Chapter 21: Nursing Assessment: Digestive, Gastrointestinal, and Metabolic Function

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? A. Liver B. Pancreas C. Stomach D. Gallbladder

B. 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.

A nurse practitioner examined a patient who had been diagnosed with hepatomegaly (enlarged liver) due to accumulated fat deposits in the liver, subsequent to obesity. The nurse would palpate the liver by placing: A. One hand under the right lower rib cage and press downward with the other hand. B. Both hands over the left lower quadrant and applying gentle pressure. C. The left hand at the level of the umbilicus and the right hand at the base of the diaphragm. D. One hand under the left lower rib cage and pressing upward toward the midline.

A. One hand under the right lower rib cage and press downward with the other hand. Refer to Figure 21-8 in the text for an illustration of this procedure. The liver is located under the diaphragm on the right side of the abdominal cavity, extending slightly left from the midline.

What would the nurse recognize as preventing a client from being able to take a fecal occult blood test (FOBT)? A. The client has hemorrhoidal bleeding B. The client took an ibuprofen tablet this morning C. The client regularly takes aspirin D. The client had a hamburger for dinner the night before

A. The client has hemorrhoidal bleeding FOBT should not be performed when there is hemorrhoidal bleeding. In the past, clients were taught to avoid aspirin, red meats, nonsteroidal anti-inflammatory agents, and horseradish for 72 hours prior to the examination. However, these restrictions are no longer advised as the actual effects on testing have not been established.

While completing an abdominal assessment, the nurse will use which landmark as the upper boundary for auscultating bowel sounds? A. Symphysis pubis B. Xiphoid process C. Umbilicus D. T12 to L3 vertebrae

B. 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 client tells the nurse that the stool was colored yellow. The nurse assesses the client for A. occult blood. B. pilonidal cyst. C. recent foods ingested. D. ingestion of bismuth.

C. 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 is assessing a client's rectum, perianal area, and anus. During assessment the nurse notes an anal fissure. Which intervention would the nurse implement? Select all that apply. A. Topical analgesics B. Hemorrhoid cream C. Acetaminophen suppository D. Lateral body positioning E. Sitz bath

A. Topical analgesics D. Lateral body positioning E. Sitz bath The final part of the examination is evaluation of the terminal portions of the GI tract, the rectum, perianal region, and anus. Sitz baths, topical and oral analgesics, and side-lying position would all be implemented to increase comfort. Hemorrhoid cream and acetaminphen suppositories would not be appropriate treatment. The client has an anal fissure, not hemorrhoids, and a suppository would not facilitate healing.

The nurse is caring for a patient who is scheduled for a gastroscopy. What preparation is needed for a gastroscopy? A. Spray or gargle the back of the throat with local anesthetic. B. Have the patient lie in a dorsal position. C. Insert a nasogastric tube. D. Administer a micro Fleet enema.

A. Spray or gargle the back of the throat with local anesthetic. Preparation for a gastroscopy includes spraying or gargling with a local anesthetic. A nasogastric tube or a micro Fleet enema is not required for this procedure. The patient should be positioned in a side-lying position in case of emesis.

While palpating a client's right upper quadrant (RUQ), the nurse would expect to find which structure? A. Spleen B. Liver C. Appendix D. Sigmoid colon

B. 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 comes into the emergency department with reports of abdominal pain. What should the nurse ask first? A. Medications taken in the last 8 hours B. Concerns about impending hospital stay C. Family history of ruptured appendix D. Characteristics and duration of pain

D. Characteristics and duration of pain A focused abdominal assessment begins with a complete history. The nurse must obtain information about abdominal pain. Pain can be a major symptom of gastrointestinal disease. The character, duration, pattern, frequency, location, distribution, and timing of the pain vary but require investigation immediately.

A client is scheduled for a urea breath test to detect for Helicobacter pylori as a reason for gastric distress. Which instruction will the nurse provide to the client to prepare for this test? Select all that apply. A. Do not use antibiotics for 1 month. B. Do not take proton pump inhibitors for 2 weeks. C. Take cimetidine 24 hours before the test. D. Take famotidine for 1 week before the test. E. Avoid bismuth subsalicylate for 1 month

A. Do not use antibiotics for 1 month. B. Do not take proton pump inhibitors for 2 weeks. E. Avoid bismuth subsalicylate for 1 month Urea breath tests detect the presence of Helicobacter pylori, the bacteria that can live in the mucosal lining of the stomach and cause peptic ulcer disease. Prior to urea breath testing, the client should be instructed to avoid antibiotics and bismuth subsalicylate for 1 month. Proton pump inhibitors should be avoided for 2 weeks. Cimetidine and famotidine should be avoided for 24 hours before the test.

A client reports a history of bleeding hemorrhoids to the nurse. Which observation supports the client's statement? A. Black tarry stool B. Blood streaks on stool C. Dark red stool D. Hard, dry stool

B. 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.

A 56-year-old presented to her nurse practitioner because she had been experiencing unprecedented constipation and the passage of pencil-like stools despite her high fluid and fiber intake. The nurse recognized the need to assess the patient for colorectal cancer and ordered diagnostic evaluations. What component of the patient's blood work would be most indicative of the presence of cancer? A. Carcinoembryonic antigen (CEA) B. Ceruloplasmin C. C-reactive protein (CRP) D. Coproporphyrin

A. Carcinoembryonic antigen (CEA) CEA is a protein that is normally not detected in the blood of a healthy person; therefore, when detected it indicates that cancer is present. The other cited blood analyses are not associated with cancer.

