GI Hesi
A client has an abdominal perineal resection with the formation of a colostomy for cancer of the rectum. The nurse evaluates that teaching about colostomy care is understood when the client states, "I will call the clinic and report:
"If I have difficulty inserting the irrigating tube into the stoma." Difficulty inserting the irrigating tube into the stoma occurs with stenosis of the stoma; forcing insertion of the tube may cause injury.
A nurse begins to teach a client how to perform a colostomy irrigation. The nurse evaluates that the instructions are understood when the client states, "I should:
"Keep the irrigating container 18-24 inches above the stoma." Keeping the irrigating container 18-24 inches above the stoma permits the solution to flow slowly with little force so that excessive peristalsis is not precipitated immediately
A client has a permanent sigmoid colostomy, and colostomy irrigations are prescribed. The client asks the nurse why they are needed. How should the nurse respond?
"They help establish an elimination schedule." Irrigations regulate the bowel to function at a specific time for the convenience of the client.
A nurse evaluates that a client understands appropriately how to take the antacids prescribed by the primary health care provider when the client states, "I will take my antacids:
30 mins after meals. Antacids are most effective when taken after digestion has started but before the stomach begins to empty. Antacids should be taken before the onset of pain; pain indicates that gastric irritation has begun, and the aim of treatment is to protect the gastrointestinal mucosa.
A client who has inoperable cancer of the head of the pancreas involving the common bile duct has a T-tube inserted. During the first 48 hours after insertion of the tube, the nurse should:
A T-tube drains by gravity into a small collection bag; the right side lying or the semi-Fowler position enhances gravity drainage.
A client has a suspected peptic ulcer in the duodenum. What should the nurse expect the client to report when describing the pain associated with this disease?
A gnawing sensation relieved by food.The act of eating allows the hydrochloric acid in the stomach to work on and be neutralized by food rather than irritate the intestinal mucosa.
An emergency department nurse assesses an older client who reports cramping pain in the left lower quadrant, weakness, bloating, and malaise. The client also has a low-grade fever. Which condition does the nurse suspect as the most likely cause of the client's clinical findings?
Although diverticula can occur at any point within the gastrointestinal tract, they are most common in the sigmoid colon; therefore, pain associated with diverticulitis occurs in the left lower quadrant.
A client is a candidate for intubation as a result of bleeding esophageal varices. Which type of tube should the nurse anticipate will most likely be used to meet the needs of this client?
Blakemore-Sengstaken includes an esophageal balloon that exerts pressure on inflation, which retards hemorrhage.
A nurse assesses a client who had a gastric resection. During the first 24 hours after surgery, the nurse expects to identify:
Bloody nasogastric drainage.
A client is placed on a heart-healthy diet to control the intake of saturated fats and cholesterol. What information should the nurse include in a teaching plan to explain best the dietary nature of this diet?
Cholesterol is an essential precursor of body substances such as vitamin D and steroid hormones; although the body synthesizes some cholesterol, a small amount is needed in the diet.
When performing the initial history and physical examination of a client with a tentative diagnosis of peptic ulcer, the nurse expects the client to describe the pain as:
Classic symptoms of peptic ulcer include gnawing, boring, or dull pain located in the midepigastrium or back; pain is caused by irritability and erosion of the mucosal lining.
The nurse evaluates that dietary teaching for a client with a colostomy is effective when the client states, "It is important that I eat:
Clients with a colostomy can eat a regular diet; only gas-forming foods that cause distention and discomfort should be avoided.
A client is experiencing an exacerbation of ulcerative colitis. A low-residue, bland, high-protein diet and parental vitamins B, C, and K have been prescribed. The nurse explains that this dietary regimen is designed to reduce:
Colonic irritation
A client with the diagnosis of ulcerative colitis has surgery for the creation of an ileostomy. Postoperatively, for which potential life-threatening complication should the nurse assess the client?
E-lyte imbalances. An ileostomy directs liquid feces out of the body, bypassing the large intestine where fluid and electrolytes normally are reabsorbed. The continuous excretion of liquid feces may deplete the body of fluid and electrolytes, resulting in a life-threatening fluid deficit and electrolyte imbalance.
After a gastrojejunostomy (Billroth II) for cancer of the stomach, a client progresses to a regular diet. After eating lunch, the client becomes diaphoretic and has palpitations. What does the nurse conclude is the probable cause of these clinical manifestations?
Extracellular fluid shift into the bowel. Hypertonic food increases osmotic pressure and pulls fluid from the intravascular compartment into the intestine (dumping syndrome).
Famotidine (Pepcid) is prescribed for a client with peptic ulcer disease. The client asks the nurse what this medication does. The nurse responds, "It:
Famotidine decreases gastric secretion by inhibiting histamine at H2 receptors. Increases gastric motility, neutralizes gastric acidity, and facilitates histamine release are not actions of famotidine.
A client is diagnosed as having the hepatitis B virus (HBV). The nurse reviews the client's health history for possible situations in which exposure may have occurred. Which event does the nurse determine is the most likely source of this infection?
Had a small tattoo on the arm three months ago
An older client's colonoscopy reveals the presence of extensive diverticulosis. What type of diet should the nurse encourage the client to follow?
High-fiber
A client with ulcerative colitis has experienced frequent severe exacerbations over the past several years. The client is admitted to the hospital with intense pain, severe diarrhea, and cachexia. Which therapeutic course should the nurse expect the health care provider to explore with this client?
If medical management fails, surgical therapy is the next logical choice because it removes the affected intestine.
A client suspected of carcinoma of the liver is scheduled for a liver biopsy. To determine if there are any procedural contraindications present, the nurse should assess the client for:
International normalized ratio (INR) greater than 4.5. A normal INR range is 0.7 to 1.8. INR values over 4.5 increase the risk of major hemorrhage. This should be corrected before the biopsy to prevent hemorrhage.
