GI Patient Assessment & Documentation 3 — Questions and Answers
Question 1: Which assessment finding requires the nurse to immediately report to the physician when caring for a patient with cirrhosis?
- Spider angiomas on the chest
- Asterixis (flapping tremor) of the hands (Correct answer)
- Mild peripheral edema
- Palmar erythema
Correct answer: Asterixis (flapping tremor) of the hands
Asterixis is a sign of hepatic encephalopathy indicating significant liver failure and ammonia toxicity, requiring immediate intervention.
Question 2: When assessing a patient for ascites, the nurse percusses dullness that shifts when the patient rolls to the side. This technique is called:
- Ballottement
- Shifting dullness (Correct answer)
- Fluid wave test
- Blumberg's sign
Correct answer: Shifting dullness
Shifting dullness is the percussion technique where dullness moves to the dependent side as the patient repositions, indicating free fluid in the peritoneal cavity.
Question 3: A patient with Crohn's disease reports steatorrhea. Which documentation accurately describes this symptom?
- Bright red blood coating the stool
- Greasy, foul-smelling stools that float (Correct answer)
- Frequent small-volume stools with mucus
- Hard pellet-like stools difficult to pass
Correct answer: Greasy, foul-smelling stools that float
Steatorrhea describes fat malabsorption resulting in greasy, foul-smelling, floating stools, common in Crohn's disease affecting the small bowel.
Question 4: The nurse is completing a GI history. Which question best elicits information about dysphagia?
- 'Do you have difficulty initiating a swallow or does food get stuck?' (Correct answer)
- 'Do you have pain after eating fatty foods?'
- 'Do you experience heartburn more than twice a week?'
- 'Have you noticed blood in your stool?'
Correct answer: 'Do you have difficulty initiating a swallow or does food get stuck?'
Asking whether difficulty initiating swallowing or food getting stuck helps differentiate oropharyngeal dysphagia from esophageal dysphagia.
Question 5: When documenting a patient's abdominal assessment, the nurse should record bowel sounds in which sequence?
- Inspect, palpate, percuss, auscultate
- Auscultate, inspect, percuss, palpate
- Inspect, auscultate, percuss, palpate (Correct answer)
- Palpate, percuss, auscultate, inspect
Correct answer: Inspect, auscultate, percuss, palpate
The abdomen is assessed in the order: inspect, auscultate, percuss, then palpate — auscultation before palpation prevents altering bowel sounds.
Question 6: A patient with a nasogastric tube has output documented as 800 mL over 8 hours. Which electrolyte imbalance is the nurse most concerned about?
- Hyperkalemia
- Hypernatremia
- Hypokalemia (Correct answer)
- Hypercalcemia
Correct answer: Hypokalemia
Gastric secretions are rich in potassium and hydrogen; prolonged NG drainage leads to hypokalemia and metabolic alkalosis.
Question 7: A patient rates their abdominal pain as 7/10 and describes it as colicky, coming in waves. This pattern is most consistent with:
- Peritonitis
- Intestinal obstruction (Correct answer)
- Peptic ulcer perforation
- Hepatic abscess
Correct answer: Intestinal obstruction
Colicky, wave-like abdominal pain is caused by smooth muscle contracting against an obstruction, characteristic of intestinal obstruction.
GI Patient Assessment & Documentation 3
Which assessment finding requires the nurse to immediately report to the physician when caring for a patient with cirrhosis?