Nurs 341 Ch. 55

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Medical Surgical Nursing: Patient-Centered Collaborative Care, 7th Edition; Ignatavicius, Workman; Chapter 55 Assessment of the gastrointestinal system

The main function of the GI tract, with the aid of organs such as the _______ and the ______, is the digestion of food to meet the body's nutritional needs and the elimination of ______ resulting from digestion.

pancreas; liver; waste

Lumen

inner wall of the GI tract

GI tract has four layers:

mucosa, submucosa, muscularis, serosa

Mucosa

innermost layer of GI tract includes a thin layer of smooth muscle and specialized exocrine gland cells and is surrounded by the submucosa.

Submucosa

surrounds the mucosa and and is surrounded BY the muscularis; is made up of connective tissue

Muscularis

surrounds the submucosa; is composed of both circular and longitudinal smooth muscles which work to keep contents moving through the tract (muscularis = muscles for contraction)

Serosa

the outermost layer of the GI tract; composed of connective tissue; surrounds the muscularis

How long is the GI tract

continuous from mouth to anus (25 foot length)

GI tract is divided into what specialized regions?

mouth, pharynx, esophagus, stomach, and small and large intestines

What things empty into the GI tract to aid in digestion?

secretions of the salivary, gastric, and intestinal glands; liver; and pancreas

What are the functions of the GI tract?

secretion, digestion, absorption, motility, and elimination.

Before food can be absorbed, it must be broken down to a liquid, called ________.

chyme

Digestion

the mechanical and chemical process in which complex foodstuffs are broken down into simpler forms that can be used by the body.

During digestion, the stomach secretes __________ _______, the liver secretes _____, and digestive _________ are released from accessory organs, aiding in food breakdown.

hydrochloric acid; bile; enzymes

After the digestive process is complete, _______ takes place.

absorption

At the upper end of the esophagus is a sphincter referred to as the upper esophageal sphincter (UES). When at rest, the UES is closed to prevent?

air into the esophagus during respiration.

The portion of the esophagus just above the gastroesophageal (GE) junction is referred to as the lower esophageal sphincter (LES). When at rest, the LES is normally closed to?

prevent reflux of gastric contents into the esophagus.

If the LES does not work properly, ________ ______ _______ can develop

gastroesophageal reflux disease (GERD)

Where is the stomach located?

midline and left upper quadrant of the abdomen and has four regions

From top to bottom, name the four regions of the stomach

Cardia, Fundus, Body (or Corpus), antrum (pylorus)

The 2 sphincters of the stomach?

cardiac (upper), pyloric (lower) (they both prevent backflow)

Decreased gastric HCl can lead to:

decreased absorption of essential minerals like iron.

Older adults are more at risk for _____ _____ than are younger adults. Younger adults are more at risk for _____ _____ ______. People of Jewish descent tend to have more _____ than other groups have.

stomach cancer; inflammatory bowel disease (IBD); IBD

Large amounts of aspirin or NSAIDs can predispose the patient to:

peptic ulcer disease and GI bleeding.

Long-term use of laxatives or enemas can cause dependence and result in:

constipation and electrolyte imbalance.

Some herbal preparations, especially ayurvedic herbs, can affect:

appetite, absorption, and elimination.

_________ is a major risk factor for most GI cancers.

Smoking

Finally, investigate the patient's travel history b/c:

This information may provide clues about the cause of symptoms like diarrhea.

Changes in the Gastrointestinal System Related to Aging: Physiologic Change - Stomach

Atrophy of the gastric mucosa is characterized by a decrease in the ratio of gastrin-secreting cells to somatostatin-secreting cells. This change leads to decreased hydrochloric acid levels (hypochlorhydria).

Changes in the Gastrointestinal System Related to Aging: Disorders Related to Change - Stomach

Decreased hydrochloric acid levels lead to decreased absorption of iron and vitamin B12 and to proliferation of bacteria. Atrophic gastritis occurs as a consequence of bacterial overgrowth.

Changes in the Gastrointestinal System Related to Aging: Nursing Interventions - Stomach

Encourage bland foods high in vitamins and iron. (Bland foods help prevent gastritis.); Assess for epigastric pain. (Assessment helps detect gastritis.)

