Exam 3 practice question Ch. 29, 30

Gently placing a cotton tamponade into the stoma opening after removing the appliance will prevent ileostomy contents from

getting on the skin and causing irritation

Once the patient is eating again, ileostomy drainage is usually emptied every 2 or 3 hours. The pouch should be emptied when it is

half full

Patients with ileostomies should avoid foods

high in fiber and dried fruits

complication of peritonitis. What patient comment suggests a return of peristalsis?

"I am sorry to pass gas while you are here." Reassure the patient that passing gas is a normal healthy sign that peristalsis and gastrointestinal (GI) function are returning to normal.

A patient with high levels of serum ammonia asks, "Why do I have to continue taking lactulose?" What is the best response?

"It reduces intestinal absorption of ammonia." Lactulose is used to induce diarrhea and prevent diffusion of ammonia out of the intestinal tract.

Symptoms of acute pancreatitis

-severe abdominal pain -nausea/vomiting -abdominal distention -Tachycardia -Fever

Patient complaining of constipation, abdominal pain, and mucous in her stool. Patient states "I have the same stomach problems my mom had when she was my age. It's always worse after I eat ice cream, so I try to avoid that. I only drink water because I'm on my feet all day. I'm a teacher, so my job can be very stressful at times. I've tried stool softeners and laxatives that help sometimes, but my stomach only feels better after I stool." The nurse suspects irritable bowel syndrome (IBS) due to the patient having which triggers

1. Family history 2. Female gender (affects females more than males) 3. Dairy sensitivity 4. Stressful lifestyle IBS may be triggered by a familial history. It affects females more than males, and it is related to food sensitivities, stress, and caffeine ingestion. The patient's use of laxatives does not appear to be a trigger for this disease because she is constipated.

If your patient is to undergo testing for gluten intolerance, they must eat wheat and gluten products for a minimum of

2 weeks

Food intolerance symptoms may not be evident for up to

4 days after the food is eaten

A nurse is caring for a patient who is postoperative after an ileostomy. Which order should the nurse question? 1. Strict intake and output recording for 8 hours 2. Clear liquid diet 3. IV fluids 125 mL/hr 4. Occlusive dressing over stoma

4. Occlusive dressing over stoma A dressing is never placed over an ileal stoma; drainage must be assessed because a decrease in output could signal a blockage, which could lead to a rupture.

Accurate recording of intake and output is especially important in the care of an ostomy patient. Total output of fecal material is calculated every

8 hours

During a home visit, a nurse provides verbal instructions to a patient with a possible blockage of an ostomy. What would be an appropriate instruction for the nurse to give?

A different body position, such as a knee-chest position, might move the blockage forward. Massage the area around the stoma, not the stoma itself. A warm bath might help. Patient would be switched to a liquid diet; a high-fiber diet could make the problem worse.

IBS Symptoms

Abdominal pain Constipation or Diarrhea Absence of detectible disease

Dicyclomine (Bentyl)

Anti-cholinergic drug used to treat symptoms of irritable bowel syndrome (IBS) by relieving spasms of the muscles.

Hepatitis B, C, and D are all transmitted by

Blood and objects contaminated by blood products

A nurse admits a 23-year-old patient with possible appendicitis. The nurse anticipates which sign(s) and/or symptom(s)? (Select all that apply.) 1. Increased red cell count 2. Abdominal tenderness 3. Anorexia and vomiting 4. Mild fever 5. Dark black stools

Correct Answers: 2, 3, 4 Tenderness, nausea, anorexia, and fever are part of the clinical picture for appendicitis. The white blood cell (not the red blood cell) count is likely to be high. Dark, black stool is more associated with GI bleeding than appendicitis.

Certolizumab pegol (Cimzia) to treat moderate to severe

Chronic disease with 50% success rate

Before being discharged to home, a patient with gallbladder disease is given instructions regarding the care of the drain and the T-tube. Which patient statements indicate successful teaching? (Select all that apply.) 1. "I must empty the bag at the same time each day." 2. "Loose-fitting clothes must be worn." 3. "I will have yellowish skin discoloration the rest of my life." 4. "Passing brown stools indicates return to normal function."

