Gastrointestinal

The patient on bowel rest has been prescribed 10% dextrose total parenteral nutrition at 50 mL/h, intravenous lipids 3 grams/kg/day, and 10 mg intravenous famotidine every other day. Which information in the patient’s chart prompts the nurse to contact the provider? 

The 21-year-old patient with a body mass index of 10.1 undergoes placement of a peripherally inserted central catheter (PICC) at 1000 and total parenteral nutrition (TPN) is initiated at 1200. At 1600, 160 mL have infused and the patient is noted to be breathing shallowly, there is blood oozing from the PICC insertion site, and the patient is exhibiting confusion. Which action does the nurse perform first? 

The patient has undergone a cystectomy with ureterosigmoidostomy. Which nursing interventions are included in the care plan? Select all that apply. 

Following a bone marrow transplant, the patient exhibits a 10-pound weight gain in 3 days, increased abdominal circumference, and yellow tinge to the sclera and skin. The nurse notifies the provider and prepares to perform which intervention?  

On Monday, the patient receiving chemotherapy for cervical cancer has an unsealed radiation source instilled into the uterus. Tuesday morning, the patient vomits after breakfast. Which action does the nurse take while cleaning the emesis?  

The nurse assesses the patient with acute myelogenous leukemia after a bone marrow transplant. Which symptom concerns the nurse the most?

Which interventions does the nurse include in care for the patient who underwent a total pelvic exenteration for a cancer diagnosis one day ago? Select all that apply.  

The patient presents to the clinic with a chief complaint of constipation with occasional ribbon-like stools. The nurse anticipates which additional findings? Select all that apply.  

The patient presents to the emergency department with severe, unrelenting abdominal pain. Which findings prompt the nurse to suspect the patient will require a Whipple procedure? Select all that apply.  

The nurse is caring for the patient recently diagnosed with colon cancer. Which assessment prompts the nurse to call for the provider immediately?  

The patient presents to the emergency department complaining of severe gastrointestinal distress after meals that has persisted for 36 hours. He reports that these symptoms have occurred off and on for a few years now, but he is seeking care now because they are interrupting his ability to sleep. Which additional assessment indicates the poorest prognosis for this patient?  

The nurse is evaluating the understanding of the patient who has been taught to perform a colostomy irrigation. Which action requires further teaching? 

The home health nurse is assessing the patient with a colostomy. Which finding indicates the patient is performing the tap water irrigations too frequently?  

The 18-year-old patient in sickle cell crisis has received multiple blood transfusions. During the shift assessment, the nurse notes the patient’s heart rate is 132 bpm, blood pressure is 102/58 mmHg, and the sclera are yellow. Which lab result would be surprising for this patient?  

The nurse who suspects that the 19-year-old patient being treated for β-thalassemia major is experiencing complications of therapy advocates for which tests? Select all that apply.  

The patient in the emergency department begins projectile vomiting. Which intervention is most important?  

The nurse is supervising the assessment of a 4-year-old patient with a Wilms tumor who was brought to the emergency department for profuse vomiting. Which statement by the student nurse requires prompt intervention by the nurse? 

The 3-year-old patient is brought to the clinic after three days of nausea, vomiting, and diarrhea. Which assessment most prompts the nurse to advocate for hospital admission?  

The nurse is preparing to care for a baby antenatally diagnosed with type C esophageal atresia with tracheoesophageal fistula. Which interventions are the priority in the first day after birth?  

The 78-year-old resident of a nursing home is brought to the emergency department for abdominal pain that is not responsive to oxycodone. She takes captopril, atenolol, lovastatin, and glyburide in addition to the oxycodone. Upon assessment, her abdomen is full and mildly tender. She has positive bowel sounds and reports passing gas but no stools for 96 hours. She denies anorexia or vomiting. A digital rectal examination is performed and stool is found in the rectum. The nurse anticipates being ordered to perform which intervention for this patient?  

The nurse is planning care for the 78-year-old patient with recurrent fecal impaction. The patient has prostate cancer that has metastasized to the bone. In addition to palliative chemotherapy, the patient receives a fentanyl transdermal patch and intravenous hydromorphone. The patient is neutropenic and thrombocytopenic. The nurse works with the provider to plan which intervention to manage the opioid-induced constipation and subsequent fecal impaction? 

