Ch. 43 Disorders of the Exocrine Pancreatic and Hepatobiliary System, Ch. 42 Disorders of Upper and Lower Gastrointestinal Systems
A client is diagnosed with a duodenal ulcer. Which is the sequence of events in the pathophysiological process in the development of peptic ulcer disease?
1. Helicobacter pylori infection 2. Imbalance of hydrochloric acid and pepsinogen 3. Mucosal erosion 4. Mucosal ulceration
The nurse is teaching a client about esophageal diverticular clinical manifestations. Which clinical manifestation should the nurse include when teaching a client about esophageal diverticula? (Select all that apply.)
A. Heartburn C. Dysphagia E. Gurgling when swallowing Esophageal diverticula can cause dysphagia, heartburn, and a gurgling sound when swallowing.
Which laboratory or diagnostic test should the nurse anticipate being ordered for a client with suspected pancreatic cancer? (Select all that apply.)
A. Magnetic resonance cholangiopancreatography (MRCP) B. Percutaneous fine-needle biopsy E. Alkaline phosphatase levels
The nurse is monitoring a client with cholelithiasis for complications related to cholestatic hepatitis. Which laboratory value should the nurse monitor?
B. Alkaline phosphatase An increase in alkaline phosphatase levels could indicate cholestatic hepatitis in clients with cholelithiasis.
Which clinical manifestation is associated with cancer of the top part of the stomach? (Select all that apply.)
A. Abdominal pain B. Nausea C. Dysphagia E. Feeling of fullness after a small meal Signs and symptoms of stomach cancer include nausea, dysphagia, abdominal pain, and early satiety with a small meal.
The nurse is caring for a client with gastroesophageal reflux disease (GERD). Which time of day should the nurse expect the client to have symptoms?
A. After a meal Symptoms of GERD can occur at any time of day but are most likely to follow a meal.
A client has intense right upper quadrant abdominal pain, jaundice, weight loss, and an elevated serum CA 19-9. Which condition does the nurse suspect?
A. Bile duct cancer The CA 19-9 radioimmunoassay (RIA) is a simple blood test that measures the level of tumor-associated antigens found in the blood. Antigens are substances that cause the immune system to make a specific immune response. CA 19-9 antigens are foreign substances released by pancreatic tumor cells. Late symptoms of bile duct cancer include RUQ pain, abdominal pain, jaundice, weight loss, and a palpable gallbladder. Early diagnosis improves the outcome. Serum CA 19-9 will often be elevated in clients with bile duct cancer and other cancers, so a definitive diagnosis must be made by a more invasive method to directly obtain cells.
A client has peptic ulcer disease (PUD). Which manifestation indicates a flare-up?
A. Epigastric pain Epigastric pain is the most common symptom of both gastric and duodenal ulcers. It is characterized by a gnawing or burning sensation and occurs after meals—classically shortly after meals with gastric ulcer and 2 to 3 hours afterward with duodenal ulcers.
A client experiencing gurgling with swallowing is prescribed continuous dynamic fluoroscopy. Which disorder is being investigated in this client?
A. Esophageal diverticulum Continuous dynamic fluoroscopy is the diagnostic test of choice to diagnose esophageal diverticula that has the symptom of gurgling when swallowing.
The nurse is teaching a class about common risk factors of chronic pancreatitis. Which should the nurse include? (Select all that apply.)
A. Gender B. Ethnicity D. Cystic fibrosis E. Excessive alcohol intake Common risk factors for chronic pancreatitis include gender, ethnicity, cystic fibrosis, and excessive alcohol intake.
Which factor can cause a small-bowel obstruction (SBO)?
A. Neoplasm Seventy-five percent of SBOs are due to adhesions. Adhesions are fibrous bands (scar tissue) that form between tissues and organs and commonly occur after abdominal surgery. Other common causes are tumors, hernias, and intrinsic defects. The mnemonic HANG IV may be used to recall the causes of SBO: hernia, adhesions, neoplasm/tumor, gallstone ileus, intussusception, and volvulus.
A client is diagnosed with a hiatal hernia. Which should the nurse expect when assessing this client? (Select all that apply.)
A. Regurgitation of food or liquids into the mouth B. Chest or abdominal pain E. Normal stool
Which clinical manifestation should the nurse expect to find on assessment of a client with chronic pancreatitis?
A. Severe pain in the mid-abdomen radiating in a band-like fashion to the mid-back Chronic pancreatitis can present with intermittent attacks of severe pain, often in the mid-abdomen or left upper abdomen, and occasionally radiating in a band-like fashion or localized to the mid-back. The pain may occur either after meals or independently of meals, but it is not fleeting or transient and tends to last for at least several hours.
