Saunders Adult GI Part 1

The nurse is caring for a client within the first 24 hours following a total gastrectomy for gastric cancer. During this time frame, the nurse would focus on which priority intervention?

Maintaining a patent nasogastric (NG) tube

The nurse is reviewing a chart of a client with irritable bowel syndrome (IBS) that is taking linaclotide. Which item documented in the client's history would prompt the nurse to consult with the registered nurse?

Partial bowel obstruction

The nurse working in the emergency department is assisting with an initial assessment on a client who is complaining of severe upper abdominal pain that spreads throughout the abdomen and radiates to the back and shoulders. The client has tried taking antacids with no relief. On assessment the abdomen is rigid and bowel sounds are absent. Which data in the client's history would the nurse be most concerned about in connection with these assessment findings?

Peptic ulcer disease

The nurse is caring for a client with a small bowel obstruction. The nurse would notify the surgeon based on which findings noted on the physical assessment?

muscle guarding on palpation

The client has a prescription for sucralfate 1 g by mouth 4 times daily. The nurse would best schedule the administration of the medication at which time?

one hour before meals and bedtime

The nurse is caring for a client with a nasogastric (NG) tube and tests the pH of the aspirate to determine correct placement. The test results indicate a pH of 5. The nurse would determine this indicates which information?

placement of the NG tube is accurate

A client reports excessive sweating, muscular weakness, diarrhea, and achiness in the bones. The nurse suspects the client is deficient in which vitamin?

vitamin D

The nurse is reinforcing discharge instructions to a client who has had a total gastrectomy. The nurse instructs the client about the importance of returning as scheduled to the health care clinic for which priority assessment?

vitamin b12 and folic acid studies

The nurse is reviewing the primary health care provider's prescriptions for a client admitted to the hospital with a diagnosis of liver disease. Which medication prescription would the nurse most question?

Acetaminophen

A client with possible hiatal hernia complains of frequent heartburn and regurgitation. The nurse would gather further information about the presence of which sign or symptom?

Difficulty swallowing

A client receiving enteral feedings develops abdominal distention and diarrhea shortly after initiation of the feedings. Which is the appropriate intervention for the nurse to implement?

Notify the primary health care provider (PHCP) of the client's signs and symptoms

A client with ulcerative colitis had a new colostomy created 2 days earlier and is beginning to pass malodorous flatus from the stoma. What is the correct interpretation by the nurse?

This is a normal, expected event.

The nurse is reinforcing discharge instructions to a client with a hiatal hernia. Which considerations would the nurse include in the teaching session? Select all that apply.

- its advisable to stop smoking cigarettes - wait at least 1 hour after meals to perform chores - be sure to elevate HOB during sleep

A sexually active 20-year-old client has been diagnosed with viral hepatitis. Which statement made by the client would indicate a need for further teaching?

"I can never drink alcohol again."

A nurse organizing care for a client diagnosed with hepatitis plans to meet the client's safety needs by performing which action?

Monitoring prothrombin and partial thromboplastin values

The nurse who is assisting in the care of a client within the first 24 hours following a total gastrectomy for gastric cancer would avoid which intervention?

Irrigating the NG tube

A client diagnosed with hepatic encephalopathy is receiving lactulose. The nurse determines that the medication is effective if which finding is observed?

The client who was previously oriented to person only can now state name, year, and present location.

The client is taking docusate sodium. The nurse would monitor which result to determine if the client is having a therapeutic effect from this medication?

regular bowel movements

A client is admitted to the hospital with a diagnosed bowel obstruction secondary to a recurrent diagnosed malignancy. The primary health care provider plans to insert a Miller-Abbott tube. When the nurse tries to explain the procedure, the client interrupts the nurse and states, "I don't want to hear about that. Just let the doctor do it." Based on the client's statement, which action would the nurse determine is best?

remain with the client and be silent

A calcium supplement is prescribed for a client diagnosed with hypoparathyroidism in the management of hypocalcemia. The client arrives at the clinic for a follow-up visit and complains of chronic constipation, and the nurse reinforces instructions to the client about measures to alleviate the constipation. Which comment by the client would indicate a need for further teaching?

"I need to add 0.5 ounce of mineral oil to my daily diet."

