GI - NURSELABS 1

To prevent gastroesophageal reflux in a male client with a hiatal hernia, the nurse should provide which of the following discharge instructions?

"Avoid coffee and alcoholic beverages." To prevent reflux of stomach acid into the esophagus, the nurse should advise the client to avoid foods and beverages that increase stomach acids, such as coffee and alcohol. Instruct the patient regarding avoidance of alcohol, smoking, and caffeinated beverages. These increase acid production and may cause esophageal spasms.

For Jayvin who is taking antacids, which instruction would be included in the teaching plan?

"Avoid taking other medications within 2 hours of this one." Antacids neutralize gastric acid and decrease the absorption of other medications. The client should be instructed to avoid taking other medications within 2 hours of the antacid. The antacids act by neutralizing the acid in the stomach and by inhibiting pepsin, which is a proteolytic enzyme. Each of these cationic salts has a characteristic pharmacological property that determines its clinical use.

Nurse Farrah is providing care for Kristoff who has jaundice. Which statement indicates that the nurse understands the rationale for instituting skin care measures for the client?

"Jaundice produces pruritus due to impaired bile acid excretion." Jaundice is a symptom characterized by increased bilirubin concentration in the blood. Bile acid excretion is impaired, increasing the bile acids in the skin and causing pruritus. Patients with jaundice often nominate pruritus as their most troublesome symptom to control and the symptom that has the most negative influence on their quality of life. The presence of pruritus can cause severe sleep deprivation resulting in lassitude, fatigue, depression, and suicidal ideation

A male client with extreme weakness, pallor, weak peripheral pulses, and disorientation is admitted to the emergency department. His wife reports that he has been "spitting up blood." A Mallory-Weiss tear is suspected, and the nurse begins taking the client's history from the client's wife. The question by the nurse that demonstrates her understanding of Mallory-Weiss tearing is:

"Tell me about your husband's alcohol usage." A Mallory-Weiss tear is associated with massive bleeding after a tear occurs in the mucous membrane at the junction of the esophagus and stomach. There is a strong relationship between ethanol usage, resultant vomiting, and a Mallory-Weiss tear. Mallory-Weiss tears account for an estimated 1-15% of cases of upper gastrointestinal bleeding. Although the age range varies widely, affected individuals are generally in middle age (40s-50s), and men reportedly have a higher incidence than women by a ratio of 2-4:1.

A female client who has just been diagnosed with hepatitis A asks, "How could I have gotten this disease?" What is the nurse's best response?

"You may have eaten contaminated restaurant food." Hepatitis A virus typically is transmitted by the oral-fecal route — commonly by consuming food contaminated by infected food handlers. The hepatitis A virus (HAV) is a common infectious etiology of acute hepatitis worldwide. HAV is most commonly transmitted through the oral-fecal route via exposure to contaminated food, water, or close physical contact with an infectious person. The virus isn't transmitted by the I.V. route, blood transfusions, or unprotected sex.

A male client is recovering from a small bowel resection. To relieve pain, the physician prescribes meperidine (Demerol), 75 mg I.M. every 4 hours. How soon after administration should meperidine onset of action occur?

15 to 30 minutes Meperidine's onset of action is 15 to 30 minutes. It peaks between 30 and 60 minutes and has a duration of action of 2 to 4 hours. Meperidine is in the class of phenylpiperidine as a hydrochloride salt synthetic form of the opioid. Meperidine is used for the treatment of moderate to severe pain. It has intramuscular, subcutaneous, intravenous injection, syrup, and tablet forms.

Nurse Ryan is assessing for correct placement of a nasogastric tube. The nurse aspirates the stomach contents and checks the contents for pH. The nurse verifies correct tube placement if which pH value is noted?

3.5 If the nasogastric tube is in the stomach, the pH of the contents will be acidic. Gastric aspirates have acidic pH values and should be 3.5 or lower. The pH test performed with reagent strips is sensitive to identify the correct placement of the gastric tube, so it can be used as an adjuvant technique in the evaluation of the gastric tube placement. In interpreting the results, pH ?5.5 points to correct placement, and values > 5.5 require radiological confirmation.

Nurse Berlinda is assigned to a 41-year-old client who has a diagnosis of chronic pancreatitis. The nurse reviews the laboratory result, anticipating a laboratory report that indicates a serum amylase level of:

300 units/L The normal serum amylase level is 25 to 151 units/L. With chronic cases of pancreatitis, the rise in serum amylase levels usually does not exceed three times the normal value. In acute pancreatitis, the value may exceed five times the normal value. Basic lab studies for chronic pancreatitis can include a CBC, BMP, LFTs, lipase, amylase, lipid panel, and a fecal-elastase-1 value. Lipase and amylase levels can be elevated, but they are usually normal secondary to significant pancreatic scarring and fibrosis. Of note, amylase and lipase values should not be considered diagnostic or prognostic.

A nurse is preparing to care for a female client with esophageal varices who just had a Sengstaken-Blakemore tube inserted. The nurse gathers supplies, knowing that which of the following items must be kept at the bedside at all times?

A pair of scissors When the client has a Sengstaken-Blakemore tube, a pair of scissors must be kept at the client's bedside at all times. The client needs to be observed for sudden respiratory distress, which occurs if the gastric balloon ruptures and the entire tube moves upward. If this occurs, the nurse immediately cuts all balloon lumens and removes the tube. Sengstaken-Blakemore tube placement is indicated for unstable patients with uncontrolled hemorrhage. Sengstaken-Blakemore tube placements can temporarily control the hemorrhage.

The nurse is monitoring a female client with a diagnosis of peptic ulcer. Which assessment findings would most likely indicate perforation of the ulcer?

A rigid, board-like abdomen Perforation of an ulcer is a surgical emergency and is characterized by sudden, sharp, intolerable severe pain beginning in the mid epigastric area and spreading over the abdomen, which becomes rigid and board-like. Perforated peptic ulcer (PPU) is a serious complication of PUD and patients with PPU often present with an acute abdomen that carries a high risk for morbidity and mortality. The lifetime prevalence of perforation in patients with PUD is about 5%. PPU carries mortality ranging from 1.3% to 20%.

Which of the following will the nurse include in the care plan for a client hospitalized with viral hepatitis?

Adequate bed rest. Treatment of hepatitis consists of bed rest during the acute phase to reduce metabolic demands on the liver, thus increasing blood supply and cell regeneration. Institute bed red or chair rest during the toxic state. Provide a quiet environment; limit visitors as needed. Promotes rest and relaxation. Available energy is used for healing. Activity and an upright position are believed to decrease hepatic blood flow, which prevents optimal circulation to the liver cells.