The 36-hour-old neonate who was born at 37 weeks gestation to a G3P2 mother has yet to pass meconium. The baby was born by cesarean section due to refractory preeclampsia with severe features. The mother reports the baby has been breastfeeding well after a slow first 12 hours. Upon assessment, the baby appears well with good tone and responsiveness. The baby’s anus is patent and the abdomen is soft and rounded; bowel sounds present. The mother denies emesis in the baby. An abdominal x-ray is obtained, which is normal. The nurse informs the mother that which test will be performed next? 

The 68-year-old patient is admitted after 5 days of extremely foul-smelling watery diarrhea with a temperature of 37.9°C, heart rate 118 bpm, and blood pressure 98/52 mmHg. The patient’s recent medical history is significant for being treated 2 weeks ago for a diverticulitis flare-up. Upon assessment, the patient is pale, diaphoretic, and has a tense, distended abdomen that he does not guard with palpation. Lab studies reveal an elevated creatinine (1.9 mg/dL), high white blood cell count (20,000 cells/mL), and normal hemoglobin and hematocrit. The nurse prepares to perform which diagnostic test for this patient?  

The 68-year-old patient is admitted after 5 days of extremely foul-smelling watery diarrhea with a temperature of 37.9°C, heart rate 118 bpm, and blood pressure 98/52 mmHg. The patient’s recent medical history is significant for being treated 2 weeks ago for a diverticulitis flare-up. Upon assessment, the patient is pale, diaphoretic, and has a tense, distended abdomen that he does not guard with palpation. Lab studies reveal an elevated creatinine (1.9 mg/dL), high white blood cell count (20,000 cells/mL), and normal hemoglobin and hematocrit. Which intervention is most important to prevent the spread of this condition to other patients? 

The 68-year-old patient is admitted after 3 days of extremely foul-smelling watery diarrhea with a temperature of 37.8°C, heart rate 122 bpm, and blood pressure 96/50 mmHg. The patient’s recent medical history is significant for being treated 2 weeks ago for a diverticulitis flare-up. Upon assessment, the patient is pale, diaphoretic, and has a tense, distended abdomen that he does not guard with palpation. Lab studies reveal an elevated creatinine (1.9 mg/dL), high white blood cell count (20,000 cells/mL), and normal hemoglobin and hematocrit. Which medication does the nurse administer without further discussion with the provider? 

The 5-day-old 38-week-gestation neonate was born to a 25-year-old primigravida woman after a pregnancy and vacuum-assisted delivery complicated by gestational diabetes, large for gestational age fetus, and shoulder dystocia. The neonate required vigorous stimulation and positive pressure ventilation. Apgar scores were 3 and 8 at 1 and 5 minutes of life. At the pediatrician’s appointment after discharge, the neonate is found to have a large bruise at the back of the head that was sustained during birth and eyes glued shut with yellow, mucopurulent discharge. A gram stain of the drainage reveals gram-negative cocci in pairs. The mother states, “No matter what I do, it keeps coming back. I’ve used warm compresses and washed it away.” Additionally, the mother reports the infant is breastfeeding well with 4 wet diapers and 1 stool per day. The nurse informs the provider of the assessment and requests which order first?  

The 20-year-old student went on a mission trip to Ghana to help at a local hospital. She presented to the clinic 12 days after her return; she began to experience anorexia, flu-like symptoms, and fatigue. Ten days later, she noticed her eyes and skin looked yellow. Her history, assessment, and vitals are within normal limits except her yellow sclera and jaundiced skin. Initial lab studies reveal a total bilirubin of 16, indirect bilirubin of 8, AST of 1320 and ALT of 1400. The nurse prepares the patient for which test next? 

The 4-week-old neonate in the neonatal intensive care unit was born at 29 weeks gestation. The patient is stable on room air and has been tolerating nasogastric feedings of expressed breast milk. Generally an active and responsive patient, the nurse notes the patient is lethargic and does not react to his diaper change. Additionally, the patient’s heart rate is 194 bpm, respiratory rate is 82 breaths per minute, and the blood pressure is 54/21 mm Hg. The patient’s abdomen is distended and discolored; dark green emesis is noted as well. An abdominal x-ray is ordered and performed. Which x-ray findings are consistent with the patient’s clinical picture? Select all that apply.  

