TEST 5 CH 5 CARE OF THE PATIENT WITH A GI DISORDER

The nurse clarifies that the end product of carbohydrate metabolism is absorbed and put into the blood stream by the:

b. villi of the small intestine

A 56 -year-old man is admitted to the emergency room with an acute attack of diverticulitis. The patient has a temperature of 102° F, and has an elevated white count. Which assessment would alert the nurse to impending septic shock?

c. Tachycardia

Because bowel contents from an ileostomy are virtually liquid, what should the nurse include in the plan of care?

c. Evaluation and assessment of periostomal skin integrity

The home health nurse caring for a patient who has dysarthria related to radiation therapy for an oral cancer would recommend that the family provide:

a. a tablet and pencil as a communication aid

Which recommendation is most appropriate for a patient who has had an esophageal dilation related to achalasia?

c. Drink 10 oz of fluid with each meal

A patient who is being evaluated for episodes of hematemesis and dyspepsia tells the nurse that pain occurs when he eats, but pain does not waken him. The nurse recognizes a diagnostic sign of which condition?

d. Peptic ulcer

d. Peptic ulcer

The nurse anticipates that the patient who has had a subtotal gastrectomy will need supplemental:

b. vitamin b12 due to the loss of the intrinsic factor

The home health nurse is caring for a patient who has frequent bouts of diverticulitis accompanied by increased flatulence, diarrhea, and nausea. Which of the following is the most appropriate suggestion to lessen these symptoms?

a. Eat a diet high in fiber content

The nurse caring for a patient with a peptic ulcer who has had a nasogastric tube inserted notes bright blood in the tube; the patient complains of pain and has become hypotensive. Which condition should the nurse recognize these as signs of?

c. Perforation

Dumping syndrome after a Billroth II procedure occurs when high-carbohydrate foods are ingested over a period of less than 20 minutes. What would the nurse suggest to reduce the risk of dumping syndrome?

d. Eating six small daily meals high in protein and fat

d. Eating six small daily meals high in protein and fat

The patient has come to the PACU following an ileostomy for the treatment of ulcerative colitis. The patient is conscious and has a nasogastric tube in place and a pouch over the stoma. What should be the nurse's initial action?

c. Attach NG tube to suction

The home health nurse evaluates a patient being treated for a peptic ulcer with Riopan (antacid) and famotidine (histamine receptor blocker). Which statement made by the patient indicates a need for further instruction?

d. "I take both those meds at the same time every morning."

What should a nurse do when obtaining a stool specimen to be examined for ova and parasites?

c. Obtain three different stool specimens on subsequent days

The nurse explains to the patient with Crohn disease that the tube feedings allow for:

a. Rapid absorption in the upper GI tract

A patient with a large inguinal hernia has abdominal distention and inguinal pain. The nurse recognizes these as indicators of which type of hernia?

a. Strangulated

A patient with a ruptured diverticulum in the descending colon has undergone a transverse loop colostomy. The patient is upset and says, "I didn't know it was going to be this awful. I hate this!" Which response made by the nurse would be most helpful?

a. "This is a temporary solution. It will be closed in 6 weeks."

A male patient complains that he will never adjust to his colostomy. Which is the best action for the nurse in this situation?

a. Encourage him to express his concern

In caring for a patient with gastric bleeding who has a nasogastric tube in place, the nurse should include in the plan of care to ensure that the NG tube is:

b. Kept patent with irrigation

What should the nurse include in a teaching plan for a patient with a hiatal hernia to reduce the frequency of heartburn?

d. Eating small meals

The nurse points out which of the following as an example of a nonmechanical bowel obstruction?

a. A paralytic ileus

Bowel sound assessment on a patient with an obstruction who has distention, nausea, and visible peristaltic waves would be:

b. high pitched

The patient with a peptic ulcer has been placed on regular doses of bismuth salicylate (Pepto-Bismol) to combat H. pylori. What color will this drug turn the stool?

a. Gray-black

Which of the following should be included in the patient teaching of a patient with a peptic ulcer?

c. Eating 6 small meals a day

Which of the following would be the most helpful nursing intervention to increase the comfort of a patient with appendicitis?

a. Application of ice bag

To assist a family with a bowel training program to reduce fecal incontinence, the nurse would suggest the use of a ___________ at an optimal time to stimulate defecation.

c. Glycerin suppository

What is the most lethal complication of a peptic ulcer?

b. Perforation

The nurse takes into consideration that a proton pump inhibitor drug, such as ______________, will completely eradicate gastric acid production.

a. omeprazole (Prilosec)

Which of the following is the purpose of antibiotic therapy in treating peptic ulcers?

a. It eradicated H. pylori

Why are peptic ulcers a common problem of aging?

c. because of overuse of NSAIDS

The patient with irritable bowel syndrome tells the home health nurse she is going to an acupuncturist for therapy for her condition. Which of the following would be the best nursing response ?

c. "It may help, but there has been no clinical proof of its effectiveness."

Which of the following are indicators of colorectal cancer? (Select all that apply.)

b. Excessive flatulence

c. Cachexia

d. Cramps

e. Rectal bleeding

f. Anemia

How should the nurse counsel the 34-year-old woman who has been prescribed sulfasalazine (Azulfidine) for Crohn disease? (Select all that apply.)

b. Tell her to drink at least 1500 mL of fluid a day

c. Advise assessing self for rash

d. Use alternate birth control methods to oral contraception

In designing a teaching plan to present to a group of older adults regarding the prevention of esophageal cancer, the nurse would include information about the significance of (select all that apply):

a. cessation of smoking.

b. good oral care.

c. regular checkups if dysphagia is present.

e. limiting alcohol consumption.

Which activities should the home health nurse suggest to an elderly patient to avoid constipation? (Select all that apply.)

a. Increasing physical activity

b. Taking bulk-forming laxatives

c. Increasing fiber intake

d. Drinking at least 1000 mL fluid

The home health nurse is caring for a patient who has frequent abdominal pain and diarrhea. The nurse uses the Rome Criteria to direct assessment for irritable bowel syndrome. What is included in the Rome Criteria? (Select all that apply.)

a. Discomfort at least 3 days a month

c. Pain relieved by defecation

f. Onset associated with change in stool consistency or frequency

Flexible sigmoidoscopy should be performed every ________ years.

5

The nurse explains that ___________, the chief enzyme of gastric juice, is activated by hydrochloric acid to begin digestion of protein.

pepsin

The nurse caring for a patient with Crohn disease will closely monitor the urinary output to ensure that the patient is excreting at least _______mL/day.

1500

The nurse takes into consideration that long-term use of antibiotics can cause an antibiotic-associated pseudomembranous colitis from the organism________.

C. difficile

Due to frequent bouts of constipation, the nurse examines the bedfast nursing home resident for ulceration of the anus, called __________________.

anal fissure

The nurse uses a poster to show the process of bowel obstruction from diverticulitis. Arrange the pathophysiologic event in order. (Separate letters by a comma and space as follows: A, B, C, D)

a. Increase in intra-abdominal pressure

b. Weakened wall of sigmoid

c. Pouch fills with fecal matter

d. Pouch protrudes through smooth muscle

e. Narrowing of bowel lumen

f. Inflammation of diverticula

b, a, d, c, f, e,

Celiac sprue in the adult can lead to systemic problems. Arrange the pathophysical events of this in order of their appearance. (Separate letters by a comma and space as follows: A, B, C, D)

a. Malabsorption

b. Weight loss/vitamin deficiency

c. Systemic involvement

d. Diarrhea

e. Ingestion of gluten

f. Destruction of villi in the small intestine

e, f, a, d, b, c