Unit O-Clients with Non-Inflammatory/Inflammatory Intestinal Disease (GI) Flashcards
The nurse is interviewing a client who reports having abdominal cramping, bloating, and diarrhea after drinking milk or ingesting other dairy products. What health problem does the client most likely have?
a. Steatorrhea
b. Ulcerative colitis
c. Crohn disease
d. Lactose intolerance
ANS: D
The client is demonstrating signs and symptoms of lactose intolerance because they occur after the client eats or drinks dairy products which contain lactose.
The primary health care provider documents that a client has a bruit over the abdominal aorta. What teaching will the nurse provide for assistive personnel (AP) based on this assessment finding?
a. “Use warm compresses on the client’s abdomen continuously.”
b. “Avoid washing the client’s abdomen too aggressively.”
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c. “Apply ice to the client’s abdomen every 4 hours.” d. “Massage the client’s abdomen to help reduce pain.”
ANS: B
A bruit heard over the abdominal aorta possible indicates stenosis or an aneurysm which should not be palpated or percussed. Therefore, the AP should wash the client’s abdomen very gently.
A client is having an esophagogastroduodenoscopy (EGD) and has been given midazolam hydrochloride. The client’s respiratory rate is 8 breaths/min. What action by the nurse is appropriate?
a. Administer naloxone.
b. Call the Rapid Response Team.
c. Provide physical stimulation.
d. Ventilate with a bag-valve-mask.
ANS:C
For an EGD, clients are given mild sedation but would still be able to follow commands. For shallow or slow respirations after the sedation is given, the nurse’s most appropriate action is to provide a physical stimulation such as a sternal rub and directions to breathe deeply. Naloxone is not the antidote for midazolam HCl. The Rapid Response Team is not needed at this point. The client does not need manual ventilation
A client is scheduled for a colonoscopy and the nurse has provided instructions on the bowel cleansing regimen. What statement by the client indicates a need for further teaching?
a. “It’s a good thing I love orange and cherry gelatin.”
b. “My spouse will be here to drive me home.”
c. “I’ll avoid ibuprofen for several days before the test.”
d. “I’ll buy a case of clear Gatorade before the prep.”
ANS: A
The client would be advised to avoid beverages and gelatin that are red, orange, or purple in color as their residue can appear to be blood. The other statements show an understanding of the preparation for the procedure.
A client had a colonoscopy and biopsy yesterday and calls the gastrointestinal clinic to report
a spot of bright red blood on the toilet paper today. What response by the nurse is appropriate?
a. Ask the client to call back if this happens again today.
b. Instruct the client to go to the emergency department.
c. Remind the client that a small amount of bleeding is possible.
d. Tell the client to come to the clinic this afternoon.
ANS: C
After a colonoscopy with biopsy, a small amount of bleeding is normal. The nurse would remind the client of this and instruct him or her to go to the emergency department for large amounts of bleeding, severe pain, or dizziness.
An older adult has had an instance of drug toxicity and asks why this happens, since the client has been on this medication for years at the same dose. What response by the nurse is best?
a. “Changes in your liver cause drugs to be metabolized differently.”
b. “Perhaps you don’t need as high a dose of the drug as before.”
c. “Stomach muscles atrophy with age and you digest more slowly.”
d. “Your body probably can’t tolerate as much medication anymore.”
ANS:A
Decreased liver enzyme activity depresses drug metabolism, which leads to accumulation of drugs—possibly to toxic levels. The other options do not accurately explain this age-related change
To promote comfort and the passage of flatus after a colonoscopy, in what position does the nurse place the client?
a. Left lateral
b. Prone
c. Right lateral
d. Supine
ANS: A
After colonoscopy, clients have less discomfort and quicker passage of flatus when placed in the left lateral position.
A nurse is assessing a client reporting right upper quadrant (RUQ) abdominal pain. What technique would the nurse use to assess this client’s abdomen?
a. Auscultate after palpating.
b. Avoid any type of palpation
c. Lightly palpate the RUQ first.
d. Lightly palpate the RUQ last.
