GI NCLEX style questions
A nurse is caring for a client who is cachectic (physical wasting with loss of weight and muscle mass due to disease) What information about the function of adipose tissue in fat metabolism is necessary to better address the needs of this client? Releases glucose for energy Regulates cholesterol production Uses lipoproteins for fat transport Stores triglycerides for energy reserves
*Stores triglycerides for energy reserves* A triglyceride is composed of three fatty acids and a glycerol molecule. When energy is required, the fatty acids are mobilized from adipose tissue for fuel. The nurse needs to consider that a client who is cachectic will have limited reserves to meet energy needs. Releasing glucose for energy is not the function of adipose tissue; its main function is storage. Regulating cholesterol production is not a function of adipose tissue; cholesterol is produced in the liver. Using lipoproteins for fat transport is not the function of adipose tissue in fat metabolism.
chronic hep C drug therapy
-*Boceprevir (Victrelis)* can be in combination with HIV meds if co-infection present -*Interferon/ribavirin* instruct patients not to miss a dose, monitor for anemia. Adverse: Flulike aches and pains
A nurse cares for a client with hepatic encephalopathy. The client is thin and cachectic in appearance, and the family expresses distress that the client is receiving little dietary protein. How should the nurse respond? a. "Less protein in the diet will help prevent confusion associated with liver failure." b. "A low-protein diet will help the liver rest and will restore liver function." c. "Increasing dietary protein will help the client gain weight and muscle mass." d. "Low dietary protein is needed to prevent fluid from leaking into the abdomen."
ANS: A A low-protein diet is ordered when serum ammonia levels increase and/or the client shows signs of PSE. A low-protein diet helps reduce excessive breakdown of protein into ammonia by intestinal bacteria. Encephalopathy is caused by excess ammonia. A low-protein diet has no impact on restoring liver function. Increasing the client's dietary protein will cause complications of liver failure and should not be suggested. Increased intravascular protein will help prevent ascites, but clients with liver failure are not able to effectively synthesize dietary protein.
A patient with a liver mass is undergoing a percutaneous liver biopsy. After the procedure the nurse assists the physician in positioning the patient. What position should they position the patient in? A) On the right side with a pillow under the costal margin B) Supine position C) On the left side with a pillow under the knees D) Trendelenberg position
ANS: A Immediately after a percutaneous liver biopsy, assist the patient to turn onto the right side and place a pillow (or sandbag) under the costal margin. Instruct the patient to remain in this position, recumbent and immobile, for several hours. The patient will not be placed in the supine or the Trendelenberg position. Option C is incorrect.
The physician has prescribed neomycin enemas for a patient with cirrhosis. The patient questions why they are being used. Which response by the nurse is most appropriate? a. These enemas help prevent infection. b. These enemas help reduce straining during a bowel movement. c. These enemas kill intestinal flora.
ANS: C Neomycin is occasionally given orally or by enema to decrease the colonic bacteria that break down protein. This treatment lowers the formation of ammonia. The bowel is cleansed by enemas to decrease ammonia production further.
A client has gastroesophageal reflux disease (GERD). The provider prescribes a proton pump inhibitor. About what medication should the nurse anticipate teaching the client? a. Famotidine (Pepcid) b. Magnesium hydroxide (Maalox) c. Omeprazole (Prilosec) d. Ranitidine (Zantac)
ANS: C Omeprazole is a proton pump inhibitor used in the treatment of GERD. Famotidine and ranitidine are histamine blockers. Maalox is an antacid. *PPI-think P-Prazole-Prior to meals* *Increased bleeding with coumadin Delayed absorption with carafate Take on an empty stomach Increased risk for bleeding with plavix*
A patient with a gastrostomy tube gets a bolus feeding of 200 mL every 4 hours. Before giving the bolus, the nurse aspirates a residual of 100 mL. After returning the residual to the patient, the nurse should: a.give the 200 mL feeding. b.record the residual and give 100 mL of the feeding. c.document the residual and hold the feeding. d.position the patient in high Fowler's and give the feeding.
ANS: C On finding a large residual, the nurse should return the residual to the patient, document the amount of the residual, and hold the feeding to avoid possible aspiration.
The patient is receiving total parenteral nutrition (TPN). The physician has prescribed insulin coverage on a sliding scale. The patient reports he has never had diabetes before. What response by the nurse is indicated? a."It is likely you have developed diabetes as a result of your illness." b."Do you have a family history for diabetes?" c."The TPN you are receiving has high amounts of glucose." d."Insulin is needed to manage your stomach's inability to adequately metabolize food at this time."
ANS: C People on TPN are prone to hyperglycemia from the high glucose content of the solution. *components of TPN are Amino acids, electrolytes, vitamins, heparin, Insulin, D20 solution, minerals*
What diagnostic testing would the nurse expect to be ordered to confirm diagnosis suspected cholelithiasis?
Abdominal Ultrasound & a CT?
After cholecystectomy, assessing for complications is important. which assessment data is an ominous sign and should be reported to the surgeon immediately?
Abdominal rigidity could indicate hemorrhage or leakage of bile into the abdominal cavity, and peritonitis. This finding must be reported immediately.
In the lab findings AST at twice the level of ALT the nurse would suspect?
Alcoholic Hepatitis
A client with cancer of the pancreas has undergone a Whipple procedure. The nurse is aware that during the Whipple procedure, the doctor will remove the: a.Head of the pancreas b.Proximal third section of the small intestines c.Stomach and duodenum d. Esophagus and jejunum
Answer A is correct. During a Whipple procedure the head of the pancreas, which is a part of the stomach, the jejunum, and a portion of the stomach are removed and reanastomosed. Answer B is incorrect because the proximal third of the small intestine is not removed. The entire stomach is not removed, as in answer C, and in answer D, the esophagus is not removed.
Nurses first priority after upper endoscopy?
