Ch 39 Gastrointestinal System 1

A patient faces difficulty in defecation due to constipation. About which conditions should the nurse ask the patient before advising him or her to perform the Valsalva maneuver? Select all that apply.

Hemorrhoids Cardiac problems Abdominal surgery

The patient has a prescription for promethazine 25 mg. To prevent harm to the patient, the dose should be administered through which site? 1 Subcutaneous 2 Intravenous 3 Intradermal 4 Intramuscular

4 Doses of promethazine should be administered intramuscularly to decrease the risk of severe tissue injury, including gangrene. Subcutaneous, intradermal, and intravenous administration are contraindicated related to the possible tissue injury and gangrene. Text Reference - p. 925

A nurse is assessing a patient who has constipation. Which information should the nurse obtain to assess the patient's elimination pattern? Select all that apply. 1 Frequency of bowel movements 2 Recall of food consumed in the past week 3 Use of laxatives 4 Use of opioid medications 5 History of abdominal pain 6 Consistency of stools

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A nurse assesses an elderly patient with colon cancer. The patient experiences much difficulty when moving and requires assistance with turning and ambulating. Which diagnostic test is appropriate to perform first? 1 Virtual colonoscopy 2 Conventional colonoscopy 3 Lower GI series examination 4 Endoscopic retrograde cholangiopancreatography

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The nurse identifies that it is likely that a magnetic resonance imaging (MRI) study will be prescribed for which patient? 1 Patient with colorectal cancer 2 Patient with symptoms of gallstones 3 Patient with symptoms of hepatitis C 4 Patient that has undergone pacemaker surgery

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A patient experiences severe abdominal pain. A nurse performs a physical examination and finds that there is tenderness in the left upper quadrant. Which organs could cause this tenderness? Select all that apply. 1 Spleen 2 Stomach 3 Hepatic flexure of the colon 4 Right lobe of the liver 5 Duodenum

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The nurse is providing immediate postprocedure care to a patient who underwent a fluoroscopic x-ray examination of the colon. What is appropriate to be included in the patient's plan of care? Select all that apply. 1 Offering fluids to the patient 2 Giving laxatives to the patient 3 Asking the patient to lie on the right side 4 Administering antibiotics to the patient 5 Keeping the patient on nothing by mouth (NPO) status

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A patient with a strong family history of colon cancer is scheduled for a screening colonoscopy. After the procedure, the nurse should perform which interventions? Select all that apply. 1 Obtain vital signs 2 Assess for abdominal cramping 3 Monitor for signs of rectal bleeding 4 Assess for abdominal distention 5 Check for return of gag reflex 6 Administer enema to empty bowel

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A patient with liver fibrosis is scheduled for a closed biopsy procedure. What should the nurse include in the procedural plan of care? Select all that apply. 1 Assessing the vital signs 2 Determining if drug allergies exist 3 Instructing the patient to lie in the supine position during the procedure 4 Administering aspirin before the test 5 Instructing the patient to not breathe during needle insertion 6 Informing the patient that an incision will be made to remove a tumor

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A patient reports a two-month history of dark tarry stools and occasional blood on the toilet paper after wiping. The patient experiences generalized weakness and tires easily. The patient denies a history of taking iron pills or blueberry consumption. The nurse anticipates that which diagnostic tests will be prescribed to determine the cause of the blood? Select all that apply. 1 Guaiac stool test for occult blood 2 Virtual colonoscopy 3 Capsule endoscopy 4 Cholangiography 5 Abdominal ultrasound 6 Magnetic resonance imaging (MRI)

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The nurse is caring for patient who is scheduled for a liver biopsy. Which interventions are appropriate to be included on the patient's plan of care? Select all that apply. 1 Check the bleeding times. 2 Check the prothrombin time. 3 Instruct the patient to avoid red meat for 48 hours before the test. 4 Maintain nothing by mouth (NPO) status for eight hours before the test. 5 While the needle is being inserted during the procedure, instruct the patient to hold the breath after expiration.

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A nurse is assessing a patient who has constipation. Which information should the nurse obtain to assess the patient's elimination pattern? Select all that apply. 1 Frequency of bowel movements 2 Recall of food consumed in the past week 3 Use of laxatives 4 Use of opioid medications 5 History of abdominal pain 6 Consistency of stools

1 3 4 6 On assessment of the patient's elimination pattern, the nurse should get detailed information about the frequency of bowel movements, use of laxatives, enemas, or opioid medications, and consistency of stools. The frequency of bowel movements helps to assess the severity of constipation. Use of laxatives or enemas helps to assess the self-care interventions used by the patient. Consistency of stools helps to determine the cause of constipation. Information about the food intake in the past week is obtained while taking the history about the nutritional metabolism pattern of the patient. Presence of abdominal pain should be assessed while obtaining information about the cognitive-perceptual pattern. Text Reference - p. 873

During the abdominal examination of a healthy patient, which actions should the nurse perform as appropriate? Select all that apply. 1 Use warm hands. 2 Advise the patient to maintain a full bladder. 3 Advise the patient to empty the bladder. 4 Advise the patient to assume the supine position with knees flexed. 5 Advise the patient to stand with arms raised.

