Chapter 44: Introduction to the Gastrointestinal System and Accessory Structures

A nurse is caring for a newly admitted client with a suspected GI bleed. The nurse assesses the client's stool after a bowel movement and notes it to be a tarry-black color. This finding is suggestive of bleeding from what location?

Upper GI tract

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?

duodenum

The nurse assesses bowel sounds and hears one to two bowel sounds in 2 minutes. How should the nurse document the bowel sounds?

hypoactive

The nurse determines one or two bowel sounds in 2 minutes should be documented as

hypoactive

Which response is a parasympathetic response in the GI tract?

increased peristalsis

The nurse performs an abdominal assessment. The nurse should peform the assessment in which order?

inspection, auscultation, percussion, palpation

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.

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?

Dyspepsia

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, what will the nurse discuss?

"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 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 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?

"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."

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."

In client education with a client who has a lower GI study scheduled, the nurse describes the organs involved and their characteristics. Approximately how long are the jejunum and the ileum if their lengths are combined?

23 feet

What is the approximate length of the large intestine?

4-5 feet

Which of the following is the primary function of the small intestine?

Absorption

What composes fecal matter?

All options are correct

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.

The nurse is performing a focused abdominal assessment of a client with a history of bowel obstruction. The nurse has positioned the client appropriately and inspected the client's abdomen carefully. What action should the nurse perform next?

Auscultate the client's abdomen

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 patient is scheduled for a fiberoptic colonoscopy. What does the nurse know that fiberoptic colonoscopy is most frequently used to diagnose?

Cancer

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

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.

The nurse is investigating a client's report of pain in the duodenal area. Where should the nurse perform the assessment?

Epigastric area and consider possible radiation of pain to the right subscapular region

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.

Following ingestion of carrots or beets, the nurse would expect which alteration in stool color?

Red

A nurse is assessing the abdomen of a client just admitted to the unit with a suspected GI disease. Inspection reveals several diverse lesions on the client's abdomen. How should the nurse best interpret this assessment finding?

GI diseases often produce skin changes.

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 nurse has auscultated a client's abdomen and noted one or two bowel sounds in a 2-minute period of time. How should the nurse document the client's bowel sounds?

Hypoactive

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.

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 mostappropriate response?

Inform the primary provider of this finding.

The nurse is preparing to perform a client's abdominal assessment. What examination sequence should the nurse follow?

Inspection, auscultation, percussion, and palpation

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?

Intrinsic factor

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.

Left upper

While palpating a client's right upper quadrant (RUQ), the nurse would expect to find which structure?

Liver

The nurse is caring for a client scheduled for a colonoscopy. The nurse should assist the client into what position during this diagnostic test?

Lying on the left side with legs drawn toward the chest

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

What part of the GI tract begins the digestion of food?

Mouth

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?

Pentagastrin

A nurse is promoting increased protein intake to enhance a client's wound healing. What is the enzyme that will initiate the digestion of the protein that the client consumes?

Pepsin

A client is being assessed for a suspected deficit in intrinsic factor synthesis. What diagnostic or assessment finding is the most likely rationale for this examination of intrinsic factor production?

Persistently low hemoglobin and hematocrit

The nurse conducts education related to test preparation for a client scheduled to undergo an abdominal ultrasonography. The nurse should give the client which instruction?

Restrict eating of solid food for 8 to 12 hours before the test.

The nurse educator is reviewing the blood supply of the GI tract with a group of medical nurses. The nurse is explaining the fact that the veins that return blood from the digestive organs and the spleen form the portal venous system. What large veins will the nurse list when describing this system? Select all that apply.

Splenic vein Inferior mesenteric vein Gastric vein

A nurse is caring for an 83-year-old client who is being assessed for recurrent and intractable nausea. What age-related change to the GI system may be a contributor to the client's health complaint?

Stomach emptying takes place more slowly.

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

The nurse determines which is a true statement regarding older clients, considering the age-related effects on their GI system?

They tend usually to have less control of the rectal sphincter.

The nurse determines which is a true statement regarding older clients, considering the age-related effects on the gastrointestinal (GI) system?

They usually have less control of the rectal sphincter.

For a patient with a disorder of the gastrointestinal (GI) system, which of the following histories would the nurse assess?

Work history for exposure to environmental toxic wastes or radioactive materials

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

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

A nurse is caring for a client with biliary colic. Where would the nurse most likely expect this client to experience referred pain?

Below the right nipple

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 client?

Do not give any food and fluids until the gag reflex returns.

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

A client has been scheduled for a urea breath test in 1 month's time. What nursing diagnosis most likely prompted this diagnostic test?

Risk For Impaired Skin Integrity Related to Peptic Ulcers

A client's sigmoidoscopy has been successfully completed and the client is preparing to return home. What teaching point should the nurse include in the client's discharge education?

The client can resume a normal routine immediately.

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.

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).

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?

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

A client will be undergoing abdominal computed tomography (CT) with contrast. The nurse has administered IV sodium bicarbonate and oral acetylcysteine (Mucomyst) before the study, as prescribed. What would indicate that these medications have had the desired therapeutic effect?

The client's BUN and creatinine levels are within reference range following the CT.

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?

To relax colonic musculature and reduce spasm.

A client who has been in a motor-vehicle collision is comatose and has developed ascites as a result of the accident. The nurse explains the condition to the client's family, and indicates that the primary function of the small intestine is to:

absorb nutrients

The nurse inspects a client's tongue. Which finding would the nurse evaluate as an indication of potential oral cancer?

red plaque on undersurface of tongue

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 is caring for a client with a duodenal ulcer and is relating the client's symptoms to the physiologic functions of the small intestine. What do these functions include? Select all that apply.

Secretion of mucus Absorption of nutrients Movement of nutrients into the bloodstream

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

A nurse is caring for a client admitted with a suspected malabsorption disorder. The nurse knows that one of the accessory organs of the digestive system is the pancreas. What digestive enzymes does the pancreas secrete? Select all that apply.

Lipase Amylase Trypsin

It is suspected that a client might have a problem in the duodenum and the client is scheduled to have GI studies done in the morning. In client education, the nurse describes the procedure and includes basic information about anatomy and the function of the organs involved. The client asks how long the duodenum is. What is the nurse's best response?

10 inches

When gastric analysis testing reveals excess secretion of gastric acid, the nurse recognizes which medical diagnoses is supported?

duodenal ulcer

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

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 mostappropriate response to this finding?

Prepare to meet the client's psychosocial needs.

Which of the following is a function of the stomach? Select all that apply.

Propels partially digested food into small intestine

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

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?

The pancreas secretes digestive enzymes.

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 receives a local anesthetic to suppress the gag reflex for a diagnostic procedure of the upper GI tract. The nurse determines which nursing intervention is advised for this client?

do not give any food and fluids until the gag reflex returns

An enzyme that begins the digestion of starches is

ptyalin

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

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?

small intestine

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?

supine with knees flexed slightly

Which enzyme aids in the digestion of protein?

trypsin

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

The nurse recognizes which change of the GI system is an age-related change?

weakened gag reflex