Assess gag reflex
Which of the following definitions best describes diverticulosis? A An inflamed outpouching of the intestine B A noninflamed outpouching of the intestine CThe partial impairment of the forward flow of intestinal contents DAn abnormal protrusion of an organ through the structure that usually holds it.
B Explanation:(-osis= abnormal condition itis= inflammation of) *Diverticulosis* involves a noninflamed outpouching of the intestine. Diverticulitis involves an inflamed outpouching. The partial impairment of forward flow of the intestine is an obstruction; abnormal protrusion of an organ is a hernia.
The nurse preparing a teaching plan for lifestyle changes for the patient with GERD would include: a. sleeping on the right side on a flat bed. b.Wait at least 3 hours after eating to lay down c.lying down after each meal for 20 minutes.
B The patient with GERD should wait at least 3 hours after a meal to lie down and should sleep with the head of the bed elevated 4 to 6 inches.
What test is used to evaluate dysphagia and risk of aspiration?
Barium Swallow or Upper GI **Must tell pt to increase fluids after test to avoid major constipation from thick barium-also expect white poop**
A condition in which the esophageal lining is replaced by a tissue resembling intestinal lining, considered to be pre-cancerous.
Barrett's Esophagus
What labs will be elevated in liver failure?
Bilirubin >17 AST 10-40 u/liter ALT 7-56 u/liter INR/PT
A patient wants to prevent problems with constipation and asks the nurse for advice about which type of laxative is safe to use for this purpose. Which class of laxative is considered safe to use on a long-term basis?
Bulk-forming laxatives are the only laxatives recommended for long-term use. Stimulant laxatives are the most likely of all the laxative classes to cause dependence.
The nurse is preparing a patient for discharge with a prescription for sucralfate (Carafate) and teaches the patient to take the medication when? A)With meals B)With an antacid before breakfast C)1 hour before or 2 hours after meals and at bedtime D)After each meal
C Feedback:Administer drug on an empty stomach, 1 hour before or 2 hours after meals and at bedtime, to ensure therapeutic effectiveness of the drug. Administer antacids, if ordered, between doses of sucralfate and not within 30 minutes of taking the drug. Options A, B, and D are not correct.
A client with acute pancreatitis is experiencing severe abdominal pain. Which of the following orders should be questioned by the nurse? A.Meperidine 100mg IM m 4 hours PRN pain B.Mylanta 30 ccs m 4 hours via NG C.Cimetadine 300mg PO b.i.d D. Morphine 8mg IM m 4 hours PRN pain
C. Cimetadine 300mg PO b.i.d Patients with acute pancreatitis are NPO!!
Crohn's disease can be described as a chronic relapsing disease. Which of the following areas in the GI system may be involved with this disease? AThe entire length of the large colon BOnly the sigmoid area C The entire large colon through the layers of mucosa and submucosa D The small intestine and colon; affecting the entire thickness of the bowel
D Explanation: Crohn's disease can involve any segment of the small intestine, the colon, or both, affecting the entire thickness of the bowel. Answers 1 and 3 describe ulcerative colitis, answer 2 is too specific and therefore, not likely. **inflammatory disease of colon, most commonly occurring in rectum extending up**
Which of the following symptoms may be exhibited by a client with Crohn's disease? A Bloody diarrhea B Narrow stools C N/V D Steatorrhea
D Explanation: Steatorrhea from malabsorption can occur with Crohn's disease. N/V, and bloody diarrhea are symptoms of ulcerative colitis. Narrow stools are associated with diverticular disease.
The nurse is caring for a client with ascites which is the best method to use for determining early ascites?
Daily measurement of abdominal girth
The health care provider orders lactulose for a patient with hepatic encephalopathy. The nurse will monitor for effectiveness of this medication for this patient by assessing what? Relief of constipation Relief of abdominal pain Decreased liver enzymes Decreased ammonia levels
Decreased ammonia levels Hepatic encephalopathy is a complication of liver disease and is associated with elevated serum ammonia levels. Lactulose traps ammonia in the intestinal tract. Its laxative effect then expels the ammonia from the colon, resulting in decreased serum ammonia levels and correction of hepatic encephalopathy.
Name of Hep A vaccine?
HAVRIX and VAQta
Adverse effect of this medication for Hepatitis C is Severe flu like symptoms.
Interferon
The nurse teaches a patient with hepatic encephalopathy that certain food should be consumed in moderation while the patient's serum ammonia level is elevated. Which food does the nurse instruct the patient to limit? Pasta Vegetables Rice Lean meats
Lean meats-The diet for those who have elevated serum ammonia levels with signs of encephalopathy includes moderate amounts of protein and fat along with simple carbohydrates. Strict protein restrictions are not required because patients need protein for healing. Pasta, rice, and vegetables are carbohydrates that are included in the diet for energy.
What are the common signs and symptoms of gallbladder disease?
Persons with gallbladder disease often experience a feeling of fullness, flatulence (gas), Nausea and vomiting especially after eating fatty foods. *Gall Bladder function: reservoir for bile/bile acids which break down fats in the digestive process*
It is the nurse's responsibility to assess and document the stoma color every 4 hours. What should the stoma look like?
Pink, moist, no excessive bleeding
A nurse is caring for a client with cholelithiasis. Which clinical manifestation does the nurse expect if the client develops obstructive jaundice? 1 Yellow sclera 2 Pain on urination 3 Dark brown stools 4 Coffee-ground emesis
Yellow sclera results from failure of bile to enter the intestines, with subsequent backup into the biliary system and diffusion into blood; bilirubin is carried to all body regions, including skin and mucous membranes. Pain on urination is not associated with obstructive jaundice, but dark brown urine is. Pain is experienced in the right upper quadrant because of spasm of the gallbladder, whether or not biliary obstruction occurs. The stools are clay-colored, not brown, because bile pigments are not present in the gastrointestinal tract; the common bile duct is obstructed.
