Gastrointestinal Practice Question

A nurse is teaching dietary-modification strategies to a client who has been diagnosed with cirrhosis. Which of the following foods should the nurse recommend? a. grilled chicken b. potato soup c. fish sticks d. baked ham

a. grilled chicken The nurse should identify that a client who has cirrhosis requires protein to compensate for disease-related weight loss. Increasing protein intake from animal or plan sources will also provide the client with more energy.

A nurse is recommending dietary modifications for a client who has GERD. The nurse should suggest eliminating which of the following foods form the client's diet. a. oranges and tomatoes b. carrots and bananas c. potatoes and squash d. whole wheat and beans

a. oranges and tomatoes Symptoms of GERD worsen following the oral intake of substance that decrease lower esophageal stricture (LES) pressure. These include alcohol, caffeine, nicotine, chocolate, fatty foods, citrus fruits, tomatoes, ad peppermint.

A nurse is caring for a client who is scheduled to undergo a liver biopsy for a suspected malignancy. Which of the following laboratory findings should the nurse monitor prior to the procedure? a. Prothrombin Time b. Serum Lipase c. Bilirubin d. Calcium

a. prothrombin time A major complication following a liver biopsy is hemorrhage. Many clients who have liver disease have clotting defects and are at risk of bleeding. In addition to prothrombin time (PT), activated partial thromboplastin time (aPTT) and platelet count should be monitored. Liver dysfunction causes the production of blood clotting factors to be reduced, which leads to increased incidence of bruising, nosebleeds, bleeding from wounds, and gastrointestinal bleeding. This is due to a deficient absorption of vitamin K from the gastrointestinal tract caused by the inability of liver cells to sure vitamin K to make prothrombin.

A nurse is preparing a community education program about hepatitis B. Which of the following statements should the nurse include in the teaching? a. "A hepatitis B immunization is recommended for those who travel, especially military personnel." b. "A hepatitis B immunization is given to infants and children." c. " Hepatitis B is acquired by eating foods that are contaminated during handling." d. "Hepatitis B can be prevented by using good personal hygiene habits and proper sanitation."

b. "A hepatitis B immunization is give to infants and children." Hepatitis B immune globulin is given as part of the standard childhood immunizations. It can be administered as early as birth, especially in infants born to mothers that are negative for hepatitis B surface antigen (HBsAg). These infants should receive the second dose between 1 and 4 months of age.

A nurse is teaching a client with Barrett's esophagus who is scheduled to undergo an esophagogastroduodenoscopy (EGD). Which of the following statements should the nurse include in the teaching? a. "This procedure is performed to measure the presence of acid in your esophagus." b. "This procedure can determine how well the lower part of your esophagus works." c. "This procedure is performed while you are under general anesthesia." d. " This procedure can determine if you have colon cancer"

b. "This procedure can determine how well the lower part of your esophagus works." An EGD is useful in determining the function of the esophageal lining and the extent of inflammation, potential scarring, and strictures.

A nurse is assessing a client who is 12 hour postoperative following an open cholecystectomy. Which of the following findings should the nurse report to the provider? a. Hypoactive bowel sounds b. Indwelling urinary catheter output of 25 mL/hr c. Heart Rate of 96/min d. Serous drainage at the surgical incision site

b. Indwelling urinary catheter output of 25 mL/hr The nurse should report a urinary output of <30mL/hr to the provider, as this can indicate hypovolemia or renal complication

A nurse in a provider's office is assessing a client who has GERD. When documenting a client's history, the nurse should expect the client to report that symptoms worsen with which of the following actions. a. stair-climbing b. bending over c. sitting d. walking

b. bending over Gastroesophageal reflux symptoms are most evidence with activities that increase intraabdominal pressure (e.g. bending over, straining, lifting, and lying down).

A nurse is assessing a client who was admitted with a bowel obstruction. The client reports severe abdominal pain. Which of the following findings indicated that a possible bowel has occurred? a. elevated blood pressure b. bowel sounds increased in frequency and pitch c. rigid abdomen d. emesis of undigested food

c. Rigid abdomen Abdominal tenderness and rigidity indicate a bowel perforation. As fluid escapes into the peritoneal cavity, a reduction in circulating blood volume occurs, lowering blood pressure.

