Care of a Patient with Gastrointestinal Problems

Question 1

Which disease is the patient with GERD at greater risk for developing?

a. Gastric Cancer
b. Gastroenteritis
c. Esophageal Cancer
d. Hiatal Hernia

Answer 1

c. Esophageal cancer

- From GI SIM lab post-quiz (10 questions)

Question 2

The nurse is administering morning medications to the patient diagnosed with gastroesophageal reflux disease (GERD). Which medication should have priority?

a. Histamine receptor antagonist
b. Non-narcotic analgesic
c. Proton pump inhibitor
d. Mucosal barrier agent

Answer 2

d. Mucosal barrier agent

Question 3

The patient had a gastroduodenostomy (Billroth I operation) and reports generalized weakness, sweating, palpitations, and dizziness 15 to 30 minutes after eating. What long-term complication is occurring?

a. Dumping syndrome
b. Bile reflux gastritis
c. Postprandial hypoglycemia
d. Malnutrition

Answer 3

a. Dumping syndrome

Question 4

A patient who underwent an abdominal-perineal resection for colorectal cancer has a Jackson Pratt (JP) drainage tube. Which assessment data warrants immediate intervention by the nurse?

a. The bulb is round and has 40 ml of fluid
b. The drainage tube is taped to the dressing
c. The JP bulb has suction and is sunken in
d. The JP insertion site is pink and has no drainage

Answer 4

a. The bulb is round and has 40 ml of fluid

The JP bulb should be depressed, which indicates suction is being applied. A round bulb indicates the bulb is full and needs to be emptied and suction reapplied.
[b, c, d are expected findings]
The tube should be taped to the dressing to prevent accidentally pulling the drain out of the insertion site.
The bulb should be sunken in or depressed, indicating suction is being applied)
The insertion site should be pink and without any sign of infection, which include drainage, warmth, and redness.

Question 5

The patient who had an abdominal-perineal resection is being discharged. Which discharge information should the nurse teach?

a. Call the provider if any blood is noted on the stoma
b. Empty the pouch when it is one-third to one-half full
c. Sit upright in a chair for at least three times daily
d. Limit ambulation to prevent pouch displacement

Answer 5

b. Empty the pouch when it is one-third to one-half full

The pouch should be emptied when it is one third to one half full to prevent the contents from becoming too heavy for the seal to hold and to prevent leakage from occurring.

Question 6

The nurse is planning the care of a patient who has had an abdominal-perineal resection for colorectal cancer. Which interventions should the nurse implement? Select all that apply.

1. Irrigate the JP drains every shift
2. Maintain the indwelling catheter
3. Provide meticulous skin care to the stoma
4. Assess the flank incision
5. Place the patient in Semi-Fowler’s position

Answer 6

2, 3, 5

Colostomy stomas are opening through the abdominal wall into the colon, through which feces exit the body. Feces can be irritating to the abdominal skin, so careful and thorough skin care is needed. There are midline and perineal incisions not flank incisions. Because of the perineal wound, the client will have an indwelling catheter to keep urine out of the incision. JP drains are emptied every shift, but not irrigated. The client should not sit upright because this causes pressure on the perineum.

Question 7

Which sign/symptom should the nurse expect to find in a patient diagnosed with ulcerative colitis?

a. Hard, rigid abdomen
b. Urinary incontinence
c. Oral temperature of 102
d. Twenty bloody stools a day

Answer 7

d. Twenty bloody stools a day

The colon is ulcerated and unable to absorb water, resulting in bloody diarrhea. 10 to 20 bloody diarrhea stools is the most common symptom of ulcerative colitis.

Question 8

Which statement by the patient with ulcerative colitis who has a new ileostomy indicates further teaching is needed?

a. “I will irrigate my ileostomy every morning”
b. “I will call my provider if i get a red, itchy rash”
c. “My stoma should be pink and moist”
d. “I will change my pouch if it starts to leak”

Answer 8

a. “I will irrigate my ileostomy every morning”

An ileostomy will drain liquid all the time and shouldn’t routinely be irrigated. a sigmoid colostomy may need daily irrigation to evacuate feces.

Question 9

The nurse is assuming care for an ulcerative colitis patient with a new ileostomy. Which abdominal quadrant should the nurse expect the stoma to be in?

a. RUQ
b. RLQ
c. LUQ
d. LLQ

Answer 9

b. RLQ

Question 10

Which intervention should the nurse implement for the patient diagnosed with an acute exacerbation of Crohn’s disease?

a. Provide a low-residue diet
b. Administer antacids orally
c. Assess vital signs daily
d. Rest the patient’s bowels

Answer 10

d. Rest the patient’s bowels

Whenever a client has an acute exacerbation of a gastrointestinal d/o, the first intervention is to place the bowel on rest. The client should be NPO with IV fluids to prevent dehydration.
The client should be NPO.
The vital signs must be taken more often than daily in a client who is having an acute exacerbation of ulcerative colitis.
The client will receive anti inflammatory and antidiarrheal meds, not antacids, which are used for gastroenteritis

