Question 1

A patient is admitted with a severe head injury.The nurse knows that critically ill patients are at risk for gastrointestinal hemorrhage due to stress-related mucosal disease.The nurse would monitor the patient for which signs and symptoms?

Accepted Answer

The initial clinical presentation of the patient with acute gastrointestinal (GI)hemorrhage is that of a patient in hypovolemic shock; the clinical presentation depends on the amount of blood lost.Hematemesis (bright red or brown,coffee grounds emesis),hematochezia (bright red stools),and melena (black,tarry,or dark red stools)are the hallmarks of GI hemorrhage.

Question 2

The nurse is caring for a patient with acute liver failure.The patient has elevated ammonia levels.Which medication would the nurse expect the practitioner to order for this patient?

Accepted Answer

Lactulose,a synthetic ketoanalogue of lactose split into lactic acid and acetic acid in the intestine,is given orally through a nasogastric tube or as a retention enema.The result is the creation of an acidic environment that results in ammonia being drawn out of the portal circulation.Lactulose has a laxative effect that promotes expulsion.Vitamin K is used to help control bleeding.Insulin would be given to control hyperglycemia.Use of benzodiazepines and other sedatives is discouraged in a patient with acute liver failure because pertinent neurologic changes may be masked,and hepatic encephalopathy may be exacerbated.

Question 3

A patient was admitted with severe epigastric pain and has been diagnosed with cancer.The patient is scheduled for an esophagectomy.The patient asks about the procedure.What would be an appropriate response from the nurse?

Accepted Answer

Esophagectomy is usually performed for cancer of the distal esophagus and gastroesophageal junction.

Question 4

A patient with a history of chronic alcoholism was admitted with acute pancreatitis.What intervention would the nurse include in the patient's plan of care?

Accepted Answer

Because pancreatitis is often associated with massive fluid shifts,intravenous crystalloids and colloids are administered immediately to prevent hypovolemic shock and maintain hemodynamic stability.Electrolytes are monitored closely,and abnormalities such as hypocalcemia,hypokalemia,and hypomagnesemia are corrected.If hyperglycemia develops,exogenous insulin may be required.

Question 5

A patient with acute pancreatitis is complaining of a pain in the left upper quadrant.Using a 1- to 10-point pain scale,the patient states the current level is at an 8.What intervention would the nurse include in the patient's plan of care to facilitate pain control?

Accepted Answer

Pain management is a major priority in acute pancreatitis.Administration of around-the-clock analgesics to achieve pain relief is essential.Morphine,fentanyl,and hydromorphone are the commonly used narcotics for pain control.Relaxation techniques and the knee-chest position can also assist in pain control.However,the patient's pain needs to be addressed first.

Question 6

A patient is admitted with a gastrointestinal hemorrhage due to esophagogastric varices.The nurse knows that varices are caused by which pathophysiologic mechanism?

Accepted Answer

Esophagogastric varices are engorged and distended blood vessels of the esophagus and proximal stomach that develop as a result of portal hypertension secondary to hepatic cirrhosis,a chronic disease of the liver that results in damage to the liver sinusoids.Without adequate sinusoid function,resistance to portal blood flow is increased,and pressures within the liver are elevated.This leads to a rise in portal venous pressure (portal hypertension),causing collateral circulation to divert portal blood from areas of high pressure within the liver to adjacent areas of low pressure outside the liver,such as into the veins of the esophagus,spleen,intestines,and stomach.

Question 7

The nurse is caring for a patient with acute liver failure.The practitioner asks the nurse to assess the patient for asterixis.How should the nurse assess for this symptom?

Accepted Answer

The patient should be evaluated for the presence of asterixis,or "liver flap," best described as the inability to voluntarily sustain a fixed position of the extremities.Asterixis is best recognized by downward flapping of the hands when the patient extends the arms and dorsiflexes the wrists.

Question 8

A patient was admitted with acute pancreatitis.The nurse understands that pancreatitis occurs as a result of what pathophysiologic mechanism?

Accepted Answer

In acute pancreatitis,the normally inactive digestive enzymes become prematurely activated within the pancreas itself,creating the central pathophysiologic mechanism of acute pancreatitis,namely autodigestion.

Question 9

A patient is admitted with a gastrointestinal hemorrhage due to esophagogastric varices.What medication would the nurse expect the practitioner to order for this patient?

Accepted Answer

In acute variceal hemorrhage,control of bleeding can be accomplished through the use of pharmacologic agents.Intravenous vasopressin,somatostatin,and octreotide have been shown to reduce portal venous pressure and slow variceal hemorrhaging by constricting the splanchnic arteriolar bed.

