gi gu exam 1

When gastric analysis testing reveals excess secretion of gastric acid, the nurse recognizes which medical diagnoses is supported? -chronic atrophic gastritis - pernicious anemia - duodenal ulcer - gastric cancer

- duodenal ulcer

The nurse prepares to administer the lavage solution to a client having a colostomy completed. The nurse stops and notifies the physician when noting that the client has which condition?- pulmonary hypertension - congestive heart failure - chronic obstructive pulmonary disease (COPD) - inflammatory bowel disease

- inflammatory bowel disease

16. An inpatient has returned to the medical unit after a barium enema. When assessing the patientssubsequent bowel patterns and stools, what finding should the nurse report to the physician? A) Large, wide stools B) Milky white stools C) Three stools during an 8-hour period of time D) Streaks of blood present in the stool

Ans: DFeedback:Barium has a high osmolarity and may draw fluid into the bowel, thus increasing the intraluminalcontents and resulting in greater output (large stools). The barium will give the stools a milky whiteappearance, and it is not uncommon for the patient to experience an increase in the number of bowelmovements. Blood in fecal matter is not an expected finding and the nurse should notify the physician.

The nurse cares for a client who receives parenteral nutrition (PN). The nurse notes on the care plan that the catheter will need to be removed 6 weeks after insertion and that the client's venous access device is a nontunneled central catheter. peripherally inserted central catheter implanted port. tunneled central catheter.

Nontunneled central catheters are used for short-term (less than 6 weeks) IV therapy in acute care settings. The subclavian vein is the most common vessel used because the subclavian area provides a stable insertion site to which the catheter can be anchored; it allows the client freedom of movement and provides easy access to the dressing site. Peripherally inserted central catheter (PICC) lines may be used for intermediate terms (3 to 12 months). Tunneled central catheters are for long-term use and may remain in place for many years. Implanted ports are devices also used for long-term home IV therapy (e.g., Port-A-Cath, Mediport, Hickman Port, P.A.S. Port).

8. The nurse is providing health education to a patient scheduled for a colonoscopy. The nurse shouldexplain that she will be placed in what position during this diagnostic test? A) In a knee-chest position (lithotomy position) B) Lying prone with legs drawn toward the chest C) Lying on the left side with legs drawn toward the chest D) In a prone position with two pillows elevating the buttocks

Lying on the left side with legs drawn toward the chest. Ans: C Feedback:For best visualization, colonoscopy is performed while the patient is lying on the left side with the legsdrawn up toward the chest. A kneechest position, lying on the stomach with legs drawn to the chest, anda prone position with two pillows elevating the legs do not allow for the best visualization.

A health care provider plans to send a client home with supplies to complete a hemoccult test on all stools for 3 days. During the client education, the nurse informs the client to avoid which medication while collecting stool for the test? - ibuprofen - docusate sodium - acetaminophen - ciprofloxacin

ibuprofen

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? - Observing for distended abdominal veins - Checking if the skin is discolored - Checking if the mucous membranes are dry - Examining the sclera if it is yellow

- Checking if the mucous membranes are dry

A few hours after eating hot and spicy chicken wings, a client presents with lower chest pain. He wonders if he is having a heart attack. How should the nurse proceed first? - Further investigate the initial complaint .- Call for an immediate electrocardiogram .- Explain that fatty foods can mimic chest pain. - Administer an over-the-counter antacid tablet.

- Further investigate the initial complaint.

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? - Borborygmi - Normal - Hyperactive - Hypoactive

- Hyperactive

Gastrin has which of the following effects on gastrointestinal (GI) motility? - Relaxation of the colon - Increased motility of the stomach - Relaxation of gastroesophageal sphincter - Contraction of the ileocecal sphincter

- Increased motility of the stomach

The nurse cares for a client after an endoscopic examination and prepares the client for discharge. The nurse includes which instruction? - Avoid driving for 24 hours - Continue a clear liquid diet - Resume regular diet - Increase fluid intake

- Resume regular diet

When evaluating the function of the GI tract, the nurse needs to understand the role of hormones. Secretin, stimulated by the pH of chyme in the duodenum, is a major GI hormone that does which of the following? - Influences contraction of the esophageal and pyloric sphincters -Stimulates the production of bicarbonate in pancreatic juice -Regulates the secretion of gastric acid - Causes the gallbladder to contract

- Stimulates the production of bicarbonate in pancreatic juice

When describing the role of the pancreas to a client with a pancreatic dysfunction, the nurse would identify which substance as being acted on by pancreatic lipase? - Protein - Glucose - Starch - Triglycerides

- Triglycerides

Which enzyme aids in the digestion of protein? - trypsin - lipase - pepsin - ptyalin

- trypsin

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

During colonoscopy, tissue biopsies can be obtained as needed, and polyps can be removed andevaluated. This is not possible during a barium enema, ERCP, or gastroscopy.

