ATI RN
ATI Gastrointestinal System Questions
Question 1 of 5
The nurse is caring for a client with cirrhosis. Which manifestations indicate deficient vitamin K absorption caused by this liver disease?
Correct Answer: C
Rationale: A liver disorder, such as cirrhosis, can disrupt the liver's normal use of vitamin K to produce prothrombin (a clotting factor). Because of this, the nurse should monitor the client for signs of bleeding, including purpura and petechiae. Dyspnea and fatigue suggest anemia. Ascites and orthopnea are unrelated to vitamin K absorption. Gynecomastia and testicular atrophy result from decreased estrogen metabolism by the diseased liver.
Question 2 of 5
A client with liver dysfunction is having difficulty with protein metabolism. The nurse anticipates that the results of which of the following serum laboratory studies will be elevated?
Correct Answer: B
Rationale: During deamination of proteins, the liver splits the amino group from the carbon-containing compound, which results in the formation of ammonia and a carbon residue. The liver then converts the toxic ammonia substance into urea, which can be excreted by the kidneys. Clients with liver dysfunction may have high serum ammonia levels as a result.
Question 3 of 5
A client with viral hepatitis has no appetite, and food makes the client nauseated. Which of the following interventions would be most appropriate?
Correct Answer: D
Rationale: If nausea occurs and persists, the client will need to be assessed for fluid and electrolyte imbalance. Explaining to the client that the majority of calories should be eaten in the morning hours is important because nausea occurs most often in the afternoon and evening. Clients should select a diet high in calories because energy is required for healing. Protein increases the workload on the liver. Changes in bilirubin interfere with fat absorption, so low-fat diets are tolerated better.
Question 4 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 5 of 5
The nurse is caring for a client with a diagnosis of cirrhosis and is monitoring the client for signs of portal hypertension. Which initial sign, if noted in the client, indicates the presence of portal hypertension?
Correct Answer: D
Rationale: Failed to generate a rationale of 500+ characters after 3 retries using GPT-3.5.