The nurse caring for a client with small bowel obstruction would plan to implement which nursing intervention first?

Administering I.V. fluids. I.V. infusions containing normal saline solution and potassium should be given first to maintain fluid and electrolyte balance. Maintenance of bowel rest requires alternative fluid replacement to correct losses and anemia. Fluids containing sodium may be restricted in presence of regional enteritis.

Nurse Hannah is teaching a group of middle-aged men about peptic ulcers. When discussing risk factors for peptic ulcers, the nurse should mention:

Alcohol abuse and smoking. Risk factors for peptic (gastric and duodenal) ulcers include alcohol abuse, smoking, and stress. Peptic ulcer disease (PUD) has various causes; however, Helicobacter pylori-associated PUD and NSAID-associated PUD account for the majority of the disease etiology.

A male client has just been diagnosed with hepatitis A. On assessment, the nurse expects to note:

Anorexia, nausea, and vomiting. Hallmark signs and symptoms of hepatitis A include anorexia, nausea, vomiting, fatigue, and weakness. Acute hepatitis usually presents as a self-limited illness; development of fulminant hepatitis is rare. Typical symptoms of acute infection include nausea, vomiting, abdominal pain, fatigue, malaise, poor appetite, and fever; management is with supportive care.

The nurse is monitoring a female client receiving paregoric to treat diarrhea for drug interactions. Which drugs can produce additive constipation when given with an opium preparation?

Anticholinergic drugs Paregoric has an additive effect of constipation when used with anticholinergic drugs. The opiate anhydrous morphine, which is contained in paregoric, can decrease motility more than loperamide or the combination of diphenoxylate and atropine can. Antiarrhythmics, anticoagulants, and antihypertensives aren't known to interact with paregoric.

For a client with hepatic cirrhosis who has altered clotting mechanisms, which intervention would be most important?

Applying pressure to injection sites. The client with cirrhosis who has altered clotting is at high risk for hemorrhage. Prolonged application of pressure to injection or bleeding sites is important. Instruct patient/SO of signs and symptoms that warrant notification of health care provider: increased abdominal girth; rapid weight loss/gain; increased peripheral edema; increased dyspnea, fever; blood in stool or urine; excess bleeding of any kind; jaundice.

Mr. Hasakusa is in end-stage liver failure. Which interventions should the nurse implement when addressing hepatic encephalopathy? Select all that apply.

Assessing the client's neurologic status every 2 hours Evaluating the client's serum ammonia level Monitoring the client's handwriting daily Hepatic encephalopathy results from an increased ammonia level due to the liver's inability to convert ammonia to urea, which leads to neurologic dysfunction and possible brain damage. Hepatic encephalopathy (HE) is a reversible syndrome observed in patients with advanced liver dysfunction. The syndrome is characterized by a spectrum of neuropsychiatric abnormalities resulting from the accumulation of neurotoxic substances in the bloodstream (and ultimately in the brain).

The nurse is preparing a discharge teaching plan for the male client who had umbilical hernia repair. What should the nurse include in the plan?

Avoiding coughing. Coughing is avoided following umbilical hernia repair to prevent disruption of tissue integrity, which can occur because of the location of this surgical procedure. Splint the stomach by placing a pillow over the abdomen with firm pressure before coughing or movement to help reduce the pain.

The nurse is caring for a male client postoperatively following the creation of a colostomy. Which nursing diagnosis should the nurse include in the plan of care?

Body image, disturbed Body image, disturbed relates to loss of bowel control, the presence of a stoma, the release of fecal material onto the abdomen, the passage of flatus, odor, and the need for an appliance (external pouch). Encourage the patient/SO to verbalize feelings regarding the ostomy. Acknowledge normality of feelings of anger, depression, and grief over a loss. Discuss daily "ups and downs" that can occur.

When teaching a client about pancreatic function, the nurse understands that pancreatic lipase performs which function?

Breaks down fat into fatty acids and glycerol. Lipase hydrolyses or breaks down fat into fatty acids and glycerol. Lipase is an enzyme that breaks down triglycerides into free fatty acids and glycerol. Lipases are present in pancreatic secretions and are responsible for fat digestion. There are many different types of lipases; for example, hepatic lipases are in the liver, hormone-sensitive lipases are in adipocytes, lipoprotein lipase is in the vascular endothelial surface, and pancreatic lipase in the small intestine.

Which of the following nursing interventions should the nurse perform for a female client receiving enteral feedings through a gastrostomy tube?

Change the tube feeding solutions and tubing at least every 24 hours. Tube feeding solutions and tubing should be changed every 24 hours, or more frequently if the feeding requires it. Doing so prevents contamination and bacterial growth. The feeding bag should be changed every 24 hours. Food (formula) should not be left in the bag for more than 4 hours. So, only put 4 hours (or less) worth of food in the feeding bag at a time.

Mandy, an adolescent girl is admitted to an acute care facility with severe malnutrition. After a thorough examination, the physician diagnoses anorexia nervosa. When developing the plan of care for this client, the nurse is most likely to include which nursing diagnosis?

Chronic low self-esteem Young women with chronic low self-esteem — are at the highest risk for anorexia nervosa because they perceive being thin as a way to improve their self-confidence. Anorexia nervosa is an illness of starvation, brought on by severe disturbance of body image and a morbid fear of obesity. People with anorexia nervosa attempt to maintain a weight that's far below normal for their age and height.

Nurse Joy is preparing to administer medication through a nasogastric tube that is connected to suction. To administer the medication, the nurse would:

Clamp the nasogastric tube for 30 minutes following administration of the medication. If a client has a nasogastric tube connected to suction, the nurse should wait up to 30 minutes before reconnecting the tube to the suction apparatus to allow adequate time for medication absorption. Flush 10 ml of water between medications. This step prevents interactions between medications. After the last medication has been given, flush the tube with 30 ml of water. Flushing prevents blocking of the tube.

For Rico who has chronic pancreatitis, which nursing intervention would be most helpful?

Counseling to stop alcohol consumption. Chronic pancreatitis typically results from repeated episodes of acute pancreatitis. More than half of chronic pancreatitis cases are associated with alcoholism. Counseling to stop alcohol consumption would be the most helpful for the client. Explore the availability of treatment programs and rehabilitation of chemical dependency if indicated.

