GI System EVOLVE
the nurse is eliciting a health history from a client with ulcerative colitis. Which factor would the nurse consider to be most likely associated with the clients colitis? fool allergy infectious agent dietary components genetic predisposition
answer: genetic predisposition studies indicate that inflammatory bowel diseases, which include ulcerative colitis and Crohn disease, are familial, which suggests that they are hereditary. Although food allergy or an infectious agent may be causative factors, they are not the most common factors. No specific dietary component has been identified.
A client is diagnosed with celiac disease. which foods would the nurse teach the client to avoid? select all that apply. corn cheese oatmeal rye bread fruit juice
answer: oatmeal and rye bread gluten is found in rye, oats, wheat, and barley, which should be avoided because gluten in these grains is irritating to the GI mucosa in clients with celiac disease.
which food selections by a client with celiac disease indicate the nurse's dietatry teaching was successful? select all that apply. green beans baked potato noodle pudding turkey sandwich whole wheat cereal
answer: 1,2 clients with celiac disease need to follow a gluten free diet. noodles, bread in the turkey sandwich, and whole wheat cereal are high in gluten.
a client with cholelithiasis is scheduled for a lithotripsy. Which would the nurse include in the client's treatment plan? opioids will be available for post procedural pain fever is a common response after this procedure heart palpitations often occur after this procedure anesthetics are not necessary during this procedure
answer: opioids will be available for post procedural pain painful biliary colic may occur in the postop period because of the passage of pulverized fragments of the calculi; this may occur 3 or more days after the lithotripsy. Fever may indicate pancreatitis, which is a rare occurrence. The delivery of shock waves during the procedure is synchronized with the heartbeat to avoid initiation of dysrhythmias. Light sedation may be used to keep the client comfortable and as still as possible.
a client with GERD needs to make dietary and lifestyle changes. which instructions would the nurse include in the client's discharge teaching? select all that apply. encourage the client to quit smoking elevate the foot of the bed avoid milk and dairy products eat three large, evenly spaced meals daily avoid lying down for 2 to 3 hours after eating
answer: 1 and 5 smoking cessation should be encouraged. Advise the client not to lie down for 2 to 3 hours after eating; this can cause reflux. The head, not the foot, of the bed should be elevated to prevent nighttime reflux; at night, infrequent swallowing and recumbent position can impair esophageal clearance. milk and dairy products do not have to be eliminated unless the client has lactose intolerance. Eating 3 large meals increases volume pressure in the stomach, which delays emptying; 4 to 6 smaller meals are preferable.
which interventions would the nurse include in the plan of care for a client with GERD? select all that apply. encourage client to follow the prescribed treatment regimen keep the client HOB elevated approximately 30 degrees avoid placing the client in the supine position for 2 to 3 hrs after a meal instruct the client to eat 6 small meals a day with last just before bedtime instruct the client to take a proton inhibitor before the first meal of the day
answer: 1,2,3 clients should be encouraged to follow the prescribed treatment regimen. nursing care of the client includes keeping the HOB elevated to approx 30 degrees and avoiding supine position 2 to 3 hrs after meals. The client should avoid food and activities that cause reflux such as eating late at night. Proton pump inhibitors should be taken before the first meal of the day and are more common in treating peptic ulcer disease.
the nurse is taking care of a client with cirrhosis of the liver. Which clinical manifestations would the nurse assess in the client? select all that apply. ascites hunger pruritus jaundice headache
answer: 1,3,4 ascites is a result of portal hypertension that occurs with cirrhosis. Pruritus is common because bile pigments seep into the skin from the bloodstream. Jaundice occurs because the bile duct becomes obstructed and bile enters the bloodstream. The appetite decreases because of the pressure on the abdominal organs from the ascites and the liver's decreased ability to metabolize food. Headache is not a common manifestation of cirrhosis of the liver.
