A-Chapter 44: Assessment of Digestive and Gastrointestinal Function NCLEX QUESTIONS

A client with extreme weakness, pallor, weak peripheral pulses, and disorientation is admitted to the emergency department. His wife reports that he has been "spitting up blood." A Mallory-Weiss tear is suspected, and the nurse begins taking a client history from the client's wife. The question by the nurse that demonstrates her understanding of Mallory-Weiss tearing is: a) "Has your partner recently fallen or injured his chest?" b) "What spices and condiments does your spouse use on food?" c) "Is your partner being treated for tuberculosis?" d) "Has your partner had recent forceful vomiting?"

"Has your partner had recent forceful vomiting?" A Mallory-Weiss tear is associated with massive bleeding after a tear occurs in the mucous membrane at the junction of the esophagus and stomach. There is a strong relationship between forceful vomiting, and a Mallory-Weiss tear. The bleeding is coming from the stomach, not from the lungs as would be true in some cases of tuberculosis. A Mallory-Weiss tear doesn't occur from chest injuries or falls and isn't associated with eating spicy foods.

A client is scheduled for magnetic resonance imaging (MRI). During the client teaching, the nurse will discuss which of the following? a) "You must be NPO for the day before the examination." b) "The examination will take only 15 minutes." c) "You must remove all jewelry but can wear your wedding ring." d) "Do you experience any claustrophobia?"

"Do you experience any claustrophobia?" MRI is a noninvasive technique that uses magnetic fields and radio waves to produce images of the area being studied. Clients must be NPO for 6 to 8 hours before the study and remove all jewelry and other metals. The examination takes 60 to 90 minutes and can induce feelings of claustrophobia, because the scanner is close fitting.

A home care nurse is caring for a client with complaints of epigastric discomfort who is scheduled for a barium swallow. Which statement by the client indicates an understanding of the test? a) "I'll take a laxative to clear my bowels before the test." b) "I'll drink full liquids the day before the test." c) "There is no need for special preparation before the test." d) "I'll avoid eating or drinking anything 6 to 8 hours before 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 he states that he 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.

The nurse is caring for a client recovering from an esophagogastroduodenoscopy (EGD). Which of the following client symptoms would require further nursing assessment? a) Thirst b) Abdominal distention c) Drowsiness d) Sore throat

Abdominal distention The nurse is correct to fully assess the client experiencing abdominal distention following an esophagogastroduodenoscopy (EGD). Abdominal distention could indicate complications such as perforation and bleeding. The client experiences drowsiness from the sedative during the early recovery process and a sore throat from passage of the scope. The client may also experience thirst because the client has not had liquids for a period of time.

Which of the following should the nurse complete prior to assessing the abdomen of a 35-year-old man? a) Ask the client to empty his bladder. b) Dim the lights for privacy. c) Prepare for a prostate examination. d) Assist the client to a Fowler's position.

Ask the client to empty his 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? a) Black b) Green c) Dark brown d) Red

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 nurse is assessing a client who underwent esophagogastroduodenoscopy (EGD) for postoperative complications. Which sign or symptom is a complication of this procedure? a) Sore throat b) Drooling c) Bloody secretions d) Absent gag reflex

Bloody secretions In EGD, a physician inserts a fiberoptic endoscope via the mouth to visualize the esophagus, stomach, and duodenum. Bleeding, though rare, signals the complication of perforation. Sore throat, drooling, and an absent gag reflex are normal findings after an EGD. The endoscope can cause the sore throat. Clients may drool until the gag reflex returns and they're able to swallow their saliva. Before performing the procedure, the physician administers a local anesthetic that inactivates the gag reflex, so the reflex may be absent for a period after the procedure.

A client is scheduled for several diagnostic tests to evaluate her gastrointestinal function. After teaching the client about these tests, the nurse determines that the client has understood the teaching when she identifies which test as not requiring the use of a contrast medium? a) Upper GI series b) Colonoscopy c) Computer tomography d) Small bowel series

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.