A nurse is caring for a client who has acute pancreatitis. Which of the following serum laboratory values should return to the expected reference range within 72 hr of treatment beginning? a. aldolase b. lipase c. amylase d. lactic dedyrogenase

c. amylase Pancreatitis is the most common diagnosis for marked elevations in serum amylase. Serum amylase begins to increase about 3 to 6 hours following the onset of acute pancreatitis. The amylase level peaks in 20 to 30 hours and returns to the expected reference range within 2 to 3 days

A nurse is caring for a client who has fulminant hepatic failure. Which of the following procedures should the nurse anticipate for the client? a. endoscopic sclerotherapy b. liver lobectomy c. liver transplant d. Transjugular intrahepatic portal-systemic shunt placement

c. liver transplant Fulminant hepatic failure, most often caused by viral hepatitis, is characterized by the development of the hepatic encephalopathy within weeks of the onset of disease in a client without prior evidence of hepatic dysfunction. Mortality remains high, even with treatment modalities such as blood or plasma exchanges, charcoal hemoperfusion, and corticosteroids. Consequently, liver transplantation ahs become the treatment of choice of these client.

A nurse is completing a history and physical assessment for a client who has chronic pancreatitis. Which of he following findings should the nurse identify as a likely cause of the client's condition? a. high-calorie diet b. prior gastrointestinal illnesses c. tobacco use d. alcohol use

d. alcohol use Alcohol consumption is a major cause of chronic pancreatitis in the US. Long-term alcohol use disorder produces hypersecretion of proteins in pancreatic secretions, which results in protein plugs and calculi within the pancreatic ducts. Alcohol also has a direct toxic effect on the cells of the pancreas. Damage to these cells is more likely to occur and to be more severe in clients who diets are poor in protein contact and either very high or very low in fat.

A nurse is teaching about secondary prevention actions for colorectal cancer for a health fair for adults in the community. Which of the following topics should the nurse include? a. smoking cessation b. benefits of a diet high in cruciferous vegetables c. new types of ostomy appliances d. importance of colonoscopy screening starting at age 50 years old

d. importance of colonoscopy screening starting at the age of 50 years old Screening examinations for colorectal cancer are secondary prevention (an action that promotes early detection of disease).

A nurse is teaching a client who has a colostomy about ways to reduce flatus and odor. Which of the following strategies should the nurse include? a. Eat crackers and yogurt regularly b. Chew minty gum throughout the day c. Drink orange juice every day d. put an aspirin in the pouch

a. eat crackers and yogurt regularly Crackers, Toast, and Yogurt can help reduce flatus, which contributes to odor.

A nurse in a provider's office is assessing a client who has GERD. The nurse should expect the client to report with of the following manifestations? (select all that apply). a. regurgitation b. nausea c. belching d. heartburn e. weight loss

a. regurgitation b. nausea c. belching d. heartburn Regurgitation and heartburn are primary manifestations of GERD. Nausea and belching are also common manifestations.

A nurse is obtaining a guaiac test from a client. This test performed to detect which of the following? a. fecal material in vomit b. blood in stool c. infestations of parasites d. microorganism in urine

b. blood in stool A guaiac test detects the presence of blood in the stool It is commonly used point-of-care test for fecal occult blood.

A nurse is providing teaching to the guardian of a child who has celiac disease. Which of the following foods should the nurse instruct the guardian to omit form the child's diet? a. cornflakes b. reduced-fat milk c. canned fruits d. wheat bread

d. wheat bread Clients who have celiac disease should eliminate as much gluten as possible from their diets. Wheat, rye, and barley contain gluten and should be eliminated from the diet of a child who has celiac disease.

A nurse is teaching a group of clients about the functions of the liver and gallbladder. Which of the following should the nurse include in the teaching as the purpose of bile? a. digesting fats b. producing chyme c. stimulating gastric aid secretion d. providing energy

a. digesting fats Bile is a product of the liver and aids in the digestion of fats.

A nurse is providing teaching to a client who has constipation. Which of the following instructions should the nurse include? a. Use bismuth subsalicylate regularly b. Consume a low-fiber diet c. Eat yogurt with live cultures d. Use Bisacodyl suppositories regularly

c. Eat yogurt with live cultures Yogurt with live bacterial cultures provides dietary probiotics that help maintain and promote bowel function.

