Gastrointestinal Disorders
Which of the following client statements indicates that the client with hepatitis B understands discharge teaching? A) "I will not drink alcohol for at least 1 year." B) "I must avoid sexual intercourse." C) "I should be able to resume normal activity in a week or two. D) "Because hepatitis B is a chronic disease, I know I will always be jaundiced."
A) "I will not drink alcohol for at least 1 year." Reason: It is important that the client understand that alcohol should be avoided for at least 1 year after an episode of hepatitis. Sexual intercourse does not need to be avoided, but the client should be instructed to use condoms until the hepatitis B surface antigen measurement is negative. The client will need to restrict activity until liver function test results are normal; this will not occur within 1 to 2 weeks. Jaundice will subside as the client recovers; it is not a permanent condition.
A nurse preceptor is working with a student nurse who is administering medications. Which statement by the student indicates an understanding of the action of an antacid? A) "The action occurs in the stomach by increasing the pH of the stomach contents and decreasing pepsin activity. " B) "The action occurs in the small intestine, where the drug coats the lining and prevents further ulceration." C) "The action occurs in the esophagus by increasing peristalsis and improving movement of food into the stomach." D) "The action occurs in the large intestine by increasing electrolyte absorption into the system that decreases pepsin absorption
A) "The action occurs in the stomach by increasing the pH of the stomach contents and decreasing pepsin activity. "Reason: 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 nurse preceptor is working with a student nurse who is administering medications. Which statement by the student indicates an understanding of the action of an antacid? A) "The action occurs in the stomach by increasing the pH of the stomach contents and decreasing pepsin activity." B) "The action occurs in the small intestine, where the drug coats the lining and prevents further ulceration." C) "The action occurs in the esophagus by increasing peristalsis and improving movement of food into the stomach." D) "The action occurs in the large intestine by increasing electrolyte absorption into the system that decreases pepsin absorption."
A) "The action occurs in the stomach by increasing the pH of the stomach contents and decreasing pepsin activity." Reason: 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.
The comatose victim of the car accident is to have a gastric lavage. Which of the following positions would be most appropriate for the client during this procedure? A) Lateral. B) Supine. C) Trendelenburg's. D) Lithotomy.
A) Lateral. Reason: An unconscious client is best positioned in a lateral or semiprone position because these positions allow the jaw and tongue to fall forward, facilitate drainage of secretions, and prevent aspiration. Positioning the client supine carries a major risk of airway obstruction from the tongue, vomitus, or nasopharyngeal secretions. Trendelenburg's position, with the head lower than the heart, decreases effective lung volume and increases the risk of cerebral edema. The lithotomy position has no purpose in this situation.
Prochlorperazine (Compazine) is prescribed postoperatively. The nurse should evaluate the drug's therapeutic effect when the client expresses relief from which of the following? A) Nausea. B) Dizziness. C) Abdominal spasms. D) Abdominal distention.
A) Nausea. Reason: Prochlorperazine is administered postoperatively to control nausea and vomiting. Prochlorperazine is also used in psychotherapy because of its effects on mood and behavior. It is not used to treat dizziness, abdominal spasms, or abdominal distention.
A client with a bleeding ulcer is vomiting bright red blood. The nurse should assess the client for which of the following indicators of early shock? A) Tachycardia. B) Dry, flushed skin. C) Increased urine output. D) Loss of consciousness.
A) Tachycardia. Reason: In early shock, the body attempts to meet its perfusion needs through tachycardia, vasoconstriction, and fluid conservation. The skin becomes cool and clammy. Urine output in early shock may be normal or slightly decreased. The client may experience increased restlessness and anxiety from hypoxia, but loss of consciousness is a late sign of shock.
A client with cholecystitis is taking Propantheline bromide (Pro-Banthine). The expected outcome of this drug is: A) Increased bile production. B) Decreased biliary spasm. C) Absence of infection. D) Relief from nausea.
B) Decreased biliary spasm. Reason: Propantheline bromide is an anticholinergic used to decrease biliary spasm. Decreasing biliary spasm helps to reduce pain in cholecystitis. Propantheline does not increase bile production or have an antiemetic effect, and it is not effective in treating infection.
