GI paper

GI EXAM [COMPANY NAME] [Company address] The patient with inflammatory bowel disease has a serum potassium of 3.4 mEq/L. Which action should the nurse implement first? Selected Answer: Incorrect a. Notify the healthcare provider Answers: a. Notify the healthcare provider Correct b. Assess the patient for muscle weakness c. Request telemetry for the patient d. Prepare to administer IV potassium 3 A client who experienced an upper GI bleed due to gastritis has had the bleeding controlled and the client's condition is now stable. For the next several hours, the nurse caring for this client should assess for what signs and symptoms of recurrence? Selected Answer: CorrectC. Tachycardia, hypotension, and tachypnea Answers: A. Sudden thirst, unrelieved by oral fluid administration B. Diaphoresis and sudden onset of abdominal pain CorrectC. Tachycardia, hypotension, and tachypnea D. Tarry, foul-smelling stools Response Feedback: Tachycardia, hypotension, and tachypnea are signs of recurrent bleeding. Clients who have had one GI bleed are at risk for recurrence. Tarry stools are expected short-term findings after a hemorrhage. Hemorrhage is not normally associated with sudden thirst or diaphoresis. Question 4 A 35-year-old male client presents at the emergency department with symptoms of a small bowel obstruction. In collaboration with the primary provider, what intervention should the nurse prioritize? Answers: A. Administration of a glycerin suppository and an oral laxative CorrectB. Insertion of a nasogastric tube C. Insertion of a central venous catheter D. Administration of a mineral oil enema Response Feedback: Decompression of the bowel through a nasogastric tube is necessary for all clients with small bowel obstruction. Peripheral IV access is normally sufficient. Enemas, suppositories, and laxatives are not indicated if an obstruction is present. Question 6 A nurse is providing care for a client who is postoperative day 2 following gastric surgery. The nurses assessment should be planned in light of the possibility of what potential complications? Select all that apply. Selected Answers: CorrectA. Hemorrhage CorrectB. Pneumonia CorrectD. Atelectasis Answers: CorrectA. Hemorrhage CorrectB. Pneumonia C. Chronic gastritis CorrectD. Atelectasis E. Malignant hyperthermia Response Feedback: 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. Question 7 Correct 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? Selected Answer: CorrectA. Eat small, frequent meals with high calorie and vitamin content. Answers: CorrectA. Eat small, frequent meals with high calorie and vitamin content. B. Try to maintain the pre-diagnosis pattern of eating. C. Eat frequent, low-fat meals with high protein content. D. Eat frequent meals with an equal balance of fat, carbohydrates, and protein. Response Feedback: 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. Question 8 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? Selected Answer: CorrectB. Administration of injections of vitamin B12 Answers: A. Enteral feeding via gastrostomy tube (G tube) CorrectB. Administration of injections of vitamin B12 C. Gastrointestinal decompression by nasogastric tube D. Periodic assessment for esophageal distension Response Feedback: 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. Question 9 A client with a history of peptic ulcer disease has presented to the emergency department (ED) in distress. What assessment finding would lead the ED nurse to suspect that the client has a perforated ulcer? Selected Answer: CorrectD. The client has a rigid, “boardlike” abdomen that is tender. Answers: A. The client is experiencing dizziness and confusion with no apparent hemodynamic changes. B. The client is experiencing intense lower right quadrant pain. C. The client has abdominal bloating that developed rapidly. CorrectD. The client has a rigid, “boardlike” abdomen that is tender. Response Feedback: An extremely tender and rigid (boardlike) abdomen is suggestive of a perforated ulcer. None of the other listed signs and symptoms is suggestive of a perforated ulcer. Question 11 A client with gastroesophageal reflux disease (GERD) has a diagnosis of Barrett esophagus with minor cell changes. What principle should be integrated into the client's subsequent care? Selected Answer: CorrectA. The client will be monitored closely to detect malignant changes. Answers: CorrectA. The client will be monitored closely to detect malignant changes. B. Small amounts of blood are likely to be present in the stools and are not