A patient arrives in the ED curled in the fetal position from extreme knife-like left abdomal pain, N/V, nurse suspects the client is experiencing
acute pancreatitis (fetal position promotes comfort)
The incubation period for hepatitis B
averages 2-3 months, but can be anywhere from 1-6 months.
What condition presenys with Caput medusa, a positive fluid wave, and exagerated veins across the upper chest.
cirrhosis with ascites
What would be ordered to confirm presence Ulcerative colitis or Crohn's?
colonoscopy
portal hypertension causes enlarged blood vessels in the throat?
esophageal varices
another term for jaundice?
icteric
In assessing with an ileostomy, what would be the consistency.
liquid or semi formed
the development of GERD is often associated with what medical condition
obesity
Bacterium H pylori is the primary cause of what type of ucler development
peptic ulcers *treated with PPIs and ABTs*
What would the nurse suspect if pt c/o severe abdominal pain following endoscopy, colonoscopy, ERCP?
perforation
GI Medication which is Contraindicated in pt with obstruction, perforation, or GI hemorrhage?
stimulant laxatives (Dulcolax) & metochlopromide (Reglan)
Which 2 Hepatitis' have a vaccine?
A and B
Liver function lab findings in viral infections?
ALT is higher than the AST
A client is bleeding from esophageal varices. The health care provider is arranging sclerotherapy for the client. Before the client goes to interventional radiology, the nurse prepares to administer which medication? a. Octreotide (Sandostatin) b. Enoxaparin (Lovenox) c. Lactulose (Heptalac) d.Spironolactone (Aldactone)
ANS: A Octreotide (Sandostatin) lowers BP in the liver, which decreases bleeding. Enoxaparin is a low-molecular-weight heparin, which would be contraindicated in a client with bleeding problems. Lactulose helps rid the body of ammonia. Aldactone is a diuretic.
A client is admitted to the hospital with slight jaundice and reports of pain on the left side and back. A diagnosis of acute pancreatitis is made. Which common response to acute pancreatitis should the nurse monitor in the client? Crackles Hypovolemia Gastric reflux Jugular vein distention
*Hypovolemia* that results from a fluid shift from the intravascular compartment to the peritoneal cavity can cause circulatory collapse; this is a life-threatening event that requires immediate intervention. Crackles indicate an accumulation of fluid in the alveoli associated with hypervolemia, not hypovolemia. Gastric reflux occurs with gastroesophageal reflux disease (GERD), not with pancreatitis. Jugular vein distention indicates hypervolemia, not hypovolemia.
The nurse is caring for a client with ascites who is scheduled for a paracentesis. The client teaching will include: Shave the client's abdomen. Medicate the client for pain. Encourage the client to drink fluids. Instruct the client to empty the bladder.
*Instruct pt to empty the bladder immediately before the procedure* Emptying the bladder of urine keeps the bladder in the pelvic area and prevents puncture when the abdominal cavity is entered. Shaving the client's abdomen and medicating the client for pain are not necessary. Encouraging fluids is unsafe; the bladder will rise into the abdominal cavity and may be punctured.
A diagnosis of acute pancreatitis is often made on the basis of symptoms and elevation of which serum lab values?
-Amylase -Lipase (these blood tests help evaluate function of the pancreas)
Antiretrovirals (drugs ending with -vir): nursing implications
-Long term adverse effects bone demineralization, osteoporosis, decreased calcium and vitamin D sometimes treated with biphosphonates -Antiviral meds = lifelong therapy
The incubation period (before symptoms appear) for hepatitis A can be
anywhere from 15-45 days (2-6 weeks), with a mean of 30 days. Symptoms begin with a flu-like prodromal phase that often persists for 1-2 weeks before jaundice appears.
A client has a colostomy after surgery for cancer of the colon. Which postoperative nursing intervention maximizes skin integrity? 1 Empty the colostomy bag when it is three fourths full 2 Allow one half inch between the stoma and the appliance 3 Help the client to remove the appliance on the first postoperative day 4 Apply stoma adhesive around the stoma and then attach the appliance
4 Apply stoma adhesive around the stoma and then attach the appliance Stoma adhesive protects the skin and helps to keep the appliance attached to the skin. The appliance should be emptied when it is one third to one half full. Allowing one half inch between the stoma and the appliance is too much space; the enzymes in feces can erode the skin. Initially the nurse should change the appliance; self-care usually is instituted more gradually depending on the client's physical and emotional response to the surgery.
The nurse administers ranitidine (Zantac) cautiously to patients with evidence of what conditions? A)Renal disease B)Diabetes mellitus C)Pulmonary disease D)Migraine headaches
A--Feedback:All histamine-2 antagonists are eliminated through the kidneys; dosages need to be reduced in patients with renal impairment. No caution is necessary with Zantac therapy in people with diabetes, pulmonary disease, or migraine headaches. **Antacids with Magnesium should not be given To patients with renal failure**
A client has cancer of the pancreas. The nurse should be most concerned about which nursing diagnosis? A.Alteration in nutrition B.Alteration in bowel elimination C.Alteration in skin integrity D. Ineffective individual coping
A. Alteration in nutrition
The nurse finds a positive Blumberg's sign in a client with abdominal pain. Which action does the nurse plan? a. Have the client be NPO in preparation for surgery. b. Document this normal finding in the client's record. c. Immediately auscultate the client's abdomen for bowel sounds.
ANS: A A positive Blumberg's sign (rebound tenderness), an abnormal sign, is indicative of peritoneal inflammation, which commonly accompanies appendicitis. The client should be made NPO in preparation for surgery to remove the appendix. The maneuver should not be repeated with the client in the supine position. The nurse should perform auscultation before percussion for the abdominal assessment.
A patient comes to the emergency department with the complaint of severe vomiting and nausea and a temperature elevation to 101° F. The patient complains of stomach pain that radiates to his right scapula. These assessments suggest: a.cholecystitis. b.hepatitis. c.pancreatitis. d gastroenteritis.
