Chapter 43: Assessment of Digestive and GI function Prep-U

Which neuroregulator increase gastric acid secretion? a. norepinephrine b. acetylcholine c. gastrin d. secretin

acetylcholine Explanation: 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.

A client tells the nurse that the stool was colored yellow. The nurse assesses the client for a. recent foods ingested. b. occult blood. c. ingestion of bismuth. d. pilonidal cyst.

recent foods ingested. Explanation: 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 recognizes which change of the gastrointestinal system is an age-related change? a. increased motility b. hypertrophy of the small intestine c. weakened gag reflex d. increased mucus secretion

weakened gag reflex Explanation: 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.

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

"Do you experience any claustrophobia?" Explanation: 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 asks the nurse why the physician ordered the blood test carcinoembryonic antigen (CEA). The nurse answers: a. "It tells the physician what type of cancer is present." b. "It indicates if a 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." Explanation: The carcinoembryonic antigen (CEA) blood test detects the presence of cancer by identifying the presence of a protein not normally detected in the blood of a healthy person. However, it does not indicate what type of cancer is present nor does it detect the functionality of the liver.

Which of the following is the primary function of the small intestine? a. Absorption b. Digestion c. Peristalsis d. Secretion

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

Which of the following digestive enzymes aids in the digesting of starch? a. Amylase b. Lipase c. Trypsin d. Bile

Amylase Explanation: 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.

Which of the following is the most definitive means of assessing for liver disease? a. Biopsy b. Paracentesis c. Cholecystography d. Ultrasonography

Biopsy Explanation: 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.

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. Bowel perforation c. Colonic polyp d. Rectal fissure

Bowel perforation Explanation: 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 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. Small bowel series b. Computer tomography c. Colonoscopy d. Upper GI series

Colonoscopy Explanation: 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 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. a. Auscultation b. Inspection c. Percussion d. Palpation

Inspection Auscultation Percussion Palpation

Swallowing is regulated by which area of the central nervous system (CNS)? a. Medulla oblongata b. Pons c. Cerebellum d. Hypothalamus

Medulla Oblongata

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

Pepsin Explaination: 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. Red b. Black c. Yellow d. Milky white

Red Explanation: 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.

It is important for a nurse to have an understanding of the major digestive enzymes and their actions. Choose the gastric mucosa secretion that plays an important role in the digestion of triglycerides. a. Ptyalin b. Trypsin c. Amylase d. Steapsin

Steapsin Explanation: Ptyalin and amylase work to digest starch; trypsin works on proteins and polypeptides. Triglycerides are digested by steapsin, and pharyngeal and pancreatic lipase.

When evaluating the function of the GI tract, the nurse needs to understand the role of hormones. Secretin, stimulated by the pH of chyme in the duodenum, is a major GI hormone that does which of the following? a. Causes the gallbladder to contract b. Influences contraction of the esophageal and pyloric sphincters c. Regulates the secretion of gastric acid d. Stimulates the production of bicarbonate in pancreatic juice

Stimulates the production of bicarbonate in pancreatic juice Explanation: Secretion inhibits gastric secretion and increases the production of bicarbonate-rich pancreatic juices, thus inhibiting gastric motility.

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

Increased motility of the stomach Explanation: 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.

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

Intrinsic factor Explanation: 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.

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

Radiography of the gallbladder Explanation: 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.

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. Resume regular diet. d. Increase fluid intake.

Resume regular diet. Explanation: 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.

Which procedure is performed to examine and visualize the lumen of the small bowel? a. small bowel enteroscopy b. colonoscopy c. panendoscopy d. peritoneoscopy

small bowel enteroscopy Explanation: 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.

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

"I really don't like to be in small, enclosed spaces." Explanation: 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. Visualization will assist the client in relaxing during the procedure.

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. Increases secretary activities d. Causes blood vessel constriction e. Creates an inhibitory effect on the GI tract

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

When examining the abdomen of a client with reports of nausea and vomiting, what would the nurse do first? a. Palpation b. Inspection c. Auscultation d. Percussion

Inspection Explanation: 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 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. A complete blood count including differential b. Serum antibodies for H. pylori c. A sigmoidoscopy d. Gastric analysis

Serum antibodies for H. Pylori Explanation: 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.