Correct Answers: 1, 2 ,4 Jaundice results as bile backs up into the liver and blood. The surgery and placement of the drain should resolve this problem. The other statements indicate that the patient has understood the instructions. Caring for the drain includes regular empty of the bag so that there is room for additional drainage. Loose-fitting clothes will prevent pressure on the drain site. Stool gets its brown color from bile. As the gastrointestinal system returns to normal function, stools should be brown in color.

Which instructions should be given to a patient regarding preventing the spread of hepatitis A? (Select all that apply.) 1. Bleach solutions must be used to clean the bathroom. 2. Somebody else should be doing the cooking right now. 3. No vaccination is available for hepatitis A. 4. Good hand hygiene prevents the likelihood of passing the virus.

Correct Answers: 1, 2, 4 Hepatitis A vaccination is available and recommended. The other statements indicate an understanding of the information (see the Home Care Considerations box, Preventing the Spread of Hepatitis Virus, for additional information).

A patient admitted with a bowel obstruction is complaining of severe pain, his abdominal girth has increased 4 inches in the past hour, and his blood pressure is now 80/50. List in priority order the actions of the nurse. 1. Assess breathing. 2. Notify the provider. 3. Position to support blood pressure. 4. Ensure IV patency.

Correct Answers: 1, 3, 4, 2 1. Increased abdominal pressure can impair the ability of the diaphragm to move and cause problems with breathing. 3. A head of bed flat position with legs elevated would be best for support of blood pressure. However, the patient may not breathe well with the HOB flat so a slight elevation may be necessary. 4. The nurse should anticipate the need for IV fluids and medications so a patient IV is essential. 2. The provider needs to be notified of the change in patient condition.

A patient with acute pancreatitis has a bluish discoloration around the umbilicus. What actions should the nurse take? (Place in priority order.) 1. Place head flat and feet elevated. 2. Notify provider. 3. Assess vital signs. 4. Verify patency of IV line.

Correct Answers: 3, 1, 4, 2 3. The nurse would check vital signs first to assess the severity of the bleeding. Bluish discoloration around the umbilicus for this patient suggests internal bleeding. 1. Placing the patient flat with feet elevated will support the blood pressure. 4. Patency of the IV is crucial in being able to replace fluids. 2. The provider needs to be notified.

Reducing inflammation during severe exacerbation of Crohns disease is the priority. This is accomplished by the administration of

Corticosteroids

Common symptoms of cancer of the pancreas?

Dark urine Jaundice Weight loss anorexia vomiting clay-colored stools epigastric pain clot formation

A patient has cirrhosis of the liver and ascites. The nurse should question which order? 1. Bed rest with bathroom privileges 2. Discontinue furosemide (Lasix) 80 mg 3. Give 2-g sodium diet 4. Fluid restriction 1500 mL/24 hr

Discontinue furosemide (Lasix) 80 mg Medical treatment includes administration of diuretics, bed rest, sodium, and fluid restriction

Pancreatitis (acute)

Disease in which the pancreas becomes inflamed. Pancreatic damage happens when the digestive enzymes are activated before they are released into the small intestine and begin attacking the pancreas.

57 year old man is admitted with a diagnosis of cirrhosis. The nurse is aware that he will most likely require what interventions

Diuretics Bleeding precautions Vegetable-based proteins Lactulose administration Because the liver produces clotting factors and is now dysfunctional, risk for bleeding exists. The liver cannot metabolize proteins, especially albumin, properly. This leads to edema and ascites and requires diuretics, preferably potassium wasting. Ammonia buildup is likely; lactulose binds with this toxic metabolic by-product and allows for its excretion through the GI tract. Patients with liver disorders are at high risk for fluid volume excess

Diverticular disease

Diverticulitis occurs when pouches in the wall of your colon become infected or inflamed

24 hours after the surgical insertion of a T-tube for a common bile duct obstruction. Stool that returns to normal (soft, formed, brown) indicates that bile is now entering the small intestines. What should the nurse do first ?

