CHAPTER 29: GASTROINTESTINAL DISORDERS AND THERAPEUTIC MANAGEMENT {Urden: Critical Care Nursing, 9th Edition}

C HAPTER 29: G ASTROINTESTINAL
D ISORDERS AND T HERAPEUTIC
M ANAGEMENT
Urden: Critical Care Nursing, 9th Edition



MULTIPLE CHOICE


1. The nurse is caring for a patient with acute liver failure. The patient has
elevated ammonia levels. Which medication would the nurse expect the
provider to order for this patient?
a. Insulin
b. Vitamin K
c. Lactulose
d. Lorazepam



ANS: C



Lactulose, a synthetic ketoanalog ue of lactose split into lactic acid and
acetic acid in the intestine, is given orally through a nasogastric tube
or as a retention enema. The result is the creation of an acidic
environment that results in ammonia being drawn out of the portal
circulation. Lactulose has a laxative effect that promotes expulsion.
Vitamin K is used to help control bleeding. Insulin would be given to
control hypergl ycemia. Use of benzodiazepines and other sedatives is
discouraged in a patient with acute liver failure because pertinent
neurologic changes may be masked, and hepatic encephalopathy may be
exacerbated.

, PTS: 1 DIF: Cognitive Level: Appl ying REF: p. 694
OBJ: Nursing Process Step: Intervention TOP:
Gastrointestinal MSC: NC LEX: Physiologic Integrit y



2. A patient was admitted with severe epigastric pain and has been diagnosed
with cancer. The patient is scheduled for an esophagectom y. The patient
asks about the procedure. What is the best response by the nurse?
a. “This procedure is usuall y performed for cancer of the proximal
esophagus and gastroesophageal junction.”
b. “This procedure is usuall y performed for cancer of the distal
esophagus and gastroesophageal junction.”
c. “This procedure is usuall y performed for cancer of the pancreatic
head.”
d. “The procedure is usuall y pe rformed for varices of the distal
esophagus and gastroesophageal junction.”



ANS: B



Esophagectom y is usuall y performed for cancer of the distal esophagus
and gastroesophageal junction.



PTS: 1 DIF: Cognitive Level: Appl ying REF: p. 695
OBJ: Nursing Pro cess Step: Intervention TOP:
Gastrointestinal MSC: NC LEX: Physiologic Integrit y



3. A patient was admitted after a Roux -en-Y gastric bypass (RYGBP). A
nursing student asks the nurse what t ype of surgery an RYGBP is. What is
the best response by the nurse?

, a. “It is an esophagectomy performed using the transthoracic
approach.”
b. “It is an esophagectomy performed using a transhiatal approach.”
c. “It is a combination of restrictive and malabsorption t ypes of
bariatric surgery.”
d. “It is a standard operation for pancrea tic cancer.”



ANS: C



Bariatric procedures are divided into three broad t ypes: (1) restrictive,
(2) malabsorptive, and (3) combined restrictive and malabsorptive. The
Roux-en-Y gastric bypass combines both strategies by creating a small
gastric pouch and anastomosing the jejunum to the pouch. Food then
bypasses the lower stomach and duodenum, resulting in decreased
absorption of digestive materials. The standard operation for pancreatic
cancer is a pancreaticoduodenectom y, also called the Whipple
procedure.



PTS: 1 DIF: Cognitive Level: Understanding REF: p.
695 | p. 696 OBJ: Nursing Process Step: Intervention
TOP: Gastrointestinal MSC: NC LEX: Physiologic
Integrit y



4. The nurse is caring for a patient after an esophagectom y. The nurse knows
the patient i s at risk for an anastomotic leak. Which finding would
indicate this occurrence?
a. Crackles in the lung bases
b. Subcutaneous emphysema
c. Incisional bleeding
d. Absent of bowel sounds