(55) A client has a routine sigmoidoscopy. What common complication is the nurse looking for in a postprocedure assessment?
C. Heavy bleeding
Excessive or heavy bleeding is a possible complication following a sigmoidoscopy. It must be reported immediately to the health care provider.
(55) 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,C, D, E
B: Smoking or any tobacco use places a client in a higher risk category for GI problems.
C: Socioeconomic status can influence the risk for GI problems. Clients may not be able to afford to seek care and may put off seeking help. They may not be able to afford treatments or therapeutic diets.
D: Some herbal preparations contribute to GI problems. Ayurvedic herbs can affect appetite, absorption, and elimination.
E: NSAIDs can predispose clients to peptic ulcer disease or GI bleeding.
A diet that is high in fiber does not place a client at risk for developing a GI disturbance. High-fiber diets are generally believed to be healthy for most clients.
(55) A client is scheduled for a colonoscopy. What does the nurse tell the client to do before the procedure is performed?
D. "Begin a clear liquid diet 12 to 24 hours before the test."
The client is instructed to be on a liquid diet for 12 to 24 hours before a colonoscopy.
The client must be NPO (except for water) 4 to 6 hours before a colonoscopy.
The client is instructed to drink a liquid preparation for cleaning the bowel (such as sodium phosphate) the evening before the colonoscopy, and may repeat that procedure on the morning of the test. In some cases, the client may require laxatives, suppositories, or one or more small-volume (i.e., Fleet) cleansing enemas.
The client is not given an oral contrast liquid to swallow for a colonoscopy.
(55) Which substance, produced in the stomach, facilitates the absorption of vitamin B12?
C. Intrinsic factor
Incorrect: Glucagon, which is produced by the alpha cells in the pancreas, is essential for the regulation of metabolism.
Parietal cells secrete hydrochloric acid, but this does not facilitate the absorption of vitamin B12.
Parietal cells in the stomach produce intrinsic factor, a substance that facilitates the absorption of vitamin B12. Absence of the intrinsic factor causes pernicious anemia.
Pepsinogen is secreted by the chief cells. Pepsinogen is a precursor to pepsin, a digestive enzyme.
(55) In aging people peristalsis in the large intestine is decreased and nerve impulses are dulled, which can result in?
postponement of bowel movements.
(55)In aging people arophy of the gastric mucosa causes AAA. This results in a decrease in BBB, causing CCC and DDD.
A) a decreased ratio of gastrin-secreting cells to somatostatin-secreting cells
B) hydrochloric acid
C) decreased absorption of iron
D) vitamin B12
(55)Calcification of pancreatic vessels occurs in aging people, with a AAA. The decrease in AAA results in BBB. CCC can subsequently occur.
A) decrease in lipase production
B) decreased fat absorption and digestion
c) Steatorrhea and diarrhea
(55) What is a common GI problem that older adult clients experience more frequently as they age?
A. Decreased hydrochloric acid
Correct: Atrophy of the gastric mucosa causes a decreased ratio of gastrin-secreting cells to somatostatin-secreting cells. This results in a decrease in hydrochloric acid, causing decreased absorption of iron and vitamin B12.
Incorrect: In the pancreas, calcification of pancreatic vessels occurs, with a decrease in lipase production. The decrease in lipase results in decreased fat absorption and digestion. Steatorrhea and diarrhea can subsequently occur.
Incorrect: The number and size of hepatic cells are decreased; this results in decreased enzyme activity. Decreased enzyme activity depresses drug metabolism. Therefore it may cause accumulation of drugs or toxic levels.
Incorrect: In the large intestine, peristalsis is decreased and nerve impulses are dulled, which can result in postponement of bowel movements in older adults.
(55) 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. Examines the right upper quadrant (RUQ) of the abdomen last
Incorrect: The sequence for examining the abdomen is inspection, auscultation, percussion, and then palpation. This sequence prevents the increase in intestinal activity and bowel sounds caused by palpation and percussion.
Correct: The client reports pain in the RUQ, so the nurse would examine this area last in the examination sequence. This sequence prevents the client from tensing abdominal muscles because of the pain, which would make the examination difficult.
