MSN Gastrointestinal Quiz 1

1. A nurse is assigned to four clients who have been diagnosed with gastric ulcers. Which one of these clients should the nurse conclude is most at risk to develop gastrointestinal (GI) bleeding?

A 40-year-old client who is positive for Helicobacter pylori (H. pylori)

A 45-year-old client who drinks 4 ounces of alcohol a day

A 70-year-old client who takes aspirin (Ecotrin®) 81 mg daily to prevent coronary artery disease

A 30-year-old pregnant client who uses acetaminophen (Tylenol®) as needed for headaches

Aging is the most critical risk factor for GI bleeding. Aspirin use is one of the most common predisposing factors. The presence of H. pylori has not been proven to predispose to GI bleeding, and although alcohol is associated with gastric mucosal injury, its causative role in bleeding is unclear. Pregnancy and acetaminophen usage do not predispose to GI bleeding.

Explanation

Aging is the most critical risk factor for GI bleeding. Aspirin use is one of the most common predisposing factors. The presence of H. pylori has not been proven to predispose to GI bleeding, and although alcohol is associated with gastric mucosal injury, its causative role in bleeding is unclear. Pregnancy and acetaminophen usage do not predispose to GI bleeding.

2. A nurse is assessing a client who is 24 hours post gastrointestinal (GI) hemorrhage. The assessment findings include blood urea nitrogen (BUN) of 40 mg/dL and serum creatinine of 0.8 mg/dL. After reviewing the assessment findings, the nurse should:

Immediately call the physician to report these results.

Monitor urine output as this may be a sign of kidney failure.

Document the findings and continue monitoring the client.

Encourage the client to limit his dietary protein intake.

The BUN can be elevated after a significant GI hemorrhage related to the breakdown of blood proteins, which release nitrogen that is then converted to urea. No treatment is required. If acute kidney failure is present, both the BUN and creatinine would be elevated. Limiting protein intake in the presence of healthy kidneys is unnecessary.

Explanation

The BUN can be elevated after a significant GI hemorrhage related to the breakdown of blood proteins, which release nitrogen that is then converted to urea. No treatment is required. If acute kidney failure is present, both the BUN and creatinine would be elevated. Limiting protein intake in the presence of healthy kidneys is unnecessary.

3. During a hospital admission history, a nurse suspects gastrointestinal reflux disease (GERD) when the client says:

“I have been experiencing headaches immediately after eating.”

“I have been waking up at night lately with a burning feeling in my chest.”

“I have been waking up at night sweating.”

“Immediately after eating I feel sleepy.”

Heartburn, which is described as a burning, tight sensation in the lower sternum, is the most common symptom of GERD. If will often wake a client from sleep. Headaches, night sweats, and postprandial sleepiness are symptoms not related to GERD.

Explanation

Heartburn, which is described as a burning, tight sensation in the lower sternum, is the most common symptom of GERD. If will often wake a client from sleep. Headaches, night sweats, and postprandial sleepiness are symptoms not related to GERD.

4. An experienced nurse explains to a new nurse that the definitive diagnosis of peptic ulcer disease (PUD) involves:

A urea breath test.

Upper gastrointestinal endoscopy with biopsy.

Barium contrast studies.

The string test.

The gastric mucosa can be visualized with an endoscope. A biopsy is possible to differentiate PUD from gastric cancer and to obtain tissue specimens to identify Helicobacter pylori. A urea breath test and a string test only test for the presence of H. pylori. Barium studies do not provide an opportunity for biopsy and H. pylori testing.

Explanation

The gastric mucosa can be visualized with an endoscope. A biopsy is possible to differentiate PUD from gastric cancer and to obtain tissue specimens to identify Helicobacter pylori. A urea breath test and a string test only test for the presence of H. pylori. Barium studies do not provide an opportunity for biopsy and H. pylori testing.

5. To assist a client to manage and decrease the sensation of nausea, which nonpharmacological intervention should a nurse recommend?

