Digestive System (3 of 3)
A client will be having a total colectomy in 4 days. The client does not have an obstruction. What does the nurse anticipate instructing the client about doing prior to the surgery to prepare the bowel?
Instructing the client about dietary restrictions and lavage agents
A client who is scheduled for an ileostomy surgery and been taking corticosteroids is instructed to taper the drug, eventually discontinuing it. The nurse would monitor this client for which of the following?
adrenal insufficiency
A client comes to the clinic and informs the nurse that he is there to see the physician for right upper abdominal discomfort, nausea, and frequent belching especially after eating a meal high in fat. What disorder do these symptoms correlate with?
cholelithiasis
A client has developed drug-induced hepatitis from a drug reaction to antidepressants. What treatment does the nurse anticipate the client will receive to treat the reaction?
high dose corticosteroids
What potentially life-threatening complication can the client have if corticosteroids are abruptly withdrawn or the client has significant stress due to the impending surgical procedure?
adrenal crisis
Which intervention would be most appropriate for a client who has undergone colostomy surgery?
Monitoring the volume of gastric secretions.
A client is scheduled to have a laparoscopic cholecystectomy as an outpatient. The client asks the nurse when he will be able to resume normal activities. What information should the nurse provide?
Normal activities may be resumed in 1 week.
The nurse is reviewing laboratory work that is consistent with a client being positive for hepatitis and in the incubation phase of the illness. What should the nurse be concerned with at this stage of the illness?
The client is infectious.
What test should the nurse prepare the client for that will locate stones that have collected in the common bile duct?
Endoscopic retrograde cholangiopancreatography (ERCP)
The nurse is listening for bowel sounds in a postoperative patient. The bowel sounds are slow, as they are heard only every 3 to 4 minutes. The patient asks the nurse why this is happening. What is the nurse's best response?
"Anesthesia during surgery and pain medication after surgery may slow peristalsis in the bowel."
The nurse is instructing a client with an ileostomy on appliance use and changing it. What statement made by the client demonstrates the client understands of using a new appliance for the first time?
"I will patch test it first on nonirritated skin at the inner aspect of my forearm."
A client who is scheduled for an ileostomy surgery says to the nurse, "I'm afraid I won't be able to look at that stoma." Which response by the nurse would be most therapeutic?
"I'll make sure there is a familiar nurse here with you the first time."
A client is to undergo surgery for the creation of a continent ileostomy. Which statement by the client indicates successful teaching?
"I'll need to learn how to empty the reservoir several times a day."
A client with an ileostomy who has been discharged from the hospital calls the clinic and asks the nurse if he should take another one of his "potassium pills" because there is a waxy coating on the ileostomy from the pill. What is the best response by the nurse?
"Some medications like this leave a "ghost" of the wax matrix coating, but it doesn't mean the drug wasn't absorbed."
A patient who was diagnosed with senile dementia has become incontinent of urine. The patient's daughter asks the nurse why this is happening. What is the nurse's best response?
"The patient is losing sphincter control due to the dementia."
A male client, age 32 years, was recently married, and he and his wife would like to have children. The client is scheduled to have a total colectomy and is concerned with being able to have children. What is the best answer given by the nurse related to the client's concern?
"You may want to consider collection and storing of sperm for later use if you are planning to have children."
A client scheduled for a total colectomy has been taking the immunosuppressive agent, azathioprine. When should the client be told to discontinue the medication to prevent negative effects on tissue healing?
1 month before surgery
The nurse is caring for a client in the immediate postoperative phase after having a colostomy created. What type of appliance should the nurse use at this time?
A disposable or temporary appliance should be used.
The client expresses fears about looking at the stoma for the first time. What can the nurse inform the client will occur when he first views and touches the stoma?
An assigned staff nurse will be there when the stoma is exposed for view.
The nurse is caring for a client with cirrhosis of the liver. What symptoms exhibited by the client would indicate to the nurse that he is experiencing central nervous system effects of the disease? Select all that apply.
Asterixis. Positive Babinski reflex. Fetor hepaticus.
A client with gallstones tells the nurse, "The doctor has to do something. Isn't there something he can give me to dissolve them?" What medication does the nurse know may help dissolve the gallstones?
Chenodiol
A client who will be having a portion of colon removed and colostomy created informs the nurse that he "will not be attractive any longer." The nurse determines the nursing diagnosis is Disturbed Body Image related to the stoma and altered bowel elimination. What expected outcome related to this diagnosis will the client have?
Client verbalizes what the changes will be and the benefits to future health.
A client is having the first stage of an ileoanal anastomosis. What should the nurse inform the client they will experience?
Continuous discharge of mucus from the anus
A client is scheduled to have a total colectomy due to a colon mass and is also taking prednisone for asthma. The physician has instructed the client to taper down on the prednisone and discontinue. What negative outcome does the nurse know may occur if the client does not adhere to the instructions?
Delayed or altered tissue healing
A client with an ileostomy tells the nurse that he is having a lot of problems with the formation of gas. What can the nurse tell the client to help her with this common issue?
Eat slowly and chew food well with mouth closed.
The nurse is discussing care of the client's ileostomy and is instructing the client to avoid certain medications that may pass through without being absorbed. What medications should the nurse instruct the client to avoid? Select all that apply.
