Clinical study guides / Gastrointestinal and liver nursing careGastrointestinal and liver nursing care Recognize bleeding, liver and bowel complications. Review nutrition, prevention, procedures and individualized stoma care.
Practice this collection Upper GI bleeding with shock signs Which findings suggest upper GI bleeding with significant blood loss?
A client with a peptic ulcer history vomits dark material.
Response and reasoning Coffee-ground or bloody vomit or black tarry stool, with dizziness, a racing pulse, pale cool skin or sweating; seek emergency help.
Coffee-ground vomit with a racing pulse, pallor and clammy skin signals life-threatening blood loss.
Bleeding plus shock signs is life-threatening.
NIDDK · GI bleeding: symptoms and causes · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Black stool: iron or bleeding? What can cause black stools besides bleeding?
A client recently started iron tablets.
Response and reasoning Iron, bismuth medicines, black licorice and blueberries; black tarry stool with dizziness or vomiting blood needs prompt evaluation.
Tarry stool with dizziness suggests bleeding rather than an iron effect.
Know the medicine list, and do not dismiss tarry stool with symptoms.
MedlinePlus · Stools: black or tarry · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Raise the head of the bed for reflux How should the bed be adjusted for nighttime reflux?
A client has heartburn when lying down at night.
Response and reasoning Raise the upper body so the head is 6–8 inches higher, using a foam wedge or bed risers.
Raising the head of the bed 6–8 inches is a recommended GERD measure.
Gravity helps keep stomach contents down.
NIDDK · Treatment for GER and GERD · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Finish H. pylori treatment and retest What follow-up confirms H. pylori has been cleared?
A client is taking combination antibiotics and an acid reducer.
Response and reasoning Take every dose as prescribed, then retest at least 4 weeks after finishing antibiotics.
All doses are taken, then testing at least 4 weeks after confirms clearance.
Feeling better is not proof of cure.
NIDDK · Treatment for peptic ulcers · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept NSAIDs and ulcers What happens to NSAID use when it has caused an ulcer?
A client with an ulcer takes ibuprofen daily for knee pain.
Response and reasoning The provider may stop the NSAID, lower the dose, switch to a non-NSAID pain reliever, or add a PPI if an NSAID is still needed.
NSAIDs may be stopped, reduced, changed or paired with a PPI by the provider.
Review pain medicines with the provider rather than continuing as before.
NIDDK · Treatment for peptic ulcers · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Limit sodium with ascites Which diet change helps manage fluid buildup in cirrhosis?
A client with cirrhosis has increasing abdominal swelling.
Response and reasoning Limit sodium as advised, alongside prescribed medicines that remove fluid.
Sodium restriction is advised, and rising weight and girth suggest fluid buildup.
Daily weights help show whether fluid is building.
NIDDK · Treatment for cirrhosis · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Keep taking lactulose for liver disease Why is lactulose prescribed for some people with liver disease?
A client with cirrhosis takes lactulose several times a day.
Response and reasoning It lowers blood ammonia by moving it into the colon for removal; changes in dose or stopping go through the prescriber.
Lactulose lowers ammonia; confusion after stopping needs prompt review.
Lactulose here treats ammonia, not constipation.
MedlinePlus · Lactulose · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Vaccines with cirrhosis Which hepatitis vaccines are recommended for people with cirrhosis?
A client with cirrhosis is not immune to hepatitis A or B.
Response and reasoning Hepatitis A and hepatitis B vaccines for a client who is not immune, plus other vaccines such as flu and pneumococcal as recommended for the client's age and health.
Both are recommended for people with cirrhosis who are not immune.
Protect a damaged liver from new infections.
NIDDK · Treatment for cirrhosis · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Check OTC medicines with cirrhosis Should a person with cirrhosis take over-the-counter pain relievers without advice?
A client with cirrhosis has a headache.
Response and reasoning No. Talk with the provider before taking OTC medicines, including NSAIDs and acetaminophen, and supplements.
People with cirrhosis should check NSAIDs and acetaminophen with their doctor first.
In cirrhosis, every new medicine gets checked first.
NIDDK · Treatment for cirrhosis · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Prevent hepatitis A spread How is hepatitis A best prevented?
A household member was diagnosed with hepatitis A.
Response and reasoning Household contacts should be assessed promptly for postexposure vaccine or immune globulin, ideally within 2 weeks of exposure, plus thorough handwashing after the bathroom and before food.
Handwashing limits spread, and vaccine or immune globulin protects best when given within 2 weeks of exposure.
Postexposure protection is time-limited; tiny amounts swallowed can spread it.
