GI Acute Tansitional
What does a low-residue, high protein diet with IV fluids and vitamins do for a UC patient? A. reduce gastric acidity B. reduce colonic irritation C. reduce intestinal absorption D. reduce bowel infection rate
reduce colonic irritation
What are some diagnostic test for cholecystitis?
- xrays - ultrasound - ERCP or MRCP
Which laboratory assessment findings will the nurse expect in a client who is diagnosed with ulcerative colitis? A. Increased albumin B. Decreased hemoglobin C. Increased sodium D. Decreased potassium E. Elevated white blood cell (WBC) count F. Elevated erythrocyte sedimentation rate
-Decreased hemoglobin -Decreased potassium -Elevated white blood cell (WBC) count -Elevated erythrocyte sedimentation rate
What should be included in an obstruction history?
-GI disorders, surgeries, treatments -pain -elimination habits
Laboratory assessments for UC?
-H&h -increased WBC, C reactive protein, ESR -low sodium, potassium, chloride -hypoalbuminemia (protein loss)
Diagnostic assessment for UC?
-MRE (magnetic resonance enterorrhaphy) -upper endoscopy -colonoscopy
Gastritis health promotion and maintenance?
-balanced diet -regular exercise -stress reduction techniques -limit foods and spices that cause gastric distress -avoid alcohol and tobacco
Nonsurgical management for GERD?
-balancing nutrition -lifestyle changes -drug therapy -endoscopic therapies
Pathophysiology of diverticular disease?
-can occur in any part of the small or large intestine -diverticula without inflammation usually cause few problems -abscess, peritonitis can develop
Surgical management for Cholecystitis?
-cholecystectomy open or laparoscopic
Etiology and Genetic risk of cholecystitis?
-excessive dietary cholesterol intake, sedentary lifestyle -American, Indian, and Mexican-American populations have the highest genetic risk
Assessment for IBS?
-fatigue, malaise -pain -changes in bowel patterns
Interventions for IBS?
-health teaching -drug therapy -stress reduction
Assessment of diverticular disease?
-may have no symptoms -may have abdominal pain, fever, tachycardia, nausea, vomiting -abdominal distention, tenderness
Which conditions or actions will the nurse expect to worsen the presence and symptoms of a client's hemorrhoids? Select all that apply. A. Pregnancy B. Straining with constipation C. Weight lifting D. Prolonged bedrest E. Strenuous exercise F. Obesity
-pregnancy -straining with constipation -weight lifting -strenuous exercise -obesity
What are obstructions more common in?
-pt who have had bowel surgery -pt with intestinal tumors -older adults
What worsen hemorrhoids?
-sitting a lot -babies -strenuous exercise -straining heavy weightlifting
Treatment of hemorrhoids?
-sitz bath -ice packs -topical anesthetic -wet cleaning cloths -dab not wipe -witch hazel
What should you avoid with hemorrhoids?
-spicy food -alcohol -nuts -caffeine
When can infection occur in peptic ulcer disease?
-when mucosal defenses become impaired, epithelium not protected from effects of acid and pepsin
The client asks the nurse to recommend foods that might be included in a diet for diverticular disease. Which foods would be correct to include in the teaching plan? Select all that apply. a. whole grains b. cooked fruits and vegetables c. nuts and seeds d. lean red meats e. milk and eggs
-whole grains -cooked fruits and vegetables -nuts and seeds -milk and eggs
A client diagnosed with hemorrhoids would present with which signs and symptoms? Select all that apply. A. flatulence B. anal itching C. blood in stool D. rectal bulging E. Pain when defecating
-anal itching -blood in stool -rectal bulging -pain when defecating
In collaboration with the registered dietitian nutritionist, which nutrients and substances will the nurse instruct a client with ulcerative colitis (UC) to avoid to reduce symptoms? Select all that apply. A. Eggs B. Corn C. Caffeine D. Vitamin C E. Dried fruits F. Carbohydrates G. Dairy products H. Pepper-based spices
-corn -caffeine -dried fruits -dairy products -pepper based spices
Key features of small bowel obstruction?
-abdominal discomfort or pain possibly accompanied by visible peristaltic waves in upper and middle abdomen -upper epigastric abdominal distention -nausea and early profuse vomit -obstipation -severe fluid and electrolyte imbalances -metabolic alkalosis
What are the three types of peptic ulcers?
-duodenal -gastric -stress ulcer
What are nonmechanical obstruction causes and genetic risk?
-handling of intestines during surgery function lost for few hours or several days consequence of peritonitis
Which simple, noninvasive tests will the nurse expect to be ordered to detect H. pylori in a client with PUD? Select all that apply. A. Serologic testing for antibodies B. Abdominal ultrasound C. Urea breath test D. Computerized tomography scan E. Stool antigen test F. Magnetic resonance imaging
A. Serologic testing for antibodies C. Urea breath test E. Stool antigen test
Which finding does the nurse understand is an early pathologic manifestation when a client is diagnosed with acute gastritis? A. Thickened, reddened mucous membrane with prominent rugae B. Patchy, diffuse inflammation C. H. pylori infection D. Thin, atrophied wall and lining of the stomach
A. Thickened, reddened mucous membrane with prominent rugae
What factors are associated with decreased lower esophagus sphincter pressure?
