PrepU Chapter 38: Assessment of Digestive and Gastrointestinal Functio
A client reports having red stools lately. What will the nurse ask during assessment questioning?
"Have you been eating beets?"
A client is scheduled for an ultrasound of the abdomen. Which statement indicates that teaching provided to the client to prepare for the test was effective?
"I will not eat or drink for 8 to 12 hours before the test."
The nurse is scheduling a client for a gastrointestinal motility study. The nurse knows that this type of diagnostic test will aid in determine which of the following alterations?
- Dumping syndrome - Diabetic gastroparesis - Disorders of gastric motility
When completing a nutritional assessment of a patient who is admitted for a GI disorder, the nurse notes a recent history of dietary intake. This is based on the knowledge that a portion of digested waste products can remain in the rectum for how many days after a meal is digested?
3 days -As much as 25% of the waste products from a meal may still be in the rectum 3 days after a meal is ingested.
The nurse is preparing the client for an assessment of the abdomen. What should the nurse complete prior to this assessment?
Ask the client to empty the bladder. -The physical examination of the gastrointestinal system includes assessment of the mouth, abdomen, and rectum. It requires good light, full exposure of the abdomen, warm hands with short nails, and a relaxed client with an empty bladder. A full bladder will interfere with inspection and may elicit discomfort with palpation and percussion, thereby altering results.
The nurse is to obtain a stool specimen from a client who reported that he is taking iron supplements. The nurse would expect the stool to be which color?
Black -Ingestion of iron can cause the stool to turn black. Meat protein causes stool to appear dark brown. Ingestion of large amounts of spinach may turn stool green while ingestion of carrots and beets may cause stool to turn red.
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 client?
Do not give any food and fluids until the gag reflex returns.
A client with abdominal pain is scheduled for a CT scan of the abdomen with contrast. Which assessment will the nurse complete before transporting the client for the diagnostic test?
History of allergies
A nurse is assessing a client who reports abdominal pain, nausea, and diarrhea. When examining the client's abdomen, which sequence should the nurse use?
Inspection, auscultation, percussion, and palpation
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?
Pancreas -The pancreas is both an exocrine gland, one that releases secretions into a duct or channel, and an endocrine gland, one that releases substances directly into the bloodstream. The other organs have a variety of functions but do not have a combination function such as the 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?
Pentagastrin
Which of the following is an enzyme secreted by the gastric mucosa?
Pepsin
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.
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 performs an abdominal assessment. The nurse should perform the assessment in which order?
inspection, auscultation, percussion, palpation
The salivary glands secrete
ptyalin.
A nurse is teaching a client with malabsorption syndrome about the disorder and its treatment. The client asks which part of the GI tract absorbs food. What is the nurse's best response?
small intestine
The nurses assesses the client for blood in the stool due to an upper GI condition. The nurse understands that if there is blood in the stool, the stool will be which color?
tarry black
The nurse recognizes which change of the gastrointestinal 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 is performing an assessment of a patient. During the assessment the patient informs the nurse of some recent "stomach trouble." What does the nurse know is the most common symptom of patients with GI dysfunction?
Dyspepsia -Dyspepsia, upper abdominal discomfort associated with eating (commonly called indigestion), is the most common symptom of patients with GI dysfunction. Indigestion is an imprecise term that refers to a host of upper abdominal or epigastric symptoms such as pain, discomfort, fullness, bloating, early satiety, belching, heartburn, or regurgitation; it occurs in approximately 25% of the adult population (Harmon & Peura, 2010).
A nurse is preparing a client with Crohn's disease for a barium enema. What should the nurse do the day before the test?
Encourage plenty of fluids.
Pepsin is secreted by the
gastric mucosa.
The nurse asks a client to point to where pain is felt. The client asks why this is important. What is the nurse's best response?
"Often the area of pain is referred from another area."
A client with a gastrointestinal disorder is scheduled for abdominal magnetic resonance imaging (MRI). Which teaching will the nurse provide to prepare the client for this test? Select all that apply.
- Remove all jewelry and metal from the body. - Take nothing by mouth for 6 to 8 hours before the test. - Expect the test to take 60 to 90 minutes to complete.