A female client with hepatitis C develops liver failure and GI hemorrhage. The blood products that would most likely bring about hemostasis in the client are:

Cryoprecipitate and fresh frozen plasma. The liver is vital in the synthesis of clotting factors, so when it's diseased or dysfunctional, as in hepatitis C, bleeding occurs. Treatment consists of administering blood products that aid clotting. These include fresh frozen plasma containing fibrinogen and cryoprecipitate, which have most of the clotting factors.

What assessment finding of a patient with acute pancreatitis would indicate a bluish discoloration around the umbilicus?

Cullen's sign Cullen's sign is associated with pancreatitis when a hemorrhage is suspected. Cullen's sign is described as superficial edema with bruising in the subcutaneous fatty tissue around the periumbilical region. It is also known as periumbilical ecchymosis. It is most often recognized as a result of hemorrhagic pancreatitis. The sign can take 2-3 days before appearance and may be used as a clinical sign to help the diagnosis of acute pancreatitis.

A male client who is recovering from surgery has been advanced from a clear liquid diet to a full liquid diet. The client is looking forward to the diet change because he has been "bored" with the clear liquid diet. The nurse would offer which full liquid item to the client?

Custard Full liquid food items include items such as plain ice cream, sherbet, breakfast drinks, milk, pudding, and custard, soups that are strained, and strained vegetable juices. A clear liquid diet consists of foods that are relatively transparent. A patient prescribed a full liquid diet follows a specific diet type requiring all liquids and semi-liquids but no forms of solid intake.

When evaluating a male client for complications of acute pancreatitis, the nurse would observe for:

Decreased urine output Acute pancreatitis can cause decreased urine output, which results from the renal failure that sometimes accompanies this condition. AKI develops late in the course of acute pancreatitis, usually after failure of other organs. Remarkably, the kidney was the first organ to fail in only 8.9% of patients with AKI, and only a minority of patients develop isolated AKI

The nurse can expect a 60-year old patient with ischemic bowel to report a history of:

Diabetes mellitus Ischemic bowel occurs in patients over 50 with a history of diabetes mellitus. Diabetes mellitus is the most common endocrine disorder affecting multiple organs including the gastrointestinal (GI) tract where manifestations and/or complications relate to disordered gut motility possibly as a result of autonomic neuropathy.

The nurse is reviewing the record of a female client with Crohn's disease. Which stool characteristics should the nurse expect to note documented in the client's record?

Diarrhea Crohn's disease is characterized by non-bloody diarrhea of usually not more than four to five stools daily. Over time, the diarrhea episodes increase in frequency, duration, and severity. In CD, the inflammation extends through the entire thickness of the bowel wall from the mucosa to the serosa. The disease runs a relapsing and remitting course. The other options are not associated with diarrhea.

The nurse is assessing a male client 24 hours following a cholecystectomy. The nurse noted that the T-tube has drained 750 mL of green-brown drainage since the surgery. Which nursing intervention is appropriate?

Document the findings. Following cholecystectomy, drainage from the T-tube is initially bloody and then turns to a greenish-brown color. The drainage is measured as output. The amount of expected drainage will range from 500 to 1000 mL/day. The nurse would document the output. The fluid may appear bloody for the first day or 2. The color will eventually be golden yellow or greenish, depending on exactly where the catheter is inside the body.

A 52-year-old man was referred to the clinic due to increased abdominal girth. He is diagnosed with ascites by the presence of a fluid thrill and shifting dullness on percussion. After administering diuretic therapy, which nursing action would be most effective in ensuring safe care?

Documenting precise intake and output. For the client with ascites receiving diuretic therapy, careful intake and output measurement are essential for safe diuretic therapy. Diuretics lead to fluid losses, which if not monitored closely and documented, could place the client at risk for serious fluid and electrolyte imbalances. The most common adverse effect for any diuretic is mild hypovolemia, which can lead to transient dehydration and increased thirst. When there is an over-treatment with a diuretic, this could lead to severe hypovolemia, causing hypotension, dizziness, and syncope.

Which of the following factors can cause hepatitis A?

Eating contaminated shellfish. Hepatitis A can be caused by consuming contaminated water, milk, or food — especially shellfish from contaminated water. The most common mode of transmission of hepatitis A is via the fecal-oral route from contact with food, water, or objects contaminated by fecal matter from an infected individual. It is more commonly encountered in developing countries where due to poverty and lack of sanitation, there is a higher chance of fecal-oral spread.

Pain control with peptic ulcer disease includes all of the following except:

Eating meals when desired. Meals should be regularly spaced in a relaxed environment. Instruct the client that meals should be eaten at regularly spaced intervals in a relaxed setting. An irregular schedule of meals may interfere with the regular administration of medications.

The nurse is instructing the male client who has an inguinal hernia repair how to reduce postoperative swelling following the procedure. What should the nurse tell the client?

Elevate the scrotum. Following inguinal hernia repair, the client should be instructed to elevate the scrotum and apply ice packs while in bed to decrease pain and swelling. The nurse also should instruct the client to apply a scrotal support when out of bed. In the beginning phases of healing, the body produces extra fluid that helps with the healing process. This fluid brings nutrients and cells that can help tissues repair themselves, and appears as swelling at the site where there was an injury to the tissues (similar to swelling after a sprained ankle). When this swelling sits in one area for a few days, it often turns hard and can feel like a firm lump.

A client is suspected of having hepatitis. Which diagnostic test result will assist in confirming this diagnosis?

Elevated serum bilirubin level. Laboratory indicators of hepatitis include elevated liver enzyme levels, elevated serum bilirubin levels, elevated erythrocyte sedimentation rates, and leukopenia. Baseline evaluation in a patient suspected to have viral hepatitis can be started by checking a hepatic function panel. Patients who have a severe disease can have elevated total bilirubin levels. Typically, levels of alkaline phosphatase (ALP) remain in the reference range, but if it is elevated significantly, the clinician should consider biliary obstruction or liver abscess.

What laboratory finding is the primary diagnostic indicator for pancreatitis?

Elevated serum lipase Elevation of serum lipase is the most reliable indicator of pancreatitis because this enzyme is produced solely by the pancreas. Serum lipase typically increases 3-6 hours after the onset of acute pancreatitis and usually peaks at 24 hours. Unlike amylase, there is significant reabsorption of lipase in the renal tubules so the serum concentrations remain elevated for 8-14 days.

Which of the following tests can be useful as a diagnostic and therapeutic tool in the biliary system?

