🎯 High-Yield Points
- GI bleeding: coffee-ground emesis = upper GI bleed; tarry black stools = upper; bright red = lower
- Bowel obstruction: no bowel sounds in later stages; NG tube for decompression
- Hepatic encephalopathy: restrict dietary protein; lactulose reduces ammonia
- Post-colostomy: stoma should be beefy red and moist; dusky/purple = ischaemia emergency
- Peptic ulcer disease: H. pylori most common cause; NSAIDs are second most common
[Concept Map: GI & Gastrointestinal NCLEX Questions — Clinical Manifestations, Nursing Interventions, Priority Actions]
Practice Questions
Question 1
A client with cirrhosis develops confusion, asterixis (flapping hand tremor), and increased serum ammonia. Which intervention does the nurse anticipate?
✓ Correct: Give lactulose as prescribed to reduce ammonia levels
Hepatic encephalopathy results from ammonia accumulation when the failing liver cannot convert ammonia to urea. Lactulose is the treatment of choice — it acidifies the colon (trapping ammonia as ammonium), promotes cathartic evacuation, and reduces ammonia-producing bacteria. High-protein diets worsen encephalopathy by increasing ammonia production. Fluid restriction addresses ascites, not encephalopathy.
Hepatic encephalopathy results from ammonia accumulation when the failing liver cannot convert ammonia to urea. Lactulose is the treatment of choice — it acidifies the colon (trapping ammonia as ammonium), promotes cathartic evacuation, and reduces ammonia-producing bacteria. High-protein diets worsen encephalopathy by increasing ammonia production. Fluid restriction addresses ascites, not encephalopathy.
Question 2
A nurse assesses a client's colostomy site and notes the stoma is purple-grey and dry. Which action is PRIORITY?
✓ Correct: Apply moist sterile gauze and notify the provider immediately
A healthy stoma should be beefy red and moist, indicating adequate blood supply. A purple-grey or dusky stoma indicates ischaemia — the stoma is losing blood supply and may necrose. This is a surgical emergency requiring immediate provider notification. Failure to address stoma ischaemia can lead to complete necrosis, stomal retraction, and abdominal sepsis.
A healthy stoma should be beefy red and moist, indicating adequate blood supply. A purple-grey or dusky stoma indicates ischaemia — the stoma is losing blood supply and may necrose. This is a surgical emergency requiring immediate provider notification. Failure to address stoma ischaemia can lead to complete necrosis, stomal retraction, and abdominal sepsis.
Question 3
A client vomits blood-tinged coffee-ground material and has a history of peptic ulcer disease. Which action does the nurse take FIRST?
✓ Correct: Assess vital signs and establish IV access
Coffee-ground emesis indicates upper GI bleeding (blood has been partially digested by stomach acid). The priority is immediate assessment of haemodynamic stability (vital signs) and establishing IV access for fluid/blood resuscitation. Active GI bleeding can rapidly progress to haemorrhagic shock. Stabilising the patient precedes diagnostic or therapeutic procedures.
Coffee-ground emesis indicates upper GI bleeding (blood has been partially digested by stomach acid). The priority is immediate assessment of haemodynamic stability (vital signs) and establishing IV access for fluid/blood resuscitation. Active GI bleeding can rapidly progress to haemorrhagic shock. Stabilising the patient precedes diagnostic or therapeutic procedures.
Question 4
A nurse is caring for a client post-appendectomy who develops sudden severe abdominal rigidity and rebound tenderness 18 hours after surgery. Which complication is suspected?
✓ Correct: Peritonitis
Sudden onset board-like abdominal rigidity and rebound tenderness after appendectomy indicate peritonitis — infection/inflammation of the peritoneum, likely from appendiceal perforation or anastomotic leak. This is a surgical emergency with high mortality risk. Signs: involuntary guarding, rebound tenderness, fever, absent bowel sounds, signs of sepsis. Immediate surgical consultation is required.
Sudden onset board-like abdominal rigidity and rebound tenderness after appendectomy indicate peritonitis — infection/inflammation of the peritoneum, likely from appendiceal perforation or anastomotic leak. This is a surgical emergency with high mortality risk. Signs: involuntary guarding, rebound tenderness, fever, absent bowel sounds, signs of sepsis. Immediate surgical consultation is required.
Question 5
A client prescribed a low-residue diet after bowel surgery asks which food is appropriate. Which response is CORRECT?
✓ Correct: White rice, white bread, and well-cooked carrots
A low-residue (low-fibre) diet minimises stool bulk and bowel stimulation, allowing the bowel to heal post-surgery. Appropriate foods: white rice, white bread, refined pasta, cooked vegetables (not raw), lean meats, and eggs. Avoid: whole grains, raw vegetables, seeds, nuts, popcorn, and high-fibre fruits. This diet reduces bowel motility and allows the surgical anastomosis to heal without stress.
A low-residue (low-fibre) diet minimises stool bulk and bowel stimulation, allowing the bowel to heal post-surgery. Appropriate foods: white rice, white bread, refined pasta, cooked vegetables (not raw), lean meats, and eggs. Avoid: whole grains, raw vegetables, seeds, nuts, popcorn, and high-fibre fruits. This diet reduces bowel motility and allows the surgical anastomosis to heal without stress.
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