Incorrect: The client would be positioned supine with the knees bent, while keeping the arms at the sides to prevent tensing of the abdominal muscles.
Incorrect: It is best to inspect the abdomen by standing at the side of the bed and then looking down on the abdomen, and also from the side at eye level.
(55) 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
(55) 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?
C. Asking the client whether he or she has passed flatus (gas)
Correct: The best and most reliable method for assessing the return of peristalsis following abdominal surgery is the client's report of passing flatus within the past 8 hours or stool within the past 12 hours.
Incorrect: Although auscultation was once a method of assessing for bowel activity, it is not the most effective method. The client's report of flatulence is.
Incorrect: Counting the number of sounds during assessment was once a method of assessing for bowel activity-it is not the most effective method. The client's report of flatulence is.
Incorrect: Observing the abdomen is one method of examining a client's abdomen; it is not a reliable way to assess for resumption of activity after surgery.
(55) 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?
C. "I will need to have a routine colonoscopy every 5 years."
Incorrect: A barium enema every 5 years is a screening option.
Correct: The 2010 guidelines indicate that routine screening with colonoscopy is performed every 10 years, not every 5 years. Other options are performed at 5-year intervals.
Incorrect: A flexible sigmoidoscopy every 5 years is acceptable for screening.
Incorrect: A "virtual" colonoscopy every 5 years is acceptable as a screening procedure.
(55) 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?
B. "When you are able to pass flatus (gas), you can have a drink."
Fluids are permitted after the client's peristalsis has returned. This is validated by the client's passing flatus, not by auscultation of bowel sounds.
The client will not be discharged home without the nurse's determining that peristalsis has returned.
(55) Which action does the nurse delegate to unlicensed assistive personnel (UAP) helping to care for a client with weight loss and anorexia?
A. Obtain a stool specimen.
(55) A nurse is assessing a client who has come to the emergency department with acute abdominal pain. Which assessment finding is of greatest concern?
C. Bruising is noted around the client's umbilicus.
All could be indicative of many GI problems but are not as immediate a concern as the possibility of hemorrhage.
"Bruising" (ecchymosis) around the umbilicus (Cullen's sign) is a sign of intra-abdominal bleeding.
(55) Which client does the charge nurse on the adult medical unit assign to an RN who has floated from the outpatient GI unit?
A. 40-year-old who needs laxatives administered and effectiveness monitored before a colonoscopy
A nurse who has experience with chronic (think outpatient) GI problems will have experience and training in instructing clients on colonoscopy preparation. All others require the experience of an acute care (inpatient) GI nurse.
(55) Which client does the charge nurse assign to an experienced LPN/LVN working on the adult medical unit?
D. 32-year-old who needs a nasogastric tube inserted for gastric acid analysis
Correct: Nasogastric tube insertion is included in LPN/LVN education and is an appropriate task for an experienced LPN/LVN.
Incorrect: Client teachingshould be done by an RN.
Incorrect: IV hypnotic medicationsshould be administered by an RN.
Incorrect: Admissionassessmentshould be done by an RN.
(55) 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)
Correct: ERCP requires conscious sedation, so the client needs immediate assessment of respiratory and cardiovascular status.
(55) 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?
B. Provide oxygen @ 6 L/min per nasal cannula
Incorrect: An antibiotic request is important but is not the first priority.
Incorrect: Fluid supplementation is important, but the client's oxygen saturation level places the client's respiratory status as the priority.
Incorrect: The client's need for analgesia should be delayed until respiratory status is addressed. Morphine depresses respiratory status and therefore might not be the right choice for this client.
Correct: Based on the data given, the client may be experiencing complications of colonoscopy such as bleeding or perforation. The most immediate concern involves respiratory status, so the client should be placed on oxygen first.
(55) An older adult is scheduled for a double-contrast barium enema. What is the priority health teaching the nurse will provide?
B. “Be sure to take the laxative as prescribed after the test.”
After the test, the client should be instructed to take a laxative to clear the contrast from the body. Although it is important that the client report flatus, removal of the barium via use of a laxative is the health teaching priority.The client will be instructed to consume a clear liquid diet the day before the procedure and will be NPO on the day of the procedure as he or she clears the bowel.