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. Ileum c. Stomach d. Large Intestine

Stomach

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 had a hamburger for dinner the night before c. The client took an ibuprofen tablet this morning d. The client regularly takes aspirin

The client has hemorrhoidal bleeding Explanation: 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.

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. loss of gag reflex b. minor throat pain c. drowsiness d. difficulty swallowing

difficulty swallowing Explanation: 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.

A client presented with gastrointestinal bleeding 2 days ago and continues to have problems. The health care provider has ordered a visualization of the small intestine via a capsule endoscopy. What will the nurse include in the client education about this procedure? a. "A capsule will be inserted into your rectum." b. "You will need to swallow a capsule." c. "The health care provider will use a scope called a capsule to view your intestine." d. "An x-ray machine will use a capsule ray to follow your intestinal tract."

"You will need to swallow a capsule." Explanation: A capsule endoscopy allows for noninvasive visualization of the small intestinal mucosa. The technique consists of the client swallowing a capsule that is embedded with a wireless miniature camera, which is propelled through the intestine by peristalsis. The capsule passes from the rectum in 1 to 2 days.

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

Abdominal distention Explanation: 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

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. Ask the client to empty the bladder. c. Assist the client to a Fowler's position. d. Dim the lights for privacy.

Ask the client to empty the bladder. Explanation: 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.

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. Decrease in intestinal flora c. Increase in bile secretion d. Dulling of nerve impulses

Atrophy of the gastric mucosa Explanation: 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.

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. Further investigate the initial complaint. b. Explain that fatty foods can mimic chest pain. c. Call for an immediate electrocardiogram. d. Administer an over-the-counter antacid tablet.

Further investigate the initial complaint. Explanation: 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 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. Decrease in nausea and vomiting c. Increase in the amount of fluids d. Ambulates independently

Increase in the amount of fluids Explanation: 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.

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. Pentagastrin b. Atropine c. Glycopyrronium bromide d. Acetylcysteine

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

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. Allow the client to ingest fat-free meal. c. Permit the client to drink only clear liquids. d. Provide saline gargles to the client.

Permit the client to drink only clear liquids Explanation: 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.

An examiner is performing the physical assessment of the rectum, perianal region, and anus. While this examination can be uncomfortable for many clients, health care providers must approach it in a prepared, confident manner. Which of the following considerations will help this examination flow smoothly and efficiently for both provider and client? Select all that apply. a. Position the client on the right side with the knees up to the chest. b. Ask the client to bear down for visual inspection. c. Cleanse gloved fingers with water to allow for easy insertion. d. Dim the lights to decrease the client's embarrassment. e. Ask the client to produce a bowel movement after the procedure.

Position the client on the right side with the knees up to the chest. Ask the client to bear down for visual inspection. Explanation: While examination of the rectum, perineum, and anus may be uncomfortable for the client, it is necessary for a thorough examination. The examiner will position the client on the right side with the knees up. He or she will use a gloved finger lubricated with a water-soluble lubricant for ease of insertion. The health care provider will encourage deep breathing during the procedure and ask the client to bear down while inspecting the anal area. The examination requires appropriate lighting for thorough inspection.

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. Triglycerides d. Glucose

Protein Explanation: 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 caring for a client who is scheduled for a percutaneous liver biopsy. Which diagnostic test is obtained prior? a. Complete blood count (CBC) b. Prothrombin time (PT) c. Blood chemistry d. Erythrocyte sedimentation rate (ESR)

Prothrombin time (PT) Explanation: The client must have coagulation studies before the procedure such as a PT or PTT 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.

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

The client should not be given any food and fluids until the gag reflex returns. Explanation: 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 nursing instruction is correct to provide the client following a barium enema? a. The client will maintain a low residue diet. b. The stools may be a white or clay colored. c. Sips of fluid may be increased if tolerated. d. An enema will be used to clear the bowel.

The stools may be a white or clay colored Explanation: 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.

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

common bile duct, pancreatic duct, and biliary tree Explanation: 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.

When gastric analysis testing reveals excess secretion of gastric acid, the nurse recognizes which medical diagnoses is supported? a. chronic atrophic gastritis b. duodenal ulcer c. gastric cancer d. pernicious anemia

duodenal ulcer Explanation: 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.

Which term describes a gastric secretion that combines with vitamin B12 so that it can be absorbed? a. amylase b. pepsin c. trypsin d. intrinsic factor

intrinsic factor Explanation: 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.