Which of the following is an enzyme secreted by the gastric mucosa?- Ptyalin - Bile - Trypsin - Pepsin

pepsin

The client is on a continuous tube feeding. The nurse determines the tube placement should be checked every shift. hour. 12 hours. 24 hours.

shift Explanation: Each nurse caring for the client is responsible for verifying that the tube is located in the proper area for continuous feeding. Checking for placement each hour is unnecessary unless the client is extremely restless or there is basis for rechecking the tube due to other client activities. Checking for placement every 12 or 24 hours does not meet the standard of care for the client receiving continuous tube feedings.

The nurse provides client education to a client about to undergo hydrogen breath testing. The nurse evaluates that the client understands the test when the client makes which statement? - "The test will detect the presence of oral cancer." - "I should avoid antibiotics for 1 month before the test." - "First, I will drink a cherry flavored liquid." - "The test will detect the presence of staph."

- "I should avoid antibiotics for 1 month before the test."

When bowel sounds are heard about every 15 seconds, the nurse would record that the bowel sounds are - absent. - sluggish. - normal. - hypoactive.

- normal.

The nurse inspects a client's tongue. Which finding would the nurse evaluate as an indication of potential oral cancer? - large, vallate papillae on dorsum of tongue - V formation on dorsum of tongue - red plaque on undersurface of tongue - thin, white coating on dorsum of tongue

- red plaque on undersurface of tongue

Which diagnostic produces images of the body by detecting the radiation emitted from radioactive substances? - Positron emission tomography (PET) - Computed tomography (CT) - Fibroscopy - Magnetic resonance imaging (MRI)

Positron emission tomography (PET)

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

Ans: AFeedback:Both sodium bicarbonate and Mucomyst are free radical scavengers that sequester the contrastbyproducts that are destructive to renal cells. Kidney damage would be evident by increased BUN andcreatinine levels. These medications are unrelated to electrolyte or fluid balance and they play no role inthe results of the CT.

15. A nurse is caring for a patient with biliary colic and is aware that the patient may experience referredabdominal pain. Where would the nurse most likely expect this patient to experience referred pain?A) Midline near the umbilicus B) Below the right nipple C) Left groin area D) Right lower abdominal quadrant

Ans: BFeedback:Patients with referred abdominal pain associated with biliary colic complain of pain below the rightnipple. Referred pain above the left nipple may be associated with the heart. Groin pain may be referredpain from ureteral colic.

Swallowing is regulated by which area of the central nervous system (CNS)? - Cerebellum - Pons - Medulla oblongata - Hypothalamus

- Medulla oblongata

The nurse is working with clients with digestive tract disorders. Which of the following organs does the nurse realize has effects as an exocrine gland and an endocrine gland? - Stomach - Liver - Pancreas - Gallbladder

- Pancreas

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?- Glycopyrronium bromide - Pentagastrin - Acetylcysteine - Atropine

- Pentagastrin

The nurse is caring for a geriatric client experiencing diarrhea. When teaching about the site in the body where water and electrolytes are absorbed, the nurse is most correct to instruct on which location? - The stomach - The large bowel - The small bowel - The cecum

- The small bowel

25. A nurse is providing preprocedure education for a patient who will undergo a lower GI tract study thefollowing week. What should the nurse teach the patient about bowel preparation? A) Youll need to fast for at least 18 hours prior to your test. B) Starting today, take over-the-counter stool softeners twice daily. C) Youll need to have enemas the day before the test. D) For 24 hours before the test, insert a glycerin suppository every 4 hours.

Ans: CFeedback:Preparation of the patient includes emptying and cleansing the lower bowel. This often necessitates alow-residue diet 1 to 2 days before the test; a clear liquid diet and a laxative the evening before; NPOafter midnight; and cleansing enemas until returns are clear the following morning.

30. A medical patients CA 19-9 levels have become available and they are significantly elevated. Howshould the nurse best interpret this diagnostic finding? A) The patient may have cancer, but other GI disease must be ruled out. B) The patient most likely has early-stage colorectal cancer. C) The patient has a genetic predisposition to gastric cancer. D) The patient has cancer, but the site is unknown.

Ans: AFeedback:CA 19-9 levels are elevated in most patients with advanced pancreatic cancer, but they may also beelevated in other conditions such as colorectal, lung, and gallbladder cancers; gallstones; pancreatitis;cystic fibrosis; and liver disease. A cancer diagnosis cannot be made solely on CA 19-9 results.

