Elsevier Emergency Nursing: GI Emergencies

Which statement by a patient with diverticulitis indicates the need for further discharge instructions? A. "I'll drink plenty of fluids." B. "I'll take my antibiotics as prescribed." C. "I'll eat a low-fiber diet." D. "I'll return to the hospital if I develop fever, chills, nausea, or vomiting."

A low-fiber diet causes low-bulk stools, which contribute to diverticulitis. After the infection has resolved, the patient should consume a high-fiber diet.

For a patient with gastroesophageal variceal bleeding, you should expect the physician to order which medication? A. Vasopressin (Pitressin) B. Pantoprazole (Protonix) C. Glucagon (GlucaGen) D. Sucralfate (Carafate)

A vasoconstrictor, such as vasopressin (Pitressin) or octreotide (Sandostatin), is used to treat variceal bleeding.

For a patient with acute pancreatitis, which intervention is the priority? A. Administration of a histamine2 (H2)-receptor antagonist B. Antibiotic administration C. Fluid resuscitation D. Administration of an opioid analgesic

Although a patient with acute pancreatitis may require all of these interventions, the priority is to establish intravenous (IV) access for fluid and electrolyte replacement with normal saline solution. Administration of an H2-receptor antagonist, such as cimetidine (Tagamet) or ranitidine (Zantac), decreases hydrochloric acid by inhibiting histamine (hydrochloric acid stimulates pancreatic activity). Antibiotic administration usually is limited to patients with some necrosis of the pancreas because they have a higher risk of infection. After securing the airway, breathing, and circulation for a patient with pancreatitis, the nurse should manage pain, usually by administering an IV opioid analgesic, such as hydromorphone (Dilaudid).

In a patient with significant upper gastrointestinal bleeding, which laboratory test result is increased? A. Platelet count B. Red blood cell (RBC) count C. Hematocrit D. Blood urea nitrogen (BUN)/creatinine level

Anticipate an elevated BUN/creatinine ratio in a patient with upper gastrointestinal bleeding because of decreased renal perfusion. An increased BUN level suggests dehydration. Bleeding with blood breakdown in the gut may contribute to the increased BUN level.

Which condition causes upper gastrointestinal bleeding? A. Portal hypertension B. Diverticulitis C. Cholecystitis D. Peptic ulcer disease

Causes of upper gastrointestinal bleeding include peptic ulcer disease, severe or prolonged retching and vomiting (as in bulimia), Mallory-Weiss syndrome, and drug-induced erosions, such as with the use of aspirin and nonsteroidal anti-inflammatory drugs.

In a patient with cholecystitis, which laboratory test result is elevated? A. Serum bilirubin level B. Serum amylase level C. Blood urea nitrogen (BUN) level D. Triglyceride levels

Cholecystitis causes an elevated serum bilirubin level.

A patient with gastroesophageal reflux disease is at risk for which complication? A. Perforation B. Pseudocyst C. Pneumonia D. Abscess

Complications of gastroesophageal reflux disease include recurrent pneumonia, sleep apnea, loss of dental enamel, nocturnal choking, chronic halitosis, and recurrent ear, nose, and throat infections.

During the abdominal assessment, which action should be performed? A. Obtain an electrocardiogram tracing. B. Insert a nasogastric tube C. Obtain plain abdominal radiographs. D. Observe the patient's position.

During the abdominal assessment, the nurse should note the patient's position because patients assume positions of comfort.

Fatty, foul-smelling, frothy stools suggest which disorder? A. Pancreatitis B. Biliary tract obstruction C. Bowel obstruction D. Upper gastrointestinal bleeding

Fatty, foul-smelling, frothy stools occur in pancreatitis.

A patient with upper gastrointestinal bleeding usually presents with which sign or symptom? A. Hematemesis B. Hematochezia C. Crampy, abdominal pain D. Abdominal pain that radiates to the back

Hematemesis (vomiting of blood or coffee ground-like material) confirms upper gastrointestinal bleeding.

