GI

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

"A hepatitis B immunization is given 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 hepatitis B surface antigen (HBSAg) negative mothers. These infants should receive the second dose between 1 and 4 months of age.

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

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

19.A nurse is collecting data from a client who has chronic pancreatitis. Which of the following findings should the nurse identify as a likely cause of the clients conditions? High-calorie diet Prior gastrointestinal illnesses Tobacco use Alcohol use

Alcohol use Alcohol consumption is one of the major causes of chronic pancreatitis in the U.S. Long-term alcohol use disorder produces hypersecretion of protein in pancreatic secretions. The result is 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 whose diets are poor in protein content and either very high or very low in fat.

15.A nurse is caring for a client who has acute pancreatitis. Which of the following serum laboratory values should the nurse anticipate returning to the expected reference range within 72 hr after treatment begins? Aldolase Lipase Amylase Lactic dehydrogenase

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

9.A nurse is collecting data from a client who is in the early stages of hepatitis A. Which of the following manifestations should the nurse expect? jaundice Anorexia Dark urine Pale feces

Anorexia Rationale: 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.

17.A nurse is collecting data from a client who is experiencing perforation of a peptic ulcer. Which of the following manifestations should the nurse expect? Decreased heart rate Yellowing of the skin Increased blood pressure Boardlike abdomen

Boardlike abdomen The nurse should expect the client who is experiencing perforation of a peptic ulcer to exhibit manifestations of a boardlike abdomen and severe pain in the abdomen or back that radiates to the right shoulder. Vomiting of blood and shock can occur if the perforation also causes hemorrhaging.

2.A community health nurse is planning an educational program about hepatitis A. When preparing the materials, the nurse should identify that which of the following groups is most at risk for developing hepatitis A? Children and young adults Older adults Women who are pregnant Middle-aged men

Children and young adults Rationale: The hepatitis A virus can be contracted from the feces, bile, and blood of infected clients. The usual mode of transmission is the fecal-oral route. Children and young adults are the two groups most often affected by the hepatitis A virus. Typically, a child or young adult acquires the infection at school, through poor hygiene, hand-to-mouth contact, or another form of close contact.

5.A nurse is caring for a client who is 2 days postoperative following a gastric bypass. The nurse notes that bowel sounds are present. Which of the following foods should the nurse provide at the initial feeding? Vanilla pudding Apple juice Diet ginger ale Clear liquids

Clear liquids Clear liquids, such as water or broth, can be given for the first oral feedings, but should be limited to only 30 ml (1 oz) per feeding. Water does not contain sugar, which could cause diarrhea due to hyperosmolarity.

18.A nurse is assisting with the care of a client who is receiving total parenteral nutrition (TP) therapy 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? Hypertension Excessive thirst Fever Diaphoresis

Diaphoresis Rationale: The nurse should recognize that the client has the potential for the development of 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.

16.A nurse is reinforcing teaching with a client who has diverticulitis about preventing acute attacks. Which of the following foods should the nurse recommend? Foods high in vitamin C Foods low in fat Foods high in fiber Foods low in calories

Foods high in fiber The result of long-term, low-fiber eating habits along with increased intracolonic pressure lead to straining during bowel movements, causing the development of diverticula. High-fiber foods help strengthen and maintain active motility of the gastrointestinal tract.

3.A nurse is assisting with the care of a client who has a history of cirrhosis and is admitted with manifestations of hepatic encephalopathy. The nurse should anticipate a prescription for which of the following laboratory tests to determine the possibility of recent excessive alcohol use? Gamma-glutamyl transferase (GGT) Alkaline phosphatase (ALP) Serum bilirubin Alanine aminotransferase (ALT)

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

10.A nurse is assisting with the admission of a client who has fulminant hepatic failure. Which of the following procedures should the nurse expect for this client? Endoscopic sclerotherapy Liver lobectomy Liver transplant Transjugular intrahepatic portal-systemic shunt placement

Liver transplant Rationale: Fulminant hepatic failure, most often caused by viral hepatitis, is characterized by the development of 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 has become the treatment of choice for these clients.

7.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. Flush the tube with water. Place the client in semi-Fowler's position. Cleanse the skin around the tube site. Aspirate the tube prior to each feeding.

Place the client in semi-Fowler's position. Rationale: A client who is receiving PEG tube feedings should be positioned with the head of the bed elevated at least 30° during and after feedings to decrease the risk of aspiration. Therefore, this is the priority action by the nurse.

8.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? Prothrombin time Serum lipase Bilirubin Calcium

Prothrombin time Rationale: A major complication following a liver biopsy is hemorrhage. Many clients who have liver disease have clotting defects and are at risk for bleeding.Along with the prothrombin time (PT), the activated partial thromboplastin time (aPTT) and the platelet count should be monitored. Liver dysfunction causes the production of blood clotting factors to be reduced, which leads to an 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 use vitamin K to make prothrombin.

13. A nurse is caring for a client who is 4 hr postoperative following a laparoscopic cholecystectomy. Which of the following findings should the nurse expect? Right shoulder pain Urine output 20 mL/hr Temperature 38.4° C (101.1° F) Oxygen saturation 92%

Right shoulder pain The client can experience pain in the right upper shoulder due to gas (carbon dioxide) injected into the abdominal cavity during the laparoscopic procedure, which can irritate the diaphragm and cause referred pain in the shoulder area. The pain disappears in 1 to 2 days. Mild analgesics and a recumbent position can help relieve client pain.

14.A nurse is checking a client who was admitted with a bowel obstruction. The client reports severe abdominal pain. Which of the following findings should indicate to the nurse that a possible bowel perforation has occurred? Elevated blood pressure Bowel sounds increased in frequency and pitch Rigid abdomen Emesis of undigested food

Rigid abdomen Rationale: Abdominal tenderness and rigidity occur with a bowel perforation. As fluid escapes into the peritoneal cavity, there is a reduction in circulating blood volume and a lowered blood pressure, or hypotension, results.

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

The head of the bed is elevated 20°. Rationale: The head of the bed should be elevated at least 30° (semi-Fowler's position) while the tube feeding is administered. This position uses gravity to help the feeding progress down through the digestive system and lessens the possibility of regurgitation,

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

To detect an ulceration in the stomach Rationale: An ED is used to visualize the esophagus, stomach, and duodenum with a lighted tube to detect tumors, ulcerations, or obstructions.

11.A nurse is assisting with the admission of a client who has bleeding esophageal varices. The nurse should anticipate a prescription for which of the following medications? Famotidine Esomeprazole Vasopressin Omeprazole

Vasopressin Rationale: 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.

4.A nurse is caring for a client who has celiac disease. Which of the following foods should the nurse remove from the client's meal tray? Wheat toast Tapioca pudding Hard-boiled egg Mashed potatoes

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