GI Nursing Care

1. 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? Ham sandwich on white bread, cup of applesauce, carbonated beverage Broiled chicken with brown rice, steamed broccoli, glass of apple juice Grilled cheese sandwich, small banana, cup of hot tea with lemon Baked tilapia, fresh green beans, cup of coffee with low-fat milk 2. A nurse assesses a client who is prescribed alosetron. Which assessment question would the nurse ask this client before starting the drug? “Have you been experiencing any constipation?” “Are you eating a diet high in fiber and fluids?” “Do you have a history of high blood pressure?” “What vitamins and supplements are you taking?” 3. 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? Abdominal distention Nausea Electrolyte imbalance Obstipation 4. A nurse assesses clients at a community health center. Which client is at highest risk for developing colorectal cancer? A 37-year-old who drinks eight cups of coffee daily. A 44-year-old with irritable bowel syndrome (IBS). A 60-year-old lawyer who works 65 hours per week. A 72-year-old who eats fast food frequently. 5. 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? Ask if the client is experiencing pain in the right shoulder. Perform a rectal examination and assess for polyps. Recommend that the client have computed tomography. Administer a laxative to increase bowel movement activity. 6. 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 7. 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? “I have a good friend with a colostomy who would be willing to talk with you.” “The ostomy nurse will be able to answer all of your questions.” “I will make a referral to the United Ostomy Associations of America.” “You’ll find that most people with colostomies don’t want to talk about them.” 8. A nurse cares for a client who states, “My husband is repulsed by my colostomy and refuses to be intimate with me.” How would the nurse respond? “Let’s talk to the ostomy nurse to help you and your husband work through this.” “You could try to wear longer lingerie that will better hide the ostomy appliance.” “You should empty the pouch first so it will be less noticeable for your husband.” “If you are not careful, you can hurt the stoma if you engage in sexual activity.” 9. 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 10. 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? “The stool will always be liquid with this type of colostomy.” “Eating additional fiber will bulk up your stool and decrease diarrhea.” “Your stool will become firmer over the next couple of weeks.” “This is abnormal. I will contact your primary health care provider.” 11. A nurse teaches a client who is at risk for colorectal cancer. Which dietary recommendation would the nurse teach the client? “Eat low-fiber and low-residual foods.” “White rice and bread are easier to digest.” “Add vegetables such as broccoli and cauliflower to your diet.” “Foods high in animal fat help to protect the intestinal mucosa.” 12. A nurse cares for a client who has a new colostomy. Which action would the nurse take? Empty the pouch frequently to remove excess gas collection. Change the ostomy pouch and barrier every morning. Allow the pouch to completely fill with stool prior to emptying it. Use surgical tape to secure the pouch and prevent leakage. 13. 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? “If you eat a low-fat and low-fiber diet, your chances decrease significantly.” “You are safe. This is an autosomal dominant disorder that skips generations.” “Preemptive surgery and chemotherapy will remove cancer cells and prevent “You should have a colonoscopy more frequently to identify abnormal polyps 14. A client is preparing to have a fecal occult blood test (FOBT). What health teaching would the nurse include prior to the test? “This test will determine whether you have colorectal cancer.” “You need to avoid red meat and NSAIDs for 48 hours before the test.” “You don’t need to have this test because you can have a virtual colonoscopy.” “This test can determine your genetic risk for developing colorectal cancer.” 15. 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? “I should have less pain after this surgery compared to having a large incision.” “I will probably be in the hospital for 3 to 4 days after surgery.” “I will be able to walk around a little on the same day as the surgery.” “I will be able to return to work in a week or two depending on how I do.” 16. 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? “This drug will make you very dry because it will decrease your diarrhea.” “Be sure to take this drug with food and water to help manage constipation.” “Avoid people who have infection as this drug will suppress your immune system.” “Include high-fiber foods in your diet to help produce more solid stools.” 17. A client is admitted with a diagnosis of possible strangulated inguinal hernia. For which complication would the nurse monitor? Paralytic ileus Bowel volvulus Sepsis Colitis 18. The nurse is teaching a client how to avoid the formation of hemorrhoids. What lifestyle change would the nurse include? Avoiding alcohol Quitting smoking Decreasing fluid intake Increasing dietary fiber 19. The nurse is caring for a client with probable colorectal cancer (CRC). What assessment findings would the nurse expect? (Select all that apply.) Weight gain Rectal bleeding Anemia Change in stool shape Electrolyte imbalances Abdominal discomfort 20. 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.) “I must change the ostomy appliance daily and as needed.” “I will use warm water and a soft washcloth to clean around the stoma.” “I might start bicycling and swimming again once my incision has healed.” “I will make sure that I make lifestyle changes to prevent constipation.” “I will be sure to have the recommended colonoscopies.” 