-caffeinated beverages -chocolate -nitrates -citrus fruits -tomato products -alcohol -peppermint
What are examples of viral gastroenteritis?
-epidemic viral (caused by many parvovirus type organisms) -Norovirus (Norwalk viruses)
The nurse is assessing a client with a diagnosis of hemorrhoids. Which factors in the clients history most likely played a role in the development of hemorrhoids? Select all that apply. a. constipation b. hypertension c. eating spicy foods d. bowel incontinence e. numerous pregnancies
-constipation -numerous pregnancies
Causes of nonbiliary PCS?
-coronary artery disease -intercostal neuritis -unexplained pain syndrome -psychiatric or neurologic disorder
What is the treatment for GERD?
-decreased fatty foods -decreased wine and alcohol -decreased spicy foods -decrease caffeine and chocolate -medications -surgery -lifestyle changes
Nonsurgical management for PUD?
-drug therapy -nutrition therapy -complementary and integrative therapies
What physical assessment/ signs or symptoms for GERD?
-dyspepsia -auscultate lungs for crackles
What should by in your physical assessment/ signs and symptoms for PUD?
-epigastric tenderness and pain -rigid, board like abdomen with rebound tenderness and pain= peritonitis
Which reported clinical manifestations would the nurse expect from a client with UC? Select all that apply. a.fever b. diarrhea c. gain in weight d. spitting up blood e. abdominal cramps
-fever -diarrhea -abdominal cramps
What are complications that could occur during a bowel obstruction?
-fluid and electrolytes -acid base imbalance -bowel perforation
Ulcerative colitis causes and genetic risk?
-genetic, immunologic, environmental factors -often found in families and twins -cellular changes can increase colon cancer risk
Which drugs will the nurse expect to administer to a client with PUD, caused by an H. pylori infection, who is prescribed PPI-triple therapy? A. A proton pump inhibitor, two antibiotics, and bismuth B. A proton pump inhibitor and two antibiotics C. An opioid drug, proton pump inhibitor, and an antibiotic D. An H2 histamine blocker, an antibiotic, and a proton pump inhibitor
B. A proton pump inhibitor and two antibiotics
When the nurse is teaching a client about bowel obstructions, which conditions will be described as mechanical bowel obstructions? Select all that Apply. A. Adhesions B. Paralytic ileus C. Tumors D. Functional obstruction E. Crohn disease F. Absent peristalsis
-adhesions -tumors -crohn disease
Which common signs and symptoms will the nurse expect to find on assessment of a 60-year-old client who has had gastroenteritis for the past 2 days? Select all that apply. A. Weight loss B. Elevated temperature C. Dry mucous membranes D. Hypotension E. Oliguria F. Poor skin turgor
-Weight loss -Elevated temperature -Dry mucous membranes -Hypotension -Oliguria -Poor skin turgor
Which assessment findings will the nurse expect to find when a client is experiencing early mechanical small bowel obstruction? Select all that apply. A. Absence of bowel sounds B. Abdominal distention C. Visible peristaltic waves D. High-pitched bowel sounds E. Abdominal rigidity F. Cramping
-abdominal distention -visible peristaltic -high pitched bowel sounds -cramping
Pathophysiology of Crohn's?
-chronic inflammatory disease of small intestine colon, or both -inflammation that causes a thickened bowel wall -complications include hemorrhage, severe malabsorption, malnourishment, debilitation, cancer (although rare)
What is fulminant UC?
>10 blood stools/day
What is moderate UC?
>4 stools/day without blood
What is the first line medication used to treat C. Difficile?
Metronidazole
A client with severe Crohn disease develops a small bowel obstruction. Which clinical finding would the nurse expect the client to report? A. bloody vomit B. projectile vomiting C. bleeding with defecation D. pain in the left lower quadrant
Projectile Vomiting
What is constipation?
a symptom not a disease, infrequent stool and or hard dry small stools that are difficult to eliminate
How long should a pt with GERD sit up after eating?
an hour
What is an incarcerated hernia?
bowel cannot return behind abdominal wall
Which information about malignant tumors of the colon would the nurse consider when providing care for a client with an obstruction of the colon? A. Detection of the malignant tumors is easy B. malignant tumors usually localize to one area C. women are more at risk than men D. colon obstructions are usually malignant
colon obstructions are usually malignant
Which condition will the nurse most likely suspect as the cause of a client's symptoms of obstipation and failure to pass flatus? A. Complete obstruction B. Partial obstruction C. Colorectal cancer D. Singultus
complete obstruction
Which autoantigens are responsible for the development of Crohn disease? a. crypt epithelial cells b. thyroid cell surface c. basement membranes of the lungs d. basement membranes of the glomeruli
crypt epithelial cells
What are hemmorrhoids?
