GI EXAM STUDY GUIDE QUESTIONS

A nurse assesses the abdomen of a newly admitted client. Which finding would necessitate further investigation? a) Flat appearance below the umbilicus b) Asymmetrical upper quadrants c) Striae of lateral abdomen d) Rounded contour

ANSWER: B Asymmetrical upper quadrantsExplanation: The client lies supine with knees flexed for the abdominal assessment. Upon inspection the nurse notes any skin changes, nodules, lesions, inflammation, or striae. Lesions are of particular importance and require further investigation, as do irregular contours or asymmetry of the abdomen.

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

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

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

ANSWER:D Avoid smoking for at least a day 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.

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) Allow the client to ingest fat-free meal. b) Instruct the client to have low-residue meals. c) Provide saline gargles to the client. d) Permit the client to drink only clear liquids.

ANSWER:D Permit the client to drink only clear liquids.Explanation: After polyethylene glycol/electrolyte solution is administered, the client should have clear liquids as 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 elderly patient diagnosed with diarrhea is taking digoxin (Lanoxin). Which of the following electrolyte imbalances should the nurse be alert to? a) Hyponatremia b) Hypokalemia c) Hypernatremia d) Hyperkalemia

B) Hypokalemia The older person taking digitalis must be aware of how quickly dehydration and hypokalemia can occur with diarrhea. The nurse teaches the patient to recognize the symptoms of hypokalemia because low levels of potassium intensify the action of digitalis, leading to digitalis toxicity.

What part of the GI tract begins the digestion of food? a) Stomach b) Mouth c) Duodenum d) Esophagus

B) MouthFood that contains starch undergoes partial digestion when it mixes with the enzyme salivary amylase, which the salivary glands secrete.

Which of the following terms describes a gastric secretion that combines with vitamin B12 so that it can be absorbed? a) Amylase b) Trypsin c) Pepsin d) Intrinsic factor

D) Intrinsic factor 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.

Which client requires immediate nursing intervention? The client who :a) complains of epigastric pain after eating. b) complains of anorexia and periumbilical pain. c) presents with ribbonlike stools. d) presents with a rigid, boardlike abdomen.

D) Presents with a rigid, boardlike abdomen A rigid, boardlike abdomen is a sign of peritonitis, a possibly life-threatening condition. Epigastric pain occurring 90 minutes to 3 hours after eating indicates a duodenal ulcer. Anorexia and periumbilical pain are characteristic of appendicitis. Risk of rupture is minimal within the first 24 hours, but increases significantly after 48 hours. A client with a large-bowel obstruction may have ribbonlike stools.

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) Ileum b) Liver c) Large intestine d) Stomach

D) Stomach The upper gastrointestinal (GI) tract begins at the mouth and ends at the jejunum. Therefore, the stomach would be a component of the upper GI tract. The lower GI tract begins at the ileum and ends at the anus. The liver is considered an accessory structure.

A client is admitted to the health care facility with a diagnosis of a bleeding gastric ulcer. The nurse expects this client's stools to be: a) black and tarry. b) coffee-ground-like. c) bright red. d) clay-colored.

A) Black and tarry Black, tarry stools are a sign of bleeding high in the GI tract, as from a gastric ulcer, and result from the action of digestive enzymes on the blood. Vomitus associated with upper GI tract bleeding commonly is described as coffee-ground-like. Clay-colored stools are associated with biliary obstruction. Bright red stools indicate lower GI tract bleeding.

A client with dysphagia is being prepared for discharge. Which outcome indicates that the client is ready for discharge? a) The client is free from esophagitis and achalasia. b) The client reports diminished duodenal inflammation. c) The client has normal gastric structures. d) The client doesn't exhibit rectal tenesmus.

A) The client is free from esophagitis and achalasia. Dysphagia may be the reason why a client with esophagitis or achalasia seeks treatment. Therefore, when the client is free of esophagitis or achalasia, he is ready for discharge. Dysphagia isn't associated with rectal tenesmus, duodenal inflammation, or abnormal gastric structures.

Which of the following would be most important to ensure that a client does not retain any barium after a barium swallow? a) Observing the color of urine. b) Placing any stool passed in a specific preservative. c) Monitoring the stool passage and its color. d) Monitoring the volume of urine.

ANSWER: C Monitoring the stool passage and its color.Explanation: Monitoring stool passage and its color will ensure that the client remains barium free following a barium swallow test. The white or clay color of the stool would indicate barium retention. The stool should be placed in a special preservative if the client undergoes a stool analysis. Observing the color and volume of urine will not ensure that the client is barium free because barium is not eliminated through urine but through stool.

