Exam 3 - GI and Liver Flashcards
On the second day after gastric resection, the client’s NG tube is draining bile-colored liquid containing coffee-ground materials. What is the best nursing action?
- Continue to monitor the amount of drainage and correlate it with any change in vital signs.
- Reposition the NG tube and irrigate the tube with normal saline solution.
- Call the physician and discuss the possibility that the client is bleeding.
- Irrigate the NG tube with iced saline solution and attach the tube to gravity drainage.
1
Coffee-ground material is characteristic of old blood. Bright red bleeding would indicate hemorrhage. This is a normal occurrence on the third postoperative day and should be correlated with the vital signs. The tube is in the correct position since it is draining gastric secretions. There is no indication to notify anyone or to irrigate the NG tube.
In planning discharge for the client who has undergone a gastrectomy, the nurse includes what information regarding dumping syndrome?
- The syndrome will be a permanent problem, and the client should eat 5 to 6 small meals per day.
- The client should decrease the amount of fluid consumed with each meal and for 1 hour after each meal.
- The client should increase the amount of complex carbohydrates and fiber in the diet.
- Activity will decrease the problem; it should be scheduled about 1 hour after meals.
2
Dumping syndrome is self-limiting; it is not a permanent problem. Decreasing fluid intake with and after meals, eating small meals, and decreasing carbohydrate and salt intake will decrease the dumping effect. Activity does not play an essential role in preventing dumping syndrome.
The nurse is caring for a client who has been diagnosed with a bleeding duodenal ulcer. What data identified on a nursing assessment would indicate an intestinal perforation and require immediate nursing action?
- Increasing abdominal distention, with increased pain and vomiting
- Decreasing hemoglobin and hematocrit with bloody stools
- Diarrhea with increased bowel sounds and hypovolemia
- Decreasing blood pressure with tachycardia and disorientation
1
Perforation is characterized by increasing distention and boardlike abdomen. There is frequently pain with fever and guarding of the abdomen. Peritonitis occurs rapidly. The nurse should maintain the client NPO, keep the client on bed rest, and immediately notify the physician. Decreasing hemoglobin and hematocrit and decreasing blood pressure are associated with hemorrhage rather than perforation. Remember to select an answer that reflects what the question is specifically asking.
A client is admitted with duodenal ulcers. What will the nurse anticipate the client’s history to include?
- Recent weight loss
- Increasing indigestion after meals
- Awakening with pain at night
- Episodes of vomiting
3
Duodenal ulcers are characterized by high gastric acid secretion and rapid gastric emptying. Food buffers the effect of the acid; consequently, pain increases when the stomach is empty. Pain does not characteristically occur after eating, and the client does not usually have bouts with nausea unless bleeding or obstruction is a problem.
The nurse is conducting discharge dietary teaching for a client with diverticulosis who is recovering from an episode of diverticulitis. Which statement by the client would indicate to the nurse that the client understood his dietary teaching?
- “I will need to increase my intake of protein and complex carbohydrates to increase healing.”
- “I need to eat foods that contain a lot of fiber to prevent problems with constipation.”
- “I will not put any added salt on my food, and I will decrease intake of foods that are high in saturated fat.”
- “Milk and milk products can cause a lactose intolerance. If this occurs, I need to decrease my intake of these products.”
2
Constipation increases problems with diverticula. A diet high in fiber is recommended. The other options do not have any specific relevance to diverticula disease.
A school-age child with a diagnosis of celiac disease asks the nurse, “Which foods will make me sick?” Which food items would the nurse teach the child to avoid?
- Rice cereals, milk and tapioca
- Corn cereals, milk, and fruit
- Corn or potato bread and peanut butter
- Malted milk, white bread, and spaghetti
4
The child with celiac disease will need a gluten-free diet, eliminating foods such as pastas and breads that are made from wheat and dessert foods made from malt whey. Remember ROW–rye, oats, and wheat. Barley is also to be avoided. Foods that would be appropriate include rice and corn cereals, milk, corn and potato breads, tapioca, peanut butter, and honey.
While talking with a client with a diagnosis of end-stage liver disease, the nurse notices the client is unable to stay awake and seems to fall asleep in the middle of a sentence. The nurse recognizes these symptoms to be indicative of what condition?
- Hyperglycemia
- Increased bile production
- Increased blood ammonia levels
- Hypocalcemia
3
In end-stage liver disease, the liver cannot break down ammonia by-products of protein metabolism. The increased ammonia levels in the serum cross the blood-brain barrier, causing uncontrolled drowsiness and confusion. Hyperglycemia is characterized by polyphagia, polydipsia, and polyuria, along with fatigue, weight loss, excessive thirst, and abdominal pain. Hypocalcemia is characterized by tetany symptoms. Increased bile production does not cause neurologic symptoms; it is related more to digestion.