Question 11

The nurse is aware that the primary symptoms of a sliding hiatal hernia are associated with reflux and should assess the patient for which symptoms?

a. Jaundice, ascites, and edema
b. Heartburn, regurgitation, and dysphagia
c. Abdominal cramps, diarrhea, and anorexia
d. Pelvic pain, fever, and board-like abdominal rigidity

Answer 11

b. Heartburn, regurgitation, and dysphagia

The most common symptom of a hiatal hernia is heartburn, also known as pyrosis. It results from reflux of gastric secretions into the esophagus. Regurgitation of gastric contents and dysphagia are other common symptoms. Jaundice, ascites, and edema are associated with liver disorders. Abdominal cramps, diarrhea, and anorexia are associated with gastroenteritis. Low abdominal pain, fever, and board-like abdominal rigidity are symptoms of appendicitis, ruptured ovarian cyst, and peritonitis (p. 904-905).

From EAQ - Upper GI (Q. 11-30)

Question 12

The nurse provides education to a group of student nurses about preoperative preparations for bowel surgery. Which statement made by a student nurse indicates the need for further teaching?

a. “Administer enemas to cleanse the bowel.”
b. “Correct malnourishment in the patient prior to surgery.”
c. “Administer antibiotics to reduce the intestinal bacteria.”
d. “Transfuse packed red blood cells to correct anemia.”

Answer 12

d. “Tranfuse packed red blood cells (RBC) to correct anemia.”

Transfusion of packed red blood cells (RBCs) to correct anemia is the preoperative preparation for stomach cancer, not bowel surgery. Administration of enemas for cleansing the bowel, correcting the malnourishment in the patient prior surgery, and administering antibiotics to reduce the intestinal bacteria are preoperative preparations for bowel surgery (p. 924-925).

Question 13

The results of a patient’s recent endoscopy indicate the presence of peptic ulcer disease (PUD). Which teaching point should the nurse provide to the patient based on this new diagnosis?

a. “You’ll need to drink at least two to three glasses of milk daily.”
b. “It would likely be beneficial for you to eliminate drinking alcohol.”
c. “Many people find that a minced or pureed diet eases their symptoms of PUD.”
d. “Your medications should allow you to maintain your present diet while minimizing symptoms.”

Answer 13

b. “It would likely be beneficial for you to eliminate drinking alcohol.”

Alcohol increases the amount of stomach acid produced, so it should be avoided. Milk may exacerbate PUD, so two to three glasses would not be recommended. There is no reason to puree or mince food, and a current diet is likely to be altered to minimize symptoms (p. 912).

Question 14

Linked to stomach cancer and non-Hodgkin’s lymphoma, what is a common cause of gastritis?

a. Syphilis
b. Cytomegalovirus
c. Heliobacter pylori
d. Myobacterium species

Answer 14

c. Heliobacter pylori

H. pylori infection is highest in underdeveloped countries and in people of low socioeconomic status. Infection likely occurs during childhood with transmission from family members to the child, possibly through a fecal-oral or oral-oral route. Syphilis, cytomegalovirus, and Mycobacterium species also are causes of chronic gastritis, but they are not as common as H. pylori (p. 909).

Question 15

What surgical procedure involves the removal of two-thirds of the stomach and anastomosis of the gastric stump to the duodenum?

a. Vagotomy
b. Pyloroplasty
c. Billroth I operation
d. Billroth II operation

Answer 15

c. Billroth I operation

A Billroth I operation, also known as a gastroduodenostomy, is a partial gastrectomy in which the distal two thirds of the stomach is removed and there is an anastomosis of the gastric stump to the duodenum. A vagotomy is the severing of the vagus nerve totally or selectively. A pyloroplasty is the surgical enlargement of the pyloric sphincter in order to facilitate easy passage of contents from the stomach. A Billroth II operation is called a gastrojejunostomy; it is the removal of the distal two thirds of the stomach and anastomosis of the gastric stump to the jejunum (p. 917).

Question 16

Which medication increases lower esophageal sphincter pressure?

a. Diazepam
b. Bethanechol
c. Theophylline
d. Morphine sulfate

Answer 16

b. Bethanechol

Bethanechol increases the pressure in the lower esophagus. Diazepam, theophylline, and morphine sulfate are medications that decrease lower esophageal pressure (p. 902).

Question 17

Which medication has a side effect of milk-alkali syndrome?

a. Misoprostol
b. Metoclopramide
c. Calcium carbonate
d. Aluminum hydroxide

Answer 17

c. Calcium carbonate

Calcium carbonate is an antacid used to treat gastroesophageal reflux disease (GERD). Ingestion of calcium carbonate may result in milk-alkali syndrome. Misoprostol causes abdominal pain, diarrhea, and gastrointestinal bleeding. Central nervous system side effects such as anxiety, hallucinations, and tremors are caused by metoclopramide. Aluminum hydroxide causes constipation (p. 903).

