MED SURG Exam 3 PrepU questions Module 8
Which diagnostic test would be used first to evaluate a client with upper GI bleeding?
Hemoglobin and hematocrit The nurse assesses for faintness or dizziness and nausea, which may precede or accompany bleeding. It is important to monitor vital signs frequently and to evaluate for tachycardia, hypotension, and tachypnea. Other nursing interventions include monitoring the hemoglobin and hematocrit, testing the stool for gross or occult blood, and recording hourly urinary output to detect anuria or oliguria (absence of or decreased urine production). If bleeding cannot be managed by the measures described, other treatment modalities such as endoscopy may be used to halt bleeding and avoid surgical intervention. There is debate regarding how soon endoscopy should be performed. Some clinicians believe endoscopy should be performed within the first 24 hours after hemorrhaging has ceased. Others believe endoscopy may be performed during acute bleeding, as long as the esophageal or gastric area can be visualized (blood may decrease visibility). An upper GI is less accurate than endoscopy and would not reveal a bleed. Arteriography is an invasive study associated with life-threatening complications and would not be used for an initial evaluation. Remember least invasive to most invasive.
The nurse cares for a client after an endoscopic examination and prepares the client for discharge. The nurse includes which instruction?
Resume regular diet. The nurse includes resumption of regular diet in the client's discharge instructions as the client is able to resume activities and diet after an endoscopic exam. There is no need to adhere to a clear liquid diet or to increase fluid intake. As sedation is not usually involved for endoscopic examinations, the client does not need to avoid driving. p. 1222
A nurse is inserting a nasogastric tube for feeding a client. Place in order the steps from 1 to 6 for correctly inserting the tube. Measure the length of the tube that will be inserted Tilt the client's nose upward Instruct the client to lower the head and swallow Apply gloves to the nurse's hands Apply water-soluble lubricant to the tip of the tube Sit the client in an upright position
Sit the client in an upright position Apply gloves to the nurse's hands Measure the length of the tube that will be inserted Apply water-soluble lubricant to the tip of the tube Tilt the client's nose upward Instruct the client to lower the head and swallow To safely insert a nasogastric tube, the nurse sits the client upright first. The nurse then applies gloves, measures the tube length, and applies lubricant to the tip of the nasogastric tube. Next, the nurse tilts the client's nose upward while inserting the tube. When the tube is at the nasopharynx area, the nurse instructs the client to lower the head and swallow.
Upon hearing that the small intestine lining has thinned, an elderly client asks, "What can this lead to?" What is the best response by the nurse?
"You may frequently experience constipation." As a person ages, the epithelial cells and villi thin in the small intestine. Implications of this consequence include decreased intestinal motility and transit time, which can lead to constipation. This would lead the nurse to discuss and advise the client on ways to prevent constipation.
The nurse is to insert a postpyloric feeding tube. How can the nurse aid in placement of the tube past the pylorus?
Administer prescribed metoclopramide. Metoclopramide (Reglan) is administered to increase peristalsis of the feeding tube into the duodenum. Placing the client on the right side, not the left side, helps to facilitate movement and placement. Having the client swallow or even to drink water facilitates placement of the tube past the epiglottis, not into the duodenum.
A community health nurse is preparing for an initial home visit to a client discharged following a total gastrectomy for treatment of gastric cancer. What would the nurse anticipate that the plan of care is most likely to include?
Administration of injections of vitamin B12 Since vitamin B12 is absorbed in the stomach, the client requires vitamin B12 replacement to prevent pernicious anemia. A gastrectomy precludes the use of a G tube. Since the stomach is absent, a nasogastric tube would not be indicated. As well, this is not possible in the home setting. Since there is no stomach to act as a reservoir and fluids and nutrients are passing directly into the jejunum, distension is unlikely.
A client has recently been diagnosed with gastric cancer. On palpation, the nurse would note what two signs that confirm metastasis to the liver? Select all that apply. Ascites Hepatomegaly Distended bladder Sister Mary Joseph's nodules Petechiae at the palpation site
Ascites Hepatomegaly The physical examination is usually not helpful in detecting the cancer because most early gastric tumors are not palpable. Advanced gastric cancer may be palpable as a mass. Ascites and hepatomegaly (enlarged liver) may be apparent if the cancer cells have metastasized to the liver. Palpable nodules around the umbilicus, called Sister Mary Joseph's nodules, are a sign of a GI malignancy, usually a gastric cancer. A distended bladder is not significant. Petechiae at the palpation site is a distractor for the question.
