Chapter 44: Introduction to the Gastrointestinal System and Accessory Structures

The nurse is caring for a client recovering from a colonoscopy. Which assessment finding will the nurse expect in the client after the procedure?

Abdominal cramps

Which of the following digestive enzymes aids in the digesting of starch?

Amylase Digestive enzymes secreted by the pancreas include trypsin, which aids in digesting protein; amylase, which aids in digesting starch; and lipase, which aids in digesting fats. Bile is secreted by the liver and is not considered a digestive enzyme.

A client reports a history of bleeding hemorrhoids to the nurse. Which observation supports the client's statement?

Blood streaks on stool

A client diagnosed with cystic fibrosis takes pancreatic enzyme replacements on a regular basis. The client's intake of trypsin facilitates what aspect of gastrointestinal (GI) function?

Digestion of proteins

Cystic fibrosis, a genetic disorder characterized by pulmonary and pancreatic dysfunction, usually appears in young children but can also affect adults. If the pancreas was functioning correctly, where would the bile and pancreatic enzymes enter the GI system?

Duodenum Explanation: The duodenum, which is approximately 10 inches long, is the first region of the small intestine and the site where bile and pancreatic enzymes enter.

An adult client is scheduled for an upper GI series that will use a barium swallow. What teaching should the nurse include about what the client should expect after the test is completed?

Fluids must be increased to facilitate the evacuation of the stool.

The nurse is assessing a client who is stating gastrointestinal upset and a feeling of bloating. Which type of meal would the nurse anticipate causing these types of symptoms?

Hamburger and French fries Explanation: Fatty foods delay stomach emptying (bloating) and can cause symptoms of gastrointestinal upset. Fried and deep fried foods contain elevated amounts of fat. The other options have a lower fat content.

The nurse is working on a general medical unit. A client is scheduled for an upper gastrointestinal series. Upon returning to the nursing unit, what does the nurse identify as the client goal?

Increase the amount of fluids

A client is scheduled for an upper gastrointestinal barium study. Which teaching will the nurse provide for the client to prepare for this diagnostic test?

Ingest nothing by mouth after midnight.

Which term describes a gastric secretion that combines with vitamin B12 so that it can be absorbed

Intrinsic factor Intrinsic factor, secreted by the gastric mucosa, combines with dietary vitamin B12 so that the vitamin can be absorbed in the ileum. In the absence of intrinsic factor, vitamin B12 cannot be absorbed and pernicious anemia results. Amylase is an enzyme that aids in the digestion of starch. Pepsin, an important enzyme for protein digestion, is the end product of the conversion of pepsinogen from the chief cells. Digestive enzymes secreted by the pancreas include trypsin, which aids in digesting protein.

Which term describes a gastric secretion that combines with vitamin B12 so that it can be absorbed?

Intrinsic factor Explanation: Intrinsic factor, secreted by the gastric mucosa, combines with dietary vitamin B12 so that the vitamin can be absorbed in the ileum. In the absence of intrinsic factor, vitamin B12 cannot be absorbed and pernicious anemia results. Amylase is an enzyme that aids in the digestion of starch. Pepsin, an important enzyme for protein digestion, is the end product of the conversion of pepsinogen from the chief cells. Digestive enzymes secreted by the pancreas include trypsin, which aids in digesting protein.

When providing health education to a client scheduled for a colonoscopy the nurse should explain that they will be placed in what position during this diagnostic test?

Lying on the left side with legs drawn toward the chest

The nurse is assisting the health care provider with a gastric acid stimulation test for a client. What medication should the nurse prepare to administer subcutaneously to stimulate gastric secretions?

Pentagastrin Explanation: The gastric acid stimulation test usually is performed in conjunction with gastric analysis. Histamine or pentagastrin is administered subcutaneously to stimulate gastric secretions.

A nurse is assessing the size and density of a client's abdominal organs. When the results of palpation are unclear to the nurse, what assessment technique should be implemented?

Percussion

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 to drink only clear liquids

Results of a client's preliminary assessment prompted an examination of the client's carcinoembryonic antigen (CEA) levels, which have come back positive. What is the nurse's most appropriate response to this finding?

Prepare to meet the client's psychosocial needs.

A client has been scheduled for a urea breath test in 1 month's time. What nursing diagnosis most likely prompted this diagnostic test?

Risk For Impaired Skin Integrity Related to Peptic Ulcers

The nurse educator is reviewing the blood supply of the GI tract with a group of medical nurses. The nurse is explaining the fact that the veins that return blood from the digestive organs and the spleen form the portal venous system. What large veins will the nurse list when describing this system? Select all that apply.

Splenic vein Inferior mesenteric vein Gastric vein

A client has returned to the medical unit after a barium enema. When assessing the client's subsequent bowel patterns and stools, what finding would warrant reporting to the health care provider?

Streaks of blood present in the stool

A medical client's CA 19-9 levels have become available and they are significantly elevated. How should the nurse best interpret this diagnostic finding?

The client may have cancer, but other GI disease must be ruled out.

A client receives a local anesthetic to suppress the gag reflex for a diagnostic procedure of the upper GI tract. Which nursing intervention is advised for this patient?

The client should not be given any food and fluids until the gag reflex returns.

The nurse determines which is a true statement regarding older clients, considering the age-related effects on the gastrointestinal (GI) system?

They usually have less control of the rectal sphincter.

