Deck 44: Care of the Patient with a Gastrointestinal Disorder

Question 1

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

A) Duodenal ulcer
B) Gastritis
C) Achalasia
D) Peptic ulcer

Answer 1

Peptic ulcer

Question 2

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

A) A paralytic ileus
B) Narrowed bowel lumen from an inflammatory process
C) Tumor of the bowel
D) Fecal impaction

Answer 2

A paralytic ileus

Question 3

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

A) Evaluation and assessment of dietary intake of fiber
B) Evaluation and assessment of patient cleanliness
C) Evaluation and assessment of periostomal skin integrity
D) Evaluation and assessment of the adequacy of the collection device

Answer 3

Evaluation and assessment of periostomal skin integrity

Question 4

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

A) a tablet and pencil as a communication aid.
B) a TV for diversion.
C) a bell to summon help.
D) a walkie-talkie.

Question 5

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

A) Turn patient to right side
B) Give patient ice chips to moisten mouth
C) Attach NG tube to suction
D) Irrigate NG tube

Question 6

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

A) protein due to the loss of some of the digestive processes.
B) vitamin B12 due to the loss of the intrinsic factor.
C) bulk to prevent constipation.
D) vitamin A due to the loss of the gastric lining.

Question 7

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

A) Clamped for 10 minutes every hour
B) Kept patent with irrigation
C) Frequently repositioned to the opposite nostril
D) Changed every 72 hours

Question 8

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

A) Eating a high-carbohydrate diet
B) Drinking 10 oz of fluids with meals
C) Remaining upright for 2 hours after meals
D) Eating six small daily meals high in protein and fat

Question 9

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

A) Encourage him to express his concern
B) Suggest that he discuss his concerns with his physician
C) Counsel him that everything will be all right
D) Assure him that his concerns will diminish when he is able to care for his colostomy

Question 10

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

A) Rapid absorption in the upper GI tract
B) Decompression of the stomach
C) Reduction of diarrheic episodes
D) A permanent nutritional support

Question 11

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

A) gastric lining of the stomach.
B) villi of the small intestine.
C) bile of the liver in the large intestine.
D) excretion from the cecum.

Question 12

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

A) "I know famotidine will not interfere with my Coumadin."
B) "I take the Riopan at least 2 hours after any of my other drugs."
C) "Boy! That Riopan keeps my stomach happy!"
D) "I take both those meds at the same time every morning."

Question 13

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

A) Strangulated
B) Hiatal
C) Ventral
D) Umbilical

Question 14

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

A) Chest pain
B) Seizure
C) Tachycardia
D) Massive diarrhea

Question 15

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

A) Use an oil retention enema to facilitate collection
B) Refrigerate the specimen immediately
C) Obtain three different stool specimens on subsequent days
D) Check the specimen for the presence of occult blood

Question 16

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

A) Drinking 10 oz of milk with every meal
B) Lie down after eating
C) Panting through mouth when symptoms begin
D) Eating small meals

Question 17

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

A) "This is a temporary solution. It will be closed in 6 weeks."
B) "This seems awful now, but you won't have the problems you had before."
C) "If everything goes well the surgeon can close this colostomy in about a year."
D) "With the appropriate pouch and loose clothing, no one will notice a thing."

Question 18

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

A) Eat a diet high in fiber content
B) Increase dietary fat intake
C) Exercise to increase intra-abdominal pressure
D) Take daily laxatives

Question 19

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

A) Consume only liquid
B) Avoid fruit juices
C) Drink 10 oz of fluid with each meal
D) Lie down for 30 minutes after each meal

Question 20

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

A) Hiatal hernia
B) Gastritis
C) Perforation
D) Bowel obstruction

Question 21

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

A) Constant diarrhea
B) Excessive flatulence
C) Cachexia
D) Cramps
E) Rectal bleeding
F) Anemia

Question 22

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

A) Introducing irritating foods in minute amounts to desensitize the stomach
B) Restricting fluid to 1000 mL per day
C) Eating 6 small meals a day
D) Drinking alcohol and caffeine in moderation

Question 23

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

A) omeprazole (Prilosec)
B) ranitidine (Zantac)
C) sucralfate (Carafate)
D) olsalazine (Dipentum)

Question 24

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

Question 25

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

A) Gray-black
B) Dark green
C) Red-orange
D) Yellow

Question 26

What is the most lethal complication of a peptic ulcer?

A) Bleeding
B) Perforation
C) Severe pain
D) Gastric outlet obstruction

Question 27

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

A) It eradicates H. pylori
B) It inhibits gastric acid secretion
C) It protects the gastric mucosa
D) It neutralizes or reduces the acidity of stomach contents

Question 28

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

A) cessation of smoking.
B) good oral care.
C) regular checkups if dysphagia is present.
D) reducing excessive weight.
E) limiting alcohol consumption.
F) reduction of consumption of citrus fruits.

Question 29

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

A) Increasing physical activity
B) Taking bulk-forming laxatives
C) Increasing fiber intake
D) Drinking at least 1000 mL fluid
E) Taking a daily stool softener
F) Using tap water enemas for persons with altered mobility

Question 30

Flexible sigmoidoscopy should be performed every ________ years.

Question 31

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

Question 32

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

A) Application of ice bag
B) Administration of small tap water enema
C) Warm compress over entire abdomen
D) Ambulate for short periods in the room

Question 33

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

A) Discomfort at least 3 days a month
B) Blood in stool
C) Pain relieved by defecation
D) Excessive flatulence
E) Nausea and vomiting associated with onset
F) Onset associated with change in stool consistency or frequency

Question 34

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

Question 35

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

A) "Go for it. Alternative medicine does great things."
B) "YIKES! An acupuncturist?"
C) "It may help, but there has been no clinical proof of its effectiveness."
D) "You should confirm that the acupuncturist is licensed."

Question 36

Why are peptic ulcers a common problem of aging?

A) Because of overuse of antibiotics
B) Because of overuse of antacids
C) Because of overuse of NSAIDs
D) Because of overuse of laxatives

Question 37

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

A) Warm bath
B) A tap water enema
C) Glycerin suppository
D) Large glass of warm lemonade

Question 38

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

Question 39

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

A) loud and clearly audible.
B) high pitched.
C) hyperactive.
D) absent.

Question 40

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

A) Expose her to sunlight at least 30 minutes a day for vitamin D synthesis
B) Tell her to drink at least 1500 mL of fluid a day
C) Advise assessing self for rash
D) Use alternate birth control methods to oral contraception
E) Take drug on an empty stomach

Question 41

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

A) Malabsorption
B) Weight loss/vitamin deficiency
C) Systemic involvement
D) Diarrhea
E) Ingestion of gluten
F) Destruction of villi in the small intestine

Question 42

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

A) Increase in intra-abdominal pressure
B) Weakened wall of sigmoid
C) Pouch fills with fecal matter
D) Pouch protrudes through smooth muscle
E) Narrowing of bowel lumen
F) Inflammation of diverticula