Chapter 38 Assessment of Digestive and Gastrointestinal Function

The nurse is caring for a client recovering from an esophagogastroduodenoscopy (EGD). Which of the following client symptoms would require further nursing assessment?

Abdominal distention

A nurse is caring for a patient admitted with a suspected malabsorption disorder. The nurse knows that one of the accessor organs of the digestive system is pancreas. What digestive enzymes does the pancreas secrete? Select all that apply. a. Pepsin b. Lipase c. Amylase d. Trypsin e. Ptyalin

B, C, D Rationale: Trypsin facilitates digestion of proteins.

A nurse is caring for a patient with biliary colic and is aware that the patient may experience referred abdominal pain. Where would the nurse most likely expect this patient to experience referred pain?

Below the right nipple Rationale: Referred pain above the left nipple may be associated with the heart. Groin pain may be referred pain from ureteral colic

During a colonoscopy with moderate sedation, the patient groans with obvious discomfort and begins bleeding from the rectum. The patient is diaphoretic and has an increase in abdominal girth from distention. What complication of this procedure is the nurse aware may be occurring?

Bowel perforation

A patient receives atropine, an anticholinergic drug, in preparation for surgery. The nurse expects this drug to affect the GI tract by doing what? A. increasing gastric emptying B. Relaxing pyloric and ileocecal sphincters C. Decreasing secretions and peristaltic action D. Stimulating the nervous system of the GI tract

C. Decreasing secretions and peristaltic action

A patient has come to the outpatient radiology department for diagnostic testing. Which of the following diagnostic procedures will allow the care team to evaluate and remove polyps? - Colonoscopy - Barium enema - ERCP - Upper gastrointestinal fibroscopy

Colonoscopy Rationale: During colonoscopy, tissue biopsies can be obtained as needed, and polyps can be removed and evaluated.

A patient has been experiencing significant psychosocial stress in recent weeks. The nurse is aware of the hormonals effects of stress, including norepinephrine release. Release of this substance would have what effect on the patients GI function?

Decreased motility

A clinic patient has described recent dark-colored stools;the nurse recognizes the need for fecal occult blood testing (FOBT). What aspect of the patient's current health status would contraindicate FOBT? A) Gastroesophageal reflux disease (GERD) B) Peptic ulcers C) Hemorrhoids D) Recurrent nausea and vomiting

Hemorrhoids

An advanced practice nurse is assessing the size and density of a patient with abdominal organs. If the results of palpation are unclear to the nurse, what assessment technique should be implemented? - Percussion - Auscultation - Inspection - Rectal examination

Percussion Rationale: Percussion is used to assess the size and density of the abdominal organs and to detect the presence of air-filled, or solid masses. Percussion is used either independently or concurrently with palpation because it can validate palpation findings.

A client undergoing a diagnostic examination for gastrointestinal disorder was given polyethylene glycol/electrolyte solution as a part of the test preparation. Which of the following measures should the nurse take once the solution is administered?

Permit the client to drink only clear liquids

A patient is being assessed for a suspected deficit in intrinsic factor synthesis. What diagnostic or assessment finding is the most likely rationale for this examination of intrinsic factor production? - Muscle wasting - Chronic jaundice in the absence of liver disease - The presence of fat in the patients stool - Persistently low hemoglobin and hematocrit

Persistently low hemoglobin and hematocrit Rationale: In the absence of intrinsic factor, vitamin B12 cannot be absorbed, and pernicious anemia results. This would result in a marked reduction in hemoglobin and hematocrit.

A patient will be undergoing abdominal CT with contrast. The nurse has administered IV sodium bicarbonate and oral acetylcysteine (Mucomyst) before the study as ordered. What would indicate that these medications have had the desired therapeutic effect? - The patients BUN and creatine levels are within reference range following the CT - The CT yields high-quality images - The patient electrolytes are stable in the 48 hours following the CT - The patient intake and output are in balance on the day after the CT

The patients BUN and creatine levels are within reference range following the CT Rationale: Both sodium bicarbonate and Mucomyst are free radical scavengers that sequester the contrast byproducts that are destructive to renal cells. Kidney damage would be evident by increased BUN and creatinine levels.

A nurse is providing preprocedural education for a patient who will undergo a lower GI tract study the following week. What should the nurse teach the patient about bowel preparation?

You will need to have enema the day before the test Rationale: Preparation of the patient includes emptying and cleansing the lower bowel. This often necessitates a low-reside diet 1 to 2 days before the test; a clear liquid diet and a laxative the evening before; NPO after midnight; and cleansing enemas until returns are clear the following morning.