(55) Intrinsic factor is released by AAA, which is necessary for the absorption of BBB in the CCC, without which red blood cell production is impossible, resulting in DDD, which is technically ONLY caused by EEE.
A) Parietal cells in stomach lining
B) Vitamin B12
C) Ilieum
D) Pernicious Anemia
E) Atrophic gastritis, parietal cell loss
(55) Pancreas AAA enzymes needed for digestion of Carbohydrates (AAA), Fats (BBB), and Proteins (CCC).
A) Amylase
B) Lipase
C) Trypsin and Chymotrypsin
(55)Pre-Carefor FOBT, e.g. Hemoccult II?
FOBT, which is different from a FIT (fecal immunochemical test) in that it requires an active component of guaiac(the test paper is coated with a phenolic compound, alpha-guaiaconic acid, that is extracted from the wood resin of Guaiacum trees).
Pts having a gFOBT ("g" for guaiac) should be taught to avoid:
Raw fruits and vegetables
Red meat
Vitamin C-rich foods, juces and tablets
Anticoagulants such as warfarin (Coumadin) and NSAIDs should be discontinued 7 days before the test.
(55) Though barium x-ray studies are less common today because of the endoscopy allows for direct visualization of the GI tract, when they are used, the Pt pre-care should include:
No foods or liquids for 8 hours before test.
If possible, opioid analgesics and anticholinergic meds are withheld for 24 hours because they decrease intestinal tract motility.
Teach that 16 ounces of barium will need to be consumed.
(55) Though barium x-ray studies are less common today because of the endoscopy allows for direct visualization of the GI tract, when they are used, the Pt post-care should include:
Teach Pt to drink plenty of water to help eliminate the barium.
Removal of the barium via use of a laxative is the health teaching priority.
Stools may be chalky white for 24-72 hours as the barium is excreted, then return to brown.
Pts at home should report abdominal fullness, pain, or a delay in return to brown stools.
(55) Pre-care for Computed Tomography (CT) studies, optionally with contrast?
All
Lie still in the rather enclosed space of the machgine.
Remove all jewelry and metal.
With ContrastQ allergies to seafood and iodine.
NPO 4 hrs prior to test.
IV access required for contrast medium, which may cause warmth and flushing on injection.
(55) Pre-Care for EGD (Esophogastroduodenoscopy)?
NPO 6-8 hours before test
AM pills can be taken
Diabetics should consult physician
If possible, avoid anticoagulants, aspirin, NSAIDS for several days before test
Teach moderate sedation via midazolam (Versed), fentanyl (Fentanyl, Sublimaze) and/or propofol (Diprivan) are commonly used
Atopine to dry secretions
Local anesthetic to inactivate gag reflex - teach that this will make swollowing difficult
Dentures removed
(55) Post-Care for EGD (Esophogastroduodenoscopy)?
Vitals q30min until sedation wears off
Side rails up
Priority care - preventaspiration - NPO until gag reflex returns, usually 1-2 hours - monitor for signs of perforation: pain, bleeding, fever
Not to drive for at least 12 hours
Teach hoarse/sore throat may persist for several days- throat lozenges may be used
(55) Pre-Care for ERCP (Endoscopic Retrograde Cholangiopancreatography)?
Often used for therpeutic rather than diagnostic reasons, e.g. gallstones (papillotomy) - in this regard, ask Pt if they have an implantable medical device such as a pacemaker - electrocautery cannot be used with these devices.
Pt placed left lateral for viewign common bile duct, then prone.
NPO 6-8 hours before test
AM pills can be taken
Diabetics should consult physician
If possible, avoid anticoagulants, aspirin, NSAIDS for several days before test
Teach moderate sedation via midazolam (Versed), fentanyl (Fentanyl, Sublimaze) and/or propofol (Diprivan) are commonly used
Atopine to dry secretions
Local anesthetic to inactivate gag reflex - teach that this will make swollowing difficult
Dentures removed
(55) Post-Care for ERCP (Endoscopic Retrograde Cholangiopancreatography)?
