MSN Gastrointestinal Quiz 2

1. A client recovering from acute pancreatitis that has been NPO (nothing per mouth) asks a nurse when he can begin eating again. Which response by the nurse is most accurate?

“As soon as you start to feel hungry you can begin eating.”

“When you have active bowel sounds and you are passing flatus.”

“When your pain is controlled and your serum lipase level has decreased.”

Once pain is controlled and the serum enzyme levels begin to decrease, the client can begin oral intake. These are signs that the pancreas is healing. Intestinal peristalsis may be slowed due to the inflammation associated with acute pancreatitis, but return of bowel sounds and flatus are not used to determine when to begin oral intake. Regaining appetite is a positive sign, but it must be accompanied by a decrease in pain before the client is allowed to take food orally. There is no specific time limit for being NPO.

Explanation

Once pain is controlled and the serum enzyme levels begin to decrease, the client can begin oral intake. These are signs that the pancreas is healing. Intestinal peristalsis may be slowed due to the inflammation associated with acute pancreatitis, but return of bowel sounds and flatus are not used to determine when to begin oral intake. Regaining appetite is a positive sign, but it must be accompanied by a decrease in pain before the client is allowed to take food orally. There is no specific time limit for being NPO.

2. A 40-year-old client is recovering from an exacerbation of chronic pancreatitis. As the client prepares for discharge, the client makes several statements to a nurse. Which statement should be concerning to the nurse because it could inhibit the client's ability to accomplish the developmental tasks of middle adulthood?

“I’m planning on continuing to be active in the local town service club.”

“I should be able to return to work in 3 weeks.”

“I’ve really missed my friends. I’m looking forward to having a glass a wine with them.”

“My spouse has been very supportive.”

The developmental task for the middle adult years is generativity versus stagnation. The individual who is working toward generativity is creatively giving of oneself to the world. The individual is volunteering and also working creatively in his/her job. Continuing to consume alcohol will cause continued progression of the pancreatic disease and could eventually result in the inability to work or to participate in community service.

Explanation

The developmental task for the middle adult years is generativity versus stagnation. The individual who is working toward generativity is creatively giving of oneself to the world. The individual is volunteering and also working creatively in his/her job. Continuing to consume alcohol will cause continued progression of the pancreatic disease and could eventually result in the inability to work or to participate in community service.

3. A nurse anticipates that the conservative treatment of a client with acute cholecystitis will include:

A bland diet.

The administration of anticholinergic medications.

Placing the client in a supine position with the head of the bed flat.

Administering laxatives to clear the bowel.

Anticholinergic medications decrease secretion and counteract smooth muscle spasms. The client should be NPO (nothing per mouth) rather than on a bland diet to decrease gallbladder stimulation. Laxatives would increase, rather than decrease, gastrointestinal stimulation. Positioning the client with the head of the bed elevated decreases the pressure of the abdominal contents on the diaphragm and promotes improved ventilation.

Explanation

Anticholinergic medications decrease secretion and counteract smooth muscle spasms. The client should be NPO (nothing per mouth) rather than on a bland diet to decrease gallbladder stimulation. Laxatives would increase, rather than decrease, gastrointestinal stimulation. Positioning the client with the head of the bed elevated decreases the pressure of the abdominal contents on the diaphragm and promotes improved ventilation.

4. A nurse is beginning client care and has been assigned to the following four clients. Which client should the nurse plan to assess first?

A 47-year-old client with esophageal varices who has influenza and has been coughing for the last30 minutes

A 60-year-old client who had an open cholecystectomy 15 hours ago and has been stablethrough the night

A 54-year-old client with cirrhosis and jaundice who is reporting itching

Bleeding esophageal varices are the most life-threatening complication of cirrhosis. Coughing can precipitate a bleeding episode. The client with a pain rating of 6 out of 10 on a numeric scale and the client reporting itching also need attention, but the pain and itching are not life-threatening concerns. The client who is post cholecystectomy is reported as being stable and could be assessed last.

Explanation

Bleeding esophageal varices are the most life-threatening complication of cirrhosis. Coughing can precipitate a bleeding episode. The client with a pain rating of 6 out of 10 on a numeric scale and the client reporting itching also need attention, but the pain and itching are not life-threatening concerns. The client who is post cholecystectomy is reported as being stable and could be assessed last.

5. A nurse is caring for a client who is 6 hours post–open cholecystectomy. The client's T-tube drainage bag is empty, and the nurse notes slight jaundice of the sclera. Which action by the nurse is most important?

Repositioning the client to promote T-tube drainage

Notifying the surgeon about these findings

Checking the client’s blood pressure immediately

Recording the findings and continuing to monitor the client

The T-tube is placed in the common bile duct to ensure patency of the duct. Lack of bile draining into the T-tube and jaundiced sclera are signs of an obstruction to bile flow and should be reported to the surgeon. Repositioning the client might promote bile flow into the T-tube if the client were lying on the tube. However, the jaundice indicates that the problem is internal. The client’s blood pressure would not be affected by this situation. Recording the findings and continuing to monitor the client is inappropriate because the client is experiencing signs of a complication.

