GI Nursing seminar
Which information about dietary management should the nurse include when teaching a patient with peptic ulcer disease (PUD)?
"Avoid foods that cause pain after you eat them."
A 26-year-old woman is being evaluated for vomiting and abdominal pain. Which question from the nurse will be most useful in determining the cause of the patients symptoms?
"Can you tell me more about the pain?"
The nurse is assessing an alert and independent 78-year-old woman for malnutrition risk. The most appropriate initial question is which of the following?
"Can you tell me the food that you ate yesterday?"
Which statement to the nurse from a patient with jaundice indicates a need for teaching?
"I use acetaminophen (Tylenol) every 4 hours for back pain."
Which information will the nurse include when teaching a patient with peptic ulcer disease about the effect of ranitidine (Zantac)?
"Ranitidine decreases gastric acid secretion."
Which area of the abdomen shown in the accompanying figure will the nurse palpate to assess for splenomegaly?
2
After change-of-shift report, which patient should the nurse assess first?
60-year-old with nausea and vomiting who has dry oral mucosa and lethargy
Which item should the nurse offer to the patient who is to restart oral intake after being NPO due to nausea and vomiting?
A dish of lemon gelatin
Which patient should the nurse assess first after receiving change-of-shift report?
A patient with esophageal varices who has a blood pressure of 92/58 mm Hg
Which patient statement indicates that the nurses teaching following a gastroduodenostomy has been effective?
A. "vitamin supplements may prevent anemia"
Which order from the health care provider will the nurse implement first for a patient who has vomited 1200 mL of blood?
Administer 1000 mL of lactated Ringers solution.
A 57-year-old man with Escherichia coli O157:H7 food poisoning is admitted to the hospital with bloody diarrhea and dehydration. Which order will the nurse question?
Administer loperamide (Imodium) after each stool.
A 53-year-old male patient with deep partial-thickness burns from a chemical spill in the workplace experiences severe pain followed by nausea during dressing changes. Which action will be most useful in decreasing the patients nausea?
Administer the prescribed morphine sulfate before dressing changes.
Which medications will the nurse teach the patient about whose peptic ulcer disease is associated with Helicobacter pylori?
Amoxicillin (Amoxil), clarithromycin (Biaxin), and omeprazole (Prilosec)
A 27-year-old female patient is admitted to the hospital for evaluation of right lower quadrant abdominal pain with nausea and vomiting. Which action should the nurse take?
Apply an ice pack to the right lower quadrant.
A 71-year-old male patient tells the nurse that growing old causes constipation so he has been using a suppository for constipation every morning. Which action should the nurse take first?
Assess the patient about risk factors for constipation.
A 26-year-old woman has been admitted to the emergency department with nausea and vomiting. Which action could the RN delegate to unlicensed assistive personnel (UAP)?
Assist the patient with oral care.
Which information will the nurse include when teaching adults to decrease the risk for cancers of the tongue and buccal mucosa?
Avoid use of cigarettes and smokeless tobacco.
A 44-year-old man admitted with a peptic ulcer has a nasogastric (NG) tube in place. When the patient develops sudden, severe upper abdominal pain, diaphoresis, and a firm abdomen, which action should the nurse take?
Check the vital signs.
Which patient choice for a snack 2 hours before bedtime indicates that the nurses teaching about gastroesophageal reflux disease (GERD) has been effective?
Cherry gelatin with fruit
A 50-year-old patient who underwent a gastroduodenostomy (Billroth I) earlier today complains of increasing abdominal pain. The patient has no bowel sounds and 200 mL of bright red nasogastric (NG) drainage in the last hour. The highest priority action by the nurse is to
Contact the surgeon
Which nursing action should be included in the postoperative plan of care for a patient after a laparoscopic esophagectomy?
Elevate the head of the bed to at least 30 degrees.
A patient complains of gas pains and abdominal distention two days after a small bowel resection. Which nursing action is best to take?
Encourage the patient to ambulate.
Which nursing action will be included in the plan of care for a 27-year-old male patient with bowel irregularity and a new diagnosis of irritable bowel syndrome (IBS)?
Encourage the patient to express concerns and ask questions about IBS.