A nurse is providing care for a client who is postoperative day 2 following gastric surgery. The nurse's assessment should be planned in light of the possibility of what potential complications? Select all that apply. Malignant hyperthermia Atelectasis Pneumonia Hemorrhage Chronic gastritis
Atelectasis Pneumonia Hemorrhage After surgery, the nurse assesses the client for complications secondary to the surgical intervention, such as pneumonia, atelectasis, or metabolic imbalances resulting from the GI disruption. Malignant hyperthermia is an intraoperative complication. Chronic gastritis is not a surgical complication.
The nurse instructs the client with gastroesophageal reflux disease (GERD) regarding dietary measures. Which action by the client demonstrates that the client has understood the recommended dietary changes?
Avoiding chocolate and coffee. Chocolate, tea, cola, and caffeine lower esophageal sphincter pressure, thereby increasing reflux. Clients do not need to eliminate spicy foods unless such foods bother them. Foods with seeds are restricted in diverticulosis. Steamed foods are encouraged to retain vitamins and decrease fat intake.
A nurse is providing oral care to a client who is comatose. What action best addresses the client's risk of tooth decay and plaque accumulation?
Brushing the client's teeth with a toothbrush and small amount of toothpaste Application of mechanical friction is the most effective way to cleanse the client's mouth. If the client is unable to brush teeth, the nurse may brush them, taking precautions to prevent aspiration; or as a substitute, the nurse can achieve mechanical friction by wiping the teeth with a gauze pad. Bactericidal mouthwash does reduce plaque-causing bacteria; however, it is not as effective as application of mechanical friction. Water-soluble gel may be applied to lubricate dry lips, but it is not part of oral care.
The nurse is caring for a client who requires enteral nutrition. For which reasons will the nurse anticipate the client having a gastrostomy tube inserted? Select all that apply.
Client is comatose Enteral support needed for over 6 weeks A gastrostomy is a procedure in which an opening is created into the stomach either for the purpose of administering nutrition, fluids, and medications via a feeding tube, or for gastric decompression in clients with gastroparesis, gastroesophageal reflux disease, or intestinal obstruction. Gastrostomy is preferred over nasogastric or orogastric feedings in the client who is comatose because the gastroesophageal sphincter remains intact, making regurgitation and aspiration less likely. A gastrostomy is preferred over a nasally inserted tube to deliver enteral nutrition support longer than 4 to 6 weeks. A gastrostomy tube is not preferred for a history of diverticulosis, hyperactive bowel sounds, or frequent bouts of constipation.
A client has been prescribed cimetidine for the treatment of peptic ulcer disease. When providing relevant health education for this client, the nurse should ensure the client is aware of what potential outcome?
Drug-drug interactions Cimetidine is associated with several drug-drug interactions. This drug does not cause bowel incontinence, abdominal pain, or heat intolerance.
The nurse is preparing to educate a group of students on a gastrointestinal assessment. Which common condition will the nurse assess for in the client with gastrointestinal disorder?
Dyspepsia Dyspepsia is the most common symptom of clients with gastrointestinal dysfunction. Commonly called indigestion, dyspepsia could include a variety of upper abdominal or epigastric symptoms to include pain, discomfort, fullness, bloating, early satiety, belching, heartburn, or regurgitation. Clients report bloating, distention, or feeling "full of gas" with excessive flatulence as a symptom of food intolerance or gallbladder disease. Nausea is a vague, uncomfortable sensation of sickness or "queasiness" that may or may not be followed by vomiting. Nausea can be triggered by odors, activity, medications, or food intake. Constipation may be associated with anal discomfort and rectal bleeding, and is a frequent reason clients seek healthcare referrals.
A client has received a diagnosis of gastric cancer and is awaiting a surgical date. During the preoperative period, the client should adopt what dietary guidelines?
Eat small, frequent meals with high calorie and vitamin content. The nurse encourages the client to eat small, frequent portions of nonirritating foods to decrease gastric irritation. Food supplements should be high in calories, as well as vitamins A and C and iron, to enhance tissue repair.
A client's enteral feedings have been determined to be too concentrated based on the client's development of dumping syndrome. What physiologic phenomenon caused this client's complication of enteral feeding?
Entry of large amounts of water into the small intestine because of osmotic pressure When a concentrated solution of high osmolality entering the intestines is taken in quickly or in large amounts, water moves rapidly into the intestinal lumen from fluid surrounding the organs and the vascular compartment. This results in dumping syndrome. Dumping syndrome is not the result of changes in HCl or gastrin levels. It is not caused by an acid-base imbalance or direct irritation of the GI mucosa.