dilated, engorged veins in the lining of the rectum
Assessment findings of a client who is admitted to the ED include cramping [ain in the left lower quadrant, weakness, bloating, malaise and a low grade fever. The nurse suspects which conditon? a. pancreatitis b. appendicitis c. cholecystitis d. diverticulitis
diverticulitis
where are duodenal ulcers?
in the duodenum
What is cholecystitis?
inflammation of the gallbladder
What is telescoping of the bowel?
intussusception usually seen in children
What is a 180 degree twisting of bowel?
volvulus
Which actions will the nurse teach a client with GERD to use to prevent harm? Select all that apply. A. Do not consume caffeinated or carbonated beverages. B. Avoid peppermint, chocolate, and fried foods. C. Eat slowly and chew food thoroughly. D. Consume four to six small meals each day. E. Do not eat for 3 hours before going to bed. F. Sleep on your side to prevent regurgitation.
A. Do not consume caffeinated or carbonated beverages. B. Avoid peppermint, chocolate, and fried foods. C. Eat slowly and chew food thoroughly. D. Consume four to six small meals each day. E. Do not eat for 3 hours before going to bed.
What are diverticula?
pouchlike herniations of the mucosa in the colon
where are gastric ulcers?
ulcer in the stomach
Which statement by a client with gastroenteritis due to infection with the norovirus indicates that the nurse's teaching about this illness has been successful? A. "I got this infection from being around my grandchildren when they had respiratory illnesses." B. "It is most likely that I got this infectious illness from either contaminated food or water." C. "I may have gotten sick when I was traveling last month to Florida." D. "It's really important that I don't go to restaurants
"It is most likely that I got this infectious illness from either contaminated food or water."
Which statement by a client to the nurse indicates correct understanding of the management of hemorrhoids after surgical removal? A. "It will take 10 to 14 days for the rubber band used on the hemorrhoid to fall off." B. "After surgery, I will need to consume a low-fiber, low-fluid diet." C. "My first bowel movement after the surgery may be very painful." D. "Stool softeners and laxatives are avoided after hemorrhoid surgery."
"My first bowel movement after the surgery may be very painful."
What is mild UC?
- < 4 stools/day with/ without blood
What labs are used for IBS?
-CBC -BMP -stool sample -parasites -sedimentation rate (inflammation)
Diagnostic assessment for obstruction?
-CT or MRI -abdominal ultrasound
Nonsurgical management for obstruction?
-NG tube -IV fluid replacement and maintenance
What should you include in your history assessment for PUD?
-assess for causes and risk factors -history of H. Pylori, GI surgeries -drugs being taken
A client with Crohn disease is admitted to the hospital with abdominal pain, fever, poor skin turgor and having experienced 10 liquid bowel movements in the past 24 hours. The nurse suspects that the client is dehydrated based on which assessment finding? Select all that apply. a. moist skin b. sunken eyes c. decreased apical pulses d. dry mucous membranes e. increased blood pressure
-sunken eyes -dry mucous membranes
Diagnostic assessment for PUD?
-testing for H. pylori -hemoglobin and hematocrit -occult blood in stool -EGD -Nuclear medicine scan
Parenteral vitamins are prescribed for the client with Crohn disease. The client asks why the vitamins have to be given IV rather than by mouth. Which rationales will the nurse provide. Select all that apply. a. they provide more rapid action results b. they decrease colon irritability c. oral vitamins are less effective d. intestinal absorption may be inadequate e. allergic responses are less likely to occur
-they provide more rapid action results -oral vitamins are less effective -intestinal absorption may be inadequate
Which risk factors will the nurse assess for when taking a history of a client suspected of having gastritis? Select all that apply. A. Use of alcohol B. Excessive caffeine intake C. Smoking cigarettes D. Life stressors E. Prescribed steroids F. Ingestion of corrosive substances
A. Use of alcohol B. Excessive caffeine intake C. Smoking cigarettes D. Life stressors E. Prescribed steroids F. Ingestion of corrosive substances
What is the most important assessment for the nurse to perform before administering the first dose of sulfasalazine to a client diagnosed with ulcerative colitis? A. Obtaining an accurate weight B. Asking whether he or she has an allergy to sulfa drugs C. Measuring heart and respiratory rate and blood pressure D. Determining the number of times the client has had a stool today
Asking whether he or she has an allergy to sulfa drugs
Which types of ulcers does the nurse teach client about when discussing peptic ulcer disease (PUD)? Select all that apply. A. Pressure ulcers B. Gastric ulcers C. Duodenal ulcers D. Stress ulcers E. Esophageal ulcers F. Colon ulcers
B. Gastric ulcers C. Duodenal ulcers D. Stress ulcers
Which priority teaching will the nurse provide to a client who is prescribed bismuth for peptic ulcer disease (PUD)? A. "Take this drug with an aspirin." B. "You may experience dyspepsia between doses." C. "Bismuth may cause your tongue and stool to appear black." D. "Be sure to take this drug before each meal and snack."