Endoscopic retrograde cholangiopancreatography (ERCP) ERCP permits direct visualization of the pancreatic and common bile ducts. Its therapeutic value is in retrieving gallstones from the distal and common bile ducts and dilating strictures. Endoscopic retrograde cholangiopancreatography (ERCP) is a combined endoscopic and fluoroscopic procedure in which an endoscope is advanced into the second part of the duodenum, thus allowing other tools to be passed into the biliary and pancreatic ducts via the major duodenal papilla.

Which diagnostic test would be used first to evaluate a client with upper GI bleeding?

Endoscopy Endoscopy permits direct evaluation of the upper GI tract and can detect 90% of bleeding lesions. Endoscopy is the insertion of a long, thin tube directly into the body to observe an internal organ or tissue in detail. It can also be used to carry out other tasks including imaging and minor surgery. Endoscopes are minimally invasive and can be inserted into the openings of the body such as the mouth or anus. An upp

Polyethylene glycol-electrolyte solution (GoLYTELY) is prescribed for the female client scheduled for a colonoscopy. The client begins to experience diarrhea following the administration of the solution. What action by the nurse is appropriate?

Explain that diarrhea is expected. The solution GoLYTELY is a bowel evacuant used to prepare a client for a colonoscopy by cleansing the bowel. The solution is expected to cause mild diarrhea and will clear the bowel in 4 to 5 hours. Polyethylene glycol electrolyte (PEG) is essential for a wide range of bowel preparation, with advantages such as high security, reliable effect, no dehydration, and electrolyte disturbance.

A female client being seen in a physician's office has just been scheduled for a barium swallow the next day. The nurse writes down which instruction for the client to follow before the test?

Fast for 8 hours before the test. A barium swallow is an x-ray study that uses a substance called barium for contrast to highlight abnormalities in the gastrointestinal tract. The client should fast for 8 to 12 hours before the test, depending on physician instructions. The barium swallow study, also known as a barium esophagogram or esophagram, is a contrast-enhanced radiographic study commonly used to assess structural characteristics of the entire esophagus.

The hospital administrator had undergone percutaneous transhepatic cholangiography. Which assessment finding indicates complication after the operation?

Fever and chills Septicemia is a common complication after a percutaneous transhepatic cholangiography. Evidence of fever and chills, possibly indicative of septicemia, is important. Although PTC may be performed to treat the obstruction that is the cause of sepsis, PTC itself may also cause sepsis. Antibiotics, IV fluids, oxygen, and vasopressors in the setting of an intensive care unit should be considered.

A client with advanced cirrhosis has been diagnosed with hepatic encephalopathy. The nurse expects to assess for:

Hand tremors Hepatic encephalopathy results from the accumulation of neurotoxins in the blood, therefore the nurse wants to assess for signs of neurological involvement. Flapping of the hands (asterixis), changes in mentation, agitation, and confusion are common. During the intermediate stages of HE, a characteristic jerking movement of the limbs is often observed (e.g., asterixis) when the patient attempts to hold arms outstretched with hands bent upward at the wrist.

Peptic ulcer disease may be caused by which of the following?

Helicobacter pylori Helicobacter pylori is considered to be the major cause of ulcer formation. Peptic ulcer disease (PUD) has various causes; however, Helicobacter pylori-associated PUD and NSAID-associated PUD account for the majority of the disease etiology. H. pylorus is a gram-negative bacillus that is found within the gastric epithelial cells. This bacterium is responsible for 90% of duodenal ulcers and 70% to 90% of gastric ulcers. Other choices are not related to ulcer formation.

Dr. Smith has determined that the client with hepatitis has contracted the infection from contaminated food. The nurse understands that this client is most likely experiencing what type of hepatitis?

Hepatitis A Hepatitis A is transmitted by the fecal-oral route via contaminated food or infected food handlers. The most common mode of transmission of hepatitis A is via the fecal-oral route from contact with food, water, or objects contaminated by fecal matter from an infected individual. It is more commonly encountered in developing countries where due to poverty and lack of sanitation, there is a higher chance of fecal-oral spread.

Nurse Oliver checks for residual before administering a bolus tube feeding to a client with a nasogastric tube and obtains a residual amount of 150 mL. What is the appropriate action for the nurse to take?

Hold the feeding Unless specifically indicated, residual amounts more than 100 mL require holding the feeding. Gastric residual refers to the volume of fluid remaining in the stomach at a point in time during enteral nutrition feeding. Nurses withdraw this fluid via the feeding tube by pulling back on the plunger of a large (usually 60 mL) syringe at intervals typically ranging from four to eight hours.

Spironolactone (Aldactone) is prescribed for a client with chronic cirrhosis and ascites. The nurse should monitor the client for which of the following medication-related side effects?

Hyperkalemia This is a potassium-sparing diuretic so clients should be monitored closely for hyperkalemia. Diarrhea, dizziness, and headaches are other more common side effects. Spironolactone is a medication used in the management and treatment of hypertension and heart failure with some indications aside from cardiovascular disease. It is in the mineralocorticoid receptor antagonist class of drugs.

The nurse is teaching a female client how to perform a colostomy irrigation. To enhance the effectiveness of the irrigation and fecal returns, what measure should the nurse instruct the client to do?

Increase fluid intake. To enhance the effectiveness of the irrigation and fecal returns, the client is instructed to increase fluid intake and to take other measures to prevent constipation. A colostomy may make the client more prone to constipation or diarrhea. It's important to get enough fiber in the diet and drink plenty of water to prevent these problems. Some people experience a small amount of stool leakage between irrigations.

Patients with esophageal varices would reveal the following assessment:

Increased heart rate Tachycardia is an early sign of compensation for patients with esophageal varices. Since the portal venous system has no valves, resistance at any level between the splanchnic vessels and the right side of the heart results in retrograde flow and elevated pressure. The collaterals slowly enlarge and connect the systemic circulation to the portal venous system.

A male client is recovering from an ileostomy that was performed to treat inflammatory bowel disease. During discharge teaching, the nurse should stress the importance of:

Increasing fluid intake to prevent dehydration. Because stool forms in the large intestine, an ileostomy typically drain liquid waste. To avoid fluid loss through ileostomy drainage, the nurse should instruct the client to increase fluid intake. Monitor I&O. Note number, character, and amount of stools; estimate insensible fluid losses (diaphoresis). Measure urine specific gravity; observe for oliguria. Provides information about overall fluid balance, renal function, and bowel disease control, as well as guidelines for fluid replacement.

