Deck 13: Care of the Patient With an Acute Gastrointestinal Bleed or Pancreatitis

Question 1

A patient is diagnosed with severe pancreatitis. Which type of nutrition should the nurse expect to be prescribed for this patient?
1) Clear liquids
2) Soft
3) Enteral
4) Parenteral

Answer 1

3
Explanation: 1. A clear liquid diet is no longer recommended.
2. A soft diet is recommended if the patient has no nausea or vomiting and the abdominal pain has resolved.
3. In severe pancreatitis, enteral nutrition is preferred over total parenteral nutrition (TPN).
4. In severe pancreatitis, enteral nutrition is preferred over total parenteral nutrition (TPN).

Question 2

A patient being prepared for an endoscopy to diagnose an upper gastrointestinal bleed asks why a nasogastric tube has to be inserted. What should the nurse respond to this patient?
1) "You need this to assist with placement of the ostomy tube."
2) "The nasogastric tube will assist in the removal of blood clots that may limit the physician in seeing your esophagus."
3) "Your physician has left orders for placement of the tube."
4) "The tube will reduce the likelihood of you vomiting during the procedure."

Answer 2

2
Explanation: 1. The nasogastric tube is not used to assist with placement of the ostomy tube.
2. The nasogastric tube may be utilized to reduce blood and aid removal of clots that might hinder observation by the physician during the test.
3. This response does not meet the patient's request for information.
4. Vomiting is not managed by a nasogastric tube during this procedure. A local anesthetic spray is applied to the back of the throat before the procedure to reduce gagging and vomiting.

Question 3

A patient with an active gastrointestinal bleed has the following vital signs: BP 80/50 mm Hg, HR 102 bpm, RR 24, and oxygen saturation of 80%. What blood component should the nurse expect the health care provider to prescribe?
1) Whole blood
2) Packed red blood cells
3) Platelets
4) Fresh frozen plasma

Answer 3

2
Explanation: 1. Whole blood may be ordered in an emergent situation while awaiting cross-matched blood.
2. Patients who are hemodynamically unstable and have had considerable blood loss will require blood transfusions of packed red blood cells. Packed RBCs are preferred as this replaces the lost red blood cells, which will help improve oxygenation. The plasma will help expand volume.
3. Platelets are not indicated at this time with this situation.
4. Fresh frozen plasma is not indicated at this time with this situation.

Question 4

A patient with acute pancreatitis asks for something to eat. Which response by the nurse is most appropriate?
1) "Your physician will likely allow you to eat when the vomiting has subsided."
2) "You will be able to have a liquid diet within a week."
3) "Once your pain is under control, and if your bowels are functioning normally, you will likely be able to begin a soft diet."
4) "During this time, you will have to get your nutrition from tube feedings."

Question 5

The nurse has been assigned to provide care for several patients on the medical-surgical unit. Which data should the nurse use to decide the patient to assess first?
1) An elevated temperature of 99.2°F and complaints of nausea
2) Complaints of feelings of fullness and no bowel movement for 2 days
3) A heart rate of 82 bpm, complaints of fatigue, and an episode of coffee ground emesis 4 hours ago
4) Two episodes of melena diarrhea within the past 2 hours

Question 6

A patient prescribed pantoprazole (Protonix) asks the purpose of the medication. Which response by the nurse is most appropriate?
1) "The medication will stop the stomach bleeding."
2) "The medication will provide a protective coating to your gastrointestinal system."
3) "The medication is used to reduce the acid in your gastric secretions and stabilize the clot to prevent further bleeding."
4) "The medication will eliminate any potential gastrointestinal infection you may have."

Question 7

A patient arrives in the emergency department with clinical manifestations consistent with a lower gastrointestinal bleed. What should the nurse assess to determine the patient's stability?
1) Hemoglobin
2) Hematocrit
3) Vital signs
4) Abdominal rigidity to determine the amount of blood being lost

Question 8

A patient with a serious gastrointestinal bleed arrives in the emergency department, and the physician intends to initiate aggressive intravenous therapy. Which solution should the nurse anticipate being used to manage this patient's condition?
1) D₅ and NS
2) D₅W
3) 0.9% NS
4) 0.45% NS

Question 9

A patient with symptoms consistent with pancreatitis reports feeling ill for the past week. Which diagnostic test will provide the most definitive diagnosis of pancreatitis?
1) Erythrocyte sedimentation rate
2) Serum lipase
3) Serum amylase
4) Complete blood count

Question 10

A patient admitted to determine the presence of an upper gastrointestinal bleed does not believe the diagnosis because of the absence of pain. How should the nurse respond to this patient?
1) "Some patients have a high pain tolerance and are able to handle the condition better than others."
2) "Pain is not a typical symptom of this condition."
3) "You should share this with your physician next time you see her."
4) "You must be in the early stages of the disease because pain does not occur until later."