The 23-year-old patient is brought to the emergency department after contacting emergency services to report profound weakness that started in his feet and worsened and spread cranially over the past few days. He reports severe diarrhea after a camping trip a week ago. Upon assessment, strength, sensation, and deep tendon reflexes are significantly reduced, with the lower extremities more severely affected than his upper extremities. Vital signs are normal and the patient seems to be breathing well. The nurse anticipates which finding on the lumbar puncture result?  

The 58-year-old patient presents to the emergency department complaining of worsening back pain that started a few days ago. He states, “I thought maybe I had slept wrong and gotten a spasm, but I’m not sure. I didn’t fall or get hit or anything. The ibuprofen I took definitely didn’t help.” His blood pressure is 174/96 mmHg and heart rate is 96 bpm. He reports being out of his antihypertensive medication for the past week while he was out of town. Other history is notable for arthritis in the hands and a 44-pack-year smoking history. He drinks socially but denies illicit drug use. Which assessment is most important? 

The 12-hour-old neonate was born at 39 weeks to a G2P2 mother after an uncomplicated pregnancy and delivery. Slight oligohydramnios was noted during the pregnancy. The neonate has not urinated. Upon assessment, the nurse notes stable vital signs and suprapubic distention. The nurse contacts the provider to advocate for which initial intervention?  

The patient with cirrhosis is admitted with severe confusion, ascites, and jaundice. He has gained 10 kg in 2 weeks. He has been coughing blood and his stool is dark and tarry. Therapeutic paracentesis results are concerning for infection.  The nurse anticipates the patient to report not taking which medications that are ordered? Select all that apply.  

The nurse is most suspicious of glucose-6-phosphate dehydrogenase (G6PD) deficiency in which patient who presents with jaundice and fatigue after receiving an antimalarial drug?  

The 2-year-old patient who has a history of drug-induced hemolysis, anemia, and hyperbilirubinemia presents to the clinic complaining of urinary urgency and dysuria. The patient has a fever and the urinalysis is positive for leukocyte esterase as well white blood cell casts. Which medications, if prescribed for the patient, prompt the nurse to clarify with the provider prior to administering them? Select all that apply.  

The mother of the 7-week-old infant reports the baby has had fewer and fewer wet diapers and hasn’t stooled in 3 days despite having a ravenous appetite. The mother reports that the child has been vomiting with increasing force and volume over the past two weeks. The emesis just appears to be partially digested breastmilk and fluid. The infant appears well and vitals are normal. Upon palpation of the abdomen, a small, olive-shaped mass is appreciated. The nurse alerts the provider and prepares education for which procedure?  

The mother of the 7-week-old infant reports the baby has had fewer and fewer wet diapers and hasn’t stooled in 3 days despite having a ravenous appetite. The mother reports that the child has been vomiting with increasing force and volume over the past two weeks. The emesis just appears to be partially digested breastmilk and fluid. The infant appears well, but mucous membranes are dry, the child has a low-grade fever, and is tachycardic. Upon palpation of the abdomen, a small, olive-shaped mass is appreciated. A serum electrolyte panel reveals a sodium of 132, potassium of 2.7, chloride of 89, and a glucose of 92. The nurse performs which nursing action first? 

A 4-year-old child presents for a well-child visit. The parents report the child is doing well, has a good appetite, and has been meeting developmental milestones appropriately. Two months ago, the child was treated with antibiotics for an upper respiratory tract infection. Otherwise, the child is quite healthy. Upon assessment, the nurse notes a left-sided flank mass. The child denies urinary issues including pain or frequency, and the parents report that the child has had no incontinence episodes for a full year. The urinalysis is normal with the exception of 2+ blood. The nurse prepares to educate the family on which condition that most likely explains the child’s symptoms?  

The patient who began taking celecoxib one week ago for severe osteoarthritis reports diarrhea for the past three days. The patient’s vital signs are all within normal limits and the urine output is adequate. Which instruction by the nurse is appropriate?