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: A) the client requires an antiviral agent. B) enteric precautions must be continued. C) enteric precautions can be discontinued. D) the client's infection may be caused by droplet transmission.
B) enteric precautions must be continued. Reason: 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.
Before an incisional cholecystectomy is performed, the nurse instructs the client in the correct use of an incentive spirometer. Why is incentive spirometry essential after surgery in the upper abdominal area? A) The client will be maintained on bed rest for several days. B) Ambulation is restricted by the presence of drainage tubes. C) The operative incision is near the diaphragm. D) The presence of a nasogastric tube inhibits deep breathing.
C) The operative incision is near the diaphragm. Reason: The incisions made for upper abdominal surgeries, such as cholecystectomies, are near the diaphragm and make deep breathing painful. Incentive spirometry, which encourages deep breathing, is essential to prevent atelectasis after surgery. The client is not maintained on bed rest for several days. The client is encouraged to ambulate by the first postoperative day, even with drainage tubes in place. Nasogastric tubes do not inhibit deep breathing and coughing.
A nurse is caring for a client with cholelithiasis. Which sign indicates obstructive jaundice? A) Straw-colored urine B) Reduced hematocrit C) Clay-colored stools D) Elevated urobilinogen in the urine
C) Clay-colored stools Reason: Obstructive jaundice develops when a stone obstructs the flow of bile in the common bile duct. When the flow of bile to the duodenum is blocked, the lack of bile pigments results in a clay-colored stool. In obstructive jaundice, urine tends to be dark amber (not straw-colored) as a result of soluble bilirubin in the urine. Hematocrit levels aren't affected by obstructive jaundice. Because obstructive jaundice prevents bilirubin from reaching the intestine (where it's converted to urobilinogen), the urine contains no urobilinogen.
Which of the following laboratory findings are expected when a client has diverticulitis? A) Elevated red blood cell count. B) Decreased platelet count. C) Elevated white blood cell count. D) Elevated serum blood urea nitrogen concentration.
C) Elevated white blood cell count. Reason: Because of the inflammatory nature of diverticulitis, the nurse would anticipate an elevated white blood cell count. The remaining laboratory findings are not associated with diverticulitis. Elevated red blood cell counts occur in clients with polycythemia vera or fluid volume deficit. Decreased platelet counts can occur as a result of aplastic anemias or malignant blood disorders, as an adverse effect of some drugs, and as a result of some heritable conditions. Elevated serum blood urea nitrogen concentration is usually associated with renal conditions.
A client who has a history of Crohn's disease is admitted to the hospital with fever, diarrhea, cramping, abdominal pain, and weight loss. The nurse should monitor the client for: A) Hyperalbuminemia. B) Thrombocytopenia. C) Hypokalemia. D) Hypercalcemia.
C) Hypokalemia. Reason: Hypokalemia is the most expected laboratory finding owing to the diarrhea. Hypoalbuminemia can also occur in Crohn's disease; however, the client's potassium level is of greater importance at this time because a low potassium level can cause cardiac arrest. Anemia is an expected development, but thrombocytopenia is not. Calcium levels are not affected.
A client with esophageal cancer decides against placement of a jejunostomy tube. Which ethical principle is a nurse upholding by supporting the client's decision? A) Autonomy B) Fidelity C) Nonmaleficence D) Veracity
A) Autonomy Reason: Autonomy refers to an individual's right to make his own decisions. Fidelity is equated with faithfulness. Nonmaleficence is the duty to "do no harm." Veracity refers to telling the truth.
1. A client who has been diagnosed with gastroesophageal reflux disease (GERD) complains of heartburn. To decrease the heartburn, the nurse should instruct the client to eliminate which of the following items from the diet? A) Lean beef. B) Air-popped popcorn. C) Hot chocolate. D) Raw vegetables.