Vitals q15min
Side rails up
Priority care - preventaspiration - NPO until gag reflex returns, usually 1-2 hours - monitor for signs of perforation: pain, bleeding, fever
Not to drive for at least 12 hours
Teach hoarse/sore throat may persist for several days- throat lozenges may be used
Teach to monitor for complications: cholangitis (inflamation of gallbladder), pancreatitis, bleeding, perforation and sepsis. Sever pain is present for any of these complcations, and fever with sepsis. Any may take several hours to 2 days to develop.
(55) Pre-Care for Small Bowel Capsule Endoscopy?
Fast (water only) 8-10 hours before
NPO 2 hours befor
One-time use capsule
Normal diet 4 hours after swallowing capsule
Limited battery (8 hr), so colon is not viewed and return to facility after 8 hrs to remove monitoring equipment.
NO post-care needed
(55) Pre-Care for colonoscopy or CT virtual colonoscopy?
Clear liquid diet day before, including Gatorage for electrolytes, and excluding red, orange or purple beverages
NPO, except water, 4-6 before
AM pills can be taken
Diabetics should consult physician
If possible, avoid anticoagulants, aspirin, NSAIDS for several days before test
Some docs Rx a gallon of GoLYTELY (chill and drink quickly to prevent nausea), though this should not be used for older adults to prevent excessive fluid and electrolyte loss
Atropine sulfate is kept available in case of bradycardia from vasovagal response
(55) Post-Care for colonoscopy?
Do not allow the patient to take anything by mouth until sedation wears off and he or she is alert and passes flatus.
Take vital signs every 15 to 30 minutes until the patient is alert.
Keep the top siderails up until the patient is alert.
Assess for rectal bleeding or severe pain.
Remind the patient that fullness and mild abdominal cramping are expected for several hours.
Assess for manifestations of bowel perforation, including severe abdominal pain and guarding. Fever may occur later.
Assess for manifestations of hypovolemic shock, including dizziness, light-headedness, decreased blood pressure, tachycardia, pallor, and altered mental status (may be the first sign).
If the procedure is performed in an ambulatory care setting,arrange for another person to drive the patient home.
(55) What is Gastric Analysis?
Measure hydrochloric acid and pepsin
For aggressive gastric and duodenal disorders
Depressed levels suggest gastric cancer
Increased levels indicate duodenal ulcers
If only a small amount of secretion is colllected basally (w/o stimulation), then a follow-up "stimulation" test is done
In both tests, collections q15min per NG tube for 1 hour
(55) Pre-Care for Gastric Analysis?
NPO 12 hours
No alcohol, tobacco, drugs for 24 hours before
(55) Pre-Care for Ultrasonography
fasting or (1-2L for bladder visualization)
No Post-Care required.
(55) Pre and Post-Care for a Liver-Spleen Scan?
IV injection of radioactive material that is taken up by primarily by the liver and secondarily by spleen.
Not for pregnant or brest-feeding women
Radionuclide out in 24 hours via urine - careful handwashing after toileting decreases exposure to radiation inurine.
(55) Mouth: Mechanical breakdown: AAA mL saliva, and alkaline enzyme, is secreted in 24 hours which begins the breakdown of starches and sugars and lubricates food for facilitating swallowing
A) 1500
(55) Stomach: AAA mL of gastric secretions, (HCI for proteins, Gastric lipase for fats, Pepsin for proteins
A) 2500
(55) Stomach: Absorption of ETOH (alchohol)and glucose
I could find no source that supports absorption of glucose by the stomach
(55) Duodenum: (1st AAA inchs)
1. BBB mL pancreatic enzymes (CH20 (monosaccharide), fat and protein)
2. CCC mL biliary secretions (emulsifies fat)
A) 12
B) 700
C) 500
(55) AAA aka BBB is the entrance of the bile and pancreatic ducts
A) Ampula of Vater
B) Duodenal papilla
(55) The acidity of the chyme stimulates th release of the hormone AAA, which is absorbed into the blood and carried to the BBB. The protein in the chyme stimulates the release of CCC. These two hormones provide the proper alkaline reaction in the duodenum, protect the duodenum mucosa by neutralizing the HCL acid, and stimulate the pancreas.