During assessment of a patient complaining of dyspepsia, the nurse is aware that abdominal pain associated with indigestion is usually which of the following? a) Less severe after an intake of fatty foods b) In the left lower quadrant c) Described as cramping or burning d) Relieved by the intake of coarse vegetables, which stimulate peristalsis

Described as cramping or burning Abdominal pain associated with indigestion (dyspepsia) is described as burning, cramping, and bloating. Also, there is abdominal fullness and heartburn. Fatty foods cause the most discomfort, as do coarse vegetables and highly seasoned foods. The pain is in the upper left quadrant.

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? a) Jejunum b) Duodenum c) Cecum d) Ileum

Duodenum 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. The duodenum is the site where bile and pancreatic enzymes enter the GI system.

A nurse is preparing a client with Crohn's disease for a barium enema. What should the nurse do the day before the test? a) Serve the client his usual diet. b) Encourage plenty of fluids. c) Order a high-fiber diet. d) Serve dairy products.

Encourage plenty of fluids. The nurse should encourage plenty of fluids because adequate fluid intake is necessary to avoid dehydration that may be caused by the bowel preparation and to prevent fecal impaction after the procedure. The client may be placed on a low-residue diet 1 to 2 days before the procedure to reduce the contents in the GI tract. Fiber intake is limited in a low-residue diet. Because dairy products leave a residue, they aren't allowed the evening before the test. Clear liquids only are allowed the evening before the test.

Which of the following is the major carbohydrate that tissue cells use as fuel? a) Glucose b) Chyme c) Proteins d) Fats

Glucose Glucose is the major carbohydrate that tissue cells use as fuel. Proteins are a source of energy after they are broken down into amino acids and peptides. Chyme stays in the small intestine for 3 to 6 hours, allowing for continued breakdown and absorption of nutrients. Ingested fats become monoglycerides and fatty acids by the process of emulsification.

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? a) Hamburger and French fries b) Salmon with cheddar mashed potatoes c) Steamed rice with pork and broccoli d) Grilled chicken on a spinach salad

Hamburger and French fries 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.

One or two bowel sounds in 2 minutes would be documented as which of the following? a) Hyperactive b) Hypoactive c) Normal d) Absent

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.

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

Increased motility of the stomach Gastrin has the following effects on GI motility: increased motility of the stomach, excitation of the colon, relaxation of ileocecal sphincter, and contraction of the gastroesophageal sphincter.

When examining the abdomen of a client with complaints of nausea and vomiting, which of the following would the nurse do first? a) Auscultation b) Percussion c) Palpation d) Inspection

Inspection When assessing the abdomen, the nurse would first inspect or observe the abdomen. This would be followed by auscultation, percussion, and lastly, palpation.

The nurse is performing an abdominal assessment. The nurse should perform the assessment in which of the following orders? a) Inspection, palpation, percussion, auscultation b) Auscultation, inspection, percussion, palpitation c) Inspection, auscultation, percussion, palpation d) Auscultation, percussion, inspection, palpation

Inspection, auscultation, percussion, palpation The correct order for the abdominal assessment is inspection, auscultation, percussion, and palpation.

Which of the following terms describes a gastric secretion that combines with vitamin B12 so that it can be absorbed? a) Amylase b) Trypsin c) Pepsin d) Intrinsic factor

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.

While palpating a client's right upper quadrant (RUQ), the nurse would expect to find which structure? a) Spleen b) Appendix c) Sigmoid colon d) Liver

Liver The RUQ contains the liver, gallbladder, duodenum, head of the pancreas, hepatic flexure of the colon, portions of the ascending and transverse colon, and a portion of the right kidney. The sigmoid colon is located in the left lower quadrant; the appendix, in the right lower quadrant; and the spleen, in the left upper quadrant.

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? a) Bent over with hands touching the floor b) Lying on the left side with knees bent c) Lying on the right side with legs straight d) Prone with the torso elevated

Lying on the left side with knees bent For a colonoscopy, the nurse initially should position the client on the left side with knees bent. Placing the client on the right side with legs straight, prone with the torso elevated, or bent over with hands touching the floor wouldn't allow proper visualization of the large intestine.