1 3 4 For the abdominal assessment, using warm hands is important to avoid eliciting muscle guarding. The patient should be advised to have an empty bladder. The patient should be in the supine position and relaxed by slightly flexing the knees. A full bladder may interfere with palpation of the abdominal organs and may cause the palpation to be painful for the patient. An abdominal assessment cannot be performed while the patient is in a standing position. Text Reference - p. 875

While caring for a bedridden patient, a nurse notices that the patient's stools are lighter than the usual brown color. What could this finding indicate? Select all that apply. 1 Liver failure 2 Pancreatitis 3 Biliary obstruction 4 Stomach ulcers 5 Colorectal cancer

1 3 Bile is broken down in the intestine to form stercobilinogen and urobilinogen. Stercobilinogen gives a brown color to the feces. If the stools are light in color, it indicates there is reduced production of bile or bile is not reaching the intestine for breakdown. Liver cells form bile; therefore liver failure could cause decreased production of bile. Biliary tract obstruction prevents the bile from reaching the intestine. Pancreatitis causes impaired fat metabolism and therefore the stools are fatty and frothy. This is called steatorrhea. Stomach ulcers and colorectal cancers may cause bleeding in the GI tract, resulting in red-colored stools. Text Reference - p. 870

A patient who is admitted with an upper gastrointestinal bleed has a history of two previous heart attacks and is presently being given large doses of intravenous fluids. For which possible complication(s) should the nurse monitor the patient? Select all that apply. 1 Pulmonary edema 2 Arrhythmias 3 Cardiac failure 4 Infection 5 Vomiting

1 3 First, the patient is being given large doses of fluids in a short period of time, which can result in volume overload. This may eventually cause cardiac failure and subsequent pulmonary edema. Also, the patient has had two previous heart attacks, which means heart function is compromised. Intravenous fluids are unlikely to cause conduction abnormalities, infection, or vomiting. Text Reference - p. 956

When the nurse is interviewing a patient about his or her health history, which conditions should the nurse include as relevant to the gastrointestinal system? Select all that apply. 1 Hemorrhoids 2 Nasal polyps 3 Monthly income 4 Lactose intolerance 5 Nausea and vomiting 6 Abdominal distension

1 4 5 6 Hemorrhoids, lactose intolerance, nausea and vomiting, and abdominal distension are conditions related to the gastrointestinal system. When interviewing the patient about this system, the nurse should inquire and obtain information about these conditions. Nasal polyps are a condition related to the upper respiratory system. Monthly income is not directly relevant to the gastrointestinal system in this context. Although economic status does influence diet and health from a broad public-health viewpoint, the health history is not about such topics; it is focused on specific conditions. Text Reference - p. 871

After teaching health promotion measures to a patient with constipation, the nurse concludes that the patient has increased risk of constipation during a follow-up visit. Which statement of the patient supports the nurse's conclusion? Select all that apply. 1 "I haven't been drinking much." 2 "I am taking aspirin regularly." 3 "I am exercising regularly." 4 "I'm not eating much dietary fiber." 5 "I don't resist the urge to defecate for long periods."

1 4 The patient with constipation should increase fluid intake because fluid consumption makes stools softer and prevents constipation. The patient should increase the intake of dietary fiber because it adds bulk to fecal material and ensures easy passage of stool through the gut and prevents constipation. Aspirin is an analgesic and does not increase the risk of constipation. Exercise enhances the gastrointestinal motility and reduces the risk of constipation. Avoiding suppressing defecation over long periods will prevent constipation. Text Reference - p. 871

When preparing a patient for a capsule endoscopy study, what should the nurse do? 1 Ensure the patient understands the required bowel preparation. 2 Have the patient return to the procedure room for removal of the capsule. 3 Teach the patient to maintain a clear liquid diet throughout the procedure. 4 Explain to the patient that conscious sedation will be used during placement of the capsule.

1 A capsule endoscopy study involves the patient performing a bowel preparation to cleanse the bowel before swallowing the capsule. The capsule is disposable and will pass naturally with the bowel movement, although the monitoring device will need to be removed. The patient will be on a clear liquid diet for one to two days before the procedure and will remain nothing by mouth (NPO) for four to six hours after swallowing the capsule. Text Reference - p. 881

A patient's blood test report reveals lipase levels of 200 U/L, fasting gastrin levels of 120 pg/mL, and amylase levels of 150 U/L. Which complication does the nurse suspect based on the findings? 1 Acute pancreatitis 2 Hemolytic problem 3 Obstructive jaundice 4 Hepatic encephalopathy

1 Acute pancreatitis is an inflammation of the pancreas characterized by increased lipase, gastrin, and amylase levels in the body. The normal lipase level is in the range of 31 to 186 U/L; therefore, a lipase level of 200 U/L indicates acute pancreatitis. The normal fasting gastrin level is in the range of 25 to 100 pg/mL. Therefore, increased gastrin levels indicate acute pancreatitis. The normal amylase levels are in the range of 30 to 122 U/L. Therefore, the amylase levels of 150 U/L indicate acute pancreatitis. Elevated unconjugated bilirubin levels indicate a hemolytic problem. Elevated levels of conjugated bilirubin indicate obstructive jaundice. Increased levels of ammonia indicate hepatic encephalopathy. Text Reference - p. 882

A patient is on a long-term treatment for arthritis and atherosclerosis. During a follow-up visit, the nurse finds that the patient has upper gastrointestinal bleeding. Which medication in the patient's prescriptions may be responsible for this condition? 1 Aspirin 2 Simvastatin 3 Amiodarone 4 Acetaminophen

1 Aspirin is a nonsteroidal antiinflammatory drug (NSAID) used to treat arthritis. Prolonged use of aspirin can cause upper gastrointestinal bleeding as a side effect. Simvastatin and amiodarone are used to lower the risk of stroke and heart attack and may cause hepatotoxicity as a side effect. Chronic high doses of acetaminophen may cause hepatotoxicity in the patient. Text Reference - p. 872

A patient has been diagnosed with a blocked bile duct. The nurse realizes that this problem will affect the patient's digestion of food in which way? 1 Difficulty digesting fats 2 Difficulty digesting proteins 3 Decreased breakdown of carbohydrates 4 Decreased absorption of B vitamins

1 Bile also consists of water, cholesterol, bile salts, electrolytes, and phospholipids. Bile salts are needed for fat emulsification and digestion. A lack of bile does not cause difficulty digesting proteins, a decrease in breakdown of carbohydrates, or decreased absorption of B vitamins.