cause for concern. C. Antacids may be discontinued when symptoms of heartburn subside. D. Liver enzymes must be checked regularly, as H2 receptor antagonists may cause hepatic damage. Response Feedback: In the client with Barrett esophagus, the cells lining the lower esophagus have undergone change and are no longer squamous cells. The altered cells are considered precancerous and are a precursor to esophageal cancer, necessitating close monitoring. H2 receptor antagonists are commonly prescribed for clients with GERD; however, monitoring of liver enzymes is not routine. Stools that contain evidence of frank bleeding or that are tarry are not expected and should be reported immediately. When antacids are prescribed for clients with GERD, they should be taken as prescribed whether or not the client is symptomatic. Question 13 Diagnostic imaging and physical assessment have revealed that a client with peptic ulcer disease has suffered a perforated ulcer. The nurse recognizes that emergency interventions must be performed as soon as possible in order to prevent the development of what complication? Selected Answer: Correct B. Peritonitis Answers: A. Acute pancreatitis CorrectB. Peritonitis C. Gastritis D. Gastroesophageal reflux Response Feedback: Perforation is the erosion of the ulcer through the gastric serosa into the peritoneal cavity without warning. Chemical peritonitis develops within a few hours of perforation and is followed by bacterial peritonitis. Gastritis, reflux, and pancreatitis are not acute complications of a perforated ulcer. Question 14 1 out of 1 points Correct A patient was admitted to the hospital with GERD. When conducting the physical examination, which signs and symptoms would indicate GERD? Selected Answer: Correct c. Midepigastric pain, cough, and heartburn Answers: a. Weight loss, diarrhea, and melena b. Weight gain, dysuria, and constipation Correct c. Midepigastric pain, cough, and heartburn d. Sore throat, flatulence, and decreased abdominal fat Question 15 A client has been diagnosed with a small bowel obstruction and has been admitted to the medical unit. The nurses care should prioritize which of the following outcomes? Selected Answer: CorrectA. Maintaining fluid and electrolyte balance Answers: CorrectA. Maintaining fluid and electrolyte balance B. Preventing infection C. Maintaining skin and tissue integrity D. Preventing nausea and vomiting Response Feedback: All of the listed focuses of care are important for the client with a small bowel obstruction. However, the client's risk of fluid and electrolyte imbalances is an immediate threat to safety, and is a priority in nursing assessment and interventions. Question 16 A nurse is preparing to provide care for a client whose exacerbation of ulcerative colitis has required hospital admission. During an exacerbation of this health problem, the nurse would anticipate that the client's stools will have what characteristics? Selected Answer: CorrectA. Watery with blood and mucus Answers: CorrectA. Watery with blood and mucus B. Hard and black or tarry C. Dry and streaked with blood D. Loose with visible fatty streaks Response Feedback: The predominant symptoms of ulcerative colitis are diarrhea and abdominal pain. Stools may be bloody and contain mucus. Stools are not hard, dry, tarry, black or fatty in clients who have ulcerative colitis. Question 17 A nurse is assessing a client who has peptic ulcer disease. The client requests more information about the typical causes of Helicobacter pylori infection. What would it be appropriate for the nurse to instruct the client? Selected Answer: CorrectD. Infection typically occurs due to ingestion of contaminated food and water. Answers: A. The H. pylori microorganism is endemic in warm, moist climates. B. Many people possess genetic factors causing a predisposition to H. pylori infection. C. Most affected clients acquired the infection during international travel. CorrectD. Infection typically occurs due to ingestion of contaminated food and water. Response Feedback: Most peptic ulcers result from infection with the gram-negative bacteria H. pylori, which may be acquired through ingestion of food and water. The organism is endemic to many areas, not only warm, moist climates. Genetic factors have not been identified. Question 18 A nurse is providing care for a client who has a diagnosis of irritable bowel syndrome (IBS). When planning this client's care, the nurse should collaborate with the client and prioritize what goal? Selected Answer: CorrectC. Client will accurately