MED SURG CHAPTER 5 & 6 GASTROINTESTINAL SYSTEM, GALLBLADDER, LIVER, BILIARY TRACT, OR EXOCRINE PANCREATIC DISORDER

The nurse clarifies that the end product of carbohydrate metabolism is absorbed and put into the bloodstream by the:
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The nurse clarifies that the end product of carbohydrate metabolism is absorbed and put into the bloodstream by the:
villi of the small intestine.
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?
Tachycardia
Because bowel contents from an ileostomy are virtually liquid, what should the nurse include in the plan of care?
Evaluation and assessment of peristomal skin integrity
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 tablet and pencil as a communication aid.
Which recommendation is most appropriate for a patient who has had an esophageal dilation related to achalasia?
Drink 10 oz of fluid with each meal.
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?
Peptic ulcer
The nurse anticipates that the patient who has had a subtotal gastrectomy will need supplemental:
vitamin B12 due to the loss of the intrinsic factor.
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?
Eat a diet high in fiber content.
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?
Perforation
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?
Eating six small daily meals high in protein and fat
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?Attach NG tube to suction.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?"I take both those meds at the same time every morning."What should a nurse do when obtaining a stool specimen to be examined for ova and parasites?Obtain three different stool specimens on subsequent days.The nurse explains to the patient with Crohn disease that the tube feedings allow for:rapid absorption in the upper GI tract.A patient with a large inguinal hernia has abdominal distention and inguinal pain. The nurse recognizes these as indicators of which type of hernia?StrangulatedA 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?"This is a temporary solution. It will be closed in 6 weeks."A male patient complains that he will never adjust to his colostomy. Which is the best action for the nurse in this situation?Encourage him to express his concern.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:kept patent with irrigation.What should the nurse include in a teaching plan for a patient with a hiatal hernia to reduce the frequency of heartburn?Eating small mealsThe nurse points out which of the following as an example of a nonmechanical bowel obstruction?A paralytic ileusBowel sound assessment on a patient with an obstruction who has distention, nausea, and visible peristaltic waves would be:high pitched.The patient with a peptic ulcer has been placed on regular doses of bismuth salicylate (Pepto-Bismol) to combat Helicobacter pylori. What color will this drug turn the stool?Gray-blackWhich of the following should be included in the patient teaching of a patient with a peptic ulcer?Eating 6 small meals a dayWhich of the following would be the most helpful nursing intervention to increase the comfort of a patient with appendicitis?Application of ice bagTo 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.glycerin suppositoryWhat is the most lethal complication of a peptic ulcer?PerforationThe nurse takes into consideration that a proton pump inhibitor drug, such as ______________, will completely eradicate gastric acid production.omeprazole (Prilosec)Which of the following is the purpose of antibiotic therapy in treating peptic ulcers?It eradicates H. pylori.Why are peptic ulcers a common problem of aging?Because of overuse of NSAIDsThe 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?"It may help, but there has been no clinical proof of its effectiveness."The nurse uses a poster to show the process of bowel obstruction from diverticulitis. What is the third sequential pathophysiologic event?Pouch protrudes through smooth muscleCeliac sprue in the adult can lead to systemic problems. What is the last pathophysical event of this in order of appearance?Systemic involvementWhich 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) AnemiaB)Excessive flatulence C) Cachexia D) Cramps E) Rectal bleeding F) AnemiaHow 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.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.