ANS: A All the symptoms and signs alert the medical staff to the probability of cholecystitis. Hepatitis causes liver dysfunction, including jaundice. Pancreatitis causes abdominal pain that is usually acute, but this can vary among individuals. The pain is steady and is localized to the epigastrium or left upper quadrant. Gastroenteritis causes nausea, vomiting, and diarrhea.
The nurse is aware that a definitive diagnosis of cirrhosis is made based on the results of a(n): a. liver biopsy. b.elevated aspartate aminotransferase (AST). c.elevated alanine aminotransferase (ALT). d.elevated lactate dehydrogenase (LDH).
ANS: A Liver biopsy is the definitive test. The other tests will be elevated, but they are not specific for cirrhosis.
A nurse teaches a client with hepatitis C who is prescribed *ribavirin*. Which statement should the nurse include in this client's discharge education? a. "Transient muscle aching is a common side effect of this medication." b. "Follow up with your provider in 1 week to test your blood for toxicity." c. "Take your radial pulse for 1 minute prior to taking this medication." d. "Use a pill organizer to ensure you take this medication as prescribed."
ANS: D Treatment of hepatitis C with ribavirin takes up to 48 weeks, making compliance a serious issue. The nurse should work with the client on a strategy to remain compliant for this length of time. Muscle aching is not a common side effect. The client will be on this medication for many weeks and does not need a blood toxicity examination. There is no need for the client to assess his or her radial pulse prior to taking the medication.
A client with cystic fibrosis is taking pancrelipase (Pancrease) *pancreatic enzymes*. The nurse should administer this medication: A.Once per day in the morning B.Three times per day with meals C.Once per day at bedtime D.Four times per day
B.Three times per day with meals -Treats pancreatic insufficiency associated with cystic fibrosis. -Monitor stools for adequate dosing (increase dose if loose, fatty stools present; decrease dose if constipation present). -Administer capsules with all meals and snacks. (APPLESAUCE preferred) -Client can swallow or sprinkle capsules on food. -*medication cannot be chewed and should not be given with plenty of water*
Which of the following mechanisms can facilitate the development of diverticulosis into diverticulitis? A Treating constipation with chronic laxative use, leading to dependence on laxatives B Chronic constipation causing an obstruction, reducing forward flow of intestinal contents C Herniation of the intestinal mucosa, rupturing the wall of the intestine D Undigested food blocking the diverticulum, predisposing the area to bacterial invasion.
D Explanation: Undigested food can block the diverticulum, decreasing blood supply to the area and predisposing the area to invasion of bacteria. Chronic laxative use is a common problem in elderly clients, but it doesn't cause diverticulitis. Chronic constipation can cause an obstruction—not diverticulitis. Herniation of the intestinal mucosa causes an intestinal perforation.
Which of the following nursing interventions should be implemented to manage a client with appendicitis? A Assessing for pain B Encouraging oral intake of clear fluids C Providing discharge teaching D Assessing for symptoms of peritonitis
D Explanation: The focus of care is to assess for peritonitis, or inflammation of the peritoneal cavity. Peritonitis is most commonly caused by appendix rupture and invasion of bacteria, which could be lethal. The client with appendicitis will have pain that should be controlled with analgesia. The nurse should discourage oral intake in preparation for surgery. Discharge teaching is important; however, in the acute phase, management should focus on minimizing preoperative complications and recognizing when such may be occurring.
What drug combination will the nurse normally administer most often to treat a gastric ulcer? A) Antibiotics and histamine-2 antagonists B) H2 antagonists, antibiotics, and bicarbonate salts C) Bicarbonate salts and antibiotics, D) Antibiotics and proton pump inhibitors
D Feedback: Currently, the most commonly used therapy for gastric ulcers is a combination of antibiotics and proton pump inhibitors that suppress or eradicate Helicobacter pylori. H2 receptor antagonists are used to treat duodenal ulcers. Bicarbonate salts are not used.
Which of these percussion findings would the nurse expect to find in a patient with a large amount of ascites?
Dullness across the abdomen A large amount of ascitic fluid produces a dull sound to percussion.
The nurse is percussing the seventh right intercostal space at the midclavicular line over the liver. Which sound should the nurse expect to hear?
Dullness: The liver is located in the right upper quadrant and would elicit a dull percussion note.
Pain which occurs 2-4 hours After meals and frequently Awakens the pt at night
Duodenal ulceration
For the patient with acute pancreatitis what is the most important thing to monitor?
For the patient with acute pancreatitis, monitor his or her respiratory status every 8 hours or more often as needed, and provide oxygen to promote comfort in breathing. Respiratory complications such as pleural effusions increase patient discomfort. Fluid overload can be detected by assessing for weight gain, listening for crackles, and observing for dyspnea. Carefully monitor for signs of respiratory failure.
Which patients are candidates for ERCP?
Patients requiring investigation for Pancreatic or biliary duct obstruction
The nurse is assessing a patient for possible peptic ulcer disease. Which condition or history often causes this problem?
Peptic ulcer disease occurs with the frequent use of nonsteroidal antiinflammatory drugs, alcohol use, smoking, and Helicobacter pylori infection.
Blumbergs sign
Rebound tenderness, indicated peritoneal irritation and inflammation
This medication can cause extrapyramidal effects, interfere with coumadin and Dilantin, & interfere with Parkinson's medications
Reglan (metachlopromide) *worst feeling ever when I took this for gastroparesis! Woke up with feeling of impending doom one night-NEVER again!*
What feeding uses a dedicated double or triple lumen catheter?
TPN *weight gain should only be 1lb/week*
What would be recommended if a pt po intake is compromised?
The Dobhoff feeding tube (also referred to as an NG tube) and PEG (percutaneous endoscopic gastrostomy) tube are the most common feeding tubes used.
What may you see on abdominal radiograph that would indicated Ulcerative Colitis due to loss of the haustral folds of large intestine?
