Chapter 44: Assessment of Digestive and Gastrointestinal Function
A client presented with gastrointestinal bleeding 2 days ago and continues to have problems. The physician has ordered a visualization of the small intestine via a capsule endoscopy. Which of the following will the nurse include in the client education about this procedure? a) "You will need to swallow a capsule." b) "A capsule will be inserted into your rectum." c) "An x-ray machine will use a capsule ray to follow your intestinal tract." d) "The physician will use a scope called a capsule to view your intestine."
a) "You will need to swallow a capsule." 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 who is scheduled for a percutaneous liver biopsy. Which diagnostic test is obtained prior? a) Prothrombin time (PT) b) Blood chemistry c) Erythrocyte sedimentation rate (ESR) d) Complete blood count (CBC)
a) Prothrombin time (PT) 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.
The nurse is conducting education relating to test preparation for a patient scheduled to undergo an abdominal ultrasonography. The nurse instructs the patient to do which of the following? a) Restrict eating of solid food for 8 to 12 hours before the test. b) Do not consume anything sweet for 24 hours before the test. c) Avoid exposure to sunlight for at least 6 to 8 hours before the test. d) Do not undertake any strenuous exercise for 24 hours before the test.
a) Restrict eating of solid food for 8 to 12 hours before the test. For a patient who is scheduled to undergo an abdominal ultrasonography, the patient should restrict him- or herself from solid food for 6 to 8 hours to avoid having images of the test obscured with gas and intestinal contents. Ultrasonography records the reflection of sound waves. Strenuous exercises, the consumption of sweets, and exposure to sunlight do not affect the results of the test in any way.
When gastric analysis testing reveals excess secretion of gastric acid, which of the following medical diagnoses is supported? a) Pernicious anemia b) Duodenal ulcer c) Gastric cancer d) Chronic atrophic gastritis
b) Duodenal ulcer Patients with duodenal ulcers usually secrete an excess amount of hydrochloric acid. Patients with chronic atrophic gastritis secrete little or no acid. Patients with gastric cancer secrete little or no acid. Patients with pernicious anemia secrete no acid under basal conditions or after stimulation.
A patient tells the nurse that his stool was colored yellow. The nurse assesses for which of the following? a) Ingestion of bismuth b) Pilonidal cyst c) Occult blood d) Recent foods ingested
d) Recent foods ingested The nurse should assess for recent foods that the patient ingested, as ingestion of senna can cause the stool to turn yellow. Ingestion of bismuth can turn the stool black and, when occult blood is present, the stool can appear to be tarry black.
The nurse working in the GI lab is caring for a patient after an endoscopic examination and preparing the patient for discharge. The nurse includes which of the following in the instructions? a) Resume regular diet. b) Continue clear liquid diet. c) Avoid driving for 24 hours. d) Increase fluid intake.
a) Resume regular diet. The nurse includes resumption of regular diet in the patient's discharge instructions as the patient 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 patient does not need to avoid driving.
A client is to have an upper GI procedure with barium ingestion and abdominal ultrasonography. While scheduling these diagnostic tests, the nurse must consider which factor? a) The ultrasonography should be scheduled before the GI procedure. b) Both tests need to be done before breakfast. c) The client may eat a light meal before either test. d) The upper GI should be scheduled before the ultrasonography.
a) The ultrasonography should be scheduled before the GI procedure. Both an upper GI procedure with barium ingestion and an ultrasonography may be completed on the same day. The ultrasonography test should be completed first, because the barium solution could interfere with the transmission of the sound waves. The ultrasonography test uses sound waves that are passed into internal body structures, and the echoes are recorded as they strike tissues. Fluid in the abdomen prevents transmission of ultrasound.
Upon hearing that his small intestine lining has thinned, an elderly client asks, "What can this lead to?" The nurse would most likely respond with which of the following comments? a) "At times you may see mucus in your stool." b) "You may frequently experience constipation." c) "It is the aging process." d) "You may frequently have diarrhea."
b) "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.
Using gastric analysis, the nurse would expect that a patient diagnosed with peptic ulcer would secrete which of the following? a) Small amount of acid b) No acid under basal condition or after stimulation c) An excess amount of acid d) Little or no acid
a) Small amount of acid Patient with peptic ulcer disease secrete some acid. Patients with gastric cancer secrete little or no acid. Patients with duodenal ulcers secrete an excess amount of acid. Patients with pernicious anemia secrete no acid under basal conditions or after stimulation.