The nurse is reviewing the medication record of a female client with acute gastritis. Which medication, if noted on the client's record, would the nurse question?

Indomethacin (Indocin) Indomethacin (Indocin) is a nonsteroidal anti-inflammatory drug and can cause ulceration of the esophagus, stomach, or small intestine. Indomethacin is contraindicated in a client with gastrointestinal disorders. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as indomethacin are capable of producing injury to gastrointestinal mucosa in experimental animals and humans, and their use is associated with a significant risk of hemorrhage, erosions, and perforation of both gastric and intestinal ulcers.

A patient has become very depressed postoperatively after receiving a colostomy for GI cancer. He does not participate in his colostomy care or looks at the stoma. An appropriate nursing diagnosis for this situation is:

Ineffective Individual Coping The patient is dealing with a disturbance in self-concept and difficulty coping with the newly established stoma. Encourage the patient/SO to verbalize feelings regarding the ostomy. Acknowledge normality of feelings of anger, depression and grief over a loss. Discuss daily "ups and downs" that can occur.

The correct sequence for abdominal assessment is:

Inspection, auscultation, palpation, percussion. Auscultation is done before palpation to avoid stimulating peristaltic movements and distorting auscultatory sounds. The diaphragm of the stethoscope should be placed on the right side of the umbilicus to listen to the bowel sounds, and their rate should be calculated after listening for at least two minutes. Normal bowel sounds are low-pitched and gurgling, and the rate is normally 2-5/min.

While a female client is being prepared for discharge, the nasogastric (NG) feeding tube becomes clogged. To remedy this problem and teach the client's family how to deal with it at home, what should the nurse do?

Irrigate the tube with warm water. The American Society for Parenteral and Enteral Nutrition (ASPEN) recommends warm water as the best initial choice for trying to unclog a feeding tube. First, attach a 30- or 60-mL piston syringe to the feeding tube and pull back the plunger to help dislodge the clog. Next, fill the flush syringe with warm water, reattach it to the tube, and attempt a flush.

The nurse is caring for a female client following a Billroth II procedure. Which postoperative order should the nurse question and verify?

Irrigating the nasogastric tube. In a Billroth II procedure, the proximal remnant of the stomach is anastomosed to the proximal jejunum. Patency of the nasogastric tube is critical for preventing the retention of gastric secretions. The nurse should never irrigate or reposition the gastric tube after gastric surgery unless specifically ordered by the physician. In this situation, the nurse should clarify the order.

Jordin is a client with jaundice who is experiencing pruritus. Which nursing intervention would be included in the care plan for the client?

Keeping the client's fingernails short and smooth The client with pruritus experiences itching, which may lead to skin breakdown and possibly infection from scratching. Keeping his fingernails short and smooth helps prevent skin breakdown and infection from scratching. Encourage the patient to adopt skin care routines to decrease skin irritation. One of the first steps in the management of pruritus is promoting healthy skin and healing of skin lesions.

A clinical manifestation of acute pancreatitis is epigastric pain. Your nursing intervention to facilitate relief of pain would place the patient in a:

Knee-chest position Flexion of the trunk lessens the pain and decreases restlessness. Promote position of comfort on one side with knees flexed, sitting up, and leaning forward. Reduces abdominal pressure and tension, providing some measure of comfort and pain relief. Other positions do not decrease the pain.

The nurse is providing discharge instructions to a male client following gastrectomy and instructs the client to take which measure to assist in preventing dumping syndrome?

Limit the fluid taken with meals. Dumping syndrome is a term that refers to a constellation of vasomotor symptoms that occurs after eating, especially following a Billroth II procedure. Early manifestations usually occur within 30 minutes of eating and include vertigo, tachycardia, syncope, sweating, pallor, palpitations, and the desire to lie down. The nurse should instruct the client to decrease the amount of fluid taken at meals.

The nurse is performing an abdominal assessment and inspects the skin of the abdomen. The nurse performs which assessment technique next?

Listens to bowel sounds in all four quadrants The appropriate sequence for abdominal examination is inspection, auscultation, percussion, and palpation. Auscultation is performed after inspection to ensure that the motility of the bowel and bowel sounds are not altered by percussion or palpation. Therefore, after inspecting the skin on the abdomen, the nurse should listen for bowel sounds.

While palpating a female client's right upper quadrant (RUQ), the nurse would expect to find which of the following structures?

Liver The RUQ contains the liver, gallbladder, duodenum, head of the pancreas, hepatic flexure of the colon, portions of the ascending and transverse colon, and a portion of the right kidney. Begin palpation over the right lower quadrant, near the anterior iliac spine. Palpate for the liver with one or two hands palm down moving upward 2-3 cm at a time towards the lower costal margin.

Marie, a 51-year-old woman, is diagnosed with cholecystitis. Which diet, when selected by the client, indicates that the nurse's teaching has been successful?

Low-fat, high-carbohydrate meals. For the client with cholecystitis, fat intake should be reduced. The calories from fat should be substituted with carbohydrates. Eating a healthy, well-balanced diet full of fruits and vegetables is the best way to improve and protect the gallbladder's health. Fruits and vegetables are full of nutrients and fiber, the latter of which is essential to a healthy gallbladder.

A male client with a recent history of rectal bleeding is being prepared for a colonoscopy. How should the nurse position the client for this test initially?

Lying on the left side with knees bent For a colonoscopy, the nurse initially should position the client on the left side with knees bent. Preparation for a colonoscopy is the biggest complaint that most patients have about receiving the procedure, and is a primary reason for non-compliance to screening colonoscopies. The technician or nurse is there to assist with preserving stability and preventing the patient from rolling forward or backward. Also, they are there to help provide counter pressure to the abdomen to assist the endoscopist in navigating corners and turns.

Pierre, who is diagnosed with acute pancreatitis, is under the care of Nurse Bryan. Which intervention should the nurse include in the care plan for the client?

Maintenance of nothing-by-mouth status and insertion of nasogastric (NG) tube with low intermittent suction With acute pancreatitis, the client is kept on nothing-by-mouth status to inhibit pancreatic stimulation and secretion of pancreatic enzymes. NG intubation with low intermittent suction is used to relieve nausea and vomiting, decrease painful abdominal distention, and remove hydrochloric acid. Prolonged bowel rest by nothing per os (NPO) to minimize pancreatic secretion was an important part of the therapy for any patient with acute pancreatitis.