Which enzyme aids in the digestion of protein? A. trypsin B. ptyalin C. lipase D. steapsin

A. trypsin Trypsin, amylase, and lipase are digestive enzymes secreted by the pancreas. Trypsin aids in digesting protein; amylase aids in digesting starch; and lipase aids in digesting fats. Digestive enzymes secreted by the pancreas include trypsin, which aids in digesting protein. Amylase is an enzyme that aids in the digestion of starch. Steapsin digests fats.

A patient has come into the radiology department to undergo testing for possible polyps. What diagnostic test may be done to diagnose this type of lesion? A. Gastroscopy B. Barium enema C. Gastric analysis D. Barium swallow

B. Barium enema The purpose of the barium enema is to detect the presence of polyps, tumors, and other lesions of the large intestine and to demonstrate any abnormal anatomy or malfunction of the bowel.

The nurse is caring for a client scheduled for a diagnostic laparoscopy. The client has questions regarding the use of anesthetic during the procedure. Which response will the nurse provide the client? A. "What type of anesthetic have you used in the past?" B. "The use of anesthetic will be discussed closer to surgery." C. "Let me have the primary health care provider explain this again to you." D. "Are you worried about pain during the procedure?"

C. "Let me have the primary health care provider explain this again to you." To ensure the client is aware of the details of the procedure it would be imperative that the surgeon speak to the client. It is out of the scope of practice for the nurse to discuss the details of the surgical procedure if the client is confused about it. If the client is asking any question it is important to give the best answer as soon as possible. It is clear the client wants to discuss the procedure so the nurse would not need to ask any further open ended questions to gather data.

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 patient? A. The client should be monitored for cramping or abdominal distention. B. The client should be monitored for any breathing-related disorder or discomforts. C. The client should not be given any food and fluids until the gag reflex returns. D. The client's fluid output should be measured for at least 24 hours after the procedure.

C. The client should not be given any food and fluids until the gag reflex returns.

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? A. Computer tomography B. Small bowel series C. Upper GI series D. Colonoscopy

D. 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.

The nurse is caring for a client recovering from a colonoscopy. Which assessment finding will the nurse expect in the client after the procedure? A. Fever B. Rectal bleeding C. Abdominal cramps D. Abdominal distention

C. Abdominal cramps After the procedure, clients are maintained on bed rest until fully alert. Some clients have abdominal cramps caused by increased peristalsis stimulated by the air insufflated into the bowel during the procedure. Fever, rectal bleeding, and abdominal distention are symptoms of bowel perforation and should be immediately reported to the health care provider.

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? A. Dyspepsia B. Abdominal bloating C. Diffuse pain D. Constipation

A. 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).

The nurse is conducting an abdominal assessment of a patient who is postoperative day 1 following an open cholecystectomy. During auscultation of the patient's abdomen, the nurse has noted that clicks and gurgles are audible approximately every 10 seconds. How should the nurse follow up this assessment finding? A. The nurse should contact the patient's care provider. B. The nurse should document normoactive bowel sounds. C. The nurse should administer a p.r.n. stool softener. D. The nurse should assess the patient for paralytic ileus.

B. The nurse should document normoactive bowel sounds. The frequency and character of bowel sounds are usually heard as clicks and gurgles that occur irregularly and range from 5 to 35 per minute. Bowel sounds occurring every 10 seconds would be an expected assessment finding that does not indicate the need for intervention.

A patient is scheduled for a fiberoptic colonoscopy. What does the nurse know that fiberoptic colonoscopy is most frequently used to diagnose? A. Cancer B. Occult bleeding C. Bowel disease of unknown origin D. Inflammatory bowel disease

A. Cancer This procedure is used commonly as a diagnostic aid and screening device. It is most frequently used for cancer screening and for surveillance in patients with previous colon cancer or polyps. In addition, tissue biopsies can be obtained as needed, and polyps can be removed and evaluated. Other uses of colonoscopy include the evaluation of patients with diarrhea of unknown cause, occult bleeding, or anemia; further study of abnormalities detected on barium enema; and diagnosis, clarification, and determination of the extent of inflammatory or other bowel disease.

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? A. Monitoring the volume of urine. B. Monitoring the stool passage and its color. C. Observing the color of urine. D. Placing any stool passed in a specific preservative.

B. 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.

The nurse is reviewing the results of a Hemoccult test with the client. Which question asked by the nurse is important in screening for the potential of a false-positive result. Select all that apply. A. "When was the last time that you included red meat in your diet?" B. "Do you take an iron supplement on a daily basis?" C. "Can you tell me the amount of alcohol that you drink on an average week?" D. "Does your diet include a moderate amount of vitamin C?" E. "Are you prescribed regular strength aspirin daily?

A. "When was the last time that you included red meat in your diet?" C. "Can you tell me the amount of alcohol that you drink on an average week?" E. "Are you prescribed regular strength aspirin daily? When obtaining a positive Hemoccult test, the client needs to be screened for a false-positive test result. Substances that may cause a false-positive include red meat, aspirin, and excessive alcohol. Screening for the frequency and amount of these are important. False-negative results are screened in individuals who ingest ascorbic acid and iron supplements.