ANS: D
If pain is present in a certain area of the abdomen, that area would be palpated last to keep the client from tensing which could possibly affect the rest of the examination. Auscultation of the abdomen occurs prior to palpation.
The nurse knows that a client with prolonged prothrombin time (PT) values (not related to medication) probably has dysfunction in which organ?
a. Kidneys
b. Liver
c. Spleen d. Stomach
ANS: B
Severe acute or chronic liver damage leads to a prolonged PT secondary to impaired synthesis of clotting proteins. The other organs are not related to this issue.
A client is recovering from an esophagogastroduodenoscopy (EGD) and requests something to drink. What action by the nurse is appropriate?
a. Allow the client cool liquids only.
b. Assess the client’s gag reflex.
c. Remind the client to remain NPO.
d. Tell the client to wait 4 hours.
ANS: B
The local anesthetic used during this procedure depresses the client’s gag reflex. After the procedure, the nurse would ensure that the gag reflex is intact before offering food or fluids. The client does not need to be restricted to cool beverages only and is not required to wait 4 hours before oral intake is allowed. Telling the client to remain NPO does not inform the client of when he or she can have fluids, nor does it reflect the client’s readiness for them.
The assistive personnel note that a client had a dark stool. What stool test would the nurse obtain for this client?
a. Culture and sensitivity
b. Parasites and ova
c. Occult blood test d. Total fat content
ANS: C
Dark stools are typical in clients who have lower GI bleeding. Therefore, an fecal occult blood test would be the most appropriate test as a follow-up.
The nurse is aware of the most recent American Cancer Society Screening Guidelines for colon cancer, which include which accepted testing modalities for people over the age of 50? (Select all that apply.)
a. Colonoscopy every 10 years
b. Endoscopy every 5 years
c. Computed tomography (CT) colonography every 5 years
d. Double-contrast barium enema every 10 years
e. Flexible sigmoidoscopy every 5 years
ANS:A,C,E
The options for colon cancer screening for people over the age of 50 include colonoscopy every 10 years and CT colonography, double-contrast barium enema, or flexible sigmoidoscopy every 5 years.
A client had an endoscopic retrograde cholangiopancreatography (ERCP). The nurse teaches the client and family about the signs of potential complications which include what problems? (Select all that apply.)
a. Cholangitis
b. Pancreatitis
c. Perforation
d. Renal lithiasis
e. Sepsis
ANS: A,B,C,E
Possible complications after an ERCP include cholangitis, pancreatitis, perforation, sepsis, and bleeding. Kidney stones are not a complication of ERCP.
The nurse working with older clients understands age-related changes in the gastrointestinal system. Which changes does this include? (Select all that apply.)
a. Decreased hydrochloric acid production
b. Diminished sensation that can lead to constipation
c. Fat not digested as well in older adults
d. Increased peristalsis in theGlaRrgAeDinEteSstLinAeB.COM
e. Pancreatic vessels become calcified
ANS: A,B,C,E
Several age-related changes occur in the gastrointestinal system. These include decreased hydrochloric acid production, diminished nerve function that leads to decreased sensation of the need to pass stool, decreased fat digestion, decreased peristalsis in the large intestine, and calcification of pancreatic vessels.
The nurse working with clients who have gastrointestinal problems knows that which laboratory values are related to which organ functions or dysfunctions? (Select all that apply.)
a. Alanine aminotransferase: biliary system
b. Ammonia: liver
c. Amylase: liver
d. Lipase: pancreas
e. Urine urobilinogen: stomach
ANS: B,D
Alanine aminotransferase and ammonia are related to the liver. Amylase and lipase are related to the pancreas. Urobilinogen evaluates both hepatic and biliary function.
A nurse cares for a client who is recovering from a colonoscopy. Which actions would the nurse take? (Select all that apply.)
a. Obtain vital signs every 15 to 30 minutes until alert.
b. Assess the client for rectal bleeding and severe pain.
c. Administer prescribed pain medications as needed.
d. Monitor the client’s serum and urine glucose levels.
e. Confirm the client has a ride home and plans to rest.
