Med/Surg II: GI Target Study Guide
Non-inflammatory conditions
Bowel obstruction due to impaction Radiation colitis
Coumadin
Can be affected by pepto bismol
Alosetron (Lotronex)
Constipation Bloating Nausea Possible ileus/obstruction
A nurse is obtaining a guaiac test from a client. This test is performed to detect which of the following? A.Fecal material in vomit B.Blood in stool C.Infestation of parasites D.Microorganisms in urine
Correct Answer: B. Blood in stool A guaiac test detects the presence of blood in the stool. It is a commonly used point-of-care test for fecal occult blood.
A nurse is caring for a client who has acute pancreatitis. Which of the following serum laboratory values should return to the expected reference range within 72 hr of treatment beginning? A.Aldolase B.Lipase C.Amylase D.Lactic dehydrogenase
Correct Answer: C. Amylase Pancreatitis is the most common diagnosis for marked elevations in serum amylase. Serum amylase begins to increase about 3 to 6 hours following the onset of acute pancreatitis. The amylase level peaks in 20 to 30 hours and returns to the expected reference range within 2 to 3 days.
A nurse is providing postoperative teaching about the management of dumping syndrome to a client who had a partial gastrectomy. Which of the following instructions should the nurse include in the teaching? A."Consume at least 4 oz of fluid with meals." B."Take a short walk after each meal." C."Use honey to flavor foods such as cereal." D."Eat protein with each meal.
Correct Answer: D. "Eat protein with each meal." The nurse should instruct the client to eat meals that are high in protein and fat with low to moderate carbohydrate content. Protein should be included in every meal because it delays digestion, which helps reduce the manifestations of dumping syndrome.
Famotidine how does it work
H2 receptors Inhibits the production of the acid
Acute Hepatitis B symptoms
Joint pain
Dietary recommendations for chronic Pancreatitis
Low fat, high protein, adequate carbs Pancreatic enzyme, every meal and snack
Prilosec
Should not be crushed, chewed, or opened
GERD-things to avoid in diet
Smoking
Chronic Hepatitis C-Meds to avoid
Tylenol
Esophageal varices/hemorrhage who is at risk?
-
Normal levels for Albumin
3.5-5.5
Monitoring Gastrectomy Post operatively
ABD distention can be indicated by hiccups
IBS
Baked chicken Rice Steamed veggies Apple juice
Signs of GI bleeding
Blood pressure hypotension Tachycardia
A nurse is assessing a client who has a bleeding duodenal ulcer. Which of the following findings should the nurse expect? A.Emesis with a coffee-ground appearance B.Increased blood pressure C.Decreased heart rate D.Bright green stools
Correct Answer: A Emesis with a coffee-ground appearance The nurse should expect a client who has a bleeding duodenal ulcer to have emesis that resembles coffee-grounds or is bright red in color. Hematemesis indicates upper gastrointestinal bleeding, occurring at or above the duodenojejunal junction.
Ileostomy signs of bowel Ischemia
Dark purple stoma
Lomotil
Difficulty having BM Can cause dependence
Normal levels for Bilirubin
0.1-1.2
Normal levels for Ammonia
15-60
Large Intestine
Absorbs liquid Forms stool
Lactulose why give this for Cirrhosis what does it do?
Aids in excretion of ammonia
FOBT
2-3 samples on 3 different days
Colonoscopy procedure (Client preparation)
24 hours bowel prep, golotley NPO after midnight Clear liquids 24 hours before
A nurse is developing a plan of care for a client who has gastroesophageal reflux disease (GERD). The nurse should plan to monitor the client for which of the following complications?A.Aspiration B.Infection C.Anemia D.Weight loss
A Aspiration is a common complication of GERD, which results when the esophageal sphincter malfunctions and allows gastric acid and undigested food to back up into the esophagus. This places the client at risk of aspiration. GERD causes effortless, uncontrolled regurgitation whether the client is in an upright position or reclining. The most common results of regurgitation are heartburn and indigestion; however, aspiration is also possible. Therefore, the nurse should monitor the client for crackles in the lung fields, which are an indication of aspiration.
Hepatic Cirrhosis expected lab Values
Ammonia Albumin Bili AST/ALT
Ulcerative colitis Client teaching to control Disease
Chronic inflammation resolution in ulcers or sores, progressive No increased fiber Sodium, potassium, chloride and electrolyte levels need to be evaluated Can cause chronic blood loss (anemia) Elevated BUN HGB level of 8.0 Diarrhea: review issues that increase symptoms Causes: infection, NSAIDS, smoking
A nurse is providing dietary teaching to a client who has ulcerative colitis. Which of the following food selections by the client indicates an understanding of the teaching? A.Raw vegetable salad with low-fat dressing B.Roast chicken and white rice C.Fresh fruit salad and milk D.Peanut butter on whole wheat bread
Correct Answer: B.Roast chicken and white rice Clients who have ulcerative colitis are restricted to a low-fiber diet, which omits whole grains and raw fruits and vegetables. Roast chicken with white rice is the best choice.