Changes in the Gastrointestinal System Related to Aging: Physiologic Change - Large Intestine

Peristalsis decreases, and nerve impulses are dulled.

Changes in the Gastrointestinal System Related to Aging: Disorders Related to Change - Large Intestine

Decreased sensation to defecate can result in postponement of bowel movements, which leads to constipation and impaction.

Changes in the Gastrointestinal System Related to Aging: Nursing Interventions- Large Intestine

Encourage a high-fiber diet and 1500 mL of fluid intake daily -if not contraindicated. & These interventions increase the sensation of needing to defecate. (These interventions increase the sensation of needing to defecate.);

Changes in the Gastrointestinal System Related to Aging: Physiologic Change - Pancreas

Distention and dilation of pancreatic ducts change. Calcification of pancreatic vessels occurs with a decrease in lipase production.

Changes in the Gastrointestinal System Related to Aging: Disorders Related to Change - Pancreas

Decreased lipase level results in decreased fat absorption and digestion. Steatorrhea, or excess fat in the feces, occurs because of decreased fat digestion.

Changes in the Gastrointestinal System Related to Aging: Nursing Interventions- Pancreas

Encourage small, frequent feedings.(Small, frequent feedings help prevent steatorrhea.); Assess for diarrhea. (Diarrhea may be steatorrhea. Excessive diarrhea can lead to dehydration.)

Changes in the Gastrointestinal System Related to Aging: Physiologic Change - Liver

A decrease in the number size of hepatic cells leads to decreased liver weight and mass. This change and an increase in fibrous tissue lead to decreased protein synthesis and changes in liver enzymes. Enzyme activity and cholesterol synthesis are diminished.

Changes in the Gastrointestinal System Related to Aging: Disorders Related to Change - Liver

Decreased enzyme activity depresses drug metabolism, which leads to accumulation of drugs—possibly to toxic levels.

Changes in the Gastrointestinal System Related to Aging: Nursing Interventions- Liver

Assess for adverse effects of all drugs. (Assessment can help detect drug toxicity.)

Gordon's re Elimination Pattern

What is your usual bowel elimination pattern? Frequency? Character? Discomfort? Laxatives?; Do you have any pain or bleeding associated with bowel movements?; Have you experienced any changes in your usual bowel pattern?; When was your last rectal examination?; Have you ever had an endoscopy or a colonoscopy?; What is your usual urinary elimination pattern? Frequency? Amount? Color? Odor? Control?; Have you noticed a change in the amount of urine?

Lactase is needed to:

convert lactose in milk and other dairy products to glucose and galactose.

Inquire about any unintentional weight loss, because:

some cancers of the GI tract may present in this manner.

What is a GI disorder that has a genetic predisposition?

familial adenomatous polyposis (FAP) (this is an inherited autosomal dominant disorder that predisposes the patient to colon cancer.)

What are some terms used to describe abdominal pain?

burning, gnawing, stabbing (ask Pt to "point" to involved site)

High-fat meals often cause pain in what GI organ?

gallbladder

Physical assessment involves a comprehensive examination of the patient's:

nutritional status, mouth, and abdomen.

Abdominal assessment differs how?

Inspection, auscultation, then light palpation (so as not to increase intestinal activity & bowel sounds)

When assessing the abdomen, nurses cannot do what? These things are left to the Nurse Practitioners or the doc.

percussion & deep palpation

Abdominal shape is best assessed when standing at the side of the bed and looking down and at eye level (for symetry). What terms are used to chart?

rounded, flat, concave, or distended

Don't forget about the umbilicus for any deviations or the presence of ecchymosis termed?

Cullen's sign (an indication of intra-abdominal bleeding)

If a bulging, pulsating mass is present, do not touch the area because the patient may have an abdominal aortic aneurysm, a life-threatening problem. What should you do?

Notify the health care provider of this finding immediately!

If peristaltic movements are observed, note the quadrant of origin and the direction of peristaltic flow. Why should you report this finding to the health care provider?

because it may indicate an intestinal obstruction.

Auscultation of the abdomen is performed with the diaphragm of the stethoscope because bowel sounds are usually _______ pitched. High or low?

High

How long should you listen for bowel sounds?

5-15 seconds

Normal frequency of bowel sounds is what?