From the following profiles of clients, which client would be most likely to undergo the diagnostic test of cholecystography? a) Mark, suspected of having stones in the gallbladder b) Steven, suspected of having a tumor in the colon c) Sandra, suspected of having lesions in the liver d) Andrew, suspected of having esophageal abnormalities

Mark, suspected of having stones in the gallbladder Cholecystography will be most appropriate for Mark because the test is used to detect stones in the gallbladder. Most likely, Andrew would require barium swallow test to detect any abnormalities in the esophagus. Steven would need a barium enema for to identify a tumor in the colon. Sandra would undergo a radionuclide image test for her lesions in the liver.

What part of the GI tract begins the digestion of food? a) Mouth b) Stomach c) Esophagus d) Duodenum

Mouth Food that contains starch undergoes partial digestion in the mouth when it mixes with the enzyme salivary amylase, which the salivary glands secrete. Food that contains starch undergoes partial digestion in the mouth.

The nurse is assisting the physician with a gastric acid stimulation test for a patient. What medication should the nurse prepare to administer subcutaneously to stimulate gastric secretions? a) Mucomyst b) Pentagastrin c) Atropine d) Robinul (glycopyrrolate)

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

Which of the following is an enzyme secreted by the gastric mucosa? a) Pepsin b) Bile c) Ptyalin d) Trypsin

Pepsin Pepsin is secreted by the gastric mucosa. Trypsin is secreted by the pancreas. The salivary glands secrete ptyalin. The liver and gallbladder secrete bile.

A patient is being prepared for esophageal manometry. The nurse should inform the patient to withhold what medication for 48 hours prior to the procedure? a) Metoprolol (Lopressor) b) Amiodarone (Cordarone) c) Aspirin d) Calan (Verapamil)

PrepU said Aspirin, but the rationale supports Calan (Verapamil) Esophageal manometry is used to detect motility disorders of the esophagus and the upper and lower esophageal sphincter. Also known as esophageal motility studies, these studies are very helpful in the diagnosis of achalasia, diffuse esophageal spasm, scleroderma, and other esophageal motor disorders. The patient must refrain from eating or drinking for 8 to 12 hours before the test. Medications that could have a direct effect on motility (e.g., calcium channel blockers, anticholinergic agents, sedatives) are withheld for 24 to 48 hours.

The nurse is scheduling gastrointestinal (GI) diagnostic testing for a client. Which GI test should be scheduled first? a) Barium swallow b) Barium enema c) Small bowel series d) Radiography of the gallbladder

Radiography of the gallbladder Radiography of the gallbladder should be performed before other GI exams in which barium is used because residual barium tends to obscure the images of the gallbladder and its duct.

Following ingestion of carrots or beets, the nurse would expect which alteration in stool color? a) Black b) Milky white c) Red d) Yellow

Red Carrots or beets will tend to change the stool color to red. Black stools are associated with iron, licorice, and charcoal. Senna is associated with yellow stools. A milky white stool is associated with administration of barium.

A client has recently obtained a set of dentures. Which of the following will the nurse do during a complete physical examination? a) Have the client rinse with warm salt water before assessing the oral cavity. b) Remove the plates to visualize the oral cavity. c) Remove the plates and rinse under hot water to remove bacteria. d) Brush the dentures before examining the oral cavity.

Remove the plates to visualize the oral cavity. A complete physical examination includes an assessment of the mouth. It is necessary to remove the dentures to allow good visualization of the entire oral cavity.

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? a) Duodenum b) Ileum c) Cecum d) Sigmoid colon

Sigmoid colon Water is reabsorbed by means of diffusion across the intestinal membrane as the contents move through the colon. By the time the mixture reaches the descending and sigmoid colon, the portion of the bowel adjacent to the rectum, it is a formed mass. The ileum and duodenum are located in the small intestine. The cecum is located at the beginning of the large intestine.