The presence of "stove pipe" bowel
What is hepatorenal syndrome?
Too rapid removal of fluid during a paracentesis results in this. It is irreversible and only a liver transplant can fix.
Preferred pain medications for pancreatitis & also reduces inflammation
Toradol
Greatest risk factors for contracting the hepatitis A
Travel to underdeveloped countries with poor sanitation systems is one of the greatest risk factors for contracting the hepatitis A virus. Shellfish and other food sources that are harvested from waters contaminated by raw sewage are likely sources of infection. Also, food that is prepared by a person who does not utilize proper hand hygiene after defecation is a potential source of infection.
Signs and symptoms of cholecystitis
Vague upper abdominal pain that radiates to right shoulder Pain triggered by high fat meals Dyspepsia (indigestion) Heartburn Flatulence (gas) Belching Rebound tenderness (Blumberg sign) Positive Murphy's sign
Medications that can cause tarry/black stools?
What is iron supplementation, and bismuth (pepto bismol)
What are the manifestations of viral hepatitis?
fever, n/v, right upper quadrant tenderness, urticaria, jaundice, pruritis, dark urine, light or clay colored stools, fatigue
What consistency will the stool from a sigmoid colostomy be?
formed
Medical term for passage of blood in the feces
hematochezia
Lethargy, confusion, agitation, headaches & asterixis are associated with this condition
hepatic encephalopathy
The nurse is administering a pancreatic enzyme to the client dx with chronic pancreatitis. which statement best explains the rationale for administering this med? 1. it is an exogenous source of protease, amylase, and lipase 2. this enzyme increases the number of bowel movements 3. this medication breaks down in the stomach to help with digestion 4. pancreatic enzymes help break down fat in the small intestine
it is an exogenous source of protease, amylase, and lipase: pancreatic enzymes enhance the digestion of starches (carbohydrates) in the gastrointestinal tract by supplying an exogenous (outside) source of the pancreatic enzymes protease, amylase and lipase
chronic hep B drug therapy
lamivudine -monitor kidney function -dose is altered if co-infection with HIV is present
Signs and symptoms of acute cholecystitis
1) jaundice 2) Dark amber urine 3) Clay colored stools: No bilirubin reaching the intestines the cause brown stool 4) Steatorrhea: fatty poops No bile salt in duodenum, preventing fat emulsion and digestion
A client complains of rectal pain and bleeding. On examination the nurse notes multiple anal fistulas. These are associated with what bowel disorder? A Crohn's disease B Diverticulitis C Diverticulosis D Ulcerative colitis
A Explanation: The lesions of Crohn's disease involve all thickness of the bowel. These lesions may perforate the bowel wall, forming fistulas with adjacent structures. Fistulas don't develop in diverticulitis or diverticulosis. The ulcers that occur in the submucosal and mucosal layers of the intestine in ulcerative colitis usually don't progress to fistula formation as in Crohn's disease. **the anorectal area is most common because of the relative thinness of the intestinal wall in this area.**
The nurse is caring for a woman recently diagnosed with viral hepatitis A. Which individual should the nurse refer for an immunoglobin (IG) injection? A caregiver who lives in the same household with the patient A friend who delivers meals to the patient and family each week A relative with a history of hepatitis A who visits the patient daily A child living in the home who received the hepatitis A vaccine 3 months ago
A caregiver who lives in the same household with the patient IG is recommended for persons who do not have anti-HAV antibodies and are exposed as a result of close contact with persons who have HAV or foodborne exposure. Persons who have received a dose of HAV vaccine more than 1 month previously or who have a history of HAV infection do not require IG.
An underweight client has autoimmune hemolytic anemia that has been unresponsive to corticosteroids, and a splenectomy is scheduled. For what complication should the nurse assess the client in the immediate postoperative period? 1 Dehiscence 2 Hemorrhage 3 Wound infection 4 Abscess formation
A client is at risk for *hemorrhage* because of the vascularity of the spleen. Dehiscence is not expected; it usually occurs in obese clients. Wound infection is a complication that will take days to develop. Abscess formation is a complication that will take days to develop.
The nurse would question an order for the proton pump inhibitor-esomeprazole (Nexium) for the patient who is: a.taking digoxin. b.noncompliant. c.asthmatic. d.on chemotherapy for cancer.
ANS: A Esomeprazole (Nexium) interferes with the absorption of digoxin, rabeprazole, and iron salts. In addition, the Food and Drug Administration (FDA) has issued a warning that long-term use of the proton pump inhibitors esomeprazole (Nexium) or omeprazole (Prilosec) may increase the risk of heart problems.
The nurse is reviewing the laboratory results of an assigned patient. The serum bilirubin is 2.8 mg/dL. The nurse would anticipate which finding in the patient's urine? a.Dark color b.Low specific gravity c.Very scant amount d.Foul odor
ANS: A Normal serum bilirubin is 0.1 to 1.2 mg/dL. Jaundice is present at readings above 2.5 mg/dL. The patient who is jaundiced will have dark, tea-colored urine. Specific gravity refers to the concentration of the urine. The amount and odor of urine will not be directly influenced by the bilirubin level.
When the patient returns to the floor at 12:30 PM after having had an upper GI (UGI) series, which action should the nurse complete first? a. Offer liquids and a snack immediately. b. Delay the meal tray until the bowel is clear of contrast media. c. Turn the patient on the right side to enhance evacuation of contrast media.
ANS: A Patients who have had a UGI series have been NPO for 12 hours and may be dehydrated. Fluids should be given generously to help evacuate the contrast media, and the meal tray should be given as quickly as possible.
When the patient complains, "I don't see why I can't have a CT scan instead of the expensive MRI," the nurse clarifies that the magnetic resonance imaging (MRI) study: a.provides better contrast between normal and pathologic tissue. b.requires less analysis and is easier to read. c.produces a digital image that can be transmitted via e-mail. d.exposes the patient to less radiation.