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. supine with legs flat on the exam table c. side-lying d. supine with knees flexed

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

The nurse determines one or two bowel sounds in 2 minutes should be documented as a. normal. b. hyperactive. c. hypoactive. d. absent.

hypoactive. Explanation: 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.

Blood flow to the GI tract is approximately what percentage of the total cardiac output? a. 10% b. 20% c. 30% d. 40%

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

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. "You may frequently have diarrhea." b. "You may frequently experience constipation." c. "It is the aging process." d. "At times you may see mucus in your stool."

"You may frequently experience constipation." Explanation: 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 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. Dark brown b. Green c. Red d. Black

Black Explanation: 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.

Which diagnostic produces images of the body by detecting the radiation emitted from radioactive substances? a. Positron emission tomography (PET) b. Computed tomography (CT) c. Magnetic resonance imaging (MRI) d. Fibroscopy

Positron emission tomography (PET) Explanation: 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.

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. Supine with knees flexed b. Knee-chest c. Lithotomy d. Left Sim's lateral

Supine with knees flexed Explanation: 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.

The nurse prepares a client for a barium enema. The nurse should place the client on which diet prior to the procedure? a. high-fiber diet 1 to 2 days prior b. soft diet 1 day prior c. nothing by mouth (NPO) 2 days prior d. clear liquids day before

clear liquids day before Explanation: The nurse should place the client 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.

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. "Do you take an iron supplement on a daily basis?" b. "Does your diet include a moderate amount of vitamin C?" c. "Are you prescribed regular strength aspirin daily?" d. "Can you tell me the amount of alcohol that you drink on an average week?" e. "When was the last time that you included red meat in your diet?"

"Are you prescribed regular strength aspirin daily?" "Can you tell me the amount of alcohol that you drink on an average week?" "When was the last time that you included red meat in your diet?" Explanation: 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.

Which enzyme aids in the digestion of protein? a. trypsin b. lipase c. steapsin d. ptyalin

Trypsin Explanation: 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 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 avoid eating or drinking anything 6 to 8 hours 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 take a laxative to clear my bowels before the test."

"I'll avoid eating or drinking anything 6 to 8 hours before the test." Explanation: 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.

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. Diffuse pain b. Dyspepsia c. Constipation d. Abdominal bloating

Dyspepsia Explanation: 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).

Which response is a parasympathetic response in the GI tract? a. decreased gastric secretion b. blood vessel constriction c. increased peristalsis d. decreased motility

increased peristalsis Explanation: 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.

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. congestive heart failure d. pulmonary hypertension

inflammatory bowel disease Explanation: 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.

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

Avoid smoking for at least 12 to 24 hours before the procedure. Explanation: 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.

While preparing a client for an upper GI endoscopy (esophagogastroduodenoscopy), the nurse should implement which interventions? Choose all that apply. a. Administer a preparation to cleanse the GI tract, such as Golytely or Fleets Phospha-Soda. b. Tell the client he shouldn't eat or drink for 6 to 12 hours before the procedure. c. Tell the client he must be on a clear liquid diet for 24 hours before the procedure. d. Inform the client that he will receive a sedative before the procedure. e. Tell the client that he may eat and drink immediately after the procedure.

Tell the client he shouldn't eat or drink for 6 to 12 hours before the procedure. Inform the client that he will receive a sedative before the procedure. Explanation: 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 and relieves anxiety during the procedure, may be administered. Atropine may be administered to reduce secretions, and glucagon may be administered to relax smooth muscle.

Specific disease processes and ingestion of certain foods and medications may change the appearance of the stool. If blood is shed in sufficient quantities into the upper gastrointestinal (GI) tract, it produces which change in the stool appearance? a. Tarry-black b. Bright red c. Blood-streaked d. Dark brown

Tarry-black Explanation: If the blood is shed in sufficient quantities into the upper GI tract, it produces a tarry-black color, whereas blood entering the lower portion of the GI tract or passing rapidly though will cause the stool to appear bright or dark red. Lower rectal or anal bleeding is suspected if there is streaking of the blood on the surface of the stool or if blood is noted on toilet tissue. Stool is normally light or dark brown.