. While palpating a female client's right upper quadrant (RUQ), the nurse would expect to find which of the following structures? a. Sigmoid colon b. Appendix c. Spleen d. Liver

Answer D. The RUQ contains the liver, gallbladder, duodenum, head of the pancreas, hepatic flexure of the colon, portions of the ascending and transverse colon, and a portion of the right kidney. The sigmoid colon is located in the left lower quadrant; the appendix, in the right lower quadrant; and the spleen, in the left upper quadrant.

A nurse is teaching an elderly client about good bowel habits. Which statement by the client indicates to the nurse that additional teaching is required? a) "I need to drink 2 to 3 liters of fluids every day." b) "I should exercise four times per week." c) "I need to use laxatives regularly to prevent constipation." d) "I should eat a fiber-rich diet with raw, leafy vegetables, unpeeled fruit, and whole grain bread."

C) "I need to use laxatives regularly to prevent constipation." The client requires more teaching if he states that he'll use laxatives regularly to prevent constipation. The nurse should teach this client to gradually eliminate the use of laxatives because using laxatives to promote regular bowel movements may have the opposite effect. A high-fiber diet, ample amounts of fluids, and regular exercise promote good bowel health.

The nurse is preparing to measure the client's abdominal girth as part of the physical examination. At which location would the nurse most likely measure? a) At the lower border of the liver b) In the right upper quadrant c) At the umbilicus d) Just below the last rib

C) At the umbilicus Measurement of abdominal girth is done at the widest point, which is usually the umbilicus. The right upper quadrant, lower border of the liver, or just below the last rib would be inappropriate sites for abdominal girth measurement.

A client is scheduled for an esophagogastroduodenoscopy (EGD) to detect lesions in the gastrointestinal tract. The nurse would observe for which of the following while assessing the client during the procedure? a) Signs of perforation b) Gag reflex c) Client's tolerance for pain and discomfort d) Client's ability to retain the barium

C) Client's tolerance for pain and discomfort The nurse has to assess the client's tolerance for pain and discomfort during the procedure. The nurse should assess the signs of perforation and the gag reflex after the procedure of EGD and not during the procedure. Assessing the client's level for retaining barium is important for a diagnostic test that involves the use of barium. EGD does not involve the use of barium.

Which of the following would be the least important assessment in a patient diagnosed with ascites? a) Measurement of abdominal girth b) Palpation of abdomen for a fluid shift c) Foul-smelling breath d) Weight

C) Foul smelling breath Foul-smelling breath would not be considered an important assessment for this patient. Measurement of abdominal girth, weight, and palpation of the abdomen for a fluid shift are all important assessment parameters for the patient diagnosed with ascites.

A nurse is preparing a client for surgery. During preoperative teaching, the client asks where is bile stored. The nurse knows that bile is stored in the: a) Cystic duct b) Duodenum c) Gallbladder d) Common bile duct

C) GallbladderThe gallbladder functions as a storage depot for bile

Crohn's disease is a condition of malabsorption caused by which of the following pathophysiological processes? a) Gastric resection b) Infectious disease c) Inflammation of all layers of intestinal mucosa d) Disaccharidase deficiency

C) Inflammation of all layers of intestinal mucosaCrohn's disease is also known as regional enteritis and can occur anywhere along the GI tract, but most commonly at the distal ileum and in the colon. Infectious disease causes problems such as small bowel bacterial overgrowth leading to malabsorption. Disaccharidase deficiency leads to lactose intolerance. Postoperative malabsorption occurs after gastric or intestinal resection.

While palpating a client's right upper quadrant (RUQ), the nurse would expect to find which structure? a) Spleen b) Appendix c) Liver d) Sigmoid colon

C) LiverThe RUQ contains the liver, gallbladder, duodenum, head of the pancreas, hepatic flexure of the colon, portions of the ascending and transverse colon, and a portion of the right kidney. The sigmoid colon is located in the left lower quadrant; the appendix, in the right lower quadrant; and the spleen, in the left upper quadrant.

When bowel sounds are heard about every 15 seconds, the nurse would record that the bowel sounds are? a) absent. b) hypoactive. c) normal. d) sluggish.

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

The nurse asks a client to point to where she feels pain. The client asks why this is important. The nurse's best response would be which of the following? a) "This determines the pain medication to be ordered." b) "If the doctor massages over the exact painful area, the pain will disappear." c) "Often the area of pain is referred from another area." d) "The area may determine the severity of the pain."