A nurse is teaching a newly licensed nurse about caring for a client who is scheduled for an esophagogastric balloon tamponade tube to treat bleeding esophageal varices. Which of the following pieces of information should the nurse include in the teaching? A.The client will be placed on mechanical ventilation prior to this procedure. B.The tube will be inserted into the client's trachea. C.The client will receive a bowel preparation with cathartics prior to this procedure. D.The tube allows the application of a ligation band to the bleeding varices.
Correct Answer: A. The client will be placed on mechanical ventilation prior to this procedure. The client will require intubation and mechanical ventilation prior to this procedure to protect the airway.
A nurse is teaching a client who has a colostomy about ways to reduce flatus and odor. Which of the following strategies should the nurse include? A.Eat crackers and yogurt regularly B.Chew minty gum throughout the day C.Drink orange juice every day D.Put an aspirin in the pouch
Correct Answer: A.Eat crackers and yogurt regularly Crackers, toast, and yogurt can help reduce flatus, which contributes to odor.
A nurse is preparing a community education program about hepatitis B. Which of the following statements should the nurse include in the teaching? A."A hepatitis B immunization is recommended for those who travel, especially military personnel." B."A hepatitis B immunization is given to infants and children." C."Hepatitis B is acquired by eating foods that are contaminated during handling." D."Hepatitis B can be prevented by using good personal hygiene habits and proper sanitation."
Correct Answer: B "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 mothers that are negative for hepatitis B surface antigen (HBsAg). These infants should receive the second dose between 1 and 4 months of age.
A nurse is providing dietary teaching to a client who has diverticulitis about preventing acute attacks. Which of the following foods should the nurse recommend? A.Foods high in vitamin C B.Foods low in fat C.Foods high in fiber D.Foods low in calories
Correct Answer: C. Foods high in fiber Long-term low-fiber eating habits and increased intracolonic pressure lead to straining during bowel movements, causing the development of diverticula. High-fiber foods help strengthen and maintain the active motility of the gastrointestinal tract.
A nurse is assessing a client who was admitted with a bowel obstruction. The client reports severe abdominal pain. Which of the following findings indicates that a possible bowel perforation has occurred? A.Elevated blood pressure B.Bowel sounds increased in frequency and pitch C.Rigid abdomen D.Emesis of undigested food
Correct Answer: C. Rigid abdomen Abdominal tenderness and rigidity indicate a bowel perforation. As fluid escapes into the peritoneal cavity, a reduction in circulating blood volume occurs, lowering blood pressure.
A nurse in the emergency department is caring for a client who has bleeding esophageal varices. The nurse should anticipate a prescription for which of the following medications? A.Famotidine B.Esomeprazole C.Vasopressin D.Omeprazole
Correct Answer: C. Vasopressin 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.
A nurse is caring for a client who has abdominal pain and possible pancreatitis. Which of the following laboratory results should the nurse identify as an indication of pancreatitis?A.Decreased white blood cell (WBC) count B.Increased albumin level C.Increased serum lipase level D.Decreased blood glucose level
Correct Answer: C.Increased serum lipase level Due to the release of lipase into the pancreas and autodigestion, pancreatitis causes an increased serum lipase level.
A nurse is caring for a client who has gastrointestinal bleeding. The provider suspects a bleeding lesion in the colon. The initial approach to treatment likely will involve which of the following procedures? A.Exploratory laparotomy B.Double-contrast barium enema C.Magnetic resonance imaging D.Colonoscopy
Correct Answer: D Colonoscopy A colonoscopy requires the insertion of a flexible scope into the rectum. The provider advances the scope carefully until it enters the colon. It can provide direct visualization of the inside of the colon and helps the provider identify the exact cause and location of bleeding.
A nurse is teaching about secondary prevention actions for colorectal cancer for a health fair for adults in the community. Which of the following topics should the nurse include?A.Smoking cessation B.Benefits of a diet high in cruciferous vegetables C.New types of ostomy appliances D.Importance of colonoscopy screening starting at age 50 years old
Correct Answer: D. Importance of colonoscopy screening starting at age 50 years old Screening examinations for colorectal cancer are secondary prevention (an action that promotes early detection of disease).