CDC · About hepatitis A · CDC · Hepatitis A clinical overview · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept How hepatitis B spreads How is hepatitis B transmitted, and how is it not?
A client's partner has chronic hepatitis B.
Response and reasoning Through blood, semen or certain other body fluids, even in tiny amounts; not by kissing, sharing utensils, hugging, coughing, breastfeeding, food or water.
Semen and other body fluids can transmit hepatitis B. Blood exposure can transmit hepatitis B.
Vaccination is the best prevention.
CDC · About hepatitis B · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Hepatitis C is curable What is the outlook with current hepatitis C treatment?
A client newly diagnosed with hepatitis C is afraid nothing can be done.
Response and reasoning More than 95% are cured with pills taken for 8–12 weeks; there is no vaccine, and all adults should be tested.
Oral treatment cures over 95% of patients in 8–12 weeks.
Test, treat, cure.
CDC · About hepatitis C · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Recognize acute pancreatitis What is the typical pain of acute pancreatitis?
A client who drinks heavily reports severe abdominal pain.
Response and reasoning Upper abdominal pain that may spread to the back, often with nausea, vomiting, fever and a fast heartbeat; severe or worsening pain needs care right away.
Upper abdominal pain to the back with vomiting, fever, tachycardia and high lipase fits pancreatitis.
Gallstones and heavy alcohol use are leading causes.
NIDDK · Pancreatitis: symptoms and causes · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept When a gallbladder attack needs care now Which signs during a gallbladder attack need care right away?
A client has upper right abdominal pain after a large, fatty meal.
Response and reasoning Pain lasting several hours, vomiting, fever or chills, yellow skin or eyes, tea-colored urine or light stools.
Prolonged pain with fever, chills and jaundice needs care right away.
Fever or jaundice changes a 'stone attack' into an urgent problem.
NIDDK · Gallstones: symptoms and causes · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Appendicitis is an emergency What pain pattern suggests appendicitis?
A young adult has sudden abdominal pain.
Response and reasoning Pain that starts near the belly button and moves lower right, worsening with movement or coughing; it needs immediate care.
This pattern suggests appendicitis, which needs immediate care.
Suspected appendicitis needs immediate evaluation.
NIDDK · Appendicitis: symptoms and causes · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Recognize bowel obstruction Which symptoms suggest an intestinal obstruction?
A client had abdominal surgery months ago.
Response and reasoning Abdominal swelling, cramping pain, nausea and vomiting, and being unable to pass gas or stool.
Vomiting is a common obstruction symptom. Inability to pass gas or stool suggests obstruction. Distention is a sign of obstruction.
Can't pass gas, swollen belly and vomiting need prompt care.
MedlinePlus · Intestinal obstruction · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Seeds, nuts and diverticular disease Do people with diverticular disease need to avoid nuts, seeds and popcorn?
A client recovered from an episode of diverticulitis.
Response and reasoning Most do not; newer research shows these foods are not harmful, and higher-fiber eating with less red meat may lower risk.
Newer evidence finds these foods are not harmful, and fiber may lower risk.
Fiber helps; blanket seed bans are outdated.
NIDDK · Eating, diet and nutrition for diverticular disease · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Recognize a severe colitis flare Which pattern suggests a severe ulcerative colitis flare?
A client with ulcerative colitis is tracking stools at home.
Response and reasoning More than six bowel movements a day with blood most of the time, especially with fever or weight loss; contact the care team.
More than six bloody stools a day with fever suggests severe disease.
Count stools and blood, and report escalation early.
NIDDK · Ulcerative colitis: symptoms and causes · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Clear liquids before colonoscopy Which drinks fit a clear-liquid colonoscopy prep?
A client starts the clear-liquid diet the day before the procedure.
Response and reasoning Water, fat-free broth, plain coffee or tea without milk, pulp-free apple or white grape juice, and light-colored gelatin or sports drinks; no red or purple.
Pulp-free apple juice is an allowed clear liquid. Plain coffee without milk or cream is allowed. Clear fat-free broth is an allowed clear liquid.
Finish the prep completely; stool should end clear and liquid.
NIDDK · Colonoscopy · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept When colorectal screening starts At what age do average-risk adults begin colorectal cancer screening?
A 46-year-old at average risk asks about screening.
Response and reasoning For average-risk adults, USPSTF recommends starting at 45 and continuing through 75; an abnormal stool test needs follow-up colonoscopy.
USPSTF recommends screening adults aged 45–49.
Start at 45, and follow up abnormal stool tests.