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? A. History of allergies B. Current list of prescribed medications C. Presence of a cochlear implant D. Last use of an oral laxative

A. History of allergies A CT scan provides cross-sectional images of abdominal organs and structures. A CT scan may be performed with or without oral or intravenous (IV) contrast, but the enhancement of the study is greater with the use of a contrast agent. A common risk from IV contrast agents is allergic reactions; therefore, the client must be screened for this risk. Any allergies to contrast agents, iodine, or shellfish must be determined before administration of a contrast agent. Clients allergic to the contrast agent may be premedicated with a corticosteroid and antihistamine. Therefore, a history of allergies must be completed before the test. Assessing for the presence of a cochlear implant is recommended before magnetic resonance imaging (MRI), but not before a CT scan. The last use of an oral laxative and current list of prescribed medications are not required before a CT scan of the abdomen.

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? A. Related to the presence of bacteria at the surgical site B. Related to the presence of a nasogastric (NG) tube postoperatively C. Related to malnutrition secondary to bowel resection with anastomosis D. Related to major surgery required by bowel resection

A. Related to the presence of bacteria at the surgical site The nurse should add "Related to the presence of bacteria at the surgical site" to the diagnosis of Risk for infection. The large intestine normally contains bacteria because its alkaline environment permits growth of organisms that putrefy and break down remaining proteins and indigestible residue. These organisms include Escherichia coli, Aerobacter aerogenes, Clostridium perfringens, and Lactobacillus. Although bowel resection with anastomosis is considered major surgery, it poses no greater risk of infection than any other type of major surgery. Malnutrition seldom follows bowel resection with anastomosis because nutritional absorption (except for some water, sodium, and chloride) is completed in the small intestine. An NG tube is placed through a natural opening, not a wound, and therefore doesn't increase the client's risk of infection.

The nurse is providing instructions to a client scheduled for a gastroscopy. What should the nurse be sure to include in the instructions? Select all that apply. A. The client must fast for 8 hours before the examination. B. The throat will be sprayed with a local anesthetic. C. After gastroscopy, the client cannot eat or drink until the gag reflex returns (1 to 2 hours). D. The health care provider will be able to determine if there is a presence of bowel disease. E. The client must have bowel cleansing prior to the proced

A. The client must fast for 8 hours before the examination. B. The throat will be sprayed with a local anesthetic. C. After gastroscopy, the client cannot eat or drink until the gag reflex returns (1 to 2 hours). The client should be NPO for 8 hours prior to the examination. Before the introduction of the endoscope, the client is given a local anesthetic gargle or spray. Midazolam (Versed), a sedative that provides moderate sedation with loss of the gag reflex and relieves anxiety during the procedure, is administered. Temporary loss of the gag reflex is expected; after the client's gag reflex has returned, lozenges, saline gargle, and oral analgesic agents may be offered to relieve minor throat discomfort.

A patient with gallbladder disease was being treated for blockage of the common bile duct due to a large gallstone. The nurse recognizes which of the following as an abnormal laboratory result? A. Total bilirubin level of 1.5 mg/dL B. Alkaline phosphatase level of 60 mg/dL C. Albumin level of 4.2 g/dL D. Aspirate aminotransferase level of 25 U/

A. Total bilirubin level of 1.5 mg/dL Gallstones form when the amount of bilirubin or cholesterol is high. As the stones mix with bile, they block the secretion of bile from the gallbladder. The normal total bilirubin level is 0 to 0.9 mg/dL. The other results are within normal ranges.

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

B. "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.

The liver performs numerous functions that contribute to homeostasis, including the synthesis of bile. How is bile utilized in the processes of digestion and absorption? A. Bile is stored in the gallbladder until it is needed for carbohydrate metabolism. B. Bile is produced in the liver but released by the gallbladder when needed for digesting fats. C. Bile production increases when an individual's fat intake is reduced over several days. D. Bile is produced in the liver in response to meals that are high in protein.

B. Bile is produced in the liver but released by the gallbladder when needed for digesting fats. Bile, which is manufactured by the liver, plays a major role in the digestion and absorption of fats in the gastrointestinal tract. It is stored temporarily in the gallbladder until it is needed for digestion, at which time the gallbladder empties and bile enters the intestine.

An adult patient is scheduled for an upper GI series that will use a barium swallow. What teaching should the nurse include when the patient has completed the test? A. This series includes analysis of gastric secretions. B. Fluids must be increased to facilitate the evacuation of the stool. C. Stool will be yellow for the first 24 hours postprocedure. D. The barium may cause diarrhea.

B. Fluids must be increased to facilitate the evacuation of the stool. Postprocedural patient education includes information about increasing fluid intake, evaluating bowel movements for evacuation of barium, and noting increased number of bowel movements. This is done because barium, due to its high osmolarity, may draw fluid into the bowel, thus increasing the intraluminal contents and resulting in greater output. The barium series does not analyze gastric secretions.

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? A. Ileocecal valve B. Pyloric sphincter C. Hypopharyngeal sphincter D. Cardiac sphincter

B. 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 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 have moderate sedation. B. The client will need to be repositioned frequently throughout the procedure in order to prevent injury. C. The client will receive antibiotics before and after the procedure. D. The client will fast prior to the procedure.

B. The client will need to be repositioned frequently throughout the procedure in order to prevent injury. It is essential that the client understands that 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.