A nurse is providing teaching to the guardian of a child who has celiac disease. Which of the following foods should the nurse instruct the guardian to omit from the child's diet?A.Cornflakes B.Reduced-fat milk C.Canned fruits D.Wheat bread
Correct Answer: D. Wheat bread Clients who have celiac disease should eliminate as much gluten as possible from their diets. Wheat, rye, and barley contain gluten and should be eliminated from the diet of a child who has celiac disease.
A nurse is completing a history and physical assessment for a client who has chronic pancreatitis. Which of the following findings should the nurse identify as a likely cause of the client's condition? A.High-calorie diet B.Prior gastrointestinal illnesses C.Tobacco use D.Alcohol use
Correct Answer: D. Alcohol use Alcohol consumption is a major cause of chronic pancreatitis in the US. Long-term alcohol use disorder produces hypersecretion of protein in pancreatic secretions, which results in 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.
A nurse is assessing a client who has a complete intestinal obstruction. Which of the following findings should the nurse expect? A.Absence of bowel sounds in all 4 abdominal quadrants B.Passage of blood-tinged liquid stool C.Presence of flatus D.Hyperactive bowel sounds above the obstruction
Correct Answer: D. Hyperactive bowel sounds above the obstruction The nurse should expect the client to have hyperactive bowel sounds above the obstruction because the intestinal peristalsis above the obstruction attempts to push the obstruction through the intestines. With a complete intestinal obstruction, there are no bowel sounds below the obstruction.
A nurse is caring for a client who has diverticulitis and a new prescription for a low-fiber diet. Which of the following food items should the nurse remove from the client's meal tray? A.Canned fruit B.White bread C.Broiled hamburger D.Coleslaw
Correct Answer: D.Coleslaw Coleslaw contains raw cabbage, which is high in fiber. Clients who are following a low-fiber diet should avoid most raw vegetables
Campylobacter Enteritis symptoms
Diarrhea (often bloody) Fever Stomach cramping
Acute Pancreatitis expected lab values
Elevated amylase
Parasitic infection
Elevated eosinophil count Hand washing Tx depends on organism
Diet for Celiac Disease
Gluten free diet Beans, nuts, fruits, veggies, rice
Colorectal Cancer expected Lab Values
Increased BUN and Hemoglobin CRC, gene testing Occult blood testing, 3 seperate stools
Signs of Peritonitis
Infection can lead to rigid board like abd, sepsis, rupture and death Resp problems Electrolyte imbalance Acute kidney injury Systemic sepsis Flexed knees/guarding decreased/absent bowel sounds Hiccups n/v Tachycardia Decreased urine output
Dietary Recommendations for Diverticulitis exacerbation
Low fiber during inflammation, high after Rice Baked fish Grilled chicken breast Steamed veggies Apple juice Interventions: Eval all stools for blood Manage pain Sudden changes in vitals and mental status Palpate and for distention Gut rest
Nursing interventions Cirrhosis with Ascites
Measure girth each shift
Metoclopramide-adverse effects
Needle/trocar is inserted through the abdominal wall into the peritoneal
Bowel obstruction
Never give laxatives with fecal impaction Small bowel Low potassium and sodium
Acute pancreatitis client assessment on admission
Pain control NPO
Symptoms of Duodenal Ulcer
Pain occurs during night, 2-3 hours after meals
Symptoms of Appendicitis
Pain suddenly disappearing is a sign of rupture McBurney's point: Midway between the naval and iliac crest RLQ pain
Paracentesis what is it?
Remove ascitic fluid from abdomen
Metamucil
Safe for frequent use
Magnesium Hydroxide- what does it do?
Saline laxative works by causing water to be retained with stool Assess kidney function
Colonoscopy
Screening for polyps after age 45 if at risk and 50 for reg. Screening for rectal cancer
Colostomy
Sexuality can be an issue, refer to therapy or coping resources Encourage pt to voice concerns Refer pt to ostomy nurse Fecal output can take 24 hours after placement Pale and blue stoma is a sign of tissue death, notify provider immediately Small amount of blood is normal Excessive bleeding can be a sign of a serious problem, call provider
Carcinoembryonic Acid (CEA) what is expected levels? What is it?
Shows effectiveness of chemo Elevated with cancer
Crohn's Disease expected symptoms
Strattoreah Chronic blood loss (anemia) Unintentional weight loss Assess for distention, massesm visible peristalsis High pitched, rushing bowel sounds in RLQ Does not lead to bowel inflammation Elevated BUM HGB level of 8.0
How to take famotidine
Take at bedtime Don't chew, break, crush
Gastrectomy-dietary recommendations
Take vitamin and mineral supplements Small frequent meals avoiding carbs
Colostomy dietary recommendations to avoid flatus/odor
Yogurt Toast Crackers Bland foods
Gastroenteritis
diarrhea/vomiting Can cause dehydration Good hand washing