Upon review of a client's chart, the nurse notes the client has been receiving antiemetics every 6 to 8 hours. What in this client's history may necessitate such frequency? a) Treatment for cancer b) Multiple leg fractures c) Pituitary tumor d) Adrenal gland removal 3 days ago
a) Treatment for cancer Antiemetics are used to treat nausea and vomiting. Common causes of nausea and vomiting include visceral afferent stimulation, peritoneal irritation, infections, radiation or chemotherapy therapy, increased intracranial pressure, and vestibular disorders. Irritation of the chemoreceptor trigger zone from cancer treatment can induce nausea and lead to vomiting.
A patient is scheduled for a fiberoptic colonoscopy. What does the nurse know that fiberoptic colonoscopy is most frequently used to diagnose? a) Inflammatory bowel disease b) Cancer screening c) Bowel disease of unknown origin d) Occult bleeding
b) Cancer screening 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.
The patient is describing to the nurse a test that he underwent to detect a small bowel obstruction prior to admission to the hospital. The patient states that the test involved insertion of a tube through the nose and lasted over 6 hours. The nurse documents the name of the test as which of the following? a) Magnetic resonance imaging b) Abdominal ultrasound c) Upper GI enteroclysis d) Positron emission tomography
c) Upper GI enteroclysis The nurse documents the test as enteroclysis. Enteroclysis is a double contrast study where a duodenal tube is inserted and 500 to 1000 mL of thin barium sulfate suspension and then methylcellulose is infused. Fluoroscopy is used to visualize the filling of the intestinal loops over a period of up to 6 hours. The test is used for detection of small bowel obstruction and diverticuli. Abdominal ultrasound, magnetic resonance imaging, and positron emission tomography do not involve insertion of a duodenal tube.
A home care nurse is caring for a client with complaints of epigastric discomfort who is scheduled for a barium swallow. Which statement by the client indicates an understanding of the test? a) "I'll avoid eating or drinking anything 6 to 8 hours before the test." b) "I'll take a laxative to clear my bowels before the test." c) "I'll drink full liquids the day before the test." d) "There is no need for special preparation before the test."
a) "I'll avoid eating or drinking anything 6 to 8 hours before the test." The client demonstrates understanding of a barium swallow when he states that he must refrain from eating or drinking for 6 to 8 hours before the test. No other preparation is needed. Before a lower GI series, the client should eat a low-residue or clear liquid diet for 2 days and take a potent laxative and an oral liquid preparation.
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) Ask the client to produce a bowel movement after the procedure. e) Dim the lights to decrease the client's embarrassment.
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. 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.
A client who had a colonoscopy with removal of a polyp is being prepared for discharge. Which of the following would the nurse include in the discharge instructions? a) "You might experience some nausea and vomiting for a day or so. This is normal." b) "You might feel some cramping and gas but these usually go away in about a day." c) "Call your physician if there is even slight bleeding with your first bowel movement." d) "Be sure to eat high fiber foods when you get home to help you move your bowels."
b) "You might feel some cramping and gas but these usually go away in about a day." After a colonoscopy, a client may experience mild cramping and flatulence which usually resolve within n 24 hours. If the client has a small growth or polyp removed, there may be a slight amount of bleeding that resolves on its own. The client should notify his physician if he experiences nausea, vomiting, fever, or excessive bleeding. The client also should avoid high-fat and high-fiber foods for at least 24 hours after the procedure.
The nurse preparing a patient for a colostomy is preparing to administer the lavage solution. The nurse stops and notifies the physician when the nurse notes that the patient has which of the following? a) Congestive heart failure b) Inflammatory bowel disease c) Chronic obstructive pulmonary disease (COPD) d) Pulmonary hypertension
b) Inflammatory bowel disease The nurse stops administering the lavage solution and notifies the physician when the nurse notes that the patient has inflammatory bowel disease. Another contraindication for use of lavage solution is intestinal obstruction. COPD, congestive heart failure, and pulmonary hypertension are not contraindications to administration of lavage solution in preparation for a colonoscopy.
A client presents to the emergency department, reporting that he has been vomiting every 30 to 40 minutes for the past 8 hours. Frequent vomiting puts this client at risk for which imbalances? a) Metabolic acidosis and hyperkalemia b) Metabolic acidosis and hypokalemia c) Metabolic alkalosis and hyperkalemia d) Metabolic alkalosis and hypokalemia
b) Metabolic acidosis and hypokalemia Gastric acid contains large amounts of potassium, chloride, and hydrogen ions. Excessive vomiting causes loss of these substances, which can lead to metabolic alkalosis and hypokalemia. Excessive vomiting doesn't cause metabolic acidosis or hyperkalemia.