5-30/minute

Bowel sounds would be diminished or absent when?

after abdominal surgery or in the patient with peritonitis or paralytic ileus.

the best, most reliable method for assessing the return of peristalsis after abdominal surgery is to do what?

ask the patient if he or she has passed flatus within the past 8 hours or a stool within the past 12 to 24 hours.

Borborygmus

Increased bowel sounds, especially loud, gurgling sounds, result from increased motility of the bowel. These sounds are usually heard in the patient with diarrhea or gastroenteritis or above a complete intestinal obstruction.

If a Pt has a complete obstruction, will you hear borborygmus above or below it?

above

Why do you percuss the abdomen?

to determine the size of solid organs; to detect the presence of masses, fluid, and air; and to estimate the size of the liver and spleen.

What terms are used to describe normal finidings on percussion?

Tympanic or Dull

Hepatomegaly (enlarged liver) or Splenomegaly (enlarged spleen) produces which percussed sound?

Dullness

What's the purpose of palpation?

to determine the size and location of abdominal organs and to assess for the presence of masses or tenderness.

As nurses, what type of palpaiton are we permitted to perform? How deep can we palpate?

light; 0.5-1 inch

During palpation, if the Pt becomes rigid (NOT voluntary guarding), what could this indicate?

peritoneal inflammation

Blumberg's sign

rebound tenderness (appendicitis presents with this)

Labs: What organ damage leads to a prolonged PT, secondary to impaired synthesis of clotting proteins?

chronic liver damage

Labs: Name an electrolyte absorbed in the GI tract that may be measured to detect malabsorption.

calcium

Labs: What are AST and ALT?

Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are two enzymes found in the liver and other organs. These enzymes are elevated in most liver disorders, but they are highest in conditions that cause necrosis, such as severe viral hepatitis and cirrhosis.

Labs: What can elevations in serum amylase and lipase indicate?

acute pancreatitis

Labs: Conjugated (direct) bilirubin (normally 0.1-0.3 mg/dL) show hepatic damage. What could increased levels could indicate?

Biliary obstruction

Labs: Unconjugated (indirect) bilirubin (normally 0.2-0.8 mg/dL) show hepatic damage. What could increased levels could indicate?

hemolysis; hepatic damage

Labs: Ammonia (normal 15-110 mg/dL) increased values indicate possible what?

hepatic disease s/a cirrhosis

Labs: Increased serum amylase (normal 56-90 international units/L or 25-125 units/L (SI units) indicate possible what?

acute pancreatitis

Labs: Increased serum lipase (normal 0-110 units/L) indicate possible what?

acute pancreatitis

Two primary oncofetal antigens—CA19-9 and CEA—are evaluated to diagnose, monitor the success of what?

cancer therapy, and assess for the recurrence of cancer in the GI tract. (also seen in benign GI conditions)

Which lab, that can actually be performed at home to obtain multiple (3) samples, measures for the presence of blood in the stool from GI bleeding (often from colorectal disease)?

fecal occult blood test (FOBT)

What is an O & P?

stool sample collected to test for ova and parasites (dx parasitic infection)

Another common stool test is for the presence of a bacterial infection called Clostridium difficile. What is C-Diff?

Prolonged antibiotic therapy, especially in older adults, depresses the natural intestinal flora, causing an overgrowth of C. difficile. The bacterium releases a toxin that causes colonic epithelium necrosis resulting in severe diarrhea that can be transmitted from person to person. You MUST actually wash your hands to get it off. The alcohol hand rub does not get rid of the spores.

An upper GI radiographic series is an x-ray visualization from the _____ to the ______ _______.

mouth; duodenojejunal junction

Barium swallow is used on which test(s)?

upper GI radiographic series;

Which test is an extension of the upper GI radiographic series and extends further, up to and including the ileocecal junction AND it detects disorders of what?

small bowel follow-through (SBFT); disorders of the jejunum or ileum

Because endoscopy procedures allow for direct visualization of the internal GI tract, SBFT and upper GI radiographic series are no longer commonly performed. If they ARE, what instructions do you give the Pt?

Remind the patient to withhold foods and liquids for 8 hours before the test. If possible, opioid analgesics and anticholinergic medications are withheld for 24 hours before the test because they decrease intestinal tract motility. Instruct the patient about the barium preparation and the need to drink about 16 ounces of the barium. The radiology nurse or technician explains that a rotating examination table will be used to assist the patient in assuming the vertical, supine, prone, and lateral positions required for this test.

