NCLEX Gastrointestinal

The nurse reviews home care management instructions with a client who was recently diagnosed with cirrhosis. Which statement by the client indicates a need for further instructions?

"I will take Tylenol for discomfort."

A client has been receiving total parenteral nutrition (TPN) at home for several weeks, and the health care provider is considering discontinuing the TPN. The nurse is aware that the client should have an adequate dietary intake before TPN is discontinued. Which statement to the client would be helpful in determining the client's readiness to have the TPN discontinued?

"It will be helpful if you would keep a journal of what you eat every day."

A client who has had extensive surgery on the gastrointestinal tract is started on total parenteral nutrition (TPN). The client states to the nurse, "I feel like I'm starving and yet that bag is supposed to be feeding me." Which is the most appropriate response from the nurse?

"It's because an empty stomach sends signals to the brain to stimulate hunger."

The home care nurse provides instructions about the management of pruritus to a client diagnosed with jaundice. Which statement made by the client suggests to the nurse that the client needs further teaching?

"Keeping the house warmer is likely to lessen the itching"

The nurse is caring for a client with a diagnosis of severe malnutrition. Which statement made by the client suggests the presence of a common complication of this condition?

"Regardless of the weather, I always feel cold."

A multidisciplinary team working with the spouse of a home care client who has end-stage liver failure is teaching the spouse about pain management. Which statement by the spouse indicates the need for further teaching?

"The medication causes very deep sleep that my husband needs."

The nurse is evaluating a weight-reduction plan designed for an obese client. Which statement by the client indicates the need for further teaching?

"This diet doesn't let me go out for lunch with my friends at work anymore."

A client diagnosed with a bowel tumor is scheduled for radiation and surgery to create an ileostomy. The client asks the nurse about sexual function after the procedure. Which statement by the nurse is accurate?

"You will still be able to experience orgasm."

Which are a priority for assessing a client diagnosed with esophageal trauma? Select all that apply.

1.Bleeding 2.Vomiting 3.Breathing 4.Dysphagia

A client who undergoes a gastric resection is at risk for developing dumping syndrome. Which manifestation should the nurse monitor the client for? Select all that apply.

1.Pallor 2.Dizziness 3.Diaphoresis

What are some medical conditions that indicate that a client may be a candidate for a liver transplant? Select all that apply.

Cirrhosis. End-stage liver disease. Chronic hepatitis B and C. Autoimmune liver disease

A primary health care provider has discontinued a prescription for continuous suction to a catheter inserted into a newly created Kock pouch. Which solution should the nurse plan to use for periodic catheter irrigations prescribed by the primary health care provider?

10 to 20 mL normal saline

The nurse is assessing drainage from a nasogastric (NG) tube in a client after a gastric resection. No drainage is noted during the past 4 hours, and the client reports of severe nausea. The nurse should take what action?

Assesses for distention and notifies the surgeon

The laboratory results of a client with a history of chronic ulcerative colitis indicate anemia. The nurse determines that which factor is most likely responsible for this laboratory finding?

Blood loss

The nurse is caring for a client with a stress-related mucosal disorder (SRMD). The nurse uses clinical reasoning to determine that this client most likely developed this gastrointestinal disorder as a result of which condition?

Burn trauma

The nurse is caring for a client who is receiving an intermittent feeding via a nasogastric (NG) tube. Before feeding the client via the NG tube, which should the nurse do first?

Check the placement of the tube.

The nurse is caring for a client who is suspected of having upper gastrointestinal bleeding. Which clinical manifestations are characteristic of this disorder? Select all that apply.

3.Bloody vomitus 4.Black, tarry stools 5.Feeling of impending doom 6.Vomitus with a coffee-ground appearance

The client is receiving an enteral feeding that delivers 1.5 calories/mL. The feeding is infusing at 30 mL/hour through a feeding pump. What is the maximum number of calories the client should receive in an 8-hour period if the tube feeding is not interrupted? Fill in the blank.

360

The nurse is obtaining a health history of a client diagnosed with chronic calcifying pancreatitis. Which finding will the nurse expect to most likely note when obtaining information regarding the client's health history?

Chronic use of alcohol

A client arrives at the emergency department complaining of severe abdominal pain. During a quick assessment, the nurse observes that the client has both Cullen's sign and Grey Turner's sign. In which priority order should the nurse perform the actions? Arrange the actions in the order that they should be performed. All options must be used.

Assess vital signs and draw blood for prescribed laboratory tests. Administer prescribed pain medications intravenously. Hydrate the client with intravenous fluids. Place a nasogastric tube; client is NPO (nothing by mouth). Inquire about when pain occurs and previous history, including medications and alcohol.

A client who is advised to take senna for the treatment of constipation asks the nurse how this medication works. Which information provided by the nurse indicates an understanding of the medication action? Select all that apply.

