Gastrointestinal Disorders

A client, age 82, is admitted to an acute care facility for treatment of an acute flare-up of a chronic GI condition. In addition to assessing the client for complications of the current illness, the nurse monitors for age-related changes in the GI tract. Which age-related change increases the risk of anemia? 1. Atrophy of the gastric mucosa 2. Decrease in intestinal flora 3. Increase in bile secretion 4. Dulling of nerve impulses

1. Atrophy of the gastric mucosa RATIONALES: Atrophy of the gastric mucosa reduces hydrochloric acid secretion; this, in turn, impairs absorption of iron and vitamin B12, increasing the risk of anemia as a person ages. A decrease in hydrochloric acid increases, not decreases, intestinal flora; as a result, the client is at increased risk for infection, not anemia. A reduction, not increase, in bile secretion may lead to malabsorption of fats and fat-soluble vitamins. Dulling of nerve impulses associated with aging increases the risk of constipation, not anemia.

As part of a routine screening for colorectal cancer, a client must undergo fecal occult blood testing. Which foods should the nurse instruct the client to avoid 48 to 72 hours before the test and throughout the collection period? Select all that apply: 1. High-fiber foods 2. Red meat 3. Turnips 4. Horseradish 5. Tomatoes 6. Apples

2. Red meat 3. Turnips 4. Horseradish RATIONALES: The client should be instructed to maintain a high-fiber diet and to refrain from eating red meat, poultry, fish, turnips, and horseradish for 48 to 72 hours before the test and throughout the collection period.

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: 1. gastric ulcers. 2. aspiration. 3. abdominal distention. 4. diarrhea.

2. aspiration. RATIONALES: Protecting the client from aspiration is essential because aspiration can cause pneumonia, a potentially life-threatening disorder. Gastric ulcers aren't a common complication of tube feeding in clients with endotracheal or tracheostomy tubes. Abdominal distention and diarrhea can both be associated with tube feeding but neither is immediately life-threatening.

The nurse is performing an assessment on a client who has developed a paralytic ileus. The client's bowel sounds will be: 1. hyperactive. 2. hypoactive. 3. high-pitched. 4. blowing.

2. hypoactive. RATIONALES: If a paralytic ileus occurs, bowel sounds will be hypoactive or absent. Hyperactive bowel sounds may signify hunger, intestinal obstruction, or diarrhea. High-pitched sounds may signify a dilated bowel. A blowing sound may be a bruit from a partially obstructed abdominal aorta.

A client with viral hepatitis A is being treated in an acute care facility. Because the client requires enteric precautions, the nurse should: 1. place the client in a private room. 2. wear a mask when handling the client's bedpan. 3. wear gloves when caring for the client and wash her hands after touching the client. 4. wear a gown when providing personal care for the client.

3. wear gloves when caring for the client and wash her hands after touching the client. RATIONALES: To maintain enteric precautions, the nurse must wear gloves when caring for the client and when contamination with stool is likely. The nurse must also wash the hands after touching the client or potentially contaminated articles and before caring for another client. A private room is warranted only if the client has poor hygiene — for instance, if the client is unlikely to wash the hands after touching infective material or is likely to share contaminated articles with other clients. For enteric precautions, the nurse need not wear a mask and must wear a gown only if soiling from fecal matter is likely.

A client is in the late stage of cirrhosis. When planning the client's diet, the nurse should focus on providing increased amounts of: 1. fat. 2. fiber. 3. protein. 4. carbohydrate.

4. carbohydrate. RATIONALES: Normally, the liver performs many metabolic functions that provide energy for the body. In cirrhosis, the liver's metabolic function is compromised, increasing the client's need for dietary carbohydrates and other energy sources to provide for cellular metabolism. The nurse should limit the client's fat intake to prevent satiation and should restrict protein intake because a cirrhotic liver can't metabolize protein efficiently. Increasing fiber intake isn't significant for a client with cirrhosis.

A physician asks a nurse to witness an informed consent of a client scheduled for gastric bypass surgery. What should the nurse do? 1. Tell the physician that only registered nurses can witness consents. 2. Explain the procedure to the client before signing the consent. 3. Sign the consent if the physician says that the client has already signed it in front of him. 4. Sign the consent only if she sees the client sign it.

4. Sign the consent only if she sees the client sign it. RATIONALES: Witnessing consent requires that the witness actually see the client sign the consent. A practical nurse as well as a registered nurse may witness consent. It is the physician's responsibility to explain the procedure to the client, not the nurse's.

Which outcome indicates effective client teaching to prevent constipation? 1. The client verbalizes consumption of low-fiber foods. 2. The client maintains a sedentary lifestyle. 3. The client limits water intake to three glasses per day. 4. The client reports engaging in a regular exercise regimen.

4. The client reports engaging in a regular exercise regimen. RATIONALE: The client having a regular exercise regimen indicates effective teaching. A regular exercise regimen promotes peristalsis and contributes to regular bowel elimination patterns. A low-fiber diet , a sedentary lifestyle, and limited water intake would predispose the client to constipation.