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.A) cessation of smoking. B) good oral care. C) regular checkups if dysphagia is present. E) limiting alcohol consumption.Which activities should the home health nurse suggest to an elderly patient to avoid constipation? (Select all that apply.) A) Schedule toileting after meals 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 mobilityA) Schedule toileting after meals B) Taking bulk-forming laxatives C) Increasing fiber intake D) Drinking at least 1000 mL fluidThe 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 frequencyA) Discomfort at least 3 days a month C) Pain relieved by defecation F) Onset associated with change in stool consistency or frequencyFlexible sigmoidoscopy should be performed every ________ years.5The nurse explains that ___________, the chief enzyme of gastric juice, is activated by hydrochloric acid to begin digestion of protein.pepsinThe 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.1500The nurse takes into consideration that long-term use of antibiotics can cause an antibiotic-associated pseudomembranous colitis from the organism ________.Clostridium difficile5. Due to frequent bouts of constipation, the nurse examines the bedfast nursing home resident for ulceration of the anus, called anal __________________.fissureThe nurse clarifies that unconjugated bilirubin, which is made up of broken-down red cells, is:water-insoluble bilirubin that must be converted by the liver.The patient with cirrhosis has an albumin of 2.8 g/dL. The nurse is aware that normal is 3.5 to 5 g/dL. Based on these findings, what would the nurse expect the patient to exhibit?EdemaWhat is an essential nursing measure to prevent injury to the patient who is to receive a paracentesis?Have patient void immediately before procedure.What should the nurse expect of a patient with a malabsorption of vitamin K?Increased prothrombin timeA patient was scheduled for a laparoscopic cholecystectomy, but complications developed and he underwent an open cholecystectomy with a T tube inserted into the common bile duct. What is the purpose of the T tube?To keep the duct open and allow drainage of the bile until edema resolves.The nurse caring for a patient who has had an open cholecystectomy with a T Tube will:position and secure the drainage bag at the chest level.Which nursing intervention should be completed immediately after the physician has performed a needle liver biopsy?Keeping the patient on the right side for a minimum of 2 hoursImmediately following a liver biopsy, the patient becomes dyspneic, the pulse increases to 100, and no breath sounds can be heard on the affected side. What should the nurse suspect?PneumothoraxWhich patient statement indicates that the patient requires additional teaching about an endoscopic retrograde cholangiopancreatography?"Right after the test, I want breakfast with black coffee."The nurse assisting in the treatment of a patient with ruptured esophageal varices who has received vasopressin IV will carefully assess for:evidence of cardiac ischemia.What should the nurse point out as a significant advantage of the laparoscopic cholecystectomy?Less invasive procedureWhat should the nurse explain is the major purpose of the Sengstaken-Blakemore tube (S/B tube)?Control esophageal varices bleeding.The patient's cirrhosis of the liver has also caused a dilation of the veins of the lower esophagus secondary to portal hypertension, resulting in the development of the complication of:esophageal varices.The patient with cirrhosis has a rising ammonia level and is becoming disoriented. The patient waves to the nurse as she enters the room. How should the nurse interpret this?As asterixisHow does the administration of neomycin (Mycifradin) reduce the production of ammonia?By decreasing the bacteria in the gutWhat is the most common procedure for the removal of the gallbladder?Laparoscopic cholecystectomyWhat should the nurse do to prepare a patient for an oral cholecystography?Administer 6 Telepaque (iopanoic acid) tablets 5 minutes apart after the evening meal.Which of the following is a classic symptom of cholecystitis?Right upper abdomen, radiating to the back or right scapulaWhat should the nurse avoid contamination from to prevent the transmission of hepatitis A?Food or waterWhat is the most appropriate method used by high-risk health workers to prevent hepatitis B?Hepatitis B vaccineThe nurse explains that the use of cyclosporine as an immunosuppressant has been successful in the reduction of rejection of liver transplants because the drug:does not suppress bone marrow.A male patient states that he returned from a 2-week camping trip a few days ago. He complains of nausea and anorexia, and dark urine. What additional information would assist in diagnosing hepatitis A?Recent ingestion of raw fishWhen caring for an extremely jaundiced patient with cirrhosis, what should the nurse include provisions for in the plan of care?Skin care to relieve pruritusThe nurse is aware that an elevated serum amylase is diagnostic of pancreatitis at an early stage as an elevation can be assessed as early as _____ after the onset of pancreatic disease.2 hoursThe 100 lb patient who has been exposed to hepatitis A is to receive an injection of immune serum globulin. What should the dose (.02 mL/kg) be?0.9 mLA family member of a patient asks the nurse about the protein-restricted diet ordered because of advanced liver disease with