Chapter 17: Gastrointestinal Alterations

The nurse is caring for a critically ill patient with end stage liver disease. The nurse knows that the patient is at risk for hyperdynamic circulation and varices. Which of the following assessments would indicate a hyperdynamic status? a. cardiac output of 8 L/min. b. normal sinus rhythm on the cardiac monitor. c. blood pressure of 180/90 mm Hg. d. Stools that are guaiac positive.

a. cardiac output of 8 L/min.

The liver detoxifies the blood by: a. converting fat-soluble compounds to water-soluble compounds. b. converting water-soluble compounds to fat-soluble compounds. c. excreting fat-soluble compounds in feces. d. metabolizing inactive toxic substances to active forms.

a. converting fat-soluble compounds to water-soluble compounds.

The patient is getting neomycin for treatment of hepatic encephalopathy. While the patient is receiving this medication, it is especially important that the nurse: a. evaluate renal function studies daily. b. give the medication every 12 hours. c. evaluate liver studies for signs of neomycin-induced damage. d. obtain stool guaiac tests to ensure that pathogens are being destroyed.

a. evaluate renal function studies daily.

Pain control is a nursing priority in patients with acute pancreatitis because pain: a. increases pancreatic secretions. b. is caused by decreased distention of the pancreatic capsule. c. decreases the patient's metabolism. d. is caused by dilation of the biliary system.

a. increases pancreatic secretions.

Nursing priorities for the management of acute pancreatitis include: (Select all that apply.) a. managing respiratory dysfunction. b. assessing and maintaining electrolyte balance. c. withholding analgesics that could mask abdominal discomfort. d. stimulating gastric content motility into the duodenum. e. utilizing supportive therapies aimed at decreasing gastrin release.

a. managing respiratory dysfunction. b. assessing and maintaining electrolyte balance. e. utilizing supportive therapies aimed at decreasing gastrin release.

The patient is admitted with pancreatitis and has severe ascites. In caring for this patient, the nurse should: a. monitor the patient's blood pressure and evaluate for signs of dehydration. b. restrict intravenous and oral fluid intake because of fluid shifts. c. avoid the use of colloid IV solutions in managing the patient's fluid status. d. only use crystalloid fluids to prevent IV lines from clotting.

a. monitor the patient's blood pressure and evaluate for signs of dehydration.

The nurse is caring for a patient with severe pancreatitis and who is orally intubated and on mechanical ventilation. The patient's calcium level this morning was 5.5 mg/dL. The nurse notifies the provider and: a. places the patient on seizure precautions. b. expects that the provider will come and remove the endotracheal tube. c. withhold any further calcium treatments. d. place an oral airway at the bedside.

a. places the patient on seizure precautions.

The patient is admitted with end-stage liver disease. The nurse evaluates the patient for which of the following? (Select all that apply.) a. Hypoglycemia b. Malnutrition c. Ascites d. Hypercoagulation e. Disseminated intravascular coagulation

b. Malnutrition c. Ascites e. Disseminated intravascular coagulation

The nurse is caring for a patient with liver disease. When assessing the patient's laboratory values, the nurse should: a. disregard the level of conjugated bilirubin. b. assess the indirect serum bilirubin. c. call the provider immediately if the direct bilirubin is elevated. d. be aware that unconjugated bilirubin is harmless.

b. assess the indirect serum bilirubin.

The patient is admitted with acute pancreatitis and is demonstrating severe abdominal pain, vomiting, and ascites. Using the Ranson classification criteria, the nurse determines that this patient: a. has a 99% chance of survival. b. has a 15% chance of dying. c. has a 40% chance of dying. d. has no chance of survival.

b. has a 15% chance of dying.

The nurse is caring for a patient with severe ascites due to chronic liver failure. The patient is lying supine in bed and complaining of difficulty breathing. The nurse's first action should be to: a. measure abdominal girth to determine the amount of fluid accumulation. b. position the patient in a semi-Fowler's position. c. prepare the patient for emergent paracentesis. d. administer diuretics.

b. position the patient in a semi-Fowler's position.

