GI and Biliary Disorders
A nurse is providing discharge teaching for a client who has peptic ulcer disease and a new famotidine. Which of the following statements by the client indicates an understanding of the teaching? A. "I should take this medication at bedtime." B. "I should expect this medication to discolor my stools." C. "I will drink iced tea with my meals and snacks." D. "I will monitor my blood glucose level regularly while taking this medication."
A. "I should take this medication at bedtime." The nurse should instruct the client to take the medication at bedtime to inhibit the action of histamine at the H2-receptor site in the stomach.
A nurse is assessing a client who has Crohn's disease. Which of the following findings should the nurse expect? A. Fatty diarrheal stools B. Hyperkalemia C. Weight gain D. Sharp epigastric pain
A. Fatty diarrheal stools Steatorrhea, or fatty stool, is an expected finding in a client who has Crohn's disease.
A nurse admits a client to the emergency department who reports nausea and vomiting that worsens when he lies down. Antacids do not help. The provider suspects acute pancreatitis. Which of the following laboratory test results should the nurse expect to see? A.) Increased serum amylase B.) Decreased serum lipase C.) Decreased WBC D.) Increased serum calcium
A.) Increased serum amylase
A nurse is assessing a client who has peritonitis. Which of the following findings should the nurse expect? A. Bloody diarrhea B. Board-like abdomen C. Periumbilical cyanosis D. Increased bowel sounds
B. Board-like abdomen A board-like, distended abdomen, accompanied by extreme pain and tenderness, is an expected finding in a client who has peritonitis.
A nurse is caring for a client who has ulcerative colitis and is teaching the client about the common link with Crohn's disease. Which of the following information should the nurse include? A.) Both require frequent surgery B.) Both are inflammatory C.) Both manifest fistula formation D.) Both begin in the rectum
B.) Both are inflammatory
A nurse is planning care for a client who has diverticulitis. Which of the following menu selections should the nurse include in the plan? A.) Turkey sandwich with celery sticks B.) Sliced ham with green salad C.) Grilled chicken breast with white rice D.) Pork tenderloin with green peas
C.) Grilled chicken breast with white rice
A nurse is caring for a client who has peptic ulcer disease. The nurse should monitor the client for which of the following findings as an indication of gastrointestinal perforation? A.) Bradycardia B.) Increased blood pressure C.) Sudden abdominal pain D.) Hyperactive bowel sounds
C.) Sudden abdominal pain
A nurse is providing dietary teaching for a client who has chronic pancreatitis. Which of the following food selections by the client indicates an understanding of the teaching? A. 8 oz whole milk B. One slice of beef bologna C. 1 oz cheddar cheese D. 1 cup sliced banana
D. 1 cup sliced bananaFoods that are high in fat can cause diarrhea for clients who have pancreatitis. One cup of sliced banana, which contains 0.49 g of fat, is a low-fat food option. Clients who have pancreatitis should consume a high-protein and low-fat diet with an adequate amount of carbohydrates and calories.
A nurse is providing teaching to a client with gastroesophageal reflux. Which of the following statements by the client indicates a need for further teaching? A.) "I take my time when I am eating." B.) "I should elevate the head of my bed while sleeping." C.) "I avoid foods and drinks made with chocolate." D.) "I drink no more than 4 cups of coffee a day."
D.) "I drink no more than 4 cups of coffee a day."
A nurse is assessing clients in a health clinic for risk factors for contracting hepatitis. Which of the following clients is at risk for developing hepatitis C? A.) A client who eats raw shellfish B.) A client who has recently traveled to a underdeveloped country C.)A client who works in a child care center D.) A client who has multiple tattoos
D.) A client who has multiple tattoos
A nurse is caring for a client following an esophagogastroduodenoscopy (EGD) procedure. Which of the following assessments is the nurse's highest priority? A.) Level of consciousness B.) Pain C.) Nausea D.) Gag reflex
D.) Gag reflex
The nurse is planning to teach the patient with gastroesophageal reflux disease (GERD) about foods or beverages that decrease LES pressure. What should be included in this list (select all that apply)? a. Alcohol b. Root beer c. Chocolate d. Citrus fruits e. Fatty foods f. Cola sodas
a, c, e, f Rationale: Alcohol, chocolate, fatty foods, and cola sodas (caffeine) as well as peppermint and spearmint will decrease lower esophageal sphincter (LES) pressure. Root beer and herbal tea do not have caffeine. Citrus fruits will not affect LES pressure.
