lOMoARcPSD|52250053

GIT Refresher - git

Nursing (University of Mindanao)

Scan to open on Studocu

Studocu is not sponsored or endorsed by any college or university

Downloaded by mawis ([email protected])
 lOMoARcPSD|52250053

GASTROINTESTINAL DISEASES
TOPRANK: REFRESHER REVIEW 2024 |PROF. KEITH KAINNE D. GARINO, RN,LPT,MAED
● GI Irritant Drugs: Decreases Motility & HCl
GASTROESOPHAGEAL REFLUX DISEASE (GERD) (hydrochloric acid)
○ Aspirin
○ NSAID
○ Anticholinergic/Antispasmodic: e.g.
Atropine sulfate (muscle relaxant and
decreases motility)
○ Ca Channel Blocker
● Diet
○ Carbohydrates: High (complex) e.g.
vegetables
○ Fiber: High to prevent overeating
○ Meal: Small, frequent feeding (6-10
small meals per day)
● Position
○ Head of the Bed: Elevated (30-45
degrees/Semi-Fowler’s is good for
CAUSE: emptying)
○ Turned to the left to position the
● Backflow of gastric contents
esophagus above the stomach (hindi
● Weak LES (open)
dapat magka level to avoid reflux)
● Slow motility
● Medications (similar to peptic ulcer
● Pylorus: end part;
disease)
● Pyloric stenosis: end part; narrowed pylorus
○ To decrease hydrochloric acid
NOTES:
■ H2 receptor blockers
● Do not lie down after a meal.
■ Proton pump inhibitor
○ Antacids: neutralize acids
CLINICAL MANIFESTATIONS:
○ Prokinetics: increase motility
● Indigestion burns your throat, larynx, and
■ Antiemetic: metoclopramide
esophagus
● High fat (-)
● Dyspnea
● Semi-Fowler’s (+)
● Nausea and vomiting
● High Fiber (+)
● Heartburn (pyrosis): most common
● 3 meals per day (-)
complaint; after meal, evening
● Atropine (-)
● Globus: feeling of fullness in the throat
● Spicy foods (-)
● Larynx (Voice box): laryngitis; dry cough,
● Avoid coffee (+)
quality of voice changes (hoarseness)
● High carbohydrate (+)
● Difficulty of swallowing (dysphagia)
● Turn to right side (-)
● Odynophagia (painful swallowing)
● Tight clothing (-)
● Aspirin (-)
INTERVENTIONS: Food should go down
● Avoid 5CAFPS GI Irritants
PEPTIC ULCER DISEASE
● Coffee
● Hydrochloric acid and pepsin: High
● Citric acid (e.g. tomato)
production
● Cigarette
● Mucus: Protective barrier: Low
● Carbonated
● Chocolate
FACTORS:
● Alcohol
● Stress: Chronic: Parasympathetic nervous
● Fats
system (Rest and digest)
● Peppermint
○ Increases acetylcholine that stimulates
● Spicy
the vagus nerve that increases
AVOID:
hydrochloric acid production
● Anything that increases IAP (intra abdominal
● Drinks
pressure): compression of the abdomen; e.g.
○ Caffeinated and decaffeinated (both
tight clothing, obese, heavy lifting
leads to peptic ulcer disease)

#RN2024!! CARMELOTES | MANLIGUIS | MASUKOL | MOLEJON | OLEA | TINGGOY 1

Downloaded by mawis ([email protected])
 lOMoARcPSD|52250053

○ Coffee has peptide that increases - chew food slowly and thoroughly;
hydrochloric acid ensure na durog-durog na food ang
● Vices papasok sa stomach
○ Smoking and alcohol ● Avoid Milk
● Drugs - especially large amount; it causes
○ Aspirin and NSAID rebound hyperacidity
● Infection ● Active phase
○ H. Pylori (comes from raw meat) - if it's active/painful, eat bland
foods
TYPES OF PUD “EPIGASTRIC” 3. Avoid Factors

