue formation. 4. Aspiration of gastric contents.

4. Clients with GERD can develop pulmonary symptoms, such as coughing, wheezing, and dyspnea, that are caused by the aspiration of gastric contents. GERD does not predispose the client to the development of laryngeal cancer. Irritation of the esophagus and esophageal scar tissue formation can develop as a result of GERD. However, GERD is more likely to cause painful and difficult swallowing.

A client with peptic ulcer disease is taking ranitidine (Zantac). What is the expected outcome of this drug? 1. Heal the ulcer. 2. Protect the ulcer surface from acids. 3. Reduce acid concentration. 4. Limit gastric acid secretion.

4. Histamine-2 (H2) receptor antagonists, such as ranitidine, reduce gastric acid secretion. Antisecretory, or proton-pump inhibitors, such as omeprazole (Prilosec), help ulcers heal quickly in 4 to 8 weeks. Cytoprotective drugs, such as sucralfate (Carafate), protect the ulcer surface against acid, bile, and pepsin. Antacids reduce acid concentration and help reduce symptoms.

A client with a peptic ulcer has been instructed to avoid intense physical activity and stress. Which strategy should the client incorporate into the home care plan? 1. Conduct physical activity in the morning so that he can rest in the afternoon. 2. Have the family agree to perform the necessary yard work at home. 3. Give up jogging and substitute a less demanding hobby. 4. Incorporate periods of physical and mental rest in his daily schedule.

4. It would be most effective for the client to develop a health maintenance plan that incorporates regular periods of physical and mental rest in the daily schedule. Strategies should be identified to deal with the types of physical and mental stressors that the client needs to cope with in the home and work environments. Scheduling physical activity to occur only in the morning would not be restful or practical. There is no need for the client to avoid yard work or jogging if these activities are not stressful.

The nurse should instruct the client to avoid which of the following drugs while taking metoclopramide hydrochloride (Reglan)? 1. Antacids. 2. Antihypertensives. 3. Anticoagulants. 4. Alcohol.

4. Metoclopramide hydrochloride (Reglan) can cause sedation. Alcohol and other central nervous system depressants add to this sedation. A client who is taking this drug should be cautioned to avoid driving or performing other hazardous activities for a few hours after taking the drug. Clients may take antacids, antihypertensives, and anticoagulants while on metoclopramide.

After assessing a client with peritonitis, the nurse most likely would document the client's bowel sounds as: a) Absent. b) High-pitched. c) Mild. d) Hyperactive.

A) Absent Since lack of bowel motility typically accompanies peritonitis, bowel sounds are absent. Therefore, the nurse will not observe mild, high-pitched, or hyperactive bowel sounds.

A client is admitted to the health care facility with a diagnosis of a bleeding gastric ulcer. The nurse expects this client's stools to be: a) black and tarry. b) coffee-ground-like. c) bright red. d) clay-colored.

A) Black and tarry Black, tarry stools are a sign of bleeding high in the GI tract, as from a gastric ulcer, and result from the action of digestive enzymes on the blood. Vomitus associated with upper GI tract bleeding commonly is described as coffee-ground-like. Clay-colored stools are associated with biliary obstruction. Bright red stools indicate lower GI tract bleeding.

When bowel sounds are heard about every 15 seconds, the nurse would record that the bowel sounds are a) absent. b) hypoactive. c) normal. d) sluggish.

C) Normal Normal bowel sounds are heard every 5 to 20 seconds. Hypoactive bowel sound is the description given to auscultation of one to two bowel sounds in 2 minutes. Sluggish is not a term a nurse would use to accurately describe bowel sounds. The nurse records that bowel sounds are absent when no sound is heard in 3 to 5 minutes.

Which diagnostic test is used first to evaluate a client with upper GI bleeding? a) Hemoglobin levels and hematocrit (HCT) b) Endoscopy c) Arteriography d) Upper GI series

A) Hemoglobin levels and hematocrit Hemoglobin and HCT are typically performed first in clients with upper GI bleeding to evaluate the extent of blood loss. Endoscopy is then performed to directly visualize the upper GI tract and locate the source of bleeding. An upper GI series, or barium study, usually isn't the diagnostic method of choice, especially in a client with acute active bleeding who's vomiting and unstable. An upper GI series is also less accurate than endoscopy. Although an upper GI series might confirm the presence of a lesion, it wouldn't necessarily reveal whether the lesion is bleeding. Arteriography is an invasive study associated with life-threatening complications and wouldn't be used for an initial evaluation.

Patients diagnosed with esophageal varices are at risk for hemorrhagic shock. Which of the following is a sign of potential hypovolemia? a) Hypotension b) Bradycardia c) Warm moist skin d) Polyuria

A) Hypotension Signs of potential hypovolemia include cool, clammy skin, tachycardia, decreased blood pressure, and decreased urine output.

