Chapter 44: Introduction to the Gastrointestinal System and Accessory Structures
A female client has presented to the emergency department with right upper quadrant pain; the health care provider has ordered abdominal ultrasound to rule out cholecystitis. The client expresses concern to the nurse about the safety of this diagnostic procedure. How should the nurse best respond?
"Abdominal ultrasound poses no known safety risks of any kind."
A client is scheduled for magnetic resonance imaging (MRI). During the client teaching, the nurse will discuss which of the following?
"Do you experience any claustrophobia?"
A client reports having red stools lately. What will the nurse ask during assessment questioning?
"Have you been eating beets?"
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?
"I'll avoid eating or drinking anything 6 to 8 hours before the test."
A client asks the nurse why the physician ordered the blood test carcinoembryonic antigen (CEA). The nurse answers:
"It indicates if a cancer is present."
A nurse is providing preprocedure education for a client who will undergo a lower GI tract study the following week. What should the nurse teach the client about bowel preparation?
"You'll need to have enemas the day before the test."
Which of the following is the primary function of the small intestine?
Absorption
Which of the following digestive enzymes aids in the digesting of starch?
Amylase
A nurse is caring for a client with recurrent hematemesis who is scheduled for upper gastrointestinal fibroscopy. How should the nurse in the radiology department prepare this client?
Apply local anesthetic to the back of the client's throat.
A client has come to the outpatient radiology department for diagnostic testing that will allow the care team to evaluate and remove polyps. The nurse should prepare the client for what procedure?
Colonoscopy
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?
Bowel perforation
A client comes into the emergency department with complaints of abdominal pain. Which of the following should the nurse ask first?
Characteristics and duration of pain
A nurse is preparing a client with Crohn's disease for a barium enema. What should the nurse do the day before the test?
Encourage plenty of fluids.
An adult client is scheduled for an upper GI series that will use a barium swallow. What teaching should the nurse include when the client has completed the test?
Fluids must be increased to facilitate the evacuation of the stool.
A client asks the nursing assistant for a bedpan. When the client is finished, the nursing assistant notifies the nurse that the client has bright red streaking of blood in the stool. The nurse's assessment should focus on what potential cause?
Hemorrhoids
A clinic client has described recent dark-colored stools and the nurse recognizes the need for fecal occult blood testing (FOBT). What aspect of the client's current health status would contraindicate FOBT?
Hemorrhoids
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?
Hyperactive
A client who has been experiencing changes in his bowel function is scheduled for a barium enema. What instruction should the nurse provide for postprocedure recovery?
Increase fluid intake to evacuate the barium.
While palpating a client's right upper quadrant (RUQ), the nurse would expect to find which structure?
Liver
A nurse is caring for clients in a stroke rehabilitation facility. Damage to what area of the brain will most affect a client's ability to swallow?
Medulla oblongata
An advanced practice nurse is assessing the size and density of a client's abdominal organs. If the results of palpation are unclear to the nurse, what assessment technique should be implemented?
Percussion
Results of a client's preliminary assessment prompted an examination of the client's carcinoembryonic antigen (CEA) levels, which have come back positive. What is the nurse's most appropriate response to this finding?
Prepare to meet the client's psychosocial needs.
Following ingestion of carrots or beets, the nurse would expect which alteration in stool color?
Red
A client has returned to the medical unit after a barium enema. When assessing the client's subsequent bowel patterns and stools, what finding would warrant reporting to the health care provider?
Streaks of blood present in the stool
A medical client's CA 19-9 levels have become available and they are significantly elevated. How should the nurse best interpret this diagnostic finding?
The client may have cancer, but other GI disease must be ruled out.
The nurse prepares a client for a barium enema. The nurse should place the client on which diet prior to the procedure
clear liquids day before
When assessing an elderly client's gastrointestinal system, it is important for the nurse to remember that older clients tend to have:
less control of the rectal sphincter.
A client is scheduled to have an upper gastrointestinal series. Which preparations will the client be asked to follow prior to the procedure?
low-residue diet for 2 to 3 days prior; NPO for 8 to 12 hours before
When bowel sounds are heard about every 15 seconds, the nurse would record that the bowel sounds are
normal.
A client tells the nurse that the stool was colored yellow. The nurse assesses the client for
recent foods ingested.
Which procedure is performed to examine and visualize the lumen of the small bowel?
small bowel enteroscopy
The nurse recognizes which change of the GI system is an age-related change?
weakened gag reflex
A client is diagnosed with megaloblastic anemia caused by vitamin B12 deficiency. The physician begins the client on cyanocobalamin (Betalin-12), 100 mcg I.M. daily. Which substance influences vitamin B12 absorption?
Intrinsic factor
What part of the GI tract begins the digestion of food?
Mouth
The nurse is assisting the physician with a gastric acid stimulation test for a patient. What medication should the nurse prepare to administer subcutaneously to stimulate gastric secretions?
Pentagastrin
A client has been brought to the emergency department with abdominal pain and is subsequently diagnosed with appendicitis. The client is scheduled for an appendectomy but questions the nurse about how his health will be affected by the absence of an appendix. How should the nurse best respond?
"Your appendix doesn't play a major role, so you won't notice any difference after your recovery from surgery."
A nurse is performing an abdominal assessment of an older adult client. When collecting and analyzing data, the nurse should be cognizant of what age-related change in gastrointestinal structure and function?
Decreased mucus secretion
A patient with cystic fibrosis takes pancreatic enzyme replacements on a regular basis. The patient's intake of trypsin facilitates what aspect of GI function?
Digestion of proteins
A client presents at the ambulatory clinic reporting recurrent sharp stomach pain that is relieved by eating. The nurse suspects that the client may have an ulcer. How should the nurse explain the formation and role of acid in the stomach to the client?
Hydrochloric acid is secreted by glands in the stomach in response to the actual or anticipated presence of food."
A nurse is caring for a client who is scheduled for a colonoscopy and whose preparation will include polyethylene glycol electrolyte lavage prior to the procedure. The presence of what health problem would contraindicate the use of this form of bowel preparation?
Inflammatory bowel disease
The nurse is caring for a client who has a diagnosis of AIDS. Inspection of the client's mouth reveals the new presence of white lesions on the client's oral mucosa. What is the nurse's most appropriate response?
Inform the primary provider of this finding.
A client has sought care because of recent dark-colored stools. As a result, a fecal occult blood test has been ordered. The nurse should give what instructions to the client?
Take no NSAIDs within 48 hours of the test
The nurse is providing health education to a client with a gastrointestinal disorder. What should the nurse describe as a major function of the GI tract?
The absorption into the bloodstream of nutrient molecules produced by digestion
The nurse is providing instructions to a patient scheduled for a gastroscopy. What should the nurse be sure to include in the instructions? (Select all that apply.)
The patient must fast for 8 hours before the examination. The throat will be sprayed with a local anesthetic. After gastroscopy, the patient cannot eat or drink until the gag reflex returns (1 to 2 hours).
A client with a recent history of intermittent bleeding is undergoing capsule endoscopy to determine the source of the bleeding. When explaining this diagnostic test to the client, what advantage should the nurse describe?
The test is noninvasive.
A client is scheduled to have an endoscopic retrograde cholangiopancreatography. Which structures are visualized during this procedure?
common bile duct, pancreatic duct, and biliary tree
The client describes a test previously completed to detect a small bowel obstruction prior to admission to the hospital. The client states that the test involved insertion of a tube through the nose and lasted over 6 hours. The nurse determines which test name should be documented?
upper GI enteroclysis