MEDICATIONS
GASTRIC ULCER DUODENAL ULCER
1. Antacids
● Poor Man’s or ● Executive ulcer ● “Carbonate/Hydroxide”; chewable,
Laborer’s ulcer - Caused by stress ineffective if you just swallow it
- Caused by ● Action: neutralized acid (gastric pH
decreased food
increases)
intake
● Time: after meal
● 20% incidence ● 80% incidence ○ Sodium Bicarbonate
■ WOF: Metabolic Alk.
● Common in people ● Common in people ○ Calcium Carbonate
50 years old and 25-50 years old
■ WOF: Hypercalcemia
above - Considered as
- they have toxic/stressful ○ Aluminum Hydroxide
decrease food stage of life ■ WOF: Constipation; decrease
intake “career stage” phosphorus
○ Magnesium Hydroxide
● Malnourished ● Well-nourished ■ WOF: Diarrhea;
● Pain: ½ - 1 hour ● Pain 2-3 hours after hypermagnesemia
after meal meal (gastric 2. Gastric Protectants/Cytoprotective
- The food may hit emptying) ● Sucralfate
the wound (ulcer) ○ Time: before meal
in the stomach ○ Action: forms a barrier
● Misoprostol
● Pain is triggered ● Pain is common at
by food intake night ➔ prostaglandin; sinasabay kay
- The pyloric antiprostaglandin (NSAID) to
sphincter is prevent PUD
usually open at ○ Time: with meal
this hour for ○ Action: reduces HCl and
digestion; if the increases mucus barrier
contents goes
○ Contraindication: Pregnant;
down, they may
hit the ulcer in causes uterine contraction
the duodenum
3. Histamine-2 Receptor Antagonist
● Action: reduces HCL
● Pain relieved by ● Pain is relieved by ● Time: before meal
vomiting food intake
● Histamine rhymes w/ tidine (ex.
● Nausea, vomiting, ● Melena (dark red; Ranitidine)
and hematemesis old blood) 4. Proton Pump Inhibitors
- upper GI bleeding ● Action: reduces HCL
● Time: before meal
INTERVENTIONS ● “-prazole” (e.g. Omeprazole)
Stomach distention = HCl production (high)
1. Meal SURGERY
● small frequent feeding; to avoid 1. Vagotomy
stomach distention ➔ decreases HCl; gastric acidity is
2. Diet decreased, and gastric pH is increased
● As tolerated 2. Gastrectomy
● Chew ➔ removal of ulcer

#RN2024!! CARMELOTES | MANLIGUIS | MASUKOL | MOLEJON | OLEA | TINGGOY 2

Downloaded by mawis ([email protected])
 lOMoARcPSD|52250053

○
Total: stomach is removed, DUMPING SYNDROME
esophagus is reconnected to small ● Large amount of food goes to the small
intestine intestine (high concentration); once it
○ Subtotal/Antrectomy: removal of reaches the small intestine the concentration
lower portion of stomach is high
3. Anastomosis: ● The small intestine contains blood vessels
● Billroth I – Gastroduodenostomy which has low concentration; the fluid from
- partial gastrectomy, remaining the bloodstream shifts to the small intestine
segment anastomosed to the (leading to high fluids in the intestine), the
duodenum blood volume in the bloodstream decreases
● Billroth II – Gastrojejunostomy and could possible lead to shock
- partial gastrectomy, remaining ● Absorption of large amount of food causes
segment anastomosed to the hyperglycemia increasing the insulin; leading
jejunum to postprandial hypoglycemia (rebound
hypoglycemia)

MANIFESTATION
● Pallor
● Hypotension
● Weakness
● Diaphoresis
● Lightheadedness
● Nausea and vomiting

MANAGEMENT
➔ “Food should stay in the stomach/delay
gastric emptying”
IMPORTANT NOTES: 1. Diet
● Partial gastrectomy, with remaining segment ● Protein: High
anastomosed to the duodenum. ● Fiber: High (as tolerated) - delays
● Removal of the lower half of the stomach. emptying
● Surgical division of the vagus nerve to ● Carbohydrate: low (simple)
eliminate the vagal impulses that stimulate ● Meals: small frequent feeding; chew
hydrochloric acid secretion in the stomach. slowly (chew more)
● Partial gastrectomy, with remaining segment ● Fluids: drink fluid in between meals
anastomosed to the jejunum. (breakfast-fluid intake, lunch-fluid intake,
● Removal of the stomach, with attachment of dinner)
the esophagus to the jejunum or duodenum. ● Discourage intake of Salt, sugar ,milk &
A. Vagotomy caffeine since it increases concentration
B. Billroth 1 2. Position: lie down after meals 20-30 minutes;
C. Billroth 2 turn to the left for the food to stay in greater
D. Total Gastrectomy curvature
E. Antrectomy 3. Medication: anticholinergic/antispasmodic;
decreases GI activity, therefore the food stays;
atropine sulfate

