Passpoint: GI Disorders
A client comes to the clinic for a follow-up appointment after diagnostic tests show gastroesophageal reflux disease. What instructions should the nurse reinforce? "Avoid alcohol and caffeine." "Drink 16 ounces of water with each meal." "Eat three well-balanced meals every day." "Lie down and rest after each meal."
"Avoid alcohol and caffeine." A client with gastroesophageal reflux disease should avoid alcohol, caffeine, and foods that increase acidity, all of which can cause epigastric pain. To further prevent reflux, the client should remain upright for 2 to 3 hours after eating; avoid eating for 2 to 3 hours before bedtime; avoid bending and wearing tight clothing; avoid drinking large fluid volumes with meals; and eat small, frequent meals to help reduce gastric acid secretion.
A client with a peptic ulcer is about to begin a therapeutic regimen that includes a bland diet, antacids, and ranitidine. Before the client is discharged, the nurse should provide which instruction? "Eat three balanced meals every day." "Avoid aspirin and products that contain aspirin." "Stop taking the drugs when your symptoms subside." "Increase your intake of fluids containing caffeine."
"Avoid aspirin and products that contain aspirin." Aspirin is a gastric irritant and should be avoided by clients with peptic ulcer to prevent further erosion of the stomach lining. The client should eat small, frequent meals rather than three large ones. Antacids and ranitidine prevent acid accumulation in the stomach; they should be taken even after symptoms subside. Caffeine should be avoided because it increases acid production in the stomach.
A client with recent onset of epigastric discomfort is scheduled for an upper GI series (barium swallow). When teaching the client how to prepare for the test, which instruction should the nurse provide? "Avoid eating or drinking anything for 6 to 12 hours before the test." "Take a potent laxative the day before the test." "Eat a clear liquid diet for 2 days before the test." "Eat a low-residue diet for 2 days before the test."
"Avoid eating or drinking anything for 6 to 12 hours before the test." The client must refrain from eating or drinking for 6 to 12 hours before an upper GI series. No other preparation is needed. Before a lower GI series, the client should eat a low-residue or clear liquid diet for 2 days and take a potent laxative (along with an oral liquid preparation).
A nurse reinforces education that has been provided to an older adult about good bowel habits. Which statement indicates that the client understands the information? "I should eat a diet that is low in fiber-rich foods." "Using a laxative each day will help to prevent constipation." "Fifteen minutes of exercise three times a week improves bowel habits." "I need to drink two to three glasses of fluid every day."
"Fifteen minutes of exercise three times a week improves bowel habits." Regular exercise for at least 15 minutes, three to four times a week can help to improve bowel elimination. The older adult client should gradually eliminate the use of laxatives and work to develop good bowel habits. The use of laxatives should occur only when necessary to decrease laxative dependence. A low fiber diet, reduced fluid intake, and laxative overuse do not promote good bowel health. Three to four quarts of fluid are recommended to improve bowel elimination.
A nurse has been asked to obtain a client's signature on an operative consent form. When the nurse approaches the client, who is scheduled for a cholecystectomy later in the day, the client asks the nurse why the procedure is needed. Which response by the nurse is appropriate? "The surgeon feels this is the best option for you at this time based on your symptoms." "I will ask the surgeon to come speak to you about the procedure." "You have stones in your gallbladder and the treatment is to remove the gallbladder." "This is a common procedure performed using a scope and will relieve your symptoms."
"I will ask the surgeon to come speak to you about the procedure." It is the surgeon's responsibility to explain the procedure to the client and to answer questions so the client can provide an informed consent. The nurse can reinforce the information after the consent is obtained and clarify the information, but the surgeon must explain the procedure initially.
The nurse is providing dietary instructions to a client with a history of pancreatitis. Which instruction is correct? "Maintain a high-fat, high-carbohydrate diet." "Maintain a high-carbohydrate, low-fat diet." "Maintain a high-fat diet and drink at least 3 L of fluid a day." "Maintain a high-sodium, high-calorie diet."