A client with an acute episode of ulcerative colitis is admitted to the hospital. Blood studies reveal that the chloride level is low. The nurse expects that the electrolyte deficiency will be corrected by:
Intravenous therapy ensures a well-controlled technique for electrolyte (chloride) replacement.
After a client has a total gastrectomy, the nurse plans to include in the discharge teaching the need for:
Intrinsic factor is lost with removal of the stomach, and vitamin B12 is needed to maintain the hemoglobin level once the client is stabilized; injections are given monthly for life.
A client has a new colostomy. The nurse has provided teaching related to when the client should irrigate the colostomy. Which client statement indicates correct understanding of the teaching?
Irrigation should be performed at the time the client routinely defecated before the colostomy, to maintain continuity in lifestyle.
A nurse is caring for a client with a nasointestinal tube. Which solution should the nurse use when instilling the tube to ensure its patency?
Isotonic saline most closely resembles body fluids; it will not cause an imbalance by pulling fluids and electrolytes out of the intravascular compartment.
A client who recently experienced a brain attack (cerebrovascular accident, CVA) and who has limited mobility complains of constipation. What is most important for the nurse to determine when collecting information about the constipation?
Length of time it's existed
The nurse is reviewing a list of current medications with a 75-year-old client who has developed gastrointestinal bleeding. Which medication prescription should the nurse discuss with the prescriber because it is contraindicated for a person who is experiencing gastrointestinal bleeding?
Lisinopril is a calcium channel blocker that is used to reduce high blood pressure and for treatment of heart failure; it can contribute to GI bleeding.
A nurse is caring for a client with a hiatal hernia. Which risk factor is associated most commonly with this diagnosis?
Obesity. Obesity causes stress on the diaphragmatic musculature, which weakens and allows the stomach to protrude into the thoracic cavity.
The nurse teaches a client that the client's new sigmoid colostomy should be irrigated when the:
Once stool is formed, peristalsis needs to be stimulated to promote the passage of the stool
A client is admitted for repair of bilateral inguinal hernias. Before surgery the nurse assesses the client for signs that strangulation of the intestine may have occurred. What is an early sign of strangulation?
Pain is wavelike, colicky, and sharp because of obstruction and localized bowel ischemia
A client with Laënnec cirrhosis has ascites and jaundice and is confused. What is the nursing priority when caring for this client?
Physical Safety. Hepatic encephalopathy, related to high ammonia levels, results in central nervous system derangement
A client who had a choledochostomy to explore the common bile duct is returned to the surgical unit with a T-tube in place. What is the priority intervention when caring for this client?
Protect the abdominal skin from bile drainage. The enzymatic activity of bile can cause excoriation and skin breakdown; the skin should be protected.
McBurney's Point?
RLQ
A client with a diagnosis of gastric cancer has a gastric resection with a vagotomy. Which clinical response should alert the nurse that the client is experiencing dumping syndrome?
Reactive hypoglycemia. Rapid gastric emptying that occurs after a gastric resection causes rapid elevation of blood glucose followed by increased insulin secretion, resulting in reactive hypoglycemia.
Which is the priority intervention for the dependant client with peptic ulcer disease (PUD) who is vomiting bright red blood?
Recall the airway, breathing, and circulation (ABCs) of priority care. The client who needs assistance to manage self-care should be placed in the side-lying position, when vomiting, to prevent aspiration.
A primary health care provider prescribes three stool specimens for occult blood for a client who complains of blood-streaked stools and a 10-pound weight loss in one month. To ensure valid test results, the nurse should instruct the client to:
Red meat can react with reagents used in the test to cause false-positive results
A client had surgery for a perforated appendix with localized peritonitis. In which position should the nurse place this client?
Semi-Fowler. The semi-Fowler position aids in localizing drainage to the lower abdominal cavity and prevents the spread of infection throughout the abdominal cavity.
A nurse identifies a moderate amount of bright red blood in a client's gastric drainage four hours after a subtotal gastrectomy. What should the nurse do first?
Some bright blood at this point is an expected finding that should be monitored
Which information should be included in the teaching plan for the elderly client with peptic ulcer disease who is taking an antacid and sucralfate (Carafate)?
Sucralfate should be taken on an empty stomach one hour before meals. Sucralfate works best in a low pH environment; therefore, it should be given on an empty stomach either one hour before or two hours after meals.
A client reports frequently taking calcium carbonate (Tums). What effect should the nurse advise the client that this can have?
The antacid action of calcium carbonate adds alkalinity, neutralizing gastric pH; this in turn stimulates renewed secretion of acid by the gastric mucosa
A nurse is caring for a postoperative client who had a gastrectomy. What early client response indicates that peristalsis has returned?
The presence of borborygmi indicates the return of peristalsis.
Which is the priority assessment for the client with active gastrointestinal bleeding?
The priority assessment of the client with active gastrointestinal bleeding is focused on evaluating for evidence of impending shock.
A client with a ruptured appendix is scheduled for an appendectomy. Preoperatively, the nurse should place the client in which position?
The semi-Fowler position localizes the spilled contents of the ruptured appendix in the lower part of the abdominal cavity.
A client had a laminectomy and is receiving a skeletal muscle relaxant that will be continued after discharge. The nurse provides education about the medication and concludes that the teaching was effective when the client says:
These drugs tend to irritate the gastric mucosa and should be taken with milk or food to limit gastrointestinal irritation.
A client has an excision of a thrombosed external hemorrhoid. What should the nurse teach the client to use when cleaning the anus after a bowel movement?
Witch hazel-moistened pads (Tucks) are not irritating and are soothing to the anal mucosa.