DIVERTICULOSIS
● Outpouching of intestinal mucosa.
○ Outpouching - lumolobo palabas
○ Diverticula - d/t weakness
● Common site: Sigmoid
● Cause: low fiber diet
- causes constipation; if you don’t
defecate, the feces will enter the
diverticula causing obstruction leading to
injury cause infection and inflammation
leading to DIVERTICULITIS

#RN2024!! CARMELOTES | MANLIGUIS | MASUKOL | MOLEJON | OLEA | TINGGOY 3

Downloaded by mawis ([email protected])
 lOMoARcPSD|52250053

DIVERTICULITIS - Diarrhea ● Increase IAP

● Inflammation of 1 or more diverticula. ● Vasodilation
● Cause: Accumulation of fecal material NOTES:
● sign of rupture - sudden disappearance of
pain

CLINICAL MANIFESTATION
● McBurney’s point
- at the umbilicus down to iliac crest;
intense pain upon palpation
● Rovsing’s sign
- palpate on LLQ; rolling pain on RLQ
● Dunphy’s sign
1. Inflammation
- pain triggered by coughing
● abdominal pain - crampy in LLQ
● Blumberg’s sign
2. Infection
- rebound tenderness (when you palpate,
● Temperature & WBC - high
no pain can be felt; but once you release
3. Injury
the hands, that’s the time the pain is
● Stool has blood
felt)
4. Obstruction
● Obturator
● Increase gas - flatulence; bloated
- manipulation of obturator muscle;
supine position; right knee flexed at 90
MANAGEMENT
degrees right; foot external rotation to
● Diverticulosis
elicit pain
○ fiber diet - high
● WBC: high
○ fluid intake - high
● Bowel sound: decreased
○ Medication - laxative
● Diverticulitis
○ Fiber - low
○ Monitor for perforation - peritonitis; may
lead to paralytic ileus
a. Peritonitis: board-like rigid
abdomen
b. Paralytic ileus - absent bowel PSOAS SIGN
movement
● Report: unexpected findings; complications

ACUTE PHASE
➢ diverticulitis, appendicitis, cholecystitis and
pancreatitis
➢ Goal: Rest the bowel; decrease GI activity
● Oral intake: NPO
● Activity: Bed Rest
OBTURATOR SIGN
● Fluids: IV
● N & V: NGT for decompression
● Malnutrition: Total Parenteral Nutrition
(TPN)
● DOC: Anticholinergic/Antispasmodic

APPENDICITIS
● Appendix - located at the lower portion of
the ascending colon; RLQ; at the back
● Most common cause: fecalith; it will cause
obstruction then will later on cause injury
causing infection and inflammation

3 FACTORS - causes rupture leading to peritonitis

● Increase peristalsis

#RN2024!! CARMELOTES | MANLIGUIS | MASUKOL | MOLEJON | OLEA | TINGGOY 4

Downloaded by mawis ([email protected])
 lOMoARcPSD|52250053

MANAGEMENT ● Portal Circulation

1. “Refer to acute phase” ○ Normal
2. Avoid:
● High peristalsis
● Increase intraabdominal pressure
● Vasodilation
3. Do not give Analgesics
4. Compress
● Do not give warm/hot - it causes
vasodilation ○ If liver is damaged
NOTE:
● Remember: If with enema, QUESTION,
VERIFY, CLARIFY with the Physician