21. 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.) “Which food types cause an exacerbation of symptoms?” “Where is your pain or discomfort and what does it feel like?” “Have you lost a significant amount of weight lately?” “Are your stools soft, watery, and black?” “Do you often experience nausea and vomiting” 22. 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.) Serum potassium of 2.8 mEq /L (2.8 mmol/L) Loss of 15 lb (6.8 kg) without dieting Abdominal pain in upper quadrants Low-pitched bowel sounds Serum sodium of 121 mEq /L (121 mmol/L) 23. 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.) Assess for proper placement of the tube every 4 hours or per agency policy. Flush the tube with water every hour to ensure patency. Secure the NG tube to the client’s chin. Disconnect suction when auscultating bowel peristalsis. Monitor the client’s skin around the tube site for irritation. 24. 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.) Assist the client into a side-lying position. Use a rubber donut device when sitting up. Apply warm compresses three to four times a day. Instruct the client to wear boxer shorts. Place an absorbent dressing over the wound. 25. The nurse assists the wound care/ostomy nurse assess a client prior to ostomy surgery. Which assessments would the nurse complete before marking the placement for the ostomy? (Select all that apply.) Contour of the abdomen when standing Location of the client’s belt line Contour of the abdomen when lying Location of abdominal muscles Contour of the abdomen when sitting 26. 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.) Apply ice to the surgical area for the first 24 hours after surgery . Encourage ambulation with assistance within the first few hours after surgery. Encourage deep breathing after surgery but teach the client to avoid coughing. Assess vital signs frequently for the first few hours after surgery . Teach the client to rest for several days after surgery when at home. Teach the client not to lift more than 10 lb (4.5 kg) until allowed by the surgeon. 27. 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.) Stool consistency is similar to paste. Stoma becomes dark and dull. Skin around the stoma becomes excoriated. Skin around stoma becomes protruded. Stoma becomes retracted into the abdomen. Chapter 52 1. The nurse assesses a client who has appendicitis. Which assessment finding would the nurse expect? Severe, steady right lower quadrant pain Abdominal pain associated with nausea and vomiting Marked peristalsis and hyperactive bowel sounds Abdominal pain that increases with knee flexion 2. The nurse reviews the laboratory results for a client who has possible appendicitis. Which laboratory test finding would the nurse expect? Decreased potassium level Increased sodium level Elevated leukocyte count Decreased thrombocyte count 3. The nurse teaches a client who has viral gastroenteritis. Which dietary instruction would the nurse include in the health teaching? “Drink plenty of fluids to prevent dehydration.” “You should only drink 1 L of fluids daily.” “Increase your protein intake by drinking more milk.” “Sips of cola or tea may help to relieve your nausea.” 4. The nurse assesses a client with gastroenteritis. What risk factor would the nurse consider as the most likely cause of this disorder? Consuming too much fruit Consuming fried or pickled foods Consuming dairy products Consuming raw seafood 5. The nurse assesses a client who is hospitalized with an exacerbation of Crohn disease. Which assessment finding would the nurse expect? Positive Murphy sign with rebound tenderness to palpitation Dull, hypoactive bowel sounds in the lower abdominal quadrants High-pitched, rushing bowel sounds in the right lower quadrant Reports of abdominal cramping that is worse at night 6. After teaching a patient with diverticular disease, a nurse assesses the client’s understanding. Which menu selection indicates the client correctly understood the teaching? Roasted chicken with rice pilaf and a cup of coffee with cream Spaghetti with meat sauce, a fresh fruit cup, and hot tea Garden salad with a cup of bean soup and a glass of low-fat milk Baked fish with steamed carrots and a glass of apple juice 7. A nurse cares for a young client with a new ileostomy. The client states, “I cannot go to prom with an ostomy.” How would the nurse respond? “ Sure you can. Purchase a prom dress one size larger to hide the ostomy “The pouch won’t be as noticeable if you avoid broccoli and carbonated drinks “Let’s talk to the ostomy nurse about options for ostomy supplies and dress “You can remove the pouch from your ostomy appliance when you are at the prom 8. The nurse teaches a client about how to prevent transmission of gastroenteritis. Which statement by the nurse indicates a need for further teaching? “I won’t let anyone use my dishes or glasses.” “I’ll wash my hands with antibacterial soap.” “I’ll keep my bathroom extra clean.” “I’ll cook all the meals for my family.” 9. After teaching a client who is prescribed adalimumab for severe ulcerative colitis (UC), the nurse assesses the client’s understanding. Which statement made by the client indicates a need for further teaching? “I will avoid large crowds and people who are sick.” “I will take this medication with my breakfast each morning .” “Nausea and vomiting are common side effects of this drug.” “I should wash my hands after I play with my dog .” 