ATI RN
ATI Gastrointestinal System Questions
Question 1 of 5
The client with ascites is scheduled for a paracentesis. The nurse is assisting the physician in performing the procedure. Which of the following positions will the nurse assist the client to assume for this procedure?
Correct Answer: D
Rationale: Paracentesis is a procedure performed to remove excess ascitic fluid from the peritoneal cavity, commonly in patients with conditions like liver cirrhosis causing ascites. The positioning of the client is critical to ensure the procedure is safe, effective, and minimizes complications such as bowel perforation or inadequate fluid drainage. The optimal position leverages gravity to pool the ascitic fluid in the lower abdomen, specifically in the right or left lower quadrant, where the needle or catheter is typically inserted under ultrasound guidance if needed. The correct position is the upright position (D), where the client sits at the edge of the bed with feet supported on a stool or floor, leaning slightly forward with arms supported on a bedside table. This posture allows gravity to draw the ascitic fluid downward into the dependent portions of the abdomen, creating a larger, more accessible fluid pocket. In this position, the abdominal wall is taut, making landmarks easier to identify, and the risk of puncturing organs like the intestines or bladder is reduced because the fluid acts as a buffer. The nurse assists by helping the client maintain stability, draping the area, and monitoring vital signs throughout. This positioning also facilitates better post-procedure recovery, as the client can remain semi-upright to prevent fluid reaccumulation or discomfort from lying flat immediately after. In contrast, the supine position (A), where the client lies flat on their back, is unsuitable because gravity causes the ascitic fluid to distribute evenly across the abdominal cavity rather than pooling in one area. This diffusion makes it challenging to locate a sufficient fluid pocket for safe needle insertion, increasing the risk of accidental injury to underlying structures like the liver, spleen, or bowel. Supine positioning is more appropriate for diagnostic imaging or other abdominal assessments but not for therapeutic paracentesis. The left side-lying position (B) is not standard for this procedure. While side-lying can be used in some abdominal interventions, placing the client on the left side would shift fluid toward the left lower quadrant, but this orientation complicates access for the physician, who typically prefers the right side due to the natural anatomy (e.g., avoiding the heart and spleen on the left). It also raises the risk of fluid spilling or inadequate drainage and is generally reserved for specific cases like left-sided pathology, not routine ascites management. Similarly, the right side-lying position (C) positions the fluid in the right flank but still does not utilize gravity as effectively as the upright posture. The client’s body curvature in side-lying can obscure the insertion site, make the abdominal wall less taut, and hinder the physician's ability to monitor the procedure visually or with palpation. This position might be considered if the client cannot tolerate upright sitting due to weakness or respiratory issues, but it is not the first-line choice and could lead to incomplete evacuation of fluid or procedural delays. Overall, selecting the upright position prioritizes procedural efficiency, patient safety, and optimal fluid dynamics, aligning with evidence-based nursing protocols from sources like the American Association of Critical-Care Nurses. Nurses must assess the client's tolerance for this position, considering factors like orthostatic hypotension or obesity, and prepare alternatives only if contraindicated, ensuring informed consent and sterile technique throughout.
Question 2 of 5
A client is admitted to the hospital with acute viral hepatitis. Which of the following signs or symptoms would the nurse expect to note based on this diagnosis?
Correct Answer: B
Rationale: Common signs of acute viral hepatitis include weight loss, dark urine, and fatigue. The client is anorexic, possibly from a toxin produced by the diseased liver, and finds food distasteful. The urine darkens because of excess bilirubin being excreted by the kidneys. Fatigue occurs during all phases of hepatitis.
Question 3 of 5
The nurse is monitoring a client admitted to the hospital with a diagnosis of appendicitis. The client is scheduled for surgery for 2 hours. The client begins to complain of increases abdominal pain and begins to vomit. On assessment the nurse notes that the abdomen distended and bowel sounds are diminished. Which of the following is the most appropriate nursing intervention?
Correct Answer: B
Rationale: Based on the signs and symptoms presented in the question, the nurse should suspect peritonitis and should notify the physician. Administering pain medication is not an appropriate intervention. Heat should never be applied to the abdomen of a client with suspected appendicitis. Scheduling surgical time is not within the scope of nursing practice, although the physician probably would perform the surgery earlier than the prescheduled time.
Question 4 of 5
A nurse is caring for a client diagnose with pancreatitis. The nurse anticipates that the client would not experience an elevation of which of the following enzymes?
Correct Answer: B
Rationale: Rationale: 1. The correct answer is B) Lactase. Lactase is an enzyme responsible for breaking down lactose (milk sugar). Pancreatitis primarily affects enzymes produced by the pancreas, such as lipase, amylase, and trypsin. Lactase is produced by the small intestine, not the pancreas. Therefore, in pancreatitis, lactase levels would not be directly affected. 2. A) Lipase is an enzyme produced by the pancreas that helps digest fats. In pancreatitis, lipase levels are typically elevated due to pancreatic inflammation and damage. 3. C) Amylase is another enzyme produced by the pancreas that aids in digesting carbohydrates. In pancreatitis, amylase levels are often elevated, as the inflamed pancreas leaks this enzyme into the bloodstream. 4. D) Trypsin is an enzyme produced by the pancreas to digest proteins. In pancreatitis, trypsin levels can be elevated due to the release of digestive enzymes into the pancreas itself, leading to auto-digestion and further damage. Key Learning Points: - Pancreatitis is an inflammatory condition affecting the pancreas. - Elevated levels of lipase and amylase are common markers of pancreatitis. - Lactase is not produced by the pancreas but by the small intestine. - Understanding enzyme functions and origins helps in diagnosing and managing pancreatic disorders. In conclusion, recognizing the specific enzymes affected in pancreatitis is crucial for accurate assessment and treatment. Lactase remains unaffected in pancreatitis, distinguishing it from the other enzymes typically elevated in this condition.
Question 5 of 5
The client is admitted to the hospital for treatment of acute hepatitis B. Which activity order would the nurse expect to be prescribed?
Correct Answer: A
Rationale: Rationale: 1. The correct answer is A) Bedrest. Acute hepatitis B is a viral infection that affects the liver, causing inflammation and damage. Bedrest is essential in the treatment of acute hepatitis B to reduce metabolic demands on the liver, promote healing, and prevent complications. Rest helps to conserve energy, reduce liver workload, and facilitate the body's immune response to fight the infection. 2. Option B) Encourage ambulation is incorrect because excessive physical activity can increase the metabolic demands on the liver, leading to further stress and potential complications. Rest is crucial for the liver to recover and regenerate. 3. Option C) Out of bed in a chair is also incorrect as it involves more physical activity than bedrest and may not provide the necessary rest for the liver to heal efficiently. Prolonged sitting may also increase the risk of complications like deep vein thrombosis. 4. Option D) No activity restrictions is incorrect because patients with acute hepatitis B require activity restrictions, especially during the acute phase of the illness. Engaging in strenuous activities can exacerbate liver inflammation and delay recovery. Educating patients on the importance of rest is vital in managing acute hepatitis B effectively.