A nurse is planning care for a client who has cholelithiasis. Which of the following interventions should the nurse include in the plan? a. restrict the client's fluid intake b. restrict the client's calcium intake c. decrease the client's fat intake d. decrease the client's potassium intake

c. decrease the client's fat intake The nurse should decrease the client's fat intake to reduce the occurrence of biliary colic

A nurse is caring for a child who had her spleen removed following a bicycle accident. The child's parent asks the nurse about the role of the spleen in the body. The nurse should explain that the spleen performs which of the following functions? a. Maintain fluid balance b. regulates calcium in the blood c. destroys old blood cells. d. produces prothrombin

c. destroys old blood cells The nurse should tell the parent that the spleen destroys old blood cells, filters antigens, and stores platelets. A client without a spleen has an increased risk of infection and sepsis due to a reduced immune function.

A nurse in the emergency department is caring for a client who has bleeding esophageal varices. The nurse should anticipate a prescription for which of the following medications a. famotidine b .esomeprazole c. vasopressin d. omeprazole

c. vasopressin vasopressin constricts the splanchnic bed and decreases portal pressure. Vasopressin also constricts the distal esophageal and proximal gastric veins, which reduces inflow into the portal system and is used to treat bleeding varices.

The nurse is caring for a client who is dehydrated and is receiving continuous tube feeding through a pump at 75 mL/hr. When the nurse assesses the client at 0800, which of the following findings requires intervention a. a full pitcher of water is sitting on the client's bedside table within the client's reach. b. the disposable feeding bag is from the previous day at 1000 and contains 200 mL of feeding. c. the client is lying on the right side with a visible dependent loop in the feeding tube. d. the head of the bed is elevated to 20 degrees

d. the head of the bed is elevated to 20 degrees The head of the bed should be elevated to at least 30 degrees (semi-fowler's position) while the tube feeding is administered. This position uses gravity to help the feeding move through the digestive system and lessens the possibility of regurgitation.

A nurse is caring for a client who has ulcerative colitis. The provider prescribes bed rest with bathroom privileges. When the client asks the nurse why he has to stay in bed, which of the following responses should the nurse provide? a. "you need to conserve energy at this time" b. "Lying quietly in bed helps slow down the activity in your intestines" c. "Staying in bed promotes the rest and comfort you need" d. "Staying in bed will help prevent injury and minimize your fall risk"

b. "Lying quietly in bed helps slow down the activity in your intestines' The greatest risk to the client is complications from severe diarrhea such as dehydration, electrolyte imbalances, and gastrointestinal bleeding and trauma. Activity restriction can help reduce intestinal peristalsis and diarrhea.

A nurse is providing discharge teaching to the partner of a client who has a new diagnosis of hepatitis A. Which of the following instructions should the nurse include in the teaching? a. "during this illness, she may take acetaminophen for fevers or discomfort" b. "encourage her to eat foods that are high in carbohydrates" c. " The provider will prescribe a medication to help her liver heal faster." d. " Have her perform moderate exercise to restore strength more quickly"

b. "encourage her to eat foods that are high in carbohydrates" The client's diet should be high in carbohydrates and calories with only moderate amounts of protein and fat, especially if nausea is present.

A nurse is caring for a client who is 3 days post-operative following abdominal surgery. The client states, "Something just popped when I coughed." Which of the following actions should the nurse take first? a. cover the client's wound with a sterile, moist dressing b. flex the client's knees c. reassure the client d. instruct the client to avoid coughing

a. cover the client's wound with a sterile, moist dressing The greatest risk to this client is an injury from infection due to wound exposure. Therefore, the first action the nurse should take is to cover the wound with a sterile, moist dressing.

A nurse is assessing a client who has a bleeding duodenal ulcer. Which of the following finds should the nurse expect? a. emesis with a coffee-ground appearance b. Increased blood pressure c. decreased heart rate d. bright green stools

a. emesis with a coffee-ground appearance The nurse should expect a client who has a bleeding duodenal ulcer to have emesis that resembles coffee-ground or is bright red in color. Hematemesis indicates upper gastrointestinal bleeding, occurring at or above the duodenojejunal junction.

