Digestive & Gastrointestinal System Disorders | NCLEX Quiz 59

1. After abdominal surgery. your patient has a severe coughing episode that causes wound evisceration. In addition to calling the doctor. which intervention is most appropriate?

Irrigate the wound & organs with Betadine.

Cover the wound with a saline soaked sterile dressing.

Apply a dry sterile dressing & binder.

Push the organs back & cover with moist sterile dressings.

Cover the organs with a sterile. nonadherent dressing moistened with normal saline. Do this to prevent infection and to keep the organs from drying out.

Explanation

Cover the organs with a sterile. nonadherent dressing moistened with normal saline. Do this to prevent infection and to keep the organs from drying out.

2. You're caring for Lewis. a 67 y.o. patient with liver cirrhosis who developed ascites and requires paracentesis. Relief of which symptom indicated that the paracentesis was effective?

Pruritus

Dyspnea

Jaundice

Peripheral Neuropathy

Ascites puts pressure on the diaphragm. Paracentesis is done to remove fluid and reducing pressure on the diaphragm. The goal is to improve the patient’s breathing. The others are signs of cirrhosis that aren’t relieved by paracentesis.

Explanation

Ascites puts pressure on the diaphragm. Paracentesis is done to remove fluid and reducing pressure on the diaphragm. The goal is to improve the patient’s breathing. The others are signs of cirrhosis that aren’t relieved by paracentesis.

3. You're caring for Jane. a 57 y.o. patient with liver cirrhosis who developed ascites and requires paracentesis. Before her paracentesis. you instruct her to:

Empty her bladder.

Lie supine in bed.

Remain NPO for 4 hours.

Clean her bowels with an enema.

A full bladder can interfere with paracentesis and be punctured inadvertently.

Explanation

A full bladder can interfere with paracentesis and be punctured inadvertently.

4. Britney. a 20 y.o. student is admitted with acute pancreatitis. Which laboratory findings do you expect to be abnormal for this patient?

Serum creatinine and BUN

Alanine aminotransferase (ALT) and aspartate aminotransferase (AST)

Serum amylase and lipase

Cardiac enzymes

Pancreatitis involves activation of pancreatic enzymes. such as amylase and lipase. These levels are elevated in a patient with acute pancreatitis.

Explanation

Pancreatitis involves activation of pancreatic enzymes. such as amylase and lipase. These levels are elevated in a patient with acute pancreatitis.

5. You're caring for Beth who underwent a Billroth II procedure (surgical removal of the pylorus and duodenum) for treatment of a peptic ulcer. Which findings suggest that the patient is developing dumping syndrome. a complication associated with this procedure?

Flushed. dry skin.

Headache and bradycardia.

Dizziness and sweating.

Dyspnea and chest pain.

After a Billroth II procedure. a large amount of hypertonic fluid enters the intestine. This causes extracellular fluid to move rapidly into the bowel. reducing circulating blood volume and producing vasomotor symptoms. Vasomotor symptoms produced by dumping syndrome include dizziness and sweating. tachycardia. syncope. pallor. and palpitations.

Explanation

After a Billroth II procedure. a large amount of hypertonic fluid enters the intestine. This causes extracellular fluid to move rapidly into the bowel. reducing circulating blood volume and producing vasomotor symptoms. Vasomotor symptoms produced by dumping syndrome include dizziness and sweating. tachycardia. syncope. pallor. and palpitations.

6. The student nurse is preparing a teaching care plan to help improve nutrition in a patient with achalasia. You include which of the following:

Swallow foods while leaning forward.

Omit fluids at mealtimes.

Eat meals sitting upright.

Avoid soft and semi soft foods.

Eating in the upright position aids in emptying the esophagus. Doing the opposite of the other three also may be helpful.

Explanation

Eating in the upright position aids in emptying the esophagus. Doing the opposite of the other three also may be helpful.

7. You're developing the plan of care for a patient experiencing dumping syndrome after a Billroth II procedure. Which dietary instructions do you include?

Omit fluids with meals.

Increase carbohydrate intake.

Decrease protein intake.

Decrease fat intake.

Gastric emptying time can be delayed by omitting fluids from your patient’s meal. A diet low in carbs and high in fat & protein is recommended to treat dumping syndrome.

Explanation

Gastric emptying time can be delayed by omitting fluids from your patient’s meal. A diet low in carbs and high in fat & protein is recommended to treat dumping syndrome.

8. You're caring for Betty with liver cirrhosis. Which of the following assessment findings leads you to suspect hepatic encephalopathy in her?

Asterixis

Chvostek’s sign

Trousseau’s sign

Hepatojugular reflex

Asterixis is an early neurologic sign of hepatic encephalopathy elicited by asking the patient to hold her arms stretched out. Asterixis is present if the hands rapidly extend and flex.

Explanation

Asterixis is an early neurologic sign of hepatic encephalopathy elicited by asking the patient to hold her arms stretched out. Asterixis is present if the hands rapidly extend and flex.

9. You are developing a care plan on Sally. a 67 y.o. patient with hepatic encephalopathy. Which of the following do you include?

Administering a lactulose enema as ordered.

Encouraging a protein-rich diet.

Administering sedatives. as necessary.

Encouraging ambulation at least four times a day.

You may administer the laxative lactulose to reduce ammonia levels in the colon.

Explanation

You may administer the laxative lactulose to reduce ammonia levels in the colon.

10. You have a patient with achalasia (incomplete muscle relaxtion of the GI tract. especially sphincter muscles). Which medications do you anticipate to administer?

Isosorbide dinitrate (Isordil)

Digoxin (Lanoxin)

Captopril (Capoten)

Propranolol (Inderal)

Achalasia is characterized by incomplete relaxation of the LES. dilation of the lower esophagus. and a lack of esophageal peristalsis. Because nitrates relax the lower esophageal sphincter. expect to give Isordil orally or sublingually.

Explanation

Achalasia is characterized by incomplete relaxation of the LES. dilation of the lower esophagus. and a lack of esophageal peristalsis. Because nitrates relax the lower esophageal sphincter. expect to give Isordil orally or sublingually.