Following a barium swallow, what color is the stool and for how long? What does Pt do to rid it? What do you teach the Pt to report?

chalky white; 24-72 hours; drink plenty of liquids and take mild laxative; abdominal fullness, pain, or a delay in return to brown stools.

A lower GI series is aka?

barium enema (an x-ray of the large intestine) (again, not commonly used d/t colonoscopy)

PTC

percutaneous transhepatic cholangiography; an x-ray of the biliary duct system using an iodinated dye instilled via a percutaneous needle inserted through the liver into the intrahepatic ducts. Not commonly used b/c better info can be obtained using ultrasound scans and endoscopic retrograde cholangiopancreatography (ERCP)

CT or CT scan

provides a noninvasive cross-sectional x-ray view that can detect tissue densities and abnormalities in the abdomen, including the liver, pancreas, spleen, and biliary tract. It may be performed with or without contrast media.

Instructions for CT scan?

the patient is told that he or she will need to lie still in a rather enclosed space of the machine. He or she must remove all jewelry and metal. If contrast medium is to be used, ask about allergies to seafood and iodine. The patient is NPO for at least 4 hours before the test if a contrast medium is to be used. IV access will be required for injection of the contrast medium. Advise the patient that he or she may feel warm and flushed on injection. The patient who is mildly claustrophobic may require a mild sedative to tolerate the study. The radiologic technician instructs the patient to lie still and to hold his or her breath when asked to take a series of images. The test takes about 30 minutes.

Endoscopy

direct visualization of the GI tract using a flexible fiberoptic endoscope. It is commonly requested to evaluate bleeding, ulceration, inflammation, tumors, and cancer of the esophagus, stomach, biliary system, or bowel. Obtaining specimens for biopsy and cell studies (e.g., H. pylori) is also possible through the endoscope. The patient must sign an informed consent form before having these invasive studies.

Esophagogastroduodenoscopy (EGD)

a visual examination of the esophagus, stomach, and duodenum. This procedure has significantly reduced the number of upper GI series that are done. If GI bleeding is found during an EGD, the physician can inject a sclerotherapy agent into the affected area to stop the bleeding. If the patient has an esophageal stricture, it can be dilated during an EGD.

What do you teach the Pt regarding EGD?

to remain NPO for 6 to 8 hours before the procedure. Usual drug therapy for hypertension or other diseases may be taken the morning of the test. However, diabetic patients should consult their health care provider for special instructions. Patients are also usually asked to avoid anticoagulants, aspirin, or NSAIDs for several days before the test unless it is absolutely necessary. Tell the patient that a flexible tube will be passed down the esophagus while he or she is under moderate sedation. Drugs for sedation are used. A local anesthetic is sprayed to inactivate the gag reflex and facilitate passage of the tube. Explain that this anesthetic will depress the gag reflex and that swallowing will be difficult. If the patient has dentures, they are removed.

What position is the Pt in during an EGD?

left lateral decubitus (Sims' - left side-lying)

What do you do following an EGD?

vital signs frequently (usually every 30 minutes) until the sedation wears off. The siderails of the bed are raised during this time. The patient remains NPO until the gag reflex returns (usually in 1 to 2 hours). The priority for care is to prevent aspiration. Do not offer fluids or food by mouth until the gag reflex is intact! Monitor for signs of perforation, such as pain, bleeding, or fever. Teach the patient to not drive for at least 12 hours after the procedure because of sedation. Remind him or her that a hoarse voice or sore throat may persist for several days after the test. Throat lozenges can be used to relieve throat discomfort.

Esophagogastroduodenoscopy allows visualization of the esophagus, the stomach, and the duodenum. If the esophagus is the focus of the examination, the procedure is called __________. If the stomach is the focus, the procedure is called ___________.

esophagoscopy; gastroscopy

Endoscopic retrograde cholangiopancreatography (ERCP) includes visual and radiographic examination of what?

the liver, gall bladder, bile ducts, and pancreas to identify the cause and location of obstruction.

How does the Pt prepare for an ERCP (Endoscopic retrograde cholangiopancreatography)?