The nurse is caring for a client with a history of cirrhosis who has been admitted with manifestations of hepatic encephalopathy. The nurse should anticipate a prescription from which of the following laboratory tests to determine the possibility of recent excessive alcohol use? a. gamma-glutamyl transferase b. alkaline phosphatase c. serum bilirubin d. alanine aminotransferase

a. gamma-glutamyl transferase The GGT laboratory test is specific to the hepatobiliary system in which levels can be raised by alcohol and hepatotoxic drugs. Therefore, it us useful for monitoring drug toxicity and excessive alcohol use.

A nurse is caring for a client who has acute diverticulitis. While the client has active inflammation, the nurse should instruct the client to include which of the following foods in her diet? a. White bread and plain yogurt b. Shredded wheat cereal and blueberries c. broccoli and kidney beans d. Oatmeal and fresh pears

a. white bread and plain yogurt Because of the acute inflammation of diverticulitis, the client should maintain a diet very low in fiber. The client can consume low-fiber foods, like white bread, low-fat milk, yogurt with active cultures, poached eggs, and canned soft fruit.

A nurse is presenting an in-service training session about nutrition. How many of the amino acids must be obtained from dietary intake? a. 6 b. 9 c. 11 d. 15

b. 9 Proteins are made up of chains of amino acids, which are composed of carbon hydrogen, oxygen, and nitrogen. Nine amino acids are considered essential for the human body and must be obtained from diet. These include histidine, isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan, and valine

A nurse is providing dietary teaching to a client who has ulcerative colitis. Which of the following food selections by the client indicates and understanding of the teaching? a. Raw vegetables salad with low-fat dressing b. Roast chicken and white rice c. Fresh fruit salad and milk d. Peanut butter on whole wheat bread

b. Roast chicken and white rice Clients who have ulcerative colitis are restricted to a low-fiber diet, which omits whole grains and raw fruits and vegetables. Roast chicken with white rice is the best choice.

A nurse is assessing a client who is in the early stages of hepatitis A. Which of the following manifestations should the nurse expect? a. jaundice b. anorexia c. dark urine d. pale feces

b. anorexia Anorexia is an early manifestation of hepatitis A and is often severe. It is thought to result from the release of a toxin by the damaged liver or by the failure of the damaged liver cells to detoxify an abnormal product.

A nurse is demonstrating colostomy care to a client who has a new colostomy. Which of the following actions should the nurse teach the client to preform? a. use antimicrobial ointment on the peristomal skin b. empty the bag when it is one-third to one-half full c. cut the skin barrier opening a little larger than the ostomy d. wash the peristomal skin with mild soap and water e. apply the skin barrier while the skin is slightly moist.

b. empty the bag when it is one-third to one-half full c. cut the skin barrier opening a little larger than the ostomy d. wash the peristomal skin with mild soap and water Allowing the bag to become too full can cause leakage. The client should cut the opening that is about 1/16 to 1/8 larger than the stoma to avoid applying any constriction pressure to the stoma. The client should avoid moisturizing soaps because lubricants can affect adhesion of the appliance.

A nurse is caring for a client who has a percutaneous endoscopic gastrostomy (PEG) tube and is receiving intermittent feedings. Prior to initiating the feeding, which of the following actions should the nurse take first? a. flush the tube with water b. place the client in the semi-fowler's position c. cleanse the skin around the tube site d. aspirate the tube for residual contents

b. place the client in semi-fowler's position The nurse should apply the ABC priority-setting framework, which emphasizes the basic core of human functioning: having an open airway, being able to breathe in adequate amounts of oxygen, and circulating oxygen to the body's orangs via the blood. An alteration in any of these areas can indicate a threat to life and is the nurse's priority concern. When applying the ABC priority-setting framework, airway is always the highest priority because the airway must be clear for oxygen exchange to occur. Breathing is the second priority because adequate ventilatory effort is essential for oxygen exchange to occur. Circulation is the third priority because the delivery of oxygen to critical organs only occurs if the heart and blood vessels are capable of efficiently carrying oxygen to them. A client who is receiving PEG tube feeding should be positioned with the head of the bed elevated at least 30 degree during and after feedings to decrease the risk of aspiration. Therefore, this is the priority action by the nurse.

