GI review

A client who was having lunch of shrimp and clams, develops a rash of hives, urticaria, tachycardia, and wheezing. The nurse should prioritize which med?

----epi oral prednisone albuterol diphenhydramine

The client is on the unit after abdominal surgery. The Client has an indwelling urinary catheter, a nasogastric (NG) tube to low continuous suction, and two IVs. The nurse observes blood draining from the NG tube. What action would the nurse take next?

A. Document the findings in the chart. B. Notify the surgeon immediately. C. Reassess the drainage in 1 hour. -------D. Take a full set of vital signs. If the drainage was older, we would expect to see be brown with old blood. The presence of blood, especially if it were bright red, indicates bleeding. The nurse would take a set of vital signs to assess for shock and then notify the surgeon. Documentation would occur but is not the first thing the nurse would do. The nurse would not wait an additional hour to reassess. The nurse should always think, "is there something I can do before I call the physician?". The physician will want to know the stability of the client, which includes VS~!

The nurse is caring for a client diagonsed with GERD. What information needs to be corrected.

DONT lie down for 30 mins after a meal - NO, YOU SHOULD LIE DOWN AFTER EATING FOR AT LEAST 30 MINS

The nurse is caring for a client who has an exacerbation of ulcerative colitis. Which action by the nurse has the highest priority?

Weigh the client -------Maintain hydration-------- think c - circulation Record intake and output Have the dietician visit the client

A patient reports gas pains and abdominal distention 2 days after a small bowel resection. Which nursing action should the nurse take?

a. Administer hydromorphone ----b. Encourage the patient to ambulate. c. Offer the prescribed promethazine. d. Instill a mineral oil retention enema. Ambulation will improve peristalsis and help the patient eliminate flatus and reduce gas pain. A mineral oil retention enema is helpful for constipation with hard stool. A return-flow enema might be used to relieve persistent gas pains. Morphine will further reduce peristalsis. Promethazine is used as an antiemetic rather than to decrease gas pains or distention.

A patient has gastroesophageal reflux disease (GERD). The provider prescribes a proton pump inhibitor. About what medication would the nurse anticipate teaching the patient?

a. Famotidine b. Magnesium hydroxide -----c. Omeprazole d. Cimetidine Omeprazole is a proton pump inhibitor used in the treatment of GERD. Famotidine and cimetadine are histamine blockers. Maalox is an antacid.

At the first postoperative checkup appointment after a gastric resection, the client reports dizziness, weakness, and palpitations that occur about 20-30 minutes after each meal. What should the nurse teach the patient to do?

a. Increase the amount of fluid with meals. b. Eat foods that are higher in carbohydrates. ----c. Lie down for about 30 minutes after eating. d. Drink sugared fluids or eat candy after meals. The patient is experiencing symptoms of dumping syndrome, which may be reduced by lying down after eating (low Fowler's will help delay the transit of food into the GI tract for digestion) Increasing fluid intake and choosing high carbohydrate foods will increase the risk for dumping syndrome. Having a sweet drink or hard candy will correct the hypoglycemia that is associated with dumping syndrome but will not prevent dumping syndrome.

Which assessment should the nurse perform first for a patient who just vomited bright red blood?

a. Measuring the quantity of emesis b. Palpating the abdomen for distention ----c. Checking the client for a patent airway d. Taking the blood pressure and pulse he patient who just vomited blood, assessing the airway for patency is the first priority. Next, the nurse is concerned about blood loss and possible hypovolemic shock in a patient with acute gastrointestinal bleeding. BP and pulse are the best indicators of these complications. The other information is important to obtain, but BP and pulse rate are the best indicators for assessing intravascular volume, but A is first!

