Gastrointestinal Disorders 2nd set
A client who is about to undergo gastric bypass surgery calls the nurse into the room. The client whispers to the nurse her concern that friends will learn about her upcoming surgery. She pleads with the nurse to keep her surgery a secret. Which response by the nurse is best?
"I'm not at liberty to discuss your case with anyone except those directly involved in your care unless you authorize me to do so."
Four months ago, the son and daughter of a client who was in a vegetative state gave consent for a feeding tube and agreed to long-term care placement. Nurses in the long-term care facility note that the son and daughter have recently become more distraught over their mother's condition. One day while visiting together, the son and daughter approach the nurse about having the feeding tube removed. Which statement by the nurse best explains the legal rights of individuals in this situation?
"Legally, there are no time constraints on previous decisions made
A client with extreme weakness, pallor, weak peripheral pulses, and disorientation is admitted to the emergency department. His wife reports that he has been "spitting up blood." A Mallory-Weiss tear is suspected, and the nurse begins taking a client history from the client's wife. The question by the nurse that demonstrates her understanding of Mallory-Weiss tearing is:
A Mallory-Weiss tear is associated with massive bleeding after a tear occurs in the mucous membrane at the junction of the esophagus and stomach. There is a strong relationship between forceful vomiting, and a Mallory-Weiss tear.
A client with a retroperitoneal abscess is receiving gentamicin (Garamycin). Which signs should the nurse monitor?
Adverse reactions to gentamicin include ototoxicity and nephrotoxicity. The nurse must monitor the client's hearing and instruct him to report any hearing loss or tinnitus. Signs of nephrotoxicity include decreased urine output and elevated BUN and creatinine levels.
After undergoing a liver biopsy, the client would be placed in which position?
After a liver biopsy, the client is placed on the right side (right lateral decubitus position) to exert pressure on the liver and prevent bleeding.
A client undergoes total gastrectomy. Several hours after surgery, the nurse notes that the client's nasogastric (NG) tube has stopped draining. How should the nurse respond?
An NG tube that fails to drain during the postoperative period should be reported to the physician immediately. It may be clogged, which could increase pressure on the suture site because fluid isn't draining adequately. Repositioning or irrigating an NG tube in a client who has undergone gastric surgery can disrupt the anastomosis. Increasing the level of suction may cause trauma to GI mucosa or the suture line.
The nurse is assessing the abdomen of a client who has suspected appendicitis and was admitted to the emergency department. Identify the area of the abdomen that the nurse should palpate last.
An acute attack of appendicitis localizes as pain and tenderness in the lower right quadrant, midway between the umbilicus and the crest of the ilium. This area should be palpated last in order to determine if pain is also present in other areas of the abdomen.
When assessing a client during a routine checkup, the nurse reviews the history and notes that the client had aphthous stomatitis at the time of the last visit. Aphthous stomatitis is best described as:
Aphthous stomatitis refers to a canker sore of the oral soft tissues, including the lips, tongue, and inside of the cheeks. Aphthous stomatitis isn't an acute stomach infection, acid indigestion, or early sign of peptic ulcer disease.
The home care nurse is making a visit with a client who had a double barrel colostomy created after bowel surgery. While the nurse is changing the client's appliance there is a knock on the door. The nurse answers the door. The client's next-door neighbor wants to visit with the client. Which intervention by the nurse is most appropriate?
Ask the neighbor to come back in 20 minutes.
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 8 hours before the test."
A client is recovering from an ileostomy that was performed to treat inflammatory bowel disease. During discharge teaching, the nurse should stress the importance of:
Because stool forms in the large intestine, an ileostomy typically drains liquid waste. To avoid fluid loss through ileostomy drainage, the nurse should instruct the client to increase fluid intake
A client is admitted to the health care facility with a diagnosis of a bleeding gastric ulcer. The nurse expects this client's stools to be:
Black, tarry stools are a sign of bleeding high in the GI tract, as from a gastric ulcer, and result from the action of digestive enzymes on the blood
A 72-year-old client seeks help for chronic constipation. This is a common problem for elderly clients due to several factors related to aging. Which is one such factor?