LIVER CIRRHOSIS
● Causes repeated injury to the liver leading to
fibrosis (scar on the tissue) resulting to “loss
of function”
TYPES OF LIVER CIRRHOSIS
1. Laennec’s Cirrhosis
● caused by alcohol; most common
LABORATORY TESTS
2. Post necrotic
1. Partial Thromboplastin time or
● caused by Hepa B & C
prothrombin time/INR (25-35 sec. / 11-
3. Biliary Cirrhosis
14sec./.8-1.2)
● caused by obstruction of gallstone
● Prolonged; risk for bleeding
4. Cardiac Cirrhosis
2. Serum Bilirubin (.03-1.9 mg/dL)
● caused by Right-sided Heart Failure
● High
3. Aspartate Aminotransferase (AST/SGOT)
CLINICAL MANIFESTATION
(10-40 U/L)
● Hemoglobin
● High (best parameter )
○ Heme (iron) - pigmented/colored portion;
4. Alanine Aminotransferase (ALT/SGPT) (7-56
this will turn into a waste product of the
U/L)
bloodstream, bilirubin (yellow, brown,
● high (best parameter)
orange); then bilirubin goes to the liver
5. BUN (10-20 mg/dL)
and becomes ingredients of the bile
● Low
- Bile contains cholesterol and
bilirubin
- Bile later on goes to the gallbladder
and it moves to the GIT specifically
in the duodenum leading to
emulsification of the fats
○ Skin: jaundice, pruritus
○ Kidney: dark urine
○ Stool: pale/clay colored
○ Stool: steatorrhea
● Protein - Amino acid
○ Normally, the ammonia upon entering the
liver becomes urea then enters the blood MANAGEMENT
then combines to nitrogen (BUN) 1. Bile: low
○ Liver is damaged ● Diet: low fat
○ Hepatic Encephalopathy 2. Hepatic Encephalopathy
■ Classic sign: Asterixis ● Monitor: LOC
■ Decreases LOC ● Avoid sedatives
■ Constructional apraxia (inability to ● Diet: low protein
draw) ○ Source of nutrients: high carbs
■ Fetor Hepaticus (breath of the dead) ● DOC: to increase/improve LOC

#RN2024!! CARMELOTES | MANLIGUIS | MASUKOL | MOLEJON | OLEA | TINGGOY 5

Downloaded by mawis ([email protected])
 lOMoARcPSD|52250053

○ Lactulose: laxative; promote GALLBLADDER

defecation; soft stool to reduce ● Is related to the fat and protein diet
the ammonia ● Fats will enter the GIT and signal the
○ Neomycin: Antibiotic; it will gallbladder to contract and release bile for
kill/reduce the bacteria in GIT emulsification.
that reduces ammonia ● When you ingest fatty foods gallbladder will
3. Portal HPN contract
● DOC: Beta Blocker “olol”; to decrease ● Bile will flow in the tube-like structure called
portal pressure decreasing the risk of “duct” and will exit in the duodenum
bleeding ● In the presence of gallstones, it causes pain
● Procedure: TIPS like colicky “colic” pain caused by the stone
○ Transjugular Intrahepatic stuck in the tube or in the cystic duct.
Portosystemic Shunt (bypass) ● The bile cannot go to the GI specifically in
the duodenum. The gallbladder will be
distended. Signs and symptoms of liver
cirrhosis will manifest.

CHOLECYSTITIS
● Inflammation of the gallbladder
● Chole “gall” cyst “bladder”

TYPES OF CHOLECYSTITIS
1. Calculous
● Gallstone and most common type
● Accompanied by cholelithiasis
2. Acalculous
4. Esophageal Varices
● Absence of stone
● Avoid: high pressure (e.g. coughing)
● Caused by injury, surgery, and
● Rupture
infection
○ Bleeding: Procedure: Balloon
Tamponade (Sengstaken Blakemore
CHOLELITHIASIS (gallstones)
Tube) application of pressure
● Supersaturation = solid, of the substance bile
● In bile, there is cholesterol (high-fat diet,
obese, and most common) and bilirubin
(pigment stone, originating from hemolysis)
● Will cause obstruction of bile and lead to
distended bladder leading to inflammation
● The absence of bile can cause indigestion of
fats
● In hepatobiliary disease the most common
cause is fats