NPO for 6 to 8 hours before the test. The patient requires IV access for moderate sedation drugs. Ask about prior exposure to x-ray dye and any sensitivities or allergies. If the patient has dentures, they are removed.

How does an ERCP differ from an EGD?

the endoscope is advanced farther to the duodenum and into the biliary tract. Lasts from 30 min to 2 hrs.

Following an ERCP?

assess vital signs frequently, usually every 15 minutes, until the patient is stable. To prevent aspiration, check to ensure that the gag reflex has returned before offering fluids or food. Teach the patient and family to monitor for severe postprocedure complications at home, including cholangitis (gallbladder inflammation), perforation, sepsis, and pancreatitis. The patient has severe pain if any of these complications occur. Fever is present in sepsis. These problems do not occur immediately after the procedure but may take several hours to 2 days to develop. Colicky abdominal pain can result from air instilled during the procedure. Instruct the patient to report abdominal pain, fever, nausea, or vomiting that fails to resolve after returning home. Be sure that the patient has someone to drive him or her home if the test was done on an ambulatory basis.

Enteroscopy (aka Small bowel capsule endoscopy)

Pt swallows a "camera"; provides a view of the small intestine; It is used to evaluate and locate the source of GI bleeding.; The capsule battery lasts around 8 hours so it is not used to view the colon.; The patient must fast (water only) for 8 to 10 hours before the test and be NPO for the first 2 hours of the testing.;

Colonoscopy

an endoscopic examination of the entire large bowel

At what age and how often is it suggested that both men and women get a colonoscopy?

50; q 10 years

What indicates a high risk for cancer?

family hx

Pt prep for a colonoscopy?

CL diet for 12-24 hrs; NPO (except water) for 6 - 8 hrs prior; avoid aspirin and NSAIDs for several days prior; Anticoagulants might be w/held; Diabetics need to check w/ HCP about drug therapy requirements on the day of the test because they are NPO.; Go-Lytely the day before; IV access for sedaton; Atropine is available in case of bradycardia resulting for vasovagal response

Follow-up care r/t colonoscopy

Check vital signs every 15 minutes until the patient is stable. Keep the siderails up until the patient is fully alert. Observe for signs of perforation (causes severe pain) and hemorrhage, such as a rapid drop in blood pressure. Reassure the patient that a feeling of fullness, cramping, and passage of flatus are expected for several hours after the test. If a polypectomy or tissue biopsy was performed, there may be a small amount of blood in the first stool after the colonoscopy. However, report excessive bleeding or severe pain to the health care provider immediately. As with other endoscopic procedures, the patient will need someone to provide transportation home. Remind the patient to avoid driving for 12 hours after the procedure because of the effects of sedation.

A noninvasive imaging procedure to obtain multi-dimensional views of the entire colon is the CT colonography.

Virtual Colonoscopy

Sigmoidoscopy (proctosigmoidoscopy)

an endoscopic examination of the rectum and sigmoid colon using a flexible scope. The purpose of this test is to screen for colon cancer, investigate the source of GI bleeding, or diagnose or monitor inflammatory bowel disease.

Sigmoidoscopy can be used as an alternative to colonoscopy for colorectal cancer screening. At what age and frequency is a sigmoidoscopy recommended?

50; q 5 years

Pt prep for sigmoidoscopy?

CL diet 24 hrs pretest; cleansing enema or Fleet's (sodium biphosphate) morning of; laxative evening before; Left side/knee-chest position; NO MODERATE SEDATION IS REQUIRED; Inform the patient that mild gas pain and flatulence may be experienced from air instilled into the rectum during the examination. If a biopsy was obtained, a small amount of bleeding may be observed. Instruct the patient that excessive bleeding should be reported immediately to the health care provider.

Gastric Analysis

measures the hydrochloric acid and pepsin content for evaluation of aggressive gastric and duodenal disorders (e.g., Zollinger-Ellison syndrome).;

There are 2 tests in gastric analysis. What are they?

basal gastric secretion and gastric acid stimulation. (Basal gastric secretion measures the secretion of hydrochloric acid between meals. If only small amounts of secretion are collected, a follow-up gastric stimulation test is given.)

Pt prep re Gastric Analysis?

NPO for at least 12 hours before the test. Teach patients to avoid alcohol, tobacco, and drugs that may affect gastric secretion for 24 hours before the study. A nasogastric (NG) tube is inserted, and gastric residual contents are aspirated and discarded.