ANS: A,B,E
During the recovery phase after a colonoscopy, the nurse would obtain vital signs
every 15 to 30 minutes until the client is alert, assess for rectal bleeding or severe pain, and confirm the client has arranged for another person to drive home to get rest. Pain medications are not necessary after the procedure, and neither is glucose monitoring.
After teaching a client with irritable bowel syndrome (IBS), a nurse assesses the client’s understanding. Which menu selection indicates that the client correctly understands the dietary teaching?
a. Ham sandwich on white bread, cup of applesauce, carbonated beverage
b. Broiled chicken with brown rice, steamed broccoli, glass of apple juice
c. Grilled cheese sandwich, small banana, cup of hot tea with lemon
d. Baked tilapia, fresh green beans, cup of coffee with low-fat milk
ANS: B
Patients with IBS are advised to eat a high-fiber diet. Chicken with brown rice, broccoli, and apple juice has the highest fiber content. Clients should avoid alcohol, caffeine, and other gastric irritants.
A nurse assesses a client who is prescribed alosetron. Which assessment question would the nurse ask this client before starting the drug?
a. “Have you been experiencing any constipation?”
b. “Are you eating a diet high in fiber and fluids?”
c. “Do you have a history of high blood pressure?”
d. “What vitamins and supplements are you taking?”
ANS: A
Ischemic colitis is a life-threatening complication of alosetron. The nurse would assess the client for constipation because it places the client at risk for this complication. The other questions do not identify the risk for complications related to alosetron.
The nurse is caring for a client who is diagnosed with a complete small bowel obstruction. For what priority problem is this client most likely at risk?
a. Abdominal distention
b. Nausea
c. Electrolyte imbalance
d. Obstipation
ANS: C
The client who has a small bowel obstruction is at the highest risk for fluid and electrolyte imbalances, especially dehydration and hypokalemia due to profuse vomiting. Nausea, abdominal distention, and obstipation are also usually present, but these problems are not as life threatening as the imbalances in electrolytes
A nurse assesses clients at a community health center. Which client is at highest risk for developing colorectal cancer?
a. A 37-year-old who drinks eight cups of coffee daily.
b. A 44-year-old with irritable bowel syndrome (IBS).
c. A 60-year-old lawyer who works 65 hours per week.
d. A 72-year-old who eats fast food frequently.
ANS: D
Colon cancer is rare before the age of 40, but its incidence increases rapidly with advancing age. Fast food tends to be high in fat and low in fiber, increasing the risk for colon cancer. Coffee intake, IBS, and a heavy workload do not increase the risk for colon cancer.
A nurse assessing a client with colorectal cancer auscultates high-pitched bowel sounds and notes the presence of visible peristaltic waves. Which action would the nurse take?
a. Ask if the client is experiencing pain in the right shoulder.
b. Perform a rectal examination and assess for polyps.
c. Recommend that the client have computed tomography.
d. Administer a laxative to increase bowel movement activity.
ANS: C
The presence of visible peristaltic waves, accompanied by high-pitched or high-pitched bowel sounds, is indicative of bowel obstruction caused by the tumor. The nurse would contact the primary health care provider with these results and recommend a computed tomography scan for further diagnostic testing. This assessment finding is not associated with right shoulder pain; peritonitis and cholecystitis are associated with referred pain to the right shoulder. The nurse generalist is not qualified to complete a rectal examination for polyps, and laxatives would not help this client.
The nurse is caring for a client who has a postoperative paralytic ileus following abdominal surgery. What drug is appropriate to manage this nonmechanical bowel obstruction?
a. Alosetron
b. Alvimopan
c. Amitiptyline d. Amlodipine
ANS: B
Alvimopan is the appropriate drug to promote peristalsis for clients who have a paralytic ileus. The other drugs do not affect intestinal activity.
