Gastrointestinal - exam 1 notes PDF

Preview

Summary

exam 1 notes...

Description

GASTROINTESTINAL T-Tube NCLEX Questions for Nursing Care 1. A patient had a cholecystectomy and has a t-tube in place. You’re helping the nursing student understand how to care for the t-tube. The nursing student asks you where the t-tube is located in the body. Your response is the: A. Cystic duct B. Hepatic duct C. Bile duct D. Pancreatic duct The answer is C. The t-tube is located in the bile duct. It will serve as a drain to help remove bile from the liver until the common bile duct is healed. 2. The nurse helps the patient with a t-tube get up from the bed and sit in the bedside chair. Where will the nurse make it priority to position the tubing and drainage bag of the t-tube? A. Slightly elevated above the t-tube insertion site B. At heart level C. Midline with the t-tube insertion site D. At or below the waist The answer is D. The t-tube drainage bag and tubing will work with the assistance of gravity to drain the bile. Therefore, the tubing and drainage bag should be below the t-tube insertion site (which is at or below the waist) to help drain bile. 3. Which position is best for a patient with a t-tube?

GASTROINTESTINAL

A. Supine B. Semi-Fowler’s C. Right lateral recumbent D. Left lateral recumbent The answer is B. To help facilitate drainage (remember in order for the t-tube to work it needs the assistance of gravity), positioning the patient at about 30-45 degrees (the SemiFowler’s position) will be the best. 4. A patient is post-op day 4 from a t-tube placement. Which finding below requires you to notify the physician? A. Drainage from the t-tube is yellowish green. B. Drainage from the t-tube within the past 24 hours is approximately 925 cc. C. Blood tinged drainage from the t-tube has decreased. D. Patient reports a decrease in nausea. The answer is B. A drainage amount of 500 cc or more within a 24 hour period is abnormal and the physician should be notified. On post-op day 4 the drainage should be decreasing (NOT increasing). It is normal for the drainage to be yellowish green. Also blood tinged drainage will decrease in the t-tube at this time (fresh post-op like day 1-2 it may be blood tinged but this will decrease over time). The patient reporting a decrease in nausea is a positive sign.

GASTROINTESTINAL 5. The physician orders a patient’s t-tube to be clamped 1 hour before and 1 hour after meals. You clamp the t-tube as prescribed. While the tube is clamped which finding requires immediate nursing intervention? A. The t-tube is not draining. B. The t-tube tubing is below the patient’s waist. C. The patient reports nausea and abdominal pain. D. The patient’s stool is brown and formed. The answer is C. A nurse should ONLY clamp a t-tube with a physician’s order. Most physicians will prescribe to clamp the t-tube 1 hour before and 1 hour after meals. WHY? So, bile will flow down into the small intestine (instead out of the body) during times when food is in the small intestine to help with the digestion of fats. This is to help the small intestine adjust to the flow of bile in preparation for the removal of the t-tube (remember normally it received bile when the gallbladder contracted but now it will flow from the liver to the small intestine continuously). Option C is an abnormal finding. The patient should not report nausea or abdominal pain when the tube is blocked. This could indicate a serious problem. Option A is correct because the t-tube should not be draining because it’s clamped. Option B is correct because the t-tube tubing should be below or at the patient’s waist level. Option D is correct because this shows the body is digesting fats and bilirubin is exiting the body through the stool (remember bilirubin is found in the bile and gives stool its brown color…it would be light colored if the bilirubin was not present). You would NOT want to see steatorrhea (fat/greasy liquid stools) because this shows the bile isn’t being delivered to help digest the fats.

GASTROINTESTINAL 6. You’re assessing a patient’s t-tube and note that it is not draining bile. The patient is reporting nausea. The nurse will first? A. Notify the physician B. Assess if the tubing from the t-tube is kinked or clamped. C. Flush the tubing. D. Administer an antiemetic medication per physician order. The answer is B. First, the nurse should make sure the tubing is not kinked or clamped. This is a quick action the nurse can perform before proceeding. The nurse should ONLY flush the tubing if he or she has a physician’s order to do so. If the nurse can’t determine the problem, the physician should then be notified. Cholecystits NCLEX Questions 1. The gallbladder is found on the __________ side of the body and is located under the ____________. It stores __________. A. right; pancreas; bilirubin B. left; liver; bile C. right; thymus’ bilirubin D. right; liver; bile The answer is D. The gallbladder is found in the RIGHT side of the body and is located under the LIVER. It stores BILE.