Document the assessment

Esophageal diverticula produce symptoms of

Dysphagia Regurgitation Nocturnal cough Halitosis

Esophageal varices

Enlarged and swollen veins that line the lower end of the esophagus. Result of portal congestion and hypertension. The congestion can lead to massive bleeding when the vein walls rupture from increased pressure or esophageal irritation.

The patient experiences nausea, vomiting, and severe abdominal pain and distention. Fever, chills, tachycardia, and pallor occur, and other symptoms of shock may emerge. Unless the condition is treated promptly and successfully, peritonitis can be

FATAL

Hepatitis E is transmitted by

Fecal-oral route Contaminated water or food

Hepatitis A is transmitted by

Fecal-oral route; poor sanitation and contaminated water shellfish Infected food

Which test will be used to predict the viral hepatitis response to therapy

GENOTYPE ASSAY can predict the patient's prognosis

Patients with IBS Inflammatory bowel disease should consume a diet that is high in protein and calories but low in fat and fiber. This includes

Grilled meat Mashed potatoes Strawberry gelatin

Western blot test is used to screen for

HIV human immunodeficiency virus

Primary symptoms of peritonitis

Severe abdominal pain Nausea and vomiting Abdominal distention

A nurse is caring for a patient who underwent radical pancreaticoduodenectomy. Which postoperative complication would be the most likely to occur and cause the greatest concern?

Hemorrhage is a possibility with any major abdominal surgery

Standard treatment for bowel ischemia

IV heparin

Late-stage cirrhosis is

Irreversible Lactulose is used to manage ammonia levels and hepatic encephalopathy, but it is not curative

Pain in the lower right side, halfway between the umbilicus and the crest of the ileum at McBurney point, is the best-known symptom of

appendicitis

Furosemide (Lasix)

Loop diuretic (water pill) that prevents your body from absorbing too much salt (SODIUM), allowing the salt to instead be passed in your urine

Health history data might indicate a predisposition to diverticular disease

Low-fiber diets and chronic constipation are high-risk factors History of passing scan, small stools (constipation)

One goal of nursing care for a patient during the acute phase of pancreatitis is reduction of pain. Which nursing interventions help alleviate pain? (Select all that apply.) 1. Reinforce use of the PCA pump. 2. Maintain IV fluids as ordered. 3. Provide a bland diet with additional fluids. 4. Administer dicyclomine (Bentyl). 5. Give pancreatic enzymes. 6. Place the patient in a supine position.

Reinforce use of the PCA pump Maintain IV fluids as ordered Administer dicyclomine (Bentyl) Correct Answers: 1, 2, 4 Encouraging use of pain medications, maintaining intravenous fluids, and administering antispasmodics will help alleviate the pain. Patient should not be given a bland diet but should remain NPO. Pancreatic enzymes are given once oral feeding has resumed. Patient is likely to be more comfortable in a knee-chest position.

Under no circumstances should laxatives be given when appendicitis is suspected because of the increased risk for

Rupture

Patient with an ostomy. A drug that is to be absorbed from the intestine, as for relief of vomiting (antiemetic suppository), should be inserted into

The distal colostomy stoma

A patient has a new colostomy. Which behavior is an early sign of acceptance in the change of body image?

The patient holds and examines a new appliance bag. One of the important goals—related to acceptance—is for the patient to perform self-care of the colostomy. Looking at the stoma and manipulating equipment are early signs of acceptance.

Why are patients with esophageal varies prone to hemorrhage?

They are no longer able to produce vitamin K

Inflammatory bowl disease (IBD) includes both

Ulcerative colitis (UC) and Chron disease (regional ileitis)

A nurse is caring for a 57-year-old patient with ascites resulting from liver disease. The nurse anticipates that the provider will use which therapeutic regimen to reduce portal hypertension?

Vascular shunting of the portal venous systems Transjugular intrahepatic portosystemic shunt (TIPS) may be used to decrease pressure between portal and hepatic veins in the liver.

