Question 1

A patient is admitted with the diagnosis of acute pancreatitis.The nurse expects which of the following laboratory test results to be elevated?

Accepted Answer

Calcium and potassium decrease with acute pancreatitis.

Question 2

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 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

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 5

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

Accepted Answer

Histamine₂ (H₂)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 forms 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 6

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 7

Which of the following is a potential cause for acute liver failure?

Accepted Answer

Diabetes is not a primary cause of acute liver failure but is associated with pancreatitis.

Question 8

Which of the following are clinical manifestations of pancreatitis?

Accepted Answer

Clinical manifestations of acute pancreatitis include pain, vomiting, nausea, fever, abdominal distention, abdominal guarding, abdominal tympany, hypoactive or absent bowel sounds, severe disease, peritoneal signs, ascites, jaundice, palpable abdominal mass, Grey-Turner sign, Cullen sign, and signs of hypovolemic shock.There may be peritonitis involved with pancreatitis and percussion will reveal a tympanic abdomen; bowel sounds will be decreased or absent.

Question 9

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 10

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 11

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 12

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 13

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 14

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 15

Esophagectomy is usually performed for

Accepted Answer

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

Question 16

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 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 17

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 18

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 19

A patient has a Salem sump to lower intermittent suction.Nursing interventions include

Accepted Answer

Interventions include irrigating the tube every 4 hours with normal saline, ensuring the blue air vent of the Salem sump is patent and maintained above the level of the patient's stomach, and providing frequent mouth and nares care.Nursing management focuses on preventing complications common to this therapy, for example, ulceration and necrosis of the nares, esophageal reflux, esophagitis, esophageal erosion and stricture, gastric erosion, and dry mouth and parotitis from mouth breathing.

Question 20

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.

Quiz 22: Gastrointestinal Disorders and Therapeutic Management