Explanation

The T-tube is placed in the common bile duct to ensure patency of the duct. Lack of bile draining into the T-tube and jaundiced sclera are signs of an obstruction to bile flow and should be reported to the surgeon. Repositioning the client might promote bile flow into the T-tube if the client were lying on the tube. However, the jaundice indicates that the problem is internal. The client’s blood pressure would not be affected by this situation. Recording the findings and continuing to monitor the client is inappropriate because the client is experiencing signs of a complication.

6. During a hospital admission history, a nurse suspects irritable bowel syndrome (IBS) when the client says:

“I am having a lot of bloody diarrhea.”

“I have been vomiting for 2 days.”

“I have lost 10 pounds in the last month.”

“I have noticed mucus in my stools.”

Mucus in the stools is a sign of IBS. Clients with this syndrome may have diarrhea, but it is not bloody. Vomiting is not a symptom of this disease, and clients do not experience unintentional weight loss.

Explanation

Mucus in the stools is a sign of IBS. Clients with this syndrome may have diarrhea, but it is not bloody. Vomiting is not a symptom of this disease, and clients do not experience unintentional weight loss.

7. A health-care provider writes the following admission orders for a client with possible appendicitis. Which order should the nurse question?

Apply heat to abdomen to decrease pain

Withhold analgesic medications to avoid masking critical changes in symptoms

Keep client NPO (nothing per mouth)

Start lactated Ringer’s solution intravenously (IV) at 125 mL/hr

Applying heat to the abdomen when appendicitis is suspected is contraindicated because heat increases circulation, which, in turn, could cause the appendix to rupture. Analgesic medications are usually withheld until a definitive diagnosis is established to avoid masking symptoms. Clients are kept NPO in case surgery is needed, and isotonic IV fluids are initiated to replace lost body fluid and prevent dehydration.

Explanation

Applying heat to the abdomen when appendicitis is suspected is contraindicated because heat increases circulation, which, in turn, could cause the appendix to rupture. Analgesic medications are usually withheld until a definitive diagnosis is established to avoid masking symptoms. Clients are kept NPO in case surgery is needed, and isotonic IV fluids are initiated to replace lost body fluid and prevent dehydration.

8. A 22-year-old college senior has just been diagnosed with acute appendicitis requiring surgery. The client has been nauseated for 2 days, rates the pain as 4 out of 10 on a numeric scale, and tells the nurse, "I can't believe this is happening. I have final exams starting in 3 days. What am I going to do?" A nurse develops the following preoperative diagnoses for this client. Which nursing diagnosis should be priority?

Anxiety related to situational crisis

Acute pain related to tissue injury

Risk deficient fluid volume related to nausea

Risk for delayed development related to illness and need for recovery

While all of these diagnoses are important, the client has expressed that the major concern is anxiety about this school situation. The client is not in immediate physical danger. In this situation, feedback from the

client is an important consideration when the nurse determines priorities.

Explanation

While all of these diagnoses are important, the client has expressed that the major concern is anxiety about this school situation. The client is not in immediate physical danger. In this situation, feedback from the

client is an important consideration when the nurse determines priorities.

9. A nurse is reviewing the history and physical of a teenager admitted to a hospital with a diagnosis of ulcerative colitis. Based on this diagnosis, which information should the nurse expect to see on this client's medical record?

Abdominal pain and bloody diarrhea

Weight gain and elevated blood glucose

Abdominal distension and hypoactive bowel sounds

Heartburn and regurgitation

The primary symptoms of ulcerative colitis are bloody diarrhea and abdominal pain. Weight loss often occurs in severe cases. Bowel sounds are often hyperactive. Heartburn and regurgitation are not symptoms of this disease.

Explanation

The primary symptoms of ulcerative colitis are bloody diarrhea and abdominal pain. Weight loss often occurs in severe cases. Bowel sounds are often hyperactive. Heartburn and regurgitation are not symptoms of this disease.

10. A 20-year-old male client is admitted to a hospital with an exacerbation of ulcerative colitis. A female nurse goes into the client's room to complete an initial assessment, and the client yells, "Get out of here! I'm tired of nurses and doctors looking at my body all the time!" Which is the nurse's best action?

Leave the room and ask a male colleague to complete the assessment.

Verbally acknowledge the client’s frustration and anger.

Call the health-care practitioner and ask for a sedative order.

Tell the client that gathering data about his current condition will promote effective timely treatmentof his health concerns.

Ulcerative colitis can be a frustrating disease that often develops before the client has developed adequate coping mechanisms. When responding to an angry client, the nurse must make a determination about the possible cause of the anger. Assessment of the cause will then lead to an appropriate intervention. In the case of the client who is genuinely frustrated and/or frightened, the first implementation strategy should be supportive listening. Once the client has been given the opportunity to express his specific concerns, the nurse can take whatever action is needed to help him regain control.

Explanation

Ulcerative colitis can be a frustrating disease that often develops before the client has developed adequate coping mechanisms. When responding to an angry client, the nurse must make a determination about the possible cause of the anger. Assessment of the cause will then lead to an appropriate intervention. In the case of the client who is genuinely frustrated and/or frightened, the first implementation strategy should be supportive listening. Once the client has been given the opportunity to express his specific concerns, the nurse can take whatever action is needed to help him regain control.