The nurse suspects a cobalamin deficiency in a patient. What symptoms has the nurse observed in this patient? 1 Smooth, red, and silky tongue 2 Deposition of calcium on the teeth 3 Reddened, ulcerated, and swollen tongue 4 White, curdlike lesions surrounded by erythematous oral mucosa

1 Cobalamin deficiency results in malabsorption, which is manifested as a smooth red and silky tongue in the patient. Deposition of calcium on the teeth indicates acute marginal gingivitis. A reddened, ulcerated, swollen tongue indicates glossitis. White, curdlike lesions surrounded by erythematous oral mucosa indicate candidiasis. Text Reference - p. 878

The primary health care provider has prescribed a barium swallow test for a patient with upper gastrointestinal disorder. The nurse explains the test to the patient before conducting it. Which statement by the patient indicates effective learning? 1 "I may pass white-colored stools up to 72 hours after the test." 2 "I should avoid liquids and food for eight hours after the test." 3 "I may feel cramping and the urge to defecate during the test." 4 "I should lie still in the supine position for two hours after the test."

1 During a barium swallow test, the patient receives an oral barium suspension. Barium is a contrast medium and may be excreted in the stools, due to which the patient may pass white-colored stools up to 72 hours after. The nurse should inform the patient to avoid drinking liquids or eating food for 8 to 12 hours before, rather than after, the test. The patient may feel cramping and the urge to defecate during a barium enema test. The patient is made to tilt in different positions during the test to obtain clear images of the esophagus, stomach, and duodenum. Text Reference - p. 879

Which microorganism is the cause of erythema and mouth ulcers in a patient complaining of ear pain and absence of saliva? 1 Streptococcus 2 Candida albicans 3 Vincent spirochetes 4 Herpes simplex virus

1 Ear pain, absence of saliva, erythema, and ulcers are manifestations of parotitis. Parotitis is the inflammation of parotid glands, which is caused by Streptococcus or Staphylococcus species. Candida albicans causes oral candidiasis. Vincent spirochetes cause Vincent's infection. Herpes simplex virus causes herpes simplex. Text Reference - p. 928

An older adult patient reports constipation to the nurse. What advice should the nurse give to this patient? 1 Increase your intake of fluids. 2 Decrease your intake of fluids. 3 Halt physical activity. 4 Take medicine for constipation daily.

1 Increasing the intake of fluids can help relieve constipation, which is commonly caused by aging. Decreasing the intake of fluids and being physically inactive can further increase the risk of constipation. Overuse of constipation medicines can make the body dependent on the drugs for defecation; therefore, they are not advisable for daily use. Text Reference - p. 871

A patient has an increase in parasympathetic stimulation. What clinical manifestation does the nurse anticipate assessing in this patient? 1 Diarrhea 2 Dysphagia 3 Loss of appetite 4 Reduced sensitivity to pain

1 Parasympathetic stimulation increases peristalsis movement in the body. Therefore, increased stimulation of the parasympathetic system can result in diarrhea. Dysphagia occurs due to decreased lower esophageal sphincter pressure. Prolonged use of amphetamines causes loss of appetite as a side effect. Decreased number and sensitivity of sensory receptors reduces sensitivity to pain. Text Reference - p. 866

A nurse assesses a patient with abdominal pain. On deep palpation over the painful site, the nurse observes that the patient experiences pain upon withdrawal of the palpating fingers. Which condition is the patient most likely experiencing? 1 Peritoneal inflammation 2 Cirrhosis of the liver 3 Splenomegaly 4 Presence of an abdominal mass

1 Rebound tenderness is a characteristic sign of peritoneal inflammation. It can be tested by pressing the painful area deeply and firmly and then withdrawing the fingers quickly. Withdrawal of the palpating fingers produces pain. Rebound tenderness is not indicative of cirrhosis, an enlarged spleen, or presence of an abdominal mass. These may be tender on deep palpation. Text Reference - p. 876

When a patient reports foul-smelling stool, what condition does the nurse suspect? 1 Steatorrhea 2 Hematemesis 3 Gallbladder disease 4 Gastrointestinal bleeding

1 Steatorrhea reduces absorption of fat by the intestine and causes excretion of abnormal quantities of fat along with the stool, which results in foul-smelling stool. Hematemesis is the presence of blood in the vomitus. Gallbladder disease causes belching and indigestion. Gastrointestinal bleeding can result in hematuria and blood in the stool but is not characterized by foul-smelling stool. Text Reference - p. 878

The nurse finds that an older adult patient is showing signs of anemia. What age-related change is the reason for this condition? 1 Atrophy of gastric mucosa 2 Reduced protein synthesis 3 Decreased HCl acid secretion 4 Destruction of β cells of islets of Langerhans