The nurse is explaining the process of bariatric surgery to a severely obese client who has attended a medically supervised weight loss program for approximately 6 months. The client is considering this procedure. What are some conditions that may interfere with a client's commitment to lifelong behavioral changes and that may lead to poor surgical outcomes? Select all that apply

all correct B. Untreated depression C. Binge eating disorders D. Drug and alcohol abuse E. Lack of family resources F. Inability to comply with nutritional recommendations Conditions that can lead to poor bariatric surgical outcomes include untreated depression, binge eating disorders, drug and alcohol abuse, and an inability to comply with nutritional recommendations. Anxiety does not directly affect bariatric surgical outcomes.

the nurse is assigned to care for a client with HIV infectiom. The nurse reviews the clients health care record and notes documentation of toxoplassmosis encephalitis. On the basis of this info, the nurse would asses for what?

lesions on skin --------mental status changes changes in bowel pattern lesion on oral mucosa

a client has a transfusion of RBC. Ten mins laterm the client develops shortness of breath, flank pain, tachycardia, and fever with chills. The nurse checks the blood, the unit is b-, and the clients blood band says the clients blood is a-. What does the nurse think is happening?

------acute hemolytic reaction (FLANK AND BACK PAIN spetic/bacterial reaction (flushed) febrile non hemolytic reaction ( there wouldn't be flank pain) anaphylactic reaction (hives, urticia, itching, usually happens fast)

The nurse is assissting in planning care for a cleint with a diagonis of immunodeifecy and would incorporate which action as a priorty?

------protecting client from infection providing emotional support discuss lifestyle changes identifying factors that decrease the immune system

A nurse is teaching patients with gastroesophageal reflux disease (GERD) about foods to avoid. Which foods would the nurse include in the teaching? (Select all that apply.)

----A. Chocolate ---B. Citrus fruits ----C. Peppermint ----D. Tomato sauce E. Decaffeinated coffee Chocolate, citrus fruits such as oranges and grapefruit, peppermint and spearmint, and tomato-based products all contribute to the reflux associated with GERD. Caffeinated teas, coffee, and sodas should be avoided.

The client is diagnosed with an acute exacerbation of ulcerative colitis. Which intervention should the nurse implement?

A Provide a low residue diet B. Assess the client's VS q 8 hr C. Administer antacids orally ----D. Rest the bowel with NPO Whenever a client has an acute exacerbation of a gastrointestinal disorder, the first intervention is to place the bowel on rest. The client should be NPO without intravenous fluids to prevent dehydration.

The client diagnosed with Crohn's disease is reporting severe abdominal pain. During the assessment, the nurse finds a rigid, hard abdomen and a temp of 102 F. Which intervention should the nurse implement?

----A. Notify the health care provider B. Prepare to administer a fleet enema C. Administer an antipyretic suppository D. Continue to monitor the client closely These are signs of peritonitis, which is life-threatening. The physicisn should not be notified immediately. In the case of a true emergency, there is not much the nurse can do (the nurse will get VS, prep for surgery, make NPO, make sure type and cross is done for blood), but the physician needs to be informed immediately as the client needs emergency surgery. A fleet enema will not help. A medication administered to help decrease the client's temperature will not help a life-threatening complication.

A CD4+ lymphocyte count is performed in a client with human immunodeficiency virus (HIV) infection. When providing education about the testing, what would the nurse tell the client?

----It establishes the stage of HIV infection." It confirms the presence of HIV infection." "It identifies the cell-associated proviral DNA." "It determines the presence of HIV antibodies in the bloodstream."

The nurse is caring for a client with has a WBC count of 1000, who has neutroenic precautions. Which actions should the nurse include in the plan of care?

----practice excellent and thorough hand washing have the client use an electric razor ensure the client gets plenty of veggies and fruits plan to give the client injections if erythropoietin (this med would be intended for anemia, low rbcs or platelet count) tell the client to avoid the use of aspirin in any form ----monitor temp every 4 hours and report if >100.4 teach the client how and when to take oral iron supplements (this would be intended for anemia, contraindicated for low WBC count)

The nurse is caring for a client who has large wounds with drainage. The client is on high protein diet. Which lab data provides evidence of aqequate healing?

----serum albumin 8.3 --- need protein for adequate healing promotion serum calcium 10.2 serum potassium 5.1 PT time 15 secs platelet count 380,000

A client exhibits erythema of the skin. The nurse plans care, knowing that which factors are responsible for this finding. Select all that apply.