What is the primary purpose of giving lactulose (Enulose) to a client with advanced liver disease?
- To ensure regular bowel movements
- To prevent bowel obstruction
- To decrease ammonia levels in the blood
- To promote clotting
3
In a client with end-stage liver disease, lactulose is used to decrease ammonia levels in the blood, thus improving cognition and alertness. The ammonia is eliminated through the regular bowel movements that the medication promotes, preventing obstructions. Lactulose is not involved in blood clotting.
The nurse is providing discharge instructions to a client following gastrectomy and instructs the client to take which measure to assist in preventing dumping syndrome?
- Ambulate following a meal.
- Eat high carbohydrate foods.
- Limit the fluids taken with meals.
- Sit in a high Fowler’s position during meals.
3
Dumping syndrome is a term that refers to a constellation of vasomotor symptoms that occurs after eating, especially following a Billroth II procedure. Early manifestations usually occur within 30 minutes of eating and include vertigo, tachycardia, syncope, sweating, pallor, palpitations, and the desire to lie down. The nurse should instruct the client to decrease the amount of fluid taken at meals and to avoid high-carbohydrate foods, including fluids such as fruit nectars; to assume a low Fowler’s position during meals; to lie down for 30 minutes after eating to delay gastric emptying; and to take antispasmodics as prescribed.
The nurse is reviewing the record of a client with Crohn’s disease. Which stool characteristic should the nurse expect to note documented in the client’s record?
- Diarrhea
- Chronic constipation
- Constipation alternating with diarrhea
- Stool constantly oozing from the rectum
1
Crohn’s disease is characterized by nonbloody diarrhea of usually not more than four to five stools daily. Over time, the diarrhea episodes increase in frequency, duration, and severity. Options 2, 3, and 4 are not characteristics of Crohn’s disease.
The nurse is doing an admission assessment on a client with a history of duodenal ulcer. To determine whether the problem is currently active, the nurse should assess the client for which symptom(s) of duodenal ulcer?
- Weight loss
- Nausea and vomiting
- Pain relieved by food intake
- Pain radiating down the right arm
3
A frequent symptom of duodenal ulcer is pain that is relieved by food intake. These clients generally describe the pain as a burning, heavy, sharp, or “hungry” pain that often localizes in the midepigastric area. The client with duodenal ulcer usually does not experience weight loss or nausea and vomiting. These symptoms are more typical in the client with a gastric ulcer.
A nurse is preparing to care for a child with a diagnosis of intussusception. The nurse reviews the child’s record and expects to note which symptom of this disorder documented?
- Watery diarrhea
- Ribbon-like stools
- Profuse projectile vomiting
- Bright red blood and mucus in the stools
4
Intussusception is a telescoping of one portion of the bowel into another. The condition results in an obstruction to the passage of intestinal contents. A child with intussusception typically has severe abdominal pain that is crampy and intermittent, causing the child to draw in the knees to the chest. Vomiting may be present, but is not projectile. Bright red blood and mucus are passed through the rectum and commonly described as currant jelly-like stools. Watery diarrhea and ribbon-like stools are not manifestations of this disorder.
A nurse admits a child to the hospital with a diagnosis of pyloric stenosis. On admission assessment, which data would the nurse expect to obtain when asking the mother about the child’s symptoms?
- Watery diarrhea
- Projectile vomiting
- Increased urine output
- Vomiting large amounts of bile
2
In pyloric stenosis, hypertrophy of the circular muscles of the pylorus causes narrowing of the pyloric canal between the stomach and duodenum. Clinical manifestations of pyloric stenosis include projectile vomiting, irritability, hunger and crying, constipation, and signs of dehydration including a decrease in urine output.
A nurse provides home care instructions to the parents of a child with celiac disease. The nurse teaches the parents to include which food item in the child’s diet?
- Rice
- Oatmeal
- Rye toast
- Wheat bread
1
Celiac disease is also known as gluten enteropathy or celiac sprue and refers to an intolerance to gluten, the protein component of wheat, barley, rye and oats. The important factor to remember is that all wheat, rye, barley, and oats should be eliminated from the diet and replaced with corn, rice, and millet. Vitamin supplements – especially the fat-soluble vitamins, iron, and folic acid – may be needed to correct deficiencies. Dietary restrictions are likely to be lifelong.
A nurse is assessing for correct placement of a nasogastric tube. The nurse aspirates the stomach contents and checks the contents for pH. The nurse verifies correct tube placement if which pH value is noted?
- 3.5
- 7.0
- 7.35
- 7.5
1
If the nasogastric tube is in the stomach, the pH of the contents will be acidic. Gastric aspirates have acidic pH values and should be 3.5 or lower. Option 2 indicates a slightly acidic pH. Option 3 indicates a neutral pH. Option 4 indicates an alkaline pH.