hepatic encephalopathy. What statement by the nurse would best explain the purpose of the diet?"The liver cannot rid the body of ammonia that is made by the breakdown of protein in the digestive system."The nurse would make provisions in the plan of care for a person who has had a liver transplant to prevent:infection.The nurse is aware that the hepatitis A immunization provides immunity in:30 days.What is the challenge in encouraging coughing and deep breathing for a postoperative patient who had an open cholecystectomy?High placement of incisionWhy is it advantageous for a live person to be a liver donor?Because the donor donates only a part of the liver.Which factors are most commonly associated with pancreatitis?Alcoholism and biliary tract diseaseA patient with pancreatitis is NPO. The patient asks the nurse why he is unable to have anything by mouth. Which of the following is the best response?"The pancreas is stimulated whenever you eat or drink and causes pain."Why is morphine contraindicated in the patient with pancreatitis?Morphine may cause spasms of the sphincter of Oddi.Which factors may increase a patient's risk of developing cancer of the pancreas?Cigarette smokers and people with diabetes mellitusWhich assessment would indicate possible gallbladder disease in an older adult?Changes in color of urine or stoolWhat should the nurse monitor in caring for the patient undergoing a paracentesis?Fluid removal over at least 30 minutesA patient with a T tube for an open cholecystectomy has resumed oral intake. The T tube is clamped 2 hours before meals and unclamped 2 hours after meals to aid in the digestion of fat. During the time the tube is clamped the patient complains of abdominal pain and nausea. Which intervention is most appropriate?Unclamp the tube immediately.The nurse clarifies that deterioration progresses through stages before presenting with liver disease. The first stage is destruction. What is the last stage?Liver diseaseWhat is the second step in the normal process of protein metabolism?Ammonia produced in the bowel.What are the indications for a liver transplant? (Select all that apply.) A) Congenital biliary abnormalities B) Hepatic malignancy C) Chronic hepatitis D) Cirrhosis due to alcoholism E) Gallbladder diseaseA) Congenital biliary abnormalities B) Hepatic malignancy C) Chronic hepatitisWhich medical interventions and management systems control the bleeding of esophageal varices? (Select all that apply.) A) Transfusions B) Sengstaken-Blakemore tub C) Band ligation D) Cryotherapy E) Portacaval shunt F) Large doses of vitamin B12B) Sengstaken-Blakemore tub C) Band ligation E) Portacaval shuntDietary teaching for a patient who is treated conservatively for cholecystitis is necessary to keep the patient comfortable. Which foods should be avoided? (Select all that apply.) A) Peanut butter B) Grilled chicken C) Rice and pasta D) Bananas, apples, oranges E) Whole milk F) Glazed chocolate doughnutsA) Peanut butter E) Whole milk F) Glazed chocolate doughnutsViral hepatitis may be treated at home. What should be taught to the patient's family? (Select all that apply.) A) Clothes should be laundered separately with hot water. B) Personal items and drinking glasses should not be shared. C) Articles soiled with feces do not require extra care. D) Hands need to be thoroughly washed after toileting. E) Contaminated items may be disposed of with regular trash.A) Clothes should be laundered separately with hot water. B) Personal items and drinking glasses should not be shared. D) Hands need to be thoroughly washed after toileting.The nurse is aware that the liver synthesizes products essential to health. Which products are synthesized by the liver? (Select all that apply.) A) Intrinsic factor B) Protein C) Vitamin K D) Red blood cells E) AlbuminB) Protein E) AlbuminWhat should the nurse do as part of the preparation for an endoscopic retrograde cholangiopancreatography (ERCP)? (Select all that apply.) A) Confirm that a recent chest x-ray is on file. B) Confirm the presence of a consent form. C) Warn patient that the procedure will take about 3 hours. D) Confirm the presence of a prothrombin time/INR. E) Withhold food and drink for 4 hours.B) Confirm the presence of a consent form. D) Confirm the presence of a prothrombin time/INR.___________ is a condition characterized by yellowing of the sclera and the skin.JaundiceThe disease that is on the increase because of the growing obesity population and is associated with coronary artery disease and use of corticosteroids is _______________.nonalcoholic fatty liver disease (NAFLD) nonalcoholic fatty liver disease NAFLDThe tumor marker that is elevated in patients with pancreatic cancer is ______.CA19-9Hepatitis D is usually seen as a coinfection with __________.hepatitis BA ___________ occurs when the body encapsulates the autodigestive debris in the pancreatic tissue, frequently becoming an abscess.pseudocyst