identify foods that trigger symptoms. Answers: A. Client will demonstrate appropriate use of standard infection control precautions. B. Client will demonstrate appropriate care of his ileostomy. CorrectC. Client will accurately identify foods that trigger symptoms. D. Client will adhere to recommended guidelines for mobility and activity. Response Feedback: A major focus of nursing care for the client with IBS is to identify factors that exacerbate symptoms. Surgery is not used to treat this health problem and infection control is not a concern that is specific to this diagnosis. Establishing causation likely is more important to the client than managing physical activity. Question 20 The patient with diverticulitis has a nasogastric tube draining green liquid bile. Which intervention should the nurse implement? Selected Answer: Correct a. Document findings as normal Answers: Correct a. Document findings as normal b. Assess the patient’s bowel c. Ask the patient about his last bowel movement d. Insert the NG tube at least 2 more inches Question 21 A client has experienced symptoms of dumping syndrome following gastric surgery. To what physiologic phenomenon does the nurse attribute this syndrome? Selected Answer: CorrectC. Influx of extracellular fluid into the small intestine Answers: A. Irritation of the phrenic nerve due to diaphragmatic pressure B. Reflux of bile into the distal esophagus CorrectC. Influx of extracellular fluid into the small intestine D. Chronic malabsorption of iron and vitamins A and C Response Feedback: The rapid bolus of hypertonic food from the stomach to the small intestines draws extracellular fluid into the lumen of the intestines to dilute the high concentrations of electrolytes and sugars, which results in intestinal dilation, increased intestinal transit, hyperglycemia, and the rapid onset of GI and vasomotor symptoms, which characterizes dumping syndrome. It is not a result of phrenic nerve irritation, malabsorption, or bile reflux. Question 24 A nurse is administering morning medications to a patient with GERD. Which medication should be a priority? Selected Answer: Correct d. A mucosal barrier agent 25 Correct An adult client has been diagnosed with diverticular disease after ongoing challenges with constipation. The client will be treated on an outpatient basis. What components of treatment should the nurse anticipate? Select all that apply. Selected Answers: CorrectA. Reduced fat intake CorrectC. Increased fiber intake Answers: CorrectA. Reduced fat intake B. Enemas on alternating days CorrectC. Increased fiber intake D. Anticholinergic medications E. Fluid reduction Response Feedback: Clients whose diverticular disease does not warrant hospital treatment often benefit from a high-fiber, low-fat diet. Neither enemas nor anticholinergics are indicated, and fluid intake is encouraged. Question 26 A client admitted with inflammatory bowel disease asks the nurse for help with menu selections. What menu selection is most likely the best choice for this client? Selected Answer: Correct C. Tofu Answers: A. Spinach B. Blueberries C. Tofu D. Multigrain bagel Response Feedback: Nutritional management of inflammatory bowel disease requires ingestion of a diet that is bland, lowresidue, high-protein, and high-vitamin. Tofu meets each of the criteria. Spinach, multigrain bagels, and blueberries are not low-residue. Question 27 The nurse is providing care for a client who has recently been diagnosed with chronic gastritis. What health practice should the nurse address when teaching the client to limit exacerbations of the disease? Selected Answer: CorrectB. Avoid taking aspirin to treat pain or fever Answers: A. Taking multivitamins as prescribed and eating organic foods whenever possible CorrectB. Avoid taking aspirin to treat pain or fever C. Performing 15 minutes of physical activity at least three times per week D. Maintaining a healthy body weight Response Feedback: Aspirin and other NSAIDs are implicated in chronic gastritis because of their irritating effect on the gastric mucosa. Organic foods and vitamins confer no protection. Exercise and a healthy body weight are beneficial to overall health but do not prevent gastritis. Question 32 Results of a client barium swallow suggest that the client has GERD. The nurse is planning health education to address the client's knowledge of this new diagnosis. Which of the following should the nurse encourage? Answers: A. Eating several small meals daily rather than 3 larger meals Correct B. Keeping the head of the bed