Med surg test 3 questions

A client discharged after a laparoscopic cholecystectomy calls the surgeon's office reporting severe right shoulder pain 24 hours after surgery. Which statement is the correct information for the nurse to provide to this client?

"This pain is caused from the gas used to inflate your abdominal area during surgery. Sitting upright in a chair, walking, or using a heating pad may ease the discomfort."

IBS is relieved by?

A bowel movement

Abdominal tenderness & rigidity can indicate what?

A bowel perforation

what discharge teaching about Crohn's disease should the nurse give?

A high protein diet is recommended

A nurse is teaching a client with ulcerative colitis. What will the nurse include?

A lower fiber diet is recommended to reduce inflammation.

What is the major cause chronic pancreatitis ?q

Alcohol consumption

What is an EARLY manifestation of hepatitis A?

Anorexia

How is chronic Hep B treated?

Antivirals such as tenofovir, entecavir, telbivudine (There is no treatment for acute hep B besides supportive care)

Which intervention should be included in the plan of care for a client who has undergone a cholecystectomy

Assessing the color of the sclera every shift If bile is not draining properly, an obstruction is probably causing bile to be forced back into the liver and bloodstream. Because jaundice may result, the nurse should assess the color of the sclerae.

Most GERD symptoms occur while?

Bending, straining, lifting, lying down

A patient has cholecystitis, what should the nurse expect to see

Blumberg's sign

A client with a peptic ulcer will experience?

Board like abdomen !!! Severe pain in abdomen or back that radiates to the right shoulder Tachycardia Hypotension

A client newly diagnosed with hepatitis A will have a diet high in what?

CARBS

How is Hep B prevented?

Childhood immunizations

What is irritable bowel syndrome?

Chronic functional disorder characterized by recurrent abdominal pain associated with disordered bowel movements, which may include diarrhea, constipation, or both

What triggers irritable bowel syndrome?

Chronic stress, sleep deprivation, surgery, infections, diverticulitis, caffeine, alcohol

How is Hep C treated?

Combination therapy with peginterferon Alfa-2a & ribavirin

A client has cirrhosis, what meds will the nurse expect to give?

Diuretics, beta blocker, & lactulose

What blood labs decrease in Crohn's disease

ESR Folic acid Albumin

What can reduce manifestations of dumping syndrome?

Eat meals high in protein & fat, low carbs (Protein delays gastric emptying )

ulcerative colitis is what?

Edema and inflammation in the rectum & rectosigmoid colon

The liver aids in digesting what?

Fats

A client has an acute exacerbation of Crohn's disease, what blood results will be elevated?

Hematocrit WBC

The most major complication following a liver biopsy ?

Hemorrhage so aPTT, PT should be monitored

bowel obstruction

High pitched bowel sounds above site of obstruction (borborygmi) & hypoactive sounds below or all hypoactive

Crohn's disease is a condition of malabsorption caused by which pathophysiological process?

Inflammation of all layers of intestinal mucosa (can be from mouth to anus)

IBS (irritable bowel syndrome) findings include what?

LLQ pain Nausea w/ meals or passing stool Constipation/diarrhea Mucous in stool

Where does appendicitis cause pain?

Lower right abdomen, RLQ

How can a client avoid dumping syndrome

Maintain a supine position after meals

A client having an exacerbation of Crohn's disease will require what ?

NPO status to ensure bowel rest

A new client has cirrhosis, what prescriptions will the nurse anticipate

Obtain PT/INR Administer lactulose 30 mL, 4x a day Obtain daily weight & abdominal girth Administer a daily multivitamin

Polyethylene glycol and electrolytes

Osmotic agents

Expected findings of GERD

Painful swallowing Bitter taste in mouth Increased burping Hypersalivation

A client has a PEG tube. Prior to intimating a feeding, what should the nurse do FIRST

Place client in semi fowler's (at least 30 degrees)

A client has been diagnosed with hepatitis C, which lab findings should the nurse expect?

Positive EIA test

Pepsin digests what?

Protein

A client has hepatitis B and ascites, what would the nurse include in the plan of care>?

Provide a high-carlorie, high carb diet

Where is McBurney's point?

RLQ

Manifestations of GERD

Regurgitation Nausea Belching Heartburn

Treatment for ulcerative colitis

Sulfasalazine Methotrexate Imuunomodulators Antidiarrheals Fluids

Guiac test

Test for blood in stool

Which is a true statement regarding regional enteritis (Crohn's disease)?

The clusters of ulcers take on a cobblestone appearance. It is characterized by remissions and exacerbations. The pain is located in the lower right quadrant. The lesions are not in continuous contact with one another and are separated by normal tissue

Why does esophageal Varices occur?

They occur as a result of portal hypertension, usually due to cirrhosis of the liver

Why would a pt with ulcerative colitis be prescribed bed rest?

To slow activity in the intestines because the client's greatest risk is complications from severe diarrhea

How are esophageal varices treated?

Vasopressin or propranolol (given prophylactic, only if client not actively bleeding)

How is Hep B transmitted?

Via blood

ulcerative colitis can also be caused by a lack of what?

