gastrointestinal questions

GI questions 1. Nina was diagnosed with peptic peptic ulcer. ulcer. The physician physician says that she has has developed the most common type of peptic ulcer. When obtaining a history from this client, the nurse should expect the reported pain to: a. intens intensify ify when when the the clien clientt vomits vomits

b. occur occur one to to three three hours hours after after meals meals c. increase increase when the clien clientt eats eats fatty fatty foods foods d. begin begin in the epigas epigastriu trium m and radiate radiate across across the the abdomen abdomen Rationale: Pain of duodenal ulcer occurs after the stomach empties; Option A- Vomiting temporarily alleviates alleviates pain because acid secretions secretions are removed. Option C- There is no intolerance intolerance of fats; eating generally alleviates alleviates pain Option D- Pain sharply localized in the epigastrium ; it can radiate across the abdomen if an ulcer has perforated.

2. After an an acute episode episode of upper upper GI bleedin bleeding, g, a client vomits vomits and and complains complains of  severe epigastric pain. The nursing assessment reveals an absence of bowels sounds, pulse rate of 134, and shallow respirations of 32 per minute. In addition to calling the physician, the nurse should:

a. Keep Keep the clien clientt NPO NPO b. Start Start oxygen oxygen per nasal nasal cannula cannula at 3 to to 4 L per minuta minuta c. Place Place the client client in the supin supine e position position with with the legs legs elevated elevated d. Ask the the client client whether whether any red or or black black stools stools have been been noted. noted. Rationale: These are classic indicators of perforated ulcer, for which immediate surgery is indicated; keeping the client NPO should be anticipated Option B- Tachycardia and tachypnea re related to pain and possible blood loss; not an airway problem Option C- trendelenburg is the position of choice for shock but the priority is surgery because of perforation Option D- indicated bleeding in the GI, not perforation

3. After a subtotal gastrectomy, a client develops dumping syndrome. In addition, about 1 and ½ hours after the initial attack, the client experiences a second period of feeling “shaky”. The nurse recognizes that this latter effect is caused by: a. A second more extensive rise in glucose b. An overwhelmed insulin- adjusting mechanism c. A distention of the duodenum from an excessive amount of chyme

d. An overproduction of insulin that occurs in response to the rise on blood glucose Rationale: The rapid absorption of the carbohydrates, stimulates production of  insulin which will result to hypoglycemic symptoms. This is also known as late dumping syndrome Option A- hyperglycemia occurs minutes after eating. Option B- not overwhelmed, but responds immediately resulting to hypoglycemia Option C- dumping syndrome is not caused by the amount of food that enters the duodenum 4. A 40-year old client is admitted with biliary cancer. The associated jaundice gets progressively worse. The nurse should be most concerned about the potential complication of: a. Pruritus

b. Bleeding c. Flatulence d. Hypokalemia Rationale: obstruction of bile impairs absorption of fat-soluble vitamin K, clotting is prolonged, priority is bleeding Option A- deposition of bile salts to the intestine can cause pruritus but is not lifethreatening Option B: flatulence is expected finding in patient with biliary disease but is not life threatening Option D- obstructive jaundice does not affect potassium levels

5. When teaching the client about the diet following a pancreatoduodenectomy (Whipple’s procedure performed for cancer of the pancreas, the statement the nurse should include would be: a. “There are no dietary restrictions; you may eat what you desire” b. “your diet should be low in calories to prevent taxing your pancreas” c. “Meals should be restricted in protein because of your compromised liver function”

d. “Low fat meals should be eaten because of interference with your fat digestion mechanism.” Rationale: Malabsorption, impaired delivery of bile to the intestines, fat metabolism is impaired

6. A client with a long history of alcohol abuse is admitted to the hospital with ascites, jaundice and confusion. A diagnosis of hepatic cirrhosis is made. A nursing priority would be to:

a. Institute safety measures b. Monitor respiratory status c. Measure abdominal girth daily d. Test stool specimens of blood Rationale: high ammonia levels contribute to deterioration of mental function “confusion”-hepatic encephalopathy, priority safety! Option B: though the patient will experience dyspnea due ascites, inc. pressure… it can be relieved through proper positioning, Option C: routine procedure to monitor ascites but not priority for confused patients Option D: priority safety! 7. Which nursing action is most appropriate for a client hospitalized with acute pancreatitis?

a. Withholding all oral intake, to decrease a pancreatic secretions b. Administering demerol, as prescribed, to relieve severe pain c. Limiting I.V. fluids, as ordered, to decrease cardiac workload

d. Keeping the client supine to increase comfort Rationale: patients with acute pancreatitis should be immediately placed on NPO to rest bowel , and decreases stimulation for the production of enzymes and subsequent autodigestion, thus pain results. Option B- Mosphine is the drug of choice Option C- IV fluids should not be limited. Nutrition can be given through PICC or TPN Option D: Positioning the client may decrease pain, flexing the knees to the abdomen not supine 8. When preparing a client, age 50 for surgery to treat appendicitis, the nurse formulates a nursing diagnosis of Risk for Infection related to inflammation, perforation, and surgery. What is the rationale for choosing this nursing diagnosis? a. Obstruction of the appendix may increase venous drainage and cause the appendix to rupture.

b. Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix c. The appendix may develop gangrene and rupture, especially in the middle-aged clients. d. Infection of the appendix diminishes necrotic arterial blood flow and increases venous drainage Rationale: The appendix becomes inflamed and edematous as a result of becoming kinked or occluded by a fecalith (ie, hardened mass of stool), tumor, or foreign body. The inflammatory process increases intraluminal pressure, initiating a progressively severe, generalized or periumbilical pain that becomes localized to the right lower quadrant of the abdomen within a few hours (Brunner 11the edition  pg. 1241) . *decreases venous outflow *reduce arterial flow-ischemia-edema-perforation *it more commonly occurs between the ages of 10 and 30 years (NIH, 2005). 9. A client with acute liver failure exhibits confusion, a declining level of  consciousness, and slowed respirations. The nurse finds him very difficult to arouse. The diagnostic information which best explains the client’s behaviour is: a. Elevated liver enzymes and low serum protein level

b. Subnormal serum glucose and elevated serum ammonia levels c. Subnormal clotting factors and platelet count. d. Elevated blood urea nitrogen and creatinine levels and hyperglycemia. Rationale: declining level of consciousness- encephalopathy (hepatic) due to increase levels of ammonia Liver problems-can cause hypoglycemia, liver stores glucose A and C- are results of liver problems but not specific to the keyword “declining level of consciousness”.

10.While preparing a client for an upper GI endoscopy (esophagogastroduodenoscopy), the nurse should implement which interventions? 1. Administer a preparation to cleanse the GI tract, such as Golytely or Fleets Phospha-Soda. 2. Tell the client he shouldn’t eat or drink for 6 to 12 hours before the procedure. 3. Tell the client he must be on a clear liquid diet for 24 hours before the procedure 4. Inform the client that he’ll receive a sedative before the procedure. 5. Tell the client that he may eat and drink immediately after the procedure.

a. 123 b. 124

c. 24 d. 234 Rationale: choices 135 are used for lower GI series or barium enema.. “Education regarding dietary changes prior to the study should include a clear liquid diet, with nothing by mouth (NPO) from midnight the night before the study; however, each physician may prefer a specific bowel preparation for specific studies.”Brunner 11 th edition, chapter 34, pg. 1133

1-Fleet enema is used to clean the colom-LGIS 3- clear liquid diet is indicated for LGIS and UGIS… UGIS- 12 hours before LGIS-24 hours, to decrease the bulk of stool 5- NPO after procedure until gag reflex returns