a client has been hospitalized with celiac disease is making dietary choices or upcoming meals. which foods are appropriate for the client? breaded veal cutlet with cheese roast beef sandwich with pickles chicken noodle soup with crackers cheese omelet with chopped spinach
answer: cheese omelet with chopped spinach a cheese omelet (dairy) and spinach do not contain gluten and are permitted in diet. The breading on the veal cutlet contains gluten. The bread for the sandwich contains gluten. Noodles and crackers contain gluten.
a client is admitted via the emergency department with a tentative diagnosis of diverticulitis. The nurse anticipates that which test will be prescribed? computed tomography (CT) scan gastroscopy colonoscopy barium enema
answer: computed tomography (CT) scan a CT scan with contrast is the best choice for diverticulitis because it effectively reflects the involved colon. A gastroscopy assesses the upper, not lower, GI tract. Colonoscopy and barium enema is contradicted because of the possibility of perforation and peritonitis.
a client with a history of recurrent cholecystitis is scheduled for abdominal cholecystectomy. Which would the nurse specifically emphasize when planning preoperative teaching for this client? possible complications food and fluid restrictions coughing and deep breathing isometric exercises of the extremities
answer: coughing and deep breathing the operative site's proximity to the diaphragm results in the client taking shallow respirations to limit pain; failure to expand the lungs can cause hypostatic pneumonia. The HCP explores possible complications when providing info for an informed consent. The nurse foes not emphasize possible complications because it may increase the client's anxiety. Preop teaching focuses on the interventions that prevent complications. Food and fluid focuses should be included; however this is not the priority. Isometric exercises of the extremities are unnecessary; the client will be allowed out of bed within several hours of surgery.
a HCP prescribes dietary and medication therapy for a client with GERD. What is appropriate for the nurse to teach the client about meal management? consume a snack each morning divide food into 4-6 meals a day eat the last three meals by 8 pm suck on peppermint candy after each meal
answer: divide food into 4-6 meals a day the volume of food in the stomach should be kept small to limit pressure on the LES. snacking in the evening can cause reflux. The last meal should be eaten at least 3 hrs before bedtime; individual bedtimes vary. Peppermint promotes reflux.
the nurse is evaluating a client who has been receiving medical intervention for a diagnosis of Crohn disease. Which expected outcome is most important for this client. performs skin care tolerates oral fluids experiences less abdominal cramping gains half a pound per week
answer: gains half a pound per week weight loss usually is severe with Crohn disease; therefore, a weight gain is a priority. This goal is specific, realistic, and measurable and has a time frame. Although skin care, tolerating oral fluids and experiencing less abdominal cramping are important, they are not as high a priority as eight gain.
the nurse is assessing two clients. one client has ulcerative colitis, and the other has Crohn disease. which is more likely to be identified in the client with ulcerative colitis? inclusion of transmural involvement of the small bowel higher occurrence of fistulas and abscesses from changes in the bowel wall pathology beginning proximally with intermittent plaques along the colon involvement starting distally with rectal bleeding that spreads continuously up the colon
answer: involvement starting distally with rectal bleeding that spreads continuously up the colon ulcerative colitis involvement starts distally with rectal bleeding that spreads continuously up the colon to the cecum. In ulcerative colitis, pathology usually is in the descending colon; in Crohn disease, it is primarily in the terminal ileum, cecum, and ascending colon. ulcerative colitis, as the name implies, affects the colon, not the small intestine. intermittent areas of pathology occur in Crohn. In ulcerative colitis, the pathology is in the inner layer and does not extend through the entire bowel wall; therefore, abscesses and fistulas are rare. Abscesses and fistulas occur more frequently in Crohn disease.
a client is admitted to the hospital with a diagnosis of Crohn disease. which is important for the nurse to include in the teaching plan for the client? controlling constipation meeting nutritional needs preventing increased weakness anticipating a sexual alteration
answer: meeting nutritional needs to avoid GI pain and diarrhea, these clients often refuse to eat and become malnourished. The consumption of high-calorie, high protein diet is advised. diarrhea, not constipation, is a problem with Crohn disease. preventing an increase in weakness is a secondary concern that results from malnutrition; correcting the malnutrition will increase strength. Anticipating a sexual alteration is generally not a problem with Crohn disease.