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. jejunum c. ileum d. cecum

duodenum Explanation: 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 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. "Do you take an iron supplement on a daily basis?" b. "Does your diet include a moderate amount of vitamin C?" c. "Are you prescribed regular strength aspirin daily?" d. "Can you tell me the amount of alcohol that you drink on an average week?" e. "When was the last time that you included red meat in your diet?"

"Are you prescribed regular strength aspirin daily?" "Can you tell me the amount of alcohol that you drink on an average week?" "When was the last time that you included red meat in your diet?" Explanation: 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.

The nurse is caring for a man who has experienced a spinal cord injury. Throughout his recovery, the client expects to gain control of his bowels. The nurse's best response to this client would be which of the following? a. "It is not going to happen. Your nerve cells are too damaged." b. "Having a bowel movement is a spinal reflex requiring intact nerve fibers. Yours are not intact." c. "Over time, the nerve fibers will regrow new tracts, and you can have bowel movements again." d. "Wearing an undergarment will become more comfortable over time."

"Having a bowel movement is a spinal reflex requiring intact nerve fibers. Yours are not intact." Explanation: The act of defecation is a spinal reflex involving the parasympathetic nerve fibers. Normally, the external anal sphincter is maintained in a state of tonic contraction. With a spinal cord injury, the client no longer has this nervous system control and is often incontinent.

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. "First, I will drink a cherry flavored liquid." b. "The test will detect the presence of staph." c. "I should avoid antibiotics for 1 month before the test." d. "The test will detect the presence of oral cancer."

"I should avoid antibiotics for 1 month before the test." Explanation: 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.

The nurse asks a client to point to where pain is felt. The client asks why this is important. What is the nurse's best response? a. "If the health care provider massages over the exact painful area, the pain will disappear." b. "The area may determine the severity of the pain." c. "This determines the pain medication to be ordered." d. "Often the area of pain is referred from another area."

"Often the area of pain is referred from another area." Explanation: Pain can be a major symptom of disease. The location and distribution of pain can be referred from a different area. If a client points to an area of pain and has other symptoms associated with a certain disease, this is valuable information for treatment.

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

Cancer

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. Order a high-fiber diet. c. Encourage plenty of fluids. d. Serve dairy products.

Encourage plenty of fluids. Explanation: 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.

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

Lying on the left side with knees bent Explanation: 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.

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 major surgery required by bowel resection b. Related to the presence of bacteria at the surgical site c. Related to malnutrition secondary to bowel resection with anastomosis d. Related to the presence of a nasogastric (NG) tube postoperatively

Related to the presence of bacteria at the surgical site Explanation: 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.

A nurse is assessing a client who reports abdominal pain, nausea, and diarrhea. When examining the client's abdomen, which sequence should the nurse use? a. Inspection, palpation, percussion, and auscultation b. Inspection, auscultation, percussion, and palpation c. Auscultation, inspection, percussion, and palpation d. Palpation, auscultation, percussion, and inspection

Inspection, auscultation, percussion, and palpation Explanation: The correct sequence for abdominal examination is inspection, auscultation, percussion, and palpation. This sequence differs from that used for other body regions (inspection, palpation, percussion, and auscultation) because palpation and percussion increase intestinal activity, altering bowel sounds. Therefore, the nurse shouldn't palpate or percuss the abdomen before auscultating. Assessment of any body system or region starts with inspection; therefore, auscultating or palpating the abdomen first would be incorrect.

A nurse is teaching a client with malabsorption syndrome about the disorder and its treatment. The client asks which part of the GI tract absorbs food. What is the nurse's best response? a. stomach b. small intestine c. large intestine d. rectum

Small intestine Explanation: 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.

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 procedure.

The client must fast for 8 hours before the examination. The throat will be sprayed with a local anesthetic. After gastroscopy, the client cannot eat or drink until the gag reflex returns (1 to 2 hours). Explanation: 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.

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

The client will need to be repositioned frequently throughout the procedure in order to prevent injury. Explanation: 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.

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 small intestine b. The stomach c. The large intestine d. The cecum

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

The ultrasonography should be scheduled before the GI procedure. Explanation: 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.

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

They tend usually to have less control of the rectal sphincter Explanation: 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 prepares a client for a barium enema. The nurse should place the client on which diet prior to the procedure? a. high-fiber diet 1 to 2 days prior b. soft diet 1 day prior c. nothing by mouth (NPO) 2 days prior d. clear liquids day before

clear liquids day before Explanation: The nurse should place the client 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.