The nurse reinforces medication instructions to a client with peptic ulcer disease. Which statement by the client indicates the best understanding of the medication therapy?

"The nizatidine will cause me to produce less stomach acid."

A client is admitted to an acute care facility with complications of celiac disease. Which question asked by the nurse initially would be most helpful in obtaining information for the nursing care plan?

"What is your understanding of celiac disease?"

A client is admitted from the emergency department with a diagnosis of bowel perforation. Which treatment strategies would the nurse anticipate based on this admitting diagnosis? Select all that apply.

- Electrocardiogram monitoring -Broad-spectrum antibiotic therapy -Insertion of an indwelling urinary catheter - Fluid replacement with lactated Ringer's solution

The nurse is reinforcing instructions to a client and his family about alcohol abuse and chronic cirrhosis. The nurse determines to include which essential elements in the discharge teaching guide? Select all that apply.

-Avoid potentially hepatotoxic over-the-counter drugs. - Teach symptoms of complications and when to seek prompt medical attention. -Explain that cirrhosis of the liver is a chronic illness and the importance of continuous health care. - Avoid spicy and rough foods and activities that increase portal pressure such as straining at stool, coughing, sneezing and vomiting.

The nurse is collecting data about how well a client diagnosed with a gastrointestinal (GI) disorder is able to digest food. The nurse determines that which processes are involved in the complete digestive process? Select all that apply.

-chemical - absorption - mechanical - active transport

An acutely ill-looking client arrives at the emergency department. The client complains of "the worst pain I ever felt in my belly. I can't get comfortable." The client is quiet but with each movement the client cries out in pain. The nurse suspects the client has peritonitis. Which data would the nurse collect to assist in validating this suspicion? Select all that apply.

-insect the abdomen for rigidity - check for the presence of hiccups - inspect the client's mucous membranes

The nurse is collecting physical assessment data for a patient with possible splenomegaly. The nurse should palpate which abdominal quadrant? Refer to figure.

2

A client with Crohn's disease has a prescription to begin taking antispasmodic medication. The nurse would schedule the medication so that each dose is taken at which time?

30 minutes before meals

The nurse is monitoring the intake and output of a client diagnosed with fatty liver disease that is exhibiting ascites. The nurse documents that the client has consumed 4 ounces of apple juice and 8 ounces of coffee with breakfast, 8 ounces of water and 8 ounces of tea with lunch, and 10 ounces of water with dinner. Additionally, the client received two doses of intravenous antibiotics mixed in 50 mL of normal saline. Also noted is 675 mL of urine output documented in the client's chart. What is the client's fluid balance in mL? Fill in the blank.

565

The nurse is talking to a nursing student about primary versus secondary peritonitis. The nurse determines that the student understands if the nursing student states which client is at risk for primary peritonitis?

A client with ascites related to cirrhosis

The nurse observes that a client's nasogastric tube has suddenly stopped draining. The tube is connected to suction, the machine is on and functioning, and all connections are snug. After checking placement, the nurse gently flushes the tube with 30 mL of normal saline, but the tube still is not draining. The nurse would conclude which is the problem, and what action would be taken?

Channels of gastric secretions may be bypassing the holes in the tube; turning the client will promote stomach emptying.

A client with Crohn's disease is scheduled to receive an infusion of infliximab. The nurse assisting with caring for the client would take which action to monitor the effectiveness of treatment?

Checking the frequency and consistency of bowel movements

A clear liquid diet has been prescribed for a client with gastroenteritis. Which item is appropriate to offer to the client?

Clam chowder

The nurse notes that the medical record of a client diagnosed with cirrhosis states that the client has asterixis. To effectively verify this information the nurse would take which action?

Ask the client to extend the arms

The nurse has a prescription to give 30 mL of an antacid through a nasogastric (NG) tube connected to wall suction. The nurse would do which best action to perform this procedure correctly?

Clamp the NG tube for 30 minutes following administration of the medication.

A client with viral hepatitis states to the nurse, "I am so yellow." The nurse would best respond by taking which action?

Assist the client in expressing feelings.

A primary health care provider places a Miller-Abbott tube in a client who has a diagnosed bowel obstruction. Six hours later, the nurse measures the length of the tube outside of the nares and notes that the tube has advanced 6 cm since it was first placed. Based on this finding, which action would the nurse take next?

