Your patient with peritonitis is npo and complaining of thirst. what is your priority?

Introduction

This is the part 2 of the Gastro quiz series. A 40-item examination with concerns Gastro.

Guidelines.

Check out each question carefully and pick the best answer.
You are offered one minute per question. Invest your time carefully!

You’re preparing a patient with a malignant tumor for colorectal surgery and subsequent colostomy. The patient tells you he’s anxious. What should your initial step be in working with this patient?

• Determine what the patient already knows about colostomies.
• Arrange for someone who has a colostomy to visit the patient.
• Provide the patient with written material about colostomy care.
• Show the patient some pictures of colostomies.

Your patient Maria takes NSAIDS for her degenerative joint disease, has developed peptic ulcer disease. Which drug is useful in preventing NSAID-induced peptic ulcer disease?

• Calcium carbonate (Tums)
• Famotidine (Pepcid)
• Misoprostol (Cytotec)
• Sucralfate (Carafate)

Hepatic encephalopathy develops when the blood level of which substance increases?

• Ammonia
• Amylase
• Potassium
• Calcium

A 53 y.o. patient has undergone a partial gastrectomy for adenocarcinoma of the stomach. An NG tube is in place and is connected to low continuous suction. During the immediate postoperative period, you expect the gastric secretions to be which color?

• Red.
• Clear.
• Yellow.
• Brown.

Elmer is scheduled for a proctoscopy and has an I.V. The doctor wrote an order for 5mg of I.V. diazepam(Valium). Which order is correct regarding diazepam?

• Give diazepam in the I.V. port closest to the vein.
• Question the order because I.V. administration of diazepam is contraindicated.
• Give diazepam rapidly I.V. to prevent the bloodstream from diluting the drug mixture.
• Mix diazepam with 50 ml of dextrose 5% in water and give over 15 minutes.

A patient has a severe exacerbation of ulcerative colitis. Long-term medications will probably include:

• Histamine2-receptor blockers.
• Corticosteroids.
• Antacids.
• Antibiotics.

Leigh Ann is receiving pancrelipase (Viokase) for chronic pancreatitis. Which observation best indicates the treatment is effective?

• She loses more than 10 lbs.
• Her appetite improves.
• There is no skin breakdown.
• Stools are less fatty and decreased in frequency.

Which stoma would you expect a malodorous, enzyme-rich, caustic liquid output that is yellow, green, or brown?

• Ascending colostomy.
• Transverse colostomy.
• Descending colostomy.
• Ileostomy.

Christina is receiving an enteral feeding that requires a concentration of 80ml of supplement mixed with 20 ml of water. How much water do you mix with an 8 oz (240ml) can of feeding?

• 60 ml.
• 80 ml.
• 90 ml.
• 70 ml.

The student nurse is participating in colorectal cancer-screening program. Which patient has the fewest risk factors for colon cancer?

• Herman, a 60 y.o. who follows a low-fat, high-fiber diet
• Janice, a 45 y.o. with a 25-year history of ulcerative colitis
• Sissy, a 72 y.o. with a history of breast cancer
• George, a 50 y.o. whose father died of colon cancer

Dark, tarry stools indicate bleeding in which location of the GI tract?

• Upper colon.
• Small intestine.
• Lower colon.
• Upper GI tract.

Your patient recently had abdominal surgery and tells you that he feels a popping sensation in his incision during a coughing spell, followed by severe pain. You anticipate an evisceration. Which supplies should you take to his room?

• Sterile water and sterile dressings.
• Sterile saline solution and sterile dressings.
• Sterile water and a suture kit.
• A suture kit.

Rob is a 46 y.o. admitted to the hospital with a suspected diagnosis of Hepatitis B. He’s jaundiced and reports weakness. Which intervention will you include in his care?

• Rest period after small, frequent meals.
• Allow patient to select his meals.
• Regular exercise.
• A low-protein diet.

George has a T tube in place after gallbladder surgery. Before discharge, what information or instructions should be given regarding the T tube drainage?