C. "Bismuth may cause your tongue and stool to appear black."
Which most accurate diagnostic test will the nurse expect to be ordered for a client to verify the diagnosis of GERD? A. Esophagogastroduodenoscopy (EGD) B. Esophageal manometry C. Ambulatory esophageal pH monitoring D. Motility testing
C. Ambulatory esophageal pH monitoring
For which client assessment finding will the nurse withhold the scheduled monthly dose of a prescribed parenteral biologic for management of ulcerative colitis (UC)? A. 5 lb (2.3 kg) weight gain B. Increased number of diarrhea stools per day C. Presence of occult blood in today's stool sample D. Cough and fever of 102°F (38.9°C)
Cough and fever of 102°F (38.9°C)
Which drug will the nurse be sure to question to prevent harm when prescribed for an older adult with gastroenteritis? A. Azithromycin B. Protective skin barrier cream C. Ciprofloxacin D. Diphenoxylate hydrochloride with atropine sulfate
Diphenoxylate hydrochloride with atropine sulfate
What is the gold standard diagnostic tool for gastritis?
EGD via endoscope with biopsy
What action does the nurse expect to occur after administering the drug linaclotide to a client with irritable bowel syndrome (IBS)? A. Control of symptoms of diarrhea B. Elimination of pain associated with bowel movement C. Reduction of anxiety and stress D. Increased fluid in the intestines to promote bowel elimination
Increased fluid in the intestines to promote bowel elimination
A client with severe diarrhea is prescribed IV fluids, sodium bicarbonate, and an antidiarrheal medication. Which antidiarrheal medication would the nurse anticipate administering? A. Psyllium B. Bisacodyl C. Loperamide D. Docusate Sodium
Loperamide
What is an order you would expect for a pt with abdominal distention, absent bowel sounds, and vomitus of dark green fluid? A. NG tube for decompression B. antiemetic for N/V C. IV lactated ringers fluid replacement D. stat electrolytes to asses for probable electrolyte imbalance
NG tube for decompression
An older client is admitted to the hospital for rehydration therapy after 3 days of diarrhea. In addition to sodium, which electrolyte would the nurse be most concerned about? A. Calcium B. Chlorides C. Potassium D. Phosphate
Potassium
Which nursing care action will the nurse assign to the assistive personnel (AP) when caring for a client with a bowel obstruction? A. Discussing surgical procedures with the client B. Checking the client's abdomen for distention C. Assessing the client's level of discomfort D. Providing mouth care every two hours as needed
Providing mouth care every two hours as needed
27. Which new-onset assessment finding in a client with Crohn disease (CD) indicates to the nurse the possibility of fistula development? A. Anorexia B. Pyuria with fever C. Smooth, beefy red tongue D. Decreased serum albumin
Pyuria with fever
The nurse is caring for a client with diarrhea. The nurse anticipates a decrease in which clinical indicator? A. Pulse rate B. tissue turgor C. specific gravity D. body temperature
Tissue Turgor
A client is experiencing chronic constipation, so the nurse discusses how to include more bulk in the diet. Which statement by the client indicates teaching by the nurse is successful? A. bulk promotes defecation by irritating the bowel wall B. bulk promotes defecation by stimulating the intestinal mucosa chemically C. bulk promotes defecation by acting on the microorganisms in the large intestine D. bulk promotes defecation by absorbing water, which softens stool and promotes peristalsis
bulk promotes defecation by absorbing water, which softens stool and promotes peristalsis
The nurse is performing a physical assessment of a client with UC. Which symptom is often associated with a serious complication of this disorder? a. decreased bowel sounds b. loose, blood tinged stools c. distention of the abdomen d. intense abdominal discomfort
decreased bowel sounds
Surgical management for obstruction?
exploratory laparotomy
A client reports vomiting and diarrhea for 3 days. Which clinical indicator is most commonly used to determine whether the client has a fluid deficit? A. Presence of dry skin B. loss of body weight C. decrease in blood pressure D. altered general appearance
loss of body weight
A client readmitted for exacerbation of UC is weak, thin, and irritable. The client states they would like an ileostomy . Which nursing intervention best meets the clients needs at this time? a. parenterally replace the clients fluids and electrolytes b. adjust clients diet to promote weight gain c. provide anticipatory teaching on the use of ileostomy appliances d. encourage client interaction with other clients who have an ileostomy
parenterally replace the clients fluids and electrolytes
The nurse is planning care for a client admitted to the hospital with abdominal spasms and pain associated with severe diarrhea. Which serum blood level would the nurse monitor? A. urea B. chloride C. potassium D. creatinine
potassium
Which serum laboratory value is most important for the nurse to monitor when caring for an older client with gastroenteritis who has an irregular heart rate and reports "feeling weak?" A. Albumin B. Sodium C. Potassium D. Leukocyte count
potassium
Whta is diverticulosis?
presence of many diverticula
What is diverticulitis?
the inflammation of a diverticulum that occurs when undigested food or bacteria become trapped in the diverticulum
The nurse obtains daily stool specimens for a client with chronic bowel inflammation. The nurse recognizes that the stool examinations were prescribed for which reason? a. to evaluate fat content b. to determine the presence of occult blood c. to determine the presence of ova and parasites d. to evaluate culture and sensitivity
to determine the presence of occult blood
Where are peptic ulcers?
ulcers in the stomach or duodenum
What is a reducible hernia?
you can push the bowel back behind the muscle wall
Etiology and genetic risk for PUD?