A client with diabetes begins to have digestive problems and is told by the physician that they are a complication of the diabetes. Which of the following explanations from the nurse is most accurate? A. Elevated glucose levels cause bacteria overgrowth in the large intestine. B. The pancreas secretes digestive enzymes. C. Insulin has an adverse effect of constipation. D. The nerve fibers of the intestinal lining are experiencing neuropathy

B. The pancreas secretes digestive enzymes. While the pancreas has the well-known function of secreting insulin, it also secretes digestive enzymes. These enzymes include trypsin, amylase, and lipase. If the secretion of these enzymes are affected by a diseased pancreas as found with diabetes, the digestive functioning may be impaired.

A 50-year-old male patient with a history of cholelithiasis (gallstones) has presented to the emergency department (ED) with severe upper right quadrant pain. The ED nurse should anticipate the need to facilitate which of the following diagnostic tests? A. Endoscopic retrograde cholangiopancreatography (ERCP) B. Barium swallow C. Abdominal ultrasonography D. Computed tomography (CT) of the abdomen

C. Abdominal ultrasonography Ultrasonography is the diagnostic procedure of choice for gallbladder disease, because it is rapid and accurate and can be used in patients with liver dysfunction and jaundice. ERCP is also relevant, and potentially curative, but ultrasound is more rapidly performed. A barium swallow is not a relevant test, and CT is unlikely to precede ultrasonography.

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. Take vitamin K before the procedure. C. Avoid smoking for at least 12 to 24 hours before the procedure. D. Take three cleansing enemas before the procedure.

C. 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.

The nurse is working on a general medical unit. A client is scheduled for an upper gastrointestinal series. Upon returning to the nursing unit, what does the nurse identify as the client goal? A. Recovery from the general anesthesia B. Ambulates independently C. Increase in the amount of fluids D. Decrease in nausea and vomiting

C. Increase in the amount of fluids The client, returning from an upper gastrointestinal series, needs to increase fluids in an effort to eliminate the barium from the body through a bowel movement. General anesthesia is not used. The client typically does not have nausea and vomiting following the procedure. If the client is able to ambulate independently prior to the procedure, the client will be able to ambulate independently following .

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. A. The scanner is soundless. B. Hold all doses of medications the morning of the test. C. Remove all jewelry and metal from the body. D. Expect the test to take 60 to 90 minutes to complete. E. Take nothing by mouth for 6 to 8 hours before the test.

C. Remove all jewelry and metal from the body. D. Expect the test to take 60 to 90 minutes to complete. E. Take nothing by mouth for 6 to 8 hours before the test. Magnetic resonance imaging (MRI) is used in gastroenterology to supplement ultrasonography and computed tomography (CT). This noninvasive technique uses magnetic fields and radio waves to produce images of the area being studied. The client should be instructed to remove all jewelry and metal from the body. The client should be instructed to take nothing by mouth for 6 to 8 hours before the test, except certain critical medications such as heart medications, which can be given the morning of the test. The client should expect the test to take 1 hour to 1.5 hours to complete. The scanner will make knocking sounds during the test. Oral laxatives are not needed the morning of the test.

The nurse is preparing to examine the abdomen of a client who reports a change in bowel pattern. The nurse would place the client in which position? A. Knee-chest B. Left Sim's lateral C. Supine with knees flexed D. Lithotomy

C. Supine with knees flexed When examining the abdomen, the client lies supine with knees flexed. This position assists in relaxing the abdominal muscles. The lithotomy position commonly is used for a female pelvic examination and to examine the rectum. The knee-chest position can be used for a variety of examinations, most commonly the anus and rectum. The left Sim's lateral position may be used to assess the rectum or vagina and to administer an enema.

Which nursing instruction is correct to provide the client following a barium enema? A. An enema will be used to clear the bowel. B. The client will maintain a low residue diet. C. The stools may be a white or clay colored. D. Sips of fluid may be increased if tolerated.

C. The stools may be a white or clay colored. It is important to instruct the client that it is normal to have a white- or clay-colored stool following the barium enema. The client should report the color of the stool to the nurse. A progression of clay colored stools to brown-colored stools should be noted. The client is prescribed a low-residue diet before the procedure. An increased fluid intake is offered to eliminate the barium from the bowel. The client is encouraged to move the bowel independently.

An elderly patient has developed Clostridium difficile-related diarrhea, a problem that has led to dehydration and hypokalemia. The increased peristalsis that characterizes diarrhea has the potential to cause fluid volume deficit and electrolyte deficits because: A. Increased peristalsis diverts energy away from the absorptive activities of the small intestine. B. Increased peristalsis creates increased metabolic demand, which in turn depletes fluid and electrolyte reserves. C. An increase in peristalsis reduces the normal surface area of the villi and microvilli in the colon. D. An increase in peristalsis means that the colon cannot absorb the substances that it normally absorbs.

D. An increase in peristalsis means that the colon cannot absorb the substances that it normally absorbs. Approximately 9 L of fluid is sent through the gastrointestinal tract daily, and all but 100 mL is reabsorbed, thus the nurse is aware that any process or pathology that increases peristalsis will result in decreased fluid, nutrient, and electrolyte reabsorption, resulting in malnutrition, profound dehydration, and electrolyte depletion. The villi and microvilli are not located in the colon.

The nurse is preparing the client for an assessment of the abdomen. What should the nurse complete prior to this assessment? A. Prepare for a prostate examination. B. Dim the lights for privacy. C. Assist the client to a Fowler's position. D. Ask the client to empty the bladder.