1 The aging process causes atrophy of the gastric mucosa and decreases blood flow to the stomach. It also causes cobalamin malabsorption, which results in anemia. Reduced protein synthesis decreases hormone metabolism. Decreased HCl acid secretion causes hypochlorhydria. Destruction of β cells of the islets of Langerhans causes diabetes mellitus. Text Reference - p. 871

Which sequence should the nurse follow in examining a patient's abdomen? 1 Inspection first, then auscultation, percussion, and palpation 2 Percussion first, then auscultation, palpation, and inspection 3 Auscultation first, then palpation, percussion, and inspection 4 Inspection first, then palpation, auscultation, and percussion

1 The correct order for an assessment of the abdomen is inspection, auscultation, percussion, and palpation. This sequence is used because it ensures that there is no disturbance to the abdomen before auscultation. Percussing first, then auscultating, palpating, and inspecting; auscultating, then palpating, percussing, and inspecting; or inspecting, then palpating, auscultating, and percussing would cause false bowel sounds because the nurse would be touching or pressing on the abdomen during percussion and palpation before auscultation. Text Reference - p. 875

What is the function of the hormone gastrin? 1 Increasing the flow of bile into the duodenum 2 Maintaining lower esophageal sphincter tone 3 Stimulating the pancreatic bicarbonate secretion 4 Contracting the gallbladder and relaxing the sphincter of Oddi

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A nurse observes yellowing of the skin when assessing a patient. On studying the blood reports, the nurse finds that the patient's bilirubin and alkaline phosphatase levels are elevated. Based on the assessment findings, the patient may be diagnosed with what? Select all that apply. 1 Hepatic mass 2 Biliary tract obstruction 3 Stones in common bile duct 4 Pancreatic mass 5 Pancreatitis

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While assessing a patient with a gastrointestinal disorder, which questions should a nurse ask to develop a deeper understanding of the disorder? Select all that apply. 1 "What is your annual income?" 2 "Are you having sleep disturbances?" 3 "Have you traveled to foreign lands in the recent past?" 4 "Have you ever suffered from respiratory tract disorders?" 5 "Have you undergone an abdominal or rectal surgery in the past?"

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The patient had a car accident and was "scared to death." The patient now is reporting constipation. The nurse should know that what affecting the gastrointestinal (GI) tract could be contributing to the constipation? 1 The patient is too nervous to eat or drink, so there is no stool. 2 The sympathetic nervous system (SNS) was activated so the GI tract was slowed. 3 The parasympathetic nervous system now is functioning to slow the GI tract. 4 The circulation in the GI system has been increased, so less waste is removed.

2 The constipation most likely is related to the sympathetic nervous system activation from the stress related to the accident. SNS activation can decrease peristalsis. Even without oral intake for a short time, stool will be formed. The parasympathetic system stimulates peristalsis. The circulation to the GI system is decreased with stress. Text Reference - p. 874

While assessing a patient with a gastrointestinal disorder, which questions should a nurse ask to develop a deeper understanding of the disorder? Select all that apply. 1 "What is your annual income?" 2 "Are you having sleep disturbances?" 3 "Have you traveled to foreign lands in the recent past?" 4 "Have you ever suffered from respiratory tract disorders?" 5 "Have you undergone an abdominal or rectal surgery in the past?"

2 3 5 People suffering from digestive tract disorders cannot sleep properly because of severe abdominal pain. Trips to foreign lands are associated with exposure to changes in the environment and climate. These changes may disturb the GI tract and result in some serious disorders. Abdominal or rectal surgery in the past can cause gastrointestinal disorders; hence information about them should be obtained at the time of assessment. The economic condition of a patient does affect food habits. However, the nurse can inquire about the diet routine of the patient to determine nutritional deficiency. Respiratory tract disorders do not have any direct connection to GI tract problems. However, the medications taken to treat that disease might cause some disturbance to the digestive tract. Text Reference - p. 872

The nurse is reviewing the function of the liver. Which of these are functions of the liver? Select all that apply. 1 Storage of bile 2 Glycogenolysis 3 Storage of fat soluble vitamins 4 Secretion of amylase and lipase 5 Synthesis and breakdown of cholesterol

2 3 5 The liver is responsible for many physiologic functions, including glycogenolysis, synthesis and breakdown of cholesterol, and storage of fat-soluble vitamins. The gallbladder stores bile. Amylase and lipase are secreted by the pancreas. Text Reference - p. 870

A patient with gastroesophageal reflux disease (GERD) has undergone an esophagogastroduodenoscopy (EGD). A nurse assessing the patient after the procedure notes a sudden spike in body temperature. What could be the cause of the increase in temperature? 1 Bleeding ulcer 2 Organ perforation 3 Obstruction in the gastrointestinal tract 4 Severe esophageal stricture

2 A high temperature after an endoscopic procedure is indicative of organ perforation. Bleeding ulcers, obstruction, and esophageal strictures are not associated with the GI endoscopy and do not cause fever. A bleeding ulcer would manifest as hematemesis. Obstruction in the GI tract would manifest as abdominal distention. Severe esophageal stricture is not a complication of esophagogastroduodenoscopy. Text Reference - p. 881

While assessing an older patient, the nurse identifies food intolerance and signs of anemia. Which part of the digestive system is likely to be affected? 1 Liver 2 Stomach 3 Esophagus 4 Small intestine

2 Anemia in older patients may occur due to cobalamin malabsorption in the stomach. Food intolerance associated with aging occurs in the stomach in the presence of intrinsic factor. Impaired liver function can result in decreased drug and hormone metabolism. Improper functioning of the esophagus can cause epigastric distress and esophagia. Impaired functional activity of the small intestine can slow the intestinal tract and cause delayed absorption of fat-soluble vitamins. Text Reference - p. 871