ANS: A The MRI uses radiofrequency signals to determine how hydrogen atoms behave in the magnetic field. In addition, the MRI provides a better contrast between healthy tissues and pathologic tissues
A patient with cirrhosis complains of the blandness of the low-protein diet and questions its effectiveness. The nurse reminds the patient that the low-protein diet helps his condition by: a. decreasing the production of ammonia. b. decreasing the production of urea. c. supporting the manufacture of clotting factors. d.decreasing the production of albumin.
ANS: A The low-protein diet reduces the production of ammonia, the metabolic toxin that can cause hepatic coma. Protein is broken down in the bowel, and one of its metabolites is ammonia.
A nurse cares for a jaundiced patient and asks, "Why is my skin so itchy?" How should the nurse respond? a. "Bile salts accumulate in the skin and cause the itching." b. "Toxins released from an inflamed gallbladder lead to itching." c. "Itching is caused by the release of calcium into the skin."
ANS: A In obstructive jaundice, the normal flow of bile into the duodenum is blocked, allowing excess bile salts to accumulate on the skin. This leads to itching, or pruritus. The other statements are not accurate
A patient with esophageal varices is receiving potent vasoconstrictors to help prevent hemorrhage. The nurse will be concerned if the patient complains of pain in the: a. chest. b. flank area. c.lower legs. d back.
ANS: A Mid-sternal chest pain is indicative of acute angina or myocardial infarction. With the use of potent vasoconstrictors such as vasopressin (Pitressin), which constricts all vessels, the possibility of it causing an MI is a very real concern. Nausea and vomiting, headache, and vertigo and syncope are not side effects of vasopressin.
A nurse cares for a client who is prescribed lactulose. The client states, "I do not want to take this medication because it causes diarrhea." How should the nurse respond? a. "Diarrhea is expected; that's how your body gets rid of ammonia." b. "You may take Kaopectate liquid daily for loose stools." c. "Do not take any more of the medication until your stools firm up." d. "We will need to send a stool specimen to the laboratory."
ANS: A The purpose of administering lactulose to this client is to help ammonia leave the circulatory system through the colon. Lactulose draws water into the bowel with its high osmotic gradient, thereby producing a laxative effect and subsequently evacuating ammonia from the bowel. The client must understand that this is an expected and therapeutic effect for him or her to remain compliant.
The nurse is preparing to administer medications and notes that a patient has sucralfate ordered qid. When is the best time to administer this medication? a.1 hour before meals b.With meals c.1 hour after meals
ANS: A This medication should be administered on an empty stomach. Taking the medication with meals, 1 hour after meals, or with a bedtime snack does not allow the medication to form its protective coat of the gastric mucosa. *Coats the stomach*
The nurse lists foods and beverages that may trigger an attack of irritable bowel syndromes (IBS), which include: (Select all that apply.) a. caffeine. b.dairy products. c.specific food allergies. d.wheat products. e.alcohol.
ANS: A, B, C, D Irritable bowel syndrome (IBS) is a functional disorder of gastrointestinal motility. The cause of IBS is unknown, but it is thought to be due to a hypersensitivity of the bowel wall leading to disruption of the normal function of the intestinal muscles. An altered bowel pattern and abdominal pain with bloating are caused by altered motility of the small and large intestines. It is thought that with IBS there is an abnormality of nerve function in the intestine. Stress, caffeine, and sensitivity to certain foods such as dairy and wheat products seem to trigger IBS in some people. Alcohol is not considered a trigger for IBS.
The nurse reading the laboratory reports for a patient with acute hepatitis is aware that indicators supporting this diagnosis are? SATA a.elevated aspartate aminotransferase (AST). b.elevated alanine aminotransferase (ALT). c.decreased temperature d. increased prothrombin time.
ANS: A, B, D During the acute phase of hepatitis the patient will likely have an elevation of AST and ALT Prothrombin times will be prolonged.
The nurse is speaking with a patient who has concerns about the development of cholelithiasis. The nurse correctly includes which risk factors for the condition? (Select all that apply.) a.Obesity b.Daily exercise regimen c.Diabetes mellitus d.Taking cholesterol-lowering drugs e. Women on HRT
ANS: A, C, D, E Cholelithiasis is the presence of gallstones within the gallbladder or in the biliary tract. All options listed are risk factors for the development of gallstones *except* a daily exercise regimen. A sedentary lifestyle is a risk factor for cholelithiasis. Women on HRT are also at risk for development of gallstones.
Which factor(s) contribute(s) to the development of PUD? (Select all that apply.) a. Cigarette smoking b. Stress c. Genetics d. Excessive ingestion of milk products e. H. pylori
ANS: A, C, E Cigarette smoking increases acid secretion and alters blood flow to the stomach. In addition, cigarette smoking interferes with prostaglandin synthesis, which compromises defense mechanisms. A genetic predisposition seems to exist for the development of PUD. Infection by H. pylori is thought to be associated with as many as 90% of duodenal and 70% of gastric ulcers. Chronic emotional stress was previously believed to cause stress ulcer, and physicians suggested that patients with this condition reduce their stress levels. However, patients who took steps to reduce the stress in their lives saw no improvement. It is now known that emotional stress does not cause ulcers, but it may make them worse. Bacteria have been shown to cause a stress ulcer, which can be treated simply by taking a dose of antibiotics. Dairy products do not contribute to the development of ulcers.
A patient who had gastric bypass surgery 5 weeks ago calls the office to report feelings of nausea, sweating, and diarrhea shortly after eating meals. What response by the nurse is most appropriate? a."This is common after the type of surgery you had." b."Reduce the amount of refined sugars that you are eating."
ANS: B Patients who have had gastric bypass surgery are at risk for dumping syndrome, which results in nausea, weakness, sweating, and diarrhea. These symptoms tend to occur after meals that include concentrated sweets; therefore patients should be advised to avoid refined sugars. Although this is not an uncommon manifestation after this type of surgery, informing the patient that this is common provides limited information to the patient and is not the best response. Reducing the speed of eating will not provide relief from the problems being described. This is not a symptom of a postoperative infection.