Question 18

A patient with a history of peptic ulcer disease has presented to the emergency department reporting severe abdominal pain and has a rigid, board-like abdomen that prompts the health care team to suspect a perforated ulcer. What intervention should the nurse anticipate?

a. Providing intravenous (IV) fluids and inserting a nasogastric (NG) tube
b. Administering oral bicarbonate and testing the patient’s gastric pH level
c. Performing a fecal occult blood test and administering IV calcium gluconate
d. Starting parenteral nutrition and placing the patient in a high Fowler’s position

Answer 18

a. Providing intravenous (IV) fluids and inserting a nasogastric (NG) tube

A perforated peptic ulcer requires IV replacement of fluid losses and continued gastric aspiration by NG tube. Oral bicarbonate would not be given because the client would be nothing by mouth, and gastric pH testing is not a priority. Calcium gluconate is not a medication directly relevant to the patient’s suspected diagnosis, and parenteral nutrition is not a priority in the short term (p. 912, 915).

Question 19

A patient has a prescription to receive famotidine (Pepcid) 30 mg intravenous piggyback (IVPB) or intravenous push (IVP) q12hr. Available is a vial containing 10 mg/mL. How many milliliters should the nurse draw up to administer this dose?

a. 0.2 mL
b. 0.75 mL
c. 3 mL
d. 5 mL

Answer 19

c. 3 mL

Multiply 10 by x and multiply 30 × 1 to yield 10x = 30. Divide 30 by 10 to yield 3 mL.

Question 20

The patient history indicates the patient was taking ondansetron at home before admission. The nurse inquires as to the effectiveness of this medication in treating which symptom?

a. Pain
b. Nausea
c. Headache
d. Leg cramps

Answer 20

b. Nausea

Ondansetron is an antiemetic. The nurse would inquire as to its effectiveness in reducing the patient’s nausea. Ondansetron will not treat headaches, pain, or leg cramps (p. 895).

Question 21

A patient requires a dose of promethazine for nausea. The prescription states to give 25 mg intravenous (IV) push q8hr as needed. On hand is a vial labeled “100 mg/mL.” How many milliliters should the nurse administer?

a. 0.15 mL
b. 0.25 mL
c. 0.5 mL
d. 1 mL

Answer 21

b. 0.25 mL

Using ratio and proportion, multiply 100 by x and multiply 25 × 1 to yield 100x = 25. Divide 25 by 100 to yield 0.25 mL.

Question 22

A patient presents with suspected gastric carcinoma. The nurse anticipates that which diagnostic test will be prescribed?

a. Radiology
b. Tissue biopsy
c. Rapid urease testing
d. Endoscopic ultrasound

Answer 22

b. Tissue biopsy

A tissue biopsy involves examining tissue removed from the stomach to detect gastric carcinoma. Radiology is not the best method because superficial mucosa is generally involved and changes will not show up clearly on x-ray examination. Rapid urease testing is used to detect the presence of urease in Helicobacter pylori infections. An endoscopic ultrasound is used to stage the disease of stomach cancer (p. 909).

Question 23

The patient has a prescription for amoxicillin 750 mg by mouth. Available is 125 mg/5 mL. How many milliliters should the nurse administer?

a. 3 mL
b. 13 mL
c. 30 mL
d. 0.3 mL

Answer 23

c. 30 mL

Using ratio and proportion, multiply 125 by x and multiply 750 × 1 to yield 125x = 3750. Divide 3750 by 125 to yield 30 mL.

Question 24

Following a gastrectomy performed for peptic ulcer disease, the patient has recovered and is ready for discharge. What instructions should the nurse include in discharge teaching to prevent dumping syndrome?

a. Take fluids along with meals
b. Reduce protein and fats in the diet
c. Divide meals into six small feedings
d. Use concetrated sweets like honey, jam, jelly

Answer 24

c. Divide meals into six small feedings

To prevent dumping syndrome after gastrectomy, the patient should avoid large meals, instead dividing meals into six small meals to avoid overloading the intestines at mealtimes. Fluids should not be taken with meals. Fluids can be taken at least 30 to 45 minutes before or after meals. This helps prevent distention or a feeling of fullness. Concentrated sweets should be avoided because they sometimes cause dizziness, diarrhea, and a sense of fullness. Protein and fats should be increased in the diet to help rebuild body tissue and to meet energy needs (p. 918).

Question 25

A 72-year-old patient was admitted with epigastric pain caused by a gastric ulcer. Which patient assessment warrants an urgent change in the nursing plan of care?

a. Chest pain relieved with eating or drinking water
b. Back pain three or four hours after eating a meal
c. Burning epigastric pain 90 minutes after breakfast
d. Rigid abdomen and vomiting following indigestion

Answer 25

d. Rigid abdomen and vomiting following indigestion

A rigid abdomen with vomiting in a patient who has a gastric ulcer indicates a perforation of the ulcer, especially if the manifestations of perforation appear suddenly. Midepigastric pain is relieved by eating, drinking water, or antacids with duodenal ulcers, not gastric ulcers. Back pain three to four hours after a meal is more likely to occur with a duodenal ulcer. Burning epigastric pain one to two hours after a meal is from an expected manifestation with a gastric ulcer related to increased gastric secretions and does not cause an urgent change in the nursing plan of care (p. 912).