The patient can receive acetaminophen 650 mg per rectum every six hours as needed for fever greater than 102º F. What is the proper technique for the nurse to administer this medication? 1 Lubricate the suppository with petroleum jelly. 2 Position the patient on the left side for administration. 3 Insert the suppository four inches into the anus. 4 Allow the suppository to dissolve before insertion

2 Because of the curvature of the large bowel, the patient should be positioned on the left side for administration of the suppository. This will help prevent it from being expelled from the rectum as readily. The suppository should be lubricated with surgical lubricant, not petroleum jelly, should be inserted two inches into the anus, and should be inserted and allowed to dissolve following insertion Text Reference - p. 872

Which cells of the islets of Langerhans secrete amylin? 1 F cells 2 Beta cells 3 Delta cells 4 Alpha cells

2 Beta cells of the islets of Langerhans secrete insulin and amylin, which regulate endocrine function. F cells secrete pancreatic polypeptide. Delta cells secrete somatostatin. Alpha cells secrete glucagon. Text Reference - p. 870

What is the function of the hormone ghrelin? 1 Fat digestion 2 Appetite stimulation 3 Breakdown of proteins 4 Breakdown of starches to maltose

2 Ghrelin is released from the stomach mucosa; it stimulates appetite. Lipase causes fat digestion. Pepsin breaks down proteins. Ptyalin breaks down starches to maltose. Text Reference - p. 867

A nurse is interviewing a patient with chronic constipation. The nurse finds that the patient performs a Valsalva maneuver to facilitate passing of feces. How is this maneuver helpful in aiding the elimination process? 1 It stimulates peristalsis 2 It increases intraabdominal pressure 3 It stimulates the parasympathetic nerve fibers 4 It initiates the gastrocolic and the duodenocolic reflex

2 The Valsalva maneuver involves contraction of the chest muscles with closed glottis and simultaneous contraction of the abdominal muscles. This increases the intraabdominal pressure, which facilitates defecation. The Valsalva maneuver does not stimulate peristalsis, stimulate the parasympathetic nerve fibers, or initiate the gastrocolic and duodenocolic reflex. Peristalsis, which propels the food towards the rectum, refers to the contraction of the smooth muscles of the intestine. The stimulation of parasympathetic nerve fibers from the sacral portions of the spinal cord relaxes the internal anal sphincter. It also contracts the rectal muscles leading to defecation. The gastrocolic and the duodenocolic reflex stimulate propulsive peristalsis in the large intestine. Text Reference - p. 869

Which anatomic part is the nurse assessing when palpating the right lower abdominal quadrant in a patient? 1 Liver and gallbladder 2 Cecum and appendix 3 Body of the pancreas 4 Portion of the descending colon

2 The cecum and appendix are located in the right lower abdominal quadrant. The liver and gallbladder are located in the right upper quadrant. The body of the pancreas is located in the left upper quadrant. A portion of descending colon is located in the left lower quadrant. Text Reference - p. 875

The patient has a new prescription to receive omeprazole 20 mg daily. Available are 40 mg tablets. How many tablets should the nurse administer? 1 0.25 tablet 2 0.5 tablet 3 1.5 tablets 4 2 tablets

2 Using ratio and proportion, multiply 40 by x and 20 by 1 to yield 40x = 20. Divide 20 by 40 to yield 0.5 tablets. Text Reference - p. 933

Inspection of an older patient's mouth reveals the presence of white, curd-like lesions on the patient's tongue. What is the most likely etiology for this abnormal assessment finding? 1 Herpes virus 2 Candida albicans 3 Vitamin deficiency 4 Irritation from ill-fitting dentures

2 White, curd-like lesions surrounded by erythematous mucosa are associated with oral candidiasis. Herpesvirus causes benign vesicular lesions in the mouth. Vitamin deficiencies may cause a reddened, ulcerated, swollen tongue. Irritation from ill-fitting dentures will cause friable, edematous, painful, bleeding gingivae. Text Reference - p. 878

Which antiemetic medication causes xerostomia as a side effect? 1 Granisetron 2 Scopolamine 3 Perphenazine 4 Domperidon

2 Xerostomia is dryness of the mouth. Scopolamine is an anticholinergic (antimuscarinic) medication that causes xerostomia. Granisetron is a serotonin (5-HT3) antagonist that causes diarrhea. Perphenazine causes constipation, dry mouth, rashes, and sedative effects. Domperidone causes anxiety, hallucinations, tremors, and dyskinesias. Text Reference - p. 926

The nurse is providing care to a patient who underwent an endoscopic retrograde cholangiopancreatography (ERCP) examination. Which is the most common postprocedure complication? 1 Malaise 2 Tenesmus 3 Pancreatitis 4 Pneumothorax

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Which reason does the nurse suspect for cheilosis in a patient? 1 Periodontitis 2 Premalignant lesion 3 Riboflavin deficiency 4 Chronic constipation

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Which secretion occurs in the cephalic phase of gastric secretion? 1 Chyme 2 Gastrin 3 Pepsinogen 4 Acidic chyme

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The patient tells the nurse of a history of abdominal pain, so the patient had a surgery to make an opening into the common bile duct to remove stones. The nurse knows that this surgery is called a 1 Colectomy 2 Cholecystectomy 3 Choledocholithotomy 4 Choledochojejunostomy