Vitamin B12

The digestion of carbohydrates is aided by

amylase

Which drug is considered a stimulant laxative?

bisacodyl

esophageal varices manifestations

hematemesis, melena, general deterioration, and shock

Appendicitis

inflammation of the appendix Caused by an obstruction of the lumen or opening of the appendix

hepatic cirrhosis

liver disease characterized by degeneration and regeneration of liver cells and (replacement) fibrosis

LFT

liver function test

Manifestations of hepatitis A

mild flu-like symptoms, low-grade fever, anorexia, later jaundice and dark urine, indigestion and epigastric distress, enlargement of liver and spleen

Clients with inflammatory bowel disease (IBD) are at significantly increased risk for which condition?

osteoporosis Rationale: Clients with IBD also have a significantly increased risk of osteoporotic fractures due to decreased bone mineral density. Clients are not at increased risk of DVT, hypotension, or pneumonia

Where does diverticular disease usually occur?

sigmoid colon

What does the gallbladder do?

stores bile

What options would a patient with ulcerative colitis eat?

Roast chicken and white rice (Low fiber diet)

Magnesium hydroxide

Saline agent

What diuretic would be used most often for a patient with ascites?

Spironolactone

Biscaodyl

Stimulant laxative

Risk factors of Hep B

Unprotected sex, infants born to infected mothers, contact with infected blood, substance use disorder

Diet therapy for clients diagnosed with irritable bowel syndrome (IBS) includes:

high fiber diet

The nurse caring for an older adult client diagnosed with diarrhea is administering and monitoring the client's medications. Because one of the client's medications is digitalis (digoxin), the nurse monitors the client closely for:

hypokalemia

Which enzyme aids in the digestion of fats?

lipase

esophageal varices

Are swollen, fragile blood vessels generally found on the submucosa of the lower esophagus, but can develop higher in the esophagus or extend in the stomach

What are indicators of hepatic encephalopathy?

Change in orientation Asterisks Fetor hepaticus

Who is the most at risk for developing hepatitis A?

Children/ young adults

A nurse is restarting a client's TPN therapy after physical therapy. What should the nurse monitor for?

Diaphoresis (Hypoglycemia can develop due to sudden withdrawal from TPN. MANIFESTATIONS OF HYPOGLYCEMIA ARE weakness, anxiety, confusion, & hunger)

What is the primary symptom of IBS?

Diarrhea

Adverse effects of sulfonamides

Do not give if sulfa allergy Nausea/vomiting Rash Avoid sun exposure Can cause skin to turn yellow/orange

inflammatory bowel disease (IBD) problems

Electrolyte imbalance Cardiac dysrhythmias GI bleed with fluid loss Perforation of the bowel

What is ascities?

Free fluid in the abdominal cavity

Aspiration is a complication of what GI disease?

GERD

How is hepatitis A treated?

Hepatitis A immuniziation is recommended for post exposure protection. Immunoglobulin is recommended for post exposure clients older than 40 & younger than 12 months

A client is receiving continuous tube feeding, the head of the bed should be elevated to at least what?

30 degrees (in semi-Fowlers position)

How is Hepatitis A spread?

Fecal-oral

How would a client with Crohn's disease present to the clinic?

Fever Diarrhea- 5 lose stools a day with mucus or pus Abdominal distention High pitched bowel sounds Steatorrhea Malnutrition/malabsorption

What test is specific to the hepatobillary to test for alcohol?

GGT

What are some risk factors of hepatitis A?

Ingesting contaminated food/water, especially shellfish Contact with infected stool

Treatment for ascites

Low sodium diet. Diuretics - aldactone - potassium sparing. No Tylenol. Bedrest. Monitor weight and abd girth. Adminsitration of salt-poor albumin. Paracentesis TIPS

What would a nurse expect to see on the intestines from a X-ray or MRI with a person with Crohn's ?

Small instestine ulcerations and narrowing Ulcerations and inflammation of sigmoid colon and rectum

The presence of mucus and pus in the stools suggests which condition?

ulcerative colitis

Treatment of Bleeding Varices

*Treat for shock; administer oxygen *IV fluids, electrolytes, volume expanders, blood and blood products *Vasopressin, somatostatin, octreotide to decease bleeding *Nitroglycerin in combination with vasopressin to reduce coronary vasoconstriction *Propranolol and nadolol to decrease portal pressure; used in combination with other treatment

Which is a clinical manifestation of cholelithiasis?

Clay-colored stools Rationale: The client with gallstones has clay-colored stools and excruciating upper right quadrant pain that radiates to the back or right shoulder. The excretion of bile pigments by the kidneys makes urine very dark. The feces, no longer colored with bile pigments, are grayish (like putty) or clay colored. The client develops a fever and may have a palpable abdominal mass. '

A patient with ulcerative colitis will present with what physical findings?

Fever Diarrhea- up to 15-20 stools/day Stools containing mucous, blood, or pus Abdominal distention, tenderness, or firmness Rectal bleeding High pitched bowel sounds Anorexia Weight loss LLQ pain

If an NPO patient with an NG tube reports nausea, what should the nurse do?

IRRIGATE THE TUBR WITH NORMAL SALINE

Treatment for IBS

If fluids NG tube decompression NPO, clear advanced as tolerated

Crohn's disease is what?

Inflammation and ulceration of the GI tract, often at the distal ileum. B12 injections may be required Fistulas are common

A typical sign/symptom of appendicitis is:

Nausea Rationale: Nausea, with or without vomiting, is typically associated with appendicitis. Pain is generally felt in the right lower quadrant. Rebound tenderness, or pain felt upon the release of pressure applied to the abdomen, may be present with appendicitis. Low-grade fever is associated with appendicitis.

Manifestations of hepatitis B

insidious and variable; similar to HAV, loss of appetite, dyspepsia, abdominal pain, generalized aching, malaise, and weakness Jaundice may be evident