Question 1

Roux-en-Y gastric bypass is

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.

Question 2

A nursing priority for a patient with GI hemorrhage is

Accepted Answer

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

Question 3

The patient at risk for GI hemorrhage should be monitored for which of the following 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 4

Which of the following disorders is the leading cause of upper GI hemorrhage?

Accepted Answer

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

Question 5

Esophagectomy is usually performed for

Accepted Answer

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

Question 6

A patient with a 10-year history of alcoholism was admitted to the critical care unit with the diagnosis of acute pancreatitis.Based on the diagnosis,the patient

Accepted Answer

Because pancreatitis if 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 7

A patient with a 10-year history of alcoholism was admitted to the critical care unit with the diagnosis of acute pancreatitis.The patient is preparing for discharge.Nursing intervention should include

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 8

A patient with a 10-year history of alcoholism was admitted to the critical care unit with the diagnosis of acute pancreatitis.The patient 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.To properly manage the patient's pain,the priority of nursing interventions is to

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.

Question 9

Verification of feeding tube placement includes

Accepted Answer

The traditional practice of confirming placement by auscultating air inserted through the tube over the epigastrium is not reliable and is not recommended.Aspiration of stomach contents and gastric pH measurement are also not recommended.If there is any doubt as to the tube's position,a repeat radiograph should be obtained.

Question 10

Signs and symptoms of an anastomotic leak include

Accepted Answer

The clinical signs and symptoms of a leak can be subtle and often go unrecognized.They 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.Upper gastrointestinal (GI)bleeding is an uncommon but life-threatening complication of GI surgery.Early bleeding usually occurs at the site of the anastomosis and can usually be treated through endoscopic intervention.The risk for pulmonary complications is substantial after GI surgery,and adverse respiratory events such as atelectasis and pneumonia are twice as likely to occur in the patient who is obese.

Question 11

Which classification of medication is used to reduce volume and concentration of gastric secretions?

Accepted Answer

Histamine? (H?)antagonists are used to reduce volume and concentration of gastric secretions.Antacids are used to buffer stomach acid and raise gastric ph.Gastric mucosal agents form an ulcer-adherent complex with proteinaceous exudate.It covers the ulcer and protects against acid,pepsin,and bile salts.Gastric proton pump inhibitors inactivate acid or hydrogen acid pump,blocking secretion of hydrochloric acid by gastric parietal cells.

Question 12

To administer sucralfate through a gastric tube it should be

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 13

A patient with a 10-year history of alcoholism was admitted to the critical care unit with the diagnosis of acute pancreatitis.The physiologic alteration that occurs in acute pancreatitis is

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 14

Absorption of Prilosec and Prevacid occurs in the

Accepted Answer

The oral PPIs (Proton Pump Inhibitors)are formulated as enteric-coated tablets or as delayed-release capsules containing enteric-coated granules.Absorption occurs in an alkaline environment and begins only after the granules leave the stomach and enter the duodenum.

Question 15

Which of the following can be used as pharmacologic method of treatment in acute variceal hemorrhage?

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 16

Esophagogastric varices are the result of

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 17

The physician orders gastric lavage to control GI bleeding.The nurse has inserted a large-bore NG tube.What temperature and irrigating fluid would be used to obtain the best results?

Accepted Answer

Historically,iced saline was favored as a lavage irrigant.Research has shown,however,that low-temperature fluids shift the oxyhemoglobin dissociation curve to the left,decrease oxygen delivery to vital organs,and prolong bleeding time and prothrombin time.Iced saline also may further aggravate bleeding; therefore,room temperature water or saline is the preferred irrigant for use in gastric lavage.

Question 18

Which of the following nursing interventions after GI surgery would have the highest priority of care?

Accepted Answer

Nursing interventions in the postoperative period are focused first on promoting ventilation,adequate oxygenation,and preventing complications such as atelectasis and pneumonia.Adequate analgesia is necessary to promote the mobility of the patient and decrease pulmonary complications.Early ambulation is encouraged to reduce the risk of pulmonary embolus.Infection prevention with hand hygiene and antibiotics is important as well.

Question 19

Which of the following medications is/are given to help control ammonia levels in a patient with acute liver failure (ALF)?

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 ALF because pertinent neurologic changes may be masked,and hepatic encephalopathy may be exacerbated.

Question 20

A major side effect of vasopressin is

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.

Quiz 30: Gastrointestinal Disorders and Therapeutic Management