The nurse is assisting the health care provider with a colonoscopy for a client with rectal bleeding. The health care provider requests the nurse to administer glucagon during the procedure. Why is the nurse administering this medication during the procedure?

To relax colonic musculature and reduce spasm.

A nurse caring for a newly admitted client with a suspected gastrointestinal (GI) bleed assesses the client's stool after a bowel movement and notes it to be a tarry-black color. This finding is suggestive of bleeding from what location?

Upper GI tract

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

Weakened gag reflex A weakened gag reflex is an age-related change of the GI system. There is decreased motility, atrophy of the small intestine, and decreased mucus secretion.

The nurse prepares a client for a barium enema. The nurse should place the client on which diet prior to the procedure?

clear liquids day before

A client has come to the outpatient radiology department for diagnostic testing that will allow the care team to evaluate and remove polyps. The nurse should prepare the client for what procedure?

colonoscopy

A client asks the nursing assistant for a bedpan. When the client is finished, the nursing assistant notifies the nurse that the client has bright red streaking of blood in the stool. The nurse's assessment should focus on what potential cause?

hemorrhoids

A clinic client has described recent dark-colored stools, and the nurse recognizes the need for fecal occult blood testing (FOBT). What aspect of the client's current health status would contraindicate FOBT?

hemorrhoids

The nurse auscultates the abdomen to assess bowel sounds. She documents five to six sounds heard in less than 30 seconds. How does the nurse document the bowel sounds?

hyperactive

Which term describes a gastric secretion that combines with vitamin B12 so that it can be absorbed?

intrinsic factor

When bowel sounds are heard about every 15 seconds, the nurse would record that the bowel sounds are

normal. Explanation: Normal bowel sounds are heard every 5 to 20 seconds. Hypoactive bowel sound is the description given to auscultation of one to two bowel sounds in 2 minutes. Sluggish is not a term a nurse would use to accurately describe bowel sounds. The nurse records that bowel sounds are absent when no sound is heard in 3 to 5 minutes.

A client tells the nurse that the stool was colored yellow. The nurse assesses the client for

recent foods ingested.

A client tells the nurse that the stool was colored yellow. The nurse assesses the client for

recent foods ingested. Explanation: The nurse should assess for recent foods that the client ingested, as ingestion of senna can cause the stool to turn yellow. Ingestion of bismuth can turn the stool black and, when occult blood is present, the stool can appear to be tarry black.

The nurse is answering questions regarding fecal matter for a client who is scheduled for a colon resection. The client is asking questions regarding the composition of the fecal matter and when it becomes a formed mass. The nurse is most correct to state at which location?

sigmoid colon

Which procedure is performed to examine and visualize the lumen of the small bowel?

small bowel enteroscopy

A female client has presented to the emergency department with right upper quadrant pain; the health care provider has ordered abdominal ultrasound to rule out cholecystitis. The client expresses concern to the nurse about the safety of this diagnostic procedure. How should the nurse best respond?

"Abdominal ultrasound poses no known safety risks of any kind."

How would the nurse explain the formation and role of acid in the stomach?

"Hydrochloric acid is secreted by glands in the stomach in response to the actual or anticipated presence of food."

A home care nurse is caring for a client with reports of epigastric discomfort who is scheduled for a barium swallow. Which statement by the client indicates an understanding of the test?

"I'll avoid eating or drinking anything 6 to 8 hours before the test."

A client asks the nurse why the physician ordered the blood test carcinoembryonic antigen (CEA). The nurse answers:

"It indicates if a cancer is present."

A client has sought care because of recent dark-colored stools. As a result, a fecal occult blood test has been ordered. The nurse should give what instructions to the client?

"Take no NSAIDs within 72 hours of the test."

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.

It is suspected that a client might have a problem in the duodenum and the client is scheduled to have GI studies done in the morning. In client education, the nurse describes the procedure and includes basic information about anatomy and the function of the organs involved. The client asks how long the duodenum is. What is the nurse's best response?

10 inches]

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 Immediately after the test, the patient is monitored for signs and symptoms of bowel perforation (e.g., rectal bleeding, abdominal pain or distention, fever, focal peritoneal signs).

When examining the skin of a client who is dehydrated due to fluid losses from the gastrointestinal tract, which of the following would be most important?

Checking if the mucous membranes are dry Mucous membranes may be dry, and skin turgor may be poor in clients suffering from dehydration as a result of fluid losses from the GI tract. Checking the skin for discoloration and inspecting the sclera if it is yellow is taken into consideration when the client could have symptoms of jaundice, not fluid losses. Distended abdominal veins are not associated with dehydration.

The nurse auscultates the abdomen to assess bowel sounds. She documents five to six sounds heard in less than 30 seconds. How does the nurse document the bowel sounds?

hyperactive Bowel sounds are assessed using the diaphragm of the stethoscope for high-pitched and gurgling sounds (Gu, Lim, & Moser, 2010). The frequency and character of the sounds are usually heard as clicks and gurgles that occur irregularly and range from 5 to 35 per minute. The terms normal (sounds heard about every 5 to 20 seconds), hypoactive (one or two sounds in 2 minutes), hyperactive (5 to 6 sounds heard in less than 30 seconds), or absent (no sounds in 3 to 5 minutes) are frequently used in documentation, but these assessments are highly subjective (Li, Wang, & Ma,