GASTROINTESTINAL 2. Which statements below are CORRECT regarding the role of bile? Select all that apply: A. Bile is created and stored in the gallbladder. B. Bile aids in digestion of fat soluble vitamins, such as A, D, E, and K. C. Bile is released from the gallbladder into the duodenum. D. Bile contains bilirubin. The answer are B, C, and D. Option A is INCORRECT because bile is created in the LIVER (not gallbladder), but bile is stored in the gallbladder. 3. You’re providing a community in-service about gastrointestinal disorders. During your teaching about cholecystitis, you discuss how cholelithiasis can lead to this condition. What are the risk factors for cholelithiasis that you will include in your teaching to the participants? Select all that apply: A. Being male B. Underweight C. Being female D. Older age E. Native American F. Caucasian G. Pregnant

GASTROINTESTINAL H. Family History I. Obesity The answers are C, D, E, G, H and I. Cholelithiasis is the formation of gallstones. Risk factors include: being female, older age (over 40), Native American or Mexican American descent, pregnant, obesity, and family history. 4. A patient is being transferred to your unit with acute cholecystitis. In report the transferring nurse tells you that the patient has a positive Murphy’s Sign. You know that this means: A. The patient stops breathing in when the examiner palpates under the ribs on the right upper side of the abdomen at the midclavicular line. B. The patient stops breathing out when the examiner palpates under the ribs on the right upper side of the abdomen at the midclavicular line. C. The patient verbalizes pain when the lower right quadrant is palpated. D. The patient reports pain when pressure is applied to the right lower quadrant but then reports an increase in pain intensity when the pressure is released. The answer is A. Murphy’s Sign can occur with cholecystitis. This occurs when the patient is placed in the supine position and the examiner palpates under the ribs on the right upper side of the abdomen. The examiner will have the patient breathe out and then take a deep breath in. The examiner will simultaneously (while the patient is breathing in) palpate on this area under the ribs at the midclavicular line (hence the location of the gallbladder). It is a POSITIVE Murphy’s Sign when the patient stops breathing in during palpation due to pain.

GASTROINTESTINAL 5. Your patient is post-op day 3 from a cholecystectomy due to cholecystitis and has a TTube. Which finding during your assessment of the T-Tube requires immediate nursing intervention? A. The drainage from the T-Tube is yellowish/green in color. B. There is approximately 750 cc of drainage within the past 24 hours. C. The drainage bag and tubing is at the patient’s waist. D. The patient is in the Semi-Fowler’s position. The answer is B. A T-Tube should not drain more than about 500 cc of drainage per day (within 24 hours). A T-Tube’s drainage will go from bloody tinged (fresh post-op) to yellowish/green within 2-3 days. The drainage bag and tubing should be below the site of insertion (at or below the patient’s waist so gravity can help drainage the bile), and the patient should be in Semi-Fowler’s to Fowler’s position to help with draining the bile. 6. The physician orders a patient’s T-Tube to be clamped 1 hour before and 1 hour after meals. You clamp the T-Tube as prescribed. While the tube is clamped which finding requires you to notify the physician? A. The T-Tube is not draining. B. The T-Tube tubing is below the patient’s waist. C. The patient reports nausea and abdominal pain. D. The patient’s stool is brown and formed.

GASTROINTESTINAL The answer is C. A nurse should ONLY clamp a T-Tube with a physician’s order. Most physicians will prescribe to clamp the T-tube 1 hour before and 1 hour after meals. WHY? So, bile will flow down into the small intestine (instead out of the body) during times when food is in the small intestine to help with the digestion of fats. This is to help the small intestine adjust to flow of bile (remember normally it received bile when the gallbladder contracted but now it will flow from the liver to the small intestine continuously). Option C is an abnormal finding. The patient should not report nausea or abdominal pain when the tube is blocked. This could indicate a serious problem. Option A is correct because the T-tube should not be draining because it’s clamped. Option B is correct because the T-tube tubing should be below or at the patient’s waist level. Option D is correct because this shows the body is digesting fats and bilirubin is exiting the body through the stool (remember bilirubin is found in the bile and gives stool its brown color…it would be light colored if the bilirubin was not present). You would NOT want to see steatorrhea (fat/greasy liquid stools) because this shows the bile isn’t being delivered to help digest the fats. 7. Your recent admission has acute cholecystitis. The patient is awaiting a cholecystostomy. What signs and symptoms are associated with this condition? Select all that apply: A. Right lower quadrant pain with rebound tenderness B. Negative Murphy’s Sign C. Epigastric pain that radiates to the right scapula D. Pain and fullness that increases after a greasy or spicy meal E. Fever