A 58-year-old woman who recently has been diagnosed with esophageal cancer tells the nurse, I do not feel ready to die yet. Which response by the nurse is most appropriate?
Having this new diagnosis must be very hard for you.
A 46-year-old female with gastroesophageal reflux disease (GERD) is experiencing increasing discomfort. Which patient statement indicates that additional teaching about GERD is needed?
I eat small meals during the day and have a bedtime snack.
A 49-year-old man has been admitted with hypotension and dehydration after 3 days of nausea and vomiting. Which order from the health care provider will the nurse implement first?
Infuse normal saline at 250 mL/hr.
Which information will the nurse include for a patient with newly diagnosed gastroesophageal reflux disease (GERD)?
Keep the head of your bed elevated on blocks.
A 64-year-old woman who has chronic constipation asks the nurse about the use of psyllium (Metamucil). Which information will the nurse include in the response?
Large amounts of fluid should be taken to prevent impaction or bowel obstruction.
A 30-year-old man is being admitted to the hospital for elective knee surgery. Which assessment finding is most important to report to the health care provider?
Liver edge 3 cm below the costal margin
An 80-year-old who is hospitalized with peptic ulcer disease develops new-onset auditory hallucinations. Which prescribed medication will the nurse discuss with the health care provider before administration?
Metoclopramide (Reglan)
Which action should the nurse in the emergency department anticipate for a 23-year-old patient who has had several episodes of bloody diarrhea?
Obtain a stool specimen for culture.
A 73-year-old patient is diagnosed with stomach cancer after an unintended 20-pound weight loss. Which nursing action will be included in the plan of care?
Offer supplemental feedings between meals
After the nurse has completed teaching a patient with newly diagnosed eosinophilic esophagitis about the management of the disease, which patient action indicates that the teaching has been effective?
Patient schedules an appointment for allergy testing.
1. Which action will the nurse include in the plan of care for a 42-year-old patient who is being admitted with Clostridium difficile?
Place the patient in a private room on contact isolation.
A 58-year-old man with blunt abdominal trauma from a motor vehicle crash undergoes peritoneal lavage. If the lavage returns brown fecal drainage, which action will the nurse plan to take next?
Prepare the patient for surgery.
Which finding in the mouth of a patient who uses smokeless tobacco is suggestive of oral cancer?
Red, velvety patches on the buccal mucosa
Which assessment should the nurse perform first for a patient who just vomited bright red blood?
Taking the blood pressure (BP) and pulse
The nurse is assessing a patient who had a total gastrectomy 8 hours ago. What information is most important to report to the health care provider?
Temperature 102.1 F (38.9 C)
The nurse and a licensed practical/vocational nurse (LPN/LVN) are working together to care for a patient who had an esophagectomy 2 days ago. Which action by the LPN/LVN requires that the nurse intervene?
The LPN/LVN positions the head of the bed in the flat position.
The nurse determines that teaching regarding cobalamin injections has been effective when the patient with chronic atrophic gastritis states which of the following?
The cobalamin injections will prevent me from becoming anemic.
A 54-year-old man has just arrived in the recovery area after an upper endoscopy. Which information collected by the nurse is most important to communicate to the health care provider?
The oral temperature is 101.6° F.
A 42-year-old woman is admitted to the outpatient testing area for an ultrasound of the gallbladder. Which information obtained by the nurse indicates that the ultrasound may need to be rescheduled?
The patient ate a low-fat bagel 4 hours ago for breakfast.
A patient returned from a laparoscopic Nissen fundoplication for hiatal hernia 4 hours ago. Which assessment finding is most important for the nurse to address immediately?
The patient has absent breath sounds in the left anterior chest.
A 58-year-old patient has just been admitted to the emergency department with nausea and vomiting. Which information requires the most rapid intervention by the nurse?
The patient is lethargic and difficult to arouse.
The nurse receives the following information about a 51-year-old woman who is scheduled for a colonoscopy. Which information should be communicated to the health care provider before sending the patient for the procedure?
The patient refused to drink the ordered polyethylene glycol (GoLYTELY).