A nurse is caring for a client who is scheduled to undergo an esophagogastroduodenoscopy (EGD). The nurse should identify that this procedure is for which of the following reasons? a. to visualize polyps in the colon b. to detect an ulceration in the stomach c.to identify an obstruction in the biliary tract d. to determine the presence of free air in the abdomen

b. to detect an ulceration in the stomach An EGD is used to visualize the esophagus, stomach, and duodenum with a lighted tube to detect a tumor, ulceration, or obstruction.

A nurse is providing teaching about nutrients to a client. Which of the following statements should the nurse include? a. "carbohydrates transport nutrients throughout the body" b. "fats prevent ketosis" c. "protein builds and repairs body tissue" d. "carbohydrates help regulate body temperature"

c. "protein builds and repairs body tissue" The primary function of protein involves building and repairing body tissue (e.g. muscles, tendons, and collagen). The skin, hair, and nails are also made of protein structures. A diet that is low in protein can impair wound healing.

A nurse is planning discharge teaching for a client who is postoperative following a traditional open cholecystectomy. Which of the following learning needs of the client is the nurse's priority? a. Dietary recommendations b. Incision care c. Coughing and deep-breathing exercises d. pain management

c. Coughing and deep-breathing exercises The greatest risk to the client is respiratory compromise. Therefore, learning how to perform coughing and deep-breathing exercises to promote lungs expansion and secretion removal is the priority.

A nurse is caring for a client from the Middle East who has celiac disease. Which of the following actions should the nurse perform regarding the client's diet? a. Provide foods prepared according to kosher dietary law b. Ask the kitchen to prepare grifts to meet the client's dietary need for grains c. determine the client's dietary preferences d. Prepare a diet tray that includes vegetables and barley soup

c. Determine the client's dietary preferences While generalizations are often made regarding the traditional eating practices of clients based on their cultural backgrounds, individual food choices can deviate from these generalizations. The nurses should assess the client's dietary habits before planning to meet dietary needs.

A nurse is providing teaching to a client who is scheduled for a sigmoid colon resection with colostomy. Which of the following statements by the client indicates a need for further teaching? a. "because most of my colon is still intact and functioning, my stool will be formed" b. "my stoma will appear large at first, but will shrink over the next several weeks" c. "my colostomy will begin to function in 2 to 6 days after surgery" d. "I will have to consume a soft diet after surgery"

d. "I will have to consume a soft diet after surgery" The nurse should identify that this statement requires further teaching. After surgery, the client quickly returns to a regular diet, and there are no food restrictions unless the client chooses to decrease the intake of foods that increase gas or odor.

A nurse is providing poster operative teaching about the management of dumping syndrome to a client who has a partial gastrectomy. Which of the following instructions should the nurse include in the teaching? a. "Consume at least 4oz of fluid with meals." b. "take a short walk after each meal" c. "use honey to flavor foods such as cereal" d. "eat protein with each meal."

d. "eat protein with each meal." The nurse should instruct the client to eat meals that are high in protein and fat with low to moderate carbohydrate content. Protein should be included in every meal because it delays digestion, which helps reduce the manifestation of dumping syndrome.

A nurse is caring for a client who has gastrointestinal bleeding. The provider suspects a bleeding lesion in the colon. The initial approach to treatment likely will involve which of the following procedures? a. exploratory laparotomy b. double-contrast barium enema c. magnetic resonance imaging d. coloscopy

d. A colonoscopy A coloscopy requires that insertion of a flexible scope into the rectum. The provider advances the scope carefully until it enters eh colon. IT can provider direct visualization of the inside of the colon and helps the provider identify the exact cause and location of bleeding

A nurse is care for a client who has diverticulitis and a new prescription for a low-fiber diet. Which of the following food items should the nurse remove from the client's meal tray? a. Canned fruit b. White bread c. Broiled hamburger d. Coleslaw

d. Coleslaw Coleslaw contains raw cabbage, which is high in fiber. Clients who are following a low-fiber diet should avoid most raw vegetables.