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 a nasogastric (NG) tube postoperatively b) Related to the presence of bacteria at the surgical site c) Related to major surgery required by bowel resection d) Related to malnutrition secondary to bowel resection with anastomosis
b) 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.
A nurse is admitting a severely malnourished and nonverbal client to the hospital. Identify which of the following factors contribute to the nutritional function of the digestive system. Select all that apply. a) Increased secretion of gastrin b) Absence of intrinsic factor in the gastric mucosa c) Intact dentition of the upper and lower teeth d) Increased saliva production e) Peristaltic contractions in the stomach
c) Intact dentition of the upper and lower teeth e) Peristaltic contractions in the stomach All cells need nutrients to function and prevent malnourishment. Several factors are necessary for proper functioning of the digestive system and nutrient absorption: the ability to chew with proper dentition, proper functioning of esophageal and stomach peristalsis, and adequate secretion of gastric enzymes and regulatory substances. The body needs intrinsic factor secretion for absorption of vitamin B12.
A patient is admitted to the hospital for an emergency appendectomy. During the admission history, the nurse notes that the patient had a cheese steak sandwich for lunch at 11 AM, 3 hours prior to admission. The nurse reported this information to the surgeon. Based on the nurse's knowledge of GI motility, she is aware that the food from lunch should reach the colon as early as ______ PM and reach the rectum by ______ PM. a) 3:00 pm; 11:00 PM b) 1:00 pm; 6:00 PM c) 6:00 pm; 9:00 PM d) 8:00 pm; 12:00 PM
a) 3:00 pm; 11:00 PM It usually takes food 4 to 5 hours to reach the colon, and 12 hours for food to reach and distend the rectum.
Lisa Bentley, a 32-year-old teacher, presents to the gastroenterology office where you work. She is known to have a history of Crohn's disease, and you have met with her several times to discuss the various health concerns that she has related to her diagnosis. When talking with the client, the nurse explains that having a GI disorder doesn't mean her problems are limited to the one area that is diseased but might also involve all of the following except ________. a) digestion b) absorption c) metabolism d) elimination e) ingestion
c) metabolism The client with a GI disorder may experience a wide variety of health problems that involve disturbances of ingestion, digestion, absorption, and elimination. The client with a GI disorder may experience health problems that involve disturbances of ingestion, digestion, absorption, and elimination.
The nurse is assisting the physician in a percutaneous liver biopsy. In which position would the nurse assist the client to assume? a) Lithotomy position b) Supine position c) Dorsal recumbent position d) A high Fowler's position
b) 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.
Which nursing instruction is correct to provide the client following a barium enema? a) Sips of fluid may be increased if tolerated. b) An enema will be used to clear the bowel. c) The stools may be a white or clay colored. d) The client will maintain a low residue diet.
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.
The nurse is caring for a patient who complains of abdominal bloating, distention, and feeling full of gas. These could be symptoms of which of the following? a) Small bowel obstruction b) Dyspepsia c) Rectal cancer d) Food allergy
d) Food allergy A patient with a food allergy complains of abdominal bloating, distention, and feeling full of gas. These are not symptoms related to small bowel obstruction or rectal cancer. Dyspepsia is abdominal discomfort associated with eating.
During the initial assessment of a patient complaining of increased stomach acid related to stress, the nurse knew that the health care provider would want to consider the influence of which following neuroregulator? a) Gastrin b) Cholecystokinin c) Secretin d) Norepinephrine
d) Norepinephrine There are two major neuroregulators, acetylcholine and norepinephrine. Norepinephrine's effects on secretions are generally inhibitory. The other choices are hormonal regulators.
During a nursing assessment, the nurse knows that the most common symptom in patients with GI dysfunction is which of the following? a) Dyspepsia b) Diffuse pain c) Abdominal bleeding d) Constipation
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.
The nurse is a preparing a patient for a barium enema. The nurse should place the patient on which of the following prior to the procedure? a) High-fiber diet 1 to 2 days prior b) Soft diet 1 day prior c) Clear liquids day before d) Nothing by mouth (NPO) 2 days prior
c) Clear liquids day before The nurse should place the patient on clear liquids the evening before the procedure, a low-residue diet 1 to 2 days before the test, and NPO at midnight in preparation for the barium enema.