Using gastric analysis, the nurse would expect that a patient diagnosed with peptic ulcer would secrete which of the following? a) Small amount of acid b) Little or no acid c) No acid under basal condition or after stimulation d) An excess amount of acid

Small amount of acid Patient with peptic ulcer disease secrete some acid. Patients with gastric cancer secrete little or no acid. Patients with duodenal ulcers secrete an excess amount of acid. Patients with pernicious anemia secrete no acid under basal conditions or after stimulation.

After 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 of the following structures as possibly being affected? a) Liver b) Stomach c) Large intestine d) Ileum

Stomach The upper gastrointestinal (GI) tract begins at the mouth and ends at the jejunum. Therefore, the stomach would be a component of the upper GI tract. The lower GI tract begins at the ileum and ends at the anus. The liver is considered an accessory structure.

A client receives a local anesthetic to suppress the gag reflex for a diagnostic procedure of the upper GI tract. Which of the following nursing interventions is advised for this patient? a) The client should not be given any food and fluids until the gag reflex returns. b) The client should be monitored for cramping or abdominal distention. c) The client should be monitored for any breathing-related disorder or discomforts. d) The client's fluid output should be measured for at least 24 hours after the procedure.

The client should not be given any food and fluids until the gag reflex returns. For a client receiving a local anesthetic that suppresses the gag reflex, the nurse is advised to withhold food and fluids until the reflex returns.

Which of the following is true statement regarding older patients, considering the age-related effects on their GI system? a) They have no awareness of the filling reflex. b) They tend to have increased muscle tone and mass. c) They tend to have higher physiologic reserves to compensate for fluid loss. d) They tend usually to have less control of the rectal sphincter.

They tend usually to have less control of the rectal sphincter. Older adults tend to have fewer physiologic reserves to compensate for fluid loss. The older adult usually has less control of the rectal sphincter than a younger adult because of age-related changes in innervations, a diminished awareness of the filling reflex, and decreased muscle tone.

Upon review of a client's chart, the nurse notes the client has been receiving antiemetics every 6 to 8 hours. What in this client's history may necessitate such frequency? a) Adrenal gland removal 3 days ago b) Multiple leg fractures c) Pituitary tumor d) Treatment for cancer

Treatment for cancer Antiemetics are used to treat nausea and vomiting. Common causes of nausea and vomiting include visceral afferent stimulation, peritoneal irritation, infections, radiation or chemotherapy therapy, increased intracranial pressure, and vestibular disorders. Irritation of the chemoreceptor trigger zone from cancer treatment can induce nausea and lead to vomiting.

Which of the following is an age-related change of the GI system? a) Increased mucus secretion b) Increased motility c) Weakened gag reflex d) Hypertrophy of the small intestine

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.

Which of the following is an age-related change of the gastrointestinal system? a) Weakened gag reflex b) Increased mucus secretion c) Hypertrophy of the small intestine d) Increased motility

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 assessing a 50-year-old, dark-skinned African American man and has noted that he appears jaundice. Most likely, the nurse made this observation by assessing which part of his body? a) Nail beds b) Skin c) Top of the hands and feet d) Mucous membranes

Mucous membranes In very dark-skinned clients, inspect the hard palate, gums, conjunctiva, and surrounding tissues for discoloration.

A client frequently reports constipation. The nurse asks the client about his bowel habits. Which of the following would be the most likely contributing factor related to constipation? a) Resisting the urge to defecate several times a day b) A vegan, organic lifestyle c) A fiber-rich diet d) Having a formed bowel movement only every other day

Resisting the urge to defecate several times a day The primary function of the colon is the reabsorption of water and electrolytes. Elimination of stool begins with distention of the rectum, which initiates contraction of the rectal muscles and relaxes the closed anal sphincter. If this sphincter is not allowed to relax for defecation and the urge is suppressed, the stool will remain in the colon for longer periods of time, thus becoming more solid as water continues to be reabsorbed. Over time the stool becomes firm and the client may experience constipation.

