pathopharm quiz 4 GI

Ulcerative colitis is commonly associated with a. bloody and/or purulent diarrhea. b. malabsorption of nutrients . c. fistula formation between loops of bowel. d. inflammation and scarring of the submucosal layer of the bowel.

a. bloody and/or purulent diarrhea. Ulcerative colitis (inflammation and ulceration of the colon and rectal mucosa) is maifested as bloody diarrhea and abdominal pain. Purulent diarrhea is also common.

A patient newly diagnosed with PUD reports taking lowdose aspirin (ASA) for prevention of cardiovascular disease. The nurse learns that the patient drinks 2 to 3 cups of coffee each day and has a glass of wine with dinner 3 or 4 nights per week. The patient eats three meals a day. The nurse will counsel this patient to: a. change the meal pattern to five or six smaller meals per day. b. discontinue taking aspirin, because it can irritate the stomach. c. stop drinking wine or any other alcoholic beverage. d. switch to a decaffeinated coffee and reduce the number of servings.

a. change the meal pattern to five or six smaller meals per day. Consumption of five or six smaller meals a day can reduce fluctuations in the intragastric pH, which may facilitate recovery. ASA should be avoided, along with other NSAIDs except for lowdose ASA used for the prevention of cardiovascular disease. No hard data implicate alcohol as a contributor to PUD. No data indicate that caffeine contributes to PUD.

Hepatic encephalopathy is associated with a. hyperbilirubinemia. b. hyperuricemia. c. toxic effects of alcohol on brain cells. d. increased blood ammonia levels.

d. increased blood ammonia levels. Hepatic encephalopathy is associated with liver failure or liver disease. It is positively correlated with elevated arterial ammonia levels. Hyperbilirubinemia is not related to hepatic encephalopathy but is associated with hypokalemia, hyponatremia, alkalosis, hypoxia, and hypercarbia. Hyperuricemia is not associated with hepatic encephalopathy. Hepatic encephalopathy is a complex neuropsychiatric syndrome characterized by symptoms ranging from mild confusion and lethargy to stupor and coma. Topic: GI Cogn Level: Knowledge

A patient will undergo a colonoscopy, and the provider has ordered sodium phosphate as a bowel cleanser before the procedure. The nurse reviews the patient's chart and notes that the patient's creatinine clearance and blood urea nitrogen are both elevated. What will the nurse do? a. Reduce the amount of fluid given with the laxative to prevent fluid retention. b. Request an order to give polyethylene glycol and electrolytes (PEGELS) instead. c. Suggest that the patient reduce the dietary sodium intake. d. Suggest using a suppository laxative instead.

b. Request an order to give polyethylene glycol and electrolytes (PEGELS) instead. PEGELS solutions provide an isosmotic solution and do not cause dehydration or electrolyte imbalance. They are safe to use in patients with renal impairment or cardiovascular disease. This patient's laboratory values suggest renal impairment. Sodium phosphate products can cause kidney damage; giving them with less fluid only increases this possibility. Reducing the dietary intake of sodium is not recommended. Suppositories are not effective bowel cleansing agents.

A pregnant patient who is taking ondansetron [Zofran] for morning sickness tells the nurse she is experiencing headache and dizziness. What will the nurse tell her? a. It is not safe to take this drug during pregnancy. b. These are common side effects of ondansetron. c. She should stop taking the ondansetron immediately. d. She should report these adverse effects to her provider.

b. These are common side effects of ondansetron. The most common side effects of ondansetron are headache, diarrhea, and dizziness. Ondansetron is used offlabel to treat morning sickness. These side effects do not indicate a need to stop taking the drug or to report the side effects to the provider.

A patient's provider has recommended a bulkforming laxative for occasional constipation. Which statement by the patient indicates understanding of the teaching about this agent? a. "I can take this medication long term." b. "I should not take this drug if I have diverticulitis." c. "I should take each dose with a full glass of water." d. "This drug can cause severe diarrhea."

c. "I should take each dose with a full glass of water." Bulk-forming laxatives provide insoluble substances that swell in water to both soften and increase the size of the fecal mass.Patients should be taught to take the dose with a full glass of water. Laxatives in general are not recommended for longterm use. Bulkforming laxatives are safe for patients with diverticulitis. They are often used to treat diarrhea, because they help form the fecal mass.

A 16yearold female presents with abdominal pain in the right lower quadrant. Physical examination reveals rebound tenderness and a lowgrade fever. A possible diagnosis would be: a. Colon cancer b. Pancreatitis c. Appendicitis d. Hepatitis

c. Appendicitis Appendicitis is manifested by right lower quadrant pain with rebound tenderness. Colon cancer may be asymptomatic, followed by bleeding. Pancreatitis is manifested by vomiting. Hepatitis would be manifested by upper abdominal pain, not lower.