Question 26

A patient with a peptic ulcer begins vomiting. The nurse would expect and be concerned with which type of vomitus?

a. Fecal
b. Bilious
c. “Coffee ground”
d. Undigested food”

Answer 26

c. “Coffee ground”

The appearance of blood exposed to hydrochloric acid and other digestive enzymes in the stomach is dark brown with a coffee-ground consistency. This should be reported by the nurse. Fecal vomitus would be experienced with a total bowel obstruction. Bilious vomitus or undigested food may be seen with various gastrointestinal disturbances, such as gallbladder disease, gastroenteritis, or gastritis (p. 922).

Question 27

Which medication used in gastroesophageal reflux disease decreases the conversion of pepsinogen to pepsin?

a. Famotidine
b. Misoprostol
c. Rabeprazole
d. Metoclopramide

Answer 27

a. Famotidine

Famotidine is a histamine (H 2) receptor blocker that reduces the conversion of pepsinogen into pepsin. Misoprostol is a prostaglandin that increases the production of gastric mucosa. Rabeprazole is a proton pump inhibitor that results in a decrease of hydrochloric acid secretion. Metoclopramide increases gastric motility and emptying (p. 903).

Question 28

A patient presents with upper gastrointestinal (GI) bleeding. During the patient’s assessment, the nurse notes coffee ground vomitus. How should the nurse classify the finding?

a. Melena
b. Hematemesis
c. Occult bleeding
d. Mallory-Weiss tear

Answer 28

b. Hematemesis

Coffee ground vomitus indicates that blood has been in the stomach for some time, which is a manifestation of hematemesis (a type of upper gastrointestinal bleeding). Melena is characterized by black, tarry stools caused by digestion of blood in the gastrointestinal (GI) tract. Occult bleeding requires a guaiac test for detection. A Mallory-Weiss tear indicates esophageal bleeding (p. 922)

Question 29

The patient receiving chemotherapy rings the call light and reports the onset of nausea. The nurse should prepare an as needed dose of which medication?

a. Morphine sulfate
b. Zolpidem
c. Ondansetron
d. Dexamethasone

Answer 29

c. Ondansetron

Ondansetron is a 5-HT 3-receptor antagonist antiemetic that is especially effective in reducing cancer chemotherapy-induced nausea and vomiting. Morphine sulfate may cause nausea and vomiting. Zolpidem does not relieve nausea and vomiting. Dexamethasone usually is used in combination with ondansetron for acute and chemotherapy-induced emesis (p. 895).

Question 30

Which microorganism causes gastritis?

a. Streptococcus
b. Fusiform bacteria
c. Candida albicans
d. Heliobacter pylori

Answer 30

d. Heliobacter pylori

H. pylori is a leading bacterial cause of gastritis. Streptococcus causes pharyngitis, cellulitis, and Scarlet fever. Candida albicans causes oral candidiasis. Fusiform bacteria cause Vincent’s infection.

Question 31

The nurse is teaching care management to a patient with gastroesophageal reflux disease (GERD). In the follow-up visit, the patient complains of severe heartburn. Which actions indicate the need for further teaching? Select all that apply.

1. The patient chews gum daily
2. The patient eats ginger daily
3. The patient east oranges daily
4. The patient eats ice cream often
5. The patient drinks 2 L of water daily
6. The patient drinks a cup of milk at bedtime

Answer 31

3, 4, 6

Oranges are a source of citric acid. Eating acidic foods aggravates the symptoms of gastroesophageal reflux disease ( GERD). Ice cream is rich in fatty acids. Fats tend to decrease lower esophageal sphincter (LES) pressure, resulting in regurgitation of stomach acid. Drinking a cup of milk at bedtime increases gastric acid secretion. Therefore the nurse recommends that the patient avoid oranges, ice cream, and milk. Drinking 2 L of water neutralizes the pH of stomach acid and reduces the symptoms of GERD. Chewing gum increases the production of saliva, thereby helping neutralize the pH of gastric acid. Ginger is known for its antiinflammatory and antacid activities (p. 900-902).