---Fever (may be red or flushed) ---Vasodilation ----Inflammation Deoxygenated hemoglobin (CYANOSIS, this is the opposite) Excessively high environmental temperature

The nurse is concerned about potential skin integrity problems for an unconscious client. Which interventions would be most appropriate to include in the plan of care for this client? Select all that apply.

---Reposition every *2* hours. ---Use a bed cradle as indicated. ---Apply protective pads to heels and elbows. ---Provide perineal care every 4-6 hours and after incontinence. care ig provided q4 hours

a nurse is caring for a client after surgical repair is a right lower leg fracture. #% mins after medicating the client with 4mg of hydromorphone the client is still in pain. What action should the nurse take?

---check for pulse and paraesthesia (earliest sign of compartment syndrome is pain outside of the site of injury- it may be cool, pale, with edema noted) checking the distal extremities is a neurovascular assessment bilaterally, always know the baseline, and always an emergency when a pulse is lost

THE CARE PLAN FOR A CLIENT WITH GERD

--CONTRAINDICATED-- LARGE MEALS HAVE A SNACK BEFORE BED TRY TO MAINTAIN A HEALTHY WEIGHT AVOID FOOD RIGHT BEFORE BED REDUCE TOMATO, CAFFIENE, CHOCLATE --INDICATED-- SLEEP WITH BED ELEVATED AVOID ALOCHOL AND SMOKING --NON ESSENTIAL -- CHECKING GLUCOSE LEVELS (unless they are diabetic)

The nurse is caring for a client experiencing an exacerbation of Crohn's disease. Which intervention would the nurse anticipate the primary health care provider prescribing?

1. Enteral feedings 2. Fluid restrictions ---3. Oral corticosteroids 4. Activity restrictions Crohn's disease is a form of inflammatory bowel disease that is a chronic inflammation of the gastrointestinal (GI) tract. It is characterized by periods of remission interspersed with periods of exacerbation. Oral corticosteroids are used to treat the inflammation of Crohn's disease, so option 3 is the correct one. In addition to treating the GI inflammation of Crohn's disease with medications, it is also treated by resting the bowel. Therefore, option 1 is incorrect. Option 2 is incorrect, as clients with Crohn's disease typically have diarrhea and would not be on fluid restrictions. Option 4, activity restrictions, is not indicated. The client can do activities as tolerated but needs to avoid stress and strain.

The nurse is teaching the postgastrectomy client about measures to prevent dumping syndrome. Which statement by the client indicates a need for further teaching?

A. "I need to lie down after eating." ---B. "I need to drink liquids with meals." C. "I need to avoid concentrated sweets." D. "I need to eat small meals 6 times daily." The client with dumping syndrome would avoid drinking liquids with meals. The client needs to be placed on a high-protein, moderate-fat, high-calorie diet and needs to lie down after eating. The client would avoid concentrated sweets, and frequent small meals are encouraged.

Which information will the nurse include for a patient with newly diagnosed gastroesophageal reflux disease (GERD)?

A. "You should avoid eating between meals to reduce acid secretion." -----B. "Keep the head of your bed elevated at least 6- 8 inches." C. "Peppermint tea may reduce your symptoms." D. "Vigorous physical activities may increase the incidence of reflux." Elevating the head of the bed will reduce the incidence of reflux while the patient is sleeping. Peppermint will decrease lower esophageal sphincter (LES) pressure and increase the chance for reflux. Small, frequent meals are recommended to avoid abdominal distention. There is no need to make changes in physical activities because of GERD.

The nurse is caring for a hospitalized client with a diagnosis of ulcerative colitis. Which finding, if noted on assessment of the client, would the nurse report to the primary health care provider (PHCP)?

A. Hypertension B. Bloody diarrhea ----C. Rebound tenderness D. A hemoglobin level of 12 mg/dL Rebound tenderness may indicate peritonitis. Bloody diarrhea is expected to occur in ulcerative colitis. Because of the blood loss, the client may be hypotensive (not hypertensive) and the hemoglobin level may be lower than normal. Signs of peritonitis must be reported to the PHCP.