A patient asks the nurse why the physician ordered the blood test carcinoembryonic antigen (CEA). The nurse answers: a) "It indicates if a cancer is present." b) "It tells the physician what type of cancer is present." c) "It determines functionality of the liver." d) "It detects a protein normally found in the blood."

"It indicates if a cancer is present." The CEA blood test detects the presence of cancer by detecting 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.

The nurse is investigating a patient's complaint of pain in the duodenal area. Where should the nurse perform the assessment? a) Left lower quadrant b) Periumbilical area, followed by the right lower quadrant c) Hypogastrium in the right or left lower quadrant d) Epigastric area and consider possible radiation of pain to the right subscapular region

Epigastric area and consider possible radiation of pain to the right subscapular region 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).

The nurse is teaching a patient scheduled for a colonoscopy. Which of the following should be included as part of the preparation for the procedure? a) Consume at least 3 quarts of water 30 minutes before the test. b) Do not void for at least 30 minutes before the test. c) Spray or gargle with a local anesthetic. d) Follow the dietary and fluid restrictions and bowel preparation procedures.

Follow the dietary and fluid restrictions and bowel preparation procedures. For a patient due to have a colonoscopy, it is essential that the patient follow the dietary and fluid restrictions and bowel preparation procedures. For the patient having an esophagogastroduodenoscopy (EGD), it is necessary for the patient to spray or gargle with a local anesthetic. The patient is not advised to consume 3 quarts of water nor to void before the test. These interventions may be essential for tests that involve ultrasonographic procedures.

A client is diagnosed with megaloblastic anemia caused by vitamin B12 deficiency. The physician begins the client on cyanocobalamin (Betalin-12), 100 mcg I.M. daily. Which substance influences vitamin B12 absorption? a) Histamine b) Hydrochloric acid c) Intrinsic factor d) Liver enzyme

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.

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? a) Instruct the client to have low-residue meals. b) Permit the client to drink only clear liquids. c) Provide saline gargles to the client. d) Allow the client to ingest fat-free meal.

Permit the client to drink only clear liquids. After polyethylene glycol/electrolyte solution is administered, the client should have clear liquids because this ensures watery stools, which are necessary for procedures like a barium enema. Allowing the client to ingest a fat-free meal is used in preparation for oral cholecystography. Instructing the client to have low-residue meals is a pretest procedure for barium enema. A client is offered saline gargles after esophagogastroduodenoscopy.

The nurse is instructing the client who was newly diagnosed with peptic ulcers. Which of the following diagnostic studies would the nurse anticipate reviewing with the client? a) Serum antibodies for H. pylori b) A complete blood count including differential c) Gastric analysis d) A sigmoidoscopy

Serum antibodies for H. pylori Helicobacter pylori, a bacterium, is believed to be responsible for the majority of peptic ulcers. Blood tests are used to determine whether there are antibodies to H. pylori in the blood. A complete blood count with differential can indicate bleeding and infection associated with a bleeding ulcer. A sigmoidoscopy assesses the lower gastrointestinal tract. Gastric analysis is more common in analyzing gastric fluid in determining problems with the secretory activity of the gastric mucosa.

The nurse is providing care to a client who has had a percutaneous liver biopsy. The nurse would monitor the client for which of the following? a) Return of the gag reflex b) Passage of stool c) Intake and output d) Signs and symptoms of bleeding

Signs and symptoms of bleeding A major complication after a liver biopsy is bleeding, so it would be important for the nurse to monitor the client for signs and symptoms of bleeding. Return of the gag reflex would be important for the client who had an esophagogastroduodenoscopy to prevent aspiration. Monitoring the passage of stool would be important for a client who had a barium enema or colonoscopy. Monitoring intake and output is a general measure indicated for any client. It is not specific to a liver biopsy.

While completing an abdominal assessment, the nurse will use which landmark as the upper boundary for auscultating bowel sounds? a) Umbilicus b) Xiphoid process c) Symphysis pubis d) T12 to L3 vertebrae

Xiphoid process Understanding the division of the abdomen into four quadrants or nine regions helps the nurse to complete thorough assessment. The xiphoid process in the epigastric region is the upper boundary for auscultating bowel sounds.