From EAQ - Class Quiz (Q. 31-41)

Question 32

A 92-year-old patient has been admitted with abdominal pain, nausea, and vomiting. The patient has an abdominal mass, and a bowel obstruction is suspected. Which assessment findings are consistent with the patient’s clinical picture?

a. Diarrhea and absent bowel sounds
b. Abdominal distention and high-pitched bowel sounds above the obstruction
c. Localized abdominal pain and generalized hypoactive bowel sounds
d. High-pitched and hypoactive bowel sounds below the area of obstruction

Answer 32

b. Abdominal distention and high-pitched bowel sounds above the obstruction

Early in the course of intestinal obstruction, the patient’s bowel sounds are hyperactive and high-pitched, sometimes referred to as “tinkling,” above the level of the obstruction. Associated symptoms include abdominal distention and generalized abdominal pain. Diarrhea would not be present because there is an obstruction preventing stool from passing. As the obstruction becomes complete, bowel sounds decrease and finally disappear (p. 951-952).

Question 33

On examining a patient suspected of having appendicitis, what characteristics of the ailment is the nurse likely to find? Select all that apply.

1. Muscle guarding
2. High-grade fever
3. Pain at the McBurney point
4. Pain decrease by coughing
5. Patient prefers to lie still, with the right leg flexed

Answer 33

1, 3, 5

Appendicitis is usually manifested by muscle guarding, localized tenderness, and rebound tenderness. The patient may have pain over the McBurney point, which is the area halfway between the umbilicus and the right iliac crest. The patient may prefer to lie still, with the right leg flexed. Fever may or may not be present; if present, then usually it is a low-grade fever. The pain increases during activities like coughing, sneezing, and deep breathing (p. 942).

Question 34

The nurse collaborates with an enterostomal therapist to create a teaching plan for a patient with Crohn’s disease who has a new ileostomy. Which lifestyle change would be appropriate for inclusion in the plan?

a. Increased intake of high-fiber foods
b. Increase fluid intake to 2 to 3 L/day
c. Decrease intake of sodium and sports drinks
d. Increased daily exercise during acute exacerbation episodes

Answer 34

b. Increase fluid intake to 2 to 3 L/day

The enterostomal therapist is a nurse who is expert in caring for ostomies and wounds. Appropriate instructions regarding Crohn’s disease are to increase fluids to 2 to 3 L/day. Patients with Crohn’s disease should decrease intake of high-fiber foods, increase sodium through sport drinks to account for losses, and limit daily exercise during acute exacerbations (p. 961-962).

Question 35

What nursing diagnostic statement would be assigned the highest priority in the plan of care for a patient who has ulcerative colitis?

a. Activity Intolerance
b. Deficient fluid volume
c. Impaired tissue integrity
d. Risk for impaired skin integrity

Answer 35

b. Deficient fluid volume

In ulcerative colitis, fluid is not absorbed from the distal large intestine because of ulceration, bleeding, and, later, scarring and narrowing of the lumen of the bowel. Fluid and electrolytes are also lost in the stool; therefore, deficient fluid volume is the priority nursing diagnostic statement. Activity intolerance, impaired tissue integrity, and risk for impaired skin integrity are all possibilities related to ulcerative colitis, but they are not as high of a risk as deficient fluid volume (p. 949).

Question 36

A patient with a rectal tumor has undergone an abdominal-perineal resection (APR). The nurse should monitor the patient for what postoperative complications? Select all that apply.

1. Hepatotoxicity
2. Sexual dysfunction
3. Delayed wound healing
4. Persistent perineal sinus tracts
5. Upper respiratory tract infection

Answer 36

2, 3, 4

APR is a colorectal cancer surgery in which both the tumor and the entire rectum are removed, and the patient has a permanent colostomy. APR involves complications such as sexual dysfunction, delayed wound healing, and persistent perineal sinus tracts. Hepatotoxicity and upper respiratory tract infections are complications associated with immunomodulators (p. 956).

Question 37

A patient undergoes gastrectomy. What should the nurse recommend to decrease the symptoms of dumping syndrome?

a. Drinking no fluids with meals
b. Remaining in a high Fowler’s position after meals
c. Increasing the carbohydrate intake with each meal
d. Consuming a large amount of water with each meal

Answer 37

a. Drinking no fluids with meals

Avoiding fluids with meals prevents dilution and liquefaction of food and thus slows the movement of food into the jejunum. Postgastrectomy patients are often instructed to eat “dry” meals. Remaining in a high Fowler’s position after meals may increase the risk for dumping syndrome. A diet high in carbohydrates, especially simple carbohydrates, increases the risk of dumping syndrome. Taking fluids with meals causes stomach contents to empty more rapidly into the jejunum, resulting in dumping syndrome (p. 917-918).

Question 38

The nurse is caring for a patient with chronic gastritis. Which of these symptoms is associated specifically with this condition?

a. Severe diarrhea
b. Gastric hemorrhage
c. Nausea and vomiting
d. Cobalamin deficiency

Answer 38

d. Cobalamin deficiency

In chronic gastritis the manifestations are similar to those described for acute gastritis. Patients with acute gastritis and chronic gastritis may experience nausea and vomiting or hemorrhage. However, with chronic gastritis, when the parietal cells are lost as a result of atrophy, the source of intrinsic factor is also lost. The loss of intrinsic factor, a substance essential for the absorption of cobalamin in the terminal ileum, ultimately results in cobalamin deficiency. With time, the body’s storage of cobalamin in the liver becomes depleted, and a state of deficiency exists. Diarrhea is not associated with gastritis (p. 909).