Which of the following medications used for the treatment of obesity prevents the reuptake of serotonin and norepinephrine? a) Sibutramine hydrochloride (Meridia) b) Orlistat (Xenical) c) Bupropion hydrochloride (Wellbutrin) d) Fluoxetine hydrochloride (Prozac)

A) Sibutramine hydrochloride (Meridia) Sibutramine hydrochloride (Meridia) inhibits the reuptake of serotonin and norepinephrine. Meridia decreases appetite. Orlistat (Xenical) prevents the absorption of triglycerides. Side effects of Xenical may include increased bowel movements, gas with oily discharge, decreased food absorption, decreased bile flow, and decreased absorption of some vitamins. Bupropion hydrochloride (Wellbutrin) is an antidepressant medication. Fluoxetine hydrochloride (Prozac) has not been approved by the FDA for use in the treatment of obesity.

A client with acute liver failure exhibits confusion, a declining level of consciousness, and slowed respirations. The nurse finds him very difficult to arouse. The diagnostic information which best explains the client's behavior is: a) subnormal serum glucose and elevated serum ammonia levels. b) subnormal clotting factors and platelet count. c) elevated liver enzymes and low serum protein level. d) elevated blood urea nitrogen and creatinine levels and hyperglycemia.

A) Subnormal serum glucose and elevated serum ammonia levels In acute liver failure, serum ammonia levels increase because the liver can't adequately detoxify the ammonia produced in the GI tract. In addition, serum glucose levels decline because the liver isn't capable of releasing stored glucose. Elevated serum ammonia and subnormal serum glucose levels depress the level of a client's consciousness. Elevated liver enzymes, low serum protein level, subnormal clotting factors and platelet count, elevated blood urea nitrogen and creatine levels, and hyperglycemia aren't as directly related to the client's level of consciousness.

A client with dysphagia is being prepared for discharge. Which outcome indicates that the client is ready for discharge? a) The client is free from esophagitis and achalasia. b) The client doesn't exhibit rectal tenesmus. c) The client has normal gastric structures. d) The client reports diminished duodenal inflammation.

A) The client is free from esophagitis and achalasia Dysphagia may be the reason why a client with esophagitis or achalasia seeks treatment. Therefore, when the client is free of esophagitis or achalasia, he is ready for discharge. Dysphagia isn't associated with rectal tenesmus, duodenal inflammation, or abnormal gastric structures.

A client with dysphagia is being prepared for discharge. Which outcome indicates that the client is ready for discharge? a) The client is free from esophagitis and achalasia. b) The client reports diminished duodenal inflammation. c) The client has normal gastric structures. d) The client doesn't exhibit rectal tenesmus.

A) The client is free from esophagitis and achalasia. Dysphagia may be the reason why a client with esophagitis or achalasia seeks treatment. Therefore, when the client is free of esophagitis or achalasia, he is ready for discharge. Dysphagia isn't associated with rectal tenesmus, duodenal inflammation, or abnormal gastric structures.

Which outcome indicates effective client teaching to prevent constipation? a) The client reports engaging in a regular exercise regimen. b) The client limits water intake to three glasses per day. c) The client verbalizes consumption of low-fiber foods. d) The client maintains a sedentary lifestyle.

A) The client reports engaging in a regular exercise regimen. The client having a regular exercise program indicates effective teaching. A regular exercise regimen promotes peristalsis and contributes to regular bowel elimination patterns. A low-fiber diet, a sedentary lifestyle, and limited water intake would predispose the client to constipation.

To prevent gastroesophageal reflux in a client with hiatal hernia, the nurse should provide which discharge instruction? a) "Lie down after meals to promote digestion." b) "Avoid coffee and alcoholic beverages." c) "Limit fluid intake with meals." d) "Take antacids with meals."

B) Avoid coffee and alcoholic beverages To prevent reflux of stomach acid into the esophagus, the nurse should advise the client to avoid foods and beverages that increase stomach acid, such as coffee and alcohol. The nurse also should teach the client to avoid lying down after meals, which can aggravate reflux, and to take antacids after eating. The client need not limit fluid intake with meals as long as the fluids aren't gastric irritants.

A patient scheduled to undergo an abdominal ultrasonography is advised to do which of the following? a) Do not undertake any strenuous exercise for 24 hours before the test b) Restrict eating of solid food for 6 to 8 hours before the test. c) Avoid exposure to sunlight for at least 6 to 8 hours before the test d) Do not consume anything sweet for 24 hours before the test

B) Avoid eating of solid food for 6 to 8 hours before the test. For a patient who is scheduled to undergo an abdominal ultrasonography, the patient should restrict herself from solid food for 6 to 8 hours to avoid having images of her test obscured with gas and intestinal contents. Ultrasonography records the reflection of sound waves. Strenuous exercises, the consumption of sweets, and exposure to sunlight do not affect the results of the test in any way.

The nurse is assessing a client with a bleeding gastric ulcer. When examining the client's stool, which of the following characteristics would the nurse be most likely to find? a) Green color and texture b) Black and tarry appearance c) Clay-like quality d) Bright red blood in stool

B) Black and tarry appearance Black and tarry stools (melena) are a sign of bleeding in the upper gastrointestinal (GI) tract. As the blood moves through the GI system, digestive enzymes turn red blood to black. Bright red blood in the stool is a sign of lower GI bleeding. Green color and texture is a distractor for this question. Clay-like stools are a characteristic of biliary disorders

A client with inflammatory bowel disease undergoes an ileostomy. On the first day after surgery, the nurse notes that the client's stoma appears dusky. How should the nurse interpret this finding? a) The ostomy bag should be adjusted. b) Blood supply to the stoma has been interrupted. c) An intestinal obstruction has occurred. d) This is a normal finding 1 day after surgery.