partially elevated C. Drinking carbonated mineral water rather than soft drinks D. Avoiding food or fluid intake after 6:00 PM. Response Feedback: The client with GERD is encouraged to elevate the head of the bed at least 30 degrees. Frequent meals are not specifically encouraged and the client should avoid food and fluid within 2 hours of bedtime. All carbonated beverages should be avoided. Question 33 A nurse is caring for a client who has been admitted to the hospital with diverticulitis. What would be appropriate nursing diagnoses for this client? Select all that apply. Selected Answers: CorrectA. Deficient Fluid Volume Related to Anorexia, Nausea, and Diarrhea CorrectB. Acute Pain Related to Increased Peristalsis and GI Inflammation CorrectD. Activity Intolerance Related to Generalized Weakness Answers: CorrectA. Deficient Fluid Volume Related to Anorexia, Nausea, and Diarrhea CorrectB. Acute Pain Related to Increased Peristalsis and GI Inflammation C. Impaired Urinary Elimination Related to GI Pressure on the Bladder CorrectD. Activity Intolerance Related to Generalized Weakness E. Bowel Incontinence Related to Increased Intestinal Peristalsis Response Feedback: Clients with diverticulitis are likely to experience pain and decreased activity levels, and are at risk of fluid volume deficit. The client is unlikely to experience fecal incontinence and urinary function is not directly influenced. Question 34 A client comes to the clinic reporting pain in the epigastric region. What statement by the client suggests the presence of a duodenal ulcer? Selected Answer: CorrectC. “My pain resolves when I have something to eat.” Answers: A. “I seem to have bowel movements more often than I usually do.” B. “The pain really interferes with my quality of life.” CorrectC. “My pain resolves when I have something to eat.” D. “I know that my father and my grandfather both had ulcers.” Response Feedback: Pain relief after eating is associated with duodenal ulcers. This type of ulcer is not associated with family history or increased frequency of bowel movements. All types of ulcers can affect the client's quality of life. Question 35 A nurse is caring for a client who just has been diagnosed with a peptic ulcer. When teaching the client about his new diagnosis, how should the nurse best describe it? Selected Answer: CorrectC. Erosion of the lining of the stomach or intestine Answers: A. Bleeding from the mucosa in the stomach B. Viral invasion of the stomach wall CorrectC. Erosion of the lining of the stomach or intestine D. Inflammation of the lining of the stomach Response Feedback: A peptic ulcer is erosion of the lining of the stomach or intestine. Peptic ulcers are often accompanied by bleeding and inflammation, but these are not the definitive characteristics. Question 36 The patient diagnosed with diverticulitis is (2) hours post-colonoscopy. Which assessment data warrant immediate intervention by the nurse? Selected Answer: Correct d. The patient’s pulse is 122 and BP is 88/54 Answers: a. The patient has a soft, non-tender abdomen b. The patient has a loose, watery stool c. The patient has hyperactive bowel sound Correct d. The patient’s pulse is 122 and BP is 88/54 Question 37 Correct The nurse is providing care for a client whose inflammatory bowel disease has necessitated hospital treatment. Which of the following would most likely be included in the client's medication regimen? Selected Answer: CorrectD. Antidiarrheal medications 30 minutes before a meal Answers: A. Beta adrenergic blockers to reduce bowel motility B. Vitamin B12 injections to prevent pernicious anemia C. Antiemetics on a PRN basis CorrectD. Antidiarrheal medications 30 minutes before a meal Response Feedback: The nurse administers antidiarrheal medications 30 minutes before a meal as prescribed to decrease intestinal motility and administers analgesics as prescribed for pain. Antiemetics, vitamin B12 injections and beta blockers do not address the signs, symptoms, or etiology of inflammatory bowel disease. Question 38 A client's health history is suggestive of inflammatory bowel disease. Which of the following would suggest Crohn's disease, rather that ulcerative colitis, as the cause of the client's signs and symptoms? Selected Answer: CorrectC. An absence of blood in stool Answers: A. A pattern of distinct exacerbations and remissions B. Severe diarrhea CorrectC. An absence of blood in stool D. Involvement of the rectal mucosa Response Feedback: Bloody stool is far more common in cases of UC than in Crohn's. Rectal involvement is