Certified Gastroenterology RN Managing GI Health Conditions Questions and Answers — Questions and Answers
Question 1: A nurse is providing dietary education to a patient newly diagnosed with celiac disease. Which meal selection by the patient demonstrates a correct understanding of the dietary restrictions?
- A turkey sandwich on rye bread with a side of coleslaw.
- Beer-battered fish with a side of seasoned fries.
- Grilled chicken, baked potato, and a side salad with vinaigrette. (Correct answer)
- A bowl of oatmeal with brown sugar and raisins.
Correct answer: Grilled chicken, baked potato, and a side salad with vinaigrette.
The correct meal is grilled chicken, a baked potato, and a salad with a simple vinaigrette, as these items are naturally free of gluten. Celiac disease requires a strict, lifelong avoidance of gluten, a protein found in wheat, barley, and rye. Rye bread and beer batter contain gluten. While oats are naturally gluten-free, they are often subject to cross-contamination with wheat during processing and should only be consumed if specifically labeled as gluten-free.
Question 2: A patient is admitted to the hospital with an acute, uncomplicated episode of diverticulitis. Which of the following initial orders should the nurse anticipate?
- High-fiber diet and increased fluid intake.
- Bowel rest (NPO or clear liquids) and intravenous antibiotics. (Correct answer)
- Administration of a stimulant laxative to prevent constipation.
- Immediate preparation for a screening colonoscopy.
Correct answer: Bowel rest (NPO or clear liquids) and intravenous antibiotics.
The initial management of acute, uncomplicated diverticulitis involves resting the colon to reduce inflammation and treating the infection. This is achieved through bowel rest (NPO or clear liquids), intravenous fluids for hydration, and intravenous antibiotics. A high-fiber diet is recommended for prevention of future episodes (diverticulosis), not during an acute flare. Laxatives and colonoscopy are contraindicated in the acute phase due to the risk of increasing intraluminal pressure and perforation.
Question 3: A gastroenterology nurse is educating a patient with IBS-D (diarrhea-predominant) about the low FODMAP diet. Which of the following foods should the nurse advise the patient to AVOID during the initial elimination phase?
- Onions, garlic, and honey. (Correct answer)
- Chicken breast and white rice.
- Blueberries and strawberries.
- Spinach and carrots.
Correct answer: Onions, garlic, and honey.
The low FODMAP diet restricts Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols. Onions (fructans), garlic (fructans), and honey (fructose) are classic high-FODMAP foods that often trigger symptoms in patients with IBS and should be avoided in the elimination phase. The other options are considered low-FODMAP foods.
Question 4: A 62-year-old male with a long history of GERD is diagnosed with Barrett's esophagus without dysplasia following an EGD with biopsies. What is the MOST important topic for the nurse to include in the patient's education plan?
- The need to discontinue his proton pump inhibitor (PPI) therapy immediately.
- The elimination of all acidic foods, such as citrus and tomatoes, from his diet.
- The critical importance of adhering to a scheduled endoscopic surveillance program. (Correct answer)
- The high likelihood that he will require esophageal surgery within the next year.
Correct answer: The critical importance of adhering to a scheduled endoscopic surveillance program.
Barrett's esophagus is a precancerous condition that increases the risk of esophageal adenocarcinoma. The cornerstone of management for non-dysplastic Barrett's esophagus is a regular endoscopic surveillance program to monitor for the development of dysplasia. Adherence to this schedule allows for early detection and treatment. PPI therapy is continued to control acid reflux. While dietary changes are helpful for GERD symptoms, surveillance is the most critical component for long-term management of cancer risk.
Question 5: A patient describing symptoms of dysphagia to both solids and liquids, regurgitation of undigested food, and substernal chest pain is suspected of having achalasia. Which diagnostic test is considered the gold standard for confirming this diagnosis?
- Upper endoscopy (EGD).
- Barium esophagram (barium swallow).
- 24-hour esophageal pH monitoring.
- Esophageal manometry. (Correct answer)
Correct answer: Esophageal manometry.
Esophageal manometry is the gold standard for diagnosing achalasia because it directly measures the pressure and motor function of the esophagus. It can definitively show the characteristic features of achalasia: incomplete relaxation of the lower esophageal sphincter (LES) and aperistalsis of the esophageal body. While a barium swallow may show a suggestive "bird's beak" appearance and an EGD can rule out other causes, manometry confirms the diagnosis.
Question 6: A nurse is caring for a patient admitted with acute pancreatitis. The patient reports severe, boring midepigastric pain radiating to the back and has elevated serum lipase levels. Which of the following is a priority nursing intervention for this patient?
- Encouraging a low-fat diet as tolerated.
- Administering opioid analgesics and maintaining NPO status. (Correct answer)
- Inserting a nasogastric tube for immediate enteral feeding.
- Preparing the patient for an urgent cholecystectomy.
Correct answer: Administering opioid analgesics and maintaining NPO status.
The immediate priorities for managing acute pancreatitis are pain control and resting the pancreas to reduce the stimulation of enzyme secretion. This is accomplished by administering analgesics (often opioids) for the severe pain and keeping the patient NPO (nothing by mouth). Aggressive IV fluid resuscitation is also a key initial intervention. Diet and enteral feeding are considered later, once the acute phase begins to resolve.
Certified Gastroenterology RN Managing GI Health Conditions Questions and Answers
A nurse is providing dietary education to a patient newly diagnosed with celiac disease.
Which meal selection by the patient demonstrates a correct understanding of the dietary restrictions?