• “If there is any drainage, notify the surgeon immediately.”
• “If the drainage stops, milk the tube toward the puncture wound.”
• “First, the drainage is dark green; then it becomes dark yellow.”
• “The drainage will decrease daily until the bile duct heals.”

Anna is 45 y.o. and has a bleeding ulcer. Despite multiple blood transfusions, her HGB is 7.5g/dl and HCT is 27%. Her doctor determines that surgical intervention is necessary and she undergoes partial gastrectomy. Postoperative nursing care includes:

• Positioning her in high Fowler’s position.
• Flushing the NG tube with sterile water.
• Giving pain medication Q6H.
• Keeping her NPO until the return of peristalsis.

Claire, a 33 y.o. is on your floor with a possible bowel obstruction. Which intervention is priority for her?

• Measure abdominal girth.
• Encourage her to increase fluids.
• Keep strict intake and output.
• Obtain daily weights.

You promote hemodynamic stability in a patient with upper GI bleeding by:

• Monitoring central venous pressure.
• Giving blood, electrolyte and fluid replacement.
• Monitoring laboratory test results and vital signs.
• Encouraging oral fluid intake.

Gail is scheduled for a cholecystectomy. After completion of preoperative teaching, Gail states,”If I lie still and avoid turning after the operation, I’ll avoid pain. Do you think this is a good idea?” What is the best response?

• “Why don’t you decide about activity after you return from the recovery room?”
• “You’ll need to turn from side to side every 2 hours.”
• “It’s always a good idea to rest quietly after surgery.”
• “The doctor will probably order you to lie flat for 24 hours.”

An intubated patient is receiving continuous enteral feedings through a Salem sump tube at a rate of 60ml/hr. Gastric residuals have been 30-40ml when monitored Q4H. You check the gastric residual and aspirate 220ml. What is your first response to this finding?

• Stop the feeding, and clamp the NG tube.
• Give a prescribed GI stimulant such as metoclopramide (Reglan).
• Discard the 220ml, and clamp the NG tube.
• Notify the doctor immediately.

Katrina is diagnosed with lactose intolerance. To avoid complications with lack of calcium in the diet, which food should be included in the diet?

• Milk and cheese products
• Dark green, leafy vegetables
• Whole grains
• Fruit

Sitty, a 66 y.o. patient underwent a colostomy for ruptured diverticulum. She did well during the surgery and returned to your med-surg floor in stable condition. You assess her colostomy 2 days after surgery. Which finding do you report to the doctor?

• Reddish-pink stoma
• Brownish-black stoma
• Edematous stoma
• Blanched stoma

You’re patient is complaining of abdominal pain during assessment. What is your priority?

• Palpate the abdomen for a mass.
• Auscultate to determine changes in bowel sounds.
• Observe the contour of the abdomen.
• Percuss the abdomen to determine if fluid is present.

Sharon has cirrhosis of the liver and develops ascites. What intervention is necessary to decrease the excessive accumulation of serous fluid in her peritoneal cavity?

• Restrict fluids
• Encourage ambulation
• Give antacids as prescribed
• Increase sodium in the diet

Annebell is being discharged with a colostomy, and you’re teaching her about colostomy care. Which statement correctly describes a healthy stoma?

• “At first, the stoma may bleed slightly when touched.”
• “The stoma should appear dark and have a bluish hue.”
• “A burning sensation under the stoma faceplate is normal.”
• “The stoma should remain swollen away from the abdomen.”

Your patient with peritonitis is NPO and complaining of thirst. What is your priority?

• Provide frequent mouth care.
• Give ice chips every 15 minutes.
• Use diversion activities.
• Increase the I.V. infusion rate.

Ralph has a history of alcohol abuse and has acute pancreatitis. Which lab value is most likely to be elevated?

• Calcium
• Potassium
• Glucose
• Magnesium

Nathaniel has severe pruritus due to having hepatitis B. What is the best intervention for his comfort?