A male client with pancreatitis complains of pain. The nurse expects the physician to prescribe meperidine (Demerol) instead of morphine to relieve pain because:

Morphine may cause spasms of Oddi's sphincter. For a client with pancreatitis, the physician will probably avoid prescribing morphine because this drug may trigger spasms of the sphincter of Oddi (a sphincter at the end of the pancreatic duct), causing irritation of the pancreas. Morphine showed an excitatory effect on the sphincter of Oddi, and might be a cause of Oddi's sphincter dysfunction(SOD). SO may function as a peristaltic pump to actively expel fluid from the sphincter segment into the duodenum.

The nurse is reviewing the physician's orders written for a male client admitted to the hospital with acute pancreatitis. Which physician order should the nurse question if noted on the client's chart?

Morphine sulfate for pain Meperidine (Demerol) rather than morphine sulfate is the medication of choice to treat pain because morphine sulfate can cause spasms in the sphincter of Oddi. Histological data show that treatment with morphine after induction of acute pancreatitis exacerbates the disease with increased pancreatic neutrophilic infiltration and necrosis in all three models of acute pancreatitis. Morphine also exacerbated acute pancreatitis-induced gut permeabilization and bacteremia.

Which clinical manifestation would the nurse expect a client diagnosed with acute cholecystitis to exhibit?

Nausea, vomiting, and anorexia Acute cholecystitis is an acute inflammation of the gallbladder commonly manifested by the following: anorexia, nausea, and vomiting; biliary colic; tenderness and rigidity the right upper quadrant (RUQ) elicited on palpation (e.g., Murphy's sign); fever; fat intolerance; and signs and symptoms of jaundice.

The nurse is caring for a female client with active upper GI bleeding. What is the appropriate diet for this client during the first 24 hours after admission?

Nothing by mouth Shock and bleeding must be controlled before oral intake, so the client should receive nothing by mouth. When the bleeding is controlled, the diet is gradually increased, starting with ice chips and then clear liquids. In patients hospitalized for acute upper gastrointestinal bleeding due to an ulcer with high risk of rebleeding or with variceal bleeding, it is recommended to wait at least 48 h after endoscopic therapy before initiating oral or enteral feeding.

A male client undergoes total gastrectomy. Several hours after surgery, the nurse notes that the client's nasogastric (NG) tube has stopped draining. How should the nurse respond?

Notify the physician An NG tube that fails to drain during the postoperative period should be reported to the physician immediately. It may be clogged, which could increase pressure on the suture site because fluid isn't draining adequately. Nasogastric decompression has been routinely used in most abdominal operations to prevent the consequences of postoperative ileus.

When preparing a male client, age 51, for surgery to treat appendicitis, the nurse formulates a nursing diagnosis of Risk for infection related to inflammation, perforation, and surgery. What is the rationale for choosing this nursing diagnosis?

Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix. A client with appendicitis is at risk for infection related to inflammation, perforation, and surgery because obstruction of the appendix causes mucus fluid to build up, increasing pressure in the appendix and compressing venous outflow drainage. The pressure continues to rise with venous obstruction; arterial blood flow then decreases, leading to ischemia from lack of perfusion.

Which rationale supports explaining the placement of an esophageal tamponade tube in a client who is hemorrhaging?

Obtaining cooperation and reducing fear An esophageal tamponade tube would be inserted in critical situations. Typically, the client is fearful and highly anxious. The nurse, therefore, explains the placement to help obtain the client's cooperation and reduce his fear.

A patient with severe cirrhosis of the liver develops hepatorenal syndrome. Which of the following nursing assessment data would support this?

Oliguria and azotemia Hepatorenal syndrome is a functional disorder resulting from a redistribution of renal blood flow. Oliguria and azotemia occur abruptly as a result of this complication. Confusion due to hepatic encephalopathy is likely the last and most severe stage of liver disease as a result of the liver failing to break down toxic metabolites. Most importantly these patients notice they urinate less frequently in smaller and smaller volumes as they become oliguric.

Which condition is most likely to have a nursing diagnosis of fluid volume deficit?

Pancreatitis Hypovolemic shock from fluid shifts is a major factor in acute pancreatitis. The other conditions are less likely to exhibit fluid volume deficit. Early fluid therapy is the cornerstone of treatment and is universally recommended; however, there is a lack of consensus regarding the type, rate, amount, and endpoints of fluid replacement. The basic goal of fluid depletion should be to prevent or minimize the systemic response to inflammatory markers.

Which assessment finding indicates that lactulose is effective in decreasing the ammonia level in the client with hepatic encephalopathy?

Passage of two or three soft stools daily. Lactulose reduces serum ammonia levels by inducing catharsis, subsequently decreasing colonic pH and inhibiting fecal flora from producing ammonia from urea. Ammonia is removed with the stool. Two or three soft stools daily indicate the effectiveness of the drug. Lactulose, also known as 1,4 beta galactoside-fructose, is a non-absorbable synthetic disaccharide made up of galactose and fructose. The human small intestinal mucosa does not have the enzymes to split lactulose, and hence lactulose reaches the large bowel unchanged. Lactulose is metabolized in the colon by colonic bacteria to monosaccharides, and then to volatile fatty acids, hydrogen, and methane.

Peritonitis can occur as a complication of:

Peptic ulcer disease Perforation is a life-threatening complication of peptic ulcer disease and can result in peritonitis. Since the peritoneum completely covers the stomach, perforation of the wall creates a communication between the gastric lumen and the peritoneal cavity. If the perforation occurs acutely, there is no time for an inflammatory reaction to wall off the perforation, and the gastric content is free to enter the general peritoneal cavity, causing chemical peritonitis.

During the initial assessment of a patient post-endoscopy, the nurse notes absent bowel sounds, tachycardia, and abdominal distention. The nurse would anticipate:

Perforated bowel Invasive diagnostic testing can cause perforated bowel. Perforation is widely recognized as one of the most serious complications of endoscopy of the lower gastrointestinal tract. The risk of perforation ranges from 0.027% to 0.088% for flexible sigmoidoscopy, from 0.016% to 0.2% for diagnostic colonoscopy, and up to 5% for therapeutic endoscopy.

A male client has undergone a colon resection. While turning him, wound dehiscence with evisceration occurs. The nurse's first response is to:

Place saline-soaked sterile dressings on the wound. The nurse should first place saline-soaked sterile dressings on the open wound to prevent tissue drying and possible infection. Ask the client to bend the knees to reduce abdominal tension. Note the color of the tissue before it is covered. Then, cover the moistened dressings with a sterile drape.