Question 11

The nurse assembles equipment needed to begin caring for a patient with a gastrointestinal bleed who is hemodynamically unstable. What size of intravenous catheter should the nurse choose?
1) 22-gauge 2-inch angiocatheter
2) 18-gauge 1-inch angiocatheter
3) 22-gauge butterfly
4) 20-gauge 2-inch angiocatheter

Question 12

A patient with acute pancreatitis is concerned about becoming addicted to the morphine prescribed for pain management. What response by the nurse is appropriate?
1) "You must only take the medication when the pain is intolerable."
2) "You may want to consider Demerol to manage your pain because it is less strong."
3) "Addiction during this period of acute pain is not likely."
4) "Addiction is a very real concern and should be considered when requesting medication."

Question 13

A patient being treated for a gastrointestinal bleed has the following assessment findings: temperature 97.2°F, blood pressure 99/70 mm Hg, heart rate 74 bpm, capillary refill of 3 seconds, and oxygen saturation 94%. Four hours later, the nurse identifies changes in the patient's condition. Which change is associated with complications from management of the condition? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Temperature 98.2°F
2) Heart rate 98 bpm
3) Oxygen saturation 85%
4) Capillary refill of 2 seconds
5) Rales auscultated bilateral bases

Question 14

The nurse cares for a patient with severe pancreatitis. Which intravenous fluid should the nurse anticipate providing to this patient?
1) D₅W
2) Lactated Ringer's
3) D₅1/2NS
4) 0.9% NS

Question 15

A patient with an active lower gastrointestinal bleed has the following vital signs: temperature 97.0°F, HR 68, RR 20, and BP 82/60 mm Hg. The nurse should place the patient in which position?
1) Prone
2) Supine with the legs bent at the knees
3) Supine with the legs raised
4) Side lying with the head of the bed elevated to 30 degrees

Question 16

A patient with severe acute pancreatitis has the following vital signs after fluid resuscitation: BP 84/53 mm Hg and HR 61 bpm. What should the nurse consider as the next step of care for this patient?
1) Assess for hypovolemic shock.
2) Prepare to administer diuretics.
3) Question if an antihypertensive would be indicated.
4) Prepare to administer potassium chloride.

Question 17

A patient being treated for a lower gastrointestinal bleed has a capillary refill of 3 seconds, a urinary output of 20 mL/hour, a heart rate of 88, and reports "feeling tired." Which finding should the nurse report to the physician?
1) Capillary refill of 3 seconds
2) Urinary output of 20 mL/hour
3) Heart rate of 88 bpm
4) Reports of fatigue

Question 18

A patient with severe acute pancreatitis receives aggressive fluid replacement therapy. Which assessment finding indicates that management of this disorder has been effective?
1) Oxygen desaturation
2) Elevated heart rate
3) Decreasing hematocrit
4) Reduced blood pressure

Question 19

A patient recovering from a colonoscopy reports abdominal pain of 4 on a 5-point scale. The patient's abdomen is rigid, and vital signs are T 99.2, HR 94, R 28, and BP 98/69. What initial action by the nurse is indicated?
1) Assist the patient to turn to aid in relieving the flatus buildup.
2) Continue to observe the patient for additional changes in 15 minutes.
3) Notify the physician.
4) Medicate the patient for discomfort.

Question 20

The nurse prepares a presentation for new graduates about pancreatitis. After attending the seminar, which statement by a graduate nurse indicates the need for additional instruction? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) "Pancreatitis is typically idiopathic."
2) "There is only one single test finding that will diagnose pancreatitis."
3) "An indication of pancreatitis is an elevation in serum amylase during the first 3 to 5 days."
4) "Necrotizing pancreatitis is a commonly occurring complication."
5) The risk of hypovolemic shock is very high with this disorder.

Question 21

The nurse assesses a patient and immediately notifies the physician because of findings consistent with a gastrointestinal bleed. What did the nurse assess in the patient? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Melena
2) Hematemesis
3) Confusion
4) Blood pressure of 180/100 mm Hg
5) Absent bowel sounds

Question 22

While awaiting the results of laboratory testing, the nurse implements interventions to aid a patient with suspected acute pancreatitis. What did the nurse assess to make this clinical determination?
1) Chest pain
2) Blood pressure 100/88 mm Hg
3) Heart rate 90 beats per minute
4) Severe left upper quadrant pain radiating to the flank

Question 23

The nurse teaches a patient about pancreatitis. What should the nurse include when instructing on the mechanism of the disease process? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) "The exact mechanism is uncertain."
2) "Cells in the pancreas become damaged and release enzymes that injure the pancreas."
3) "Gallbladder stones block the ducts in the pancreas, causing damage."
4) "A poor diet because of alcohol intake causes the pancreas to become inflamed."
5) "The pancreas contracts an infection from poor blood supply through the organ."