A nurse cares for a client with colorectal cancer who has a new colostomy. The client states, “I think it would be helpful to talk with someone who has had a similar experience.” How would the nurse respond?
a. “I have a good friend with a colostomy who would be willing to talk with you.”
b. “The ostomy nurse will be able to answer all of your questions.”
c. “I will make a referral to the United Ostomy Associations of America.”
d. “You’ll find that most people with colostomies don’t want to talk about them.”
ANS: C
Nurses need to become familiar with community-based resources to better assist clients. The local chapter of the United Ostomy Associations of America has resources for clients and their families, including ostomates (specially trained visitors who also have ostomies). The nurse would not suggest that the client speak with a personal contact of the nurse. Although the ostomy nurse is an expert in ostomy care, talking with him or her is not the same as talking with someone who actually has had a colostomy. The nurse would not brush aside the client’s request by saying that most people with colostomies do not want to talk about them. Many people are willing to share their ostomy experience in the hope of helping others.
The nurse is caring for a client with a large bowel obstruction due to fecal impaction. What position would be appropriate for the client while in bed?
a. Prone
b. Supine
c. Recumbent
d. Semi-Fowler
ANS: D
Having the client in a semi-sitting position helps to decrease the pressure caused by abdominal distention and promotes thoracic expansion to facilitate breathing.
A nurse cares for a client who had a colostomy placed in the ascending colon 2 weeks ago. The client states, “The stool in my pouch is still liquid.” How would the nurse respond?
a. “The stool will always be liquid with this type of colostomy.”
b. “Eating additional fiber will bulk up your stool and decrease diarrhea.”
c. “Your stool will become firmer over the next couple of weeks.”
d. “This is abnormal. I will contact your primary health care provider.”
ANS: A
The stool from an ascending colostomy can be expected to remain liquid because little large bowel is available to reabsorb the liquid from the stool. This finding is not abnormal. Liquid stool from an ascending colostomy will not become firmer with the addition of fiber to the client’s diet or with the passage of time.
A nurse teaches a client who is at risk for colorectal cancer. Which dietary recommendation would the nurse teach the client?
a. “Eat low-fiber and low-residual foods.”
b. “White rice and bread are easier to digest.”
c. “Add vegetables such as broccoli and cauliflower to your diet.”
d. “Foods high in animal fat help to protect the intestinal mucosa.”
ANS: C
The client would be taught to modify his or her diet to decrease animal fat and refined carbohydrates. The client should also increase high-fiber foods and Brassica vegetables, including broccoli and cauliflower, which help to protect the intestinal mucosa from colon cancer.
A nurse cares for a client who has a new colostomy. Which action would the nurse take?
a. Empty the pouch frequently to remove excess gas collection.
b. Change the ostomy pouch and barrier every morning.
c. Allow the pouch to completely fill with stool prior to emptying it.
d. Use surgical tape to secure the pouch and prevent leakage.
ANS: A
The nurse would empty the new ostomy pouch frequently because of excess gas collection, and empty the pouch when it is one-third to one-half full of stool. The ostomy pouch does not need to be changed every morning. Ostomy barriers would be used to secure and seal the ostomy appliance; surgical tape would not be used.
A nurse cares for a client who has a family history of colorectal cancer. The client states, “My father and my brother had colon cancer. What is the chance that I will get cancer?” How would the nurse respond?
a. “If you eat a low-fat and low-fiber diet, your chances decrease significantly.”
b. “You are safe. This is an autosomal dominant disorder that skips generations.”
c. “Preemptive surgery and chemotherapy will remove cancer cells and prevent
cancer. ”
d. “You should have a colonoscopy more frequently to identify abnormal polyps
early. ”
ANS: D
The nurse would encourage the patient to have frequent colonoscopies to identify abnormal polyps and cancerous cells early. The abnormal gene associated with colon cancer is an autosomal dominant gene mutation that does not skip a generation and places the client at high risk for cancer. Changing the client’s diet to more high-fiber (not low-fiber) and preemptive chemotherapy may decrease the client’s risk of colon cancer but will not prevent it.