CLINICAL MANIFESTATIONS
1. Inflammation
● Biliary colic
○ Originating from the cystic tube
○ Severe pain
● Abdominal pain
○ Location: Right upper quadrant
● Rebound tenderness
○ Causes pain when there is release
pressure in the back
● Radiating
○ On the right shoulder
● Usually after a fatty or heavy meal
○ The inflamed gallbladder contracts
2. Indigestion: fats → accumulate gas in the
colon

#RN2024!! CARMELOTES | MANLIGUIS | MASUKOL | MOLEJON | OLEA | TINGGOY 6

Downloaded by mawis ([email protected])
 lOMoARcPSD|52250053

● N&V 4. Infection
○ NGT ● Fever
● Belching
○ Kabag-kabag MANAGEMENT
● Flatulence 1. “Refer to Acute phase”
● GI activity: decrease
MURPHY’S SIGN (PROCEDURE) ● GIT sends signal to contract gallbladder
● Position: supine so activity must be decreased
● Hand is placed on hepatic margin or ● DOC: anticholinergic/antispasmodic
subcostal area (last rib) 2. Diet
● Instruct patient to inhale, then diaphragm ● Fat: Low
will contract ● Meal: Small, frequent feedings
● The nurse will feel the gallbladder, where ● Avoid gas-forming foods
the patient can feel pain ○ Almost all vegetables found in
● INTERPRETATION: positive = presence of chop suey
pain 3. Medications
● given in mild cases to dissolve the
stone
● Patient is on NGT because of
decompression which can cause to N/V
● Ursodeoxycholic acid (UDCA)
● Chenodeoxycholic acid (chenodiol or
CDCA)

BOA’S SIGN (PROCEDURE)

● Position: Sitting position
● Pain in the right scapula since the gallbladder
is located at the back

PANCREAS
● The majority is in the lower upper quadrant
at the back
● Organ in front of the pancreas is stomach
● When food is taken, the stomach produces
HCL, signaling the pancreas to release
3. Obstruction digestive enzymes going to the duodenum.
● Skin ● Trypsin (protein), Lipase (fats), protease
○ Jaundice (protein), amylase (carbohydrates)
○ pruritus
● Stool ACUTE PANCREATITIS
○ Pale/clay ● “Bangungot”
○ Lulutang ● Caused by alcohol and gallstone
○ Steatorrhea = foul-smelling ● If there is a gallstone, the pancreatic
● Urine enzymes cannot pass through, causing the
○ Dark colored urine pancreas to digest itself (autodigestion)
● Vitamin Deficiency leading to internal bleeding where the blood
○ Vitamin k deficiency flows downward.
○ High-risk for bleeding ● Serum amylase and serum lipase → HIGH

#RN2024!! CARMELOTES | MANLIGUIS | MASUKOL | MOLEJON | OLEA | TINGGOY 7

Downloaded by mawis ([email protected])
 lOMoARcPSD|52250053

CLINICAL MANIFESTATION enzymes. But with pancreatitis, there is

1. Inflammation injury/autodigestion causing pain.
● Pain
○ Location: Left Upper Quadrant 1. “Refer to Acute phase”
(LUQ) ● No food leads to = low HCL→ low,
● Radiating pancreatic enzyme → low, pain → less
○ To the back of the abdomen 2. Medications:
● Aggravated by: Antispasmodic/Anticholinergic
○ Diet: Fats ● H2 receptor blocker: decreases
○ Beverage: Alcohol hydrochloric acid to decrease
○ Position: Flat on bed pancreatic enzyme (First line
● Bowel sound: Decreased medication)
○ Absent means paralytic ileus ● Proton pump inhibitor: decreases HCL
● Nausea and Vomiting where the pancreatic enzyme
○ Due to indigestion decreases. First line medication
○ MGT: NGT for decompression ● Morphine: palliative/ analgesic
2. Bleeding ● (According to Saunder) Avoid
● Dehydration meperidine/demerol since it has
● Weight loss metabolite which can cause seizure in
● Cullen’s & Grey Turner’s Sign patient with pancreatitis
○ In pancreatitis, the skin is CULL and
GRAY due to bleeding. CHRONIC PANCREATITIS
● Repeated injury
● Undergo healing: calcium is the electrolyte
used in healing → Titigas → Fibrosis →
Nonfunctional = loss of function of Pancreas
→ low pancreatic enzyme → malnourished
and low insulin leads to DM