What is a clinical manifestation of age-related changes in the GI system that the nurse may find in an older patient? a. gastric hyperacidity b. intolerance to fatty foods c. yellowish tinge to the skin d. reflux of gastric contents into the esophagus

d. reflux of gastric contents into the esophagus

The nurse recognizes which change of the gastrointestinal system is an age-related change?

weakened gag reflex

A client is scheduled for a urea breath test to detect for Helicobacter pylori as a reason for gastric distress. Which instruction will the nurse provide to the client to prepare for this test? Select all that apply.

- Do not use antibiotics for 1 month - Avoid bismuth subsalicylate for 1 month - Do not take proton pump inhibitors for 2 weeks

The nurse is providing instructions to a client scheduled for a gastroscopy. What should the nurse be sure to include in the instructions? Select all that apply.

1.) The client must fast for 8 hours before the examination 2.) The throat will be sprayed with a local anesthetic. 3.) After gastroscopy, the client cannot eat or drink until the gag reflex returns (1 to 2 hours).

Normal physical assessment findings of the GI system are (select all).. a. nonpalpable liver and spleen b. borborygmi in upper right quadrant c. tympany on percussion of the abdomen d. liver edge 2 to 4 cm below the costal margin e. finding of a firm, nodular edge on the rectal examination

A, C

A nurse is caring for a patient with recurrent hematemesis who is scheduled for upper gastrointestinal fibroscopy (UGF). How should the nurse in the radiology department prepare this patient? - Insert a nasogastric tube - Administer a micro fleet enema at least 3 hours before the procedure - Have the patient lie in a supine position for the procedure - Apply local anesthetic to the back of the patients throat

Apply local anesthetic to the back of the patients throat

The nurse is caring for a patient with duodenal ulcer and is relating the patients symptoms to the physiologic function of the small intestine. What do these functions include? Select all that apply. a. Secretion of Hcl b. Reabsorption of water c. Secretion of mucus d. Absorption of nutrients e. Movement of nutrients into the bloodstream

C, D, E Rationale: Hcl is secreted by the stomach. Water reabsorption primarily takes place in the large bowel.

Which nursing actions are indicated for a liver biopsy? (select all) a. observe for white stools b. monitor for rectal bleeding c. monitor for internal bleeding d. position to right side after test e. ensure bowel preparation was done f. check coagulation status before test

C, D, F

An adult patient is scheduled for an upper GI series that will use a barium swallow. What teaching should the nurse include when the patient has completed the test? - Stool will be yellow for the first 24 hours postprocedural - The barium may cause diarrhea for the next 24 hours - Fluids must be increased to facilitate the evacuation of the stool - Slight anal bleeding may be noted as the barium is passed

Fluids must be increased to facilitate the evacuation of the stool Rationale: Postprocedural patient education includes information about increasing fluid intake; evaluating bowel movements for evacuation of barium; and noting increased number of bowel movements, because barium, due to its high osmolarity, may draw fluid into the bowel, thus increasing the intraluminal contents and resulting in greater output. Yellow stool, diarrhea, and anal bleeding are not expected.

A nurse is assessing the abdomen of a patient just admitted to the unit with a suspected GI disease. Inspection reveals several diverse lesions of the patients abdomen. How should the nurse best interpret this assessment finding? - Abdominal lesions are usually due to age-related skin changes - Integumentary disease often cause GI disorders - GI disease often produce skin changes - The patient needs to be assessed for self-harm

GI disease often produce skin changes Rationale: Abdominal lesions are of particular importance, because GI disease often produce skin changes. Skin problems do not normally cause GI disorders. Age-related skin changes do not have pronounced effect on the skin of the abdomen when compared to other skin surfaces. Self-harm is a less likely explanation for skin lesions on the abdomen.

A patient asks the nursing assistant for a bedpan. When the patient is finished, the nursing assistant notifies the nurse that the patient has bright red streaking of blood in the stool. What is this most likely as a result of? - Diet high in red meat - Upper GI bleed - Hemorrhoids - Use of iron supplements

Hemorrhoids Rationale: Lower rectal on anal bleeding is suspected if there is streaking of blood on the surface of the stool. Hemorrhoids are often a cause of anal bleeding since they occur in the rectum. Blood from an upper GI bleed would be dark rather than frank. Iron supplements make the stool dark, but not bloody and red meat consumption would not cause frank blood.

A nursing student has auscultated a patient abdomen and noted one or two bowel sounds in a 2--minute period. How would you tell the student to document the patient bowel sounds? - Normal - Hypoactive - Hyperactive - Paralytic ileus

Hypoactive Rationale: Normal means sounds heard every 5 to 20 seconds. Hypoactive means one or two sounds in 2 minutes. Hyperactive means 5 to 6 sounds heard in less than 30 second, and absent means no sounds in 3 to 5 minutes.

The nurse prepares to administer the lavage solution to a client having a colonoscopy completed. The nurse stops and notifies the physician when noting that the client has which condition? - Inflammatory bowel disease - Intestinal polyps - Diverticulitis - Colon cancer

Inflammatory bowel disease

A client with a recent history of rectal bleeding is being prepared for a colonoscopy. Initially, how should the nurse position the client for this test?