Duodenal and gastric ulcers have similar as well as differentiating features. What characteristics are unique to duodenal ulcers (select all that apply)? a. Pain is relieved with eating food. b. They have a high recurrence rate. c. Increased gastric acid secretion occurs. d. Associated with Helicobacter pylori infection. e. Hemorrhage, perforation, and obstruction may result. f. There is burning and cramping in the mid-epigastric area
a, c,f Rationale: Duodenal ulcers have increased HCl gastric secretion, which causes the burning and cramping in the midepigastric area; the pain is relieved with food. The other options occur with both duodenal and gastric ulcers
Which patient is at highest risk of having a gastric ulcer? a. 55-year-old female smoker with nausea and vomiting b. 45-year-old female admitted for illicit drug detoxification c. 27-year-old male who is being divorced and has back pain d. 37-year-old male smoker who was in an accident while looking for a job
a. 55-year-old female smoker with nausea and vomiting Rationale: The 55-year-old female smoker experiencing nausea and vomiting is more likely to have a gastric ulcer. The other patients are not in the highest-risk age range or do not have enough risk factors. Although lower socioeconomic status, smoking, and drug use increase the risk of gastric ulcers, these patients are more likely to have duodenal ulcers but further assessment is needed.
What type of bleeding will a patient with peptic ulcer disease with a slow upper GI source of bleeding have? a. Melena b. Occult blood c. Coffee-ground emesis d. Profuse bright-red hematemesis
a. Melena rationale: Melena is black, tarry stools from slow bleeding from an upper gastrointestinal (GI) source when blood passes through the GI tract and is digested. Occult blood is the presence of guaiac-positive stools or gastric aspirate. Coffee-ground emesis is blood that has been in the stomach for some time and has reacted with gastric secretions. Profuse bright-red hematemesis is arterial blood that has not been
A nurse is providing discharge teaching for a client who has GERD. Which of the following statements by the client indicates an understanding of the teaching? a.) "I will decrease the amount of carbonated beverages I drink." b.) "I will avoid drinking liquids for 30 minutes after taking a chewable antacid tablet." c.) "I will eat a snack before going to bed." d.) "I will lie down for at least 30 minutes after eating each meal."
a.) "I will decrease the amount of carbonated beverages I drink." Rationale: The nurse should instruct the client to limit or eliminate fatty foods, coffee, tea, carbonated beverages, and chocolate from the diet because they irritate the lining of the stomach.
A nurse is assessing a client who has acute hepatitis B. Which of the following findings should the nurse expect? a.) joint pain b.) obstipation (failure to pass stools) c.) abdominal distention d.) periumbilical discoloration
a.) Joint pain
26) Which statements describe the use of antacids for peptic ulcer disease (select all that apply)? a. Used in patients with verified H. pylori b. Neutralize HCl in the stomach c. Produce quick, short-lived relief of heartburn d. Cover the ulcer, protecting it from erosion by acids e. High incidence of side effects and contraindications f. May be given hourly after an acute phase of GI bleeding
b, c, f Rationale: Antacids provide a quick, short-lived relief of heartburn by neutralizing HCl in the stomach that prevents the conversion of pepsinogen to pepsin. Antacids may be given hourly, orally or through an NG tube, after an acute phase of GI bleeding to neutralize HCl in the stomach. Amoxicillin/clarithromycin/omeprazole are used in patients with verified H. pylori. Sucralfate (Carafate) covers the ulcer to protect it from acid erosion. The side effects are manageable.
Which esophageal disorder is described as a precancerous lesion and is associated with GERD? a. Achalasia b. Barrett's esophagus c. Esophageal strictures d. Esophageal diverticula
b. Barrett's esophagus Rationale: Barrett's esophagus is an esophageal metaplasia primarily related to gastroesophageal reflux disease (GERD). Achalasia is a rare chronic disorder with delayed emptying of the lower esophagus and is associated with squamous cell cancer. Esophageal strictures are narrowing of the esophagus from scarring by many causes. Esophageal diverticula are saclike outpouchings of 1 or more layers of the esophagus. They often occur above the esophageal sphincter.