"Maintain a high-carbohydrate, low-fat diet." A client with a history of pancreatitis should avoid foods and beverages that stimulate the pancreas, such as fatty foods, caffeine, and gas-forming foods; should avoid eating large meals; and should eat plenty of carbohydrates, which are easily metabolized. An increased sodium or fluid intake isn't necessary because chronic pancreatitis isn't associated with hyponatremia or fluid loss.
A client with inflammatory bowel disease undergoes an ileostomy. On the first day after surgery, the nurse notes that the client's dusky-appearing stoma is related to which factor? An intestinal obstruction has occurred. Blood supply to the stoma has been interrupted. The ostomy bag should be adjusted. This is a normal finding 1 day after surgery.
Blood supply to the stoma has been interrupted. An ileostomy stoma is formed by bringing the ileum through the abdominal wall to the skin surface, creating an artificial opening for waste elimination. The stoma should appear cherry red, indicating adequate arterial perfusion. A dusky stoma suggests decreased perfusion, which may result from interruption of the stoma's blood supply and may lead to tissue damage or necrosis. Adjusting the ostomy bag wouldn't affect stoma color, which depends on blood supply to the area. An intestinal obstruction also wouldn't change stoma color.
The nurse is caring for a client who is postoperative after abdominal surgery and reporting "gas pains." What action by the nurse can assist the client with alleviating the discomfort associated with gas? Administer opioid analgesics. Have the client turn to the right side. Encourage the client to ambulate. Encourage the client to drink iced liquids.
Encourage the client to ambulate. The nurse should encourage the client to ambulate to increase peristaltic movement of the bowel to alleviate gas and promote bowel function. Opioid analgesics often make the problem of gas worse by slowing motility. Hot liquids and not cold promote the elimination of gas. The client should lay on the left side to promote evacuation of gas.
The nurse is assessing a client who complains of abdominal pain, nausea, and diarrhea. When examining the client's abdomen, which sequence should the nurse use? Inspection, auscultation, percussion, and palpation Inspection, palpation, percussion, and auscultation Auscultation, inspection, percussion, and palpation Palpation, auscultation, percussion, and inspection
Inspection, auscultation, percussion, and palpation The correct sequence for abdominal examination is inspection, auscultation, percussion, and palpation. This sequence differs from that used for other body regions (inspection, palpation, percussion, and auscultation) because palpation and percussion increase intestinal activity, altering bowel sounds. Therefore, the nurse shouldn't palpate or percuss the abdomen before auscultating. Assessment of any body system or region starts with inspection; therefore, auscultating or palpating the abdomen first would be incorrect.
When caring for a client with acute pancreatitis, the nurse should use which comfort measure? Administering an analgesic once per shift, as prescribed, to prevent drug addiction Encouraging frequent visits from family and friends Positioning the client on the side with the knees flexed Administering frequent oral feedings
Positioning the client on the side with the knees flexed The nurse should place the client with acute pancreatitis in a side-lying position with knees flexed; this position promotes comfort by decreasing pressure on the abdominal muscles. The nurse should administer an analgesic, as needed and prescribed, before pain becomes severe, rather than once each shift. Because the client needs a quiet, restful environment during the acute disease stage, the nurse should discourage frequent visits from family and friends. Frequent oral feedings are contraindicated during the acute stage to allow the pancreas to rest.
A client is scheduled for an endoscopy. On admission, the nurse asks the client if he has an advance directive, and the client states, "No." What should the nurse do next? Ask the client if he has a substitute document, such as a living will or a durable power of attorney. Provide the client with information about an advance directive. Advise the client that an advance directive is required before the procedure. Refer the client to the admissions office, where he can obtain an advance directive.