The nurse is reviewing the laboratory results from a patient who has been diagnosed with liver disease. Which finding would be consistent with this condition? a. Prothrombin time (PT) 12.4 seconds b. Prothrombin time (PT) 10 seconds
ANS: B Prothrombin is a protein produced by the liver and used in blood clotting. The normal value is 12 to 14 seconds. It is reduced in patients with liver disease, causing a prolonged clotting time.
When caring for a client who has cirrhosis of the liver. Which action should the nurse take to decrease the presence of ascites? a. Monitor intake and output. b. Provide a low-sodium diet. c. Increase oral fluid intake. d. Weigh the client daily.
ANS: B A low-sodium diet is one means of controlling abdominal fluid collection. Monitoring intake and output does not control fluid accumulation, nor does weighing the client. These interventions merely assess or monitor the situation. Increasing fluid intake would not be helpful.
A nurse plans care for a client with acute pancreatitis. Which intervention should the nurse include in this client's plan of care to reduce discomfort? a. Administer morphine sulfate intravenously every 4 hours as needed. b. Maintain nothing by mouth (NPO) and administer intravenous fluids. c. Provide small, frequent feedings with no concentrated sweets. d. Place the client in semi-Fowler's position with the head of bed elevated.
ANS: B The client should be kept NPO to reduce GI activity and reduce pancreatic enzyme production. IV fluids should be used to prevent dehydration. The client may need a nasogastric tube. Pain medications should be given around the clock and more frequently than every 4 to 6 hours. A fetal position with legs drawn up to the chest will promote comfort.
The nurse is discussing dietary and lifestyle changes with a patient diagnosed with GERD. When reviewing necessary modifications, the nurse will include information regarding: (Select all that apply.) a.limiting coffee intake to 2 cups/day. b.smoking cessation. c.avoiding NSAIDs. d.decreasing protein foods. e.using nonfat milk
ANS: B, C, E Interventions to help relieve symptoms associated with GERD include cessation of smoking, avoidance of NSAIDs, and use of nonfat milk. *Coffee should be avoided completely* Protein foods should be increased.
When administering a bulk-forming laxative, the nurse instructs the patient to drink the medication mixed in a full 8-ounce glass of water. Which statement best explains the rationale for this instruction? a.The water acts to stimulate bowel movements. b.The water will help to reduce the bulk of the intestinal contents. c.These laxatives may cause esophageal obstruction if taken with insufficient water. d.The water acts as a lubricant to produce bowel movements.
ANS: C Bulk-forming drugs increase water absorption, which results in greater total volume (bulk) of the intestinal contents. Bulk-forming laxatives tend to produce normal, formed stools. Their action is limited to the gastrointestinal tract, so there are few, if any, systemic effects. However, they need to be taken with liberal amounts of water to prevent esophageal obstruction and fecal impaction.
The nurse explains to a patient with cholelithiasis that the purpose of the HIDA scan is to: a. visualize the location of the gallstones. b. assess the amount of inflammatory swelling. c. diagnose abnormal contraction of the gallbladder.
ANS: C The HIDA scan can diagnose abnormal contractions of the gallbladder, which occur in the presence of gallstones or a gallbladder that is not functioning properly.
The nurse is planning to administer an antacid to a patient diagnosed with Peptic Ulcer Disease who will receive an H2 antagonist at 8:00 AM. When is the most appropriate time for the nurse to provide the antacid to this patient? a. With the H2 antagonist b. 30 minutes prior to the H2 antagonist c. 2 hours after the H2 antagonist d. Within an hour after the H2 antagonist
ANS: C Because antacid therapy is often continued during early therapy of PUD, administer 1 hour before or 2 hours after H2 antagonist dose. **Smoking reduces the effectiveness Of this classification of drugs**
The nurse explains that the jaundice observed in a person with hepatitis is related to the: a.ischemia of the liver. b.increased bile production by the enlarged Kupffer cells. c.destruction of RBCs by the hepatitis virus. d. congestion in the liver obstructing bile flow.
ANS: D Congestion from the inflammation obstructs the bile from entering the duodenum and keeps it in the circulating volume.
In reviewing the physical assessments of several patients, the nurse recognizes that the patient most likely to have gallstones would be the: a.37-year-old white man of normal weight on long-term corticosteroids for asthma. b.42-year-old African American man of normal weight who has smoked for 25 years. c.46-year-old Indonesian woman who is under normal weight and has recently had radiation treatments. d.50-year-old obese Mexican American woman who has type 1 diabetes.
ANS: D Obesity, diabetes mellitus, rapid weight loss, and Crohn's disease increase the risk for the development of gallstones. Native Americans and Mexican Americans have an ethnic predisposition to gallstones.
A patient is about to undergo a diagnostic bowel procedure. The nurse expects which drug to be used to induce total cleansing of the bowel? a.docusate sodium (Colace) b.magnesium hydroxide (milk of magnesia) c. mineral oil d.polyethylene glycol (GoLYTELY)
ANS: D Polyethylene glycol is a very potent laxative that induces total cleansing of the bowel and is most commonly used before diagnostic or surgical bowel procedures. The other options are incorrect.
The critical care nurse is caring for a patient with cirrhosis. What is an essential nursing function when caring for a patient with cirrhosis? A) Monitoring the patient's oral intake B) Monitoring the patient's support network C) Monitoring the patient for signs of hypervolemia D) Monitoring the patient's mental status
ANS: D Monitoring is an essential nursing function to identify early deterioration in mental status. The nurse monitors the patient's mental status closely and reports changes so that treatment of encephalopathy can be initiated promptly. An extensive neurologic evaluation is key to identify progression through the four stages of encephalopathy. The nurse would monitor the oral intake and watch for signs of hypervolemia, but they are not as essential as the patient's mental status because of the encephalopathy that goes with cirrhosis. Monitoring the support network is not essential at this time.