10. The nurse is caring for a client who is prescribed sulfasalazine. Which question would the nurse ask the client before starting this drug? “Are you taking Vitamin C or B? “Do you have any allergy to sulfa drugs?” “Can you swallow pills pretty easily?” “Do you have insurance to cover this drug?” 11. A nurse assesses a client who has ulcerative colitis and severe diarrhea. Which assessment would the nurse complete first? Inspection of oral mucosa Recent dietary intake Heart rate and rhythm Percussion of abdomen 12. A nurse reviews the electronic health record of a client who has Crohn disease and a draining fistula. Which documentation would alert the nurse to urgently contact the primary health care provider for additional prescriptions? Serum potassium of 2.6 mEq /L (2.6 mmol/L) Client ate 20% of breakfast meal White blood cell count of 8200/mm 3 (8.2 10 9 /L) Client’s weight decreased by 3 lb (1.4 kg) 13. A client is preparing to have a laparoscopic restorative proctocolectomy with ileo pouch-anal anastomosis (RCA-IPAA). Which preoperative health teaching would the nurse include? “You will have to wear an appliance for your permanent ileostomy.” “You should be able to have better bowel continence after healing occurs.” “You will have a large abdominal incision that will require irrigation .” “This procedure can be performed under general or regional anesthesia.” 14. After teaching a client who has diverticulitis, a nurse assesses the client’s understanding. Which statement made by the client indicates a need for further teaching? “I’ll ride my bike or take a long walk at least three times a week.” “I must try to include at least 25 g of fiber in my diet every day.” “I will take a laxative nightly at bedtime to avoid becoming constipated.” “I should use my legs rather than my back muscles when I lift heavy objects.” 15. The nurse plans care for a client with Crohn disease who has a heavily draining fistula. Which intervention would be the nurse’s priority action? Low-fiber diet Skin protection Antibiotic administration Intravenous glucocorticoids 16. The nurse assesses a patient who is recovering from an ileostomy placement. Which assessment finding would alert the nurse to immediately contact the primary health care provider? Pale and bluish stoma Liquid stool Ostomy pouch intact Blood-tinged output 17. A nurse cares for a client with a new ileostomy. The client states, “I don’t think my friends will accept me with this ostomy.” How would the nurse respond? “Your friends will be happy that you are alive.” “Tell me more about your concerns.” “A therapist can help you resolve your concerns.” “With time you will accept your new body.” 18. The nurse teaches a community group ways to prevent Escherichia coli infection. Which statements would the nurse include in this group’s teaching? (Select all that apply.) “Wash your hands after any contact with animals.” “It is not necessary to buy a meat thermometer.” “Stay away from people who are ill with diarrhea.” “Use separate cutting boards for meat and vegetables.” “Avoid swimming in backyard pools and using hot tubs.” 19. The nurse assesses a client with ulcerative colitis. Which complications are paired correctly with their physiologic processes? (Select all that apply.) Lower gastrointestinal bleeding—erosion of the bowel wall Abscess formation—localized pockets of infection develop in the ulcerated bowel Toxic megacolon—transmural inflammation resulting in pyuria and fecaluria Nonmechanical bowel obstruction—paralysis of colon resulting from colorectal Fistula—dilation and colonic ileus caused by paralysis of the colon 20. A nurse assesses a patient who has celiac disease. Which signs and symptoms would the nurse expect? ( Select all that apply.) Weight gain Anorexia Constipation Anal fistula Abdominal pain 21. A nurse cares for an older adult who is admitted to the hospital with complications of diverticulitis. Which actions would the nurse include in the client’s plan of care? (Select all that apply.) Administer pain medications as prescribed. Palpate the abdomen for distention. Assess for sudden changes in mental status. Provide the client with a high-fiber diet. Evaluate stools for occult blood. 22. A nurse prepares to discharge a client who is newly diagnosed with a chronic inflammatory bowel disease. Which questions would the nurse ask in preparation for discharge? (Select all that apply.) Does your gym provide yoga classes? When should you contact your provider? What do you plan to eat for dinner? Do you have a scale for daily weights? How many bathrooms are in your home? 23. After teaching a patient who has a permanent ileostomy, a nurse assesses the client’s understanding. Which dietary items chosen for dinner indicate that the client needs further teaching? (Select all that apply.) Corn String beans Carrots Wheat rice Squash 24. A nurse cares for a patient who has a chronic inflammatory bowel disease. Which actions would the nurse take to prevent skin excoriation? (Select all that apply.) Cleanse the perineum with an antibacterial soap. Use medicated wipes instead of toilet paper. Identify foods that decrease constipation. Apply a thin coat of aloe cream to the perineum. Gently pat the perineum dry after cleansing. 25. The nurse is caring for a client who is diagnosed with celiac disease and preparing to start natalizumab. Which health teaching would the nurse include in the teaching? (Select all that apply.) Need to have drug administered by a primary health care provider . Need to avoid crowds and individuals who have infection. Need to report injection reactions such as redness and swelling. Awareness of a rare but potentially fatal drug complication . Need to report any signs and symptoms of infection immediately. 26. The nurse is caring for a client with peritonitis. What assessment findings would the nurse expect? (Select all that apply.) Nausea and vomiting Distended rigid abdomen Abdominal pain Bradycardia Decreased urinary output Fever