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.
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
The nurse is preparing to examine the abdomen of a client with reports of nausea and vomiting. What action would the nurse perform first?
Inspection
The instructor has just finished teaching a group of students about the various organs of the upper gastrointestinal tract and possible disorders. The instructor determines that the teaching was successful when the students identify which structure as possibly being affected?
Stomach
A client was diagnosed with pernicious anemia. Which vitamin cannot be absorbed without an intrinsic factor?
Vitamin B12 -Vitamin B12 needs to be absorbed in the ileum, where the pH is higher than in the stomach. This vitamin is transported by a glycoprotein known as intrinsic factor.
The liver and gallbladder secrete
bile.
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 tells the nurse that the stool was colored yellow. The nurse assesses the client for
recent foods ingested. -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 determines one or two bowel sounds in 2 minutes should be documented as
hypoactive -Hypoactive bowel sound is the description given to auscultation of one to two bowel sounds in 2 minutes. Normal bowel sounds are heard every 5 to 20 seconds. Hyperactive bowel sounds occur when 5 or 6 sounds are heard in less than 30 seconds. The nurse records that bowel sounds are absent when no sound is heard in 3 to 5 minutes.
A client with a gastrointestinal condition asks why the mouth needs to be examined. Which response will the nurse make?
"Changes in the mouth can help explain why your condition is occurring." - A complete assessment of the oral cavity is essential because many disorders, such as cancer, diabetes, and immunosuppressive conditions resulting from medication therapy or acquired immunodeficiency syndrome, may be manifested by changes in the oral cavity, including stomatitis. Assessment of the mouth is not done because it is the body part least examined. It is not assessed because it is a part of every assessment. The nurse has no way of knowing if the client's gastrointestinal problem is in the client's mouth.
Which of the following is the primary function of the small intestine?
Absorption -Absorption is the primary function of the small intestine. Digestion occurs in the stomach. Peristalsis occurs in the colon. The duodenum secretes enzymes.
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. -An upper GI fluoroscopy delineates the entire GI tract after the introduction of a contrast agent such as barium. To prepare for the test, the client should be instructed to ingest nothing after midnight before the test. Clear liquids are not permitted the morning of the test. Most oral medications are withheld the morning of the test, but not for 24 hours before. There is no reason to avoid products containing aspirin for a week before the test.
A client is diagnosed with megaloblastic anemia caused by vitamin B12 deficiency. The health care provider begins the client on cyanocobalamin (Betalin-12), 100 mcg I.M. daily. Which substance influences vitamin B12 absorption?
Intrinsic factor -Vitamin B12 absorption depends on intrinsic factor, which is secreted by parietal cells in the stomach. The vitamin binds with intrinsic factor and is absorbed in the ileum. Hydrochloric acid, histamine, and liver enzymes don't influence vitamin B12 absorption.
After 20 seconds of auscultating for bowel sounds on a client recovering from abdominal surgery, the nurse hears nothing. What should the nurse do based on the assessment findings?
Listen longer for the sounds. -Auscultation is used to determine the character, location, and frequency of bowel sounds. The frequency and character of sounds are usually heard as clicks and gurgles that occur irregularly and range from 5 to 35 per minutes. Normal sounds are heard about every 5 to 20 seconds, whereas hypoactive sounds can be one or two sounds in 2 minutes. Postoperatively, it is common for sounds to be reduced; therefore, the nurse needs to listen at least 3 to 5 minutes to verify absent or no bowel sounds.
Trypsin is secreted by the
pancreas.
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?
"I should avoid antibiotics for 1 month before the test." -The nurse evaluates that the client understands the education when the client states antibiotics should be avoided one month before the test. In addition, the client should avoid loperamide, sucralfate, and omeprazole for 1 week prior to the test, and cimetidine, famotidine, and nizatidine for 24 hours before the test. During the test, the client swallows a capsule of carbon-labeled urea and a breath sample is obtained 10 to 20 minutes later. The hydrogen breath test detects the presence of <italic>Helicobacter pylori, the bacteria that causes peptic ulcer disease.