A client is admitted to the hospital with elevated serum amylase, lipase & glucose levels and a decreased calcium & magnesium level. Which GI health problem is indicated by these lab findings?
Acute pancreatitis
A 54-year-old patient admitted with diabetes mellitus, malnutrition, osteomyelitis, and alcohol abuse has a serum amylase level of 280 U/L and a serum lipase level of 310 U/L. To what diagnosis does the nurse attribute these findings? Malnutrition Osteomyelitis Alcohol abuse Diabetes mellitus
Alcohol abuse The patient with alcohol abuse could develop pancreatitis as a complication, which would increase the serum amylase (normal 30-122 U/L) and serum lipase (normal 31-186 U/L) levels as shown.
Cirrhosis is a chronic condition that leaves scars on the liver. What effects do the scars have on the body?
Although cells and tissues will attempt to regenerate, this will result in permanent scarring and irreparable damage.Permanent scars form in response to attempts by the cells to regenerate and create problems in blood circulation moving through the liver. Liver scarring will create problems with blood clotting, cholesterol levels, and blood pressure, as well as with the metabolism of drugs and toxins.
A client has a liver biopsy. Which nursing intervention is appropriate for monitoring or preventing a post-liver biopsy complication? 1 Place the client in a left side-lying position. 2 Keep the client supine on bed rest for six hours. 3 Take the client's pulse and blood pressure every shift. 4 Assess the client for pain in the right upper quadrant.
Ans: 4 If there is bleeding, subcapsular accumulation of blood will occur and cause pressure and pain in the area of the liver. Placing the client in a left side-lying position is to no avail, as the liver is on the right side of the body. A right side-lying or supine position is maintained for one to two hours. Taking the client's pulse and blood pressure every shift is too infrequent. Performing this every 15 minutes for two hours and then every 30 minutes for two hours is more appropriate.
A client with pancreatic cancer has an infusion of TPN (Total Parenteral Nutrition). The doctor has ordered for sliding-scale insulin. The most likely explanation for this order is: a) Total Parenteral Nutrition leads to negative nitrogen balance and elevated glucose levels. b) Total Parenteral Nutrition cannot be managed with oral hypoglycemics. c) Total Parenteral Nutrition is a high-glucose solution that often elevates the blood glucose levels. d) Total Parenteral Nutrition leads to further pancreatic disease.
Answer C is correct. Total Parenteral Nutrition is a high-glucose solution. This therapy often causes the glucose levels to be elevated. Because this is a common complication, insulin might be ordered. Answers A, B, and D are incorrect. TPN is used to treat negative nitrogen balance; it will not lead to negative nitrogen balance. Total Parenteral Nutrition can be managed with oral hypoglycemic drugs, but it is difficult to do so. Total Parenteral Nutrition will not lead to further pancreatic disease.
A nurse is caring for a client with cholelithiasis and obstructive jaundice. When assessing this client, the nurse should be alert for which common clinical indicators associated with these conditions? (Select all that apply.) 1 Ecchymosis 2 Yellow sclera 3 Dark brown stool 4 Straw-colored urine 5 Pain in right upper quadrant
Ecchymosis Yellow sclera Pain in right upper quadrant Inadequate bile flow interferes with vitamin K absorption, contributing to ecchymosis, hematuria, and other bleeding. Yellow sclera results from failure of bile to enter the intestines, with subsequent backup into the biliary system and diffusion into the blood. The bilirubin is carried to all body regions, including the skin and mucous membranes. Pain in the right upper quadrant occurs especially after eating foods high in fat and is characteristic of acute cholecystitis and biliary colic. With obstructive jaundice the stool is clay colored, not dark brown; the presence of bile causes stool to be brown. When bile levels in the bloodstream are high, as in obstructive jaundice, there is bile in the urine, causing it to have a dark color.
Complications of Acute Pancreatitis
In acute pancreatitis, *pulmonary failure* accounts for more than half of all deaths that occur in the first week of the disease. -*(acute respiratory distress syndrome-ARDS) - hypovolemia -Multi System organ failure
You recall what you know about the pathophysiology of acute pancreatitis. What best describes acute pancreatitis?
In acute pancreatitis, pancreatic enzymes attack pancreatic cells. Inflammation with edema follows. With severe forms of pancreatitis, pancreatic tissue becomes necrotic and may become infected. Pancreatic tissue may also become hemorrhagic.
The patient with sudden pain in the left upper quadrant radiating to the back and vomiting was diagnosed with acute pancreatitis. What intervention(s) should the nurse expect to include in the patient's plan of care? -Immediately start enteral feeding to prevent malnutrition. -Insert an NG and maintain NPO status to allow pancreas to rest. -Initiate early prophylactic antibiotic therapy to prevent infection. -Administer acetaminophen (Tylenol) every 4 hours for pain relief.
Insert an NG and maintain NPO status to allow pancreas to rest. Initial treatment with acute pancreatitis will include an NG tube if there is vomiting and being NPO to decrease pancreatic enzyme stimulation and allow the pancreas to rest and heal. Fluid will be administered to treat or prevent shock. The pain will be treated with IV morphine because of the NPO status. Enteral feedings will only be used for the patient with severe acute pancreatitis in whom oral intake is not resumed. Antibiotic therapy is only needed with acute necrotizing pancreatitis and signs of infection.
The nurse asks a patient with liver disease to raise the arms to shoulder level and dorsiflex the hands. A few moments later, the hand begins to flap upward and downward. How does the nurse correctly document this in the medical record?
Liver flap or asterixis is related to increased serum ammonia levels—the dorsiflexed hands begin to flap upward and downward when outstretched for a few moments. .
You're performing an abdominal assessment. In which order do you proceed?
Observation, auscultation, percussion, palpation