20. A nurse is caring for a patient admitted with a suspected malabsorption disorder. The nurse knows thatone of the accessory organs of the digestive system is the pancreas. What digestive enzymes does thepancreas secrete? Select all that apply. A) Pepsin B) Lipase C) Amylase D) Trypsin E) Ptyalin

Ans: B, C, DFeedback: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. Pepsin is secreted by the stomachand ptyalin is secreted in the saliva.

22. A nurse is performing an abdominal assessment of an older adult patient. When collecting and analyzingdata, the nurse should be cognizant of what age-related change in gastrointestinal structure and function? A) Increased gastric motility B) Decreased gastric pH C) Increased gag reflex D) Decreased mucus secretion

Ans: DFeedback:Older adults tend to secrete less mucus than younger adults. Gastric motility slows with age and gastricpH rises due to decreased secretion of gastric acids. Older adults tend to have a blunted gag reflexcompared to younger adults.

27. Results of a patients preliminary assessment prompted an examination of the patients carcinoembryonicantigen (CEA) levels, which have come back positive. What is the nurses most appropriate response tothis finding? A) Perform a focused abdominal assessment. B) Prepare to meet the patients psychosocial needs. C) Liaise with the nurse practitioner to perform an anorectal examination. D) Encourage the patient to adhere to recommended screening protocols.

Ans: BFeedback:CEA is a protein that is normally not detected in the blood of a healthy person; therefore, when detectedit indicates that cancer is present, but not what type of cancer is present. The patient would likely belearning that he or she has cancer, so the nurse must prioritize the patients immediate psychosocialneeds, not abdominal assessment. Future screening is not a high priority in the short term.

35. 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 complaint? A) Stomach emptying takes place more slowly. B) The villi and epithelium of the small intestine become thinner. C) The esophageal sphincter becomes incompetent. D) Saliva production decreases.

Ans: AFeedback:Delayed gastric emptying occurs in older adults and may contribute to nausea. Changes to the smallintestine and decreased saliva production would be less likely to contribute to nausea. Loss ofesophageal sphincter function is pathologic and is not considered an age-related change.

33. Probably the most widely used in-office or at-home occult blood test is the Hemoccult II. The patient hascome to the clinic because he thinks there is blood in his stool. When you reviewed his medications, younoted he is on antihypertensive drugs and NSAIDs for early arthritic pain. You are sending the patienthome with the supplies necessary to perform 2 hemoccult tests on his stool and mail the samples back tothe clinic. What instruction would you give this patient? A) Take all your medications as usual. B) Take all your medications except the antihypertensive medications. C) Dont eat highly acidic foods 72 hours before you start the test. D) Avoid vitamin C for 72 hours before you start the test.

Ans: DFeedback:Red meats, aspirin, nonsteroidal anti-inflammatory drugs, turnips, and horseradish should be avoided for72 hours prior to the study, because they may cause a false-positive result. Also, ingestion of vitamin Cfrom supplements or foods can cause a false-negative result. Acidic foods do not need to be avoided.

A client is receiving a parenteral nutrition admixture that contains carbohydrates, electrolytes, vitamins, trace minerals, and sterile water and is now scheduled to receive an intravenous fat emulsion (Intralipid). What is the best action by the nurse? Stops the admixture while the fat emulsion infuses Starts a peripheral IV site to administer the fat emulsion Attaches the fat emulsion tubing to a Y connector close to the infusion site Connects the tubing for the fat emulsion above the 1.5 micron filter

Attaches the fat emulsion tubing to a Y connector close to the infusion site Explanation: An intravenous fat emulsion is attached to a Y connector close to the infusion site. The fat emulsion is administered simultaneously with the parenteral nutrition admixture. A separate peripheral IV site is not necessary. The fat emulsion is not administered through a filter.

40. A female patient has presented to the emergency department with right upper quadrant pain; thephysician has ordered abdominal ultrasound to rule out cholecystitis (gallbladder infection). The patientexpresses concern to the nurse about the safety of this diagnostic procedure. How should the nurse bestrespond? A) Abdominal ultrasound is very safe, but it cant be performed if youre pregnant. B) Abdominal ultrasound poses no known safety risks of any kind. C) Current guidelines state that a person can have up to 3 ultrasounds per year. D) Current guidelines state that a person can have up to 6 ultrasounds per year.

Ans: BFeedback:An ultrasound produces no ill effects and there are not specific limits on its use, even during pregnancy.

