GI Disorders 1. Most common complication related to constipation is: Hemorrhoids 2. Acute pain in the LLQ with nausea and vomiting is a hallmark symptom of: Diverticulitis 3. This is emerging as the most effective treatment for reoccurring C-diff Fecal Microbiota Transplantation (FMT) 4. The most lethal complication of a peptic ulcer that has clinical manifestations consisting of: severe & sudden onset of pain, tachycardia, rigid, board like abdomen, N&V, absent BS Perforation 5. Name 2 gerontologic considerations in the management of N&V: a. Increased susceptibility to CNS side effects of antiemetic drugs b. Cardiac/renal insufficiency c. Fluid overload, electrolyte imbalances, increased likelihood of aspiration of emesis GI Disorders 1. The most common upper GI problem seen in adults, often caused by a variety of issues such as weakened LES, obesity, hiatial hernia & diet: GERD 2. This disorder is characterized by the membrane lining the cavity of the abdomen and abdominal organs becoming inflamed. Peritonitis 3. This area of the brain responds to stimuli of drugs and toxins and sets off the sequence of events that warrants vomiting: Chemoreceptor Trigger Zone (CTZ) 4. Name 2 things the nurse needs to assess for in the patient with an intestinal obstruction: a. Onset/ Frequency/ Color of Emesis, Bowel Function b. NG tube assessment, vital signs, I&O 5. This type of hiatal hernia is considered a medical emergency and WHY: Rolling/ paraesophageal- Cuts of blood supply Diagnostics 1. A flexible tube with a light and camera are used in this procedure to view the esophagus, stomach and upper part of the small intestine. Endoscopy 2. This test may be done to determine the cause of painful swallowing, difficulty with swallowing, abdominal pain, bloodstained vomit, or unexplained weight loss by ingesting a metallic compound that shows up on x-ray and is tracked through the digestive system Barium Swallow 3. Name 2 prep related instructions and 2 discharge related instructions for a patient undergoing a colonoscopy Prep a. Clear liquid day before, No red liquids, bowel prep until clear b. NPO after midnight, Alert MD if taking anticoagulants Discharge a. No driving or making important decisions, bloated, passing gas is normal b. Sleepiness from sedative, watch for blood in stool, fever 4. This test is ordered if the patient has had diarrhea for longer than 2 weeks: Ova and Parasites 5. The most common cause of infectious diarrhea is: E-coli Drug Therapy 1. Name the two categories of drugs used for the management of GERD: PPI and Histamine-2 Blockers 2. This type of medication may be helpful in thickening/ adding bulk to stool: Insoluble fiber (Metamucil) 3. This common antiemetic agent is an antihistamine and is available in PO, IV, IM, and PR routes. Caution must be used due to its sedative effects. Promethazine (Phenergan) 4. This anti-emetic drug is a serotonin receptor antagonist and is commonly used with chemotherapy patients and for control of post op N&V: Ondansetron (Zofran) 5. Name 3 common side effects of PPIs: a. Headache b. N/V/D c. Constipation, Flatulence NCLEX Questions Lower GI 1. The nurse identifies a need for additional teaching when a patient with acute infectious diarrhea states: a. I can use A&D ointment or Vaseline jelly around the anal area to protect my skin. b. Gatorade is a good liquid to drink because it replaces the fluid and salts, I have lost. c. I must wash my hands after every bowel movement to prevent spreading the diarrhea to my family. d. I should use over the counter Loperamide (Imodium) as needed to control the diarrhea. Antiperistalic agents should not be used with infectious diarrhea because of the potential of prolonging exposure to the infectious agent 2. The fluid and electrolyte imbalances that occur with a lower small bowel obstruction are a result of: a. Decreased secretion of interstitial fluids b. Loss of hydrochloric acid from persistent vomiting c. Bleeding from a strangulated obstruction resulting in necrosis d. Movement of fluid and electrolytes from the bowel into the peritoneal cavity Increased Pressure of fluids and secretions retained in the bowel during an obstruction causes and increase in capillary permeability and extravasation of fluids and electrolytes into the peritoneal cavity, resulting in a severe reduction in circulating blood volume and hypovolemic shock. 