ATI RN
ATI Gastrointestinal System Test
1. When planning care for a client with ulcerative colitis who is experiencing symptoms, which client care activities can the nurse appropriately delegate to a unlicensed assistant?
- A. Assessing the client's bowel sounds
- B. Providing skin care following bowel movements
- C. Evaluating the client's response to antidiarrheal medications
- D. administration of pain medication every 4 hours
Correct answer: B
Rationale: Providing skin care following bowel movements, maintaining intake and output records, and obtaining the client's weight can be delegated to a unlicensed assistant.
2. An intubated patient is receiving continuous enteral feedings through a Salem sump tube at a rate of 60ml/hr. Gastric residuals have been 30-40ml when monitored Q4H. You check the gastric residual and aspirate 220ml. What is your first response to this finding?
- A. Notify the doctor immediately.
- B. Stop the feeding, and clamp the NG tube.
- C. Discard the 220ml, and clamp the NG tube.
- D. Give a prescribed GI stimulant such as metoclopramide (Reglan).
Correct answer: B
Rationale: If gastric residuals are high during continuous enteral feedings, the first response is to stop the feeding and clamp the NG tube.
3. Before bowel surgery, Lee is to administer enemas until clear. During administration, he complains of intestinal cramps. What do you do next?
- A. Discontinue the procedure.
- B. Lower the height of the enema container.
- C. Complete the procedure as quickly as possible.
- D. Continue administration of the enema as ordered without making any adjustments.
Correct answer: B
Rationale: If a patient complains of intestinal cramps during an enema, lowering the height of the enema container can help reduce discomfort.
4. You’re preparing a patient with a malignant tumor for colorectal surgery and subsequent colostomy. The patient tells you he’s anxious. What should your initial step be in working with this patient?
- A. Determine what the patient already knows about colostomies.
- B. Show the patient some pictures of colostomies.
- C. Arrange for someone who has a colostomy to visit the patient.
- D. Provide the patient with written material about colostomy care.
Correct answer: A
Rationale: When a patient with a malignant tumor is anxious about colorectal surgery and a colostomy, the initial step is to determine what the patient already knows about colostomies.
5. You’re advising a 21 y.o. with a colostomy who reports problems with flatus. What food should you recommend?
- A. Peas
- B. Cabbage
- C. Broccoli
- D. Yogurt
Correct answer: D
Rationale: Yogurt can help reduce problems with flatus in patients with a colostomy.
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