13. A nursing student has auscultated a patients abdomen and noted one or two bowel sounds in a 2-minuteperiod of time. How would you tell the student to document the patients bowel sounds? A) Normal B) Hypoactive C) Hyperactive D) Paralytic ileus

Ans: BFeedback:Documenting bowel sounds is based on assessment findings. The terms normal (sounds heard aboutevery 5 to 20 seconds), hypoactive (one or two sounds in 2 minutes), hyperactive (5 to 6 sounds heard inless than 30 seconds), or absent (no sounds in 3 to 5 minutes) are frequently used in documentation.Paralytic ileus is a medical diagnosis that may cause absent or hypoactive bowel sounds, but the nursewould not independently document this diagnosis.

21. The nurse is caring for a patient with a duodenal ulcer and is relating the patients symptoms to thephysiologic functions of the small intestine. What do these functions include? Select all that apply. A) Secretion of hydrochloric acid (HCl) B) Reabsorption of water C) Secretion of mucus D) Absorption of nutrients E) Movement of nutrients into the bloodstream

Ans: C, D, EFeedback:The small intestine folds back and forth on itself, providing approximately 7000 cm2 (70 m2) of surfacearea for secretion and absorption, the process by which nutrients enter the bloodstream through theintestinal walls. Water reabsorption primarily takes place in the large bowel. HCl is secreted by thestomach.

The nurse is inserting a nasogastric tube for a patient with pancreatitis. What intervention can the nurse provide to allow facilitation of the tube insertion? Spray the oropharynx with an anesthetic spray. Have the patient maintain a backward tilt head position. Allow the patient to sip water as the tube is being inserted. Have the patient eat a cracker as the tube is being inserted.

Allow the patient to sip water as the tube is being inserted. Explanation: During insertion, the patient usually sits upright with a towel or other protective barrier spread in a biblike fashion over the chest. The nostril may be swabbed or the oropharynx sprayed with an anesthetic agent to numb the nasal passage and suppress the gag reflex. The tip of the patient's nose is tilted upward, and the tube is aligned to enter the nostril. When the tube reaches the nasopharynx, the patient is instructed to lower the head slightly and, if able, to begin to swallow as the tube is advanced. The patient may also be encouraged to sip water through a straw to facilitate advancement of the tube if this action is not contraindicated.

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

Ans: CFeedback:Abdominal lesions are of particular importance, because GI diseases often produce skin changes. Skinproblems do not normally cause GI disorders. Age-related skin changes do not have a pronounced effecton the skin of the abdomen when compared to other skin surfaces. Self-harm is a less likely explanationfor skin lesions on the abdomen.

19. A patient with a recent history of intermittent bleeding is undergoing capsule endoscopy to determine thesource of the bleeding. When explaining this diagnostic test to the patient, what advantage should thenurse describe? A) The test allows visualization of the entire peritoneal cavity. B) The test allows for painless biopsy collection. C) The test does not require fasting. D) The test is noninvasive.

Ans: DFeedback:Capsule endoscopy allows the noninvasive visualization of the mucosa throughout the entire smallintestine. Bowel preparation is necessary and biopsies cannot be collected. This procedure allowsvisualization of the entire GI tract, but not the peritoneal cavity. ou'll be asked to stop eating and drinking at least 12 hours before the procedure. In some cases, your doctor may ask you to take a laxative before your capsule endoscopy to flush out your small intestine.

The nurse observes dry mucous membranes in a client who is receiving tube feedings after an oral surgery. The client also reports unpleasant tastes and odors. Which measure should be included in the client's plan of care? Ensure adequate hydration with additional water. Provide frequent mouth care. Keep the feeding formula refrigerated. Flush the tube with water before adding the feedings.

Frequent mouth care helps to relieve the discomfort from dryness and unpleasant odors and tastes. It can be done with the help of ice chips and analgesic throat lozenges, gargles, or sprays. Adequate hydration is essential. If urine output is less than less than 500 mL/day, formula and additional water can be given as ordered. Keeping the feeding formula refrigerated and unopened until it is ready for use and flushing the tube with water before adding feedings are measures to protect the client from infections.

A patient is receiving parenteral nutrition. The current solution is nearing completion, and a new solution is to be hung, but it has not arrived from the pharmacy. Which action by the nurse would be most appropriate? Slow the current infusion rate so that it will last until the new solution arrives. Hang a solution of dextrose 10% and water until the new solution is available. Have someone go to the pharmacy to obtain the new solution. Begin an infusion of normal saline in another site to maintain hydration.

Hang a solution of dextrose 10% and water until the new solution is available. Explanation: The infusion rate of the solution should not be increased or decreased; if the solution is to run out, a solution of 10% dextrose and water is used until the next solution is available. Having someone go to the pharmacy would be appropriate, but there is no way to determine if the person will arrive back before the solution runs out. Starting another infusion would be inappropriate. Additionally, the infusion needs to be maintained through the central venous access device to maintain patency.