GI Assessment
A patient is having a colonoscopy tomorrow morning, the nurse prepares the patient by (Select all that apply)
a. keeping the patient on a clear liquid diet prior to midnight
b. providing the patient with instructions on GoLYTELY solution
c. educating the patient that bowels must be clear before exam to be completed
d. obtaining informed consent for procedure
ALL true except d as obtaining consent is the providers responsibility.
The client with a gastric ulcer has a prescription for sucralfate (Carafate), 1g by mouth 4 times per day. The nurse schedules the medication for which times?
a. with meals and at bedtime
b. every 6 hours around the clock
c. one hour after meals and at bedtime
d. one hour before meals and at bedtime
d. one hour before meals and at bedtime
Rationale: Sucralfate is a gastric protectant. The medication should be scheduled for administration 1 hour before meals and at bedtime. The medication is timed to allow it to form a protective coating over the ulcer before food intake stimulates gastric acid production and mechanical irritation.
a. offer ice chips to suck as needed
b. provide mouth care frequently
c. irrigate the tube with normal saline every 8 hours
d. keep the patient supine HOB 15 degrees
b. mouth care frequently due to vomiting, fecal taste & odor, and mouth breathing. NO ice chips as patient NPO, unless MD order. NGT should be checked for placement and only irrigated if ordered. HOB >30
A patient diagnosed with Celiac Disease following a workup for iron-deficiency anemia and decreased bone density. The nurse identifies the patient needs additional teaching when the patient makes which statement?
a. "I should ask my close relatives to be screened for Celiac disease."
b. "If I do not follow a gluten free diet, I will likely develop malnutrition."
c. "I don't need to restrict gluten intake because I don't have diarrhea or bowel symptoms."
d. "It is going to be hard to follow a gluten free diet because it's found in so many foods."
c. The autoimmune process associated with celiac disease continues as long as the body is exposed to gluten, regardless of the symptoms it produces, and a life-long gluten-free diet is necessary. The other statements are all true
A client has developed hepatitis A after eating contaminated oysters. The nurse assesses the client for which of the following?
a. malaise
b. dark stools
c. weight gain
d. LUQ discomfort
a.
Rationale:
Hepatitis causes gastrointestinal symptoms such as anorexia, nausea, RUQ pain, weight loss. Fatigue and malaise are common. Stools will be light or clay colored if conjugated bilirubin is unable to flow out of liver due to inflammation or obstruction of bile ducts.
Which medications are used to decrease gastric or HCl secretion? Select all that apply
a. Famotidine (Pepcid)
b. Sucralfate (Carafate)
c. Omeprazole (Prilosec)
d. Misoprostol (Cytotec)
e. Bethanechol (Urecholine)
a, c, d
Rationale: Famotidine reduces HCl secretion by blocking histamine and omeprazole decreases gastric secretion by blocking adenosine triphosphatase enzyme. Misoprostol has antisecretory effects. Sucralfate coats the ulcer to protect from acid erosion. Urecholine can be used for GERD facilitating gastric emptying.
The nurse is monitoring a client admitted to the hospital with a diagnosis of appendicitis who is scheduled for surgery in 2 hours. The client begins to complain of increased abdominal pain and vomiting. On assessment the nurse notes the abdomen is distended and bowel sounds are diminished. What is the appropriate intervention?
a. notify physician
b. administer prescribed pain meds
c. call and ask the OR to perform surgery ASAP
d. reposition the patient and apply a heating pad to abdomen
a. suspect peritonitis and notify physician
Administering pain meds is not appropriate. Heat should never be applied to a client with appendicitis as it could cause rupture. Scheduling the OR is not within RN scope of practice, physician can initiate sooner.
The nurse is reviewing the record of a client with diagnosis of cirrhosis and notes there is documentation of asterixis "liver flap". How should the nurse assess for its presence?
a. Dorsiflex the clients foot
b. measure the abdominal girth
c. ask client to extend their arms
d. instruct the client to lean forward
c. ask client to extend their arms
Rationale: Asterixis is irregular flapping of the fingers and wrists when the hands and arms are outstretched, with palms down, wrists bent up, and fingers spread. Most common and reliable sign that hepatic encephalopathy is developing.