D. 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.

Which of the following is the most definitive means of assessing for liver disease? A. Paracentesis B. Cholecystography C. Ultrasonography D. Biopsy

D. Biopsy Liver biopsy is the most effective means of diagnosing liver disease. Guided liver biopsy can be conducted using laparoscopy, the insertion of a fiberoptic endoscope through a small abdominal incision. 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. Ultrasonography may also be used to visualize the liver and diagnose conditions such as liver fibrosis; noninvasive techniques such as this can reduce the need for liver biopsy.

The nurse is investigating a client's report of pain in the duodenal area. Where should the nurse perform the assessment? A. Left lower quadrant B. Hypogastrium in the right or left lower quadrant C. Periumbilical area, followed by the right lower quadrant D. Epigastric area and consider possible radiation of pain to the right subscapular region

D. Epigastric area and consider possible radiation of pain to the right subscapular reg 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 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? A. Administer an over-the-counter antacid tablet. B. Explain that fatty foods can mimic chest pain. C. Call for an immediate electrocardiogram. D. Further investigate the initial complaint

D. Further investigate the initial complaint While fatty foods can cause discomfort similar to chest pain, the nurse must fully assess all the client's symptoms. Investigation of chief complaint begins with a complete history. The underlying cause of pain influences the characteristics, duration, pattern, location, and distribution of pain.

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? A. Hypoactive B. Borborygmi C. Normal D. Hyperactive

D. Hyperactive Bowel sounds are assessed using the diaphragm of the stethoscope for high-pitched and gurgling sounds (Gu, Lim, & Moser, 2010). The frequency and character of the sounds are usually heard as clicks and gurgles that occur irregularly and range from 5 to 35 per minute. The terms normal (sounds heard about every 5 to 20 seconds), hypoactive (one or two sounds in 2 minutes), hyperactive (5 to 6 sounds heard in less than 30 seconds), or absent (no sounds in 3 to 5 minutes) are frequently used in documentation, but these assessments are highly subjective (Li, Wang, & Ma, 2012).

The nurse determines which is a true statement regarding older clients, considering the age-related effects on the gastrointestinal (GI) system? A. They have no awareness of the filling reflex. B. They tend to have higher physiologic reserves to compensate for fluid loss. C. They tend to have increased muscle tone and mass. D. They usually have less control of the rectal sphincter.

D. They usually 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.

The nurse is preparing to assess the abdomen of a client experiencing a gastrointestinal condition. Place in order the actions the nurse will take to complete this assessment. Use all options. Click an option, hold and drag it to the desired position, or click an option to highlight it and move it up or down in the order using the arrows to the left. 1 Auscultate bowel sounds. 2 Palpate for tenderness and masses. 3 Inspect the skin. 4 Position supine. 5 Flex the knees. 6 Percuss abdominal organs.

Position supine. Flex the knees. Inspect the skin. Auscultate bowel sounds. Percuss abdominal organs. Palpate for tenderness and masses. When conducting an abdominal assessment, the client is to be placed in the supine position with the knees flexed. Inspection is performed first, noting skin changes, nodules, lesions, scarring, discolorations, inflammation, bruising, or striae. Auscultation always precedes percussion and palpation because they may alter sounds. Auscultation is used to determine the character, location, and frequency of bowel sounds and to identify vascular sounds. Percussion is used to assess the size and density of the abdominal organs and to detect the presence of air-filled, fluid-filled, or solid masses. The use of light palpation is appropriate for identifying areas of tenderness or muscular resistance, and deep palpation is used to identify masses.

Blood flow to the GI tract is approximately what percentage of the total cardiac output? A. 30% B. 20% C. 40% D. 10%

B. 20% Blood flow to the GI tract is about 20% of the total cardiac output and increases significantly after eating.

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

B. normal. Normal bowel sounds are heard every 5 to 20 seconds. Hypoactive bowel sound is the description given to auscultation of one to two bowel sounds in 2 minutes. Sluggish is not a term a nurse would use to accurately describe bowel sounds. The nurse records that bowel sounds are absent when no sound is heard in 3 to 5 minutes.

Which neuroregulator increase gastric acid secretion? A. norepinephrine B. gastrin C. acetylcholine D. secretin

C. acetylcholine Acetylcholine causes increased gastric acid. Norepinephrine inhibits secretions of the GI tract. Gastrin increases secretion of gastric juice, which is rich in HCL. Secretin in the stomach inhibits gastric secretion somewhat.

The nurse is assessing the abdomen of the client with an undiagnosed disorder. In which sequence would the nurse conduct the abdominal assessment? Use all options. Click an option, hold and drag it to the desired position, or click an option to highlight it and move it up or down in the order using the arrows to the left. Inspection Auscultation Palpation Percussion

Inspection Auscultation Percussion Palpation The nurse is correct to assess the abdomen in a specific order to be able to judge the undisturbed status of the abdominal region. Begin with inspection of the abdomen using the nurse's assessment skills. Next, auscultate the abdomen before percussing and finally palpating.

A client reports a new onset of diarrhea. For which additional symptoms will the nurse assess this client? Select all that apply. A. Vomiting B. Cramping C. Heartburn D. Abdominal pain E. Nausea

A. Vomiting B. Cramping D. Abdominal pain E. Nausea Diarrhea, an abnormal increase in the frequency and liquidity of the stool or in daily stool weight or volume, commonly occurs when the contents move so rapidly through the intestine and colon that there is inadequate time for the GI secretions and oral contents to be absorbed. This physiologic function is typically associated with nausea, vomiting, cramping, or abdominal pain. Heartburn is not a symptom associated with diarrhea.