The nurse teaches lifestyle modifications to a client with gastroesophageal reflux disease (GERD). Which statement by the client indicates understanding?
A. "I will avoid acidic foods."
The nurse is teaching a client with colon cancer about modifiable risks factors. Which statement by the client indicates that teaching has been effective?
A. "I'll stop smoking." Some of the cancer-causing substances associated with smoking may be swallowed, increasing the risk of colorectal cancer, so the client's statement about stopping smoking indicates that teaching has been effective.
Which client should the nurse identify as being at risk for the development of esophageal diverticula?
A. 56-year-old man Esophageal diverticula is an acquired, non-gender-specific condition that usually affects middle-aged and older adults.
The nurse recognizes that 10% of acute pancreatitis caused by etiologies other than gallstones and alcohol consumption are related to which factor? (Select all that apply.)
A. Post-cardiac bypass B. Trauma C. Medications E. Hypercalcemia Etiology of acute pancreatitis is most often associated with gallstones and alcohol consumption. Other causes include medications, hypercalcemia, post-ERCP, trauma, and post-cardiac bypass.
A client has symptoms consistent with cholecystitis. The nurse anticipates that diagnostic tests will show that which area affected by a stone is causing the client's condition?
C. Cystic duct
Which manifestation should the nurse expect to assess in a client with a small-bowel obstruction (SBO)? (Select all that apply.)
B. Abdominal distention C. Pain D. Nausea E. Vomiting The classic signs and symptoms of SBO are abdominal pain, nausea, vomiting, and abdominal distention. Clients report the inability to satisfactorily pass gas or stool. On physical examination, clients with SBO demonstrate hyperactive, high-pitched bowel sounds ("rushes and tinkles"); an absence of bowel sounds is noted with an ileus.
A client has a history of Crohn disease (CD). Which manifestation is most likely related to this condition? (Select all that apply.)
B. Abdominal pain C. Weight loss D. Diarrhea E. Intestinal strictures General symptoms associated with Crohn disease (CD) include fever, loss of appetite, weight loss, fatigue, and night sweats. Specific symptoms of CD include nausea, vomiting, and diarrhea with or without blood. Clients with CD also experience abdominal pain and pain with defecation due to anorectal fissures.
A client has right upper quadrant pain, fever, dark-colored urine, jaundice, clay-colored stools and an increased bilirubin level. Which diagnosis should the nurse expect for this client?
B. Cholangitis Clients with cholangitis present with symptoms similar to those of cholelithiasis and acute cholelithiasis. These symptoms include RUQ pain, fever, jaundice, abdominal tenderness, and pruritis. As a result of elevated bilirubin, the client will have dark-colored urine and clay-colored stools. The client with advanced cholangitis will have clinical signs consistent with sepsis, such as hypotension and changes in mental status.
The nurse is caring for a client with peptic ulcer disease. Which location should the nurse expect the client to report pain?
B. Epigastric Peptic ulcers may cause epigastric pain.
Which factor should the nurse anticipate finding when reviewing the medical history of a client diagnosed with acute pancreatitis? (Select all that apply.)
B. Gallstones C. Taking acetaminophen D. Viral infection The most common risk factors for acute pancreatitis include gallstones, pregnancy, drugs (e.g., acetaminophen or thiazide diuretics), heavy alcohol intake, viral infection, and genetic predisposition.
The nurse is assessing a client who presents with symptoms of acute pancreatitis. Which risk factor should the nurse expect to find in the client's history?
B. Heavy alcohol intake The most common risk factors for acute pancreatitis are heavy alcohol intake, gall bladder attacks, gallstones, and a genetic predisposition. Drugs, such as antibiotics and steroids, do not affect the pancreas.
Which factor should the nurse providing care for a client with liver cancer anticipate finding on assessment? (Select all that apply.)
B. Hepatomegaly D. White, chalky stools E. Unintentional weight loss Clinical manifestations of liver cancer include hepatomegaly (enlarged liver); white, chalky stools; and unintentional weight loss
The nurse providing care for a client with suspected pancreatitis should monitor which laboratory value for signs of additional complications?
B. Serum amylase and lipase levels Serum amylase and lipase levels are increased due to the release of enzymes from the pancreas as a result of inflammation.
The nurse is reviewing information about colon cancer with a new nurse. Which statement by the nurse indicates that further teaching is required?