Enteric-coated products Slow-release beads Layered tablets
The nurse is caring for a patient who has suffered a spinal cord injury and is concerned about the patient's elimination status. What is the nurse's best action?
Establish a bowel and bladder program for the patient.
The nurse is preparing to irrigate a client's single-barrel colostomy after surgery. The nurse would expect an order from the healthcare provider to irrigate the colostomy on what day after surgery?
Fourth or fifth postoperative day
A client had an open cholecystectomy with a T-tube insertion, and the nurse is measuring the bile drainage every 8 hours. When should the nurse notify the physician?
If more than 500 mL of bile drainage is present in 24 hours.
A client with severe acute pancreatitis has a glucose level of 750 mg/dL. What does the nurse understand is the cause of this level of hyperglycemia?
Imbalance of glucagon, insulin, and somatostatin
During an assessment, the patient states that his bowel movements cause discomfort because the stool is hard and difficult to pass. As the nurse, you make which of the following suggestions to assist the patient with improving the quality of his bowel movement? (Select all that apply.)
Increase fiber intake. Increase water consumption.
A client is to have a total colectomy and has been on prednisone 3 months ago for the treatment of Crohn's disease. What medication does the nurse anticipate administering in the preoperative phase to prevent adrenal crisis?
Intravenous hydrocortisone
The nurse is providing ostomy care to the client with an ileostomy. What can the nurse use to protect the skin and promote adhesion of the ostomy appliance?
Karaya gum
The client is having a total colectomy with an ileostomy created. What does the nurse explain to the client that the stool consistency will be?
Liquid or mushy
A male client will be having an ileoanal anastomosis for the treatment of chronic ulcerative colitis. What is the benefit to this client of having this procedure rather than a total colectomy? Select all that apply.
Maintains bowel continence Unlikely to experience bladder dysfunction Unlikely to experience erectile dysfunction Unlikely to experience infertility
A client is preparing to have colorectal surgery and will have a colostomy created temporarily in hopes that he may be able to have it reversed in 6 months. The client is very concerned about the care of the colostomy. What preoperative interaction would the client benefit from?
Meeting with an enterostomal therapist
What is a primary prevention tool used for colon cancer screening?
Occult blood testing
A client is admitted to the hospital with acute hemorrhage from esophageal varices. What medication should the nurse anticipate administering that will reduce pressure in the portal venous system and control esophageal bleeding?
Octreotide
A client has had surgery to create an ileoanal reservoir surgery. Which instruction would the nurse give to reduce the risk for bowel incontinence?
Perform perineal exercises.
When the nurse is teaching the client about attachment of the faceplate around the stoma, what measure will ensure secure attachment of the pouch to the peristomal skin?
Press the adhesive faceplate around the stoma for about 30 seconds.
A nurse is preparing to administer the prescribed vitamin B12 to a client who has had most of his ileum removed. The nurse understands that this is necessary for which reason?
Prevents deficiencies
When conducting a health history assessment, the nurse would want to know what most important information about the patient's elimination status? (Select all that apply.)
Recent changes in elimination patterns Changes in color, consistency, or odor of stool or urine Discomfort or pain with elimination List of medications taken by patient
A client with cirrhosis has portal hypertension, which is causing esophageal varices. What is the goal of the interventions that the nurse will provide?
Reduce fluid accumulation and venous pressure.
The nurse is asking the client with acute pancreatitis to describe the pain. What pain symptoms does the client describe related to acute pancreatitis?
Severe mid-abdominal to upper abdominal pain radiating to both sides and to the back
The nurse is administering furosemide to promote urinary excretion of excess fluids for a client with cirrhosis. When administering furosemide to this client, what should the nurse closely monitor?
Sodium level
A client with a colostomy is concerned with the odor that is left on the ostomy appliance and believes it may be caused by some of the medication that they take. What suggestion should the nurse provide to the client to determine if her medication is causing this problem?
The client can obtain a list of drugs from an ostomy association or appliance manufacturers.
A client has been discharged from the acute care facility with an ileostomy. The client comes to the clinic for a follow-up visit and informs the nurse that the wound has been draining and they are having abdominal pain and running a fever. What does the nurse suspect is occurring with the client?
The client has developed a wound infection.
The nurse is assisting the physician with a procedure to remove ascitic fluid from a client with cirrhosis. What procedure does the nurse ensure the client understands will be performed?
abdominal paracentesis
Which of the following instructions should the nurse include in the teaching plan of a client who has undergone colostomy?
chew food well
A client is seeing the physician for a suspected tumor of the liver. What laboratory study results would indicate that the client may have a primary malignant liver tumor?
elevated alpha fetoprotein
The nurse is assessing the stool consistency of a client with an ascending colostomy. Which of the following would the nurse expect to find?
semiliquid
The process of digestion is important for every living organism for the purpose of nourishment. Where does most digestion take place in the body?
small intestine
A client is having a procedure that will remove the entire colon and rectum and will bring the end of the ileum through a separate area on the right lower quadrant of the abdomen. What type of procedure does the nurse understand this client will be having?
total colectomy
The nurse is preparing a client for surgery and observes on the operative permit that the client will be having a double-barrel colostomy. What portion of the large intestine is the nurse aware that this is performed?
transverse
A client who had a total colectomy with an ileostomy has rectal packing in place to absorb drainage and promote healing. When does the nurse know that the rectal packing will be removed?
within 1 week