Provide the client with information about an advance directive. As a client advocate, a nurse must ensure that a client has adequate information on the advance directive so that he can make an informed decision about this legal document. A client isn't required to sign an advance directive before a procedure. Living wills and durable powers of attorney are forms of advance directives, not substitutes. The nurse should be able to inform the client about the advance directive and not have to refer the client to the admissions office for the information.
A client is scheduled for a laparoscopic cholecystectomy under general anesthesia. When the nurse asks the client what procedure the client will be having to compare with the informed consent, the client responds, "The doctor is going to take a piece of my liver out." What action should the nurse take at this time? Inform the client that the procedure will have to be canceled until the health care provider can provide further education about the type of surgery. Inform the client that he or she is mistaken and will not be having a portion of the liver removed. Shred the current consent form and provide another for the health care provider to sign. Request that the health care provider speak with the client before surgery to clarify the surgical procedure.
Request that the health care provider speak with the client before surgery to clarify the surgical procedure. Before the surgical procedure, the nurse must ensure that the client understands the type of procedure that will be performed. The nurse is obligated to inform the health care provider that what the client states and what is on the consent form conflict. The health care provider should then come to explain the procedure to the client. The health care provider may have discussed removing a portion of the liver for biopsy and not listed it on the consent form.
The client with a peptic ulcer is prescribed an antacid. After administering the medication, the nurse assesses the pH of which organ contents to determine effectiveness? Esophagus Large intestine Small intestine Stomach
Stomach The action of an antacid occurs in the stomach. The anions of an antacid combine with the acidic hydrogen cations secreted by the stomach to form water, thereby increasing the pH of the stomach contents. Increasing the pH and decreasing the pepsin activity provide symptomatic relief from peptic ulcer disease. Antacids don't work in the large or small intestine or in the esophagus.
A client is scheduled to undergo an exploratory laparoscopy. The registered nurse (RN) asks the licensed practical nurse (LPN) to prepare the client for surgery. The RN must confirm that the LPN has specialized training before delegating which task? initiating I.V. therapy, as ordered teaching the client coughing and deep breathing exercises weighing the client teaching the client how to collect a urine specimen
initiating I.V. therapy, as ordered The RN must confirm that the LPN has specialized I.V. training before asking the LPN to begin I.V. therapy for this client. Initiating I.V. therapy is beyond the usual scope of practice for an LPN. Weighing the client, teaching coughing and deep breathing exercises, and teaching the client how to collect a urine specimen are within the scope of LPN practice and don't require additional training.
A nurse is analyzing a client's laboratory values in the morning on a medical-surgical unit. Which laboratory value is critical to report the health care provider? Select all that apply. magnesium 1.2 mEq/L (1.2 mmol/L) sodium 158 mEq/L (158 mmol/L) chloride 100 mEq/L (100 mmol/L) bicarbonate 22 mEq/L (22 mmol/L) phosphate 3.5 mEq/L (3.5 mmol/L)
magnesium 1.2 mEq/L (1.2 mmol/L); sodium 158 mEq/L (158 mmol/L) The nurse needs to report the decreased magnesium level 1.2 mEq/L (1.2 mmol/L) and the increased sodium level 158 mEq/L (158 mmol/L). Potassium, sodium, calcium, and magnesium is needed for neuromuscular activity. Magnesium influences use of potassium, calcium, and protein, and when there is a magnesium deficit, there is frequently a potassium and calcium deficit. Normal bicarbonate levels are 20-30 mEq/L (20-30 mmol/L), normal phosphate levels are 3.0-4.5 mEq/L (3.0 - 4.5 mmol/L, and normal chloride is 95-105 mEq/L (95-105 mmol/L).
When assisting with development of a postoperative care plan for a client after gastric resection, which would be the priority? skin care nutritional needs body image spiritual needs
nutritional needs After gastric resection, a client may require total parenteral nutrition or jejunostomy tube feedings to maintain adequate nutritional status. Body image isn't much of a problem for this client because clothing can cover the incision site. Wound care of the incision site is necessary to prevent infection; otherwise, the skin shouldn't be affected. Spiritual needs may be a concern, depending on the client, and should be addressed as the client demonstrates readiness to share concerns.