Drinking tea made from ginger root

Changing positions quickly when moving

Decreasing food intake

Playing loud rock music

Ginger has demonstrated antiemetic properties, and it also has analgesic and sedative effects on gastrointestinal motility. Avoidance of sudden changes in position and decreasing activity are recommended to control nausea. All food should be stopped when nausea is present to prevent stomach stretching and stimulation of the afferent nerve fibers. A quiet, calm environment is recommended to decrease nausea.

Explanation

Ginger has demonstrated antiemetic properties, and it also has analgesic and sedative effects on gastrointestinal motility. Avoidance of sudden changes in position and decreasing activity are recommended to control nausea. All food should be stopped when nausea is present to prevent stomach stretching and stimulation of the afferent nerve fibers. A quiet, calm environment is recommended to decrease nausea.

6. A nurse, writing a nursing diagnosis in the care plan for a female client after bariatric surgery, should write, "Risk for nausea related to:

Overfilling of the stomach pouch.”

The stomach pouch.”

The lower half of the stomach becoming spastic.”

Handling of the duodenum with resulting inflammatory response.”

Bariatric surgery results in the construction of a small pouch (10–30 mL) in the upper part of the stomach. Overfilling of this pouch stimulates afferent nerve fibers, which relay information to the chemoreceptor trigger zone in the brain. Bariatric surgery is performed on both men and women. The function of the lower half of the stomach is not affected by this surgery, and the duodenum is not handled during this surgery.

Explanation

Bariatric surgery results in the construction of a small pouch (10–30 mL) in the upper part of the stomach. Overfilling of this pouch stimulates afferent nerve fibers, which relay information to the chemoreceptor trigger zone in the brain. Bariatric surgery is performed on both men and women. The function of the lower half of the stomach is not affected by this surgery, and the duodenum is not handled during this surgery.

7. A nurse is discharging a client after Billroth II surgery (gastrojejunostomy). To assist the client to control dumping syndrome, the client's discharge instructions should include:

Drinking fluids with meals.

Eating a high-carbohydrate, low-protein diet.

Waiting at least 5 hours between meals.

Lying down for 20 to 30 minutes after meals.

Lying down after meals slows the passage of the food bolus into the intestine. To control dumping syndrome, the meal size must be reduced. Drinking fluids at meal time increases the size of the food bolus that enters the stomach. Carbohydrates are more rapidly digested than fats and proteins and would cause the food bolus to pass quickly into the intestine, increasing the likelihood that dumping syndrome would occur. Meals high in carbohydrates result in postprandial hypoglycemia, which is considered a variant of

dumping syndrome. Small frequent meals are recommended to decrease dumping syndrome.

Explanation

Lying down after meals slows the passage of the food bolus into the intestine. To control dumping syndrome, the meal size must be reduced. Drinking fluids at meal time increases the size of the food bolus that enters the stomach. Carbohydrates are more rapidly digested than fats and proteins and would cause the food bolus to pass quickly into the intestine, increasing the likelihood that dumping syndrome would occur. Meals high in carbohydrates result in postprandial hypoglycemia, which is considered a variant of

dumping syndrome. Small frequent meals are recommended to decrease dumping syndrome.

8. A nurse is performing an initial postoperative assessment on a client following upper gastrointestinal surgery. The client has a nasogastric tube to low, intermittent suction. To best assess the client for the presence of bowel sounds, the nurse should:

Place the stethoscope to the left of the umbilicus.

Turn off the nasogastric suction.

Use the bell of the stethoscope.

Turn the suction on the nasogastric tube to continuous.

When listening for bowel sounds on a client who has a nasogastric tube to suction, the nurse should turn off the suction during auscultation to prevent mistaking the suction sound for bowel sounds. The diaphragm of the stethoscope should be utilized for bowel sounds and the bell for abdominal vascular sounds, such as bruits. When the client has hypoactive bowel sounds, which would be expected in a postsurgical client, the nurse should begin listening over the ileocecal valve in the right lower abdominal quadrant, as this normally is a very active area.

