GI Questions Flashcards
The 2015 guidelines indicate that routine screening:
The 2015 guidelines indicate that routine screening with colonoscopy is performed every 10 years, not every 5 years.Other options are performed at 5-year intervals. A barium enema every 5 years is a screening option. A flexible sigmoidoscopy and a “virtual” colonoscopy every 5 years are also acceptable for screening. A “virtual” colonoscopy or CT colonography is a noninvasive imaging procedure that takes multidimensional views of the entire colon.
What is a common gastrointestinal problem that older adults experience more frequently as they age?
In older adults, decreased hydrochloric acid levels (hypochlorhydria) results from atrophy of the gastric mucosa.A decrease in lipase production results from calcification of pancreatic vessels. A decrease in the number and size of hepatic cells leads to decreased liver weight and mass. Peristalsis decreases, and nerve impulses are dulled.
The nurse is assessing an alert client who had abdominal surgery yesterday. What method provides the most accurate data about resumption of peristalsis in the client?
The best and most reliable method for assessing the return of peristalsis following abdominal surgery is the client’s report of passing flatus within the past 8 hours or stool within the past 12 hours.Although auscultation and counting the number of sounds was once a method of assessing for bowel activity, it is no longer considered the most effective method. Observing the abdomen is one method of examining a client’s abdomen, but it is not a reliable way to assess for resumption of activity after surgery.
The nurse is assessing a client who has come to the emergency department with acute abdominal pain. The client is very thin and the nurse observes visible peristaltic movements when inspecting the abdomen. What does the nurse suspect?
The nurse would suspect an intestinal obstruction related to peristaltic movements. Peristaltic movements are rarely seen except in thin clients. This needs to be reported to the HCP.Acute diarrhea does not cause visible peristaltic movements. Aortic aneurysm may cause a bulging, pulsatile mass. Pancreatitis is characterized by severe pain.
After a colonoscopy, a client reports severe abdominal pain. The nurse obtains these data: temperature 100.2°F (37.9°C), pulse 122 beats/min, blood pressure 100/45 mm Hg, respirations 44 breaths/min, and O2 saturation 89%. Which request from the health care provider does the nurse implement first?
The first request the nurse complies with is to place the client on oxygen. This is the most immediate concern because it involves the client’s respiratory status. Based on the data given, the client may be experiencing complications of colonoscopy such as bleeding or perforation.An antibiotic request is important but is not the first priority. Fluid supplementation is important, but the client’s oxygen saturation level places the client’s respiratory status as the priority. The client’s need for analgesia should be delayed until respiratory status is addressed. Morphine depresses respiratory status and therefore might not be the right choice for this client.
The nurse is caring for a client diagnosed with aphthous ulcers. The nurse instructs the client to avoid which foods?
Aphthous ulcers (canker sores) are small, shallow lesions that develop on the soft tissues in the mouth or at the base of the gums. The nurse tells the client that certain foods such as cheese, nuts, and potatoes may trigger allergic responses that cause aphthous ulcers and should be avoided.Apples and bananas are not acidic and do not trigger allergic responses that cause aphthous ulcers.
The nurse is caring for a postoperative client who had an extensive oral and neck surgery. The client is now describing throbbing pain in the head. The nurse anticipates that the health care provider will request which medication for this client?
Intravenous morphine sulfate is indicated for severe pain and is given initially. Clients undergoing surgery for oral cancer describe their pain as throbbing or pounding.Diphenhydramine is an anti-inflammatory agent and is not indicated for treatment of pain. Midazolam is used for conscious sedation and is not indicated for pain. Oxycodone/acetaminophen is given for systematic relief of moderate pain. This client may also have trouble swallowing.
As a result of being treated with radiation for oral cancer, a client is experiencing xerostomia. What collaborative resource does the nurse suggest for this client’s care?
Xerostomia is the subjective feeling of oral dryness, which is often (but not always) associated with hypofunction of the salivary glands. It is a long-term effect of radiation therapy and requires ongoing oral care such as the use of saliva substitutes and follow-up dental visits.Occupational therapists, psychiatrists, and speech therapists are not the appropriate resource for a client with xerostomia.
A client who has undergone surgery and completed radiation therapy to treat oral cancer reports persistent dry mouth. What will the nurse teach this client about managing this symptom?
Xerostomia is a common effect of oral irradiation and may be permanent. Clients should be advised to use saliva substitutes.The condition is common, but often permanent. Lozenges and hard candies are not as effective as saliva substitutes. Dry mouth is a side effect of therapy, not a symptom of complications. Frequent sips of water is the preferred method of treating xerostomia during radiation therapy.
A client has undergone a partial glossectomy for cancer. What community resource does the nurse refer the client to when dressing supplies will be needed at home?
The American Cancer Society supplies dressings and transportation to and from follow-up visits or medical treatments for clients with cancer. A partial glossectomy is removal of part of the tongue (see Chapter 29).The Oral Cancer Foundation is an organization for local support groups and resources. The Client Advocate Foundation provides education, legal counseling, and referrals to clients with cancer and survivors concerning managed care, insurance, financial issues, job discrimination, and debt crisis matters. The American Medical Supply Foundation does not exist.
The nurse is reinforcing the instructions on swallowing provided by the speech-language pathologist to a patient diagnosed with esophageal cancer. Which of the following instructions should be included in the teaching?
The nurse should instruct the patient to place food at the back of the mouth when eating. This will help the patient avoid aspiration of food. Food aspiration can cause airway obstruction, pneumonia, or both, especially in older adults.Both tongue movements and sealing of the lips should be monitored in this patient. The patient’s head should be tilted forward in the chin-tuck position and not back. The patient needs to be able to reach food particles on her or his lips and around the mouth with the tongue.
The nurse is observing a coworker who is caring for a patient with a nasogastric tube following esophageal surgery. Which actions by the coworker require the nurse to intervene?
The nurse would intervene to make sure the nasogastric tube is checked every 4 to 8 hours and not every 12 hours. Also, the head of the bed needs to be elevated at least 30 degrees and not kept flat. Oral hygiene would be provided every 2 to 4 hours and not every 8 hours.The patient should be placed upright when taking sips or small amounts of water to prevent choking and to allow observation of the patient for dysphagia. The tube should be secured to prevent dislodgment.
The nurse prepares a teaching session regarding lifestyle changes needed to decrease the discomfort associated with a patient’s gastroesophageal reflux disease (GERD). Which change does the nurse recommend to this patient?
The patient should avoid working while bent over because this position presses on the diaphragm, causing discomfort.The patient with GERD needs to eat four to six meals a day. The head of the patient’s bed would be elevated approximately 6 inches (15 cm). Both tea and coffee need to be eliminated from this patient’s diet because of the caffeine content.
The nurse is reviewing the medication history for a patient diagnosed with gastroesophageal reflux disease (GERD) who has been prescribed esomeprazole (Nexium) once daily. The patient reports that this proton pump inhibitor medication doesn’t completely control the symptoms. The nurse contacts the primary health care provider to discuss which intervention?
The nurse contacts the primary health care provider about changing the Proton pump inhibitor to twice daily. These medications are usually effective when given once daily but can be given twice daily if symptoms are not well controlled.Adding a second medication, increasing the dose, or switching to another proton pump inhibitor is not recommended.
The nurse is assessing a patient with gastroesophageal reflux disease (GERD). Which findings does the nurse expect to observe
When assessing a patient for GERD, the nurse expects to find dyspepsia (heartburn), excessive salivation, flatulence which is common after eating, and regurgitation (backward flow of food and fluid into the throat).Blood-tinged sputum and excessive salivation are not symptoms of GERD.