B) Blood supply to the stoma has been interrupted. An ileostomy stoma forms as the ileum is brought through the abdominal wall to the surface skin, creating an artificial opening for waste elimination. The stoma should appear cherry red, indicating adequate arterial perfusion. A dusky stoma suggests decreased perfusion. The nurse should interpret this finding as an indication that the stoma's blood supply is interuppted, which may lead to tissue damage or necrosis. A dusky stoma isn't a normal finding 1 day after surgery. Adjusting the ostomy bag wouldn't affect stoma color, which depends on blood supply to the area. An intestinal obstruction also wouldn't change stoma color.

A nurse is caring for a client who underwent a subtotal gastrectomy. To manage dumping syndrome, the nurse should advise the client to: a) restrict fluid intake to 1 qt (1,000 ml)/day. b) drink liquids only between meals. c) don't drink liquids 2 hours before meals. d) drink liquids only with meals.

B) Drink liquids only between meals. A client who experiences dumping syndrome after a subtotal gastrectomy should be advised to ingest liquids between meals rather than with meals. Taking fluids between meals allows for adequate hydration, reduces the amount of bulk ingested with meals, and aids in the prevention of rapid gastric emptying. There is no need to restrict the amount of fluids, just the time when the client drinks fluids. Drinking liquids with meals increases the risk of dumping syndrome by increasing the amount of bulk and stimulating rapid gastric emptying. Small amounts of water are allowable before meals.

A nurse is applying an ostomy appliance to the ileostomy of a client with ulcerative colitis. Which action is appropriate? a) Maintaining wrinkles in the faceplate so it doesn't irritate the skin b) Gently washing the area surrounding the stoma using a facecloth and mild soap c) Scrubbing fecal material from the skin surrounding the stoma d) Cutting the faceplate opening no more than 2? larger than the stoma

B) Gently washing the area surrounding the stoma using a facecloth and mild soap For a client with an ostomy, maintaining skin integrity is a priority. The nurse should gently wash the area surrounding the stoma using a facecloth and mild soap. Scrubbing the area around the stoma can damage the skin and cause bleeding. The faceplate opening should be no more than 1/8? to 1/6? larger than the stoma. This size protects the skin from exposure to irritating fecal material. The nurse can create an adequate seal and prevent leakage of fecal material from under the faceplate by applying a thin layer of skin barrier and smoothing out wrinkles in the faceplate. Eliminating wrinkles in the faceplate also protects the skin surrounding the stoma from pressure.

A nurse is caring for a client newly diagnosed with hepatitis A. Which statement by the client indicates the need for further teaching? a) "I'll wash my hands often." b) "How did this happen? I've been faithful my entire marriage." c) "I'll take all my medications as ordered." d) "I'll be very careful when preparing food for my family."

B) How did this happen? I've been faithful my entire marriage The client requires further teaching if he suggests that he acquired the virus through sexual contact. Hepatitis A is transmitted by the oral-fecal route or through ingested food or liquid that's contaminated with the virus. Hepatitis A is rarely transmitted through sexual contact. Clients with hepatitis A need to take every effort to avoid spreading the virus to other members of their family with precautions such as preparing food carefully, washing hands often, and taking medications as ordered.

A nurse is caring for a client with active upper GI bleeding. What is the appropriate diet for this client during the first 24 hours after admission? a) Skim milk b) Nothing by mouth c) Regular diet d) Clear liquids

B) NPO Shock and bleeding must be controlled before oral intake, so the client should receive nothing by mouth. When the bleeding is controlled, the diet is gradually increased, starting with ice chips and then clear liquids. Skim milk shouldn't be given because it increases gastric acid production, which could prolong bleeding. A clear liquid diet is the first diet offered after bleeding and shock are controlled.

A client with a disorder of the oral cavity cannot tolerate tooth brushing or flossing. Which of the following strategies can the nurse employ to assist this client? a) Regularly wipe the outside of the client's mouth to prevent germs from entering. b) Provide the client with an irrigating solution of baking soda and warm water. c) Recommend that the client drink a small glass of alcohol at the end of the day to kill germs. d) Urge the client to regularly rinse the mouth with tap water.

B) Provide the client with an irrigating solution of baking soda and warm water If a client cannot tolerate brushing or flossing, an irrigating solution of 1 tsp of baking soda to 8 oz of warm water, half strength hydrogen peroxide, or normal saline solution is recommended.

When a central venous catheter dressing becomes moist or loose, what should a nurse do first? a) Notify the physician. b) Remove the dressing, clean the site, and apply a new dressing. c) Remove the catheter, check for catheter integrity, and send the tip for culture. d) Draw a circle around the moist spot and note the date and time.