3 A choledocholithotomy is an opening into the common bile duct for the removal of stones. A colectomy is the removal of the colon. The cholecystectomy is the removal of the gallbladder. The choledochojejunostomy is an opening between the common bile duct and the jejunum. Text Reference - p. 872

The nurse recalls that which term is used to describe the process of transferring broken down food components from the gastrointestinal system to the blood? 1 Ingestion 2 Digestion 3 Absorption 4 Elimination

3 Absorption is the process in which the nutrients from the broken down food are assimilated by the blood and transferred into the circulatory system. Ingestion refers to the process of taking in of food. Digestion refers to the process of breaking down the food into simpler particles. Elimination is the process of removal of waste products of digestion from the body. Text Reference - p. 866

A patient receives a prescription for an indirect serum bilirubin test. What health problem does the nurse recognize that the test is being performed to help diagnose? 1 Liver cirrhosis 2 Obstructive jaundice 3 Hemolytic conditions 4 Obstruction in the biliary tract

3 An indirect serum bilirubin test is used to diagnose hemolytic conditions by measuring unconjugated bilirubin in the patient. Serum cholesterol levels should be checked in a patient who has the symptoms of cirrhosis. A direct serum bilirubin test is used to diagnose obstructive jaundice. Alkaline phosphatase levels are measured to diagnose obstruction in the biliary tract. Text Reference - p. 884

On examining a patient's mouth, a nurse notes white curd-like lesions surrounded by erythematous mucosa. Which condition should the nurse suspect? 1 Cheilitis 2 Glossitis 3 Candidiasis 4 Leukoplakia

3 Candidiasis manifests as white curd-like lesions that are surrounded by erythematous lesions in the mouth. Cheilitis is inflammation of the lips with fissuring, scaling, and crusting. Glossitis manifests as a reddened, ulcerated, swollen tongue. Leukoplakia refers to the presence of thick white patches on the tongue. Text Reference - p. 878

The nurse is preparing to examine a patient's abdomen. Which procedure will the nurse perform first? 1 Palpation 2 Percussion 3 Auscultation 4 The order of procedures does not matter

3 During examination of the abdomen, auscultate before percussion and palpation because these latter procedures may alter the bowel sounds. Text Reference - p. 875

When assessing a patient's abdomen, what would be most appropriate for the nurse to do? 1 Palpate the abdomen before auscultation 2 Percuss the abdomen before auscultation 3 Auscultate the abdomen before palpation 4 Perform deep palpation before light palpation

3 During examination of the abdomen, auscultation is done before percussion and palpation, because these latter procedures may alter the bowel sounds. Text Reference - p. 874

The nurse is caring for a patient diagnosed with encephalopathy. Which laboratory finding is consistent with the diagnosis? 1 5.0 g/dL albumin 2 9 ng/mL α-Fetoprotein 3 52 mcg N/dL ammonia 4 250 mg/dL serum cholesterol

3 Elevated ammonia levels in the blood indicate hepatic encephalopathy. A normal ammonia level is in the range of 15 to 45 mcg N/dL; therefore, an ammonia level of 52 mcg N/dL is elevated. An albumin level of 5.0 g/dL is a normal finding. An α-Fetoprotein level below 10 ng/mL is a normal finding. When the normal serum cholesterol level is below 200 mg/dL and serum cholesterol level is 250 mg/dL, it indicates biliary obstruction. Text Reference - p. 884

The health care team is assessing a male patient for acute pancreatitis after he presented to the emergency department with severe abdominal pain. Which laboratory value is the best diagnostic indicator of acute pancreatitis? 1 Gastric pH 2 Blood glucose 3 Serum amylase 4 Serum potassium

3 Elevated serum amylase levels indicate early pancreatic dysfunction and are used to diagnose acute pancreatitis. Serum lipase levels stay elevated longer than serum amylase in acute pancreatitis. Blood glucose, gastric pH, and potassium levels are not direct indicators of acute pancreatic dysfunction. Text Reference - p. 882

Which disorder does the nurse suspect to be present in an alcoholic patient who complains of excessive salivation? 1 Parotitis 2 Gingivitis 3 Stomatitis 4 Aphthous stomatitis

3 Excessive salivation in a patient abusing alcohol indicates stomatitis, which is inflammation of the mouth. Parotitis is the inflammation of parotid glands involving the absence of saliva. Gingivitis involves inflamed gingivae and interdental papillae due to neglected oral hygiene. Aphthous stomatitis is characterized by ulcers of mouth and lips due to recurrent infection, trauma, and stress. Text Reference - p. 928

When performing an abdominal assessment on a 60-year-old man, the nurse is able to palpate the spleen. Which nursing action is the most appropriate? 1 Prepare for further investigations. 2 Document this as a normal finding. 3 Discontinue palpating the spleen. 4 Tap the spleen and nearby area.

