Stromberg: Medical-Surgical Nursing, 5th Edition

Chapter 27: The Gastrointestinal System

Answer Guidelines for Think Critically

Why do you think health care providers frequently place hospitalized patients on GI prophylaxis
medication?
Hospitalization and surgery with the fear of the unknown cause added levels of stress. Extra
stress causes increased gastric secretion of acid and also diminishes blood flow to the gastric
and duodenal mucosa. This can predispose to mucosal erosion and ulcer formation.

Are there any GI problems that seem to run in your family? What measures can family members
take to prevent such problems?
Eat a well-balanced diet that includes fiber, calcium, and low fat and drink at least eight glasses
of water a day. Develop routine exercise habits. Avoid obesity and smoking and reduce alcohol
consumption. Practice safe food handling and hygiene to reduce infections. Do not delay
defecation.

How would you teach your family and friends about ways to decrease the risk of colon cancer?
What would you recommend to your adult relatives regarding screening for colorectal cancer?
Certain foods should be avoided, as they may contribute to colon cancer (see Patient Teaching:
Foods That May Contribute to Colon Cancer). Eating a diet that is high in fiber and low in fat
and consuming at least eight glasses of water a day is good advice. Patients should be advised to
follow the most recent guidelines from the American Cancer Society for colorectal cancer
screenings. (Recommendations may vary due to a patient’s personal or family history.) General
recommendations include stool specimens for Hemoccult and DNA for primary screening
methods. Other tests include colonoscopy, virtual colonoscopy, flexible sigmoidoscopy, and
double-contrast barium enema.

Identify three ways to teach a patient prevention of excessive gas postoperatively.

Encourage the patient to ambulate if possible. Avoid hot or chilled drinks. Teach exercises to
reduce gas (see Patient Teaching: Exercise to Reduce Gas and Bloating). Massaging the
abdomen (if no pain or incisions) may help; massage right to left and downward toward the
rectum. Also, placing the patient in Trendelenburg position (if not contraindicated) causes the
gas to rise toward the rectum.

List six foods the high in fiber that a patient might add to diet to combat constipation.
High-fiber foods include cereals or breads made with whole grains. Generally, most fruits and
vegetables are good sources. The skin of fruits such as apples or pears is a good source of fiber.
Legumes are also a good source.

Copyright © 2023 by Elsevier Inc. All rights reserved.

Answers and Rationales for Clinical Judgment and Next-Generation NCLEX®
Examination–Style Questions

1. Correct Answer: 4

Excessive amounts of acetaminophen can cause liver toxicity and failure. (1) Patients need to be
reminded to check other medications and over-the-counter medications for acetaminophen. No
more than 4000 mg per day of acetaminophen should be taken on a regular basis. (1)
Hydrochlorothiazide can cause liver damage in some patients, but a more common cause is too
much acetaminophen. (2) Consumption of a high-fat diet may cause gallbladder problems, not
liver toxicity. (3) Long-term smoking can damage the lungs and blood vessels and contribute to
the formation of various cancers, but it does not cause liver toxicity.

2. Correct Answer: 1

Drinking excessive alcohol on a consistent basis may cause erosion of the gastric mucosa and
predispose to ulcer formation. (2) Taking an occasional aspirin does not predispose to a
gastrointestinal ulcer. (3) Taking an H2 inhibitor on a daily basis is not recommended for
prevention of an ulcer. (4) Eating hot, spicy food at least once a day is not recommended for
ulcer prevention.

3. Correct Answer: 3

(See Table 27.1 for specific nursing care related to diagnostic testing.) Patients who undergo
liver biopsy are at risk for postprocedural bleeding or respiratory problems, such as dyspnea,
cyanosis, or restlessness, which might indicate pneumothorax. They require frequent vital signs
and close observation. (1) Ultrasound is a noninvasive procedure; routine monitoring is
sufficient. (2) Patients who undergo hepatobiliary scintigraphy should be informed that there is
little danger of radioactivity; routine monitoring is sufficient. (4) The Helicobacter pylori
antibody test requires a blood sample, so routine care of a venipuncture site is sufficient.

4. Correct Answers: 1, 2, 5, 6

Decreasing fears and anxieties promotes psychological well-being related to the upcoming
procedure. A signed consent form is necessary for a liver biopsy. Coagulation studies are
assessed before a liver biopsy to determine any increased risk of bleeding. Allergy to local
anesthetic used during the procedure must be determined before the test. (3) Assessing for
dehydration and electrolyte balance is not indicated for a liver biopsy. (4) The patient should be
positioned supine or on the left side for a liver biopsy.