B) Remove dressing, clean the site, and apply a new dressing. A nurse maintaining a central venous catheter should change the dressing every 72 hours or when it becomes soiled, moist, or loose. After removing the soiled dressing, the nurse should use sterile technique to clean around the site in accordance with facility policy. After the cleaning solution has dried, the nurse should cover the site with a transparent semipermeable dressing. A nurse who notes drainage on a wound dressing should draw a circle around the moist spot and note the date and time. She should notify the physician if she observes any catheter-related complications. Only a nurse with the appropriate qualifications may remove a central venous catheter, and a moist or loose dressing isn't a reason to remove the catheter.

A nurse is providing postprocedure instructions for a client who had an esophagogastroduodenoscopy. The nurse should perform which action? a) Tell the client to call back in the morning so she can give him instructions over the phone. b) Review the instructions with the person accompanying the client home. c) Tell the client there aren't specific instructions for after the procedure. d) Give instructions to the client immediately before discharge.

B) Review the instructions with the person accompanying the client home A client who undergoes esophagogastroduodenoscopy receives sedation during the procedure, and his memory becomes impaired. Clients tend not to remember instructions provided after the procedure. The nurse's best course of action is to give the instructions to the person who is accompanying the client home. It isn't appropriate for the nurse to tell the client to call back in the morning for instructions. The client needs to be aware at discharge of potential complications and signs and symptoms to report to the physician.

A client receives a local anesthetic to suppress the gag reflex for a diagnostic procedure of the upper GI tract. Which of the following nursing interventions is advised for this patient? a) The client should be monitored for any breathing related disorder or discomforts b) The client should not be given any food and fluids until the gag reflex returns c) The client should be monitored for cramping or abdominal distention d) The client's fluid output should be measured for at least 24 hours after the procedure

B) The client should not be given any food and fluids until the gag reflex returns. For a client receiving a local anesthetic that suppresses the gag reflex, the nurse is advised to withhold food and fluids until the reflex returns.

A nurse is teaching an elderly client about good bowel habits. Which statement by the client indicates to the nurse that additional teaching is required? a) "I need to drink 2 to 3 liters of fluids every day." b) "I should exercise four times per week." c) "I need to use laxatives regularly to prevent constipation." d) "I should eat a fiber-rich diet with raw, leafy vegetables, unpeeled fruit, and whole grain bread."

C) "I need to use laxatives regularly to prevent constipation." The client requires more teaching if he states that he'll use laxatives regularly to prevent constipation. The nurse should teach this client to gradually eliminate the use of laxatives because using laxatives to promote regular bowel movements may have the opposite effect. A high-fiber diet, ample amounts of fluids, and regular exercise promote good bowel health.

A longitudinal tear or ulceration in the lining of the anal canal is termed a (an) a) hemorrhoid. b) anorectal abscess. c) anal fissure. d) anal fistula.

C) Anal fissure Fissures are usually caused by the trauma of passing a large, firm stool or from persistent tightening of the anal canal secondary to stress or anxiety (leading to constipation). An anorectal abscess is an infection in the pararectal spaces. An anal fistula is a tiny, tubular, fibrous tract that extends into the anal canal from an opening located beside the anus. A hemorrhoid is a dilated portion of vein in the anal canal.

The nurse is preparing to measure the client's abdominal girth as part of the physical examination. At which location would the nurse most likely measure? a) At the lower border of the liver b) In the right upper quadrant c) At the umbilicus d) Just below the last rib

C) At the umbilicus Measurement of abdominal girth is done at the widest point, which is usually the umbilicus. The right upper quadrant, lower border of the liver, or just below the last rib would be inappropriate sites for abdominal girth measurement.

Which of the following terms is used to refer to intestinal rumbling? a) Diverticulitis b) Tenesmus c) Borborygmus d) Azotorrhea

C) Borborygmus Borborygmus is the intestinal rumbling that accompanies diarrhea. Tenesmus is the term used to refer to ineffectual straining at stool. Azotorrhea is the term used to refer to excess of nitrogenous matter in the feces or urine. Diverticulitis refers to inflammation of a diverticulum from obstruction (by fecal matter) resulting in abscess formation.

A nurse is caring for a client who had gastric bypass surgery 2 days ago. Which assessment finding requires immediate intervention? a) The client states he has been passing gas. b) The client states he is nauseated. c) The client's right lower leg is red and swollen. d) The client complains of pain at the surgical site.

C) Client's right lower leg is red and swollen A red, swollen extremity is a possible sign of a thromboembolism, a common complication after gastric surgery because of the fact that the clients are obese and tend to ambulate less than other surgical clients. The nurse should inform the physician of the finding. Pain at the surgical site should be investigated, but the red, swollen leg is a higher priority. It isn't unusual for a client to be nauseated after gastric bypass surgery. The nurse should follow up with the finding, but only after she has notified the physician about the possible thromboembolism. Passing gas is normal and a sign that the client's intestinal system is beginning to mobilize.

A client is scheduled for an esophagogastroduodenoscopy (EGD) to detect lesions in the gastrointestinal tract. The nurse would observe for which of the following while assessing the client during the procedure? a) Signs of perforation b) Gag reflex c) Client's tolerance for pain and discomfort d) Client's ability to retain the barium

C) Client's tolerance for pain and discomfort The nurse has to assess the client's tolerance for pain and discomfort during the procedure. The nurse should assess the signs of perforation and the gag reflex after the procedure of EGD and not during the procedure. Assessing the client's level for retaining barium is important for a diagnostic test that involves the use of barium. EGD does not involve the use of barium.