• Give tepid baths.
• Use cold water to decrease the itching.
• Use hot water to increase vasodilation.
• Avoid lotions and creams.

You’re patient, post-op drainage of a pelvic abscess secondary to diverticulitis, begins to cough violently after drinking water. His wound has ruptured and a small segment of the bowel is protruding. What’s your priority?

• Obtain vital signs, call the doctor, and obtain emergency orders.
• Have a CAN hold the wound together while you obtain vital signs, call the doctor and flex the patient’s knees.
• Ask the patient what happened, call the doctor, and cover the area with a water-soaked bedsheet.
• Have the doctor called while you remain with the patient, flex the patient’s knees, and cover the wound with sterile towels soaked in sterile saline solution.

Kevin has a history of peptic ulcer disease and vomits coffee-ground emesis. What does this indicate?

• He has fresh, active upper GI bleeding.
• He needs a transfusion of packed RBC’s.
• His gastric bleeding occurred 2 hours earlier.
• He needs immediate saline gastric lavage.

Your patient, Christopher, has a diagnosis of ulcerative colitis and has severe abdominal pain aggravated by movement, rebound tenderness, fever, nausea, and decreased urine output. This may indicate which complication?

• Fistula.
• Bowel perforation.
• Abscess.
• Bowel obstruction.

You’re discharging Nathaniel with hepatitis B. Which statement suggests understanding by the patient?

• “My family knows that if I get tired and start vomiting, I may be getting sick again.”
• “I’ll never have a problem with my liver again, even if I drink alcohol.”
• “Now I can never get hepatitis again.”
• “I can safely give blood after 3 months.”

Your patient has a retractable gastric peptic ulcer and has had a gastric vagotomy. Which factor increases as a result of vagotomy?

• Peristalsis.
• Gastric acidity.
• Gastric motility.
• Gastric pH.

You’re caring for a 28 y.o. woman with hepatitis B. She’s concerned about the duration of her recovery. Which response isn’t appropriate?

• Encourage her to not worry about the future.
• Encourage her to express her feelings about the illness.
• Provide avenues for financial counseling if she expresses the need.
• Discuss the effects of hepatitis B on future health problems.

Findings during an endoscopic exam include a cobblestone appearance of the colon in your patient. The findings are characteristic of which disorder?

• Crohn’s disease
• Ulcerative colitis
• Chronic gastritis
• Ulcer

Your patient has a GI tract that is functioning, but has the inability to swallow foods. Which is the preferred method of feeding for your patient?

• Oral liquid supplements
• NG feeding
• TPN
• PPN

The student nurse is teaching the family of a patient with liver failure. You instruct them to limit which foods in the patient’s diet?

• Potatoes and pastas.
• Meats and beans.
• Cakes and pastries.
• Butter and gravies.

Before bowel surgery, Lee is to administer enemas until clear. During administration, he complains of intestinal cramps. What do you do next?

• Continue administration of the enema as ordered without making any adjustments.
• Discontinue the procedure.
• Lower the height of the enema container.
• Complete the procedure as quickly as possible.

A patient who underwent abdominal surgery now has a gaping incision due to delayed wound healing. Which method is correct when you irrigate a gaping abdominal incision with sterile normal saline solution, using a piston syringe?

• Apply a wet-to-dry dressing to the wound after the irrigation.
• Moisten the area around the wound with normal saline solution after the irrigation.
• Irrigate continuously until the solution becomes clear or all of the solution is used.
• Rapidly instill a stream of irrigating solution into the wound.

What information is correct about stomach cancer?

• Chemotherapy and radiation are often successful treatments.
• Surgery is often a successful treatment.
• The patient can survive for an extended time with TPN.
• Stomach pain is often a late symptom.

A patient has an acute upper GI hemorrhage. Your interventions include:

• Treating hypervolemia.
• Controlling the bleeding source.
• Treating hypovolemia.
• Treating shock and diagnosing the bleeding source.