Decreased abdominal strength, muscle tone of the intestinal wall, and motility all contribute to chronic constipation in the elderly. A decrease in hydrochloric acid causes a decrease in absorption of iron and B12, whereas an increase in intestinal bacteria actually causes diarrhea.
During a client-teaching session, which instruction should the nurse give to a client receiving kaolin and pectin (Kaopectate) for treatment of diarrhea?
Drink 8 to 13 8-oz glasses (2 to 3 L) of fluid daily."
A client is diagnosed with shigellosis. The nurse teaches the client and family how the disease is transmitted and treated and discusses the need for enteric precautions. The nurse should explain that enteric precautions must be maintained:
Enteric precautions are required until three fecal cultures are negative for Shigella. Absence of diarrhea doesn't indicate absence of Shigella. Shigellosis is a bacterial infection, so no virus is shed. Shigella still may be present 48 hours after anti-infective therapy begins.
What is the primary nursing diagnosis for a client with a bowel obstruction?
Feces, fluid, and gas accumulate above a bowel obstruction. Then the absorption of fluids decreases and gastric secretions increase. This process leads to a loss of fluids and electrolytes in circulation.
A client with a recent history of rectal bleeding is being prepared for a colonoscopy. How should the nurse position the client for this test initially?
For a colonoscopy, the nurse initially should position the client on the left side with knees bent. Placing the client on the right side with legs straight, prone with the torso elevated, or bent over with hands touching the floor wouldn't allow proper visualization of the large intestine.
The nurse is assessing a client who is receiving total parenteral nutrition (TPN). Which finding suggests that the client has developed hyperglycemia?
Glucose supplies most of the calories in TPN; if the glucose infusion rate exceeds the client's rate of glucose metabolism, hyperglycemia arises. When the renal threshold for glucose reabsorption is exceeded, osmotic diuresis occurs, causing an increased urine output.
The nurse is teaching a client how to irrigate his stoma. Which action indicates that the client needs more teaching?
Hanging the irrigation bag 24″ to 36″ (60 to 90 cm) above the stoma
Which factor can cause hepatitis A?
Hepatitis A can be caused by consuming contaminated water, milk, or food — especially shellfish from contaminated water. Hepatitis B is caused by blood and sexual contact with an infected person. Hepatitis C is usually caused by contact with infected blood, including receiving blood transfusions.
A client is diagnosed with Crohn's disease after undergoing two weeks of testing. The client's boss calls the medical-surgical floor requesting to speak with the nurse manager. He expresses concern over the client and explains that he must know the client's diagnosis for insurance purposes. Which response by the nurse is best?
I appreciate your concern, but I can't give out any information
A client is admitted with increased ascites related to cirrhosis. Which nursing diagnosis should receive top priority?
In ascites, accumulation of large amounts of fluid causes extreme abdominal distention, which may put pressure on the diaphragm and interfere with respiration. If uncorrected, this may lead to atelectasis or pneumonia. Although fluid volume excess is present, the diagnosis Ineffective breathing pattern takes precedence because it can lead more quickly to life-threatening consequences.
A client is diagnosed with a hiatal hernia. Which statement indicates effective client teaching about hiatal hernia and its treatment?
In hiatal hernia, the upper portion of the stomach protrudes into the chest when intra-abdominal pressure increases. To minimize intra-abdominal pressure and decrease gastric reflux, the client should eat frequent, small, bland meals that can pass easily through the esophagus
During preparation for bowel surgery, a client receives an antibiotic to reduce intestinal bacteria. Antibiotic therapy may interfere with synthesis of which vitamin and may lead to hypoprothrombinemia?
Intestinal bacteria synthesize such nutritional substances as vitamin K, thiamine, riboflavin, vitamin B12, folic acid, biotin, and nicotinic acid. Therefore, antibiotic therapy may interfere with synthesis of these substances, including vitamin K.
While palpating a client's right upper quadrant (RUQ), the nurse would expect to find which of the following structures?