Question 39

During rounds, the nurse notes that a patient who had a total gastrectomy the day before has a very small amount of fluid draining from the nasogastric (NG) tube. What is the nurse’s priority action?

a. Increase the power on the suction device
b. Irrigate the NG tube with 50 mL of sterile saline
c. Notify the primary health care provider immediately
d. Continue to monitor the patient and NG tube drainage

Answer 39

d. Continue to monitor the patient and NG tube drainage

After total gastrectomy, the NG tube does not drain a large quantity of secretions because removal of the stomach has eliminated the reservoir capacity. The nurse will only need to continue to monitor the patient and the NG tube drainage. Increasing the level of suction places the patient at higher risk for acid-base imbalance. Irrigating the NG tube is not necessary. The health care provider does not need to be notified, because this is a normal finding (p. 918-919).

Question 40

The nurse is assessing a patient who has undergone a total proctocolectomy with ileal pouch/anal anastomosis 6 months ago. Which finding indicates a positive outcome of surgery?

a. Clear yellow liquid stool
b. Increase blood urea nitrogen level
c. Decreased number of bowel movements
d. Absence of cancer at the resected margin of the polyp

Answer 40

c. Decreased number of bowel movements

An ileal pouch is created in total proctocolectomy with the ileal pouch/anal anastomosis surgical procedure. Patients usually require 3 to 6 months to adapt to the pouch. A decreased number of bowel movements indicates that the patient has adapted. Clear yellow liquid stool indicates that the colon is cleaned. An increased blood urea nitrogen level indicates acute kidney injury. The absence of cancer at the resected margin of the polyp during a colonoscopy is a positive outcome of a polypectomy (p. 948-950).

Question 41

The student nurse is providing postoperative care to a patient who underwent ostomy surgery. Which action of the student nurse indicates the need for correction?

a. Using open-ended and transparent pouches
b. Emptying collecting bags when filled completely
c. Placing a pouch on irritated skin using a skin barrier
d. Expelling flatus from the bag with a charcoal filter

Answer 41

b. Emptying collecting bags when filled completely

The weight of drainage from the stoma pulls the skin barrier away from the skin and loosens the seal. Therefore, the nurse should empty the ostomy bag when it is one-third full, instead of when it is completely full. Using open-ended and transparent pouches helps the nurse to observe the stoma and collect the drainage. Placing a pouch on irritated skin using a skin barrier is done to prevent harm to the area. Expelling flatus from the bag with a charcoal filter helps to control odor (p. 960).

Question 42

The nurse is caring for a patient with colorectal cancer who had a polypectomy during a colonoscopy. Which finding indicates a positive outcome?

a. Clear yellow liquid stools
b. Normal control over defecation
c. Increase WBC count
d. Absence of malignancy at the resected margin of the polyp

Answer 42

d. Absence of malignancy at the resected margin of the polyp

The absence of cancer at the resected margin of the polyp is a positive outcome after a polypectomy during colonoscopy. Clear yellow liquid stool indicates that the colon is cleaned. Normal control over defecation is not an indicator of a successful resection. An increased white blood cell count indicates infection (p. 956).

From EAQ - lower GI (Q 42-60)

Question 43

A patient with abdominal trauma has a urinalysis that indicates there is blood in the urine. For what condition does the nurse monitor this patient?

a. Peritonitis
b. Kidney damage
c. Diaphragm rupture
d. Abdominal compartment syndrome

Answer 43

b. Kidney damage

Blood in the urine of a patient with abdominal trauma indicates kidney damage. Loss of bowel sounds indicates peritonitis. The presence of bowel sounds near the chest indicates diaphragm rupture. Abdominal hypertension indicates abdominal compartment syndrome (p. 940-941).

Question 44

A patient taking a medication for irritable bowel syndrome (IBS) has developed severe constipation with abdominal pain and has bloody stools. Which medication does the nurse suspect to be responsible?

a. Alosetron
b. Linaclotide
c. Loperamide
d. Lubiprostone

Answer 44

a. Alosetron

A patient with IBS taking alosetron may have severe constipation, abdominal pain, and blood in the stools due to reduced blood flow to the intestine. Linaclotide can be given with IBS and constipation. Loperamide is used to treat diarrhea in the patient with IBS. Lubiprostone can be used in the treatment of IBS with constipation in women (p. 940-941)

Question 45

The nurse is assessing a colostomy in a patient who had a colectomy 24 hours ago. Which of these assessment findings is considered normal for a new stoma?

a. Pale pink color
b. Dusky blue color
c. Brown or black color
d. Dark pink to red color

Answer 45

d. Dark pink to red color

The stoma should be dark pink to red. The stoma should not be pale and pink. A dusky blue stoma indicates ischemia, and a brown-black stoma indicates necrosis. Assess and document stoma color every 4 hours and ensure that there is no excessive bleeding (p. 960).