Document the finding in the client's record.

A client is resuming a diet after partial gastrectomy. To minimize complications, the nurse would instruct the client to avoid which behavior?

Drinking liquids with meals

The nurse is reinforcing dietary instructions for a client diagnosed with peptic ulcer disease. Which action would the nurse encourage the client to do?

Eat anything as long as it does not aggravate or cause pain.

The nurse would document that a client diagnosed with a hiatal hernia is implementing effective health maintenance measures after the client reports doing which action?

Eating low-fat or nonfat foods

Before administering an intermittent tube feeding through a nasogastric tube, the nurse checks for gastric residual volume. Which is the best rationale for checking gastric residual volume before administering the tube feeding?

Evaluate absorption of the last feeding.

The nurse is caring for a client with dehydration. The nurse is aware that dehydration is associated with which imbalances?

Extracellular fluid volume deficit and hypernatremia

The nurse is collecting data on a client with a diagnosis of peptic ulcer disease. Which history would the nurse determine is least likely associated with this disease?

History of the use of acetaminophen for pain and discomfort

The nurse is providing care for a client suspected of having appendicitis. Which priority intervention would the nurse anticipate will be prescribed for this client?

No oral intake of liquids or food

A client diagnosed with acute pancreatitis is experiencing severe pain from the disorder. The nurse would instruct the client to avoid which position that could aggravate the pain?

lying flat

The nurse is participating in a health screening clinic and is preparing materials about colorectal cancer. The nurse would include which risk factor for colorectal cancer in the material?

Personal history of ulcerative colitis or gastrointestinal (GI) polyps

The nurse has inserted a nasogastric (NG) tube in a client and is checking for the correct placement of an NG tube. Which is the most reliable data to ensure that the end of the tube is in the stomach?

Placement is verified on x-ray.

The nurse is caring for a client with a Sengstaken-Blakemore tube. To effectively prevent ulceration and necrosis of oral and nasal mucosa, the nurse would plan to implement which action?

Provide frequent oral and nasal care on a regular basis.

The nurse is caring for a client with a diagnosis of acute anal fissure. Which characteristic assessment finding would the nurse expect to note?

Recent constipation

A client diagnosed with a peptic ulcer scheduled for a vagotomy asks the nurse about the purpose of this procedure. The nurse would explain to the client that a vagotomy primarily serves which purpose?

Reduces the stimulation of acid secretions

The nurse has assisted the primary health care provider with a liver biopsy, which was done at the bedside. Upon completion of the procedure, the nurse would assist the client into which position?

Right side-lying with a small pillow or towel under the puncture site

The nurse is administering a cleansing enema to a client with a fecal impaction. Before administering the enema, the nurse asks the client to assume a modified left lateral recumbent position. The nurse explains that this positioning is preferred because of which reason?

The enema will flow into the bowel easily.

The nurse is reinforcing instructions to a client about insertion of a Sengstaken-Blakemore tube. Which statement by the client indicates a need for further teaching?

The tube will be inserted through my mouth to my stomach.

The nurse observes that a client with a nasogastric tube connected to continuous gastric suction is mouth breathing, has dry mucous membranes, and has a foul breath odor. When planning care, which nursing intervention would be best to maintain the integrity of this client's oral mucosa?

Use diluted mouthwash and water to swab the mouth after brushing teeth.

The nurse working in an outpatient clinic is assisting with the admission intake on a client. The nurse asks about the reason for the visit, and the client describes a dull abdominal pain with diminished appetite and nausea. On further assessment, the pain is described as right sided and low, persistent, and continuous; the abdomen is tender, rigid with guarding and rebound tenderness. Based on the assessment findings, the nurse anticipates which diagnostic tests to be prescribed?

White blood cell count with differential

The nurse is teaching a client with a newly diagnosed hiatal hernia about measures to prevent recurrence of symptoms. Which statement is most appropriate to be included in the teaching?

"Avoid lying down for an hour after eating."

The nurse is teaching a client who is newly diagnosed with a hiatal hernia about measures to prevent recurrence of symptoms. Which statement would the nurse make to the client for consideration?

"Be sure to sleep with your head elevated in bed."