Calcium in the blood is used for healing, where it

goes to the pancreas so the blood will have a
lower level of calcium = hypocalcemia.
● Cullen’s = umbilliCULLEN’s
CLINICAL MANIFESTATION
● Right side → Grey Turner (nasa gilid/flank)
1. Inflammation
LABORATORY FINDINGS ● Abdominal pain: left upper quadrant
2. Fibrosis
1. WBC
● Mass: Left upper quadrant
○ High
● Calcium: from the blood is utilized in the
2. Glucose
healing process → calcium goes to blood
○ High
→ then to pancreas → can decrease
3. Bilirubin (same with alkaline)
calcium in the blood → leading to
4. Alkaline phosphatase
hypocalcemia
○ from the liver
3. Loss of function
○ If there is obstruction, it will stay in the
● Weight: Loss
blood
● Bilirubin: High
○ High
● Stool: Yellow, steatorrhea
5. Serum and urinary amylase
● Glucose: High even w/o insulin
○ Best Indicator: High
6. Serum lipase
MANAGEMENT
○ High
○ Best indicator: if the patient is in 1. Diet
recovery result would be low ● Food: Bland diet; no spicy, no salty
foods, no coffee
MANAGEMENT ● Meals: small frequent feeding
● Fat: low intake
● REMEMBER: If the stomach digests the food,
● Protein: low intake
it will produce HCl, releasing pancreatic
● Calorie: high in carbs intake

#RN2024!! CARMELOTES | MANLIGUIS | MASUKOL | MOLEJON | OLEA | TINGGOY 8

Downloaded by mawis ([email protected])
 lOMoARcPSD|52250053

2. Medications ● Rest and relaxation

● Same with acute pancreatitis ● Bawal sa buntis ang misoprostol
● First line of drug is H2 blocker (Prostaglandin → binibigay sa
● Avoid Demerol which can cause Antiprostaglandin na NSAIDS)
seizure ● Decrease acid
○ Pancreatin: Given because of loss ● Gastric pH high
of function of the pancreas ● Diverticulosis outpouching, Common in
○ Pancrelipase: Given because of loss sigmoid → LLQ can cause ulceration
of function of the pancreas ● High fiber
○ Insulin & OHA: given to decrease ● Give laxative
blood sugar since there is a APPENDICITIS
complication of diabetes mellitus ● ACUTE PHASE: dec GI activity (NPO)
● Bedrest, IV fluids
● NGT = n/v
● Nutrition: TPN
● Anticholinergic/antispasmodic
● Pain: RLQ
● Cause: Pigarin di ko sure anang pigarin?
● No enema
● Cold compress

LIVER CIRRHOSIS
● Dark urine
● Pale/clay stool
RECAP ● Jaundice
● Bilirubin high
GERD ● Stool steatorrhea foul smelling
● Problem in GERD: gastric contents going up ● Bile production is low
● Classic problem: heartburn/ pyrosis ● Low fat diet
● FOod should go down (MGT) ● Low protein para bababa ang ammonia levels
● HEa of the bed elevated ● Jaundice is related to bile
● High fiber and carbohydrates ● Hand flapping/ Asterixis- negative
● SFF ● Laxative = lactulose = defecation (soft)
Complication of gastrectomy is dumping syndrome ● Improve ang LOC
(Food going down) ● Pain: RUQ
● Hypoglycemia ● Portal hypertension
● MGT: Food should stay ● Hepatic encephalopathy
● High protein and low fiber ● Caput medusae
● Diet as tolerated CHOLECYSTITIS
● Complication: diarrhea ● Pain: LLQ
● Carb diet: low ● Gallstone
● No salt or coffee Suga ● Boa’s sign (scapula)
● Lie down, turn to left ● Murphy’s sign
● DOC: antispasmodic,atropine sulfate, ● Obturator sign
anticholinergic PANCREATITIS
PEPTIC ULCER DISEASE ● Decrease GI activity
● Gastric -pain with food ● NPO
● Common at night duodenal ● Bed rest
● Relieved by food is duodenal ● NGT
● Hematemesis is gastric ● TPN for nutrition
● Relieved by vomiting gastric ● DOC: Antispasmodic/ anticholinergic/
● No bedtime snack ● LUQ
● SFF ● Cullen sign
● Chew food ● Autodigestion
● Do not drink coffee ● Serum amylase and serum lipase
● Do not use aspirin ● Greys turner
● Cook food thoroughly ● cullen‘s sign