The nurse is caring for a client who is planning to have a laparoscopic colon resection for colorectal cancer tomorrow. Which statement by the client indicates a need for further teaching?
a. “I should have less pain after this surgery compared to having a large incision.”
b. “I will probably be in the hospital for 3 to 4 days after surgery.”
c. “I will be able to walk around a little on the same day as the surgery.”
d. “I will be able to return to work in a week or two depending on how I do.”
ANS:B
All of these statements are correct about having minimally invasive laparoscopic surgery except that the hospital stay will likely be only 1 or 2 days
The nurse is caring for a client who has been prescribed lubiprostone for irritable bowel syndrome (IBS-C). What health teaching will the nurse include about taking this drug?
a. “This drug will make you very dry because it will decrease your diarrhea.”
b. “Be sure to take this drug with food and water to help manage constipation.”
c. “Avoid people who have infection as this drug will suppress your immune system.”
d. “Include high-fiber foods in your diet to help produce more solid stools.”
ANS: B
Lubiprostone is an oral laxative approved for women who have IBS with constipation (IBS-C). Water and food will also help to improve constipation. The drug is not used for clients who have diarrhea and does not affect the immune system. Although high-fiber foods are important for clients who have IBS, this client does not need fiber to help make stool more solid. Instead the fiber will help prevent constipation.
A client is admitted with a diagnosis of possible strangulated inguinal hernia. For which complication would the nurse monitor? a. Paralytic ileus b. Bowel volvulus c. Sepsis d. Colitis
ANS: C
The client who has a strangulated inguinal hernia would likely develop bowel necrosis which can lead to sepsis. The nurse would observe for early signs and symptoms of sepsis such as fever, tachypnea, and tachycardia. If the client’s condition is not promptly managed, bowel perforation, septic shock, and death can result.
The nurse is teaching a client how to avoid the formation of hemorrhoids. What lifestyle change would the nurse include?
a. Avoiding alcohol
b. Quitting smoking
c. Decreasing fluid intake
d. Increasing dietary fiber
ANS:C
The major cause of hemorrhoid formation is constipation. Therefore, the nurse teaches the client ways to prevent constipation, which include increasing dietary fiber, increasing exercise and fluid intake, and avoiding straining when have a stool.
The nurse is caring for a client with probable colorectal cancer (CRC). What assessment findings would the nurse expect? (Select all that apply.)
a. Weight gain
b. Rectal bleeding
c. Anemia
d. Change in stool shape
e. Electrolyte imbalances
f. Abdominal discomfort
ANS: B,C,D,F
The client who has CRC usually experiences unintentional weight loss and rectal bleeding, either gross or occult. As a result of bleeding, the client has anemia and fatigue. Electrolyte imbalances are not common, but the client may note that the shape or consistency of stool has changed.
After teaching a client who is recovering from a colon resection to treat early-stage colorectal cancer (CRC), the nurse assesses the client’s understanding. Which statements by the client indicate understanding of the teaching? (Select all that apply.)
a. “I must change the ostomy appliance daily and as needed.”
b. “I will use warm water and a soft washcloth to clean around the stoma.”
c. “I might start bicycling and swimming again once my incision has healed.”
d. “I will make sure that I make lifestyle changes to prevent constipation.”
e. “I will be sure to have the recommended colonoscopies.”
ANS: C,D,E
The client has had a colon resection for early CRC and there is no indication that the client also had a colostomy. Follow up with recommended colonoscopies are essential to monitor for CRC recurrence. Avoiding constipation will help improve intestinal motility which helps to decrease the risk for CRC recurrence. Exercise and other activities do not need to be restricted after the client has healed.