The nurse is providing discharge instructions to a client following hemorrhoidectomy. Which statement, if made by the client, indicates a need for further instruction?

"I should use a doughnut to relieve pressure while sitting down."

A client diagnosed with peptic ulcer disease and scheduled for a pyloroplasty asks the nurse about the procedure. The nurse would base the response on which information?

A pyloroplasty involves an incision and resuturing of the pylorus to relax the muscle and enlarge the opening from the stomach to the duodenum.

The nurse is instructing a client who had a herniorrhaphy about how to reduce postoperative swelling following the procedure. Which would the nurse suggest to the client to prevent swelling?

Elevate the scrotum.

The nurse is reviewing the record of a client with Crohn's disease. Which stool characteristic would the nurse expect to see documented in the record?

diarrhea

The nurse has been providing care for a client with a Sengstaken-Blakemore tube. While the tube is inflated the nurse would monitor for which priority sign/symptom?

respiratory distress

The nurse assigned to care for a client diagnosed with cirrhosis reviews the medical record and notes that the client has difficulty maintaining an effective breathing pattern due to pressure on the diaphragm. The nurse plans care knowing that which client position will best assist in facilitating breathing?

semi-fowlers

The nurse is caring for a client with a diagnosis of dehydration. Which laboratory finding, as noted in the client's medical record, supports this diagnosis?

sodium level of 149mEq/L

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

sweating and pallor

The nurse is administering pantoprazole to a client with gastroesophageal reflux disease (GERD). The nurse understands that pantoprazole has which potential adverse effects? Select all that apply.

- fx -pna - hypomagnesemia

The nurse is caring for a client with suspected esophageal stricture. Which statement from the client supports this diagnosis?

"I've been having trouble swallowing meat."

The nurse is reviewing concepts related to irritable bowel syndrome (IBS) with a nursing student. Which statement by the nursing student indicates there is a need for further teaching?

"IBS is characterized by only episodes of diarrhea."

A licensed practical nurse (LPN) is preparing to assist a registered nurse (RN) with removing a nasogastric (NG) tube from the client. Which interventions would be included in the procedure? Select all that apply.

- Explain the procedure to the client. - Ask the client to take a deep breath and hold. - Pull the tube out in one continuous steady motion. - Remove the device or tape securing the tube from the nose.

The nurse is reviewing a client's laboratory studies. Which laboratory studies support that the client is experiencing malnutrition? Select all that apply.

- Hemoglobin 8.6 g/dL (86 mmol/L)3 - Serum magnesium 1.3 mEq/L (0.53 mmol/L)5 - Alanine aminotransferase (ALT) 57 U/L (57 U/L) Submit

A primary health care provider asks the nurse to obtain a Salem sump tube for gastric intubation. The nurse would correctly select which tube from the unit storage area?

A tube with a larger lumen and an air vent

The nurse is interpreting the laboratory results of a client who has a history of diagnosed chronic ulcerative colitis. The nurse would determine that which result indicates a complication of ulcerative colitis?

Hgb 10.2

The nurse should include which most appropriate information when reinforcing home care instructions for a client who has been diagnosed with peptic ulcer disease?

Learn to use stress reduction techniques.

A client who has undergone a colostomy several days ago is reluctant to leave the hospital and has not yet looked at the ostomy site. Which measures will most likely promote coping? Select all that apply.

- Ask a member of the local ostomy club to visit with the client before discharge. - Ask the enterostomal nurse specialist to consult with the client before discharge. -Ask the client to begin doing one part of the ostomy care each day and increase tasks daily.

A client receiving a high cleansing enema complains of pain and cramping. Which corrective action is most appropriate for the nurse to take?

Clamp the tubing for 30 seconds and restart the flow at a slower rate.

The nurse analyzes the results of laboratory studies performed on a client with diagnosed peptic ulcer disease (PUD). Which laboratory value would most indicate a complication associated with the disease?

Hgb 10.2

The client complains of stomach pain 30 minutes to 1 hour after eating. The pain is not relieved by further intake of food, although it is relieved by vomiting, and a gastric ulcer is suspected. The nurse would gather which additional data from the client to support this diagnosis?

History of alcohol use, smoking, and weight loss

The nurse would include which instruction in a teaching plan for a client who has been diagnosed with peptic ulcer disease?