A client reports a history of bleeding hemorrhoids to the nurse. Which observation supports the client's statement?
Blood streaks on stool -Blood in the stool can present in various ways and must be investigated. Lower rectal or anal bleeding is suspected if there is streaking of blood on the surface of the stool or if blood is noted on toilet tissue. Hard, dry stool occurs in constipation. If blood is shed in sufficient quantities into the upper GI tract, it produces a dark red color, a tarry-black color, or melena.
When preparing a client for magnetic resonance imaging (MRI) of the abdomen, which statement would indicate the need to notify the health care provider?
"I really don't like to be in small, enclosed spaces." -An MRI scanner is a narrow, tunnel-like machine that will enclose the client during the test. Clients who are claustrophobic (fear enclosed spaces) may need sedation because it is imperative that they lie still and not panic during the test. Therefore, the nurse should notify the health care provider about the client's statement. Typically, the client is NPO for 6 to 8 hours before the test, and he or she must remove any metal objects, credit cards, jewelry, and watch before the test. The machine makes loud repetitive noises while the test is in progress, so earphones may be helpful.
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." -The carcinoembryonic antigen (CEA) blood test detects the presence of cancer by identifying the presence of a protein not normally detected in the blood of a healthy person. However, it does not indicate what type of cancer is present nor does it detect the functionality of the liver.
A nurse is giving a client barium swallow test. What is the most important assessment a nurse would make to ensure that a client does not retain any barium after a barium swallow?
Monitoring the stool passage and its color. -Monitoring stool passage and its color will ensure that the client remains barium free following a barium swallow test. The white or clay color of the stool would indicate barium retention. The stool should be placed in a special preservative if the client undergoes a stool analysis. Observing the color and volume of urine will not ensure that the client is barium free because barium is not eliminated through urine but through stool.
A group of students are studying for an examination on the gastrointestinal (GI) system and are reviewing the structures of the esophagus and stomach. The students demonstrate understanding of the material when they identify which of the following as the opening between the stomach and duodenum?
Pyloric sphincter -The pyloric sphincter is the opening between the stomach and duodenum. The cardiac sphincter is the opening between the esophagus and the stomach. The hypopharyngeal sphincter or upper esophageal sphincter prevents food or fluids from re-entering the pharynx. The ileocecal valve is located at the distal end of the small intestine and regulates flow of intestinal contents into the large intestine.
The client describes a test previously completed to detect a small bowel obstruction prior to admission to the hospital. The client states that the test involved insertion of a tube through the nose and lasted over 6 hours. The nurse determines which test name should be documented?
upper GI enteroclysis -Enteroclysis is a double contrast study where a duodenal tube is inserted and 500 to 1000 mL of thin barium sulfate suspension and then methylcellulose is infused. Fluoroscopy is used to visualize the filling of the intestinal loops over a period of up to 6 hours. The test is used for detection of small bowel obstruction and diverticuli. Abdominal ultrasound, magnetic resonance imaging, and positron emission tomography do not involve insertion of a duodenal tube.
A client is scheduled for bowel resection with anastomosis involving the large intestine. Because of the surgical site, the nurse formulates the nursing diagnosis of Risk for infection. To complete the nursing diagnosis statement, the nurse should add which "related-to" phrase?
Related to the presence of bacteria at the surgical site
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." -The client demonstrates understanding of a barium swallow when stating he or she must refrain from eating or drinking for 6 to 8 hours before the test. No other preparation is needed. Before a lower GI series, the client should eat a low-residue or clear liquid diet for 2 days and take a potent laxative and an oral liquid preparation.
A client is to have an upper GI procedure with barium ingestion and abdominal ultrasonography. While scheduling these diagnostic tests, the nurse must consider which factor?
The ultrasonography should be scheduled before the GI procedure.
A client is scheduled for several diagnostic tests to evaluate gastrointestinal function. After teaching the client about these tests, the nurse determines that the client has understood the teaching when the client identifies which test as not requiring the use of a contrast medium?
Colonoscopy -A colonoscopy is a direct visual examination of the entire large intestine. It does not involve the use of a contrast agent. Contrast medium may be used with a small bowel series, computed tomography, and upper GI series.