C) Hot chocolate. Reason: With GERD, eating substances that decrease lower esophageal sphincter pressure causes heartburn. A decrease in the lower esophageal sphincter pressure allows gastric contents to reflux into the lower end of the esophagus. Foods that can cause a decrease in esophageal sphincter pressure include fatty foods, chocolate, caffeinated beverages, peppermint, and alcohol. A diet high in protein and low in fat is recommended for clients with GERD. Lean beef, popcorn, and raw vegetables would be acceptable.
A home health nurse who sees a client with diverticulitis is evaluating teaching about dietary modifications necessary to prevent future episodes. Which statement by the client indicates effective teaching? A) "I'll increase my intake of protein during exacerbations." B) "I should increase my intake of fresh fruits and vegetables during remissions." C) "I'll snack on nuts, olives, and popcorn during flare-ups." D) "I'll incorporate foods rich in omega-3 fatty acids into my diet."
B) "I should increase my intake of fresh fruits and vegetables during remissions." Reason: A client with diverticulitis needs to modify fiber intake to effectively manage the disease. During episodes of diverticulitis, he should follow a low-fiber diet to help minimize bulk in the stools. A client with diverticulosis should follow a high-fiber diet. Clients with diverticular disease don't need to modify their intake of protein and omega-3 fatty acids.
A client with inflammatory bowel disease is receiving total parenteral nutrition (TPN). The basic component of the client's TPN solution is most likely to be: A) An isotonic dextrose solution. B) A hypertonic dextrose solution. C) A hypotonic dextrose solution. D) A colloidal dextrose solution.
B) A hypertonic dextrose solution. Reason: The TPN solution is usually a hypertonic dextrose solution. The greater the concentration of dextrose in solution, the greater the tonicity. Hypertonic dextrose solutions are used to meet the body's calorie demands in a volume of fluid that will not overload the cardiovascular system. An isotonic dextrose solution (e.g., 5% dextrose in water) or a hypotonic dextrose solution will not provide enough calories to meet metabolic needs. Colloids are plasma expanders and blood products and are not used in TPN.
A client with an incomplete small-bowel obstruction is to be treated with a Cantor tube. Which of the following measures would most likely be included in the client's care once the Cantor tube has passed into the duodenum? A) Maintain bed rest with bathroom privileges. B) Advance the tube 2 to 4 inches at specified times. C) Avoid frequent mouth care. D) Provide ice chips for the client to suck.
B) Advance the tube 2 to 4 inches at specified times. Reason: Once the intestinal tube has passed into the duodenum, it is usually advanced as ordered 2 to 4 inches every 30 to 60 minutes. This, along with gravity and peristalsis, enables passage of the tube forward. The client is encouraged to walk, which also facilitates tube progression. A client with an intestinal tube needs frequent mouth care to stimulate saliva secretion, to maintain a healthy oral cavity, and to promote comfort regardless of where the tube is placed in the intestine. Ice chips are contraindicated because hypotonic fluid will draw extra fluid into an already distended bowel.
A client has a nasogastric tube inserted at the time of abdominal perineal resection with permanent colostomy. This tube will most likely be removed when the client demonstrates: A) Absence of nausea and vomiting. B) Passage of mucus from the rectum. C) Passage of flatus and feces from the colostomy. D) Absence of stomach drainage for 24 hours.
C) Passage of flatus and feces from the colostomy. Reason: A sign indicating that a client's colostomy is open and ready to function is passage of feces and flatus. When this occurs, gastric suction is ordinarily discontinued, and the client is allowed to start taking fluids and food orally. Absence of bowel sounds would indicate that the tube should remain in place because peristalsis has not yet returned. Absence of nausea and vomiting is not a criterion for judging whether or not gastric suction should be continued. Passage of mucus from the rectum will not occur in this client because the rectum is removed in this surgery.
Which of the following interventions would be most appropriate for the nurse to recommend to a client to decrease discomfort from hemorrhoids? A) Decrease fiber in the diet. B) Take laxatives to promote bowel movements. C) Use warm sitz baths. D) Decrease physical activity.
C) Use warm sitz baths. Reason: Use of warm sitz baths can help relieve the rectal discomfort of hemorrhoids. Fiber in the diet should be increased to promote regular bowel movements. Laxatives are irritating and should be avoided. Decreasing physical activity will not decrease discomfort.