3 If the spleen is palpable, the nurse should discontinue palpating, because manual compression of an enlarged spleen may cause it to rupture. In a 60-year-old healthy man, the spleen should not be palpable. Further tapping of the spleen and nearby area is not advisable, owing to the risk of splenic rupture. Thereafter, the patient can be prepared for further investigations as prescribed by the health care provider. Text Reference - p. 876

A patient is to obtain a stool specimen for occult blood. The nurse should provide instructions to the patient that, within three days of the test, the patient should avoid: 1 Shellfish 2 Iron supplements 3 Large amounts of red meat 4 Increased intake of fatty foods

3 If the stool is Hemoccult positive, it contains trace blood. A false-positive reading may occur if the patient has ingested significant amounts of red meat in the three days preceding the test. Iron supplements, shellfish, and increased intake of fatty foods will not cause false-positive findings on a test for occult blood. Text Reference - p. 882

The nurse recognizes that which test is performed to diagnose celiac disease in a patient? 1 Fibro test 2 Sigmoidoscopy 3 Video capsule endoscopy 4 Endoscopic retrograde cholangiopancreatography

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When caring for the patient with heart failure, the nurse knows that which gastrointestinal process is most dependent on cardiac output and may affect the patient's nutritional status? 1 Ingestion 2 Digestion 3 Absorption 4 Elimination

3 Substances that interface with the absorptive surfaces of the gastrointestinal tract (primarily in the small intestine) diffuse across the intestinal membranes into intestinal capillaries and then are carried to other parts of the body for use in energy production. The cardiac output provides the blood flow for this absorption of nutrients to occur. Text Reference - p. 868

The nurse finds that a patient's gallbladder is not functioning well due to cholelithiasis and sludge. Which function will primarily be affected in the patient? 1 Secretion of insulin 2 Secretion of somatostatin 3 Concentration and storage of bile 4 Stimulation of pancreatic bicarbonate secretion

3 The gallbladder is a pear-shaped sac located below the liver, and its main function is to concentrate and store bile. Therefore, damage to the gall bladder affects the concentration and storage of bile. Bile salts cause fat emulsification. The Δ cells of the islets of Langerhans secrete somatostatin. Secretin hormone stimulates pancreatic bicarbonate secretion. Text Reference - p. 870

A nurse is assessing a patient who reports pain when swallowing and difficulty swallowing. The patient has a history of smoking for the past 15 years. What could be the most likely cause of the symptoms in this patient? 1 Reflux disease 2 Hiatal hernia 3 Esophageal cancer 4 Peptic ulcer disease

3 The patient has dysphagia and is a chronic smoker. The most likely cause of these symptoms is esophageal cancer. Pain and difficulty in swallowing are not symptoms commonly observed in reflux disease, hiatal hernia, or peptic ulcer disease. Abdominal pain is the most common symptom in these conditions. Text Reference - p. 872

patient has impaired pancreatic function from chronic pancreatitis. Which enzyme secretion will be affected in this patient? 1 Ptyalin 2 Lipase 3 Sucrase 4 Chymotrypsin

4

A patient experiences a recent onset of diarrhea following a new medication regimen. The nurse recognizes that which drug most likely caused the diarrhea? 1 Nonsteroidal antiinflammatory drugs (NSAIDs) 2 Amphetamines 3 Antacids 4 Antibiotics

4 Antibiotics disturb the normal bacterial composition of the large intestine and result in diarrhea. Diarrhea is not a known side effect of NSAIDs, amphetamines, and antacids. High doses of NSAIDs can cause hepatotoxicity. Amphetamines cause distention of the stomach. Antacids cause interference with the absorption of other drugs. Text Reference - p. 872

Which gland secretes an alkaline fluid that contains bicarbonate? 1 Parotid gland 2 Sublingual gland 3 Adrenal gland 4 Brunner's gland

4 Brunner's gland, which is present in the submucosa of the duodenum, secretes an alkaline fluid containing bicarbonate. The parotid and sublingual glands secrete saliva, which contains water, protein, mucin, inorganic salts, and salivary amylase; they do not secrete an alkaline fluid containing bicarbonate. Adrenal glands secrete hormones that regulate metabolism and help in managing stress; they do not secrete an alkaline fluid containing bicarbonate. Text Reference - p. 867

Which secretion occurs in the intestinal phase of gastric secretion? 1 Mucus 2 Gastrin 3 Pepsinogen 4 Cholecystokynin

4 Cholecystokynin is released by acid chyme in the intestinal phase of gastric secretion in order to reduce hydrochloric acid release. Mucus is released during the cephalic phase of gastric secretion. Gastrin is released during the gastric phase of gastric secretion. Pepsinogen is released during the intestinal phase of gastric secretion. Text Reference - p. 868

Which enzyme causes activation of trypsinogen to trypsin? 1 Lactase 2 Maltase 3 Peptidases 4 Enterokinase

4 Enterokinase is secreted in the small intestine and triggers the activation of trypsinogen to trypsin. Lactase causes the conversion of lactose to glucose and galactose. Maltase causes the conversion of maltose to two glucose molecules. Peptidases help in protein digestion. Text Reference - p. 868

Which nursing intervention is beneficial for a patient who is scheduled for a sigmoidoscopy procedure? 1 Administering antibiotics to the patient before the test 2 Placing the patient in the dorsal decubitus position during the examination 3 Administering sedatives to the patient immediately before and during the procedure 4 Administering enemas to the patient on the evening before and morning of the procedure

4 Sigmoidoscopy is used to detect infectious diseases, fissures, and hemorrhoids. Administering enemas to the patient on the evening before and morning of the procedure will help evacuate the bowel to facilitate clear visualization of the anatomy of the rectum and sigmoid colon. Antibiotics are administered to the patient before performing endoscopic retrograde cholangiopancreatography. The knee-chest position is preferred while performing sigmoidoscopy and the dorsal decubitus position is preferred for fibro scan. Sedatives are administered to the patient while performing endoscopic retrograde cholangiopancreatography. Text Reference - p. 881

What is the function of the area depicted in the figure?