Liver
After checking the client's chart for possible contraindications, the nurse is administering meperidine (Demerol), 50 mg I.M., to a client with pain after an appendectomy. Which type of drug therapy would contraindicate the use of meperidine?
MAO inhibitors increase the effects of meperidine and can cause rigidity, hypotension, and excitation
A client seeks medical attention after developing acute abdominal pain. Which action by the nurse would help ensure accurate auscultation of the client's bowel sounds?
Making sure the client's bladder is empty before auscultating
After admission for acute appendicitis, a client undergoes an appendectomy. He complains of moderate postsurgical pain for which the physician prescribes pentazocine (Talwin), 50 mg by mouth every 4 hours. How soon after administration of this drug can the nurse expect the client to feel relief?
Orally administered pentazocine has an onset of action of 15 to 30 minutes, reaches peak concentration in less than 1 hour, and has a duration of 3 to 4 hours.
The nurse is monitoring a client receiving paregoric to treat diarrhea for drug interactions. Which drugs can produce additive constipation when given with an opium preparation?
Paregoric has an additive effect of constipation when used with anticholinergic drugs. Antiarrhythmics, anticoagulants, and antihypertensives aren't known to interact with paregoric.
The nurse should expect to administer which vaccine to the client after a splenectomy?
Pneumovax 23, a polyvalent pneumococcal vaccine, is administered prophylactically to prevent the pneumococcal sepsis that sometimes occurs after splenectomy.
A client with advanced cirrhosis has a prothrombin time (PT) of 15 seconds, compared with a control time of 11 seconds. The nurse expects to administer:
Prothrombin synthesis in the liver requires vitamin K. In cirrhosis, vitamin K is lacking, precluding prothrombin synthesis and, in turn, increasing the client's PT. An increased PT, which indicates clotting time, increases the risk of bleeding. Therefore, the nurse should expect to administer phytonadione (vitamin K1) to promote prothrombin synthesis
Which symptom is a warning sign of colon cancer?
Rectal bleeding of dark to bright red blood is a warning sign of colon cancer.
Nursing assessment of a client with peritonitis (acute or chronic inflammation of the peritoneum) reveals hypotension, tachycardia, and signs and symptoms of dehydration. The nurse also expects to find:
Severe abdominal pain with direct palpation or rebound tenderness Peritonitis decreases intestinal motility and causes intestinal distention. A classic sign of peritonitis is a sudden, diffuse, severe abdominal pain that intensifies in the area of the underlying causative disorder (such as appendicitis, diverticulitis, ulcerative colitis, or a strangulated obstruction).
After taking an antacid, the client asks the nurse where antacids act in the body. How should the nurse respond?
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 32-year-old male client with appendicitis is experiencing excruciating abdominal pain. An abdominal X-ray film reveals intraperitoneal air. The nurse should prepare the client for:
The client should be prepared for surgery because his signs and symptoms indicate bowel perforation.
While preparing a client for an upper GI endoscopy (esophagogastroduodenoscopy), the nurse should implement which interventions?
The client shouldn't eat or drink for 6 to 12 hours before the procedure to assure that his upper GI tract is clear for viewing. The client will receive a sedative before the endoscope is inserted that will help him relax, but allow him to remain conscious.
While preparing a client for cholecystectomy, the nurse explains that incentive spirometry will be used after surgery primarily to:
The high abdominal incision used in a cholecystectomy interferes with respirations postoperatively, increasing the risk of atelectasis. Ans. increase respiratory effectiveness
A client with gastroenteritis is admitted to an acute care facility and presents with severe dehydration and electrolyte imbalances. Diagnostic tests reveal the Norwalk virus as the cause of gastroenteritis. Based on this information, the nurse knows that:
The nurse must continue enteric precautions for a client with gastroenteritis caused by the Norwalk virus because this virus is transmitted by the fecal-oral route. No safe and effective antiviral agent is available specifically for treating viral gastroenteritis. The Norwalk virus isn't transmitted by droplets.