Which disorders commonly cause lower gastrointestinal bleeding in young adults? A. Diverticulitis and angiodysplasia B. Hemorrhoids and inflammatory bowel disease C. Anal fissures and angiodysplasia D. Colon cancer and inflammatory bowel disease

Hemorrhoids, anal fissures, and inflammatory bowel disease are common causes of lower gastrointestinal bleeding in younger patients

Which condition can cause acute pancreatitis? A. Pregnancy B. Chronic hypercalcemia C. Diabetes mellitus D. Chronic hepatitis

In addition to gallstone disease and alcoholism, causes of acute pancreatitis include chronic hypercalcemia, autoimmune disorders, malignant strictures that obstruct the pancreatic duct, abdominal trauma, infections (such mumps or cytomegalovirus infection), drugs (such as antimetabolites), and toxins (such as organophosphate insecticides or scorpion venom).

Which disorder can cause bronchospasm? A. Gastroesophageal varices B. Peptic ulcer disease C. Gastroesophageal reflux disease D. Acute pancreatitis

In addition to regurgitation, heartburn, chest pain, and dysphagia, patients with gastroesophageal reflux disease may report bronchospasm (caused by acid reflux), a sensation of a lump in the throat that is not relieved with swallowing or coughing, nausea, a chronic cough, or laryngitis

Which finding commonly occurs in patients with a bowel obstruction? A. Diarrhea B. Fever C. Intractable vomiting D. Black, tarry stools

Intractable vomiting or feces in emesis suggests a bowel obstruction.

Which disorder is most likely to result in an episode of rebleeding after the initial emergency management? A. Esophageal varices B. Peptic ulcer disease C. Diverticulitis D. Ileitis

More than 40 percent of patients with variceal bleeding rebleed within 48 to 72 hours.

Which disorder results from obstruction and distention of a lumen, causing decreased blood flow, ischemia, and bacterial invasion? A. Gastroesophageal varices B. Cholecystitis C. Pancreatitis D. Appendicitis

Obstruction of the appendiceal lumen may be the most common mechanism for the development of appendicitis.

Which medication is classified as a proton pump inhibitor? A. Metoclopramide (Reglan) B. Cimetidine (Tagamet) C. Omeprazole (Prilosec) D. Ranitidine (Zantac)

Omeprazole (Prilosec), lansoprazole (Prevacid), pantoprazole (Protonix), and rabeprazole (AcipHex) are all proton pump inhibitors and are used to reduce gastric acid production. Metoclopramide (Reglan) is classified as a dopamine antagonist and is used to increase lower esophageal sphincter pressure. Cimetidine (Tagamet) and ranitidine (Zantac) are histamine2 (H2)-receptor antagonists, which are antisecretory agents.

A patient presents to the emergency department with abdominal pain, coffee-ground emesis, and black, tarry stools. You should suspect the patient has which condition? A. Upper gastrointestinal bleeding B. Lower gastrointestinal bleeding C. Diverticulitis D. Cholecystitis

Patient with upper gastrointestinal bleeding exhibit abdominal pain, bright red blood or coffee-ground emesis, and black, tarry stools.

Which statement by a patient with acute gastroenteritis indicates an accurate understanding of discharge instructions? A. "I'll go home and eat a high-fiber diet." B. "I'll wash my hands frequently." C. "I'll ask my primary doctor to prescribe an antibiotic." D. "I'll drink at least four glasses of milk today."

Proper hand hygiene prevents the spread of gastroenteritis.

Which type of pain is a patient likely to describe as a sharp, localized pain? A. Neuropathic B. Somatic C. Visceral D. Referred

Somatic pain is produced by bacterial or chemical irritation of nerve fibers. The patient usually describes somatic pain as sharp and localized in one area.

In response to asking the patient what provokes the abdominal pain, which reply should you expect? A. "The pain is sharp and stabbing." B. "The pain usually starts after I eat fried food." C. "The pain starts in my right abdomen and goes through to my back." D. "The pain has been continuous for the last 5 hours."

The "P" stands for provocation, which is determined by asking if an action or movement increases or changes the pain.

For a patient with gastroesophageal reflux disease, the physician may order which medication to promote gastric emptying? A. Diazepam (Valium) B. Bethanechol (Urecholine) C. Nitroglycerin (Nitro-Bid) D. Hyoscyamine (Levsin)

The cholinergic medication bethanechol increases lower esophageal sphincter pressure and promotes gastric emptying.

Which symptom is typically experienced by patients with gastroesophageal reflux disease (GERD)? A. Abdominal cramping B. Bleeding tendency C. Rebound tenderness D. Regurgitation

Typical signs and symptoms of gastroesophageal reflux disease include regurgitation, heartburn, chest pain, and dysphagia