ATI RN
ATI Gastrointestinal System Quizlet Questions
Question 1 of 5
The nurse is teaching the client how to perform a colostomy irrigation. To enhance the effectiveness of the irrigation and fecal returns, what measure should the nurse instruct the client to do?
Correct Answer: A
Rationale: In the context of teaching a client how to perform a colostomy irrigation, instructing them to increase fluid intake is the correct measure to enhance the effectiveness of the irrigation and fecal returns. By increasing fluid intake, the client can help soften the stool, making it easier to remove during the irrigation process. Adequate hydration also promotes overall bowel function and helps prevent complications such as constipation. Reducing the amount of irrigation solution (Option B) would not be beneficial as it may not provide enough fluid to effectively cleanse the colostomy. Performing the irrigation in the evening (Option C) does not directly impact the effectiveness of the procedure. Placing heat on the abdomen (Option D) may provide comfort but does not specifically enhance the irrigation process. In an educational context, it is important for nurses to teach clients about proper colostomy care to promote independence and quality of life. Understanding the rationale behind each instruction helps clients feel empowered and confident in managing their colostomy effectively. By highlighting the rationale for increasing fluid intake, nurses can ensure that clients grasp the importance of this measure in maintaining colostomy health.
Question 2 of 5
The nurse is doing an admission assessment on a client with a history of duodenal ulcer. To determine whether the problem is currently active, the nurse would assess the client for which of the following most frequent symptom(s) of duodenal ulcer?
Correct Answer: A
Rationale: In assessing a client with a history of duodenal ulcer, the nurse must be aware of the typical symptoms associated with this condition. The correct answer, option A, "Pain that is relieved by food intake," is indicative of a duodenal ulcer. This pain occurs because food helps to neutralize the gastric acid and provides temporary relief. Option B, "Pain that radiated down the right arm," is not a common symptom of duodenal ulcers. This type of radiation is more typical of cardiac-related issues like a heart attack. Option C, "N/V (nausea/vomiting)," can be a symptom of duodenal ulcers but is not as specific or frequent as the pain relieved by food intake. Option D, "Weight loss," is a consequence of untreated or severe duodenal ulcers but is not a primary symptom that would help determine if the problem is currently active. Educationally, understanding the hallmark symptoms of duodenal ulcers is crucial for nurses to accurately assess, diagnose, and intervene in the care of patients with gastrointestinal conditions. Recognizing these symptoms can lead to prompt treatment and improved patient outcomes.
Question 3 of 5
The nurse instructs the ileostomy client to do which of the following as a part of essential care of the stoma?
Correct Answer: A
Rationale: In the care of an ileostomy, option A, which instructs the client to cleanse the peristomal skin meticulously, is the correct choice. Proper cleansing of the stoma and surrounding skin is essential to prevent skin breakdown, irritation, and infection. By keeping the area clean, the client can maintain skin integrity and prevent complications. Option B, recommending high-fiber foods like nuts, is incorrect for an ileostomy client. High-fiber foods can increase stool output and may cause blockages or issues for the client with an ileostomy, as their digestive system may not be able to process these foods effectively. Option C, massaging the area below the stoma, is also incorrect. Massaging the stoma or surrounding area can cause trauma or injury to the delicate tissues, leading to complications and discomfort for the client. Option D, limiting fluid intake to prevent diarrhea, is not an appropriate recommendation for an ileostomy client. Adequate hydration is crucial for ileostomy clients to prevent dehydration and maintain fluid balance, especially considering their increased risk of electrolyte imbalances due to higher fluid losses through their stoma. In an educational context, it is vital for nurses to understand the specific care needs of clients with ostomies, such as ileostomies. Providing accurate and evidence-based education to clients on stoma care helps promote their physical and emotional well-being, as well as prevent complications. Nurses play a key role in empowering clients to manage their ostomies effectively and improve their quality of life.
Question 4 of 5
The client who has undergone creation of a colostomy has a nursing diagnosis of Disturbed body image. The nurse would evaluate that the client is making the most significant progress toward identified goals if the client:
Correct Answer: D
Rationale: The correct answer is D: Practices cutting the ostomy appliance. This choice indicates that the client is actively involved in self-care and adapting to the colostomy. By practicing cutting the ostomy appliance, the client is demonstrating independence and self-management skills, showing significant progress towards overcoming the disturbed body image. Choices A, B, and C do not involve active participation in self-care tasks related to the colostomy, which are essential for the client's adaptation and acceptance.
Question 5 of 5
The nurse is assessing for stoma prolapse in a client with a colostomy. The nurse would observe which of the following if stoma prolapse occurred?
Correct Answer: D
Rationale: In this scenario, the correct answer is D) Protruding stoma. When a stoma prolapse occurs in a client with a colostomy, the stoma will protrude further out from the abdominal wall than usual. This happens due to the weakening of the surrounding muscles and support structures, causing the stoma to extend beyond its normal position. Option A) Sunken and hidden stoma is incorrect because a sunken stoma would signify a retracted or inwardly positioned stoma, which is not indicative of prolapse. Option B) Dark- and bluish-colored stoma is incorrect as discoloration would suggest ischemia or inadequate blood supply to the stoma, not prolapse. Option C) Narrowed and flattened stoma is incorrect as these characteristics do not align with the physical presentation of a prolapsed stoma. Educationally, understanding the signs and symptoms of stoma complications like prolapse is crucial for nurses caring for patients with ostomies. Recognizing these changes early can help prevent further complications and promote timely intervention and management. Nurses should also educate patients on stoma care, signs of complications, and when to seek medical assistance to promote optimal outcomes and quality of life for individuals with ostomies.