LACHARITY 12 Gastrointestinal and Nutritional Problems Flashcards
The charge nurse is reviewing the medication administration records for
several clients. Which situation needs to be brought to the attention of the
prescribing health care provider?
1. A client with gastroesophageal reflux disease is receiving magnesium
hydroxide.
2. An older adult client with new-onset constipation is getting psyllium three
times a day.
3. A client who needs a bowel prep is getting polyethylene glycol-electrolyte
solution.
4. A client with abdominal pain secondary to diverticulitis is receiving
bisacodyl.
Ans: 4 Laxatives should not be administered to clients with undiagnosed
abdominal pain, cramps, or nausea. Appendicitis, diverticulitis, ulcerative
colitis, acute surgical abdomens, and bowel obstruction are also
contraindications. The other clients are receiving medications that are
appropriate for their conditions. Focus: Prioritization.
The charge nurse is reviewing the medication administration records for
several clients. Which situation needs to be brought to the attention of the
prescribing health care provider?
1. A client with gastroesophageal reflux disease is receiving magnesium
hydroxide.
2. An older adult client with new-onset constipation is getting psyllium three
times a day.
3. A client who needs a bowel prep is getting polyethylene glycol-electrolyte
solution.
4. A client with abdominal pain secondary to diverticulitis is receiving
bisacodyl.
Ans: 2 The UAP can reinforce dietary and fluid restrictions after the RN has
explained the information to the client. It is also possible that the UAP can
administer the enema; however, special training is required, and policies may
vary among institutions. Medication administration should be performed by
licensed personnel. Focus: Delegation.
The nurse is reviewing medication lists for clients who are being treated for
peptic ulcer disease (PUD). The nurse is most likely to question the use of
which medication?
1. Ibuprofen
2. Omeprazole
3. Amoxicillin
4. Clarithromycin
Ans: 1 Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID), and
NSAIDs are thought to be one of the aggravating factors of PUD.
Omeprazole, amoxicillin, and clarithromycin are used as a triple combination
therapy for treatment of PUD. Focus: Prioritization; Test Taking Tip:
NSAIDs are commonly prescribed and self-selected as over-the-counter
medications; thus, knowing the pharmacology, drug–drug interactions, and
side effects are worthwhile for test taking purposes and clinical practice.
The nurse would be most concerned about a prescription for a total
parenteral nutrition (TPN) fat emulsion for a client with which condition?
1. Gastrointestinal (GI) obstruction
2. Severe anorexia nervosa
3. Chronic diarrhea and vomiting
4. Fractured femur
Ans: 4 A client with a fractured femur is at risk for fat embolism, so a fat
emulsion should be used with caution. Vomiting may be a problem if the
emulsion is infused too rapidly. TPN is commonly used in clients with GI
obstruction, severe anorexia nervosa, and chronic diarrhea or vomiting.
Focus: Prioritization.
The nurse is preparing to administer total parenteral nutrition (TPN) through
a central line. Place the following steps for administration in the correct order.
1. Thread the IV tubing through an infusion pump.
2. Check the solution for cloudiness or turbidity.
3. Connect the tubing to the central line, using aseptic technique.
4. Select and flush the correct tubing and filter.
2365. Set the infusion pump at the prescribed rate.
6. Confirm the order for TPN before administration.
Ans: 6, 2, 4, 1, 3, 5 The nurse should always check the order before
administering TPN; generally, each bag is individually prepared by the
pharmacist. The solution should not be cloudy or turbid. Prepare the
equipment by priming the tubing and threading the pump. To prevent
infection, scrub the hub and use aseptic technique when inserting the
connector into the injection cap and connecting the tubing to the central line.
Set the pump at the prescribed rate. Focus: Prioritization.
The nurse is caring for a client with peptic ulcer disease (PUD). Which
assessment finding is the most serious?
1. Projectile vomiting
2. Burning sensation 2 hours after eating
3. Coffee-ground emesis
4. Boardlike abdomen with shoulder pain
Ans: 4 A boardlike abdomen with shoulder pain is a symptom of a
perforation, which is the most lethal complication of PUD. A burning
sensation is a typical report and can be controlled with medications. Projectile
vomiting can signal an obstruction. Coffee-ground emesis is typical of slower
bleeding, and the client will require diagnostic testing. Focus: Prioritization.
The nurse is taking an initial history for a client seeking surgical treatment for
obesity. Which finding should be called to the attention of the surgeon?