GASTROINTESTINAL F. Tachycardia G. Nausea The answers are C, D, E, F, and G. Option A and B are not associated with cholecystitis, but a POSITIVE Murphy’s Sign is. 8. A patient in the emergency room has signs and symptoms associated with cholecystitis. What testing do you anticipate the physician will order to help diagnose cholecystitis? Select all that apply: A. Lower GI series B. Abdominal ultrasound C. HIDA Scan (Hepatobiliary Iminodiacetic AciD scan) D. Colonoscopy The answers are B and C. These two tests can assess for cholecystitis. A lower GI series would not assess the gallbladder but the lower portions of the GI system like the rectum and large intestine. Option D is wrong because it would also assess the lower portions of the GI system. 9. You’re precepting a nursing student who is helping you provide T-Tube drain care. You explain to the nursing student that the t-shaped part of the drain is located in what part of the biliary tract? A. Cystic duct B. Common hepatic duct

GASTROINTESTINAL C. Common bile duct D. Pancreatic duct The answer is C. The “T-shaped” part of the drain is located in the common bile duct and helps deliver bile to the duodenum (small intestine). 10. Your patient is unable to have a cholecystectomy for the treatment of cholecystitis. Therefore, a cholecystostomy tube is placed to help treat the condition. Which statement about a cholecystostomy (C-Tube) is TRUE? A. The C-Tube is placed in the cystic duct of the gallbladder and helps drain infected bile from the gallbladder. B. Gallstones regularly drain out of the C-Tube, therefore, the nurse should flush the tube regularly to ensure patency. C. The C-Tube is placed through the abdominal wall and directly into the gallbladder where it will drain infected bile from the gallbladder. D. The tubing and drainage bag of the C-Tube should always be level with the insertion site to ensure the tube is draining properly. The answer is C. This is the only correct statement about a cholecystostomy. A cholecystostomy, also sometimes called a C-Tube, is placed when a patient can’t immediately have the gallbladder removed (cholecystectomy) due to cholecystitis. It is placed through the abdominal wall and into the gallbladder. It will drain infected bile (NOT gallstones). The tubing and drainage bag should be at or below waist level so it drains properly.

GASTROINTESTINAL 11. A patient, who has recovered from cholecystitis, is being discharged home. What meal options below are best for this patient? A. Baked chicken with steamed carrots and rice B. Broccoli and cheese casserole with gravy and mashed potatoes C. Cheeseburger with fries D. Fried chicken with a baked potato The answer is A. The patient should eat a low-fat diet and avoid greasy/fatty/gassy foods. Option B is wrong because this contains dairy/animal fat like the cheese and gravy, and broccoli is known to cause gas. Option C and D are greasy food options. 12. Your patient is diagnosed with acute cholecystitis. The patient is extremely nauseous. A nasogastric tube is inserted with GI decompression. The patient reports a pain rating of 9 on 110 scale and states the pain radiates to the shoulder blade. Select all the appropriate nursing interventions for the patient: A. Encourage the patient to consume clear liquids. B. Administered IV fluids per MD order. C. Provide mouth care routinely. D. Keep the patient NPO. E. Administer analgesic as ordered. F. Maintain low intermittent suction to NG tube.

GASTROINTESTINAL The answers are B, C, D, E, and F. The treatment for cholecystitis includes managing pain, managing nausea/vomiting (a NG tube with GI decompression (removal of stomach contents) to low intermittent suction may be ordered to help severe cases), keep patient NPO until signs and symptoms subside, mouth care from vomiting and nasogastric tube, and administer IV fluids to keep the patient hydrated.

Viral hepatitis occurs when a virus attacks the liver. There are various types of viral hepatitis and each type varies on how it is transmitted, if it will lead to an acute or chronic infection, vaccines available, and preventative measures. As a nurse providing care to a patient with hepatitis, it is important to know the signs and symp 1.