Learn to use stress reduction techniques.

The nurse gathers data from a client admitted to the hospital with a diagnosis of gastroesophageal reflux disease (GERD) scheduled for a Nissen fundoplication. Based on an understanding of this disease, the nurse would determine that the client may be most at risk for which complication?

aspiration

The nurse is getting a client who underwent umbilical hernia repair ready for discharge. The nurse explains to the client that it is important to continue to do which action after discharge?

avoid coughing

A client diagnosed with chronic gastritis has been told that there is too little intrinsic factor being produced. The nurse would explain to the client that which therapy will be prescribed to treat the problem?

vitamin B12 injections

The nurse is teaching a client with irritable bowel syndrome (IBS) about food items that may exacerbate the condition. The nurse identifies a need for further teaching if the client states which food item is acceptable to consume?

cauliflower

The nurse is caring for a client in the pre-operative period scheduled for a hemorrhoidectomy. The nurse would inform the surgeon about which medication, if noted in the client's home medication list?

clopidogrel

The nurse is caring for a client with a diagnosis of anal fistula. Which condition would the nurse most likely expect to note in the client's medical history?

crohn's disease

The nurse is collecting admission data on the client with a diagnosis of hepatitis. Which finding would the nurse recognize to be a direct result of this client's condition?

drowsiness

The nurse is preparing to administer an enteral feeding through a nasogastric tube. The nurse would place the client in which position during and after the feedings?

fowlers

The nurse is providing dietary instructions to a client with a diagnosis of ulcerative colitis. The client is prescribed to follow a low residue diet during episodes of diarrhea. Which food would the nurse instruct the client to avoid?

fresh corn on the cob

The nurse is assessing a client who fell at home and is complaining of abdominal pain. The nurse notes ecchymosis on the client's flanks and documents this as which assessment finding?

grey turner's sign

A client with a possible hiatal hernia complains of difficulty swallowing. Which other sign/symptom associated with a hiatal hernia would the nurse recognize?

heartburn and regurgitation

After the deflation of the balloon of a client's Sengstaken-Blakemore tube, the nurse would monitor the client closely for which priority esophageal complication?

hemorrhage

The nurse is caring for a client diagnosed with anal fistula and is monitoring for complications of this problem. Which priority complication would the nurse monitor for while managing care for this client?

infection

The nurse is caring for a client after a Billroth II (gastrojejunostomy) procedure. During review of the postoperative prescriptions, which would the nurse clarify?

irrigating the NG tube

The nurse is reviewing the health care record of a client with a diagnosis of chronic pancreatitis. The nurse would determine that which data noted in the record indicate poor absorption of dietary fats?

steatorrhea

The nurse is providing care for a client with with ulcerative colitis who underwent the creation of a transverse colostomy. Which observation requires immediate notification of the surgeon?

stoma has purple discoloration

The nurse is reinforcing home care instructions to a client following a gastric resection. The nurse would include which instruction to the client?

take actions to prevent dumping syndrome

The nurse is providing care for a client with a nasogastric tube. Which observation is most appropriate in determining that the tube is correctly placed?

the pH of the aspirate is 5

The nurse is asked to assist with preparing a client who will be receiving a continuous total parenteral nutrition (TPN) solution via a central line. The nurse plans to institute which interventions for this client related to the TPN? Select all that apply.

- Central line dressing changes per protocol -blood glucose monitoring around the clock -Using an electronic infusion pump with the infusion - Reviewing prescribed blood laboratory values including electrolytes Submit

When reinforcing dietary instructions to a client with irritable bowel syndrome whose primary symptom is alternating constipation and diarrhea, which foods would the nurse tell the client are best to include in the diet for this disorder? Select all that apply.

- apples - whole grain bread

The nurse is teaching the client with vitamin B12 deficiency about foods that are good sources of vitamin B12. The nurse identifies a need for further teaching if the client states which foods are good sources of vitamin B12? Select all that apply.

- broccoli - citrus fruits

The nurse is reinforcing teaching to a client diagnosed with an anal fissure. The nurse discusses the possible treatment measures for this problem. The nurse accurately identifies which measures during the teaching session? Select all that apply.