1. Obesity for approximately 5 years
2. History of counseling for body dysmorphic disorder
3. Failure to reduce weight with other forms of therapy
4. Body weight 100% above the ideal for age, gender, and height
Ans: 2 Body dysmorphic disorder is a preoccupation with an imagined
physical defect. Corrective surgery can exacerbate this disorder when the
client continues to feel dissatisfied with the results. The other findings are
criterion indicators for this treatment. Focus: Prioritization.
The nurse is taking report on an elderly client who was admitted with
abdominal pain and nausea, vomiting, and diarrhea. The client also has a
history of chronic dementia. Which comment by the night shift nurse is most
concerning?
1. The client has a flat affect and rambling and repetitive speech.
2. The client has memory impairments and thinks the year is 1948.
3. The client lacks motivation and demonstrates early morning awakening.
4. The client has a fluctuating level of consciousness and mood swings.
Ans: 4 Fluctuating level of consciousness and mood swings are associated
more with acute delirium, which could be caused by many things, such as
246electrolyte imbalances, sepsis, or medications. Information about the client’s
baseline behavior is essential; however, based on knowledge of
pathophysiology, the nurse knows that flat affect and rambling and repetitive
speech, memory impairments, and disorientation to time are behaviors
typically associated with chronic dementia. Lack of motivation and early
morning awakening are associated with depression. Focus: Prioritization;
Test Taking Tip: A sudden change in level of consciousness and mental
status signal a need to conduct further assessment for an acute process. This
question requires the ability to differentiate between acute and chronic
disease processes and accompanying symptoms.
In the care of a client with gastroesophageal reflux disease, which task would
be appropriate to delegate to unlicensed assistive personnel (UAP)?
1. Sharing successful strategies for weight reduction
2. Encouraging the client to express concerns about lifestyle modification
3. Reminding the client not to lie down for 2 to 3 hours after eating
4. Explaining the rationale for eating small frequent meals
Ans: 3 Reminding the client to follow through on advice given by the nurse is
an appropriate task for the UAP. The RN should take responsibility for
teaching rationale, discussing strategies for the treatment plan, and assessing
client concerns. Focus: Delegation.
The client needs diagnostic testing to confirm symptoms of peptic ulcer
disease (PUD), and the health care provider tells the nurse that the client
prefers noninvasive methods. Which brochure is the nurse most likely to
prepare for the client?
1. “Three Simple Ways to Detect H. pylori Using Your Blood, Breath, or Stool.”
2. “How Your Doctor Uses a Chest and Abdomen X-ray Series to Detect
PUD.”
3. “Esophagogastroduodenoscopy: The Major Diagnostic Test for PUD.”
4. “Common Questions and Answers About Nuclear Medicine Scans.”
Ans: 1 H. pylori is frequently associated with PUD, and the organism can be
detected through breath, blood, or stool. Esophagogastroduodenoscopy is the
best test for PUD; however, it is considered an invasive procedure. Chest and
abdominal series may be ordered if perforation is suspected, and a nuclear
medicine scan may be ordered if gastrointestinal bleeding is present. Focus:
Prioritization.
The nurse is providing the immediate postoperative care for a client who
237had fundoplication to reinforce the lower esophageal sphincter for the
purpose of a hiatal hernia repair. What is the priority action for the care of
this client?
1. Elevate the head of the bed at least 30 degrees.
2. Assess the nasogastric tube for yellowish-green drainage.
3. Assist the client to start taking a clear liquid diet.
4. Assess the client for gas bloat syndrome.
Ans: 1 The primary concern in the immediate postoperative period is the
potential for airway complications. Elevating the head at least 30 degrees
decreases the chance for aspiration and facilitates respiratory effort. The other
options are also correct but will occur later in the postoperative period.
Focus: Prioritization.
A client with chronic hepatitis C has been taking the antiviral medication
ledipasvir–sofosbuvir daily for the past month. Which information gathered
during a home visit is most important for the nurse to communicate to the
health care provider?
1. The client reports frequent headaches.
2. The client complains of feeling chronically tired.
3. The client occasionally misses a dose of the medication.
4. The client always takes the medication just before eating.
Ans: 3 Effective treatment of chronic hepatitis C requires careful adherence
to the medication regimen for the entire treatment time (usually 12 weeks).
Headache and fatigue are common adverse effects of ledipasvir–sofosbuvir,
and the medication can be taken with or without food. Focus: Prioritization.
Which client is the most appropriate to assign to an LPN/LVN under the
supervision of an RN?