Accumulates water in the stool and increases peristalsis. Changes the transport of water and electrolytes in the large intestine

The nurse caring for a client diagnosed with acute pancreatitis should give which client problem priority?

Acute pain related to inflammation and enzyme leakage

The nurse educates a client diagnosed with hepatitis about measures to use to control fatigue. The nurse determines that the client needs additional instructions if the client states the need to take which action?

Complete all daily activities in the morning when the client is most rested.

A client diagnosed with viral hepatitis reports having a poor appetite and that the presence of food causes nausea. The nurse should encourage which intervention to help assure adequate nutrition?

Consume the majority of calories in the morning hours.

The nurse is caring for a client with a diagnosis of malnutrition. Which is the most effective measure to monitor the client's nutritional status?

Daily weights

The nurse provides a client with dietary information about measures to prevent dumping syndrome after a gastric resection. Which instructions should the nurse give the client? Select all that apply.

Drink liquids between meals only. Eliminate milk, sweets, and sugars from the diet.

The nurse instructs a client at risk for hypokalemia about the foods high in potassium that should be included in the daily diet. The nurse determines that the client needs further teaching if the client states that which food is high in potassium?

Eggs

What intervention should the nurse plan to implement to prevent tracheal aspiration in a client diagnosed with a hiatal hernia?

Elevate the head of bed after meals.

A client with ascites from cirrhosis is being discharged to home. Which foods should the nurse encourage the client to include in the diet?

Fresh apples

A client diagnosed with a peptic ulcer frequently experiences the exacerbation of the disease. Which factor should the nurse consider as most likely causing the exacerbation of this condition?

Inability to take breaks at work or days off

The nurse is planning stress management strategies for the client diagnosed with irritable bowel syndrome (IBS). Which suggestion should the nurse give to the client?

Learn measures such as biofeedback or progressive relaxation.

A client has cirrhosis complicated by ascites. Which expected but adverse laboratory result should the nurse monitor for?

Low serum albumin

A client manages peptic ulcer disease (PUD) with excessive amounts of oral antacids. Signs/symptoms of which acid-base imbalance should the nurse assess for?

Metabolic alkalosis

The nurse is reviewing the laboratory results of a client hospitalized with a diagnosis of Crohn's disease. The client has a magnesium level of 1.0 mEq/L (0.5 mmol/L). Which is the most appropriate intervention for the nurse to implement?

Monitor the client for cardiac dysrhythmias.

When oral lactulose is prescribed for a client diagnosed with a hepatic disorder, the nurse provides medication education. The nurse determines that the client needs additional instructions if the client states the need to take which action?

Notify the doctor immediately if nausea occurs.

The nurse is monitoring a client who was recently prescribed total parenteral nutrition (TPN). Which action should the nurse take when obtaining a finger-stick glucose reading of 425 mg/dL (24.28 mmol/L)?

Notify the primary health care provider.

The nurse notes that the stoma of a client with a new colostomy is a dark, dusky color. Which is the action the nurse should take initially?

Notify the primary health care provider.

The nurse is discharging a client diagnosed with ulcerative colitis who has been prescribed a low-residue diet. What foods should the nurse teach this client to avoid? Select all that apply.

Nuts, grains, raw fruit, whole wheat

The nurse suspects that the client who experienced gastric bypass surgery 3 days ago has developed an anastomotic leak. What assessment findings most likely validate this suspicion? Select all that apply.

Oliguria. Restlessness. Abdominal pain. Unexplained tachycardia.

A client with a history of duodenal ulcer is reporting abdominal pain. The nurse interprets that the client's discomfort is consistent with this disease when which is noted?

Pain is relieved by food intake.

Which is the priority order of the steps the nurse will implement for the application of an ostomy appliance? Arrange the actions in the order they should be performed. All options must be used.

Perform hand hygiene and don gloves. Remove used pouch and barrier. Cleanse peristomal area with warm water. Assess stoma and skin. Cut opening on appliance 1/16 inch larger than stoma. Press adhesive backing of pouch against skin.

The nurse is preparing to feed a client diagnosed with dysphagia. Which action should the nurse perform to best assist the client with swallowing?

Provide foods that have a soft consistency.

A primary health care provider prescribes the deflation of the esophageal balloon of a Sengstaken-Blakemore tube used to treat esophageal varices. Which problem is the client at risk for due to the deflation of the esophageal balloon?

Recurrent hemorrhage from the esophageal varices

A client is admitted to the hospital with a tentative diagnosis of pernicious anemia. The nurse assesses the client for which signs/symptom to help confirm the diagnosis?

Red tongue that is smooth and sore

The clinic nurse is assessing a client who had a total gastrectomy 2 months ago. Which assessment would indicate a specific complication of this surgical procedure if it exists?

Signs/symptoms of vitamin B12 deficiencies

The nurse caring for a client with a diagnosis of chronic pancreatitis collects data on the client, knowing that which sign/symptom indicates poor absorption of dietary fats?