A patient tells the nurse that his stool was colored yellow. The nurse assesses for which of the following? a) Recent foods ingested b) Pilonidal cyst c) Occult blood d) Ingestion of bismuth

Recent foods ingested The nurse should assess for recent foods that the patient 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 teaching the client about the upcoming endoscopic retrograde cholangiopancreatography (ERCP). Although the nurse instructs on several pertinent points of care, which is emphasized? a) The client will change positions frequently throughout the procedure. b) The client will have moderate sedation. c) The client will fast prior to the procedure. d) The client will receive antibiotics before and after the procedure.

The client will change positions frequently throughout the procedure. It is essential that the client understands that the cooperation is essential in changing positions throughout the procedure to prevent injury of the gastrointestinal tract. All of the other options are also correct but do not carry a risk for injury if not completed.

Which of the following would be most important to ensure that a client does not retain any barium after a barium swallow? a) Observing the color of urine. b) Placing any stool passed in a specific preservative. c) Monitoring the stool passage and its color. d) Monitoring the volume of urine.

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.

Which of the following is an age-related change in the esophagus? a) Increased motility b) Weakened gag reflex c) Increased muscle tone d) Increased emptying

Weakened gag reflex Age-related changes that are associated with the esophagus include a weakened gag reflex, decreased motility and emptying, decreased muscle tone, and weakness in the lower esophageal sphincter.

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. The nurse tells the client that products of digestion are absorbed mainly in the: a) large intestine. b) small intestine. c) rectum. d) stomach.

small intestine. The small intestine absorbs products of digestion, completes food digestion, and secretes hormones that help control the secretion of bile, pancreatic juice, and intestinal secretions. The stomach stores, mixes, and liquefies the food bolus into chyme and controls food passage into the duodenum; it doesn't absorb products of digestion. Although the large intestine completes the absorption of water, chloride, and sodium, it plays no part in absorbing food. The rectum is the portion of the large intestine that forms and expels feces from the body; its functions don't include absorption.

A nurse is admitting a severely malnourished and nonverbal client to the hospital. Identify which of the following factors contribute to the nutritional function of the digestive system. Select all that apply. a) Increased secretion of gastrin b) Peristaltic contractions in the stomach c) Absence of intrinsic factor in the gastric mucosa d) Intact dentition of the upper and lower teeth e) Increased saliva production

• Peristaltic contractions in the stomach • Intact dentition of the upper and lower teeth All cells need nutrients to function and prevent malnourishment. Several factors are necessary for proper functioning of the digestive system and nutrient absorption: the ability to chew with proper dentition, proper functioning of esophageal and stomach peristalsis, and adequate secretion of gastric enzymes and regulatory substances. The body needs intrinsic factor secretion for absorption of vitamin B12.

The nurse is a preparing a patient for a barium enema. The nurse should place the patient on which of the following prior to the procedure? a) Soft diet 1 day prior b) Clear liquids day before c) High-fiber diet 1 to 2 days prior d) Nothing by mouth (NPO) 2 days prior

Clear liquids day before The nurse should place the patient on clear liquids the evening before the procedure, a low-residue diet 1 to 2 days before the test, and NPO at midnight in preparation for the barium enema.

When preparing a client for magnetic resonance imaging (MRI) of the abdomen, which statement would indicate the need to notify the physician? a) "I brought earphones to shut out the loud noise." b) "I left all my jewelry and my watch at home." c) "I really don't like to be in small, enclosed spaces." d) "I haven't had anything to eat or drink since midnight last night."

"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 physician 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 nursing instructor tells the class that review of oral hygiene is an important component during assessment of the gastrointestinal system. One of the students questions this statement. Which of the following explanations from the nurse educator is most appropriate? a) "Injury to oral mucosa or tooth decay can lead to difficulty in chewing food." b) "Bad breath will encourage ingestion of fatty foods to mask odor." c) "Mouth sores are caused by bacteria that can thin the villi of the small intestine." d) "Decaying teeth secrete toxins that decrease the absorption of nutrients."