Ultrasonography

a technique in which high-frequency, inaudible vibratory sound waves are passed through the body via a transducer. The echoes of the sound waves created are then recorded and converted into images for analysis. US is commonly used to view soft tissues, such as the liver, the spleen, the pancreas, the gallbladder, and the biliary system. The advantages of this test are that it is painless and noninvasive and requires no radiation.

Endoscopic ultrasonography (EUS)

provides images of the GI wall and high-resolution images of the digestive organs. The ultrasonography is performed through the endoscope. This procedure is useful in diagnosing the presence of lymph node tumors, mucosal tumors, and tumors of the pancreas, stomach, and rectum. The patient preparation and follow-up care are similar to the preparation and follow-up care for both endoscopy and ultrasonography.

Liver-Spleen Scan

uses IV injection of a radioactive material that is taken up primarily by the liver and secondarily by the spleen. The scan evaluates the liver and the spleen for tumors or abscesses, organ size and location, and blood flow.

A client has a routine sigmoidoscopy. What common complication is the nurse looking for in a postprocedure assessment?
A. Excessive diarrhea
B. Heavy bleeding
C. Nausea and vomiting
D. Severe rectal pain

Heavy bleeding

Which factors place the client at risk for GI problems? Select all that apply.
A. Eating a high-fiber diet
B. Smoking a half-pack of cigarettes per day
C. Socioeconomic status
D. Some herbal preparations
E. Use of nonsteroidal anti-inflammatory drugs (NSAIDs)

B. Smoking a half-pack of cigarettes per day
C. Socioeconomic status
D. Some herbal preparations
E. Use of nonsteroidal anti-inflammatory drugs (NSAIDs)

A client is scheduled for a colonoscopy. What does the nurse tell the client to do before the procedure is performed?
A. "Begin a clear liquid diet 12 to 24 hours before the test."
B. "Do not eat or drink anything for 12 hours before the test."
C. "Give yourself tap water enemas until the fluid returns are clear."
D. "You will have to drink a contrast liquid 2 hours before the test."

"Begin a clear liquid diet 12 to 24 hours before the test."

A client with newly diagnosed irritable bowel syndrome (IBS) reports having five to six loose stools daily. What is the common psychological client response to this GI health problem?
A. Acceptance
B. Embarrassment
C. Euphoria
D. Grief

Embarrassment

Which substance, produced in the stomach, facilitates the absorption of vitamin B12?
A. Glucagon
B. Hydrochloric acid
C. Intrinsic factor
D. Pepsinogen

Intrinsic factor

What is a common GI problem that older adult clients experience more frequently as they age?
A. Decreased hydrochloric acid
B. Excess lipase production
C. Increased liver enzymes
D. Increased peristalsis

Decreased hydrochloric acid

A 49-year-old woman comes to the emergency department (ED) with reports of black tarry stools that started 2 weeks ago. In taking a GI history, which questions does the nurse ask that pertain to Gordon's Functional Health Patterns? Select all that apply.
A. "Are you having any difficulty having sex? How frequently do you have sex?"
B. "Do you have any difficulty chewing or swallowing?"
C. "Do you have pain, diarrhea, gas, or any other problems? Do any specific foods cause these symptoms for you?"
D. "What is your usual bowel elimination pattern? Frequency? Character?"
E. "When was your last colonoscopy?"

B. "Do you have any difficulty chewing or swallowing?"
C. "Do you have pain, diarrhea, gas, or any other problems? Do any specific foods cause these symptoms for you?"
D. "What is your usual bowel elimination pattern? Frequency? Character?"
E. "When was your last colonoscopy?"