5. Correct Answers: 3, 4, 6

Dehydration is a possible adverse effect of rigorous bowel preparations. Muscle cramps can
occur with the loss of potassium caused by the diarrhea from the bowel prep. Loss of fluid that
causes dehydration can lower blood pressure. (1) Constipation will not occur because of the
bowel preparation; it causes diarrhea. (2) Rash could occur if the patient has an allergy to a

Copyright © 2023 by Elsevier Inc. All rights reserved.

component of the fluid, but it is not a likely side effect. (5) Chest pains are not a likely side
effect.

6. Correct Answer: 3

A lack of intrinsic factor may cause pernicious anemia, which can manifest as fatigue and
activity intolerance. (1) Atrophy of taste buds results in difficulty in distinguishing between salty
and sweet flavors. (2) Change in stool quality can be related to many disorders or bodily
functions but not to lack of intrinsic factor; however, changes in lipase or bile will change the
stool characteristics. (4) Difficulties with mastication can be related to poor dentition or ill-fitting
dentures.

7. Correct Answer: 4

ALT, ammonia, and INR all assess the liver and its functions. (1) These labs would be done to
assess kidney function. (2) Elevation in these labs would indicate pancreatitis. (3) These labs
evaluate the heart.

8. Correct Answer: 4

The patient has understood that fruits and vegetables are good sources of fiber. (1) White bread
and dairy products do not supply fiber. (2) Fluid consumption must be spaced throughout the
day. If fluids are restricted to mealtimes, it will be difficult to drink the recommended amount.
(3) Adding milk to cereal does not increase the fiber content.

9. Correct Answer: 3

Deficient fluid volume is the priority since symptoms and the condition are related to excessive
fluid loss. (1) Nothing in the history suggests that the patient is having trouble breathing. (2, 4)
These are not priority nursing diagnoses. The patient is likely to have activity intolerance, and
her hypotension suggests a decreased cardiac output, but both problems should readily resolve if
the fluid deficit is corrected.

10. Correct Answers: 1, 2, 3

Sufficient fiber, a well-balanced diet, and regular exercise are all good advice. (4) Encourage at
least eight glasses of fluid a day, unless there is a medical reason for fluid restriction. (5) Routine
use of laxatives should be discouraged to avoid physiologic dependence.

11. Correct Answers: 1, 2, 3

Determining food preferences and encouraging family visits are appropriate to meet the cultural
needs of the patient. Offering small, frequent amounts of foods and fluids is an appropriate
intervention regardless of cultural background. (4) Considering parenteral nutrition is premature
if enteral methods are still an option. (5) Consulting a dietitian might be appropriate after cultural

Copyright © 2023 by Elsevier Inc. All rights reserved.

needs are explored. Consulting speech therapy is appropriate if there are problems with chewing
and swallowing.

12. Correct Answer: 27.77 or 28 gtt/min

Total Volume × Drop factor

Formula: =gtt /min
Total time∈minutes
1000 mL ×10 gtt /mL
=27.77∨28 gtt /min
360 minutes

13. Highlight or place an X by the potential problems the patient is at risk of developing from the
options below.

OPTIONS
Urinary incontinence
X Dehydration
Hyponatremia
X Hypokalemia
X Dysrhythmias
X Acute kidney injury
Muscle rigidity
X Bowel incontinence
Hypernatremia
X Hypotension

The loss of fluid from vomiting and diarrhea causes dehydration, particularly in the older adult.
This fluid loss easily leads to hypotension. Even brief periods of hypotension can cause acute
kidney injury. The main electrolyte lost from the GI tract is potassium resulting in hypokalemia
and potentially causing dysrhythmias. Liquid stool is difficult to control and bowel incontinence
is common.
Urinary incontinence is not an expected result of the presenting symptoms. GI fluid and
electrolyte disturbances do not include alterations in calcium levels. Muscle rigidity is
associated with low blood calcium levels. With dehydration it might be expected that sodium
levels would rise. However, when the dehydration is secondary to vomiting and diarrhea, sodium
is lost with the fluid and overall sodium levels drop.

Type of Question: Multiple Response Select All That Apply

Cognitive Level: Prioritize Hypotheses

Copyright © 2023 by Elsevier Inc. All rights reserved.