Question 46

A patient who has a family history of colon cancer asks the nurse about tests for colon cancer. Which of these is considered the best method for colorectal cancer (CRC) screening?

a. Colonoscopy
b. Barium enema
c. Sigmoidoscopy
d. Fecal occult blood test (FOBT)

Answer 46

a. Colonoscopy

Colonoscopy is the gold standard for CRC screening because the entire colon is examined (only 50 percent of CRCs are detected by sigmoidoscopy), biopsies can be obtained, and polyps can be removed immediately and sent to the laboratory for examination. A less favorable, but acceptable, screening method includes testing the stool for fecal blood. The FOBT and fecal immunochemical test (FIT) look for blood in the stool. Stool tests must be done frequently because tumor bleeding occurs at intervals and easily may be missed if only a single test is done (p. 955).

Question 47

A patient is brought to the emergency department after a motor vehicle accident. On examination, the nurse finds that the patient has sustained facial trauma and suspects a fractured pelvis. The nurse also notes that a large piece of glass is impaled in the abdomen. What nursing actions are appropriate for this patient?

a. Insert a NG tube
b. Remove the impaled piece of glass
c. Insert an indwelling urinary catheter
d. Ensure a patent airway

Answer 47

d. Ensure a patent airway

The first step after receiving any patient after a motor vehicle injury is to ensure a patent airway and ensure that the patient is breathing. A nasogastric tube should be inserted if there is no facial trauma. Any impaled object should be stabilized with bulky dressing, but should not be removed, in order to prevent further injury and bleeding. If the patient has sustained a fractured pelvis, inserting a urinary catheter is not advised (p. 939).

Question 48

The nurse is caring for a patient after a sigmoid colostomy. What type of stool does the nurse anticipate when assessing the patient?

a. Liquid
b. Formed
c. Semiliquid
d. Semiformed

Answer 48

b. Formed

Formed stool is observed in a patient after a sigmoid colostomy. Liquid stool is observed in a patient after an ileostomy. Semiliquid stool is observed after an ascending colostomy. Semiformed stool is observed after a transverse colostomy (p. 958).

Question 49

The nurse is planning care for a 68-year-old patient with an abdominal mass and suspected bowel obstruction. Which factor in the patient’s history increases the patient’s risk for colorectal cancer?

a. Osteoarthritis
b. Hx of colorectal polyps
c. Hx of lactose intolerance
d. Use of herbs as dietary supplements

Answer 49

b. Hx of colorectal polyps

A history of colorectal polyps places this patient at risk for colorectal cancer. This tissue can degenerate over time and become malignant. Osteoarthritis, lactose intolerance, and the use of herbs do not pose additional risks to the patient (p. 955).

Question 50

The nurse is educating a patient about dietary fiber and the ways to incorporate it into the daily diet. What information should the nurse include while teaching this patient about fiber intake?

a. Drink at least 2 L of water daily
b. Avoid having prunes and prune juice
c. Check flatulence formation in the case of dietary fiber intake
d. Check for milk and milk products that are high in dietary fiber

Answer 50

a. Drink at least 2 L of water daily

Dietary fiber absorbs water. Therefore, when adding dietary fiber to a diet, it is important to maintain a good fluid intake. Prunes and prune juices are high in dietary fiber and should be included in this diet. Initially, fiber may increase the production of gas but that effect decreases with time. Milk and milk products do not have a high-fiber content (p. 937).

Question 51

For what complication should the nurse assess a patient after total proctocolectomy with an ileal pouch/anal anastomosis surgery?

a. Pouchitis
b. Hemorrhoids
c. Constipation
d. Hypokalemia

Answer 51

a. Pouchitis

Pouchitis may occur in a patient after total proctocolectomy with ileal pouch/anal anastomosis surgery. Pouchitis is an inflammation of the pouch that occurs due to irritation. Hemorrhoids occur due to increased anal pressure. The overuse of antidiarrheal drugs will increase the risk of constipation. Hypokalemia occurs due to prolonged treatment with diuretics (p. 948).

Question 52

A 68-year-old patient has been admitted with an abdominal mass and suspected bowel obstruction. Which factor in the patient’s history places the patient at greatest risk for colorectal cancer?

a. Osteoarthritis
b. Recurrent rectal polyps
c. GERD
d. Daily use of NSAIDs

Answer 52

b. Recurrent rectal polyps

A history of rectal polyps places this patient at risk for colorectal cancer. This tissue can degenerate over time and become malignant. Daily use of NSAIDS, GERD, and osteoarthritis do not place the patient at risk for colorectal cancer (p. 953).

Question 53

Which condition is a common manifestation associated with protein deficiency?

a. Paresthesia
b. Hypotension
c. Hair thinning
d. Peripheral neuropathy

Answer 53

c. Hair thinning

Hair thinning and muscle wasting are common manifestations associated with protein deficiency because a strand of hair or muscle is composed mostly of protein. Paresthesia is a manifestation associated with cobalamin deficiency. Hypotension is a manifestation associated with dehydration. Peripheral neuropathy is also associated with cobalamin deficiency (p. 966).

