Gastrointestinal NCLEX
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Question 1 of 5.
The nurse is preparing to care for the client immediately after a Whipple procedure. The nurse should plan to include which action?
A. Monitor the blood glucose levels
B. Administer enteral feedings
C. Irrigate the NG tube with 30 mL of saline
D. Assist with bowel elimination within 8 hours of surgery
Explanation: A. The Whipple procedure induces insulin-dependent diabetes because the proximal pancreas is resected. Thus, the blood glucose levels should be monitored closely starting immediately after surgery. B. Parenteral (not enteral) feedings are the method of choice for providing nutrition immediately after surgery. C. The NG tube is strategically placed during surgery and should not be irrigated without a surgeon's order. With an order, gentle irrigation with 10 to 20 mL of NS is appropriate. D. Since this surgery reshapes the GI tract, the client will not have peristalsis and bowel movements for several days.
Question 2 of 5.
The nurse caring for a client diagnosed with GERD writes the client problem of 'behavior modification.' Which intervention should be included for this problem?
A. Teach the client to sleep with a foam wedge under the head.
B. Encourage the client to decrease the amount of smoking.
C. Instruct the client to take over-the-counter medication for relief of pain.
D. Discuss the need to attend Alcoholics Anonymous to quit drinking.
Explanation: Sleeping with a foam wedge elevates the head, reducing reflux by preventing stomach acid from flowing into the esophagus during sleep, a key behavioral modification for GERD. Smoking cessation is beneficial but less specific to immediate symptom relief, and the other options are not directly related to behavior modification for GERD.
Question 3 of 5.
The nurse is administering morning medications at 0730. Which medication should have priority?
A. A proton pump inhibitor.
B. A nonnarcotic analgesic.
C. A histamine receptor antagonist.
D. A mucosal barrier agent.
Explanation: Proton pump inhibitors (PPIs) are the mainstay treatment for GERD, reducing acid production and preventing esophageal damage. They should be prioritized over analgesics, histamine receptor antagonists, or mucosal barrier agents, which are less critical for immediate symptom control and healing.
Question 4 of 5.
Which disease is the client diagnosed with GERD at greater risk for developing?
A. Hiatal hernia.
B. Gastroenteritis.
C. Esophageal cancer.
D. Gastric cancer.
Explanation: Chronic GERD increases the risk of esophageal cancer, particularly adenocarcinoma, due to prolonged acid exposure causing Barrett's esophagus, a precancerous condition. Hiatal hernia is a risk factor for GERD, not a consequence, and gastroenteritis and gastric cancer are less directly linked.
Question 5 of 5.
The client diagnosed with IBD is prescribed total parenteral nutrition (TPN). Which intervention should the nurse implement?
A. Check the client's glucose level.
B. Administer an oral hypoglycemic.
C. Assess the peripheral intravenous site.
D. Monitor the client's oral food intake.
Explanation: TPN, high in dextrose, can cause hyperglycemia, so monitoring glucose levels is essential, especially in IBD patients with potential metabolic stress. Oral hypoglycemics are inappropriate, TPN uses central lines, and oral intake is typically minimal.