3. A 71-year-old male patient tells the nurse that growing old causes constipation, so he has been using a suppository for constipation every morning. Which action should the nurse take first? a. Encourage the patient to increase oral fluid intake b. Assess the patient about risk factors for constipation c. Suggest that the patient increase intake of high-fiber foods d. Teach the patient that a daily bowel movement is unnecessary 4. During a routine screening colonoscopy on a 56-year-old patient, a rectosigmoid polyp was identified and removed. The patient asks the nurse if his risk for colon cancer is increased because of the polyp. The best response by the nurse is: a. It is rare for polyps to become malignant; I wouldn’t worry too much about it b. Individuals with polyps have a 100% lifetime risk of developing colorectal cancer c. All polyps are abnormal and should be removed, but the risk for cancer depends on the type and if malignant cells are present d. All polyps are premalignant and a source of colon cancer. You’ll need to have a colonoscopy every 6 months. 5. A patient returns to the medical surgical unit with an NG tube to low intermittent suction, IV fluids, and a JP drain at the surgical site following an exploratory laparotomy and repair of a bowel perforation. Four hours after arriving, the patient experiences nausea and vomiting. An appropriate nursing intervention is to: a. Assess the abdomen for bowel sounds and palpate for pain b. Inspect the surgical site and drainage in the JP drain c. Check the amount of gastric drainage and patency of the NG tube d. Administer Phenergan to control the nausea and vomiting An adequately functioning NG tube should prevent nausea and vomiting because stomach contents are continuously being removed. Hodge Podge 1. Pyrosis means: Heartburn 2. What type of precautions are required for C-diff and what equipment is requirement? Contact (Gown and Gloves) 3. Name 3 interventions you would implement for a patient following Gastric Surgery a. TCDB/ IS/ Splinting b. Pain Management c. Thorough Assessment d. I&O/ Diet Education e. Early Ambulation 4. Symptoms of this postoperative complication include generalized weakness, abdominal cramping, sweating, palpations & dizziness 15 to 30 minutes after eating: Dumping Syndrome 5. Often uncommon, yet serious complications the nurse should monitor for in the patient receiving Metoclopramide (Reglan) are: a. Nausea, vomiting, diarrhea b. Hallucinations & unusual muscle movements c. Hyper or hypoglycemic episodes d. Increased hemoglobin and hematocrit count Visual or auditory hallucinations as well as tardive dyskinesia (uncontrollable unusual muscle movements of face, arms, legs) NCLEX Questions Upper GI 1. After administering a dose of promethazine (Phenergan) to a patient with nausea and vomiting, what common temporary adverse effect of the medication does the nurse explain may be experienced? a. Tinnitus b. Drowsiness c. Reduced hearing d. Sensation of falling 2. The nurse determines that a patient has experienced the beneficial effects of therapy with famotidine (Pepcid) when which symptom is relieved? a. Nausea b. Belching c. Epigastric pain d. Difficulty swallowing H2-receptor antagonist that inhibits parietal cell output of HCl acid and minimizes damage to gastric mucosa related to hyperacidity, thus relieving epigastric pain. 3. A patient has a sliding hiatal hernia. What nursing intervention may reduce the symptoms of heartburn and dyspepsia that the patient is experiencing? a. Keep the patient NPO b. Put the bed in Trendelenburg position c. Have the patient eat 4 to 6 smaller meals a day d. Give various antacids to determine which one works for the patient Eating smaller meals will decrease the gastric pressure and the symptoms of hiatal hernia. 4. A patient with a history of peptic ulcer disease has presented to the emergency department reporting severe abdominal pain and has a rigid, board like abdomen that prompts the health care team to suspect a perforated ulcer. What intervention should the nurse anticipate? a. Providing IV fluids and inserting a nasogastric (NG) tube b. Administering oral bicarbonate and testing the patient’s gastric pH level c. Performing a fecal occult blood test and administering IV calcium gluconate d. Starting parenteral nutrition and placing the patient in high-Fowler’s position Perforated peptic ulcer requires IV replacement of fluid losses and continued gastric aspiration by NG tube. NPO and gastric pH testing is not a priority. Ca gluconate is not a medication directly relevant to the patient’s suspected diagnosis, and parenteral nutrition is not a priority in the short term. 5. Ondansetron (Zofran) is prescribed for a patient with chemotherapy induced vomiting. The nurse understands that this drug: a. Is a derivative of cannabis and has a potential for abuse b. Has a strong antihistamine effect that provides sedations and induces sleep c. Is used only when other therapies are ineffective because of side effects of anxiety and hallucinations d. Relieves vomiting centrally by action in the vomiting center (CTZ) of the brain and peripherally by promoting gastric emptying Zofran is a serotonin antagonist that acts both centrally and peripherally to reduce vomiting and does not cause sedation or have a potential for abuse.