nearly 100% in cases of UC (versus 20% in Crohn's) and clients with UC typically experience severe diarrhea. UC is also characterized by a pattern of remissions and exacerbations, while Crohn's often has a more prolonged and variable course. Question 39 A nurse is completing a health history on a client whose diagnosis is chronic gastritis. Which of the data should the nurse consider most significantly related to the etiology of the client's health problem? Selected Answer: CorrectC. Smokes one pack of cigarettes daily. Answers: A. Consumes one or more protein drinks daily. B. Takes over-the-counter antacids frequently throughout the day. CorrectC. Smokes one pack of cigarettes daily. D. Reports a history of social drinking on a weekly basis. Response Feedback: Nicotine reduces secretion of pancreatic bicarbonate, which inhibits neutralization of gastric acid and can underlie gastritis. Protein drinks do not result in gastric inflammation. Antacid use is a response to experiencing symptoms of gastritis, not the etiology of gastritis. Alcohol ingestion can lead to gastritis; however, this generally occurs in clients with a history of consumption of alcohol on a daily basis. Question 40 Diagnostic testing of a client with a history of dyspepsia and abdominal pain has resulted in a diagnosis of gastric cancer. The nurses anticipatory guidance should include what information? Selected Answer: CorrectC. The possibility of surgery, chemotherapy and radiotherapy Answers: A. The good prognosis for clients who are treated for gastric cancer B. The possibility of needing a short-term or long-term colostomy CorrectC. The possibility of surgery, chemotherapy and radiotherapy D. The benefits of weight loss and exercise as tolerated during recovery Response Feedback: Treatment of gastric cancer is usually multimodal, but does not necessitate a colostomy. Weight loss is not a goal during recovery; exercise is not a high priority and may be unrealistic. The prognosis for patients with gastric cancer is generally poor. Question 41 A nurse is planning discharge teaching for a 21-year-old client with a new diagnosis of ulcerative colitis. When planning family assessment, the nurse should recognize that which of the following factors will likely have the greatest impact on the client's coping after discharge? Selected Answer: CorrectB. The familys ability to provide emotional support Answers: A. The family's ability to manage the client's medication regimen CorrectB. The family's ability to provide emotional support C. The family's ability to take care of the client's special diet needs D. The family's ability to monitor the client's changing health status Response Feedback: Emotional support from the family is key to the client's coping after discharge. A 21-year-old would be expected to self-manage the prescribed medication regimen and the family would not be primarily responsible for monitoring the client's health status. It is highly beneficial if the family is willing and able to accommodate the client's dietary needs, but emotional support is paramount and cannot be solely provided by the client alone. 42 A nurse is providing health promotion education to a client diagnosed with an esophageal reflux disorder. What practice should the nurse encourage the client to implement? Selected Answer: CorrectA. Avoid carbonated drinks. Answers: CorrectA. Avoid carbonated drinks. B. Keep the head of the bed lowered. C. Eat a low-protein diet. D. Drink a cup of hot tea before bedtime. Response Feedback: For a client diagnosed with esophageal reflux disorder, the nurse should instruct the client to keep the head of the bed elevated. Carbonated drinks, caffeine, and tobacco should be avoided. Protein limitation is not necessary. Question 44 A client is admitted to the medical unit with a diagnosis of intestinal obstruction. When planning this clients care, which of the following nursing diagnoses should the nurse prioritize? Selected Answer: IncorrectD. Imbalanced Nutrition: Less Than Body Requirements Related to Impaired Absorption Answers: CorrectA. Ineffective Tissue Perfusion Related to Bowel Ischemia B. Anxiety Related to Bowel Obstruction and Subsequent Hospitalization C. Impaired Skin Integrity Related to Bowel Obstruction D. Imbalanced Nutrition: Less Than Body Requirements Related to Impaired Absorption Response Feedback: When the bowel is completely obstructed, the possibility of strangulation and tissue necrosis (i.e., tissue death) warrants surgical intervention. As such, this immediate physiologic need is a