A client with end-stage pancreatic cancer has decided to terminate medical intervention. What should a nurse anticipate when consulting with palliative care? decreased need for pain medications referral for bereavement counseling decreased need for nutritional supplementation decreased need for antidepressant medication
referral for bereavement counseling Referral to a bereavement counselor may help the client and the client's family make decisions about unfinished business. This client should continue to receive pain medications, antidepressants, and nutritional therapy at home and in the hospice setting. It isn't appropriate to decrease these comfort measures.
The nurse administers lactulose to a client with cirrhosis. Which finding indicates to the nurse that the medication has been effective? serum sodium level 156 mEq/L four or more loose stools in 24 hours reduction in abdominal ascites improvement in mental status
serum sodium level 156 mEq/L Lactulose, used to treat portal-systemic encephalopathy in clients with cirrhosis, works by acidifying colonic contents and trapping ammonia in the colon. The laxative action of lactulose assists in expelling the ammonia from the colon. This leads to a reduction in serum ammonia levels and improvements in mental and cardiac status. Diarrhea is a side effect caused by lactulose and is expected, but it is not the intended effect of the medication. Adverse effects of lactulose are increased serum sodium and decreased serum potassium levels. Abdominal ascites is not affected by this medication.
The nurse reinforces home care instructions given to a client with a diagnosis of hiatal hernia. Which statement made by the client indicates an understanding of the instructions? "I should eat three large, high-carbohydrate meals each day." "I'll drink carbonated cola beverages with my meals." "I'll sleep with my head elevated about 3 to 4 inches." "I'll be sure to lie down immediately after eating."
"I'll sleep with my head elevated about 3 to 4 inches." With a hiatal hernia, sleeping with the head of the bed elevated 30 degrees (about 3 to 4 inches [7.5 to 10 cm]) prevents stomach acids from refluxing into the esophagus. Carbonated beverages would create gas and belching (eructation), causing an increase in intra-abdominal pressure, which will irritate the herniated area. Lying down immediately after eating leads to the reflux of stomach acids, causing irritation. Clients with hiatal hernia should eat small meals.
Which nursing intervention is the best way to help reduce the occurrence of poisoning in children? Place the number for poison control in the home. Provide education to those who care for children. Identify children who are at risk of poisoning. Teach parents to read toy labels.
Provide education to those who care for children. Educating those who care for children about poisoning is the best way to reduce the occurrence of poisoning. Identifying high-risk groups will help but won't reduce poisoning. Reading toy labels will help to identify toys that may contain lead and may help reduce lead exposure. Having the number to poison control is essential if poisoning has occurred but will not prevent poisoning.
For a client who must undergo colon surgery, the physician orders preoperative cleansing enemas. The nurse anticipates administration of neomycin to this client to: decrease the intestinal bacteria count. control postoperative nausea and vomiting. prevent the development of megacolon. increase the intestinal bacteria count.
decrease the intestinal bacteria count. The antibiotic neomycin sulfate is prescribed to decrease the bacterial count and reduce the risk of fecal contamination during surgery. After surgery, the physician may prescribe an antiemetic — not an antibiotic — to control postoperative nausea and vomiting. Antibiotics have no relation to megacolon development. To prevent this complication, the client should avoid opioid analgesics, such as morphine, which can decrease intestinal motility and contribute to megacolon.
Which condition should the nurse closely monitor that may occur during chelation therapy in a child with lead poisoning? hypoglycemia hypocalcemia hyperglycemia hypercalcemia
hypocalcemia A calcium chelating agent is used for the treatment of lead poisoning, so calcium is removed from the body with the lead. Hypocalcemia, not hypercalcemia, occurs. Hyperglycemia and hypoglycemia don't occur as a result of chelation therapy.