A client was treated in the emergency department and critical care unit after ingesting bleach. What possible complication of the resulting gastritis should the nurse recognize?
Esophageal or pyloric obstruction related to scarring A severe form of acute gastritis is caused by the ingestion of strong acid or alkali, which may cause the mucosa to become gangrenous or to perforate. Scarring can occur, resulting in pyloric stenosis (narrowing or tightening) or obstruction. Chronic referred pain to the lower abdomen is a symptom of peptic ulcer disease, but would not be an expected finding for a client who has ingested a corrosive substance. Bacterial proliferation and hyperacidity would not occur.
A client is having a colonic transit study to diagnose a gastrointestinal disorder. Which instruction will the nurse provide to the client after taking a capsule containing radionuclide markers?
Follow a regular diet and usual daily activities. Colonic transit studies are used to evaluate colonic motility and obstructive defecation syndromes. The client is given a capsule containing 20 radionuclide markers and instructed to follow a regular diet and usual daily activities. There is no reason for the client to follow a clear liquid diet, take over-the-counter laxatives, maintain nothing by mouth status, take oral medications, eat a low-fat diet, or take proton pump inhibitor medications.
An emergency department nurse is admitting a 3-year-old brought in after swallowing a piece from a wooden puzzle. The nurse should anticipate the administration of what medication in order to relax the esophagus to facilitate removal of the foreign body?
Glucagon Glucagon is given prior to removal of a foreign body because it relaxes the smooth muscle of the esophagus, facilitating insertion of the endoscope. Haloperidol is an antipsychotic drug and is not indicated. Prostigmine is prescribed for clients with myasthenia gravis. It increases muscular contraction, an effect opposite that which is desired to facilitate removal of the foreign body. Epinephrine is indicated in asthma attack and bronchospasm.
A nurse is caring for a client admitted with a suspected malabsorption disorder. The nurse knows that one of the accessory organs of the digestive system is the pancreas. What digestive enzymes does the pancreas secrete? Select all that apply. Pepsin Lipase Amylase Trypsin Ptyalin
Lipase Amylase Trypsin Digestive enzymes secreted by the pancreas include trypsin, which aids in digesting protein; amylase, which aids in digesting starch; and lipase, which aids in digesting fats. Pepsin is secreted by the stomach and ptyalin is secreted in the saliva.
A nurse is providing education to a client with GERD. The client asks what measures can be taken independently to help reduce the symptoms. Which interventions would the nurse recommend? Select all that apply. Maintaining an upright position following meals Avoiding foods that intensify symptoms Sleeping in a supine position ensuring intake of food and fluids 2 to 3 hours before bedtime
Maintaining an upright position following meals Avoiding foods that intensify symptoms Conservative measures used in the treatment of GERD are maintaining an upright position following meals, avoiding foods that intensify symptoms, elevating the head of the bed when sleeping, and avoiding the intake of food and fluids 2 to 3 hours before bedtime.
A client reports a new onset of diarrhea. For which additional symptoms will the nurse assess this client? Select all that apply. Nausea Vomiting Cramping Heartburn Abdominal pain
Nausea Vomiting Cramping Abdominal pain Diarrhea, an abnormal increase in the frequency and liquidity of the stool or in daily stool weight or volume, commonly occurs when the contents move so rapidly through the intestine and colon that there is inadequate time for the GI secretions and oral contents to be absorbed. This physiologic function is typically associated with nausea, vomiting, cramping, or abdominal pain. Heartburn is not a symptom associated with diarrhea.
A client undergoes total gastrectomy. Several hours after surgery, the nurse notes that the client's nasogastric (NG) tube has stopped draining. How should the nurse respond?
Notify the health care provider. The nurse should notify the health care provider because an NG tube that fails to drain during the postoperative period may be clogged, which could increase pressure on the suture site because fluid isn't draining adequately. Repositioning or irrigating an NG tube in a client who has undergone gastric surgery can disrupt the anastomosis. Increasing the level of suction may cause trauma to GI mucosa or the suture line.
A nurse is admitting a client to the postsurgical unit following a gastrostomy. When planning assessments, the nurse should be aware of what potential postoperative complication of a gastrostomy?
Premature removal of the G tube A significant postoperative complication of a gastrostomy is premature removal of the G tube. Constipation is a less immediate threat and bowel perforation and PUD are not noted to be likely complications.