What should the nurse emphasize when teaching patients at risk for upper GI bleeding to prevent bleeding episodes? a. All stools and vomitus must be tested for the presence of blood. b. The use of over-the-counter (OTC) medications of any kind should be avoided. c. Antacids should be taken with all prescribed medications to prevent gastric irritation. d. Misoprostol (Cytotec) should be used to protect the gastric mucosa in individuals with peptic ulcers.
b. The use of over-the-counter (OTC) medications of any kind should be avoided. Rationale: All OTC drugs should be avoided because their contents may include drugs that are contraindicated because of the irritating effects on the gastric mucosa. Patients are taught to test suspicious vomitus or stools for occult blood, but all stools do not have to be tested. Antacids cannot be taken with all medications because they prevent the absorption of many drugs. Patients with a history of ulcers who must take low-dose aspirin are prescribed misoprostol to protect the gastric mucosa.
a nurse is providing discharge teaching for a client who has chronic hepatitis C. Which of the following statements by the client indicates an understanding of the teaching? a.) "I will avoid alcohol until I'm no longer contagious" b.) "I will avoid medications that contain acetaminophen" c.) "I will decrease my intake of calories" d.) "I can donate blood once when I am in remission"
b.) "I will avoid medications that contain acetaminophen" Rationale: A client who has hepatitis C should avoid medications that contain acetaminophen, which can cause additional liver damage.
A nurse is reviewing the lab results of a client who has acute pancreatitis. Which of the following findings should the nurse expect? a.) Blood glucose 110 mg/dL b.) Increased amylase c.) WBC count of 9,000 d.) Decreased bilirubin
b.) increased amylase Rationale: Serum amylase levels are increased in a client who has acute pancreatitis due to pancreatic cell injury.
The nurse determines that teaching for the patient with peptic ulcer disease has been effective when the patient makes which statement? a. "I should stop all my medications if I develop any side effects." b. "I should continue my treatment regimen as long as I have pain." c. "I have learned some relaxation strategies that decrease my stress." d. "I can buy whatever antacids are on sale because they all have the same effect."
c. "I have learned some relaxation strategies that decrease my stress." Rationale: Increased vagal stimulation from emotional stress causes hypersecretion of HCl, and stress reduction is an important part of the patient's management of peptic ulcers, especially duodenal ulcers. If side effects to medications develop, the patient should notify the HCP before altering the drug regimen. Although effective treatment will promote pain relief in several days, the treatment regimen should be continued until there is evidence that the ulcer has healed completely. Interchanging brands and preparations of antacids and histamine (H2 )-receptor blockers without checking with HCPs may cause harmful side effects, and patients should take only prescribed medications.
A patient receives atropine, an anticholinergic drug, in preparation for surgery. The nurse expects this drug to affect the gastrointestinal (GI) tract by which action? a. Increasing gastric emptying b. Relaxing pyloric and ileocecal sphincters c. Decreasing secretions and peristaltic action d. Stimulating the nervous system of the GI tract
c. Decreasing secretions and peristaltic action Rationale: The parasympathetic nervous system stimulates activity of the gastrointestinal (GI) tract, increasing motility and secretions and relaxing sphincters to promote movement of contents. Atropine is a anticholinergic drug that blocks this activity, and decreases secretions and peristalsis, slows gastric emptying, and contracts sphincters.
What does the nurse include when teaching a patient with newly diagnosed peptic ulcer disease? a. Maintain a bland, soft, low-residue diet. b. Use alcohol and caffeine in moderation and always with food. c. Eat as normally as possible, eliminating foods that cause pain or discomfort. d. Avoid milk and milk products because they stimulate gastric acid production.
c. Eat as normally as possible, eliminating foods that cause pain or discomfort. Rationale: There is no specific diet used for the treatment of peptic ulcers, and patients are encouraged to eat as normally as possible, eliminating foods that cause discomfort or pain. Eating 6 meals a day prevents the stomach from being totally empty and is recommended. Caffeine and alcohol should be eliminated from the diet because they are known to cause gastric irritation. Milk and milk products do not have to be avoided but they can add fat content to the diet.