A client is scheduled for several diagnostic tests to evaluate her gastrointestinal function. After teaching the client about these tests, the nurse determines that the client has understood the teaching when she identifies which test as not requiring the use of a contrast medium? a) Computer tomography b) Small bowel series c) Colonoscopy d) Upper GI series

C) Colonoscopy A colonoscopy is a direct visual examination of the entire large intestine. It does not involve the use of a contrast agent. Contrast medium may be used with a small bowel series, computed tomography, and upper GI series.

A client with a gastrojejunostomy is beginning to take solid food. Which finding would lead the nurse to suspect that the client is experiencing dumping syndrome? a) Slowed heart beat b) Hyperglycemia c) Diarrhea d) Dry skin

C) Diarrhea Clients with a gastrojejunostomy are at risk for developing the dumping syndrome when they begin to take solid food. This syndrome produces weakness, dizziness, sweating, palpitations, abdominal cramps, and diarrhea, which result from the rapid emptying (dumping) of large amounts of hypertonic chyme (a liquid mass of partly digested food) into the jejunum. This concentrated solution in the gut draws fluid from the circulating blood into the intestine, causing hypovolemia. The drop in blood pressure can produce syncope. As the syndrome progresses, the sudden appearance of carbohydrates in the jejunum stimulates the pancreas to secrete excessive amounts of insulin, which in turn causes hypoglycemia.

A client is scheduled for magnetic resonance imaging (MRI). During the client teaching, the nurse will discuss which of the following? a) "The examination will take only 15 minutes." b) "You must be NPO for the day before the examination." c) "Do you experience any claustrophobia?" d) "You must remove all jewelry but can wear your wedding ring."

C) Do you experience any claustrophobia? MRI is a noninvasive technique that uses magnetic fields and radio waves to produce images of the area being studied. Clients must be NPO for 6 to 8 hours before the study and remove all jewelry and other metals. The examination takes 60 to 90 minutes and can induce feelings of claustrophobia, because the scanner is close fitting.

Which of the following would be the least important assessment in a patient diagnosed with ascites? a) Measurement of abdominal girth b) Palpation of abdomen for a fluid shift c) Foul-smelling breath d) Weight

C) Foul smelling breath Foul-smelling breath would not be considered an important assessment for this patient. Measurement of abdominal girth, weight, and palpation of the abdomen for a fluid shift are all important assessment parameters for the patient diagnosed with ascites.

A nurse is preparing a presentation for a local community group about hepatitis. Which of the following would the nurse include? a) Hepatitis B is transmitted primarily by the oral-fecal route. b) Hepatitis A is frequently spread by sexual contact. c) Hepatitis C increases a person's risk for liver cancer. d) Infection with hepatitis G is similar to hepatitis A.

C) Hep C increases a person's risk for liver cancer Infection with hepatitis C increases the risk of a person developing hepatic (liver) cancer. Hepatitis A is transmitted primarily by the oral-fecal route; hepatitis B is frequently spread by sexual contact and infected blood. Hepatitis E is similar to hepatitis A whereas hepatitis G is similar to hepatitis C.

Which of the following is a protrusion of the intestine through a weakened area in the abdominal wall? a) Tumor b) Adhesion c) Hernia d) Volvulus

C) Hernia A hernia is a protrusion of intestine through a weakened area in the abdominal muscle or wall. A tumor that extends into the intestinal lumen, or a tumor outside the intestine causes pressure on the wall of the intestine. Volvulus occurs when the bowel twists and turns on itself. An adhesion occurs when loops of intestine become adherent to areas that heal slowly or scar after abdominal surgery.

Crohn's disease is a condition of malabsorption caused by which of the following pathophysiological processes? a) Gastric resection b) Infectious disease c) Inflammation of all layers of intestinal mucosa d) Disaccharidase deficiency

C) Inflammation of all layers of intestinal mucosa Crohn's disease is also known as regional enteritis and can occur anywhere along the GI tract, but most commonly at the distal ileum and in the colon. Infectious disease causes problems such as small bowel bacterial overgrowth leading to malabsorption. Disaccharidase deficiency leads to lactose intolerance. Postoperative malabsorption occurs after gastric or intestinal resection.

The nurse asks a client to point to where she feels pain. The client asks why this is important. The nurse's best response would be which of the following? a) "This determines the pain medication to be ordered." b) "If the doctor massages over the exact painful area, the pain will disappear." c) "Often the area of pain is referred from another area." d) "The area may determine the severity of the pain."

C) Often the area of pain is referred from another area Pain can be a major symptom of disease. The location and distribution of pain can be referred from a different area. If a client points to an area of pain and has other symptoms associated with a certain disease, this is valuable information for treatment.

Which of the following represents the medication classification of a proton (gastric acid) pump inhibitor? a) Famotidine (Pepcid) b) Metronidazole (Flagyl) c) Omeprazole (Prilosec) d) Sucralfate (Carafate)

C) Omeprazole Omeprazole decreases gastric acid by slowing the hydrogen-potassium adenosine triphosphatase pump on the surface of the parietal cells. Sucralfate is a cytoprotective drug. Famotidine is a histamine-2 receptor antagonist. Metronidazole is an antibiotic, specifically an amebicide.