- H. PYLORI - NSAIDS - other substances that alter gastric secretions
A client is admitted via the emergency department with a tentative diagnosis of diverticulitis. The nurse anticipates that which test will be prescribed? a. CT scan b. gastroscopy c. colonoscopy d. barium enema
CT scan
What priority teaching will the nurse provide to prevent harm when a client with gastritis reports taking ibuprofen regularly for discomfort related to arthritis? A. "Do not take ibuprofen more than twice a day." B. "Ibuprofen can interfere with the action of the drugs you take for gastritis." C. "This drug is excellent for pain relief related to arthritis." D. "Avoid taking ibuprofen because it can cause gastritis."
D. "Avoid taking ibuprofen because it can cause gastritis."
From where does the nurse suspect a client with PUD is bleeding when massive coffee-ground emesis occurs? A. Colon B. Rectum C. Small intestine D. Upper GI system
D. Upper GI system
What is an inguinal hernia?
groin area hernia, gap in lower abdominal wall were testicles come in while a baby
What would a diet for a pt with diverticulosis look like? a. low fat b. high fiber c. high protein d. low carb
high fiber
A client with an NG tube is on continuous suction. Which clinical finding would the nurse expect if the client becomes dehydrated? A. restlessness B. constipation C. inelastic skin turgor D. increased BP
inelastic skin turgor
What is a grade one hemorrhoids?
no prolapse just prominent blood vessels
What is a mechanical obstruction?
something that is actually blocking (tumor, adhesions, telescoping, 180 degree twisting)
What are some anti-inflammatory medications for UC?
steroids might start pt on biologicals (immunological drugs)
What is a hiatal hernia?
stomach goes up through diaphragm
What is impaction?
results from unrelieved constipation a collection of hardened feces wedged in the rectum that a person cannot expel
What should be included in your physical assessment of an obstruction?
-obstipation (severe form of constipation person cannot go) -pain -distention
What is PCS?
-postcholecystectomy syndrome which can be biliary or nonbiliary
What should be included in your assessment of gastroenteritis?
-recent travel, eating at restaurants or elsewhere -encourage fluid replacement and oral rehydration therapy -antibiotics may be needed
How to treat chronic gastritis?
-treat based on causative agent -may require vitamin B12 -drug therapy to treat H. pylori
Interventions for acute gastritis?
-treated with supportive care -eliminate causative factor -drugs that block and buffer gastric acid secretions
Assessment of Crohn's?
-unintentional weight loss, stool characteristics, fever, abdominal pain -assess for distention, masses, visible peristalsis -anemia is common
What are conditions that favor development of gastric ulcers?
normal gastric acid secretion and delayed stomach emptying with increased diffusion of gastric acid back into stomach tissue
Signs and Symptoms of Cholecystitis?
-upper abdominal pain or pain radiating to right shoulder -pain triggered by high fat or high volume meal -anorexia -n/v -dyspepsia -flatulence -abdominal fullness feeling -rebound tenderness (blumberg sign) -fever -jaundice -clay colored stools or dark urine
What diagnostic assessment is used to diagnose GERD?
-upper endoscopy (EGD) -ambulatory esophageal pH monitoring
What is a nonmechanical obstruction?
nothing mechanical causing bowel not to work it's a neurological stunned for 24 hrs (bowel stunned by handling during surgery, paralytic ileus)
Assessment of history for UC?
nutrition and elimination history
What are the complications of ulcers?
-hemorrhage (most serious) -perforation -pyloric obstruction -intractable disease
Nonsurgical management for cholecystitis?
-managing acute pain (ESWL) -promoting nutrition
What are solutions to manage UC?
-managing diarrhea (antidiarrheal and fluids) -managing pain -preventing or monitoring for lower GI bleeding
Cues for chronic gastritis?
-may have few symptoms unless ulceration occurs -nausea, vomiting, upper abdominal discomfort
Physical assessment/ signs and symptoms of UC?
-may have low grade fever -usually finding are nonspecific
Pathophysiology of GERD?
-most common upper GI disorder in US -occurs as a result of backward flow of stomach contents into esophagus -hiatal hernias increase risk for GERD -during healing, barrett's epithelium and esophageal stricture are concerns
Which alternative or complementary therapies will the nurse teach a client that may be helpful in managing irritable bowel Syndrome (IBS)? Select all that apply. A. "Probiotics can help decrease bacteria and IBS symptoms." B. "Ginkgo can be used for abdominal discomfort and to expel gas." C. "Meditation may help decrease stress and help eliminate IBS symptoms." D. "Regular exercise will help decrease stress and lead to regular bowel movements." E. "Peppermint oil has been used to expel gas and relax spastic intestinal muscles." F. "Hydrotherapy may help decrease IBS symptoms."