Question 24

The nurse reviews laboratory values for a patient newly diagnosed with acute pancreatitis. Which value should the nurse expect to be elevated?
1) Amylase and lipase
2) Hemoglobin
3) Platelets
4) Prothrombin time

Question 25

A patient has been diagnosed with pancreatitis. What risk factors will help determine the severity of the patient's disease? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Age
2) Body weight
3) Chest x-ray findings
4) Oxygen saturation
5) Hemoglobin level

Question 26

A patient with acute gallstone-induced pancreatitis is recovering from an endoscopic retrograde cholangiopancreatogram (ERCP). Which observation indicates that the patient's condition is deteriorating after this procedure? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Increased pain
2) Fever and chills
3) Nausea and vomiting
4) Normal body temperature
5) Reduced gastric distention

Question 27

A patient being treated for acute gastrointestinal bleeding is receiving 0.9% normal saline at 200 mL/hour through two large-bore IVs. What assessment finding should the nurse report immediately to the physician?
1) Crackles in both lung bases
2) Urinary output of 50 mL in 1 hour
3) Capillary refill of less than 2 seconds
4) Approximately 200 mL of coffee ground emesis

Question 28

During an assessment, the nurse notifies the physician because a newly admitted patient is experiencing an upper gastrointestinal bleed. What finding caused the nurse to come to this conclusion? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Black, tarry stool
2) Bright red bloody emesis
3) Bright red rectal bleeding
4) Emesis with coffee grounds
5) Bloody sputum

Question 29

The nurse is completing the assessment of a patient admitted with an upper gastrointestinal bleed. Which risk factors should the nurse be certain to ask about during the assessment? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) History of H. pylori
2) Routine use of NSAIDs
3) Use of aspirin
4) History of smoking
5) Diagnosis of diabetes

Question 30

A patient admitted to the ICU with a diagnosis of acute pancreatitis is prescribed pain medication through a PCA pump. What should the nurse include when teaching the patient and family about the proper use of the pump?
1) The patient should only use the PCA pump when the pain is severe.
2) The family may help by "pushing the button" when they feel the patient is in pain.
3) The PCA allows the patient to administer smaller amounts of pain medication more frequently, which helps to get more effective pain relief.
4) The PCA delivers pain medication every time the button is pushed.

Question 31

The nurse assesses the effectiveness of pain management with morphine sulfate through a PCA pump in a patient with acute pancreatitis. Besides the patient's verbal response to the pain scale, what objective assessment finding indicates that the patient's pain level is decreasing? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Blood pressure increase
2) Slow, easy respirations
3) Pulse decrease
4) Facial grimacing
5) Blood pressure decrease

Question 32

A patient is surprised to learn the diagnosis of pancreatitis. Which risk factors should the nurse be certain to ask about during the assessment? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Frequency of alcohol intake
2) History of gallstones
3) List of current medications
4) History of smoking
5) History of peptic ulcer disease

Question 33

The nurse is concerned that a patient being treated for an acute upper gastrointestinal bleed is experiencing poor tissue perfusion because of which finding? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Flat jugular veins
2) Cold, clammy skin
3) Capillary refill of 5 seconds
4) Narrowed pulse pressure
5) Bounding peripheral pulses

Question 34

During preoperative care, a patient asks the nurse, "Why are they removing my gallbladder? I thought I had pancreatitis." What is the best response for the nurse to make?
1) "Only the surgeon can answer that question."
2) "You don't need to worry about the surgery. The surgeons know what they are doing."
3) "One common cause of acute pancreatitis is stones in your gallbladder."
4) "You said that you had gallbladder problems when you were admitted. The two are not connected."

Question 35

Prior to an endoscopy for an upper gastrointestinal bleed, the nurse administers a dose of intravenous erythromycin. What should the nurse explain about the purpose of this medication to the patient?
1) "This medication is to treat the infection that you have in your stomach."
2) "This medication is to stop the infection you have from spreading to other organs in your body."
3) "This medication helps clear out any material in your stomach so better visualization can occur."
4) "This medicine makes sure you don't get an infection because of the instruments used for the test."

Question 36

A patient is admitted with acute pancreatitis. Which information for the health history should the nurse expect when assessing this patient?
1) Alcohol abuse
2) CHF
3) Diabetes
4) Asthma

Question 37

A patient with an upper gastrointestinal bleed asks why an endoscopy needs to be done. What should the nurse respond to this patient? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) "It will identify where the bleeding is coming from."
2) "So the doctor can possibly stop the bleeding by injecting a medication into the area."
3) "The doctor may be able to stop the bleeding by sewing up the area that is bleeding."
4) "To figure out how much blood you will need to receive."
5) "To identify which antibiotics to prescribe for your treatment."