The nurse is assisting the health care provider with a colonoscopy for a client with rectal bleeding. The health care provider requests the nurse to administer glucagon during the procedure. Why is the nurse administering this medication during the procedure? A. To relieve anxiety during the procedure for moderate sedation. B. relax colonic musculature and reduce spasm. C. To reduce air accumulation in the colon. D. The client is probably hypoglycemic and requires the glucagon

B. relax colonic musculature and reduce spasm. Glucagon may be administered, if needed, to relax the colonic musculature and to reduce spasm during the colonoscopy.

The nurse recognizes which change of the GI system is an age-related change? A. weakened gag reflex B. increased mucus secretion C. increased motility D. hypertrophy of the small intestine

A. 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.

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. duodenum B. cecum C. jejunum D. ileum

A. 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.

What part of the GI tract begins the digestion of food? A. Duodenum B. Mouth C. Stomach D. Esophagus

B. 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.

Which of the following digestive enzymes aids in the digesting of starch? A. Bile B. Amylase C. Lipase D. Trypsin

B. 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.

A focused GI assessment begins with a complete history and physical examination. Identify the quadrant of the abdomen to be palpated or percussed for a patient with pancreatitis. A. Right lower B. Left upper C. Left lower D. Right upper

B. Left upper The pancreas, which is about 6 inches long, is located behind the stomach in the upper left side of the body.

Which procedure is performed to examine and visualize the lumen of the small bowel? A. colonoscopy B. small bowel enteroscopy C. peritoneoscopy D. panendoscopy

B. small bowel enteroscopy Small bowel enteroscopy is the endoscopic examination and visualization of the lumen of the small bowel. Colonoscopy is the examination of the entire large intestine with a flexible fiberoptic colonoscope. Panendoscopy is the examination of both the upper and lower GI tracts. Peritoneoscopy is the examination of GI structures through an endoscope inserted percutaneously through a small incision in the abdominal wall.

A client with a gastrointestinal condition asks why the mouth needs to be examined. Which response will the nurse make? A. "It is a part of the assessment of every client." B. "Your problem is in your mouth and not your abdomen." C. "Changes in the mouth can help explain why your condition is occurring." D. "It is a body part that is least examined."

C. "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.

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

C. duodenal ulcer Clients with duodenal ulcers usually secrete an excess amount of hydrochloric acid. Clients with chronic atrophic gastritis secrete little or no acid. Clients with gastric cancer secrete little or no acid. Clients with pernicious anemia secrete no acid under basal conditions or after stimulation.

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

D. Resume regular diet. The nurse includes resumption of regular diet in the client's discharge instructions as the client is able to resume activities and diet after an endoscopic exam. There is no need to adhere to a clear liquid diet or to increase fluid intake. As sedation is not usually involved for endoscopic examinations, the client does not need to avoid driving.

A male patient's present signs and symptoms are suggestive of an incompetent cardiac sphincter, and he has been scheduled for an upper GI series (barium swallow). What preprocedure teaching should the nurse provide to this patient? A. "Make sure that you don't eat anything after midnight the day before your test." B. "It's important that you take your laxatives as ordered on the day prior to your barium swallow." C. "You'll need to restrict your fluid intake for 24 hours after the test." D. "Make sure to tell your doctor about any allergies to shellfish."

A. "Make sure that you don't eat anything after midnight the day before your test." An upper GI series typically requires fasting from the night prior. Shellfish allergies are not relevant, and bowel preparation is not required. Fluid intake should be increased, not restricted, after the test.

The nurse cares for a client after a gastroscopy for which the client received sedation. The nurse should report which finding to the physician? A. difficulty swallowing B. minor throat pain C. loss of gag reflex D. drowsiness

A. difficulty swallowing The nurse should report difficulty swallowing to the physician as this may be a sign of perforation. Loss of gag reflex, minor throat pain, and drowsiness are expected findings after a gastroscopy for which the client received sedation and therefore there is no need to report to the physician.

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

B. 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.

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

C. "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 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? A. "I will take an over-the-counter enema before the test." B. "I will take medications to reduce gastric acid before the test." C. "I will not eat or drink for 8 to 12 hours before the test." D. "I will ingest a clear liquid diet for 3 days before the test."

C. "I will not eat or drink for 8 to 12 hours before the test." Ultrasonography is a noninvasive diagnostic technique in which high-frequency sound waves are passed into internal body structures, and the ultrasonic echoes are recorded on an oscilloscope as they strike tissues of different densities. It is particularly useful in the detection of an enlarged gallbladder or pancreas, or the presence of gallstones, an enlarged ovary, an ectopic pregnancy, or appendicitis. The client should be instructed to fast for 8 to 12 hours before the test to decrease the amount of gas in the bowel. Enemas are not needed before an abdominal ultrasound. A clear liquid diet is not needed before the test. Medications to reduce gastric acid are not required before the test.

Upon hearing that the small intestine lining has thinned, an elderly client asks, "What can this lead to?" What is the best response by the nurse? A. "It is the aging process." B. "You may frequently have diarrhea." C. "You may frequently experience constipation." D. "At times you may see mucus in your stool."

C. "You may frequently experience constipation." As a person ages, the epithelial cells and villi thin in the small intestine. Implications of this consequence include decreased intestinal motility and transit time, which can lead to constipation. This would lead the nurse to discuss and advise the client on ways to prevent constipation.