1. A client with oral cancer who is scheduled in the morning for glossectomy
2. An obese client returned from surgery after a vertical banded gastroplasty
3. A client with anorexia nervosa who has muscle weakness and decreased
urine output
4. A client with intermittent nausea and vomiting related to chemotherapy
Ans: 4 Nausea and vomiting are common after chemotherapy.
Administration of antiemetics and fluid monitoring can be done by an
LPN/LVN. The RN should perform the preoperative teaching for the
glossectomy client. Clients returning from surgery need extensive
assessment. The client with anorexia is showing signs of hypokalemia and is
at risk for cardiac dysrhythmias. Focus: Assignment.
For clients with peptic ulcer disease (PUD), what is the most important lifestyle modification? 1. Avoiding caffeine 2. Decreasing alcohol intake 3. Smoking cessation 4. Controlling stress
Ans: 3 Smoking is associated with PUD. The other lifestyle modifications
may be desirable, but the current evidence does not show strong linkage to
the development of or recovery from PUD. Focus: Prioritization.
The postoperative care of a morbidly obese client is being planned. Which
task best uses the expertise of the LPN/LVN, under the supervision of the RN
team leader?
1. Obtaining an oversized blood pressure cuff and a large-size bed
2. Setting up a reinforced trapeze bar
3. Assisting in the planning of toileting, turning, and ambulation
4. Assigning tasks to unlicensed assistive personnel (UAP) and other ancillary
staff
Ans: 3 The LPN/LVN can offer valuable assistance in planning the
interventions, but the RN has ultimate responsibility for the care plan. The
LPN/LVN can delegate and assign tasks to UAPs; however, if the RN is the
team leader, it is better if UAPs are not receiving instructions from multiple
people. Obtaining equipment should be delegated to a UAP. A physical
247therapist should be contacted to set up specialized equipment. Focus:
Assignment.
A client with proctitis needs a rectal suppository. A senior nursing student
assigned to care for this client tells the nurse that she is afraid to insert a
suppository because she has never done it before. What is the most
appropriate action in supervising this student?
2381. Give the medication and tell the student to talk to the instructor.
2. Ask the student to leave the clinical area because she is unprepared.
3. Reassign the client to an LPN/LVN and send the student to observe.
4. Show the student how to insert the suppository and talk to the instructor.
Ans: 4 Showing the student how to insert the suppository meets both the
immediate client need and the student’s learning need. The instructor can
address the student’s fears and long-term learning needs after he or she is
aware of the incident. It is preferable that students express fears and learning
needs. The other options will discourage the student’s future disclosure of
clinical limitations and need for additional training. Focus: Supervision,
Assignment.
The nurse is teaching the client and family how to perform colostomy
irrigation. Place the following information in the correct order.
1. Hang the container at about shoulder height.
2. Allow solution to flow slowly and steadily for 5 to 10 minutes.
3. Don clean gloves and put 500 to 1000 mL of lukewarm water in the
container.
4. Lubricate the stoma cone and gently insert the tubing tip into the stoma.
5. Clean, rinse, and dry the skin, and apply a new drainage pouch.
6. Allow 15 to 20 minutes for initial evacuation; then the client should walk
for 30 to 45 minutes for secondary evacuation.
Ans: 3, 1, 4, 2, 6, 5 Putting on a pair of clean gloves protects the hands from
colostomy secretions. The water should be warm (cold water can cause
cramping), and the container should be hung at shoulder height (hanging the
container too high or too low will alter the rate of flow). Lubricating the
stoma and gently inserting the tubing tip will allow the water to flow into the
stoma. A slow and steady flow prevents cramps and spillage. Providing
adequate time allows for complete evacuation. Walking stimulates the bowel.
Careful attention to the skin prevents breakdown. Focus: Prioritization.
The nurse is caring for a client with a nasogastric (NG) tube. Which task can
be delegated to experienced unlicensed assistive personnel (UAP)?
1. Removing the NG tube at the prescribed time
2. Securing the tape if the client accidentally dislodges the tube
3. Disconnecting the suction to allow ambulation to the toilet
4. Reconnecting the suction after the client has ambulated
Ans: 3 Disconnecting the tube from suction is an appropriate task to
delegate. (The nurse must give specific instructions or verify that the UAP
knows how to do this task.) Suction should be reconnected by the nurse so
that correct pressure is checked. If the UAP is permitted to reconnect the tube,
the RN is still responsible for checking that the pressure setting is correct.
During removal of the tube, there is a potential for aspiration, so the nurse
should perform this task. If the tube is dislodged, the nurse should recheck
placement before it is secured. Focus: Delegation.