Lying on the left side with knees bent

A nurse in a stroke rehabilitation facility recognizes that the brain regulates swallowing. Damage to what area of the brain will most affect the patients ability to swallow?

Medulla oblongata

A patient has sought care because of recent dark-colored stools. As a result, fetal occult blood test has been ordered. The nurse should instruct the patient to avoid which of the following prior to collecting a blood sample? - NSAIDs - Acetaminophen - OTC vitamin D supplements - Fiber supplements

NSAIDs

A patient has been scheduled for a urea breath test in one months time. What nursing diagnosis most likely prompted this diagnostic test? - Impaired dentition related to gingivitis - Risk for impaired skin integrity related to peptic ulcers - Imbalanced nutrition: less than body requirements related to enzyme deficiency - Diarrhea related to Clostridium Difficile infection

Risk for impaired skin integrity related to peptic ulcers

A nurse is caring for an 83 year old patient who is being assessed for recurrent and intractable nausea. What age related change to the GI system may be a contributor to the patients health complaints? - Stomach emptying takes place more slowly - The villi and epithelium of the small intestine become thinner - The esophageal sphincter becomes incompetent - Saliva production decreases

Stomach emptying takes place more slowly

The physiology instructor is discussing the GI system with the pre-nursing class. What should the instructor describe as a major function of the GI tract? A) The breakdown of food particles into cell form for digestion B) The maintenance of fluid and acid-base balance C) The absorption into the bloodstream of nutrient molecules produced by digestion D) The control of absorption and elimination of electrolytes

The absorption into the bloodstream of nutrient molecules produced by digestion Rationale: Primary function include breakdown of food particles into molecular (not cell form) form for digestion; the absorption into the bloodstream of small nutrients produced by digestion; and the elimination of undigested unabsorbed food stuffs and other waste products.

A patients sigmoidoscopy has been successfully completed and the patient is preparing to return home. Which of the following teaching points should the nurse include in the patients discharge instruction? - The patient should drink at least 2 liters of fluid in the next 12 hours - The patient can resume a normal routine immediately - The patient should expect fecal urgency for several hours The patient can expect some recent rectal bleeding

The patient can resume a normal routine immediately

what problem should the nurse assess the patient for if the patient was on prolonged antibiotic therapy? a. coagulation problems b. elevated serum ammonia levels c. impaired absorption of amino acids d. increased mucus and bicarbonate secretion

a. coagulation problems Rationale: This is because antibiotics can reduce the number of normal bacteria in the gut, which can lead to a decrease in the production of vitamin K by these bacteria.

A 58 yr old woman has just returned to the nursing unit after an esophagogastroduodenoscopy (EGD). Which action by UAP requires that the RN intervene? a. offering the patient a drink of water b. positioning the patient on the right side c. checking the vital signs every 30 minutes d. swabbing the patient's mouth with cold water

a. offering the patient a drink of water

A patient is being scheduled for endoscopic retrograde cholangiopancreatography (ERCP) as soon as possible. Which actions from the agency policy for ERCP should the nurse take first? a. place the patient on NPO status b. administer sedative medications c. ensure the consent form is signed d. teach the patient about the procedure

a. place the patient on NPO status

What characterizes auscultation of the abdomen? a. the presence of borborygmi indicates hyperperistalsis b. the bell of the stethoscope is used to auscultate high-pitched sounds c. high-pitched, rushing, and tinkling bowel sounds are heard after eating d. absence of bowel sounds for 1 minute in each quadrant is reported as abnormal

a. the presence of borborygmi indicates hyperperistalsis Rationale: Borborygmi refers to the characteristic gurgling or rumbling sounds that the stomach and intestines make as food, fluids, or gas pass through them. Hyperperistalsis usually indicates severe gastrointestinal bleeding.

A patient has an elevated blood level of indirect (unconjugated) bilirubin. One cause of this finding is that.. a. the gallbladder is unable to contract to release stored bile b. bilirubin is not being conjugated and excreted into the bile by the liver c. the Kupffer cells in the liver are unable to remove bilirubin from the blood d. there is an obstruction in the biliary tract preventing flow of bile into the small intestine

b. bilirubin is not being conjugated and excreted into the bile by the liver

During an examination of the abdomen the nurse should.. a. position the patient in the supine position with the bed flat and knees straight b. listen for bowel sounds in the epigastrium and all four quadrants for 2 minutes c. describe bowel sounds as absent if no sound is heard in a quadrant after 2 minutes d. use the following order of techniques: inspection, palpation, percussion, auscultation

b. listen for bowel sounds in the epigastrium and all four quadrants for 2 minutes

A 30 yr old man is being admitted to the hospital for elective knee surgery. Which assessment finding is most important to report to the health care provider? a. tympany on percussion of the abdomen b. liver edge 3cm below the costal margin c. bowel sounds of 20/minute in each quadrant d. aortic pulsations visible in the epigastric area

b. liver edge 3cm below the costal margin

What is a normal finding on physical examination of the abdomen? a. auscultation of bruits b. observation of visible pulsations c. percussion of liver dullness in the left midclavicular line d. palpation of the spleen 1 to 2 cm below the left costal margin

b. observation of visible pulsations Rationale: The pulsation felt is usually that of the aorta in the epigastric area, and it is a result of normal blood flow.