Question 10

A patient is admitted with an upper gastrointestinal bleed.Which disorder is the leading cause of upper gastrointestinal (GI)hemorrhage?

Accepted Answer

Peptic ulcer disease (gastric and duodenal ulcers),resulting from the breakdown of the gastro mucosal lining,is the leading cause of upper gastrointestinal (GI)hemorrhage,accounting for approximately 21% of cases.

Question 11

A Salem sump nasogastric tube has two lumens.The first lumen is for suction and drainage.What is the purpose of the second lumen?

Accepted Answer

The Salem sump has one lumen that is used for suction and drainage and another that allows air to enter the patient's stomach and prevents the tube from adhering to the gastric wall and damaging the mucosa.

Question 12

A patient is admitted with a gastrointestinal hemorrhage due to esophagogastric varices.The patient has been started on a vasopressin drip.The nurse would monitor the patient for which side effect of the medication?

Accepted Answer

A major side effect of the medication is systemic vasoconstriction,which can result in cardiac ischemia,chest pain,hypertension,acute heart failure,dysrhythmias,phlebitis,bowel ischemia,and cerebrovascular accident.These side effects can be offset with concurrent administration of nitroglycerin.Other complications include bradycardia and fluid retention.

Question 13

How would the nurse administer sucralfate through a gastric tube?

Accepted Answer

Sucralfate should not be crushed but may be dissolved in 10 mL of water to form a slurry.It is also available as a suspension.

Question 14

The nurse is caring for a patient after an esophagectomy.In the immediate postoperative period,which nursing intervention would have the highest priority?

Accepted Answer

It is imperative to appropriately manage the patient's pain after gastrointestinal (GI)surgery.Adequate analgesia is necessary to promote the mobility of the patient and decrease pulmonary complications.Initial pain management may be accomplished by intravenous opioid (morphine,hydromorphone)administration by means of a patient-controlled analgesia (PCA)pump or through continuous epidural infusion of an opioid and local anesthetic (bupivacaine).

Question 15

A patient was admitted with acute liver failure.The patient is lethargic,confused,and has marked asterixis.The nurse suspects the patient is in what stage of hepatic encephalopathy.

Accepted Answer

The patient is in Stage 2 hepatic encephalopathy as evidenced by lethargy,moderate confusion,marked asterixis,and abnormal electroencephalography (EEG).

Question 16

A patient with a history of chronic alcoholism was admitted with acute pancreatitis.The nurse is developing a patient education plan.Which topic would the nurse include in the plan?

Accepted Answer

As the patient moves toward discharge,teaching should focus on the interventions necessary for preventing the recurrence of the precipitating disorder.If an alcohol abuser,the patient should be encouraged to stop drinking and be referred to an alcohol cessation program.

Question 17

Which nursing intervention is a priority for a patient with gastrointestinal hemorrhage?

Accepted Answer

Priorities in the medical management of a patient with gastrointestinal hemorrhage include airway protection,fluid resuscitation to achieve hemodynamic stability,correction of comorbid conditions (eg,coagulopathy),therapeutic procedures to control or stop bleeding,and diagnostic procedures to determine the exact cause of the bleeding.

Question 18

The nurse is caring for a patient after an esophagectomy.The nurse knows the patient is at risk for an anastomotic leak.Which finding would indicate this occurrence?

Accepted Answer

The clinical signs and symptoms include tachycardia,tachypnea,fever,abdominal pain,anxiety,and restlessness.In a patient who had an esophagectomy,a leak of the esophageal anastomosis may manifest as subcutaneous emphysema in the chest and neck.

Question 19

An older patient reports taking cimetidine for several years.The nurse knows that this medication can cause central nervous system side effects.For what side effect would the nurse monitor the patient?

Accepted Answer

Side effects of histamine antagonists include central nervous system (CNS)toxicity (confusion or delirium)and thrombocytopenia.

Question 20

A patient was admitted after a Roux-en-Y gastric bypass (RYGBP).A nursing student asks the nurse what type of surgery an RYGBP is.What would be an appropriate response from the nurse?

Accepted Answer

Bariatric procedures are divided into three broad types: (1)restrictive,(2)malabsorptive,and (3)combined restrictive and malabsorptive.The Roux-en-Y gastric bypass combines both strategies by creating a small gastric pouch and anastomosing the jejunum to the pouch.Food then bypasses the lower stomach and duodenum,resulting in decreased absorption of digestive materials.The standard operation for pancreatic cancer is a pancreaticoduodenectomy,also called the Whipple procedure.

Quiz 29: Gastrointestinal Disorders and Therapeutic Management