Question 54

The nurse provides postoperative care one day after a patient undergoes colostomy surgery. The patient’s stoma is moist and dark pink, with no obvious drainage. Which action should the nurse take?

a. Document the normal findings
b. Consult the enterostomal therapist
c. Irrigate the ostomy with normal saline
d. Palpate the abdomen around the stoma

Answer 54

a. Document the normal findings

A colostomy stoma that is moist and dark pink without any drainage on the first postoperative day is normal. These findings should be documented in the patient’s medical record. Consulting the enterostomal therapist, irrigating the ostomy, and palpating the abdomen are not necessary because the colostomy stoma is normal (p. 960).

Question 55

A 28-year-old woman calls the office nurse and states, “I am having the worst abdominal pain! It just started this afternoon. Is there anything I can take to get relief?” Which answer by the nurse is appropriate?

a. “Try taking a laxative and let us know how that works.”
b. “You could try an enema to see if that brings quick relief.”
c. “Take some aspirin or acetaminophen and let us know if the pain is not relieved.”
d. “Please have someone bring you to the office today so that we can do an examination.”

Answer 55

d. “Please have someone bring you to the office today so that we can do an examination.”

Encourage the patient with abdominal pain to see a health care provider and to avoid self-treatment. Laxatives and enemas are especially dangerous because the resulting increased peristalsis may cause perforation of an inflamed appendix. Taking pain medication is not an appropriate action for abdominal pain of unknown origin (p. 938-939).

Question 56

Which is a manifestation of electrolyte depletion?

a. Flatulence
b. Steatorrhea
c. Muscle cramps
d. Night blindness

Answer 56

c. Muscle cramps

Muscle cramps are a condition in which the muscle tightens and does not relax. Electrolyte depletion affects the activity of muscles and causes muscle cramps. Flatulence occurs due to bacterial fermentation of unabsorbed carbohydrates. Steatorrhea is caused by undigested and unabsorbed fat. Night blindness is caused by vitamin A deficiency (p. 966).

Question 57

The wound, ostomy, and continence (WOC) nurse selects the site where the ostomy will be placed. What should be included in the consideration for the site?

a. The patient must be able to see the site
b. Outside the rectus muscle area is the best site
c. It is easier to seal the drainage bag to a protrubing area
d. The ostomy will need irrigation so the area should not be tender

Answer 57

a. The patient must be able to see the site

In selection of the ostomy site, the WOC nurse will want a site visible to the patient so the patient can take care of it, within the rectus muscle to avoid hernias, and on a flat surface to more easily create a good seal with the drainage bag. The ostomy should not need irrigation (p. 960).

Question 58

Which statement is true regarding celiac disease?

a. It occurs due to lactose ingestion.
b. It is not related to bacterial overgrowth.
c. It does not occur due to genetic predisposition.
d. It occurs due to an immune-mediated response.

Answer 58

d. It occurs due to an immune-mediated response.

Celiac disease is an autoimmune disease characterized by damage to the small intestinal mucosa. The factors that trigger the development of celiac disease include gluten ingestion, but not lactose ingestion. Bacterial overgrowth and congenital lactase deficiency are necessary for developing lactose intolerance. Celiac disease is associated with a genetic predisposition because many patients with celiac disease have human leukocyte antigen (HLA) alleles HLA-DQ2 and HLA-DQ8 (p. 966-967).

Question 59

A patient has an inguinal hernia. The patient asks the nurse to explain the diagnosis. How should the nurse respond?

a. Tell the patient not to worry because hernias are common
b. Refer the patient to the primary health care provider for additional information
c. Explain that a hernia is often the result of prenatal growth abnormalities that appear later in life
d. Explain that a hernia is a loop of bowel protruding through a weak spot in the muscles of the abdomen

Answer 59

d. Explain that a hernia is a loop of bowel protruding through a weak spot in the muscles of the abdomen

Explaining that a hernia is a loop of bowel protruding through a weak spot in the muscles of the abdomen is the correct information to give the patient. Once the nurse explains to the patient about inguinal hernia, the patient should be referred to his primary health care provider for additional consultation. Telling the patient not to worry and offering inaccurate explanations are inappropriate responses by the nurse (p. 964).

Question 60

Which manifestation should be suspected in a patient with riboflavin deficiency?

a. Anemia
b. Cheilosis
c. Paresthesia
d. Peripheral neuropathy

Answer 60

b. Cheilosis

Riboflavin is a water-soluble vitamin that lowers the risk of cheilosis. Therefore, deficiency of riboflavin causes cheilosis. Cheilosis is a painful inflammation and cracking in the corners of the mouth. Anemia is caused by folic acid deficiency. Paresthesia and peripheral neuropathy are caused by cobalamin deficiency (p. 966).