A client with a gastrointestinal disorder is scheduled for abdominal magnetic resonance imaging (MRI). Which teaching will the nurse provide to prepare the client for this test? Select all that apply. The scanner is soundless. Hold all doses of medications the morning of the test. Remove all jewelry and metal from the body. Take nothing by mouth for 6 to 8 hours before the test. Expect the test to take 60 to 90 minutes to complete.
Remove all jewelry and metal from the body. Take nothing by mouth for 6 to 8 hours before the test. Expect the test to take 60 to 90 minutes to complete. Magnetic resonance imaging (MRI) is used in gastroenterology to supplement ultrasonography and computed tomography (CT). This noninvasive technique uses magnetic fields and radio waves to produce images of the area being studied. The client should be instructed to remove all jewelry and metal from the body. The client should be instructed to take nothing by mouth for 6 to 8 hours before the test, except certain critical medications such as heart medications, which can be given the morning of the test. The client should expect the test to take 1 hour to 1.5 hours to complete. The scanner will make knocking sounds during the test. Oral laxatives are not needed the morning of the test.
The nurse is reviewing the chart of a client with swallowing problems. Which factors would raise suspicion that the client has cancer of the esophagus? Select all that apply. Smoking history of 20 years Male gender Previous treatment for gastroesophageal reflux disease European American Age 72 years
Smoking history of 20 years Male gender Previous treatment for gastroesophageal reflux disease In the United States, carcinoma of the esophagus occurs more than three times as often in men as in women. It is seen more frequently in African Americans than in European Americans and usually occurs in the fifth or sixth decade of life. Cancer of the esophagus has been associated with the ingestion of alcohol and the use of tobacco. There is an apparent association between GERD and adenocarcinoma of the esophagus.
A client's sigmoidoscopy has been successfully completed and the client is preparing to return home. What teaching point should the nurse include in the client's discharge education?
The client can resume a normal routine immediately. Following sigmoidoscopy, clients can resume their regular activities and diet. There is no need to push fluids and neither fecal urgency nor rectal bleeding is expected.
The nurse is teaching the client about the upcoming endoscopic retrograde cholangiopancreatography (ERCP). Although the nurse instructs on several pertinent points of care, which is emphasized?
The client will need to be repositioned frequently throughout the procedure in order to prevent injury. It is essential that the client understands that cooperation is essential in changing positions throughout the procedure to prevent injury of the gastrointestinal tract. All of the other options are also correct but do not carry a risk for injury if not completed.
A client's neck dissection surgery resulted in damage to the client's superior laryngeal nerve. What area of assessment should the nurse consequently prioritize?
The client's swallowing ability If the superior laryngeal nerve is damaged, the client may have difficulty swallowing liquids and food because of the partial lack of sensation of the glottis. Damage to this particular nerve does not inhibit speech and only indirectly affects management of secretions and airway patency.
A nurse is preparing to discharge a client after recovery from gastric surgery. What is an appropriate discharge outcome for this client?
Weight is maintained or gained. Weight loss is common in the postoperative period, with early satiety, dysphagia, reflux and regurgitation, and elimination issues contributing to this problem. The client should weigh oneself daily, with a goal of maintaining or gaining weight. The client should not have bowel movements that maintain a loose consistency, because this would indicate diarrhea and would warrant intervention as it is a symptom of dumping syndrome. The client should be able to tolerate six small meals per day, rather than three large meals. The client does not require a diet excessively rich in calcium but should consume a diet high in calories, iron, vitamin A and vitamin C.
After a client received a diagnosis of gastric cancer, the surgical team decides that a Billroth II would be the best approach to treatment. How would the nurse explain this procedure to the family? Limited resection in the distal position of the stomach and removal of about 25% of the stomach. Wide resection of the middle and distal portions of the stomach with removal of about 75% of the stomach. Proximal subtotal gastrectomy. Total gastrectomy and esophagogastrectomy.
Wide resection of the middle and distal portions of the stomach with removal of about 75% of the stomach. The Billroth I involves a limited resection and offers a lower cure rate than the Billroth II. The Billroth II procedure is a wider resection that involves removing approximately 75% of the stomach and decreases the possibility of lymph node spread or metastatic recurrence. A proximal subtotal gastrectomy may be performed for a resectable tumor located in the proximal portion of the stomach or cardia. A total gastrectomy or an esophagogastrectomy is usually performed in place of this procedure to achieve a more extensive resection.