The nurse is administering IV fluid boluses and nasogastric irrigation to a patient with acute gastrointestinal (GI) bleeding. Which assessment finding is most important for the nurse to communicate to the health care provider?
The patients lungs have crackles audible to the midchest.
1. Which information about an 80-year-old man at the senior center is of most concern to the nurse?
Unintended weight loss
A 58-year-old woman has just returned to the nursing unit after an esophagogastroduodenoscopy (EGD). Which action by unlicensed assistive personnel (UAP) requires that the registered nurse (RN) intervene?
a. Offering the patient a drink of water
Which finding by the nurse during abdominal auscultation indicates a need for a focused abdominal assessment?
absent bowel sounds
A 38-year old woman receiving chemotherapy for breast cancer develops a Candida albicans oral infection. The nurse will anticipate the need for
administration of nystatin (Mycostatin) tablets.
A 62- year-old man reports chronic constipation. To promote bowel evacuation, the nurse will suggest that the patient attempt defecation
after eating breakfast.
The health care provider prescribes antacids and sucralfate (Carafate) for treatment of a patients peptic ulcer. The nurse will teach the patient to take
antacids after meals and sucralfate 30 minutes before meals.
A 68-year-old male patient with a stroke is unconscious and unresponsive to stimuli. After learning that the patient has a history of gastroesophageal reflux disease (GERD), the nurse will plan to do frequent assessments of the patients
breath sounds.
When caring for a patient with a history of a total gastrectomy, the nurse will monitor for
cobalamin (vitamin B12) deficiency.
The nurse will anticipate preparing a 71-year-old female patient who is vomiting coffee-ground emesis for
endoscopy
A family member of a 28-year-old patient who has suffered massive abdominal trauma in an automobile accident asks the nurse why the patient is receiving famotidine (Pepcid). The nurse will explain that the medication will
inhibit development of stress ulcers.
At his first postoperative checkup appointment after a gastrojejunostomy (Billroth II), a patient reports that dizziness, weakness, and palpitations occur about 20 minutes after each meal. The nurse will teach the patient to
lie down for about 30 minutes after eating.
A 62-year-old man patient who requires daily use of a nonsteroidal antiinflammatory drug (NSAID) for the management of severe rheumatoid arthritis has recently developed melena. The nurse will anticipate teaching the patient about
misoprostol (Cytotec) to protect the gastrointestinal (GI) mucosa.
A 68-year-old patient with a bleeding duodenal ulcer has a nasogastric (NG) tube in place, and the health care provider orders 30 mL of aluminum hydroxide/magnesium hydroxide (Maalox) to be instilled through the tube every hour. To evaluate the effectiveness of this treatment, the nurse
periodically aspirates and tests gastric pH.
A patient is being scheduled for endoscopic retrograde cholangiopancreatography (ERCP) as soon as possible. Which actions from the agency policy for ERCP should the nurse take first?
place the patient on NPO status.
After assisting with a needle biopsy of the liver at a patients bedside, the nurse should
place the patient on the right side with the bed flat.
To palpate the liver during a head-to-toe physical assessment, the nurse
places one hand on the patient's back and presses upward and inward with the other hand below the patient's right costal margin.
The nurse will anticipate teaching a patient experiencing frequent heartburn about
proton pump inhibitors.
While interviewing a 30-year-old man, the nurse learns that the patient has a family history of familial adenomatous polyposis (FAP). The nurse will plan to assess the patients knowledge about
risk for developing colorectal cancer.
A 26-year-old patient with a family history of stomach cancer asks the nurse about ways to decrease the risk for developing stomach cancer. The nurse will teach the patient to avoid
smoked foods such as ham and bacon.
When a 72-year-old patient is diagnosed with achalasia, the nurse will teach the patient that
treatment may include endoscopic procedures.
The nurse explaining esomeprazole (Nexium) to a patient with recurring heartburn describes that the medication
treats gastroesophageal reflux disease by decreasing stomach acid production.
A 50-year-old man vomiting blood-streaked fluid is admitted to the hospital with acute gastritis. To determine possible risk factors for gastritis, the nurse will ask the patient about
use of nonsteroidal antiinflammatory drugs (NSAIDs).