USPSTF · Colorectal cancer screening (2021) · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Check stoma color What does a healthy stoma look like, and which colors need a call?
A client is two days home after ileostomy surgery.
Response and reasoning Pink or red, moist and a little shiny; purple, black or white, or marked swelling, needs a call to the provider.
A purple, black or white stoma needs to be reported.
Color changes can signal poor blood flow to the stoma.
MedlinePlus · Ileostomy: discharge · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept High output and dehydration Why do people with an ileostomy need to watch for dehydration?
Ileostomy output is often liquid.
Response and reasoning Watery output can cause fluid and electrolyte loss; report dehydration signs promptly. Very high output with low urine and lightheadedness needs urgent assessment and a stoma-team fluid plan, which may include specific oral rehydration or IV fluids.
Output far exceeds intake with low urine and lightheadedness; urgent assessment and a stoma-team plan are needed.
Track output, urine and symptoms together; do not delay reporting.
MedlinePlus · Ileostomy: discharge · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept An empty pouch can mean blockage When does no ileostomy output need a call?
The pouch has stayed empty since breakfast.
Response and reasoning If the pouch stays empty for more than 4–6 hours, especially with cramping, a swollen stoma or nausea, contact the provider right away; do not just take a laxative.
No output for more than 4–6 hours with cramping needs prompt contact.
Brief pauses are normal; prolonged silence with cramps is not.
MedlinePlus · Ileostomy: discharge · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Eating with dumping syndrome Which eating changes help dumping syndrome?
A client has symptoms after meals following stomach surgery.
Response and reasoning Six small meals, waiting at least 30 minutes after a meal to drink, fewer simple sugars, more protein, fiber and fat, and reclining for 30 minutes after eating.
Small meals and separating fluids from meals are recommended.
Separate fluids from meals and slow the sugar load.
NIDDK · Eating, diet and nutrition for dumping syndrome · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Living with lactose intolerance Must people with lactose intolerance avoid all dairy?
A client has bloating after drinking milk.
Response and reasoning Usually not; most can have some lactose, especially with meals, and can use lactose-free products or lactase enzymes while getting enough calcium and vitamin D.
Small amounts and lactose-free options are possible, and calcium and vitamin D matter.
Adjust lactose; protect calcium and vitamin D.
NIDDK · Eating, diet and nutrition for lactose intolerance · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Wait for the gag reflex after EGD When can a client eat or drink after an upper endoscopy?
A numbing spray was used on the throat.
Response and reasoning After the client is alert and the gag reflex has returned, following the ordered post-procedure instructions, so food and liquid are not choked on.
Food and liquid wait until the gag reflex returns to prevent choking.
Check swallowing protection before the first sip.
MedlinePlus · EGD (esophagogastroduodenoscopy) · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Flush the feeding tube between medicines What is done between medicines given through a gastrostomy tube?
A caregiver gives two medicines through a child's G-tube.
Response and reasoning Flush the tube with the amount of water in the child's care plan between medicines, with the child sitting up.
Flushing between medicines is the stated instruction; the volume follows the child's care plan.
Flushing keeps medicines separate and the tube clear.
MedlinePlus · Gastrostomy feeding tube: bolus · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Hepatitis A timing How long after exposure do hepatitis A symptoms usually appear?
A household contact was exposed one week ago and feels well.
Response and reasoning Usually 2–7 weeks after exposure, and many infected people have no symptoms.
Feeling well soon after exposure does not rule out infection, so prevention steps and vaccination advice still matter.
Absence of early symptoms is not reassurance.
CDC · About hepatitis A · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Appendicitis can look atypical Do all people with appendicitis have the classic pain pattern?
A child has abdominal pain without the typical migrating pain.
Response and reasoning No. Some people, especially children, do not have the typical signs.
Relying only on the classic pattern can delay care for a medical emergency.
Atypical does not mean unlikely.
NIDDK · Appendicitis: symptoms and causes · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Hepatitis C testing in pregnancy When does CDC recommend hepatitis C screening?
A pregnant client asks why hepatitis C testing was included in prenatal labs.
Response and reasoning All adults at least once, and all pregnant women during each pregnancy, except in settings where HCV prevalence is below 0.1%; people with ongoing risk need periodic testing.
Hepatitis C often causes no symptoms, and treatment cures most infections.
Testing is routine, not an accusation.
CDC · Clinical screening and diagnosis for hepatitis C · CDC · About hepatitis C · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Sources Use these notes to study clinical concepts. In patient care, follow the setting's emergency response and treatment protocols.