-topical nitrates - fiber supplements - Lateral sphincterotomy - Botox injections - topical calcium channel blockers

The nurse provides information to a client following a gastrectomy who is now diagnosed with pernicious anemia. Which instructions about pernicious anemia would the nurse reinforce to the client? Select all that apply.

- Provide meticulous and frequent oral hygiene. - Use additional lightweight blankets as needed. - Check blood serum vitamin B12 levels every 1 to 2 years.

The nurse caring for a client with a diagnosis of cholelithiasis observes for signs of obstruction of the bile ducts. Which assessment findings are indicative of this complication? Select all that apply.

- fever - jaundice - dark, foamy urine - clay-colored stools

The nurse is assisting in caring for a client that has arrived to the post-anesthesia care unit following an esophagogastroduodenoscopy (EGD) to confirm diagnosis of esophageal stricture. Which findings are signs of esophageal perforation? Select all that apply.

- fever - tachypnea - hypotension

A client has had a partial gastrectomy, and the nurse is reinforcing discharge instructions. The nurse would reinforce instructions to the client about the need for which supplements? Select all that apply.

-iron supplements - calcium supplements - vitamin b12 injections

The nurse is reviewing a client's medications. The nurse determines which medications increase the client's risk of dehydration? Select all that apply.

-lactulose -Spironolactone -polyethylene glycol

A client receiving iron supplements is complaining of constipation and the stool that is passed is black. Which information is appropriate for the nurse to share with the client? Select all that apply.

- Increase your fluid intake. - Include more fiber in your diet. - Ferrous sulfate changes the color of stool to black. - Iron slows colonic acid and often leads to constipation.

The nurse is reviewing a client's laboratory results. The nurse notes that which results support a diagnosis of dehydration? Select all that apply.

- Increased creatinine - Increased hemoglobin - Increased serum sodium - Decreased estimated glomerular filtration rate (eGFR)

The nurse working on the medical-surgical unit admits a client with acute appendicitis scheduled for an appendectomy the following morning. Which interventions would the nurse implement in managing care for this client in the pre-operative period? Select all that apply.

- Monitor vital signs - Administer antiemetics - Administer pain medications - Administer intravenous fluids - Nothing by mouth (NPO) status

The nurse is providing education to a client regarding foods that can aggravate the symptoms of gastroesophageal reflux disease (GERD). The nurse identifies a need for further teaching when the client states which foods are acceptable to consume? Select all that apply.

- cofee - chocolate - fried chicken

The nurse is reviewing the risk factors for Clostridium difficile (C. difficile) infection with a student nurse. The nurse would determine there is a need for further teaching if the student nurse identifies which clients as being at risk for developing a C. difficile infection? Select all that apply.

- A client with coronary artery disease - A client receiving total parenteral nutrition

The nurse is assisting in caring for a client who suffered blows to the face with a baseball bat and a gunshot wound to the abdomen. The nurse is reviewing the prescriptions in the client's medical record and determines there is a need for follow-up with the primary health care provider if which prescription is noted?

Nasogastric tube insertion

A client who has undergone a subtotal gastrectomy is being prepared for discharge. Which considerations concerning ongoing self-management would the nurse reinforce to the client? Select all that apply.

- Eat smaller and more frequent meals. - Drink fluids between meals, not with them.

The nurse is monitoring for stoma prolapse in a client with a colostomy. Which stoma observation would indicate that a prolapse has occurred?

protruding and swollen

The nurse is teaching a client with nonalcoholic fatty liver disease about measures to manage the condition. The nurse determines the client has a need for further teaching if the client makes which statement?

"I should stop taking my cholesterol medication as it puts stress on my liver."

Which infection control method would the nurse determine to be the priority to include in the plan of care to prevent hepatitis B in a client considered to be at high risk for exposure?

Hep B vaccine

A client complains of stomach pain 30 minutes to 1 hour after eating. The pain is not relieved by further intake of food, although it is relieved by vomiting. A gastric ulcer is suspected. The nurse would determine that which data would further support this diagnosis?

History of chronic obstructive pulmonary disease with weight loss

The nurse is reinforcing dietary instructions for a client diagnosed with peptic ulcer disease. Which statement made by the client indicates a need for further teaching?

I will eat a bland diet only.