The nurse is caring for a client with cirrhosis. Which assessment findings indicate that the client has deficient vitamin K absorption caused by this hepatic disease? a) Dyspnea and fatigue b) Ascites and orthopnea c) Purpura and petechiae d) Gynecomastia and testicular atrophy

C) Purpura and petechiae A hepatic disorder, such as cirrhosis, may disrupt the liver's normal use of vitamin K to produce prothrombin (a clotting factor). Consequently, the nurse should monitor the client for signs of bleeding, including purpura and petechiae. Dyspnea and fatigue suggest anemia. Ascites and orthopnea are unrelated to vitamin K absorption. Gynecomastia and testicular atrophy result from decreased estrogen metabolism by the diseased liver.

A group of students are studying for an examination on the gastrointestinal (GI) system and are reviewing the structures of the esophagus and stomach. The students demonstrate understanding of the material when they identify which of the following as the opening between the stomach and duodenum? a) Hypoharyngeal sphincter b) Cardiac sphincter c) Pyloric sphincter d) Ileocecal valve

C) Pyloric Sphincter The pyloric sphincter is the opening between the stomach and duodenum. The cardiac sphincter is the opening between the esophagus and the stomach. The hypopharyngeal sphincter or upper esophageal sphincter prevents food or fluids from re-entering the pharynx. The ileocecal valve is located at the distal end of the small intestine and regulates flow of intestinal contents into the large intestine.

A nurse is teaching a client with malabsorption syndrome about the disorder and its treatment. The client asks which part of the GI tract absorbs food. The nurse tells the client that products of digestion are absorbed mainly in the: a) rectum. b) stomach. c) small intestine. d) large intestine.

C) Small intestine The small intestine absorbs products of digestion, completes food digestion, and secretes hormones that help control the secretion of bile, pancreatic juice, and intestinal secretions. The stomach stores, mixes, and liquefies the food bolus into chyme and controls food passage into the duodenum; it doesn't absorb products of digestion. Although the large intestine completes the absorption of water, chloride, and sodium, it plays no part in absorbing food. The rectum is the portion of the large intestine that forms and expels feces from the body; its functions don't include absorption.

After teaching a group of students about the various organs of the upper gastrointestinal tract and possible disorders, the instructor determines that the teaching was successful when the students identify which of the following structures as possibly being affected? a) Large intestine b) Ileum c) Stomach d) Liver

C) Stomach The upper gastrointestinal (GI) tract begins at the mouth and ends at the jejunum. Therefore, the stomach would be a component of the upper GI tract. The lower GI tract begins at the ileum and ends at the anus. The liver is considered an accessory structure.

A client has noticed increased incidence of constipation since he broke his ankle and cannot complete his daily three-mile walk. As his home care nurse, you complete your assessment and discuss the potential causes. During your client education session, what do you explain as the mechanical cause of his constipation? a) No known cause b) Ingesting excessive fiber c) Stool remaining in the large intestine too long. d) Drinking excessive water

C) Stool remaining in the large intestine too long Whenever stool remains stationary in the large intestine, moisture continues to be absorbed from the residue. Consequently, retention of stool, for any number of reasons, causes stool to become dry and hard.

A patient who has undergone colostomy surgery is experiencing constipation. Which of the following interventions should a nurse consider for such a patient? a) Instruct the patient to keep a record of food intake b) Instruct the patient to avoid prune or apple juice c) Suggest fluid intake of at least 2 L per day d) Assist the patient regarding the correct diet or to minimize food intake

C) Suggest fluid intake of at least 2 L per day For constipation the nurse should suggest a fluid intake of at least 2L per day. The nurse should also offer prune or apple juice because they promote elimination. The nurse should encourage the patient to eat regular meals. Dieting or fasting can decrease stool volume and slow elimination. The nurse should instruct the patient to keep a record of food intake in case of diarrhea because this helps identify specific foods that irritate the GI tract.

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? a) Imbalanced nutrition: Less than body requirements related to biliary inflammation b) Anxiety related to unknown outcome of hospitalization c) Deficient knowledge related to prevention of disease recurrence d) Acute pain related to biliary spasms

D) Acute pain related to biliary spasms The chief symptom of cholecystitis is abdominal pain or biliary colic. Typically, the pain is so severe that the client is restless and changes positions frequently to find relief. Therefore, the nursing diagnosis of Acute pain related to biliary spasms takes highest priority. Until the acute pain is relieved, the client can't learn about prevention, may continue to experience anxiety, and can't address nutritional concerns.

A nurse is teaching a group of middle-aged men about peptic ulcers. When discussing risk factors for peptic ulcers, the nurse should mention: a) alcohol abuse and a history of acute renal failure. b) a history of hemorrhoids and smoking. c) a sedentary lifestyle and smoking. d) alcohol abuse and smoking.

D) Alcochol abuse and smoking The nurse should mention that risk factors for peptic (gastric and duodenal) ulcers include alcohol abuse, smoking, and stress. A sedentary lifestyle and a history of hemorrhoids aren't risk factors for peptic ulcers. Chronic renal failure, not acute renal failure, is associated with duodenal ulcers.