Molecular assay detects

Viral nucleic acid

Thiamine is given to correct

Vitamin B1 deficiency

Suspect this disorder when an older adult complains of sudden abdominal pain with vomiting, has abdominal distention with a palpable mass, has increased bowel sounds on auscultation, and shows signs of dehydration.

Volvulus twisting of the intestines

How will a patient with ulcerative colitis eliminate stool from their body after a colectomy and a creation of an ileal reservoir?

With a catheter inserted into the reservoir Patients with ill reservoirs or Kick pouches are able to employ the reservoir via catheter and not wear a collection pouch

The purpose of having a patient with irritable bowel syndrome (IBS) keep a food diary is to identify foods that may cause bloating;

a diary will help establish a pattern of eating and of symptoms.

Patients with ileostomies should not take time-release capsules and enteric-coated tablets, as there is not enough time for

adequate absorption before the medication is expelled through the stoma

Common causes of acute pancreatitis

alcohol abuse Gallstones (High calcium)

HPV is associated with about 90% of

anal cancer in homosexual males

Enzyme immunoassay detects

antibodies to various types of hepatitis

Barium enema and colonoscopy should be avoided in acute cases of diverticulitis because of the risk of

bowel perforation

A slight temperature elevation (1° F), nausea and vomiting, and an increase in the white cell count also are

characteristic of appendicitis

Neomycin is occasionally given orally or by enema to decrease the

colonic bacteria

Fecal odor or material in the emesis suggests a

complete intestinal obstruction

Irrigation of the sigmoid colostomy gives the patient some

control over the time elimination occurs

Peppermint oil may provide some temporary relief of abdominal pain for patients with IBS; however, those with

gastroesophageal reflux disease (GERD) should avoid this alternative therapy because it can worsen heartburn

A chief concern for patients with chronic cholecystitis is infection and rupture of the gallbladder, leading to peritonitis that would be associated with

generalized abdominal pain and fever.

Diverticulitis of the intestine produces symptoms of

diarrhea or constipation, acute left lower abdominal pain, bloating, nausea, and vomiting. The condition may be complicated by intestinal obstruction or by peritonitis if the intestinal wall ruptures.

Ileal Reservoir/Kock pouch

diverts urine into a surgically created pouch or pocket that functions as a bladder. The stoma is continent and the client removes urine by regular self-catheterization

If your patient has ulcerative colitis, opioid medications or anticholinergic medications should be avoided if there is

fever, leukocytosis, or worsening symptoms because these medications will further reduce the tone of the colon

The symptoms of diarrhea and fever suggest the need for increased

fluid intake

peritonitis

inflammation of the peritoneum (membrane lining the abdominal cavity and surrounding the organs within it) Usually occurs when one of the organs it encloses ruptures or is perforated

We often assume that liver disorders are associated with jaundice; however, be aware that viral hepatitis without jaundice (anicteric hepatitis)

is two to three times more common than viral hepatitis with jaundice

For IBS, the nurse would ensure that the patient received a diet of

low-fat low-fiber high protein High caloric content Small frequent feedings are best. Lactose avoidance helps some patients.

Hepatitis B virus infection is 5 to 12 times more common among Asian Americans than the general U.S. population. It is the leading cause of liver disease and cancer among Asians. Because of the high number of people who are unaware of their infection, the virus is passed from

mother to child and within families

Patient with an ileoanal anastomosis retains control ver the anal sphincter and defecates

normally

Whatever the cause, malabsorption creates a

nutritional deficiency

A purple stoma may indicate

obstruction of blood flow to the stoma

Chewing gum postoperatively to decrease

postoperative ileus

Never use heat to relieve abdominal pain if appendicitis is suspected. Heat might bring enough blood and fluid to the appendix to cause it to

rupture and cause peritonitis

As soon as ostomy postoperative pain is well controlled, it is best if the patient can

talk with another person who has fully adjusted to her ostomy and is living a full and active life.

Dressings must be changed carefully because T-tubes are sutured in place, and if they are accidentally pulled out,

the patient must be returned to the operating room and the incision reopened to replace the tube.

infliximab (Remicade) IV to treat Crohns disease

with 80% success rate