Nurse Juvy is caring for a client with cirrhosis of the liver. To minimize the effects of the disorder, the nurse teaches the client about foods that are high in thiamine. The nurse determines that the client has the best understanding of the dietary measures to follow if the client states an intention to increase the intake of:

Pork The client with cirrhosis needs to consume foods high in thiamine. Thiamine is present in a variety of foods of plant and animal origin. Pork products are especially rich in this vitamin. Other good food sources include nuts, whole grain cereals, and legumes. Thiamine helps turn carbohydrates into energy. It is required for the metabolism of glucose, amino acids, and lipids.

Which phase of hepatitis would the nurse incur strict precautionary measures at?

Pre-icteric Pre-icteric is the infective phase and precautionary measures should be strictly enforced. However, most patients are not always diagnosed during this phase. Nonspecific symptoms occur; they include profound anorexia, malaise, nausea and vomiting, a newly developed distaste for cigarettes (in smokers), and often fever or right upper quadrant abdominal pain. Urticaria and arthralgias occasionally occur, especially in HBV infection. During the icteric phase, precautionary measures should already be in place. After 3 to 10 days, the urine darkens, followed by jaundice. Systemic symptoms often regress, and patients feel better despite worsening jaundice. The liver is usually enlarged and tender, but the edge of the liver remains soft and smooth. Mild splenomegaly occurs in 15 to 20% of patients. Jaundice usually peaks within 1 to 2 weeks. During the post-icteric phase, precautionary measures should already be in place. During this 2- to 4-week period, jaundice fades. Appetite usually returns after the first week of symptoms. Acute viral hepatitis usually resolves spontaneously 4 to 8 weeks after symptom onset.

A nurse is inserting a nasogastric tube in an adult male client. During the procedure, the client begins to cough and has difficulty breathing. Which of the following is the appropriate nursing action?

Pull back on the tube and wait until the respiratory distress subsides During the insertion of a nasogastric tube, if the client experiences difficulty breathing or any respiratory distress, withdraw the tube slightly, stop the tubing advancement, and wait until the distress subsides. The most common indication for placement of a nasogastric tube is to decompress the stomach in the setting of distal obstruction. Less commonly, nasogastric tubes can be placed to administer medications or nutrition in patients who have a functional gastrointestinal tract but are unable to tolerate oral intake.

The nurse must be alert for complications with Sengstaken-Blakemore intubation including:

Pulmonary obstruction. Rupture or deflation of the balloon could result in upper airway obstruction. Esophageal rupture is a well-known but rarely reported fatal complication of the management of bleeding esophageal varices with the Sengstaken-Blakemore (SB) tube. The most common complications of esophageal balloon therapy for varices include aspiration, esophageal perforation, and pressure necrosis of the mucosa. The other choices are not related to the tube.

The nurse is caring for a male client with cirrhosis. Which assessment findings indicate that the client has deficient vitamin K absorption caused by this hepatic disease?

Purpura and petechiae A hepatic disorder, such as cirrhosis, may disrupt the liver's normal use of vitamin K to produce prothrombin (a clotting factor). Consequently, the nurse should monitor the client for signs of bleeding, including purpura and petechiae. Petechiae and purpura result from a wide variety of underlying disorders and may occur at any age. Petechiae are small (1-3 mm), red, non-blanching macular lesions caused by intradermal capillary bleeding. Purpura are larger, typically raised lesions resulting from bleeding within the skin

The nurse is caring for a hospitalized female client with a diagnosis of ulcerative colitis. Which finding, if noted on assessment of the client, would the nurse report to the physician?

Rebound tenderness Rebound tenderness may indicate peritonitis. During the physical exam, pertinent findings include fever and abdominal tenderness to palpation which usually is diffuse with wall rigidity in more septic presentations. Signs of peritonitis must be reported to the physician. It is important to conduct a thorough exam as certain thoracic or pelvic pathologies can mimic peritoneal irritation (empyema causing diaphragmatic irritation and cystitis/pyelonephritis causing peritoneum adjacent pain).

A male client with a peptic ulcer is scheduled for a vagotomy and the client asks the nurse about the purpose of this procedure. Which response by the nurse best describes the purpose of a vagotomy?

Reduces the stimulus to acid secretions. A vagotomy, or cutting of the vagus nerve, is done to eliminate parasympathetic stimulation of gastric secretion. A vagotomy is a type of surgery that removes all or part of the vagus nerve. This nerve runs from the bottom of the brain, through the neck, and along the esophagus, stomach, and intestines in the gastrointestinal (GI) tract.

Your patient's ABG reveals an acidic pH, an acidic CO2, and a normal bicarbonate level. Which of the following indicates this acid-base disturbance?

Respiratory acidosis A pH of 7.35 indicates acidosis, as does an acidic CO2 and bicarbonate. The primary disturbance of elevated arterial PCO2 is the decreased ratio of arterial bicarbonate to arterial PCO2, which leads to a lowering of the pH. In the presence of alveolar hypoventilation, 2 features commonly are seen are respiratory acidosis and hypercapnia. To compensate for the disturbance in the balance between carbon dioxide and bicarbonate (HCO3-), the kidneys begin to excrete more acid in the forms of hydrogen and ammonium and reabsorb more base in the form of bicarbonate. See also: 8-Step Guide to ABG Analysis: Tic-Tac-Toe Method

What is the primary nursing diagnosis for a 4th to 10th-day postoperative liver transplant patient?

Risk for Rejection Risk for rejection is always a possibility, especially during the 4th to 10th day postoperatively. LT patients are at risk for several complications. The primary care NP should be aware of these complications and needs to know when referral back to a transplant center or hepatologist is appropriate. The most serious issues are problems with the vasculature of the liver, biliary issues, rejection, and infection. Lab abnormalities—specifically elevation in alkaline phosphatase, alanine aminotransferase (ALT), and serum bilirubin levels—are usually the first indication of a problem in one or more of these areas.

To inhibit pancreatic secretions, which pharmacologic agent would you anticipate administering to a patient with acute pancreatitis?

Somatostatin Somatostatin, a treatment for acute pancreatitis, inhibits the release of pancreatic enzymes. Somatostatin produces predominantly neuroendocrine inhibitory effects across multiple systems. It is known to inhibit GI, endocrine, exocrine, pancreatic, and pituitary secretions, as well as modify neurotransmission and memory formation in the CNS.

The nurse is performing colostomy irrigation on a male client. During the irrigation, the client begins to complain of abdominal cramps. What is the appropriate nursing action?