The patient being treated with diuretics for ascites from cirrhosis must be monitored for (select all that apply)
a. GI bleeding
b. hypokalemia
c. renal function
d. body image disturbances
e. increasing clotting tendencies
b, c
Rationale: Fluid and electrolytes must be monitored; serum sodium, chloride, bicarbonate, and potassium-especially for hypokalemia. Renal function specifically BUN & creatinine. Water excess is manifested by muscle cramping, weakness, lethargy, and confusion. GI bleeding, body image disturbances, and bleeding tendencies are associated with liver disease but not related to diuretics.
The patient has hepatic encephalopathy. What is the priority nursing intervention to keep the patient safe?
a. turn the patient every 3 hours
b. encourage increasing ambulation
c. assist the patient to the bathroom
d. prevent constipation to reduce ammonia production
c. assist the patient to the bathroom
Patient may not be oriented or able to walk to the bathroom alone. Turning should be done every 2 hours to prevent skin breakdown. Activity should be limited to decrease ammonia production. Although constipation will be prevented, it will not keep the patient safe.
A patient with a history of peptic ulcer disease is hospitalized with symptoms of perforation. During the initial assessment, what should the nurse expect the patient to report?
a. vomiting bright red blood
b. projectile vomiting of undigested food
c. sudden, severe generalized abdominal and back pain
d. hyperactive bowel sounds and upper abdominal swelling
c. sudden, severe generalized abdominal and back pain
Rationale: Perforation of an ulcer causes sudden, severe abdominal pain that becomes generalized and may be referred to the back, accompanied by rigid, board-like abdomen, shallow respirations, and a weak, rapid pulse. Vomiting blood indicates hemorrhage of ulcer. Gastric outlet obstruction is characterized by projectile vomiting of undigested foods, hyperactive bowel sounds, and upper abdominal swelling.
A laxative is contraindicated in a patient:
A. with cancer taking daily narcotics for pain control
B. complaining of abdominal pain and distention
C. scheduled for a colonoscopy
D. with limited mobility due to Parkinson’s disease
b. risk for perforation
During the treatment of the patient with bleeding esophageal varices, what is the most important thing for the nurse to do?
a. prepare the patient for immediate portal shunting surgery
b. perform guaiac testing on all stools to detect occult blood
c. maintain the patient's airway and prevent aspiration of blood
d. monitor for cardiac effects of IV vasopressin and nitroglycerin
c. bleeding varices is a medical emergency
Management of airway and preventing aspiration is critical! Portal shunting may happen later, but not during acute hemorrhaging. Occult blood would be expected. Vasopressin causes vasoconstriction, decreased heart rate, and decreased coronary blood flow. Nitro will be given in conjunction to counter the side effects.
A 20 year old patient with history of Crohn's disease comes to the clinic with persistent diarrhea. What are common characteristics of Crohn's disease? Select all that apply.
a. weight loss
b. rectal bleeding
c. abdominal pain
d. toxic megacolon
e. segmented distribution
f. involves entire thickness of bowel wall
a.c.e.f
Rationale: Crohn's disease may have severe weight loss, crampy abdominal pain, and segmented distribution through the entire wall of bowel. Rectal bleeding and toxic megacolon are seen with ulcerative colitis
Mr. Parks is a 62-year-old retired teacher who has recently been diagnosed with hepatic encephalopathy. His physician has prescribed lactulose 45 mL three or four times daily and has told Mr. Parks to adjust the amount of the medication so that he has three to four soft stools a day. A month later, Mr. Parks returns to the clinic and states that he has been taking only half of the medication once a day because he dislikes having more than one stool a day.
What additional education regarding the lactulose and his liver disease does the nurse give to Mr. Parks?
The nurse should instruct Mr. Parks that in liver disease, ammonia accumulates and can cause stupor or coma. Ammonia is produced by metabolism of dietary protein and intestinal bacteria. Lactulose decreases production of ammonia in the intestine. The goal of treatment is usually to maintain two to three soft stools daily.
What treatment measure is used in managing the patient with acute pancreatitis?
a. surgery to remove the inflamed pancreas
b. pancreatic enzymes supplements with meals
c. NGT suctioning to prevent gastric secretions from entering the duodenum
d. Endoscopic pancreatic sphincterotomy using ERCP
c. NGT suctioning to prevent gastric secretions from entering the duodenum
Pancreatic rest and suppression of secretions are promoted by preventing any gastric contents from entering the duodenum, which would stimulate pancreatic activity. Surgery is not indicated, but may be used to drain an abscess or cysts. Pancreatic enzymes only used in chronic pancreatitis if decrease in secretion occurs. ERCP with sphincterotomy used if gallstones present.