A patient is being prepared for esophageal manometry. The nurse should inform the patient to withhold what medication for 48 hours prior to the procedure? a) Aspirin b) Calan (Verapamil) c) Metoprolol (Lopressor) d) Amiodarone (Cordarone)
a) Aspirin Esophageal manometry is used to detect motility disorders of the esophagus and the upper and lower esophageal sphincter. Also known as esophageal motility studies, these studies are very helpful in the diagnosis of achalasia, diffuse esophageal spasm, scleroderma, and other esophageal motor disorders. The patient must refrain from eating or drinking for 8 to 12 hours before the test. Medications that could have a direct effect on motility (e.g., calcium channel blockers, anticholinergic agents, sedatives) are withheld for 24 to 48 hours.
When assisting with preparing a client scheduled for a barium swallow, which of the following would be appropriate to include? a) Take vitamin K before the procedure. b) Take three cleansing enemas before the procedure. c) Avoid the intake of red meat before the procedure. d) Avoid smoking for at least a day before the procedure.
d) Avoid smoking for at least a day 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.
A client comes into the emergency department with complaints of abdominal pain. Which of the following should the nurse ask first? a) Medications taken in the last 8 hours b) Concerns about impending hospital stay c) Characteristics and duration of pain d) Family history of ruptured appendix
c) 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.
When gastric analysis testing reveals excess secretion of gastric acid, which of the following medical diagnoses is supported? a) Pernicious anemia b) Gastric cancer c) Duodenal ulcer d) Chronic atrophic gastritis
c) Duodenal ulcer Patients with duodenal ulcers usually secrete an excess amount of hydrochloric acid. Patients with chronic atrophic gastritis secrete little or no acid. Patients with gastric cancer secrete little or no acid. Patients with pernicious anemia secrete no acid under basal conditions or after stimulation.
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) Abdominal bloating d) Constipation
b) 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).
Which of the following is a function of the stomach? Select all that apply. a) Food storage b) Secretion of digestive fluids c) Secretion of bile d) Propels partially digested food into small intestine e) Secretion of digestive enzymes
a) Food storage b) Secretion of digestive fluids d) Propels partially digested food into small intestine The stomach stores food during eating, secretes digestive fluids, and propels the partially digested foods into the small intestine. Secretion of digestive enzymes is completed by the pancreas. The liver secretes bile.
The hydrogen breath test was developed to evaluate which type of absorption? a) Protein b) Vitamin B12 c) Fat d) Carbohydrate
d) Carbohydrate The hydrogen breath test that is used to evaluate carbohydrate absorption is performed if carbohydrate malabsorption is suspected. The hydrogen test does not evaluate fat, protein, or vitamin B12 absorption.
The nurse is investigating a patient's complaint of pain in the duodenal area. Where should the nurse perform the assessment? a) Left lower quadrant b) Periumbilical area, followed by the right lower quadrant c) Hypogastrium in the right or left lower quadrant d) Epigastric area and consider possible radiation of pain to the right subscapular region
d) Epigastric area and consider possible radiation of pain to the right subscapular region Indigestion is an imprecise term that refers to a host of upper abdominal or epigastric symptoms such as pain, discomfort, fullness, bloating, early satiety, belching, heartburn, or regurgitation; it occurs in approximately 25% of the adult population (Harmon & Peura, 2010).
While completing an abdominal assessment, the nurse will use which landmark as the upper boundary for auscultating bowel sounds? a) Umbilicus b) Symphysis pubis c) T12 to L3 vertebrae d) Xiphoid process
d) 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 nurse is preparing a client with Crohn's disease for a barium enema. What should the nurse do the day before the test? a) Order a high-fiber diet. b) Serve the client his usual diet. c) Serve dairy products. d) Encourage plenty of fluids.
d) Encourage plenty of fluids. The nurse should encourage plenty of fluids because adequate fluid intake is necessary to avoid dehydration that may be caused by the bowel preparation and to prevent fecal impaction after the procedure. The client may be placed on a low-residue diet 1 to 2 days before the procedure to reduce the contents in the GI tract. Fiber intake is limited in a low-residue diet. Because dairy products leave a residue, they aren't allowed the evening before the test. Clear liquids only are allowed the evening before the test.
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) Provide saline gargles to the client. b) Permit the client to drink only clear liquids. c) Allow the client to ingest fat-free meal. d) Instruct the client to have low-residue meals.
b) Permit the client to drink only clear liquids. After polyethylene glycol/electrolyte solution is administered, the client should have clear liquids because this ensures watery stools, which are necessary for procedures like a barium enema. Allowing the client to ingest a fat-free meal is used in preparation for oral cholecystography. Instructing the client to have low-residue meals is a pretest procedure for barium enema. A client is offered saline gargles after esophagogastroduodenoscopy.