What clinical finding would suggest an esophageal cause of a client's report of dysphagia? a. Nasal regurgitation b. Airway obstruction with swallowing c. Chest pain/discomfort seconds after eating. d. Coughing when swallowing

c. Chest pain/discomfort seconds after eating. Two types of pain occur in the esophagus: (1) heartburn (also called pyrosis) and (2) pain located in the middle of the chest, which may mimic the pain of angina pectoris. Heartburn is caused by the reflux of gastric contents into the esophagus and is a substernal burning sensation that may radiate to the neck or throat. A person experiencing pharyngeal contractions may cough and expel the ingested food or fluids through their mouth and nose or aspirate when they attempt to swallow. Airway obstruction with swallowing would be an oropharyngeal cause of dysphagia. A person experiencing pharyngeal contractions may cough and expel the ingested food or fluids through his or her mouth and nose or aspirate

A 30yearold male patient will begin a threedrug regimen to treat peptic ulcer disease. The regimen will consist of bismuth subsalicylate, tetracycline, and cimetidine [Tagamet]. The nurse will include which information when teaching this patient about this drug regimen? a. Black discoloration of the tongue and stools should be reported immediately. b. Central nervous system depression and confusion are likely to occur. c. Decreased libido, impotence, and gynecomastia are reversible side effects. d. Staining of the teeth may occur and is an indication for discontinuation of these drugs.c

c. Decreased libido, impotence, and gynecomastia are reversible side effects. Cimetidine has antiandrogenic effects and can cause decreased libido, impotence, and gynecomastia. These effects are reversible. Black stools and discoloration of the tongue are side effects associated with bismuth but are not harmful. Central nervous system (CNS) depression and confusion are not likely. Staining of the teeth associated with tetracycline use occurs only in developing teeth; it is a problem in children younger than 8 years and in pregnant woman because of this risk to the fetus.

Tissue damage in pancreatitis is caused by: a. Insulin toxicity b. Autoimmune destruction of the pancreas c. Leakage of pancreatic enzymes d. Hydrochloric acid reflux into the pancreatic duct

c. Leakage of pancreatic enzymes Leaked enzymes become activated, initiating autodigestion, inflammation, oxidative stress, and acute pancreatitis. Tissue damage is caused by leaked enzymes that become activated, initiating autodigestion, inflammation, oxidative stress, and acute pancreatitis. It is not due to insulin toxicity. Tissue damage is caused by leaked enzymes that become activated, initiating autodigestion, inflammation, oxidative stress, and acute pancreatitis. It is not due to autoimmune destruction. The cause is unknown. Tissue damage is caused by leaked enzymes that become activated, initiating autodigestion, inflammation, oxidative stress, and acute pancreatitis. It is not due to hydrochloric acid reflux.

An older adult patient with severe gastroesophageal reflux disease (GERD) has had only minimal relief using a histamine2receptor antagonist (H2RA). The patient is to begin taking omeprazole [Prilosec]. What will the nurse teach this patient? a. A complete cure is expected with this medication. b. Lifestyle changes can be as effective as medication therapy. c. Longterm therapy may be needed. d. The medication will be used until surgery can be performed.

c. Longterm therapy may be needed. Proton pump inhibitors, such as omeprazole, are much better than H2RAs for treating GERD. For patients with severe GERD, longterm maintenance therapy is recommended. These drugs do not cure GERD; relapse is common when the drugs are discontinued. Lifestyle changes can help but should not be considered a substitute for drugs. Surgery is reserved for young, healthy patients who cannot or will not stick to a drug regimen.

A 50yearold male is experiencing reflux of gastric fluid from the stomach. He is diagnosed with gastroesophageal reflux. This condition is caused by: a. Fibrosis of the lower third of the esophagus b. Sympathetic nerve stimulation c. Loss of muscle tone at the lower esophageal sphincter d. Reverse peristalsis of the stomach

c. Loss of muscle tone at the lower esophageal sphincter Gastroesophageal reflux is due to loss of muscle tone at the lower esophageal sphincter. Gastroesophageal reflux is due to loss of muscle tone at the lower esophageal sphincter; it is not due to fibrosis. Gastroesophageal reflux is due to loss of muscle tone at the lower esophageal sphincter, not stimulation of sympathetic nerves. Gastroesophageal reflux is due to loss of muscle tone at the lower esophageal sphincter, not reverse peristalsis.

The most common cause of mechanical bowel obstruction is a. volvulus. b. intussusception. c. adhesions. d. fecal impaction.

c. adhesions. the most frequent contributing factors for bowel obstructions are previous abdominal surgery with adhesions and congenital abnormalities of the bowel.

A patient is admitted with lower abdominal pain and nausea. The nurse performing the initial assessment notes that the patient's abdomen is distended and firm, and hypoactive bowel sounds are present. The patient has not had a stool for 3 days. The nurse will contact the provider, who will most likely: a. order a bulkforming laxative. b. order extra fluids and fiber. c. perform diagnostic tests. d. prescribe a cathartic laxative.

c. perform diagnostic tests. Laxatives are contraindicated for patients with abdominal pain, nausea, cramps, or other symptoms of abdominal disease or an acute surgical abdomen. Laxatives should not be used in patients with obstruction or impaction. This patient shows signs of abdominal obstruction, and laxatives could cause a bowel perforation secondary to increased peristalsis. A bulkforming laxative is contraindicated. Patients with acute abdomens should be kept NPO pending diagnosis. A cathartic laxative is contraindicated.