Steatorrhea

A client who has a subtotal gastrectomy is prescribed an oral diet. The nurse should plan to monitor the client for which signs/symptoms of dumping syndrome?

Weakness, diaphoresis, and diarrhea

A diet consisting of bland foods has been prescribed for a client diagnosed with symptomatic peptic-ulcer disease. The nurse provides dietary instructions encouraging the client to avoid which food?

cola

A client diagnosed with peptic ulcer disease has been taught dietary modifications to reduce episodes of epigastric pain. The nurse determines that the client understands the information if the client states the intention to limit or eliminate which item from the diet? Select all that apply.

tea, beer, fresh apples

A client with a hiatal hernia asks the nurse about fluids that are safe to drink and that will not irritate the gastric mucosa. What fluid should the nurse tell the client to drink?

Apple juice

The surgery center nurse is performing discharge teaching to a postoperative laparoscopic cholecystectomy (gallbladder surgery) client who is reporting thoracic discomfort. What comment by the client indicates that further teaching is needed?

"I know that heat to my chest area will make the discomfort worse."

The home care nurse visits a client who is receiving continuous total parenteral nutrition (TPN) through a central venous catheter. Which statement by the client indicates the need for further teaching regarding the TPN?

"I slowed the IV down yesterday because I was feeling full."

The nurse is providing instructions to a client with peptic ulcer disease about symptom management. Which statement by the client indicates that teaching was effective?

"It is important that I eat slowly and chew my food thoroughly."

The nurse assesses a client with hepatic encephalopathy for the presence of asterixis. What should the nurse do to appropriately test for asterixis?

Ask the client to extend the wrist and the fingers.

A client presents to the emergency department complaining of acute abdominal pain. The client is suspected of having an upper gastrointestinal (GI) bleed. The client's vital signs are blood pressure (BP), 92/72 mm Hg; Spo2, 85%; apical pulse rate, 113 beats per minute; and respirations, 22 breaths per minute. Which priority action should the nurse plan to take?

Administer O2 via non-rebreather face mask.

A client admitted to the hospital with a diagnosis of Laënnec's cirrhosis is ready for discharge and expresses the motivation to prevent this condition from worsening. To assist this client, which resource should the nurse inform the client about?

Alcoholics Anonymous

A client has had a nasointestinal (NI) tube in place for 24 hours. Which assessment finding indicates that the tube is properly located in the intestine?

Aspirate from the tube has a pH of 7.

A client admitted to the hospital with a diagnosis of cirrhosis demonstrates massive ascites causing dyspnea. The nurse performs which intervention as a priority measure to assist the client with this complication?

Elevates the head of the bed 60 degrees

A client has just had surgery to create an ileostomy. The nurse reminds the nursing student who is caring for the client to assess for which frequent complication of this surgery in the immediate postoperative period?

Fluid and electrolyte imbalance

The nurse performing a history and physical assessment on a client diagnosed with peptic ulcer disease determines that which datum is unrelated to the client's current disorder? Select all that apply.

Frequent use of acetaminophen. Consumes noncaffeinated beverages only

A client has sustained chemical burns to the esophagus after the ingestion of lye. Which prescription should the nurse plan to question?

Gastric lavage

A client is diagnosed with pernicious anemia. Which risk factor is associated with the development of this type of anemia?

Gastric resection

The nurse is conducting dietary teaching with a client diagnosed with cholecystitis. The nurse tells the client that which food item is acceptable to eat?

Grilled swordfish

To stop the bleeding in a client with esophageal varices, a Sengstaken-Blakemore tube is inserted. After insertion of the tube, the nurse implements safety measures and takes which additional actions?

Has suction available and scissors at the bedside

The nurse caring for a client with a diagnosis of cirrhosis and hepatopulmonary syndrome should maintain the client in what position while in bed?

Head of the bed elevated at least 30 degrees

A client diagnosed with irritable bowel syndrome has been prescribed dicyclomine. Which frequent side effects of this medication should the nurse assesses the client for?

Heartburn and constipation

The nurse understands that which bacterial organisms are a primary cause of gastritis? Select all that apply.

Helicobacter pylori. Staphylococcus organisms

The nursing instructor teaching a group of nursing students about preventive measures for diverticular disease should recommend which intervention for the prevention of this disease? Select all that apply.

High fluid intake. A high-fiber diet. Low intake of red meat. A diet consisting mainly of fruits and vegetables

A client diagnosed with cirrhosis of the liver is receiving oral triamterene daily. Which sign/symptom would indicate to the nurse that the client is experiencing an adverse effect of the medication?

Hyperkalemia

The nurse is consulting with a dietitian in planning a menu for a hospitalized client who is a vegan on a regular diet. Which food item is most appropriate for the nurse and the dietitian to include in the client's meal?

Stir-fried vegetables