A nurse assesses a client with irritable bowel syndrome (IBS). Which questions would the nurse include in this client’s assessment? (Select all that apply.)
a. “Which food types cause an exacerbation of symptoms?”
b. “Where is your pain or discomfort and what does it feel like?”
c. “Have you lost a significant amount of weight lately?”
d. “Are your stools soft, watery, and black?”
e. “Do you often experience nausea and vomiting”
ANS: A,B
The nurse would ask the client about factors that may cause exacerbations of symptoms, including food, stress, and anxiety. The nurse would also assess the location, intensity, and quality of the patient’s pain or discomfort. Clients who have IBS do not usually lose weight, have nausea and vomiting, or have stools that are black
A nurse is caring for a client who has been diagnosed with a small bowel obstruction. Which assessment findings would the nurse correlate with this diagnosis? (Select all that apply.)
a. Serum potassium of 2.8 mEq/L (2.8 mmol/L)
b. Loss of 15 lb (6.8 kg) without dieting
c. Abdominal pain in upper quadrants
d. Low-pitched bowel sounds
e. Serum sodium of 121 mEq/L (121 mmol/L)
ANS: A,C,E
Small bowel obstructions often lead to severe fluid and electrolyte imbalances. The client is hypokalemic (normal range is 3.5 to 5.0 mEq/L [3.5 to 5.0 mmol/L]) and hyponatremic ). Abdominal pain across the upper quadrants is associated with small bowel obstruction. Dramatic weight loss without dieting followed by bowel obstruction leads to the probable development of colon cancer. High-pitched sounds may be noted with small bowel obstructions.
The nurse is caring for a client who has a nasogastric tube (NGT). Which actions would the nurse take for client care? (Select all that apply.)
a. Assess for proper placement of the tube every 4 hours or per agency policy.
b. Flush the tube with water every hour to ensure patency.
c. Secure the NG tube to the client’s chin.
d. Disconnect suction when auscultating bowel peristalsis.
e. Monitor the client’s skin around the tube site for irritation.
ANS: A,D,E
The nurse would frequently assess for NGT placement, patency, and output (drainage) every 4 hours or per agency policy. The nurse would also monitor the skin around the tube for irritation and secure the tube to the client’s nose. When auscultating bowel sounds for peristalsis, the nurse would disconnect suction. NGT irrigation may or may not be prescribed. If it is prescribed, hourly irrigation is not appropriate.
The nurse is caring for a client who has perineal surgical wound. Which actions would the nurse take to promote comfort and wound healing? (Select all that apply.)
a. Assist the client into a side-lying position.
b. Use a rubber donut device when sitting up.
c. Apply warm compresses three to four times a day.
d. Instruct the client to wear boxer shorts.
e. Place an absorbent dressing over the wound.
ANS: A,C,E
The nurse would place an absorbent pad over the wound and apply warm compresses to the wound area. The nurse would also instruct the male client to wear jockey-type shorts for support rather than boxers, assume a side-lying position in bed, avoid sitting for long periods, and use foam pads or soft pillows whenever in a sitting position. The patient should avoid the use of air rings or rubber donut devices.
The nurse is caring for a client who just had a minimally invasive inguinal hernia repair. Which nursing actions would the nurse implement? (Select all that apply.)
a. Apply ice to the surgical area for the first 24 hours after surgery.
b. Encourage ambulation with assistance within the first few hours after surgery.
c. Encourage deep breathing after surgery but teach the client to avoid coughing.
d. Assess vital signs frequently for the first few hours after surgery.
e. Teach the client to rest for several days after surgery when at home.
f. Teach the client not to lift more than 10 lb (4.5 kg) until allowed by the surgeon.
ANS: A,B,C,D,E,F
All of these nursing actions are appropriate for the client having MIS for inguinal hernia repair.
The nurse is teaching a client who had a descending colostomy 2 days ago about the ostomy stoma. Which changes in the stoma would the nurse teach the client to report to the primary health care provider? (Select all that apply.)
a. Stool consistency is similar to paste.
b. Stoma becomes dark and dull.
c. Skin around the stoma becomes excoriated.
d. Skin around stoma becomes protruded.
e. Stoma becomes retracted into the abdomen
ANS: B,C,D,E
A colostomy placed in the descending colon would be expect to have a paste-like stool consistency. However, if the stoma becomes retracted or discolored, the client should report those changes to the primary health care provider. Skin around the stoma that becomes protruded would suggest the formation of a peristomal hernia, and skin excoriation needs appropriate management. Therefore, both of those skin changes would need to be reported to the primary health care provider.