"Injury to oral mucosa or tooth decay can lead to difficulty in chewing food." Poor oral hygiene can result in injury to the oral mucosa, lip, or palate; tooth decay; or loss of teeth. Such problems may lead to disruption in the digestive system. The ability to chew food or even swallow may be hindered.

A nurse assesses the abdomen of a newly admitted client. Which finding would necessitate further investigation? a) Flat appearance below the umbilicus b) Striae of lateral abdomen c) Rounded contour d) Asymmetrical upper quadrants

Asymmetrical upper quadrants The client lies supine with knees flexed for the abdominal assessment. Upon inspection the nurse notes any skin changes, nodules, lesions, inflammation, or striae. Lesions are of particular importance and require further investigation, as do irregular contours or asymmetry of the abdomen.

When assisting with preparing a client scheduled for a barium swallow, which of the following would be appropriate to include? a) Avoid the intake of red meat before the procedure. b) Avoid smoking for at least 12 to 24 hours before the procedure. c) Take vitamin K before the procedure. d) Take three cleansing enemas before the procedure.

Avoid smoking for at least 12 to 24 hours before the procedure. The nurse should instruct the client to avoid smoking for at least a day before the procedure of barium swallow because smoking stimulates gastric motility. The client is advised to take vitamin K before a liver biopsy and instructed to take three cleansing enemas before a barium enema. Instruction to avoid red meat would be appropriate for a client who is having a Hemoccult test.

Which of the following is considered the gold standard for the diagnosis of liver disease? a) Cholecystography b) Paracentesis c) Ultrasonography d) Biopsy

Biopsy Liver biopsy is considered the gold standard for the diagnosis of liver disease. Paracentesis is the removal of fluid (ascites) from the peritoneal cavity through a puncture or a small surgical incision through the abdominal wall under sterile conditions. Cholecystography and ultrasonography may be used to detect gallstones.

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? a) Infection b) Rectal fissure c) Bowel perforation d) Colonic polyp

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).

A nurse is providing postprocedure instructions for a client who had an esophagogastroduodenoscopy. The nurse should perform which action? a) Tell the client to call back in the morning so she can give him instructions over the phone. b) Review the instructions with the person accompanying the client home. c) Give instructions to the client immediately before discharge. d) Tell the client there aren't specific instructions for after the procedure.

Review the instructions with the person accompanying the client home. A client who undergoes esophagogastroduodenoscopy receives sedation during the procedure, and his memory becomes impaired. Clients tend not to remember instructions provided after the procedure. The nurse's best course of action is to give the instructions to the person who is accompanying the client home. It isn't appropriate for the nurse to tell the client to call back in the morning for instructions. The client needs to be aware at discharge of potential complications and signs and symptoms to report to the physician.

The nurse has been directed to position a patient for an examination of the abdomen. What position should the nurse place the patient in for the examination? a) Reverse Trendelenburg position to facilitate the natural propulsion of intestinal contents b) Supine position with the knees flexed to relax the abdominal muscles c) Prone position with pillows positioned to alleviate pressure on the abdomen d) Semi-Fowler's position with the left leg bent to minimize pressure on the abdomen

Supine position with the knees flexed to relax the abdominal muscles The patient lies supine with knees flexed slightly for inspection, auscultation, percussion, and palpation of the abdomen.

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? a) The client may eat a light meal before either test. b) Both tests need to be done before breakfast. c) The upper GI should be scheduled before the ultrasonography. d) The ultrasonography should be scheduled before the GI procedure.

The ultrasonography should be scheduled before the GI procedure. Both an upper GI procedure with barium ingestion and an ultrasonography may be completed on the same day. The ultrasonography test should be completed first, because the barium solution could interfere with the transmission of the sound waves. The ultrasonography test uses sound waves that are passed into internal body structures, and the echoes are recorded as they strike tissues. Fluid in the abdomen prevents transmission of ultrasound.