-"Probiotics can help decrease bacteria and IBS symptoms." -"Meditation may help decrease stress and help eliminate IBS symptoms." -"Regular exercise will help decrease stress and lead to regular bowel movements." -"Peppermint oil has been used to expel gas and relax spastic intestinal muscles."
What are examples of bacterial gastroenteritis?
-campylobacter enteritis -Escherichia coli diarrhea -shigellosis
Which client with symptoms of chronic abdominal pain and frequent bowel movements will the nurse consider at highest risk for a diagnosis of ulcerative colitis (UC)? A. 26-year-old white woman of Jewish ancestry who has an identical twin sister with the disorder B. 40-year-old black man who has just returned home from a business trip to Southeast Asia C. 50-year-old Latino man with liver cirrhosis whose uncle died of colon cancer D. 65-year-old obese Asian woman who has chronic inflammatory cystitis
26-year-old white woman of Jewish ancestry who has an identical twin sister with the disorder
What is severe UC?
>6 bloody stools/day
Which lunch food selection made by a client with diverticulosis indicates to the nurse the correct understanding of the necessary dietary modifications for management of the problem? A. A turkey sandwich on whole wheat bread, steamed carrots, and a raw apple B. Roasted chicken, potato salad, and a glass of milk C. Chicken salad sandwich on white bread, creamed soup, and hot tea D. Fried shrimp, lettuce and tomato salad, and a dinner roll
A turkey sandwich on whole wheat bread, steamed carrots, and a raw apple
Which actions will the nurse teach a client with severe GERD that causes pain after each meal, lasts for at least 45 minutes, and worsens when he or she lies down? Select all that apply. A. "Drink fluids right away." B. "When you lie down, try lying on your side." C. "Take an antacid as prescribed by the health care provider." D. "Eat something bland such as a slice of white bread." E. "Maintain an upright position for at least an hour after you eat." F. "Try pressing over your abdomen to mobilize the food in your stomach."
A. "Drink fluids right away." C. "Take an antacid as prescribed by the health care provider." E. "Maintain an upright position for at least an hour after you eat."
When providing discharge teaching, for which symptoms will the nurse teach a client with peptic ulcer disease (PUD) to seek immediate medical attention? Select all that apply. A. Bloody or black stools B. Dyspepsia or reflux C. Bloody vomit or vomit that looks like coffee grounds D. Odynophagia with nausea E. Sharp, sudden, persistent, and severe epigastric or abdominal pain F. Loss of appetite with dysphagia
A. Bloody or black stools C. Bloody vomit or vomit that looks like coffee grounds E. Sharp, sudden, persistent, and severe epigastric or abdominal pain
What priority teaching points will the nurse include when instructing a client and family about how to prevent gastritis? Select all that apply. A. Eat a well-balanced diet and exercise regularly. B. Do not take large doses of aspirin, other NSAIDs (e.g., ibuprofen), and corticosteroids. C. Decrease the amount of smoking and/or use of other forms of tobacco. D. Manage stress levels using complementary and integrative therapies such as relaxation and meditation techniques. E. Use over-the-counter (OTC) proton pump inhibitors if you experience symptoms of esophageal reflux. F. Protect yourself against exposure to toxic substances in the workplace such as lead and nickel.
A. Eat a well-balanced diet and exercise regularly. B. Do not take large doses of aspirin, other NSAIDs (e.g., ibuprofen), and corticosteroids. D. Manage stress levels using complementary and integrative therapies such as relaxation and meditation techniques. F. Protect yourself against exposure to toxic substances in the workplace such as lead and nickel.
Which drug does the nurse expect to administer to a client in order to decrease hydrochloric acid secretion in the stomach? A. Famotidine B. Gaviscon C. Mylanta D. Antibiotic
A. Famotidine
What is a grade two hemorrhoids?
prolapse upon bearing down but spontaneous reduction
Which drugs will the nurse expect to give a client with acute gastritis that are antisecretory agents? Select all that apply. A. Famotidine B. Omeprazole C. Sucralfate D. Pantoprazole E. Nizatidine F. Calcium carbonate
B. Omeprazole D. Pantoprazole
Which complication does the nurse suspect when a client with PUD suddenly develops sharp epigastric pain that spreads over the entire abdomen? A. Gastric erosion B. Perforation C. Hemorrhage D. Gastric cancer
B. Perforation
Which condition or symptom does the nurse associate with a client who has chronic gastritis? A. Hematemesis B. Pernicious anemia C. Dyspepsia D. Epigastric burning
B. Pernicious anemia
What is a grade three hemorrhoids?
prolapse upon bearing down requiring manual reduction
What is a grade four hemorrhoids?
