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
The nurse caring for a patient diagnosed with chronic gastritis. The nurse monitors the patient for which vitamin deficiency?
a. Vitamin A
b. Vitamin B12
c. Vitamin C
d. Vitamin E
B. Chronic gastritis causes deterioration and atrophy of the stomach lining, leading to loss of the function of parietal cells. The source of the intrinsic factor is lost, thus the ability to absorb B12. Not at risk for the other Vit deficiencies listed.
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.
When medications are used in the treatment of obesity, what is the most important for the nurse to teach the patient?
a. Over-the-counter diet aids are safer than other agents and can be used for controlling appetite.
b.Drugs should be used only as an adjunct to a diet and exercise program as treatment for chronic condition
c. All drugs used for weight control can affect central nervous system function and should be used with caution
d. The primary effect of medications is psychologic, controlling the urge to eat in response to feelings of rejection.
b.Drugs should be used only as an adjunct to a diet and exercise program as treatment for chronic condition
Drugs do not cure obesity, so once meds are discontinued weight gain will reoccur without lifestyle changes. Medications work in a variety of ways to control appetite but over-the-counter drugs are the least effective and most abused.
The client admitted to the hospital with viral hepatitis, complaining of "no appetite" and " losing my taste for food". What instruction should the nurse give the client to provide adequate nutrition?
a. select foods high in fat
b. increase intake of fluids, including juices
c. eat a good supper when anorexia is not severe
d. eat less often, preferably only three large meals daily.
b. No special diet is required to treat. However, low fat due to decreased bile production. Small frequent meals preferred and may help with nausea. Appetite usually better in the morning and able to eat good breakfast. Adequate fluid intake including juice is important
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.
Nursing management of a patient with chronic gastritis includes teaching the patient to
a. maintain a nonirritating diet with 6 small meals per day
b. take antacids before meals to decrease stomach acid
c. eliminate alcohol and caffeine from the diet when symptoms occur
d. use nonsteroidal antiinflammatory drugs (NSAIDs) instead of aspirin for minor pain relief
a. maintain a nonirritating diet with 6 small meals per day-helps control symptoms of gastritis
Antacids are often used for control of symptoms but have the best neutralizing effect if taken after meals. Caffeine and alcohol should be eliminated entirely because they may precipitate gastritis. NSAIDs are just as irritating to the stomach as aspirin and shouldn't be taken.
What does a nurse include in teaching a patient newly diagnosed with peptic ulcer disease?
a. maintain a soft bland diet
b. use alcohol and caffeine in moderation and always with food
c. Eat as normally as possible, eliminating foods that cause pain or discomfort
d. Avoid milk and milk products because they stimulate gastric acid production
c. no specific diet required, but encouraged to eat as normal as possible while eliminating foods that cause discomfort or pain. Eating 6 small meals a day keeps the stomach from being completely empty and is recommended. Caffeine and alcohol should be eliminated. Milk and milk products do not need to be eliminated, but do add fat content to the diet.
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.
The patient with a new ileostomy needs discharge teaching. What should the nurse plan to include in this teaching?
a. the pouch can be worn for up to 2 weeks before changing it
b. decrease the amount of fluid intake to decrease the amount of drainage
c. the pouch can be removed when bowel movements have been regulated
d. if leakage occurs, promptly remove the pouch, clean the skin, and apply a new pouch.
d. the ileostomy drainage is extremely irritating to the skin, so the skin must be cleaned and a new solid skin barrier and pouch applied as soon as a leak occurs to prevent skin damage. The pouch is usually worn for 4 to 7 days unless there is a leak. Because initial drainage from ileostomies are high, fluids should be increased. The pouch must always be worn, the drainage will be liquid and not formed.
A patient with chronic cholecystitis ask the nurse whether she will need to continue a low fat diet after she has a cholecystectomy. What is the best response by the nurse?
a. "A low fat diet will prevent the development of further gallstones and should be continued."
b. "Yes, because you will not have a gallbladder to store bile, you will not be able to digest fats adequately."
c. "A low fat diet is recommended for a few weeks after surgery until the intestine adjusts to receiving a continuous flow of bile."
d. "Removing the gallbladder will eliminate the source of your pain that was associated with fat intake, so you may eat whatever you like."
c. After removal of the gallbladder, bile drains directly to the duodenum and a low fat diet is recommended until adjustment to this change occurs. Most patients tolerate a regular diet with moderate fat intake but should avoid excessive fat intake, as large volumes of bile previously stored in the gallbladder are no longer available. Steatorrhea can occur with large fat intake.
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.
The nurse has taught the client about an upcoming endoscopic retrograde cholangiopancreatography (ERCP) procedure. The nurse determines the patient needs further teaching when the client states...
a. "I know I must sign the consent form."
b. "I hope the throat spray keeps me from gagging."
c. "I'm glad I don't have to lie still for this procedure."
d. "I am glad some IV medication will be given to relax me."
c. The client does have to remain still for ERCP which takes about an hour to perform. The client does need to sign consent. IV sedation will be given to relax the client, and an anesthetic spray to keep the patient from gagging while the scope is advanced.
What information should be included in dietary teaching for a patient after gastric bypass? Select all that apply
a. avoid sugary foods and fluids
b. gradually increase from clear liquids to solids as tolerated over 8 weeks postoperatively
c. Consume foods high in complex carbs, protein, and fiber.
d. Consume high protein, low carb, low fat, and low roughage diet
a, b, d
Diet focused on helping prevent diarrhea & dumping syndrome and considerate of stomach size.