B. "Most colorectal cancers do not develop from polyps." Most colorectal cancers develop from polyps. Removal of colon polyps can help prevent colorectal cancer. Colon polyps and early cancer may have no early signs or symptoms. Therefore, regular colorectal cancer screening is important.
Which statement by the nurse is true about acute pancreatitis? (Select all that apply.)
B. "Protein plugs from prolonged alcohol use may activate enzymatic processes." D. "Early trypsin activation by cathepsin B leads to pancreatic autodigestion." E. "Digestive enzymes are prematurely activated within the acinar cells."
The nurse recognizes that a multiparous 58-year-old woman with a history of estrogen replacement therapy is at increased risk for which health condition?
C. Cholelithiasis Risk factors for cholelithiasis specific to women include multiparous, users of estrogen replacement therapy, oral contraceptives, and the Five Fs: female, fair, fat, fertile, and forty. Other risk factors include a sedentary lifestyle, diabetes mellitus, regional enteritis, and having family members who have had cholelithiasis.
A 5-week-old infant is vomiting 30-60 minutes after feedings and exhibiting persistent hunger. Which health problem should the nurse suspect this infant is experiencing?
C. Hypertrophic pyloric stenosis The classic manifestations of infantile hypertrophic pyloric stenosis (IHPS) include gradual onset of worsening nonbilious projectile vomiting beginning at 4-6 weeks of age, dehydration or weight loss, and possibly visible peristalsis in the upper abdomen. The baby is hungry after vomiting and eager to feed.
The client reports that which symptom, associated with pancreatic cancer, prompted the initial visit for medical care?
C. Jaundice Symptoms of pancreatic cancer are slow to develop, contributing to the delay in diagnosis and treatment. Vague abdominal discomfort and weight loss are often observed first; however, it is the jaundice from the bile duct obstruction that often causes the individual to initially seek medical attention.
The nurse suspects that a client has acute pancreatitis. Which elevated laboratory result will help confirm this diagnosis? (Select all that apply.)
C. Lipase E. Amylase Acute pancreatitis is initially diagnosed on the basis of abnormal laboratory results. Lipase and amylase are the results that help guide diagnosis, because they are often elevated to 3 times the normal limit.
The nurse providing care for a client with cirrhosis should monitor for which complication? (Select all that apply.)
C. Liver cancer D. Portal hypertension E. Hepatic encephalopathy Cirrhosis is the extensive scarring of the liver caused by necrotic injury or a chronic reaction to inflammation over a prolonged period of time. Cirrhosis can lead to liver cancer, portal hypertension, and liver failure, which in turn can lead to hepatic encephalopathy.
Which question should the nurse ask the client when assessing risk factors for pancreatic cancer?
C. "Do you have a history of chronic pancreatitis?" A history of chronic pancreatitis increases the client's risk for pancreatic cancer by 26%.
Which is the least invasive treatment for esophageal perforation?
D. Diversion and delayed repair
While assessing a client, the nurse observes the Cullen sign. Which medical condition should the nurse suspect?
D. Hemorrhagic pancreatitis Hemorrhagic pancreatitis causes bruising and edema to the subcutaneous layer surrounding the umbilicus, known as the Cullen sign.
The nurse is caring for a client with ulcerative colitis. Which treatment should the nurse anticipate for this client?
D. Immunosuppressants Immunosuppressants are part of the medical management of the client with ulcerative colitis.
The nurse is teaching a class about the etiology of cholecystitis. Which information should the nurse include?
D. The retention of bile may cause chemical irritation of the gallbladder wall. Cholecystitis refers to inflammation of the gallbladder and occurs when the tissues of the gallbladder are irritated. Contributing factors include gallstones obstructing the cystic duct, chemical irritation by bile, and bacterial inflammation.
The nurse reviews actions to prevent colorectal cancer to a client with no risk factors. Which client statement should indicate that teaching has been effective?
D. "Screening may include testing for blood that cannot be seen." Screening for colorectal cancer includes testing for occult blood, which is blood that is not visible to the naked eye. Men and women are both to begin screening at age 50 if there are no risk factors. Those with risk factors should begin screening before age 50. There are genetic tests available for colorectal cancer screening.
A client complaining of heartburn and dysphagia is diagnosed with eosinophilic esophagitis. Which response should the nurse make when asked the reason for the inflammation?
D. "Your esophagus is inflamed by an allergic response." Eosinophilic esophagitis is an allergic reaction that results in inflammation of the esophagus. Clients who are immunosuppressed are at risk for infectious esophagitis.
