GI Disorders/Management (CC Final, 33)

4 (The nursing priority is to see that venous access is achieved so that fluid and blood resuscitation therapy can begin.)

A nursing priority for the patient with gastrointestinal hemorrhage is: 1. positioning the patient in high Fowler's position. 2. assessing the neurologic status frequently. 3. irrigating the nasogastric tube with iced saline. 4. maintaining venous access so that fluids and blood can be administered.

2 (With intestinal obstruction, if intestinal distention progresses, the bowel wall edema can ultimately impel venous and arterial blood supply and cause bowel necroses and perforation. Once the bowel perforates, peritonitis and sepsis ensue.)

Bowel perforation from intestinal obstruction results in: 1. massive hemorrhage. 2. peritonitis. 3. hypovolemia. 4. hyperkalemia.

1 (Esophagogastric varices are the result of portal hypertension causing collateral circulation to divert portal blood from high-pressure areas to adjacent low-pressure areas. The tiny esophageal vessels that receive this diverted blood lack sturdy mucosal protection. As these vessels become engorged and form varices, they become vulnerable to damage from gastric secretions, with subsequent rupture and hemorrhage.)

Esophagogastric varices are the result of: 1. portal hypertension resulting in diversion of blood from a high-pressure area to a low-pressure area. 2. superficial mucosal erosions as a result of increased stress levels. 3. pro-ulcer forces breaking down the mucosal resistance. 4. inflammation and ulceration secondary to nonsteroidal antiinflammatory drug use.

acute pancreatitis

Grey Turner sign and Cullen sign are associated with this disease.

hypotension

Hemodynamic instability is common in patients with ALF. Vasoactive medications and fluid administration should be given to prevent prolong episodes of ___________________.

3 (Ms. M. is a 60-year-old woman with a 10-year history of alcoholism. She is admitted to the critical care unit with acute pancreatitis. 10. The physiologic alteration that occurs in acute pancreatitis is: 1. uncontrolled hypoglycemia due to an increased release of insulin. 2. loss of storage capacity for senescent red blood cells. 3. premature activation of inactive digestive enzymes, resulting in autodigestion. 4. release of glycogen into the serum, resulting in hyperglycemia.)

Ms. M. is a 60-year-old woman with a 10-year history of alcoholism. She is admitted to the critical care unit with acute pancreatitis. 10. The physiologic alteration that occurs in acute pancreatitis is: 1. uncontrolled hypoglycemia due to an increased release of insulin. 2. loss of storage capacity for senescent red blood cells. 3. premature activation of inactive digestive enzymes, resulting in autodigestion. 4. release of glycogen into the serum, resulting in hyperglycemia.

3 (Because outputs greater than 1000 ml/8 hours can occur, the patient should be monitored for signs of hyponatremia, hypokalemia, and fluid volume deficit.)

Nursing management of the patient with an intestinal obstruction should include which of the following interventions? 1. Encourage fluids. 2. Monitor for side effects of vasopressin. 3. Monitor for signs of hyponatremia and hypokalemia. 4. Lavage the nasogastric tube with warm saline.

1 ( Intravenous vasopressin is used to control variceal bleeding by reducing portal venous pressure and slowing blood flow by constricting the splanchnic arteriolar bed.)

The drug used to help control variceal bleeding is: 1. vasopressin. 2. an antacid. 3. Solu-Medrol. 4. cimetidine.

4 (The nursing objective regarding pain control should be to achieve pain relief while maintaining ventilations at a normal depth and rate. Analgesics should be used liberally within these guidelines.)

The goal of pain management for acute pancreatitis patients is to: 1. use analgesics only when needed so that subjective symptoms are not blunted. 2. use distraction and relaxation techniques to avoid the use of narcotics. 3. avoid medicating for pain because this may accelerate progression of the disease. 4. achieve pain relief while maintaining ventilations at a normal depth and rate.

4 (Hematemesis, bloody nasogastric aspirate, and melena are hallmark manifestations of gastrointestinal bleeding.)

The patient at risk for GI hemorrhage should be monitored for which of the following signs and symptoms? 1. Metabolic acidosis and hypovolemia 2. Decreasing hemoglobin and hematocrit 3. Hyperkalemia and hypernatremia 4. Hematemesis and melena

1 (With acute pancreatitis, extravasation of plasma and red blood cells causes fluid to be redistributed from the intravascular space to the retroperitoneum and bowel. Large amounts of plasma volume sequestration, hypovolemia, and hypotension occur, and the patient goes into shock.)

The patient with acute pancreatitis: 1. is at risk for hypovolemic shock from plasma volume depletion. 2. requires observation for hypoglycemia and hypercalcemia. 3. should be started on enteral feedings once the nasogastric tube is placed. 4. is placed on a fluid restriction to avoid the fluid sequestration.

respiratory alkalosis, metabolic acidosis

When a patient has acute liver failure, arterial blood gases may reflect ______________________ and ______________________.

renal failure

When treating acute liver failure, mannitol must be used with caution in patients with _______________ to avoid hyperosmolarity.

4 (The Minnesota tube has four lumens: one each for gastric balloon, esophageal balloon, gastric suction, and esophageal suction.)

Which of the following GI tubes has both a gastric and esophageal balloon and allows for suction in the stomach and esophagus? 1. Miller-Abbott 2. Sengstaken-Blakemore 3. Linton 4. Minnesota

2 (Peptic ulcer disease is the leading cause of upper gastrointestinal (GI) hemorrhage, accounting for approximately 50% of cases.)

Which of the following disorders is the leading cause of upper gastrointestinal (GI) hemorrhage? 1. Stress ulcers 2. Peptic ulcers 3. Nonspecific erosive gastritis 4. Esophageal varices

increase

Calcium, magnesium, bilirubin, white blood cells, and potassium ______________________ in acute pancreatitis.

lactulose

Gold standard of treatment to lower ammonia levels when a patient has acute liver failure.

decrease

Platelet levels may ___________________ in acute level failure.

2 (If a patient with a balloon tamponade tube develops respiratory distress, the gastric and esophageal balloon ports should be cut immediately.)

Which of the following interventions should be undertaken in the event that a patient with a balloon tamponade tube develops respiratory distress? 1. Call the physician to intubate the patient. 2. Cut the balloon ports immediately. 3. Ensure that suction ports are above the level of the patient's stomach. 4. Remove the tube slowly at a rate of 6 inches per hour.

Lipase

________________, a pancreatic enzyme, flows into damaged tissue and is absorbed into the systemic circulation and causes fat necrosis of the pancreas in patients with acute pancreatitis.