What kind of feeding should be administered to a client who is at the risk of diarrhea due to hypertonic feeding solutions? a) Bolus feeding b) Intermittent feeding c) Cyclic feeding d) Continuous feedings

D) Continuous feedings. Continuous feedings should be administered to a client who is at the risk of diarrhea due to hypertonic feeding solutions.

What are medium-length nasoenteric tubes are used for? a) Aspiration b) Emptying c) Decompression d) Feeding

D) Feeding Placement of the tube must be verified prior to any feeding. A gastric sump and nasoenteric tube are used for gastrointestinal decompression. Nasoenteric tubes are used for feeding. Gastric sump tubes are used to decompress the stomach and keep it empty.

Which of the following is the major carbohydrate that tissue cells use as fuel? a) Proteins b) Fats c) Chyme d) Glucose

D) Glucose Glucose is the major carbohydrate that tissue cells use as fuel. Proteins are a source of energy after they are broken down into amino acids and peptides. Chyme stays in the small intestine for 3 to 6 hours, allowing for continued breakdown and absorption of nutrients. Ingested fats become monoglycerides and fatty acids by the process of emulsification.

Which type of jaundice seen in adults is the result of increased destruction of red blood cells? a) Obstructive b) Nonobstructive c) Hepatocellular d) Hemolytic

D) Hemolytic Hemolytic jaundice results because, although the liver is functioning normally, it cannot excrete the bilirubin as quickly as it is formed. Obstructive jaundice is the result of liver disease. Nonobstructive jaundice occurs with hepatitis. Hepatocellular jaundice is the result of liver disease.

Crohn's disease is a condition of malabsorption caused by which of the following pathophysiological processes? a) Infectious disease b) Gastric resection c) Disaccharidase deficiency d) Inflammation of all layers of intestinal mucosa

D) Inflammation of all layers of intestinal mucosa Crohn's disease is also known as regional enteritis and can occur anywhere along the GI tract, but most commonly at the distal ileum and in the colon. Infectious disease causes problems such as small bowel bacterial overgrowth leading to malabsorption. Disaccharidase deficiency leads to lactose intolerance. Postoperative malabsorption occurs after gastric or intestinal resection.

A client is diagnosed with megaloblastic anemia caused by vitamin B12 deficiency. The physician begins the client on cyanocobalamin (Betalin-12), 100 mcg I.M. daily. Which substance influences vitamin B12 absorption? a) Hydrochloric acid b) Histamine c) Liver enzyme d) Intrinsic factor

D) Intrinsic factor Vitamin B12 absorption depends on intrinsic factor, which is secreted by parietal cells in the stomach. The vitamin binds with intrinsic factor and is absorbed in the ileum. Hydrochloric acid, histamine, and liver enzymes don't influence vitamin B12 absorption.

A nurse is caring for a client who is undergoing a diagnostic workup for a suspected GI problem. The client reports gnawing epigastric pain following meals and heartburn. The nurse suspects the client has: a) diverticulitis. b) peptic ulcer disease. c) appendicitis. d) ulcerative colitis.

D) Peptic Ulcer Disease Peptic ulcer disease is characterized by dull, gnawing pain in the midepigastrium or the back that worsens with eating. Ulcerative colitis is characterized by exacerbations and remissions of severe bloody diarrhea. Appendicitis is characterized by epigastric or umbilical pain along with nausea, vomiting, and low-grade fever. Pain caused by diverticulitis is in the left lower quadrant and has a moderate onset. It's accompanied by nausea, vomiting, fever, and chills.

Which client requires immediate nursing intervention? The client who: a) complains of epigastric pain after eating. b) complains of anorexia and periumbilical pain. c) presents with ribbonlike stools. d) presents with a rigid, boardlike abdomen.

D) Presents with a rigid, boardlike abdomen A rigid, boardlike abdomen is a sign of peritonitis, a possibly life-threatening condition. Epigastric pain occurring 90 minutes to 3 hours after eating indicates a duodenal ulcer. Anorexia and periumbilical pain are characteristic of appendicitis. Risk of rupture is minimal within the first 24 hours, but increases significantly after 48 hours. A client with a large-bowel obstruction may have ribbonlike stools.

A client is admitted with a diagnosis of acute appendicitis. When assessing the abdomen, the nurse would expect to find rebound tenderness at which location? a) Left lower quadrant b) Left upper quadrant c) Right upper quadrant d) Right lower quadrant

D) Right lower quadrant The pain of acute appendicitis localizes in the right lower quadrant (RLQ) at McBurney's point, an area midway between the umbilicus and the right iliac crest. Often, the pain is worse when manual pressure near the region is suddenly released, a condition called rebound tenderness.

The patient is on a continuous tube feeding. The tube placement should be checked every a) 24 hours. b) 12 hours. c) hour. d) shift.

D) Shift Each nurse caring for the patient is responsible for verifying that the tube is located in the proper area for continuous feeding. Checking for placement each hour is unnecessary unless the patient is extremely restless or there is basis for rechecking the tube based on other patient activities. Checking for placement every 12 or 24 hours does not meet the standard of care due the patient receiving continuous tube feedings.