The liver receives blood from two sources. The _____________ is responsible for pumping

blood rich in nutrients to the liver. A.

hepatic artery

B.

hepatic portal vein

C.

mesenteric artery

D.

hepatic iliac vein

The answer is B. The liver receives blood from two sources. The hepatic portal vein is responsible for pumping blood rich in nutrients to the liver. 2.

Which statements are INCORRECT regarding the anatomy and physiology of the liver?

Select all that apply: A.

The liver has 3 lobes and 8 segments.

GASTROINTESTINAL B.

The liver produces bile which is released into the small intestine to help digest fats.

C.

The liver turns urea, a by-product of protein breakdown, into ammonia.

D.

The liver plays an important role in the coagulation process.

The answers are A and C. The liver has 2 lobes (not 3), and the liver turns ammonia (NOT urea), which is a by-product of protein breakdown, into ammonia. All the other statements are true about liver’s anatomy and physiology. 3.

You’re providing an in-service on viral hepatitis to a group of healthcare workers. You are

teaching them about the types of viral hepatitis that can turn into chronic infections. Which types are known to cause ACUTE infections ONLY? Select all that apply: A.

Hepatitis A

B.

Hepatitis B

C.

Hepatitis C

D.

Hepatitis D

E.

Hepatitis E

The answers are A and E. Only Hepatitis A and E cause ACUTE infections…not chronic. Hepatitis B, C, and D can cause both acute and chronic infections. 4.

Which patients below are at risk for developing complications related to a chronic hepatitis

infection, such as cirrhosis, liver cancer, and liver failure? Select all that apply: A.

A 55-year-old male with Hepatitis A.

B.

An infant who contracted Hepatitis B at birth.

GASTROINTESTINAL C.

A 32-year-old female with Hepatitis C who reports using IV drugs.

D.

A 50-year-old male with alcoholism and Hepatitis D.

E.

A 30-year-old who contracted Hepatitis E.

The answers are B, C, and D. Infants or young children who contract Hepatitis B are at a very high risk of developing chronic Hepatitis B (which is why option B is correct). Option C is correct because most cases of Hepatitis C turn into chronic cases and IV drug use increases this risk even more. Option D is correct because Hepatitis D occurs when Hepatitis B is present and constant usage of alcohol damages the liver. Therefore, the patient is at high risk of developing chronic hepatitis. Hepatitis A and E tend to only cause acute infections….not chronic. 5.

A patient is diagnosed with Hepatitis A. The patient asks how a person can become infected

with this condition. You know the most common route of transmission is? A.

Blood

B.

Percutaneous

C.

Mucosal

D.

Fecal-oral

The answer is D. Hepatitis A is most commonly transmitted via the fecal-oral route. 6.

Which of the following is NOT a common source of transmission for Hepatitis A? Select

all that apply: A.

Water

B.

Food

GASTROINTESTINAL C.

Semen

D.

Blood

The answers are C and D. The most common source for transmission of Hepatitis A is water and food. 7.

A 36-year-old patient’s lab work show anti-HAV and IgG present in the blood. As the nurse

you would interpret this blood work as? A.

The patient has an active infection of Hepatitis A.

B.

The patient has recovered from a previous Hepatitis A infection and is now immune to it.

C.

The patient is in the preicetric phase of viral Hepatitis.

D.

The patient is in the icteric phase of viral Hepatitis.

The answer is B. When a patient has anti-HAV (antibodies of the Hepatitis A virus) and IgG, this means the patient HAD a past infection of Hepatitis A but it is now gone, and the patient is immune to Hepatitis A now. If the patient had anti-HAV and IgM, this means the patient has an active infection of Hepatitis A. 8.

TRUE or FALSE: A patient with Hepatitis A is contagious about 2 weeks before signs and

symptoms appear and 1-3 weeks after the symptoms appear. The answer is TRUE. 9.

A 25-year-old patient was exposed to the Hepatitis A virus at a local restaurant one week

ago. What education is important to provide to this patient?

GASTROINTESTINAL A.

Inform the patient to notify the physician when signs and symptoms of viral Hepatitis start

to appear. B.

Reassure the patient the chance of acquiring the virus is very low.

C.

Inform the patient it is very important to obtain the Hepatitis A vaccine immediately to

prevent infection. D.

Inform the patient to promptly go to the local health department to receive immune

globulin. The answer is D. Since the patient was exposed to Hepatitis A, the patient would need to take preventive measures to prevent infection because inf...