A patient is admitted to the hospital with LUQ pain. What organ may be a possible source of the pain? a. liver b. pancreas c. appendix d. gallbladder

b. pancreas

In preparing a patient for a colonoscopy, the nurse explains that.. a. a signed permit is not necessary b. sedation will be used during the procedure c. one cleansing enema is necessary for preparation d. light meals should be eaten for 3 days before the procedure

b. sedation will be used during the procedure

The nurse will plan to monitor a patient with an obstructed common bile duct for.. a. melena b. steatorrhea c. decreased serum cholesterol levels d. increased serum indirect bilirubin levels

b. steatorrhea

which statement to the nurse from a patient with jaundice indicates a need for teaching? a. "I used cough syrup several times a day last week" b. "I take a baby aspirin every day to prevent strokes" c. "I use acetaminophen (Tylenol) every 4 hours for back pain" d. "I need to take an antacid for indigestion several times a week"

c. "I use acetaminophen (Tylenol) every 4 hours for back pain"

which finding by the nurse during abdominal auscultation indicates a need for a focused abdominal assessment? a. loud gurgles b. high-pitched gurgles c. absent bowel sounds d. frequent clicking sounds

c. absent bowel sounds

When caring for a patient who has had most of the stomach surgically removed, what is important for the nurse to teach to the patient? a. extra iron will need to be taken to prevent anemia b. avoid foods with lactose to prevent bloating and diarrhea c. lifelong supplementation of cobalamin (vitamin B12) will be needed d. because of the absence of digestive enzymes, protein malnutrition is likely

c. lifelong supplementation of cobalamin (vitamin B12) will be needed

After assisting with a needle biopsy of the liver at a patient's bedside, the nurse should.. a. put pressure on the biopsy site using a sandbag b. elevate the head of the bed to facilitate breathing c. place the patient on the right side with the bed flat d. check the patient's post biopsy coagulation studies

c. place the patient on the right side with the bed flat

While interviewing a 30 yr old man, the nurse learns that the patient has a family history of familial adenomatous polyposis (FAP). The nurse will plan to assess the patient's knowledge about.. a. preventing noninfectious hepatitis b. treating inflammatory bowel disease c. risk for developing colorectal cancer d. using antacids and proton pump inhibitors

c. risk for developing colorectal cancer

A 54 yr old man has just arrived in the recovery area after an upper endoscopy. Which information collected by the nurse is most important to communicate to the health care provider? a. the patient is very drowsy b. the patient reports a sore throat c. the oral temperature is 101.6 F d. the apical pulse is 104 beats/minute

c. the oral temperature is 101.6 F

A patient's serum liver enzyme tests reveal an elevated aspartate aminotransferase (AST). The nurse recognizes what about the elevated AST? a. it eliminates infection as a cause of liver damage b. it is diagnostic for liver inflammation and damage c. tissue damage in organs other than the liver may be identified d. nervous system symptoms related to hepatic encephalopathy may be the cause

c. tissue damage in organs other than the liver may be identified

A 68 yr old patient is in the office for a physical. She notes that she no longer has regular bowel movements. Which suggestion by the nurse would be most helpful to the patient? a. take an additional laxative to stimulate defecation b. eat less acidic foods to enable the gastrointestinal system to increase peristalsis c. eat less food at each meal to prevent feces from backing up related to slowed peristalsis d. attempt defecation after breakfast because gastrocolic reflexes increase colon peristalsis at that time

d. attempt defecation after breakfast because gastrocolic reflexes increase colon peristalsis at that time

A patient is admitted to the hospital with a diagnosis of diarrhea with dehydration. The nurse recognizes that increased peristalsis resulting in diarrhea can be related to.. a. sympathetic inhibition b. mixing and propulsion c. sympathetic stimulation d. parasympathetic stimulation

d. parasympathetic stimulation

After eating, a patient with an inflamed gallbladder experiences pain caused by contraction of the gallbladder. What is the mechanism responsible for this action? a. production of bile by the liver b. production of secretin by the duodenum c. release of gastrin from the stomach antrum d. production of cholecystokinin by the duodenum

d. production of cholecystokinin by the duodenum