prolapse with inability to be manually reduced
Which diagnostic test does the nurse expect will be ordered for a client with suspected gastritis? A. Computed tomography (CT) scan B. Upper gastrointestinal (GI) series C. Esophagogastroduodenoscopy (EGD) D. Barium swallow
C. Esophagogastroduodenoscopy (EGD)
Which acid-base imbalance does the nurse expect when a client experiences a bowel obstruction high in the small intestine? A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic acidosis D. Metabolic alkalosis
metabolic alkalosis
The nurse is providing nutrition instructions for a client who has inflammatory bowel disease of the ascending colon. Which suggestion by the nurse is appropriate? A. consume scrambled eggs and applesauce B. consume bbq chicken and fries C. consume fruit and cheese D. consume chunky peanut butter on whole wheat bread
consume scrambles eggs and applesauce
What conditions favor the development of duodenal ulcers?
normal diffusion of acid back into stomach tissues with increased secretions of gastric acid and increased stomach emptying
While awaiting surgery a client with a history of Crohn disease is receiving TPN on an outpatient basis. The nurse teaches the client that TPN helps prepare for surgery by which process? a. decreasing fecal bulk b. preventing bowel infection c. providing stimulation of secretions d. maintaining negative nitrogen balance
decreasing fecal bulk
The nurse is caring for a client who is having diarrhea. Which data would the nurse closely monitor to prevent an adverse reaction? A. skin condition B. fluid and electrolytes C. food intake D. intake and output
fluid and electrolytes
A client with the diagnosis of Crohn disease tells the nurse, " my partner dates other people. I believe that behavior has caused an increase in my symptoms." Which is an appropriate initial nursing response? a. help the client explore personal attitudes b. educate the partner about the illness and events that affect the clients symptoms c. suggest the client should not date the partner to determine if symptoms change d. schedule the client and the partner for a counseling session
help the client explore personal attitudes
Which statement made by an older adult most strongly supports the nurses conclusion that the client has impacted stool? a. i have a lot of gas pain b. i dont have much of an appetite c. i feel like i have to go but i just seep d. i havent had a bowel movement for several days
i feel like i have to go but i just seep
Which pathophysiological rational explains why a client who is 4 days postabdominal surgery has not passed flatus and has hypoactive bowel sounds and why a paralytic ileus is suspected of developing? A. decreased blood supply B. impaired neural functioning C. perforation of the bowel wall D. obstruction of the bowel lumen
impaired neural functioning
Corticosteroid therapy is prescribed for a client with an exacerbation of UC. The nurse evaluates that teaching is effective when the client identifies which times for medical schedule? a. at bedtime with snack b. three times a day with meals c. in the early morning with food d. one hour before or two hours after eating
in the early morning with food
The nurse is assessing a client with UC and Crohn disease. Which is more likely to be identified in the client with UC? A. inclusion of transmural involvement of the small bowel wall B. higher occurrence of fistulas and abscesses from changes in the bowel wall C. pathology beginning proximally with intermittent plaques found along the colon D. involvement starting distally with rectal bleeding that spreads continuously up the colon
involvement starting distally with rectal bleeding that spreads continuously up the colon
Which potential causes will the nurse monitor for when a client is suspected of having irritable bowel syndrome? Select all that apply. A. Stress B. Caffeinated beverages C. Sugary desserts D. Anxiety E. Red meats F. Dairy products
-Stress -caffeinated beverages -anxiety -dairy products
What are laboratory assessments for obstruction?
-WBC -H&H -Creatinine -BUN -serum sodium, chloride, potassium -serum amylase (pancreas)
What history questions should you ask for GERD?
-morning hoarseness -coughing or wheezing at night
What are the biliary causes of PCS?
-pseudocyst -common bile duct leak -CBD or pancreatic duct stricture or obstruction -sphincter dysfunction -gallstone -pancreatic or liver mass
What priority teaching points will the nurse include when teaching a group of older adults about preventing fecal impaction? Select all that apply. A. "Eat high-fiber foods, including raw fruits and vegetables." B. "Consume adequate fluids, especially water." C. "Use a laxative daily as needed to foster bowel regularity." D. "Walking every day is an excellent exercise for promoting intestinal motility." E. "Use natural foods to stimulate peristalsis, such as warm beverages and prune juice." F. "Avoid bulk-forming products to ease bowel elimination."
-"Eat high-fiber foods, including raw fruits and vegetables." -"Consume adequate fluids, especially water." -"Walking every day is an excellent exercise for promoting intestinal motility." -"Use natural foods to stimulate peristalsis, such as warm beverages and prune juice."
What are the differences between Crohn's and UC?
-Crohn's may involve any segment of GI tract -Crohn's has prolonged diarrhea with abdominal pain, fatigue, and weight loss -Crohn's has anal fistulae, abscesses, fissures, and ulcers -UC has recurring episodes of inflammation limited to the mucosal layer of colon -UC has bloody diarrhea with mucous
Which potential causes will the nurse be sure to ask about when taking a history from an older client suspected of having a mechanical obstruction? Select all that apply. A. Fecal impaction B. Strictures from previous radiation therapy C. Fibrosis related to endometriosis D. Recent bowel surgery E. Benign tumor F. Diverticulitis
-Fecal impaction -strictures from previous radiation therapy -fibrosis related to endometriosis -benign tumor -diverticulitis
Which disease features will the nurse commonly associate with a client who has Crohn disease (CD) that are rare or absent in a client with ulcerative colitis (UC)? Select all that apply. A. The problem first appears in the rectum and proceeds in a continuous manner toward the cecum. B. Fistulas commonly develop. C. Clients have five to six soft, loose, non-bloody stools daily. D. There is a greatly increased risk for colon cancer. E. Many clients have one or more extraintestinal problems such as arthritis, ankylosing spondylitis, and erythema nodosum. F. The appearance of the affected intestine areas resembles "cobblestone."