#RN2024!! CARMELOTES | MANLIGUIS | MASUKOL | MOLEJON | OLEA | TINGGOY 9

Downloaded by mawis ([email protected])
 lOMoARcPSD|52250053

POST TEST Which manifestation should the nurse monitor

the client for?
A. Pallor
1. A client with gastroesophageal reflux disease
B. Constipation
is complaining of chest pain after a meal. The
C. Bradycardia
nurse tells the client to avoid which of the
D. Hypertension
following?
NOTES:
A. A. High Fiber diet.
- Small Intestine: high liquids
B. High carbohydrate diet.
- Shock/ diaphoresis
C. Lying down after eating.
- Hypoglycemia
D. Turing on the left side, with HOB
elevated 30
7. A client was admitted to the ER. The client
feels pain from light touch in the right lower
2. The nurse assesses a client with hepatic
scapular region. The client also reported pain
encephalopathy for the presence of asterixis.
at the right upper quadrant after a fatty
What should the nurse do to appropriately
meal. Which of the following disorders is the
test for asterixis?
client most likely experiencing?
A. Examine the client’s handwriting
A. Pancreatitis
movements
B. Appendicitis
B. Check the stool for clay-colored
C. Diverticulitis
pigmentation
D. Cholecystitis
C. Ask the client to extend the wrist and
the fingers
8. The nurse is doing an admission assessment on
D. Check the serum bilirubin and liver
a client with duodenal ulcer. To determine
enzyme levels
whether the problem is currently active, the
nurse should assess the client for which
3. Medical management of the client with acute
symptom of duodenal ulcer?
episodes of diverticulitis should include which
A. Weight loss
of the following treatments?
B. Nausea and vomiting
A.Reduced fluid intake
C. Pain relieved by food intake
B. Increased fiber in diet
D. Pain radiating down the right arm
C. Administration of antispasmodics
D. Exercises to increase intra-abdominal
9. A patient with a history of diverticulosis is
pressure
admitted with abdominal pain. The physician
suspects diverticulitis. What other findings
4. The nurse is providing instructions to a client
would correlate with diverticulitis?
with peptic ulcer disease about symptom
A. Cramping type pain
management. Which statement by the client
B. Positive Cullen’s Sign
indicates they are learning about the disease?
C. Pain found at McBurney’s Point
A. “I should eat a snack at bedtime.”
D. Abdominal pain that is mainly present in
B. “I should drink more milk each meal.”
the upper right quadrant
C. “I can take aspirin to relieve gastric
pain.”
10. You’re caring for a client with liver cirrhosis.
D. “It is important that I eat slowly and
Which of the following assessment findings
chew my food thoroughly.”
would suggest hepatic encephalopathy?
A. Fetor Hepaticus
5. A client is resuming a diet after a Billroth II
B. McBurney's point
procedure. To minimize complications from
C. Cullen’s sign
eating, which actions should the nurse teach
D. Murphy’s sign
the client to do?
A. Lay down after eating
11. You are developing a plan of care on a 67 y.o.
B. Drink liquids with meals
patient with hepatic encephalopathy. Which
C. Eat a diet high in carbohydrates
of the following interventions will you include
D. Eat concentrated sweets between meals
in the plan of care?
only
A. Administering sedatives, as necessary.
B. Administering a lactulose as ordered.
6. A client who undergoes a gastric resection is
C. Encouraging a protein-rich diet.
at risk for developing dumping syndrome.
D. Encouraging a fat diet.