After teaching a group of students about the various organs of the upper gastrointestinal tract and possible disorders, the instructor determines that the teaching was successful when the students identify which of the following structures as possibly being affected? a) Ileum b) Liver c) Large intestine d) Stomach

D) Stomach The upper gastrointestinal (GI) tract begins at the mouth and ends at the jejunum. Therefore, the stomach would be a component of the upper GI tract. The lower GI tract begins at the ileum and ends at the anus. The liver is considered an accessory structure.

A client with acute liver failure exhibits confusion, a declining level of consciousness, and slowed respirations. The nurse finds him very difficult to arouse. The diagnostic information which best explains the client's behavior is: a) elevated liver enzymes and low serum protein level. b) subnormal clotting factors and platelet count. c) elevated blood urea nitrogen and creatinine levels and hyperglycemia. d) subnormal serum glucose and elevated serum ammonia levels.

D) Subnormal serum glucose and elevated serum ammonia levels. In acute liver failure, serum ammonia levels increase because the liver can't adequately detoxify the ammonia produced in the GI tract. In addition, serum glucose levels decline because the liver isn't capable of releasing stored glucose. Elevated serum ammonia and subnormal serum glucose levels depress the level of a client's consciousness. Elevated liver enzymes, low serum protein level, subnormal clotting factors and platelet count, elevated blood urea nitrogen and creatine levels, and hyperglycemia aren't as directly related to the client's level of consciousness.

Why should total parental nutrition (TPN) be used cautiously in clients with pancreatitis? a) Such clients can digest high-fat foods. b) Such clients are at risk for hepatic encephalopathy. c) Such clients are at risk for gallbladder contraction. d) Such clients cannot tolerate high-glucose concentration.

D) Such clients cannot tolerate high glucose concentration Total parental nutrition (TPN) is used carefully in clients with pancreatitis because some clients cannot tolerate a high-glucose concentration even with insulin coverage. Intake of coffee increases the risk for gallbladder contraction, whereas intake of high protein increases risk for hepatic encephalopathy in clients with cirrhosis. Patients with pancreatitis should not be given high-fat foods because they are difficult to digest.

Blood shed in sufficient quantities into the upper GI tract, produces which color of stool? a) Bright red b) Milky white c) Green d) Tarry-black

D) Tarry-black Blood shed in sufficient quantities into the upper GI tract produces a tarry-black stool. Blood entering the lower portion of the GI tract or passing rapidly through it will appear bright or dark red. A milky white stool is indicative "of" a patient who received barium. A green stool is indicative of a patient who has eaten spinach.

The most significant complication related to continuous tube feedings is a) an interruption in fat metabolism and lipoprotein synthesis. b) a disturbance in the sequence of intestinal and hepatic metabolism. c) the interruption of GI integrity, d) the potential for aspiration,

D) The potential for aspiration Because the normal swallowing mechanism is bypassed, consideration of the danger of aspiration must be foremost in the mind of the nurse caring for the patient receiving continuous tube feedings. Tube feedings preserve GI integrity by intraluminal delivery of nutrients. Tube feedings preserve the normal sequence of intestinal and hepatic metabolism. Tube feedings maintain fat metabolism and lipoprotein synthesis.

Why are antacids administered regularly, rather than as needed, in peptic ulcer disease? a) To increase pepsin activity b) To maintain a regular bowel pattern c) To promote client compliance d) To keep gastric pH at 3.0 to 3.5

D) To keep gastric pH at 3.0 to 3.5 To maintain a gastric pH of 3.0 to 3.5 throughout each 24-hour period, regular (not as needed) doses of an antacid are needed to treat peptic ulcer disease. Frequent administration of an antacid tends to decrease client compliance rather than promote it. Antacids don't regulate bowel patterns, and they decrease pepsin activity.

A nurse is providing care for a client recovering from gastric bypass surgery. During assessment, the client exhibits pallor, perspiration, palpitations, headache, and feelings of warmth, dizziness, and drowsiness. The client reports eating 90 minutes ago. The nurse suspects: a) Peritonitis b) A normal reaction to surgery c) Dehiscence of the surgical wound d) Vasomotor symptoms associated with dumping syndrome

D) Vasomotor symptoms associated with dumping syndrome Early manifestations of dumping syndrome occur 15 to 30 minutes after eating. Signs and symptoms include vertigo, tachycardia, syncope, sweating, pallor, palpitations, diarrhea, nausea, and the desire to lie down. Dehiscence of the surgical wound is characterized by pain and a pulling or popping feeling at the surgical site. Peritonitis presents with a rigid, boardlike abdomen, tenderness, and fever. The client's signs and symptoms aren't a normal reaction to surgery.

A client with cholelithiasis has a gallstone lodged in the common bile duct. When assessing this client, the nurse expects to note: a) black, tarry stools. b) circumoral pallor. c) light amber urine. d) yellow sclerae.

D) Yellow sclerae Yellow sclerae are an early sign of jaundice, which occurs when the common bile duct is obstructed. Urine normally is light amber. Circumoral pallor and black, tarry stools don't occur in common bile duct obstruction; they are signs of hypoxia and GI bleeding, respectively.