a client is experiencing an exacerbation of ulcerative colitis. A low residue, high protein diet and IV fluids with vitamins have been prescribed. When implementing these prescriptions, which goal is the nurse trying to achieve. reduce gastric acidity reduce colonic irritation reduce intestinal absorption reduce bowel infection rate
answer: reduce colonic irritation a low residue diet is designed to reduce colonic irritation, motility, and spasticity. reduction of gastric acidity is the aim of bland diets used in the treatment of gastric ulcers. reducing colonic irritation, motility, and spasticity hopefully will increase, not reduce absorption. This diet is followed to allow the bowel to rest, not to reduce infection rates.
the nurse is teaching a client about GERD. Which statement made by the client indicates correct understanding of GERD management? "Three meals per day is the best regimen to avoid GERD symptoms" "i can reduce my GERD symptoms through high carbohydrate and low fat diet" "a snack before bedtime will help reduce the acidity of my stomach during the night" "i will place a 6 inch block under the head of my bed to help with digestion"
answer: "i will place a 6 inch block under the head of my bed to help with digestion" elevation of the head of bed can enhance esophageal emptying and reduce symptoms. Eating should be avoided 3 hrs before bedtime to reduce acid production, and the client should be instructed to consume small. frequent meals throughout the day to avoid gastric distention.
the nurse is creating a dietary plan for a client with cholecystitis who has been placed on a modified diet. Which is appropriate to include in the diet plan? soft textured foods to reduce the digestive burden low cholesterol foods to avoid further formation of gallstones increased protein protein to promote tissue healing and improve energy reserves reduced fat intake to avoid stimulation of the cholecystokinin mechanism for bile release
answer: reduced fat intake to avoid stimulation of the cholecystokinin mechanism for bile release fat intake stimulates cholecystokinin release that signals the gallbladder to contract, causing pain. Soft textured foods are unnecessary. Eating low cholesterol foods to avoid further formation of gallstones is not true for all clients with cholecystitis; low cholesterol foods are necessary of the cholecystitis is precipitated by cholelithiasis and the stones are composed of cholesterol. An increase in protein intake is necessary to promote tissue healing and improve energy reserves after cholecystectomy, but is not important as fat intake for cholecystitis.
which reported clinical manifestations would the nurse expect from a client with ulcerative colitis? select all that apply. fever diarrhea gain in weight spitting up blood abdominal cramps
answers: 1,2,5 the inflammatory process can promote a fever and tends to increase peristalsis, causing intestinal spasms and diarrhea. As ulceration occurs, the loss of blood leads to anemia. The client will lose weight (not gain it) because of anorexia and malabsorption. Hemoptysis (coughing up blood) is not a related sign.
a client with a long history of alcohol abuse is admitted to the hospital with ascites and jaundice. A diagnosis of hepatic cirrhosis is made. Which is a nursing priority? institute fall prevention and safety measures evaluate coping skills measure abdominal girth daily test stool specimens for blood
high ammonia levels contribute to deterioration of mental function and then to heapatic encephalopathy and hepatic coma; safety is the priority. Although it is important to evaluate the client's coping skills, it is not the priority. Although measuring abdominal girth daily is done to monitor ascites; it is not the priority. Testing stool specimens is not the priority.
a client has been diagnosed with cholelithiasis. Which fact about the condition would the nurse recall when assessing this client for risk factors? men are more likely to be affected than women young people are affected more frequently than older people individuals who are obese are more prone to this condition than those who are thin people who are physically active are more apt to develop this condition than those who are sedentary
answer: individuals who are obese are more prone to this condition than those who are thin cholelithiasis occurs more frequently in individuals who are obese and have hyperlipidiema. Women are more likely to develop. Middle aged people, usually over 40 years, are likely to develop this condition then younger people; aging increases risk. People who have sedentary lifestyles are more likely to develop this condition than those who are active.