A client with a history of alcohol abuse comes to the emergency department and complains of abdominal pain. Laboratory studies help confirm a diagnosis of acute pancreatitis. The client's vital signs are stable, but the client's pain is worsening and radiating to his back. Which intervention takes priority for this client?
The nurse should address the client's pain issues first by administering morphine I.V. as prescribed. The other interventions don't take priority over addressing the client's pain issues.
A client with a history of stroke underwent a right hemicolectomy three days ago. The client is calling out, asking for pain medication. The nurse caring for the client is administering medications to her other clients when she hears him call out. Concerned that he is disturbing the other clients, she quickly administers his pain medication. A short time later, the nurse returns to the client's room and finds him very difficult to arouse. The nurse suddenly realizes that she administered 25 ml of the liquid medication instead of the prescribed 25 mg, which is contained in 5 ml. How could the nurse have prevented this error?
The nurse should always take the time to identify the client, carefully review the medication order, read the medication label, and calculate the ordered dose. Consistently following these steps helps prevent medication administration errors. The nurse should double-check her calculations with another nurse,
While a client is being prepared for discharge, the nasogastric (NG) feeding tube becomes clogged. To remedy this problem and teach the client's family how to deal with it at home, what should the nurse do?
The nurse should irrigate the tube with cola because its effervescence and acidity are suited to the purpose,
A client with complaints of right, lower quadrant pain is admitted to the emergency department. Blood specimens are drawn and sent to the laboratory. Which laboratory finding should be reported to the physician immediately?
The nurse should report the elevated WBC count, which is evident in option 2. This finding, which is a sign of infection, indicates that the client's appendix might have ruptured
As a result of a viral infection, a client develops gastroenteritis. The physician prescribes kaolin and pectin mixture (Kaopectate), 60 ml by mouth after each loose bowel movement, up to eight doses daily. The client asks the nurse how soon the medication will take effect. How should the nurse respond?
The onset of action of kaolin and pectin occurs within 30 minutes after oral administration. Duration of action is 4 to 6 hours.
The surgeon is discussing surgery with a client diagnosed with colon cancer. The client is visibly shaken over the possibility of a colostomy. Based on the client's response, the surgeon should collaborate with which health team member?
The surgeon should collaborate with the enterostomal nurse who can address the client's concerns. The enterostomal nurse may schedule a visit with a client who has a colostomy to offer support to the client
A client who underwent abdominal surgery who has a nasogastric (NG) tube in place begins to complain of abdominal pain that he describes as "feeling full and uncomfortable." Which assessment should the nurse perform first?
When an NG tube is no longer patent, stomach contents collect in the stomach giving the client a sensation of fullness. The nurse should begin by assessing patency of the NG tube. The nurse can measure abdominal girth, auscultate bowels, and assess vital signs, but she should check NG tube patency first to help relieve the client's discomfort.
The nurse is caring for a client with an endotracheal tube who receives enteral feedings through a feeding tube. Before each tube feeding, the nurse checks for tube placement in the stomach as well as residual volume. The purpose of the nurse's actions is to avoid:
aspiration.
A client with a bleeding peptic ulcer is admitted to an acute care facility. As part of therapy, the physician prescribes cimetidine (Tagamet) I.V. The nurse must avoid administering this drug too rapidly because doing so may cause:
bradycardia.
A college student comes to the campus health care center complaining of headache, malaise, and a sore throat that has gotten worse over the past 10 days. The nurse measures a temperature of 102.6° F (39.2° C) and finds an enlarged spleen and liver and exudative tonsillitis. Laboratory tests reveal a leukocyte count of 20,000/mm3, antibodies to Epstein-Barr virus, and abnormal liver function tests. These findings suggest:
infectious mononucleosis
The nurse is caring for a client who underwent a subtotal gastrectomy 24 hours ago. The client has a nasogastric (NG) tube. The nurse should:
irrigate the NG tube gently with normal saline solution if ordered.
A client is admitted with suspected cirrhosis. During assessment, the nurse is most likely to detect:
muscle wasting.