Explanation

When listening for bowel sounds on a client who has a nasogastric tube to suction, the nurse should turn off the suction during auscultation to prevent mistaking the suction sound for bowel sounds. The diaphragm of the stethoscope should be utilized for bowel sounds and the bell for abdominal vascular sounds, such as bruits. When the client has hypoactive bowel sounds, which would be expected in a postsurgical client, the nurse should begin listening over the ileocecal valve in the right lower abdominal quadrant, as this normally is a very active area.

9. A client returns to a surgical unit following a radical neck dissection for oral cancer. The nursing plan of care for this client should include:

Positioning the client in a supine position.

Monitoring the wound drainage tubes around the neck incision for amount and color of drainage andpatency.

Maintaining bed rest for 48 hours post surgery.

Offering ice chips orally 2 hours post surgery.

Wound suction, using portable surgical drains, should be placed around the surgical site to remove tissue fluid and, therefore, prevent edema, which could compress the airway. Positioning the client flat in bed would increase edema formation around the surgical site. The client can breathe best in a semi-Fowler’s position. The client should be up in a chair on the first postoperative day (POD) and should begin to ambulate on the second POD. Edema at the surgical site prohibits oral intake. The client will return from surgery with a nasogastric tube in place, which should be used for feeding initially.

Explanation

Wound suction, using portable surgical drains, should be placed around the surgical site to remove tissue fluid and, therefore, prevent edema, which could compress the airway. Positioning the client flat in bed would increase edema formation around the surgical site. The client can breathe best in a semi-Fowler’s position. The client should be up in a chair on the first postoperative day (POD) and should begin to ambulate on the second POD. Edema at the surgical site prohibits oral intake. The client will return from surgery with a nasogastric tube in place, which should be used for feeding initially.

10. A nurse is reviewing the health history of a client admitted to a hospital with a diagnosis of nonalcoholic fatty liver disease (NAFLD). When conducting the client's health history, which finding is consistent with this disease process?

70 years old

Obese

History of recent antibiotic use

Living in colder climates

The risk for developing NAFLD is directly related to body weight and is a major complication of obesity. Adults in their forties are most at risk for NAFLD. Antibiotic use and climate have no influence on disease

development.

Explanation

The risk for developing NAFLD is directly related to body weight and is a major complication of obesity. Adults in their forties are most at risk for NAFLD. Antibiotic use and climate have no influence on disease

development.

11. The serum ammonia level of a client with cirrhosis is elevated. As a priority, a nurse should plan to:

Monitor the client’s temperature every 4 hours.

Observe for increasing confusion.

Measure the urine specific gravity.

Restrict the client’s oral fluid intake.

Elevated serum ammonia levels may cause neurological changes, such as confusion. The client’s temperature or urine specific gravity will not be affected. Oral fluid intake should be encouraged if tolerated by the client.

Explanation

Elevated serum ammonia levels may cause neurological changes, such as confusion. The client’s temperature or urine specific gravity will not be affected. Oral fluid intake should be encouraged if tolerated by the client.

12. A client is hospitalized for conservative treatment of cirrhosis. As part of the collaborative plan of care, a nurse would anticipate:

Monitoring the client’s blood sugar.

Maintaining NPO (nothing by mouth) status.

Administering antibiotics.

Encouraging frequent ambulation.

Clients with cirrhosis may develop insulin resistance. Impaired glucose tolerance is common, and about 20% to 40% of clients with cirrhosis also have diabetes. For some clients with cirrhosis, however, hypoglycemia

may occur during fasting because of decreased hepatic glycogen reserves and decreased gluconeogenesis. Clients with cirrhosis should receive a high-protein diet unless hepatic encephalopathy is present. Antibiotics are not part of the treatment plan of cirrhosis because it is not caused by microorganisms. The client with cirrhosis requires rest, thus activity should not be encouraged.

Explanation

Clients with cirrhosis may develop insulin resistance. Impaired glucose tolerance is common, and about 20% to 40% of clients with cirrhosis also have diabetes. For some clients with cirrhosis, however, hypoglycemia

may occur during fasting because of decreased hepatic glycogen reserves and decreased gluconeogenesis. Clients with cirrhosis should receive a high-protein diet unless hepatic encephalopathy is present. Antibiotics are not part of the treatment plan of cirrhosis because it is not caused by microorganisms. The client with cirrhosis requires rest, thus activity should not be encouraged.