The nurse cares for a client following a Roux-en-Y gastric bypass surgery. Which nursing intervention is appropriate?

A. Maintain position on the client's left side. B. Encourage the client to stay in bed and rest. C. Frequently irrigate the NGT with 30 mL saline. ----D. Give the client 30mL of sugar-free liquids every 2 hr. In the post-op period, the client should be offered every 30 mL of water & SF liquids while awake (w/a)before transitioning to a high-protein liquid diet before DC (↓ carb/sugar), and they should not consume liquids with solid food- RD consult needed. Bariatric clients are at risk for developing DVT and atelectasis and should ambulate after surgery and then frequently. Option B is incorrect, as positioning on the left side is not indicated; positioning on the right side would be more appropriate to facilitate gastric emptying. Option C is incorrect, as the stomach after a Roux-en-Y procedure is very small and often holds only 30 mL, so frequent irrigation with 30 mL could disrupt the anastomosis or staple line, leading to peritonitis and sepsis.

The nurse is caring for the client who had gastric bypass (Roux-en-Y procedure) surgery. Which action in the post op care plan needs to be CORRECTED?

AMBULATE IMMEDIATELY AFTER SURGERY, MULTIPLE TIMES A DAY Use the IS hourly (10x hourly in the perfect world) Give small amounts of liquid every 2 hr. - 30 ML OF WATER OR SUGAR FREE DRINKS AVOID FLUID INTAKE WITH MEALS Splint or brace abdomen for coughing HIGH PROTEIN DIET TEACH S/S OF DUMPING SYNDROME LOW SUGAR DIET MUST MONITOR INCISION SITE (TINEA, SKIN FOLDS, ETC)

The nurse is preparing to care for a client with immunodeficiency. The nurse would plan to address which problem as the priority?

Anxiety Fatigue ---Risk for infection----- Need for social isolation

The nurse is caring for a client with GERD symptoms who had an upper endoscopy procedure. What action indicated after the procedure?

Check stools for OB Maintain patent airway Give intravenous fluids Keep NPO for a few hours

famotidine

H2 antagonist "dine" Decrease secretion of HCL by binding to histamine-2 receptors in gastric mucosal cells that stimulate the production of gastric acid

The nurse cares for multiple clients. Which clients would benefit from enteral nutrition? Select all that apply.

MUST HAVE A WORKING GI SYSTEM ---client with severe dysphagia following a stroke YES ---Client with a severe head injury YES Client with exacerbation of Crohn's (NPO DURING EXCERABATION) Client with a bowel obstruction NOOO- RISK FOR ASPIRATION ---Client with malnutrion and abnormal lab values YES ---Client with breathing tube and ventilator YES

The nurse is caring for a client who has an order to start peripheral parenteral nutrition (PPN). Which action should the nurse take?

PPN CAN BE PICC , CENTRAL, IV ----Wash hands before handling the IV----- Check the client's blood glucose daily ( check Q4-6 hours) Change the tubing and bag every 12 hours ( its 24 hrs) If the PPN is stopped for any reason, hang D10)

The nurse is assessing the client who is admitted with left leg cellulitis. What does the nurse anticipate finding on the assessment of the left lower extremity?

Pallor Cyanosis Jaundice ---Erythema

A client with a history of asthma comes to the emergency department complaining of itchy skin and shortness of breath after starting a new antibiotic. What is the first action the nurse would take?

Place the client on 100% oxygen and prepare for intubation. -----Assess for anaphylaxis and prepare for emergency treatment. (epi, steriod, diphenhydramine) Teach the client about the relationship between asthma and allergies. Obtain an arterial blood gas and immunoglobulin E (IgE) blood level.

pantoprazole

Proton Pump Inhibitor "Zole" Decrease hydrochloric acid by inhibiting the proton pump (stops acid production) Take it before the day's first meal, before food to decrease stomach acid production & promote healing