The nurse is planning a treatment and prevention program for chronic
bowel incontinence for an elderly client. Which intervention should the nurse
try first?
1. Administer a glycerin suppository 15 minutes before evacuation time.
2. Insert a rectal tube at specified intervals each day.
3. Assist the client to the commode or toilet 30 minutes after meals.
4. Use incontinence briefs or adult-sized diapers.
Ans: 3 The goal of bowel training is to establish a pattern that mimics
normal defecation, and many people have the urge to defecate after a meal. If
this is not successful, a suppository can be used to stimulate the urge. The use
of incontinence briefs is embarrassing for the client, and they must be
changed frequently to prevent skin breakdown. Routine use of rectal tubes is
not recommended because of the potential for damage to the mucosa and
sphincter tone. Focus: Prioritization.
A client hospitalized with ulcerative colitis reports 10 to 20 small diarrhea
stools per day, with abdominal pain before defecation. The client appears
depressed and underweight and is uninterested in self-care or suggested
therapies. What is the priority nursing concept to consider when planning
interventions for this client?
1. Elimination
2. Nutrition
3. Pain
4. Adherence
Ans: 1 The immediate problem is controlling the diarrhea. Addressing this
problem is a step toward correcting the nutritional imbalance and decreasing
the diarrheal cramping. Self-care and adherence with the treatment plan are
important long-term goals that can be addressed when the client is feeling
better physically. Focus: Prioritization.
While transferring a dirty laundry bag, an unlicensed assistive personnel
(UAP) sustains a puncture wound to the finger from a contaminated needle.
239The unit has several clients with hepatitis and acquired immunodeficiency
syndrome; the needle source is unknown. Place the following instructions, for
the UAP, in the correct order of priority.
1. Have blood test(s) performed per protocol.
2. Complete and file an incident report.
3. Perform a thorough aseptic hand washing.
4. Report to the occupational health nurse.
5. Follow up for laboratory results and counseling.
6. Begin prophylactic drug therapy.
Ans: 3, 4, 1, 6, 2, 5 Immediate decontamination is appropriate because
exposure time can affect viral load. The occupational health nurse will direct
the UAP to get the appropriate laboratory tests, obtain prophylaxis within 72
hours (the sooner the better), file the correct forms, and follow up on results.
Focus: Prioritization, Supervision.
The home health nurse sees that the client is taking cimetidine. What
question is the nurse most likely to ask to evaluate the efficacy of the
therapy?
1. “Are you still having problems with constipation?”
2. “Has the medication helped to relieve the acid indigestion?”
3. “Did the medication relieve the nausea and vomiting?”
4. “Do you feel like your appetite has improved?”
Ans: 2 Cimetidine is available over the counter and is used to relieve
248heartburn, acid indigestion, and sour stomach. Focus: Prioritization.
The nurse is caring for an obese postoperative client who underwent surgery
for bowel resection. As the client is moving in bed, he comments, “Something
popped open.” Upon examination, the nurse notes wound evisceration. Place
the steps in order for handling this complication.
1. Cover the intestine with sterile moistened gauze.
2. Stay calm and stay with the client.
3. Check the vital signs, especially blood pressure and pulse.
4. Have a colleague gather sterile supplies and contact the health care
provider (HCP).
5. Put the client into semi-Fowler position with knees slightly flexed.
6. Prepare the client for surgery as ordered.
Ans: 2, 5, 3, 4, 1, 6 Stay calm and stay with the client. Any increase in intra-
abdominal pressure will worsen the evisceration; placement of the client in a
semi-Fowler position with knees flexed will decrease the strain on the wound
site. (Note: If shock develops, the client’s head should be lowered.)
Continuously monitor vital signs (particularly for a decrease in blood
pressure or increase in pulse rate) while a colleague gathers supplies and
notifies the HCP. Covering the site protects tissue. Ultimately, the client will
need emergency surgery. Focus: Prioritization.
The nurse is providing postoperative care for a client who underwent
laparoscopic cholecystectomy. What should be reported immediately to the
health care provider?
1. The client cannot void 5 hours postoperatively.
2. The client reports shoulder pain.
3. The client reports right upper quadrant pain.
4. Output does not equal input for the first few hours.
Ans: 3 Right upper quadrant pain is a sign of hemorrhage or bile leakage.
The ability to void should return within 6 hours postoperatively. Right
shoulder pain is related to unabsorbed carbon dioxide and will be resolved
by placing the client in a Sims position. For the first several hours after
surgery, output is not expected to equal input. Focus: Prioritization.