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

C. red plaque on undersurface of tongue Red or white plaque located on the undersurface of the tongue can be indicative of oral cancer. A thin, white coating on the dorsum of the tongue and large vallate papillae that form a V on the distal portion of the tongue are normal findings.

The nurse is assisting the physician in a percutaneous liver biopsy. In assisting with positioning, the nurse should assist the client into a: A. high Fowler's position. B. lithotomy position. C. supine position. D. dorsal recumbent position.

C. supine position. The nurse is correct to instruct the client to assume the supine position. Also, the nurse places a rolled towel beneath the right lower ribs.

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? A. "I'll drink full liquids the day before the test." B. "There is no need for special preparation before the test." C. "I'll take a laxative to clear my bowels before the test." D. "I'll avoid eating or drinking anything 6 to 8 hours before the test."

D. "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.

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

D. Positron emission tomography (PET) PET produces images of the body by detecting the radiation emitted from radioactive substances. CT provides cross-sectional images of abdominal organs and structures. MRI uses magnetic fields and radio waves to produce an image of the area being studied. Fibroscopy of the upper GI tract allows direct visualization of the esophageal, gastric, and duodenal mucosa through a lighted endoscope.

A male patient's present signs and symptoms are suggestive of an incompetent cardiac sphincter, and he has been scheduled for an upper GI series (barium swallow). What preprocedure teaching should the nurse provide to this patient? A. "Make sure to tell your doctor about any allergies to shellfish." B. "You'll need to restrict your fluid intake for 24 hours after the test." C. "It's important that you take your laxatives as ordered on the day prior to your barium swallow." D. "Make sure that you don't eat anything after midnight the day before your test."

A. "Make sure to tell your doctor about any allergies to shellfish." An upper GI series typically requires fasting from the night prior. Shellfish allergies are not relevant, and bowel preparation is not required. Fluid intake should be increased, not restricted, after the test.

Which of the following is the primary function of the small intestine? A. Absorption B. Peristalsis C. Digestion D. Secretion

A. Absorption Absorption is the primary function of the small intestine. Digestion occurs in the stomach. Peristalsis occurs in the colon. The duodenum secretes enzymes.

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. Cecum B. Ileum C. Duodenum D. Sigmoid colon

D. 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.

A client is scheduled for a flexible sigmoidoscopy. Which preparation will the nurse instruct the client to complete before the procedure? A. Administer tap water enemas until liquid from rectum is clear. B. Avoid aspirin products a week before the procedure. C. Take oral laxatives for 2 days before the procedure. D. Maintain liquid diet for 3 days before the procedure.

A. Administer tap water enemas until liquid from rectum is clear. The flexible fiberoptic sigmoidoscope permits the colon to be examined up to 40 to 50 cm (16 to 20 inches) from the anus. It has many of the same capabilities as the scopes used for the upper GI study, including the use of still or video images to document findings. This examination requires only limited bowel preparation, including a warm tap water or Fleet enema until returns are clear. Dietary restrictions usually are not necessary. Oral laxatives before the procedure are not needed. There are no medication restrictions before the procedure.

The nurse prepares to administer the lavage solution to a client having a colonoscopy completed. The nurse stops and notifies the physician when noting that the client has which condition? A. inflammatory bowel disease B. chronic obstructive pulmonary disease C. pulmonary hypertension D. congestive heart failure

A. inflammatory bowel disease The nurse stops administering the lavage solution and notifies the physician when the nurse notes that the client has inflammatory bowel disease. Another contraindication for use of lavage solution is intestinal obstruction. Chronic obstructive pulmonary disease (COPD), congestive heart failure, and pulmonary hypertension are not contraindications to administration of lavage solution in preparation for a colonoscopy.

An older adult client is admitted to an acute care facility for treatment of an acute flare-up of a chronic gastrointestinal condition. In addition to assessing the client for complications of the current illness, the nurse monitors for age-related changes in the gastrointestinal tract. Which age-related change increases the risk of anemia? A. Atrophy of the gastric mucosa B. Dulling of nerve impulses C. Decrease in intestinal flora D. Increase in bile secretion

A. Atrophy of the gastric mucosa Atrophy of the gastric mucosa reduces hydrochloric acid secretion; this, in turn, impairs absorption of iron and vitamin B12, increasing the risk of anemia as a person ages. A decrease in hydrochloric acid increases, not decreases, intestinal flora; as a result, the client is at increased risk for infection, not anemia. A reduction, not increase, in bile secretion may lead to malabsorption of fats and fat-soluble vitamins. Dulling of nerve impulses associated with aging increases the risk of constipation, not anemia.

An individual has had a snack consisting of half a bagel with cream cheese, lox (smoked salmon), red onions, and capers. Stimulation of the person's gastrointestinal tract has resulted in the secretion of numerous digestive enzymes into the small intestine, including trypsin. What component of this person's snack will be primarily digested by the action of trypsin? A. The cream cheese B. The red onions and capers C. The bagel D. The lox

D. The lox Trypsin aids in digesting protein, such as fish. Amylase aids in digesting starch, such as the carbohydrates in a bagel. Lipase aids in digesting fats, such as those found in many dairy products.

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? A. Starch B. Protein C. Glucose D. Triglycerides

D. Triglycerides Pancreatic lipase acts on lipids, especially triglycerides. Salivary amylase and pancreatic amylase act on starch. Pepsin and hydrochloric acid in the stomach and trypsin from the pancreas act on proteins. Insulin acts on glucose.