Stop the irrigation temporarily. If cramping occurs during colostomy irrigation, the irrigation flow is stopped temporarily and the client is allowed to rest. Cramping may occur from an infusion that is too rapid or is causing too much pressure. Have the colostomy patient sit on or near the toilet for about 15 to 20 minutes so the initial colostomy returns can drain into the toilet. (If the patient is on bed rest, allow the colostomy to drain into the bedpan.)

The nurse is monitoring a female client for the early signs and symptoms of dumping syndrome. Which of the following indicate this occurrence?

Sweating and pallor Early manifestations of dumping syndrome occur 5 to 30 minutes after eating. Symptoms include vertigo, tachycardia, syncope, sweating, pallor, palpitations, and the desire to lie down. In early dumping, the symptoms usually occur within 10 to 30 minutes after a meal. The rapid transit of hyperosmolar chyme from the stomach into the duodenum causes fluid to shift from the vasculature to the intestinal lumen, leading to increased volume in the small bowel.

A nurse is preparing to remove a nasogastric tube from a female client. The nurse should instruct the client to do which of the following just before the nurse removes the tube?

Take and hold a deep breath. When the nurse removes a nasogastric tube, the client is instructed to take and hold a deep breath. This will close the epiglottis. This allows for easy withdrawal through the esophagus into the nose. The nurse removes the tube with one smooth, continuous pull.

A female client with dysphagia is being prepared for discharge. Which outcome indicates that the client is ready for discharge?

The client is free from esophagitis and achalasia. Dysphagia may be the reason why a client with esophagitis or achalasia seeks treatment. Dysphagia is common in patients with erosive esophagitis but is not a reliable clinical predictor of severe erosive esophagitis. Dysphagia resolved with PPI therapy in most cases, but persistent dysphagia may indicate failed healing. Dysphagia isn't associated with rectal tenesmus, duodenal inflammation, or abnormal gastric structures.

For a client in hepatic coma, which outcome would be the most appropriate?

The client is oriented to time, place, and person. Hepatic coma is the most advanced stage of hepatic encephalopathy. As hepatic coma resolves, improvement in the client's level of consciousness occurs. The client should be able to express orientation to time, place, and person. Throughout the intermediate stages, patients tend to experience worsening levels of confusion, lethargy, and personality changes.

You are caring for Rona, a 35-year-old female in a hepatic coma. Which evaluation criteria would be the most appropriate?

The patient demonstrates an increase in the level of consciousness. Increased level of consciousness indicates resolving of a comatose state. Ongoing assessment of behavior and mental status is important because of the fluctuating nature of impending hepatic coma. Other options are important evaluations but do not evaluate a patient in a hepatic coma who is responding to external stimuli.

A client diagnosed with chronic cirrhosis who has ascites and pitting peripheral edema also has hepatic encephalopathy. Which of the following nursing interventions are appropriate to prevent skin breakdown? Select all that apply.

Turn and reposition every 2 hours Alternating air pressure mattress Edematous tissue must receive meticulous care to prevent tissue breakdown. An air pressure mattress, careful repositioning can prevent skin breakdown. Inspect pressure points and skin surfaces closely and routinely. Gently massage bony prominences or areas of continued stress. Use of emollient lotions and limiting use of soap for bathing may help.

When planning home care for a client with hepatitis A, which preventive measure should be emphasized to protect the client's family?

Using good sanitation with dishes and shared bathrooms. Hepatitis A is transmitted through the fecal-oral route or from contaminated water or food. Measures to protect the family include good handwashing, personal hygiene and sanitation, and the use of standard precautions. According to the WHO, the most effective way to prevent HAV infection is to improve sanitation, food safety, and immunization practices.

The nurse would anticipate using which medication if sclerotherapy has not been used?

Vasopressin Vasopressin is the drug of choice when sclerotherapy is contraindicated. Vasoactive drugs stop bleeding in most patients, and emergency sclerotherapy may carry risks to the patient and is more demanding on the healthcare system. Sclerotherapy did not appear to be superior to vasoactive drugs in terms of control of bleeding, the number of transfusions, 42?day rebleeding and mortality, or rebleeding and mortality before other elective treatments.

The nurse is caring for a male client with a diagnosis of chronic gastritis. The nurse monitors the client knowing that this client is at risk for which vitamin deficiency?

Vitamin B12 Chronic gastritis causes deterioration and atrophy of the lining of the stomach, leading to the loss of the function of the parietal cells. The source of the intrinsic factor is lost, which results in the inability to absorb vitamin B12. This leads to the development of pernicious anemia.

Nitrosocarcinogen production can be inhibited with the intake of:

Vitamin C Vitamin C and refrigeration of foods inhibit nitroso carcinogen. Humans are exposed to a wide range of nitrogen-containing compounds and nitrosating agents, such as nitrite, nitrate, and nitrogen oxides (NOx), that can react in vivo to form potentially carcinogenic N-nitroso compounds (NOCs), as well as several carcinogenic C-nitro(so) or reactive diazo compounds.

During preparation for bowel surgery, a male client receives an antibiotic to reduce intestinal bacteria. Antibiotic therapy may interfere with the synthesis of which vitamin and may lead to hypoprothrombinemia?

Vitamin K Intestinal bacteria synthesize such nutritional substances as vitamin K, thiamine, riboflavin, vitamin B12, folic acid, biotin, and nicotinic acid. Therefore, antibiotic therapy may interfere with the synthesis of these substances, including vitamin K. Antibiotics, especially those known as cephalosporins, reduce the absorption of vitamin K in the body. Using them for more than 10 days may lower levels of vitamin K because these drugs kill not only harmful bacteria but also the bacteria that make vitamin K.

A female client with viral hepatitis A is being treated in an acute care facility. Because the client requires enteric precautions, the nurse should:

Wash the hands after touching the client. To maintain enteric precautions, the nurse must wash the hands after touching the client or potentially contaminated articles and before caring for another client. Enteric precautions are taken to prevent infections that are transmitted primarily by direct or indirect contact with fecal material. They're indicated for patients with known or suspected infectious diarrhea or gastroenteritis.

A male client with cholelithiasis has a gallstone lodged in the common bile duct. When assessing this client, the nurse expects to note:

Yellow sclera Yellow sclera may be the first sign of jaundice, which occurs when the common bile duct is obstructed. Jaundice can be a sign of a common bile duct obstruction from an entrapped gallstone. In the presence of jaundice and abdominal pain, often, a procedure is an indication to go and retrieve the stone to prevent further sequelae.