The patient is diagnosed with hepatitis. In caring for this patient, the nurse should: a. administer antiinflammatory medications. b. provide rest, nutrition, and antiemetics if needed. c. provide antianxiety medications freely to decrease agitation. d. instruct the patient to take over-the-counter antiinflammatory medications at home.

b. provide rest, nutrition, and antiemetics if needed.

Lactulose is considered the first-line treatment for hepatic encephalopathy and works by: a. causing ammonia to enter the bloodstream via the colon. b. trapping ammonia in the bowel for excretion. c. causing constipation and inhibiting the excretion of ammonia. d. creating an alkaline environment in the bowel.

b. trapping ammonia in the bowel for excretion.

The patient is admitted with severe abdominal pain due to pancreatitis. The patient asks the nurse, "What causes this? Why does it hurt so much?" The nurse should answer: a. "Pancreatitis is extremely rare and no one knows why it causes pain." b. "Pancreatitis is caused by diabetes; you should be checked." c. "Injury to certain cells in the pancreas causes it to digest (eat) itself, causing pain." d. "The pain is localized to the pancreas. Fortunately, it will not affect anything else."

c. "Injury to certain cells in the pancreas causes it to digest (eat) itself, causing pain."

The nurse is assessing the patient admitted with pancreatitis. In doing so, the nurse: a. palpates the pancreas for size and shape. b. emphasizes to the patient that pancreatic inflammation does not spread. c. assesses symptoms that could indicate involvement of the stomach. d. explains to the patient that back pain is not a sign of pancreatitis.

c. assesses symptoms that could indicate involvement of the stomach.

Metronidazole is being given to treat hepatic encephalopathy. When administering this medication, the nurse: a. watches the patient for diarrhea. b. evaluates renal function daily. c. assesses the patient for epigastric discomfort. d. instructs the patient that this medication must be taken for 2 weeks.

c. assesses the patient for epigastric discomfort.

The patient is admitted with acute pancreatitis and is later diagnosed as having a pseudocyst. The nurse realizes that: a. surgery for pseudocysts must be done immediately. b. a cholecystectomy is usually done when pseudocysts are found. c. pseudocysts may resolve spontaneously, so surgery may be delayed. d. pseudocysts require pancreatic resection, removing the entire pancreas.

c. pseudocysts may resolve spontaneously, so surgery may be delayed.

The liver plays a major role in homeostasis by: a. synthesizing factor I but not factor II. b. synthesizing clotting factors without the need for vitamin K. c. removing active clotting factors from the circulation. d. synthesizing factor II but not factor I.

c. removing active clotting factors from the circulation.

The nurse is caring for a patient with acute pancreatitis. To provide adequate pain control, the nurse: a. should suggest that the patient receive epidural analgesia. b. provides oral pain medication on an "as needed" (PRN) basis. c. removes any nasogastric tubes. d. administers pain medication on a routine schedule.

d. administers pain medication on a routine schedule.

The patient is admitted with acute pancreatitis. The nurse should: a. assess pain level because pancreatic pain is unique in character. b. examine laboratory values for low amylase levels. c. expect lipase levels to decrease within 24 hours. d. evaluate C-reactive protein as a gauge of severity.

d. evaluate C-reactive protein as a gauge of severity.

Trends in nutritional management of the patient with pancreatitis are changing. As a result, the nurse understands that: a. patients with pancreatitis must eat nothing in order to prevent release of secretin. b. nasogastric suction is essential in treating patients with pancreatitis. c. a nasogastric tube is no longer required to treat patients with ileus. d. immediate oral feeding in patients with mild pancreatitis may help recovery.

d. immediate oral feeding in patients with mild pancreatitis may help recovery.

The patient is being admitted to the hospital. At home, the patient take an over-the-counter supplement of Vitamin D and is concerned because the doctor did not order that vitamin D to be given in the hospital. The nurse explains that a. the body does not store vitamins so the doctor will have to be called. b. the kidneys will produce enough vitamin D and that supplements are not needed. c. over-the-counter supplements are never given in the hospital. d. vitamins D is stored in the liver with a 10-month supply to prevent deficiency.

d. vitamins D is stored in the liver with a 10-month supply to prevent deficiency.