4 The arrow indicates the ileocecal valve of the small intestine. The ileocecal valve prevents the reflux of large intestine contents into the small intestine. Maltase enzyme helps convert maltose to two glucose molecules. Intrinsic factor promotes cobalamin absorption in the small intestine. The function of the Kupffer cells is to break down hemoglobin from old red blood cells into bilirubin. Text Reference - p. 867

What is the function of the area indicated in the figure?

4 The arrow indicates the portal vein of the liver. The portal vein carries absorbed products of digestion directly to the liver. β cells of the islets of Langerhans secrete insulin hormone. The gallbladder concentrates and stores bile pigment. The function of Kupffer cells is to break down white blood cells. Text Reference - p. 869

A patient reports severe pain in the upper right part of the abdomen. A nurse observes an enlarged abdomen and suspects a diagnosis of hepatocellular carcinoma. Which should be the first diagnostic test to confirm the disease? 1 Liver MRI 2 Liver biopsy 3 Abdominal ultrasound 4 Alpha-fetoprotein test

4 The elevated level of alpha fetoprotein in serum indicates hepatocellular carcinoma. Less than 10 ng/mL alpha fetoprotein in blood is normal. After assessing the test report, other diagnostic tests can be ordered. A liver MRI is helpful in determining the size and location of the tumor, whereas a liver biopsy is helpful in removing these tumors. Abdominal ultrasound is also used to determine the size and location of the tumor. Text Reference - p. 884

A patient is admitted to the hospital with a diagnosis of gastroesophageal reflux. The nurse recognizes that reflux of gastric contents into the esophagus normally is prevented by which structure? 1 Epiglottis 2 Laryngeal pharynx 3 Upper esophageal sphincter 4 Lower esophageal sphincter

4 The muscular layers contract (peristalsis) and propel the food to the stomach. There are two sphincters: the upper esophageal sphincter (UES) at the proximal end of the esophagus and the lower esophageal sphincter (LES) at the distal end. The LES remains contracted except during swallowing, belching, or vomiting. The LES is an important barrier that normally prevents reflux of acidic gastric contents into the esophagus. The epiglottis, laryngeal pharynx, and upper esophageal sphincter do not prevent reflux of gastric contents into the esophagus. Text Reference - p. 867

A dose of ondansetron 4 mg is scheduled to be given by the intravenous (IV) route at 0800. Available is a vial containing 6 mg/mL for injection. How many mL of this medication should be drawn up to give this dose? 1 0.4 mL 2 0.5 mL 3 0.6 mL 4 0.7 mL

4 Using the medication calculation equation of dose desired (4 mg) divided by dose on hand (6 mg) and multiplied by the quantity (1 mL), the answer is 0.66, or 0.7 mL. Text Reference - p. 926

The emergency department nurse has inspected, auscultated, and palpated the abdomen with no obvious abnormalities, except pain. When the nurse palpates the abdomen for rebound tenderness, there is severe pain. The nurse should know that this could indicate what problem? 1 Hepatic cirrhosis 2 Hypersplenomegaly 3 Gall bladder distention 4 Peritoneal inflammation

4 When palpating for rebound tenderness, the problem area of the abdomen will produce pain and severe muscle spasm when there is peritoneal inflammation. Hepatic cirrhosis, hypersplenomegaly, and gall bladder distention do not manifest with rebound tenderness. Text Reference - p. 875

What is the order of flow of secreted bile in the body?

Biliary canaliculi interlobular bile ducts hepatic ducts cystic duct common bile duct

The nurse is reviewing the laboratory reports of four patients. Which patient is at high risk of infections?

Kupffer cells help to remove bacteria and toxins from the blood by phagocytosis. Therefore, damage to the Kupffer cells results in impaired removal of bacteria from the body, and puts the patient at high risk for infections. Chief cells help secrete pepsinogen; damage to chief cells does not increase the risk of infection. Parietal cells secrete hydrochloric acid, water, and intrinsic factor; damage to the parietal cells does not increase the risk of infection. The Δ cells of the pancreas produce somatostatin; damage to the Δ cells of the pancreas does not increase the risk of infection. Text Reference - p. 870

The nurse is assessing four patients. When the nurse does assessment of the patient, which patient requires relief from performing the Valsalva maneuver?

The Valsalva maneuver is used to facilitate defecation. It involves contraction of the chest muscles on a closed glottis, and simultaneous contraction of the abdominal muscles. It increases intraabdominal pressure, thereby helping eliminate the stool. The Valsalva maneuver is recommended for constipation. The Valsalva maneuver is contraindicated for patients who have head injuries, because it may increase intracranial pressure. The Valsalva maneuver increases the pressure inside the abdomen and pelvis. It pushes the blood in the rectal veins into the anus and may worsen hemorrhoids. The Valsalva maneuver is not recommended for a patient who has recently undergone eye surgery, because it may increase intraocular venous pressure, which may rupture the retinal capillaries. Text Reference - p. 869

The nurse reviews the results of liver function tests of four patients. Which patient's findings are abnormal?

The normal liver function test findings for total serum bilirubin levels, globulin levels, prothrombin time, and γ-glutamyltranspeptidase are in the range of 0.2 to 1.2 mg/dL, 25 to 35 g/L, 11 to 16 seconds, and 0 to 30 U/L, respectively. Patient C has elevated total serum bilirubin levels, globulin levels, prothrombin time, and γ-glutamyltranspeptidase levels. Patients A, B, and D show normal findings for total serum bilirubin levels, globulin levels, prothrombin time, and γ-glutamyltranspeptidase levels. Text Reference - p. 884