-Fistulas commonly develop. -Clients have five to six soft, loose, non-bloody stools daily. -The appearance of the affected intestine areas resembles "cobblestone."
Which actions will the nurse include when providing care for a client with a nasogastric tube (NGT) in place? Select all that apply. A. Assessing for NGT placement every 8 hours B. Keeping the client in a semi-Fowler position C. If the NGT is repositioned, confirm placement with an x-ray D. Instructing the client that feeling nausea is due to the NGT placement E. Monitoring the contents and drainage from the NGT F. Irrigating the NGT with 30 mL of normal saline as prescribed
-Keeping the client in a semi-Fowler position -If the NGT is repositioned, confirm placement with an x-ray -Monitoring the contents and drainage from the NGT -Irrigating the NGT with 30 mL of normal saline as prescribed
What is the nurse's best first action when a client with a gastric ulcer is found lying in the knee-chest (fetal) position with a rigid, tender, and painful abdomen? A. Notify the primary health care provider. B. Administer opioid pain medication. C. Reposition the client supine. D. Measure the abdominal circumference.
A. Notify the primary health care provider.
Which are the most common symptoms of gastroesophageal reflux disease (GERD)reported to the nurse by a client? Select all that apply. A. Eructation B. Water brash C. Dyspepsia D. Regurgitation E. Odynophagia F. Flatulence
C. Dyspepsia D. Regurgitation
The nurse is caring for a client with chronic inflammation of the bowel. For which most serious complication would the nurse monitor in this client? a.ileus b.pain c. perforation d. obstruction
perforation
What does the nurse suspect has occurred when a client with a bowel obstruction starts passing flatus and has a small bowel movement? A. Blockage is complete. B. Peritonitis has occurred. C. Peristalsis has returned. D. Client is rehydrated.
peristalsis has returned
After many years of coping with UC a client makes the decison to have a colectomy. Which is most likely the significant factor that affected the clients decision? a. it is temporary until the colon heals b. surgical treatment cures UC c. UC can progress to crohns d. without surgery eating table food is contraindicated
surgical treatment cures UC
What are some labs to test for cholecytitis?
-increased WBC -alkaline phosphate -AST -LDH -Serum bilirubin levels
Pathophysiology of gastritis?
-inflammation of gastric mucosa -erosive versus nonerosive -acute versus chronic -often caused by long term NSAID use -can be caused by H. pylori
Key features of large bowel obstruction?
-intermittent lower abdominal cramping -intermittent lower abdominal cramping -minimal or no vomiting -obstipation or ribbon like stools -no major fluid and electrolyte imbalances -metabolic acidosis
The nurse provides dietary teaching for a client with an acute exacerbation of UC and afterward puts together of list he believes he can eat which foods are correct on his list? Select all that apply. A. Orange juice B. creamed soup C. jelly sandwich D. lean roast beef E. scrambled eggs
-jelly sandwich -lean roast beef -scrambled eggs
Interventions of Crohn's?
-nonsurgical management (antibiotics, steroids, biological medications) -surgical management (take out pieces of intestine that are the worst)
Cues for acute gastritis?
-rapid onset of epigastric pain and dyspepsia -sometimes accompanied by gastric bleeding, hematemesis or melena
Which actions will the nurse teach a client to take to prevent the spread of gastroenteritis? Select all that apply. A. Washing hands well for at least 30 seconds B. Using easily accessible hand sanitizers C. Taking broad-spectrum antibiotics prophylactically D. Testing all food preparation employees E. Sanitizing all surfaces that may be contaminated F. Properly preparing food and beverages
-Washing hands well for at least 30 seconds -Using easily accessible hand sanitizers -Sanitizing all surfaces that may be contaminated
What are mechanical obstruction causes and genetic risk?
-adhesions -tumors -appendicitis complications -hernia -fecal impactions -strictures -intussusception -volvulus -fibrosis
Which priority teaching will the nurse provide to an older client with GERD who is prescribed omeprazole for symptom relief? A. "Older adults taking this drug may beat increased risk for hip fracture because it interferes with calcium absorption." B. "Because of this drug's side effect of decreasing potassium, you may be prescribed a potassium supplement." C. "This drug causes sodium retention, so you may be prescribed a dietary sodium restriction." D. "A pacemaker may be necessary because this drug changes magnesium levels which can lead to life-threatening dysrhythmias."
A. "Older adults taking this drug may beat increased risk for hip fracture because it interferes with calcium absorption."
Sequence to examine the abdomen starting with inspection?
Auscultation Percussion Palpation