13. While caring for a male client with cirrhosis, a nurse adds the nursing diagnosis Disturbed body image related to physical manifestations of illness when the client is overheard telling his brother:

“I don’t think I can handle this disease.”

“I know the doctors say I have liver failure, but I don’t really believe them.”

“I know I should rest more, but I’m just not that type of person.”

“I don’t like the fact that I seem to have breasts now.”

One of the defining characteristics of the diagnosis disturbed body image is verbalization of feelings that reflect an altered view of one’s body. Option 1 is an example of the client evaluating himself as unable to

deal with the situation and would support the diagnosis situational low self-esteem. Option 2 is an example of the client denying the problem and would support the diagnosis defensive coping. Option 3 is an example of the client failing to take actions that would prevent further health problems and would support the diagnosis impaired adjustment.

Explanation

One of the defining characteristics of the diagnosis disturbed body image is verbalization of feelings that reflect an altered view of one’s body. Option 1 is an example of the client evaluating himself as unable to

deal with the situation and would support the diagnosis situational low self-esteem. Option 2 is an example of the client denying the problem and would support the diagnosis defensive coping. Option 3 is an example of the client failing to take actions that would prevent further health problems and would support the diagnosis impaired adjustment.

14. A registered nurse (RN) is caring for a client following a liver biopsy with the assistance of a student nurse. The RN evaluates that the student understands the post procedure care when the student nurse:

Plans to monitor vital signs every hour.

Promotes ambulation 1 hour after the procedure.

Positions the client on the right side.

Encourages the client to cough and deep breathe immediately following the procedure.

Positioning the client on the right side after a liver biopsy splints the puncture site to prevent and decrease bleeding. Vital signs should be assessed every 15 minutes times two, every 30 minutes times four, and then

every hour times four after a liver biopsy to monitor for shock, peritonitis, and pneumothorax. The client should be kept flat in bed for 12 to 14 hours following the procedure to prevent the risk of bleeding. The client should be cautioned to avoid coughing, which could precipitate bleeding.

Explanation

Positioning the client on the right side after a liver biopsy splints the puncture site to prevent and decrease bleeding. Vital signs should be assessed every 15 minutes times two, every 30 minutes times four, and then

every hour times four after a liver biopsy to monitor for shock, peritonitis, and pneumothorax. The client should be kept flat in bed for 12 to 14 hours following the procedure to prevent the risk of bleeding. The client should be cautioned to avoid coughing, which could precipitate bleeding.

15. During a hospital admission history, a nurse suspects acute pancreatitis when a 40-year-old client reports:

The sudden onset of intense pain in the upper left abdominal quadrant that radiates to the back.

Persistent abdominal pain in the lower abdomen that has shifted to the lower right quadrant.

Bloody diarrhea and colicky abdominal pain.

Mild upper abdominal pain and projectile vomiting.

The predominant symptom of acute pancreatitis is severe, deep or piercing, continuous or steady abdominal pain in the upper left quadrant. The pain may radiate to the back because of the retroperitoneal location of the pancreas. Middle-age individuals are at increased risk for developing acute pancreatitis. Abdominal pain, located mainly in the right lower quadrant, is a symptom of appendicitis, which is more common in younger adults. Bloody diarrhea and colicky abdominal pain are symptoms of inflammatory bowel disease, also more common in young adults. Upper abdominal pain and projectile vomiting are symptoms of gastric

outlet obstruction.

Explanation

The predominant symptom of acute pancreatitis is severe, deep or piercing, continuous or steady abdominal pain in the upper left quadrant. The pain may radiate to the back because of the retroperitoneal location of the pancreas. Middle-age individuals are at increased risk for developing acute pancreatitis. Abdominal pain, located mainly in the right lower quadrant, is a symptom of appendicitis, which is more common in younger adults. Bloody diarrhea and colicky abdominal pain are symptoms of inflammatory bowel disease, also more common in young adults. Upper abdominal pain and projectile vomiting are symptoms of gastric

outlet obstruction.