11. A nurse is caring for a client diagnosed with Crohn's disease, who has undergone a barium enema that demonstrated the presence of strictures in the ileum. Based on this finding, the nurse should monitor the client closely for signs of:

Peritonitis.

Obstruction.

Malabsorption.

Fluid imbalance.

Bowel strictures are a common complication of Crohn’s disease and can result in an acute bowel obstruction. Peritonitis would not be an expected sequel of a bowel stricture nor would malabsorption. Fluid balance would be affected once total obstruction develops.

Explanation

Bowel strictures are a common complication of Crohn’s disease and can result in an acute bowel obstruction. Peritonitis would not be an expected sequel of a bowel stricture nor would malabsorption. Fluid balance would be affected once total obstruction develops.

12. While discharging a 25-year-old female client after a small bowel resection for Crohn's disease, a nurse overhears the client talking to her husband and realizes that the client needs more education when the client says:

“I’m so glad I won’t ever need any more surgeries.”

“I’ll need to continue to monitor my weight.”

“If I have another exacerbation I know they will probably put me back on hydrocortisone.”

“I will probably have to take vitamin supplements all of my life.”

Crohn’s disease can occur throughout the gastrointestinal (GI) tract. Surgery in one area of the GI tract will not prevent the disease from reoccurring in another area. This reoccurrence can result in the need for further surgery. Clients with Crohn’s disease will always need to monitor their weight and will need vitamins to maintain adequate nutrient levels, since inflamed areas of the GI tract do not absorb nutrients well.

Most likely, the client will need some type of glucocorticoid medication to treat a future exacerbation.

Explanation

Crohn’s disease can occur throughout the gastrointestinal (GI) tract. Surgery in one area of the GI tract will not prevent the disease from reoccurring in another area. This reoccurrence can result in the need for further surgery. Clients with Crohn’s disease will always need to monitor their weight and will need vitamins to maintain adequate nutrient levels, since inflamed areas of the GI tract do not absorb nutrients well.

Most likely, the client will need some type of glucocorticoid medication to treat a future exacerbation.

13. A nurse is assessing a client diagnosed with acute diverticulitis. Which finding should make the nurse suspect that the client has an intestinal perforation?

Elevated white blood cells (WBCs)

Temperature of 101°F (38.3°C)

Absent bowel sounds

Abdominal pain

Clients with intestinal perforation will develop paralytic ileus. Increased temperature, WBCs, and abdominal pain are all symptoms of acute diverticulitis.

Explanation

Clients with intestinal perforation will develop paralytic ileus. Increased temperature, WBCs, and abdominal pain are all symptoms of acute diverticulitis.

14. For a client with a newly created colostomy, a nurse creates this diagnosis: risk for sexual dysfunction related to body image change. To promote satisfying sexual functioning after ostomy surgery, which recommendation should the nurse make to the client?

Participate in sexual activity only in a darkened room

Utilize self-gratification for the majority of sexual needs

Empty and clean the ostomy pouch immediately before sexual activity

Utilize only the female superior position for sexual activity

Emptying the pouch before sexual activity is suggested to decrease the concern of pouch breakage or leakage. Self-gratification, if it involves emotional distancing, can be destructive to the client’s sexual relationship. Various positions should be explored during sexual activity with the goal of minimizing stress and pressure on the pouch. Participating in sex only in a darkened room may be a way of coping with body image concerns, but it is not necessary.

Explanation

Emptying the pouch before sexual activity is suggested to decrease the concern of pouch breakage or leakage. Self-gratification, if it involves emotional distancing, can be destructive to the client’s sexual relationship. Various positions should be explored during sexual activity with the goal of minimizing stress and pressure on the pouch. Participating in sex only in a darkened room may be a way of coping with body image concerns, but it is not necessary.

15. While caring for a surgical client during the first 24 hours after an abdominal–perineal resection, a nurse should give the highest priority to:

Providing a low-residue diet.

Monitoring the amount and color of stool in the colostomy bag.

Assessing perineal dressings and drainage.

Encouraging observation and acceptance of the colostomy site.

After an abdominal–perineal resection, the client will have two incisions— one in the abdomen and one in the perineal area. A colostomy stoma will also be present. The perineal incision must be examined frequently to assess for drainage and the need for dressing changes. After bowel surgery, a temporary ileus is expected; thus the client would be NPO (nothing per mouth) initially, and there would not be stool coming from the colostomy. The client’s physiological needs in the early postoperative period take precedence over the integration of the body image change into the client’s self-concept.

Explanation

After an abdominal–perineal resection, the client will have two incisions— one in the abdomen and one in the perineal area. A colostomy stoma will also be present. The perineal incision must be examined frequently to assess for drainage and the need for dressing changes. After bowel surgery, a temporary ileus is expected; thus the client would be NPO (nothing per mouth) initially, and there would not be stool coming from the colostomy. The client’s physiological needs in the early postoperative period take precedence over the integration of the body image change into the client’s self-concept.