How should the nurse teach the patient with a hiatal hernia or GERD to control symptoms? a. Drink 10 to 12 ounces of water with each meal. b. Space 6 small meals a day between breakfast and bedtime. c. Sleep with the head of the bed elevated on 4- to 6-inch blocks. d. Perform daily exercises of toe-touching, sit-ups, and weightlifting.
c. Sleep with the head of the bed elevated on 4- to 6-inch blocks. Rationale: The use of blocks to elevate the head of the bed facilitates gastric emptying by gravity and is strongly recommended to prevent nighttime reflux. Liquids should be taken between meals to prevent gastric distention with meals. Small meals should be eaten frequently, but patients should not eat at bedtime or lie down for 2 to 3 hours after eating. Activities that involve increasing intraabdominal pressure, such as bending over, lifting, or wearing tight clothing, should be avoided.
A nurse is providing discharge teaching for a client who has mild diverticulitis. Which of the following statements by the client indicates an understanding of the teaching? a.) "I may experience right lower quadrant pain" b.) "I will remain active by working in my garden every day" c.) "I should eat foods that are low in fiber" d.) "I will use a mild laxative every day"
c.) "I should eat foods that are low in fiber" rationale: Patients have to follow a low-fiber diet. When the inflammation subsides, the client should consume foods high in fiber.
A nurse is assessing a client who has upper gastrointestinal bleeding which of the following findings should the nurse expect? a.) Bradycardia b.) bounding peripheral pulse c.) hypotension d.) increased hematocrit levels
c.) hypotension Rationale: A client who has upper gastrointestinal bleeding is at risk for hemorrhagic shock. Hypotension is a manifestation of hemorrhagic shock.
A nurse is admitting a client who has acute pancreatitis. Which of the following actions should the nurse take first? a.) insert a nasogastric tube for the client b.) administer ceftazidime c.) identify the client's current level of pain d.) instruct the client to remain NPO
c.) identify the client's current level of pain Rationale: The first action the nurse should take when using the nursing process is to assess the client. Clients who have acute pancreatitis often have severe abdominal pain. By assessing the client's level of pain, the nurse can identify the need for and implement interventions to alleviate the client's pain.
41. The nurse evaluates that management of the patient with upper GI bleeding is effective when assessment and laboratory findings reveal which result? a. Hematocrit (Hct) of 35% b. Urinary output of 20 mL/hr c. Urine specific gravity of 1.030 d. Decreasing blood urea nitrogen (BUN)
d. Decreasing blood urea nitrogen (BUN) rationale: The patient's blood urea nitrogen (BUN) is usually elevated with a significant hemorrhage because blood proteins are subjected to bacterial breakdown in the GI tract. With control of bleeding, the BUN will return to normal. During the early stage of bleeding, the hematocrit (Hct) is not always a reliable indicator of the amount of blood lost or the amount of blood replaced and may be falsely high or low. A urinary output of ≤ 20 mL/hr indicates impaired renal perfusion and hypovolemia and a urine specific gravity of 1.030 indicates concentrated urine typical of hypovolemia.
A nurse is caring for a client who has GERD and a new prescription for metoclopramide. The nurse should plan to monitor for the following adverse effects? a.) Thrombocytopenia b.) Hearing loss c.) Hypersalivation d.) Ataxia
d.) Ataxia Rationale: The nurse should plan to monitor the client for extrapyramidal symptoms, such as ataxia, and should report any of these findings to the provider.
A nurse is assessing a client who has a duodenal ulcer. Which of the following findings should the nurse expect? a.) The client states that the pain is in the upper epigastrium b.) The client is malnourished c.) The client states that ingesting food intensifies the pain d.) The client reports that pain occurs at night
d.) The client reports that pain occurs at night Rationale: Pain associated with a duodenal ulcer occurs when the stomach is empty, which is typically 1.5 to 3 hr after meals and during the night.