A nurse is teaching a client who has cirrhosis of the liver and a history of alcohol consumptions. The nurse should explain that alcohol can cause liver cirrhosis through which of the following actions? a. increasing the workload of the liver by releasing stored glycogen b. causing ulceration of liver tissue that can lead to bleeding c. dilating veins in the portal circulation d. destroying liver cells that are later replaced with scare tissue

d. destroying liver cells that are later replaced with scar tissue The development of cirrhosis in a client who consumes alcohol is related to liver inflammation and cell destruction. Over time, nonfunctional scar tissue and fibrosis replace the necrotic liver cells.

A nurse is caring for a client who is receiving total parenteral nutrition (TPN) and has just returned to the room following physical therapy. The nurse notes that the infusion pump for the client's TPN is turned off. After restarting the infusion pump, the nurse should monitor the client for which of the following findings? a. hypertension b. excessive thirst c. fever d. diaphoresis

d. diaphoresis The nurse should recognize that the client has the potential to develop hypoglycemia due to the sudden withdrawal of the TPN solution. In addition to diaphoresis, other potential manifestations of hypoglycemia can include weakness, anxiety, confusion, and hunger.

A nurse is updating the plan of care for a a client who has dumping syndrome. Which of the following instructions should the nurse include? a. Consume beverages with meals b. Eat 3 large meals per day c. include high-fiber foods in the diet d. eat a source of protein with each meal

d. eat a source of protein with each meal The nurse should include in the client's plan of care the instruction to eat a source of protein with each meal because protein delays gastric emptying.

A nurse is assessing a client who has a complete intestinal obstruction. Which of the following findings should the nurse expect? a. absence of bowel sounds in all 4 abdominal quadrants b. passage of blood-tinged liquid stool c. presence of flatus d. hyperactive bowel sounds above the obstruction

d. hyperactive bowel sounds above the obstruction The nurse should expect the client to have hyperactive bowel sounds above the obstruction because the intestinal peristalsis above the obstruction attempts to push the obstruction through the intestines, with a complete intentional obstruction, there are no bowel sounds below the obstruction

A nurse is monitoring the laboratory results of a client who has end-stage liver failure. Which of the following results should the nurse expect? a. decrease lactate dehydrogenase b. increase serum albumin c. decrease serum ammonia d. increased prothrombin time

d. increased prothrombin time Clients who has end-stage live failure have an inadequate supply of clotting factors and an increased (i.e. prolonged) prothrombin time.

A nurse is assisting a provider with performing a paracentesis on a client. Which of the following actions should the nurse take? a. Ask the client to empty his bladder before the procedure b. Place the client leaning forward over the bedside table for the procedure c. Inform the client he will be sedated during the procedure d. Instruct the client to fast for 6 hour prior to the procedure

a. Ask the client to empty his bladder before the procedure The nurse should ask the client to empty his bladder before the procedure to prevent injury to the bladder

A nurse is caring for a client who has an acute exacerbation of Crohn' s disease. Which of the following actions should the nurse take? a. Ensure bowel rest b. Offer sparkling water frequently c. Administer a stool softener d. Offer a plain warm tea frequently

a. Ensure bowel rest Clients who has an exacerbation of Crohn's disease usually require NPO status to ensure bowel rest and promote healing and recovery.

A nurse is providing dietary teaching to a client who has dumping syndrome following gastric bypass surgery 4 days ago. Which of the following recommendations should the nurse include in the teaching? a. avoid foods containing protein b. drink liquids during each meal c. eat foods that contain simple sugars d. maintain a supine position after meals

d. maintain a supine position after meals The nurse should instruct the client to lie supine after eating to help slow the rapid emptying of food into the small intestine. A client who has dumping syndrome should decrease the amount of food eaten at once, eat small meals more frequently, and eliminate fluids at mealtime. Fluid shifts occur in the upper gastrointestinal tract when food contents and simple sugars exit the stomach too rapidly, attracting fluid into the upper intestine and decreasing blood volume, which causes the client to experience nausea and vomiting, sweating, syncope, palpitations, increased heart rate, and hypotension.

A nurse is caring for a client who has celiac disease. Which of the following foods should the nurse remove form the client's meal tray? a. Wheat toast b. Tapioca pudding c. Hard-boiled egg d. Mash Potatoes

a. Wheat Toast Celiac disease is an autoimmune disorder characterized by a permanent intolerance to wheat, barley, and rye. Wheat toast contains gluten and should be removed form the client's tray.