#RN2024!! CARMELOTES | MANLIGUIS | MASUKOL | MOLEJON | OLEA | TINGGOY 10

Downloaded by mawis ([email protected])
 lOMoARcPSD|52250053

NOTES: B. Famotidine
- Lactulose improves LOC C. Misoprostol
D. Sucralfate
12. A 20 y.o. client is admitted with acute
pancreatitis. Which laboratory findings would 18. Which of the following complications is
you expect to be abnormal for this patient? thought to be the most common cause of
A. Blood Ammonia appendicitis?
B. Serum creatinine and BUN A. A fecalith
C. Serum amylase and lipase B. Bowel kinking
D. Alanine aminotransferase and aspartate C. Internal bowel occlusion
aminotransferase D. Abdominal bowel swelling
NOTES:
- Blood Ammonia: Liver 19. An enema is prescribed for a client with
- Serum creatinine and BUN: Kidney suspected appendicitis. Which of the
- Serum amylase and lipase: Pancreas following actions should the nurse take?
- Alanine aminotransferase: Liver A. Prepare 750 ml of irrigating solution
warmed to 100*F
13. A patient with diverticulosis is your patient. B. Provide privacy and explain the
Which interventions would you expect to procedure to the client
include in his/her care? C. Assist the client to left lateral Sim’s
A. Low-fiber diet and fluid restrictions. position
B. Total parenteral nutrition and bed rest. D. Question the physician about the
C. Administration of analgesics and order
antacids.
D. High-fiber diet and administration of 20. The nurse is reviewing the physician’s orders
laxatives. written for a client admitted with acute
pancreatitis. Which physician order would the
14. A client is receiving pancrelipase for chronic nurse question if noted on the client’s chart?
pancreatitis. Which observation best indicates A. NPO status
that the treatment is effective? B. Insert nasogastric tube
A. There is no skin breakdown. C. An anticholinergic medication
B. The client’s appetite improves. D. Demerol for pain
C. A decrease in body weight.
D. Stools are less fatty. 21. The Nurse is providing care for Kristoff who
has jaundice. Which statement indicates that
15. The student nurse is teaching the family of a the nurse understands the rationale for
patient with liver cirrhosis. Which of the instituting skin care measures for the client?
following food items should be limited in the A. “Jaundice is associated with pressure
patient’s diet? ulcer formation.”
A. Meats and beans. B. “Jaundice impairs urea production,
B. Banana and orange. which produces pruritus.”
C. Potatoes and pastas. C. “Jaundice produces pruritus due to
D. Baked fish and vegetables. impaired bile acid excretion.”
D. “Jaundice leads to decreased tissue
16. Your patient has a retractable gastric peptic perfusion and subsequent breakdown.”
ulcer and has had a gastric vagotomy. Which
factor increases as a result of vagotomy? 22. Which assessment finding indicates that
A. Peristalsis. lactulose is effective in decreasing the
B. Gastric acidity. ammonia level in the client with hepatic
C. Gastric motility. encephalopathy?
D. Gastric pH. A. Passage of two or three soft stools
daily
17. Your patient takes NSAIDS for her B. Evidence of watery diarrhea
degenerative joint disease, has developed C. Daily deterioration in the client’s
peptic ulcer disease. Which drug is useful in handwriting
preventing NSAID-induced peptic ulcer D. Appearance of frothy, foul-smelling
disease? stools
A. Calcium carbonate

#RN2024!! CARMELOTES | MANLIGUIS | MASUKOL | MOLEJON | OLEA | TINGGOY 11

Downloaded by mawis ([email protected])
 lOMoARcPSD|52250053

23. A patient with a history of diverticulosis is

admitted with abdominal pain. The physician
suspects diverticulitis. What other findings
would NOT correlate with diverticulitis?
A. Fever
B. Crampy abdominal pain
C. Abdominal bloating
D. Positive Cullen’s Sign

24. A client is diagnosed with cholecystitis. The

nurse reviews the client’s medical record,
expecting to note documentation of which
manifestations of this disorder?
A. Dark stools
B. Light-colored and clear urine
C. Positive Murphy’s sign
D. Upper abdominal pain that radiates to
the left shoulder

25. The nurse is doing an admission assessment on

a client with gastric ulcer. To determine
whether the problem is currently active, the
nurse should assess the client for which
symptom of gastric ulcer?
A. Weight gain
B. Pain common at night
C. Pain relieved by food intake
D. Pain relieved by vomiting

#RN2024!! CARMELOTES | MANLIGUIS | MASUKOL | MOLEJON | OLEA | TINGGOY 12

Downloaded by mawis ([email protected])