NR 324 Comprehensive Exam with
Complete Solutions
Considerations for the eldery in relation to GI changes - ✔✔-increased periodontal disease →
loss of teeth, xerostomia (decreased salivation) --- associated w/dysphagia
-smooth muscle weakness = delayed gastric emptying and incompetent lower esophageal
sphincter
-decreased # of parietal cells = decrease in intrinsic factor secreted
What affect does gastric surgery have on the client - ✔✔decreases intrinsic factor= pernicious
(b12) anemia, b12 deficiencies
Teaching points for a client undergoing a colonoscopy...what is it? Why do we do them? What
are we looking for? What is the preparation required? - ✔✔Scope the intestines; procedure to
see polyps/cancer/inflammation on intestinal walls; bowel prep is required → clear liquids for
1-2 days before OR GoLYTELY. Explain procedure to pt. Pt may experience discomfort (gas) after
procedure when peristalsis starts again.
What is an Upper Endoscopy? What are the dangers associated with this? What must we assess
for following an upper GI? - ✔✔direct visualization (by lighted fiberoptic camera) of upper GI
structures; dangers → perforation; assess for bleeds and keep pt NPO until gag reflex returns
What is a PEG tube? How do we use it for feeding? - ✔✔percutaneous endoscopic gastrostomy
tube (it is a method for placing the tube without actual surgery); feeds directly into stomach;
check for hyperglycemia of elderly; keep HOB 30*-45*; flush tube before and after feeding
What are nursing considerations for clients requiring PN feeding? - ✔✔check vitals every 4-8
hrs; get daily weight (edema due to less protein); lung sounds; do not stop PN feeding abruptly;
change tubing every 24 hours; monitor for hyperglycemia; monitor for "re-feeding syndrome"
(fluid retention, electrolyte imbalances)
, What effect does anorexia nervosa/laxative abuse have on the client systemically? -
✔✔decreased nutrients → deficiencies
hypokalemia → put them on a heart monitor
Nursing considerations/care of a client following gastric surgery - ✔✔pain meds, turn, cough,
deep breath, mouth/nose care (NG tube), ROM, check wound site, keep NG tube patent, watch
for vomiting, skin care, increase protein in diet for first 2 weeks
Diet for advancement following period of N/V - ✔✔ice chips, clear liquids (jello included?), full
liquids, bland food
Teaching points for a client with GERD - ✔✔client should stop smoking; keep HOB 30* and pt
shouldn't lay down 2-3 hours after eating
avoid chocolate, peppermint, tomatoes, coffee, and tea (increase gastric acid)
Drug therapy for the treatment of H pylori and nursing considerations for these/teaching points
regarding these - ✔✔PPI's, bismuth, tetracycline, metronidazole (Flagyl); usually transmitted
among family members (may treat family at same time)
PPI's (protonix) → teach, Carafate, antacids
Nursing considerations for the treatment of a client with PUD...both bleeding and non bleeding
- ✔✔risk factors for PUD: aspirin/NSAID use, stress, smoking, alcohol, caffeine; pts with PUD at
risk for perforation
Non-bleeding ulcers → supportive (reduce stress, lifestyle/diet modification); bleeding → check
vital signs frequently (hemorrhage), given may need transfusions
What is the significance of vomiting bright red blood vs coffee ground emesis? - ✔✔Bright red
blood has not been exposed to gastric acids; coffee ground emesis is curdled blood from the
stomach acid
Complete Solutions
Considerations for the eldery in relation to GI changes - ✔✔-increased periodontal disease →
loss of teeth, xerostomia (decreased salivation) --- associated w/dysphagia
-smooth muscle weakness = delayed gastric emptying and incompetent lower esophageal
sphincter
-decreased # of parietal cells = decrease in intrinsic factor secreted
What affect does gastric surgery have on the client - ✔✔decreases intrinsic factor= pernicious
(b12) anemia, b12 deficiencies
Teaching points for a client undergoing a colonoscopy...what is it? Why do we do them? What
are we looking for? What is the preparation required? - ✔✔Scope the intestines; procedure to
see polyps/cancer/inflammation on intestinal walls; bowel prep is required → clear liquids for
1-2 days before OR GoLYTELY. Explain procedure to pt. Pt may experience discomfort (gas) after
procedure when peristalsis starts again.
What is an Upper Endoscopy? What are the dangers associated with this? What must we assess
for following an upper GI? - ✔✔direct visualization (by lighted fiberoptic camera) of upper GI
structures; dangers → perforation; assess for bleeds and keep pt NPO until gag reflex returns
What is a PEG tube? How do we use it for feeding? - ✔✔percutaneous endoscopic gastrostomy
tube (it is a method for placing the tube without actual surgery); feeds directly into stomach;
check for hyperglycemia of elderly; keep HOB 30*-45*; flush tube before and after feeding
What are nursing considerations for clients requiring PN feeding? - ✔✔check vitals every 4-8
hrs; get daily weight (edema due to less protein); lung sounds; do not stop PN feeding abruptly;
change tubing every 24 hours; monitor for hyperglycemia; monitor for "re-feeding syndrome"
(fluid retention, electrolyte imbalances)
, What effect does anorexia nervosa/laxative abuse have on the client systemically? -
✔✔decreased nutrients → deficiencies
hypokalemia → put them on a heart monitor
Nursing considerations/care of a client following gastric surgery - ✔✔pain meds, turn, cough,
deep breath, mouth/nose care (NG tube), ROM, check wound site, keep NG tube patent, watch
for vomiting, skin care, increase protein in diet for first 2 weeks
Diet for advancement following period of N/V - ✔✔ice chips, clear liquids (jello included?), full
liquids, bland food
Teaching points for a client with GERD - ✔✔client should stop smoking; keep HOB 30* and pt
shouldn't lay down 2-3 hours after eating
avoid chocolate, peppermint, tomatoes, coffee, and tea (increase gastric acid)
Drug therapy for the treatment of H pylori and nursing considerations for these/teaching points
regarding these - ✔✔PPI's, bismuth, tetracycline, metronidazole (Flagyl); usually transmitted
among family members (may treat family at same time)
PPI's (protonix) → teach, Carafate, antacids
Nursing considerations for the treatment of a client with PUD...both bleeding and non bleeding
- ✔✔risk factors for PUD: aspirin/NSAID use, stress, smoking, alcohol, caffeine; pts with PUD at
risk for perforation
Non-bleeding ulcers → supportive (reduce stress, lifestyle/diet modification); bleeding → check
vital signs frequently (hemorrhage), given may need transfusions
What is the significance of vomiting bright red blood vs coffee ground emesis? - ✔✔Bright red
blood has not been exposed to gastric acids; coffee ground emesis is curdled blood from the
stomach acid