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. Red C. Dark brown D. Green

A. 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 aware that both the sympathetic and parasympathetic portions of the autonomic nervous system affect GI motility. What are the actions of the sympathetic nervous system? Select all that apply. A. Decreases gastric motility B. Relaxes the sphincters C. Creates an inhibitory effect on the GI tract D. Increases secretary activities E. Causes blood vessel constriction

A. Decreases gastric motility C. Creates an inhibitory effect on the GI tract E. Causes blood vessel constriction Generally, the sympathetic nervous system inhibits the gastrointestinal tract and the parasympathetic nerve stimulates the tract, increasing peristalsis and secretary activities.

Which of the following is an enzyme secreted by the gastric mucosa? A. Pepsin B. Trypsin C. Bile D. Ptyalin

A. 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.

Following ingestion of carrots or beets, the nurse would expect which alteration in stool color? A. Yellow B. Milky white C. Red D. Black

C. 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.

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. Gastric analysis B. A sigmoidoscopy C. A complete blood count including differential D. Serum antibodies for H. pylori

D. 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 collecting a stool specimen from a patient. What characteristic of the stool indicates to the nurse that the patient may have an upper GI bleed? A. Clay-colored B. Greasy and foamy C. Threaded with mucus D. Tarry and black

D. Tarry and black Blood in the stool can present in various ways and must be investigated. If blood is shed in sufficient quantities into the upper GI tract, it produces a tarry-black color (melena).

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? A. The large intestine B. The small intestine C. The cecum D. The stomach

A. The large intestine The nurse is correct in instructing the client that water and electrolytes are mainly absorbed in the large intestine. The other options are not the best site for absorption.

A client was diagnosed with pernicious anemia. Which vitamin cannot be absorbed without an intrinsic factor? A. Vitamin B12 B. Vitamin C C. Vitamin D D. Vitamin A

A. 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.

A nurse is assessing a client for GI dysfunction. What is the most common symptom in a client with GI dysfunction? A. Dyspepsia B. Constipation C. Abdominal bleeding D. Diffuse pain

A. Dyspepsia Dyspepsia is a condition that usually involves a combination of symptoms: abdominal pain, bloating, distention, nausea, and belching. Dyspepsia refers to altered digestion that is not associated with a pathologic condition.

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? A. 1 day B. 2 days C. 3 days D. 4 days

C. 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.

A nurse is doing a physical assessment on a client with a GI disorder. Which position will the nurse most likely ask the client to assume when performing an abdominal examination? A. supine with knees flexed slightly B. side-lying C. supine with knees flexed D. supine with legs flat on the exam table

A. supine with knees flexed slightly The client should lie in a supine position with knees flexed slightly to assist in relaxing the abdominal muscles.

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? A. "I should avoid antibiotics for 1 month before the test." B. "First, I will drink a cherry flavored liquid." C. "The test will detect the presence of staph." D. "The test will detect the presence of oral cancer."

A. "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.

Which response is a parasympathetic response in the GI tract? A. blood vessel constriction B. increased peristalsis C. decreased gastric secretion D. decreased motility

B. increased peristalsis Increased peristalsis is a parasympathetic response in the GI tract. Decreased gastric secretion, blood vessel constriction, and decreased motility are sympathetic responses in the GI tract.

A client is scheduled to have an endoscopic retrograde cholangiopancreatography. Which structures are visualized during this procedure? A. common bile duct, portal vein, and gallbladder B. portal vein, gallbladder, and pancreatic duct C. common bile duct, pancreatic duct, and biliary tree D. portal vein, pancreatic duct, and biliary tree

C. common bile duct, pancreatic duct, and biliary tree With the use of endoscopy, dye is injected through a catheter into the common bile duct and the pancreatic duct, permitting visualization and evaluation of the biliary tree. The common bile duct, the pancreatic duct, and the biliary tree are visualized.

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? A. Withhold oral medications for 24 hours before the test. B. Avoid products containing aspirin for a week before the test. C. Eat a clear liquid breakfast before the test. D. Ingest nothing by mouth after midnight.

D. 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.

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? A. Document that the client is constipated. B. Return in 1 hour and listen again to confirm findings. C. Call the health care provider to report absent bowel sounds. D. Listen longer for the sounds.

D. 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.

The nurse is caring for a geriatric client and notices polypharmacy. Which diagnostic studies are anticipated? A. Urinalysis B. Complete blood count C. Blood chemistry D. Liver function studies

D. Liver function studies The liver metabolizes and biotransforms the medications ingested. Geriatric clients who experience polypharmacy or multiple medications have an elevated risk of liver impairment. Routine liver function studies monitor the status of the liver and its ability to metabolize.

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? A. Glycopyrronium bromide B. Acetylcysteine C. Atropine D. Pentagastrin

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

The nurse is caring for a client who is scheduled for a percutaneous liver biopsy. Which diagnostic test is obtained prior? A. Erythrocyte sedimentation rate (ESR) B. Blood chemistry C. Complete blood count (CBC) D. Prothrombin time (PT)

D. Prothrombin time (PT) The client must have coagulation studies (PT, aPTT, INR, platelet count) before the procedure because a major complication after a liver biopsy is bleeding. Clients at risk for serious bleeding may receive precautionary vitamin K. A complete blood count and blood chemistry may be completed for baseline values. Typically, an ESR is not associated with the procedure.