A client is admitted to the hospital with severe right upper quadrant (RUQ) abdominal pain. Which assessment technique does the nurse use for this client?
A. Assesses the abdomen in the following sequence: inspection, palpation, percussion, auscultation
B. Examines the right upper quadrant (RUQ) of the abdomen last
C. Has the client lie in a supine position with legs straight and arms at the sides
D. Views the abdomen by looking directly down while standing over the client's abdominal area

Examines the right upper quadrant (RUQ) of the abdomen last

A client is admitted to the hospital with elevated serum amylase and lipase levels and a decreased calcium level. Which GI health problem is indicated by these laboratory findings?
A. Acute pancreatitis
B. Cirrhosis
C. Crohn's disease
D. Diarrhea

Acute pancreatitis

A nurse is assessing a client who had abdominal surgery yesterday. What method provides the most accurate data about resumption of peristalsis in the client?
A. Asking the client whether he or she has passed flatus (gas)
B. Auscultating bowel sounds in all abdominal quadrants
C. Counting the number of bowel sounds in each abdominal quadrant
D. Observing the abdomen for symmetry and distention

Asking the client whether he or she has passed flatus (gas)

A nurse is educating a group of older adults about screening for colorectal cancer. Which statement by a group member indicates the need for further clarification about these guidelines?
A. "A barium enema every 5 years is a screening option."
B. "I will need to have a routine colonoscopy every 5 years."
C. "My routine flexible sigmoidoscopy every 5 years is OK."
D. "The 'virtual' colonoscopy every 5 years is acceptable."

"I will need to have a routine colonoscopy every 5 years."

An outpatient clinic nurse is recovering a client who had a colonoscopy. The client asks for a drink. How does the nurse respond to the client's request?
A. "After I hear bowel sounds, you can have a drink."
B. "Twenty (20) minutes after the procedure was completed, you may have some liquids."
C. "When you are able to pass flatus (gas), you can have a drink."
D. "You can have fluids when you get home and are settled."

"When you are able to pass flatus (gas), you can have a drink."

Which action does the nurse delegate to unlicensed assistive personnel (UAP) helping to care for a client with weight loss and anorexia?
A. Document a nutritional assessment.
B. Lightly palpate the client's abdomen.
C. Monitor the client after endoscopy.
D. Obtain a stool specimen.

Obtain a stool specimen.

A nurse is assessing a client who has come to the emergency department with acute abdominal pain. Which assessment finding is of greatest concern?
A. Bowel sounds are hypoactive in all quadrants.
B. The client reports spasmodic cramping.
C. The client says, "I have not had a bowel movement for 3 days."
D. Bruising is noted around the client's umbilicus.

Bruising is noted around the client's umbilicus.

Which client does the charge nurse on the adult medical unit assign to an RN who has floated from the outpatient GI unit?
A. 38-year-old who needs discharge instructions after having an endoscopic retrograde cholangiopancreatography (ERCP)
B. 40-year-old who needs laxatives administered and effectiveness monitored before a colonoscopy
C. 43-year-old recently admitted with nausea, abdominal pain, and abdominal distention
D. 50-year-old with epigastric pain who needs conscious sedation during a scheduled endoscopy procedure

40-year-old who needs laxatives administered and effectiveness monitored before a colonoscopy

Which client does the charge nurse assign to an experienced LPN/LVN working on the adult medical unit?
A. 32-year-old who needs a nasogastric tube inserted for gastric acid analysis
B. 36-year-old who needs teaching about an endoscopic retrograde cholangiopancreatography (ERCP)
C. 40-year-old who will need administration of IV midazolam hydrochloride (Versed) during an upper endoscopy
D. 46-year-old who was recently admitted with abdominal cramping and diarrhea of unknown causes

32-year-old who needs a nasogastric tube inserted for gastric acid analysis

While working in the outpatient procedure unit, an RN is assigned to these clients. Which client does the nurse assess first?
A. 51-year-old who recently had an endoscopic retrograde cholangiopancreatography (ERCP)
B. 54-year-old who is ready for discharge following a colonoscopy
C. 58-year-old who has just arrived for basal gastric secretion and gastric acid stimulation testing
D. 60-year-old with questions about an endoscopic ultrasound examination

51-year-old who recently had an endoscopic retrograde cholangiopancreatography (ERCP)

After a colonoscopy, a client reports severe abdominal pain. A nurse obtains these data: temperature 100.2° F (37.9° C), pulse 122, blood pressure 100/45, respirations 44, and O2 saturation 89%. Which request from the health care provider does the nurse implement first?
A. Give cefazolin (Ancef) 500 mg IV.
B. Infuse normal saline at 200 mL/hr.
C. Give morphine sulfate 2 mg IV.
D. Provide oxygen @ 6 L/min per nasal cannula (N/C).

Provide oxygen @ 6 L/min per nasal cannula (N/C).

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