nursing priority. Nutritional support and management of anxiety are necessary, but bowel ischemia is a more immediate threat. Skin integrity is not threatened. Question 45 A nurse is caring for a client who has a diagnosis of GI bleed. During shift assessment, the nurse finds the client to be tachycardic and hypotensive, and the client has an episode of hematemesis while the nurse is in the room. In addition to monitoring the client's vital signs and level of conscious, what would be a priority nursing action for this client? Selected Answer: CorrectA. Notify the health care provider. Answers: CorrectA. Notify the health care provider. B. Provide the client with ice water to slow any GI bleeding. C. Place the client in a prone position. D. Prepare for the insertion of an NG tube. Response Feedback: The nurse must always be alert for any indicators of hemorrhagic gastritis, which include hematemesis (vomiting of blood), tachycardia, and hypotension. If these occur, the physician is notified and the client's vital signs are monitored as the client's condition warrants. Putting the client in a prone position could lead to aspiration. Giving ice water is contraindicated as it would stimulate more vomiting. Question 46 A clients large bowel obstruction has failed to resolve spontaneously and the client's worsening condition has warranted admission to the medical unit. Which of the following aspect of nursing care is most appropriate for this client? Selected Answer: CorrectD. Preparing the client for surgical bowel resection Answers: A. Performing deep palpation as prescribed to promote peristalsis B. Administering bowel stimulants as prescribed C. Administering bulk-forming laxatives as prescribed CorrectD. Preparing the client for surgical bowel resection Response Feedback: The usual treatment for a large bowel obstruction is surgical resection to remove the obstructing lesion. Administration of laxatives or bowel stimulants is contraindicated if the bowel is obstructed. Palpation would be painful and has no therapeutic benefit. Question 48 The nurse is assessing a client who had an ileostomy created three days ago for the treatment of irritable bowel disease. The nurse observes that the client's stoma is bright red and there are scant amounts of blood on the stoma. What is the nurse's best action? Selected Answer: CorrectB. Document these expected assessment findings Answers: A. Apply barrier ointment to the stoma as prescribed Correct B. Document these expected assessment findings C. Contact the care provider to have the client's hemoglobin and hematocrit measured D. Cleanse the stoma with alcohol or chlorhexidine. Response Feedback: Redness and slight bleeding are expected, so no further intervention or assessment is likely necessary. Question 49 An adult client with a history of dyspepsia has been diagnosed with chronic gastritis. The nurse's health education should include what guidelines? Select all that apply. Selected Answers: CorrectA. Avoid drinking alcohol CorrectE. Avoid non-steroidal anti-inflammatories Answers: CorrectA. Avoid drinking alcohol B. Adopt a low-residue diet C. Prepare for the possibility of surgery D. Take calcium gluconate as prescribed CorrectE. Avoid non-steroidal anti-inflammatories Response Feedback: Clients with chronic gastritis are encouraged to avoid alcohol and NSAIDs. Calcium gluconate is not a common treatment and the condition is not normally treated with surgery. Dietary modifications are usually recommended, but this does not necessitate a low-residue diet. Question 50 A client admitted with acute diverticulitis has experienced a sudden increase in temperature and reports a sudden onset of exquisite abdominal tenderness. The nurse's rapid assessment reveals that the client's abdomen is uncharacteristically rigid on palpation. What is the nurse's best response? Selected Answer: CorrectB. Contact the primary provider promptly and report these signs of perforation. Answers: A. Page the primary provider and report that the client may be obstructed. CorrectB. Contact the primary provider promptly and report these signs of perforation. C. Administer a Fleet enema as prescribed and remain with the client. D. Position the client supine and insert an NG tube. Response Feedback: The client's change in status is suggestive of perforation, which is a surgical emergency. Obstruction does not have this presentation involving fever and abdominal rigidity. An enema would be strongly contraindicated. An order is needed for NG insertion and repositioning is not a priority.