CH 45 Care of the Patient With a GI Disorder

The nurse clarifies that the end product of food is absorbed and put into the bloodstream by which anatomical feature?

• gastric lining of the stomach.

• villi of the small intestine.

• bile of the liver in the large intestine.

• excretion from the cecum.

Answer explanation

The inner surface of the small intestine contains millions of tiny, fingerlike projections called villi, which contain small blood vessels. They are responsible for absorbing the products of digestion.

A 56-year-old man is admitted to the emergency room with an acute attack of diverticulitis. The patient has a temperature of 102°F, and has an elevated white count. Which assessment would alert the nurse to impending septic shock?

• Chest pain

• Seizure

• Tachycardia

• Massive diarrhea

Answer explanation

The patient with diverticulitis who has fever and an elevated white count has an infection that could lead to septic shock, which will present as tachycardia and hypotension.

Because bowel contents from an ileostomy are virtually liquid, which does the nurse expect to see in the plan of care?

• Evaluation and assessment of dietary intake of fiber

• Evaluation and assessment of patient cleanliness

• Evaluation and assessment of peristomal skin integrity

• Evaluation and assessment of the adequacy of the collection device

Answer explanation

The nurse should assess the peristomal skin for impairment of integrity. The fecal material is liquid and has a potential for severe skin excoriation from the digestive enzymes.

The home health nurse caring for a patient who has dysarthria related to radiation therapy for an oral cancer would recommend that the family provide which device?

• a tablet and pencil as a communication aid.

• a TV for diversion.

• a bell to summon help.

• a walkie-talkie.

Answer explanation

The provision of an alternative method of communicating will lessen the frustration of the patient who has trouble speaking understandably. The call bell would be helpful also, but without a way to communicate, the bell is not as essential as a method of communication.

Which recommendation is most appropriate for a patient who has had an esophageal dilation related to achalasia?

• Consume only liquid.

• Avoid fruit juices.

• Drink 10 oz of fluid with each meal.

• Lie down for 30 minutes after each meal.

Answer explanation

The patient should drink fluid with each meal to increase lower esophageal pressure to push food into the stomach.

A patient who is being evaluated for episodes of hematemesis and dyspepsia tells the nurse that pain occurs when he eats, but pain does not waken him. The nurse recognizes a diagnostic sign of which condition?

• Duodenal ulcer

• Gastritis

• Achalasia

• Peptic ulcer

Answer explanation

A significant subjective data assessment for a peptic ulcer is the patient report that pain is associated with eating. With duodenal ulcers the patient often complains of pain 1 to 2 hours after eating.

The nurse anticipates that the patient who has had a subtotal gastrectomy will need which type of supplement?

• protein due to the loss of some of the digestive processes.

• vitamin B12 due to the loss of the loss of the intrinsicfactor.

• bulk to prevent constipation.

• vitamin A due to the loss of the gastric lining.

Answer explanation

It is recommended that all patients with a gastrectomy have a blood serum vitamin B12 level measured every 1 to 2 years. Decreased absorption of vitamin B12 may cause pernicious anemia.

The home health nurse is caring for a patient who has frequent bouts of diverticulitis accompanied by increased flatulence, diarrhea, and nausea. Which is the most appropriate suggestion to lessen these symptoms?

• Eat a diet high in fiber content.

• Increase dietary fat intake.

• Exercise to increase intraabdominal pressure.

• Take daily laxatives.

Answer explanation

The symptoms of diverticulitis can be reduced or prevented by eating a high-fiber diet, reduction of meat and fats in the diet, and avoiding activities that increase intraabdominal pressure. Although laxatives might be prescribed sparingly, daily laxatives are not recommended.

The nurse caring for a patient with a peptic ulcer who has had a nasogastric tube inserted notes bright blood in the tube; the patient complains of pain and has become hypotensive. Which condition should the nurse recognize these as signs of?

• Hiatal hernia

• Gastritis

• Perforation

• Bowel obstruction

Answer explanation

Perforation of the gastric wall causes pain, hypotension, and hematemesis. Immediate reporting to the charge nurse/physician is essential as peritonitis, potentially lethal, is the result of a perforation.

Dumping syndrome after a Billroth II procedure occurs when high-carbohydrate foods are ingested over a period of less than 20 minutes. Which will the nurse suggest to reduce the risk of dumping syndrome?

• Eating a high-carbohydrate diet

• Drinking 10 oz of fluids with meals

• Remaining upright for 2 hours after meals

• Eating six small daily meals high in protein and fat

Answer explanation

Treatment for dumping syndrome includes eating six small meals daily that are high in protein and fat, and low in carbohydrates. Fluids should be avoided during meals. If possible, the patient should lie down for 1 hour after meals.