C) Often the area of pain is referred from another areaPain 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.

Which of the following represents the medication classification of a proton (gastric acid) pump inhibitor? a) Famotidine (Pepcid) b) Metronidazole (Flagyl) c) Omeprazole (Prilosec) d) Sucralfate (Carafate)

C) Omeprazole Omeprazole decreases gastric acid by slowing the hydrogen-potassium adenosine triphosphatase pump on the surface of the parietal cells. Sucralfate is a cytoprotective drug. Famotidine is a histamine-2 receptor antagonist. Metronidazole is an antibiotic, specifically an amebicide.

The nurse is caring for a client with cirrhosis. Which assessment findings indicate that the client has deficient vitamin K absorption caused by this hepatic disease? a) Ascites and orthopnea b) Gynecomastia and testicular atrophy c) Purpura and petechiae d) Dyspnea and fatigue

C) Purpura and petechiaeA hepatic disorder, such as cirrhosis, may disrupt the liver's normal use of vitamin K to produce prothrombin (a clotting factor). Consequently, the nurse should monitor the client for signs of bleeding, including purpura and petechiae. Dyspnea and fatigue suggest anemia. Ascites and orthopnea are unrelated to vitamin K absorption. Gynecomastia and testicular atrophy result from decreased estrogen metabolism by the diseased liver.

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

ANSWER:A PepsinExplanation: Pepsin is secreted by the gastric mucosa. Trypsin is secreted by the pancreas. The salivary glands secrete ptyalin. The liver and gallbladder secrete bile.

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

AmylaseExplanation: Digestive enzymes secreted by the pancreas include trypsin, which aids in digesting protein; amylase, which aids in digesting starch; and lipase, which aids in digesting fats. Bile is secreted by the liver and is not considered a digestive enzyme.

A male client with a recent history of rectal bleeding is being prepared for a colonoscopy. How should the nurse position the client for this test initially? 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

Answer B. 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.

To prevent gastroesophageal reflux in a client with hiatal hernia, the nurse should provide which discharge instruction? a) "Lie down after meals to promote digestion." b) "Avoid coffee and alcoholic beverages." c) "Limit fluid intake with meals." d) "Take antacids with meals."

B) Avoid coffee and alcoholic beveragesTo prevent reflux of stomach acid into the esophagus, the nurse should advise the client to avoid foods and beverages that increase stomach acid, such as coffee and alcohol. The nurse also should teach the client to avoid lying down after meals, which can aggravate reflux, and to take antacids after eating. The client need not limit fluid intake with meals as long as the fluids aren't gastric irritants.

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 dairy products. b) Encourage plenty of fluids. c) Serve the client his usual diet. d) Order a high-fiber diet.

B) 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 receives a local anesthetic to suppress the gag reflex for a diagnostic procedure of the upper GI tract. Which of the following nursing interventions is advised for this patient? a) The client should be monitored for any breathing related disorder or discomforts b) The client should not be given any food and fluids until the gag reflex returns c) The client should be monitored for cramping or abdominal distention d) The client's fluid output should be measured for at least 24 hours after the procedure

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

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. The nurse tells the client that products of digestion are absorbed mainly in the :a) rectum .b) stomach .c) small intestine. d) large intestine.

C) Small intestine 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.

A client with cholelithiasis has a gallstone lodged in the common bile duct. When assessing this client, the nurse expects to note: a) black, tarry stools. b) circumoral pallor. c) light amber urine. d) yellow sclerae.

D) Yellow scleraeYellow sclerae are an early sign of jaundice, which occurs when the common bile duct is obstructed. Urine normally is light amber. Circumoral pallor and black, tarry stools don't occur in common bile duct obstruction; they are signs of hypoxia and GI bleeding, respectively.

True or False?Obsruction of the biliary tract is indicated by increased unconjugated (indirect) bilirubin levels in the blood.

False Obsruction of the biliary tract is indicated by increased conjugated (direct) bilirubin levels in the blood.

True or False? The secretion of hydrochloric acid and pepsinogen is stimulated by the sight, smell, and taste of food.

True

A patient receives atropine, an anticholinergic drug, in preparation for surgery. The nurse expects this drug to affect the GI tract by: a) increasing gastric emptying b) relaxing pyloric and ileocecal sphincters c) decreasing secretions and peristaltic action d) stimulating the nervous system of the GI tract

c) decreasing secretions and peristaltic action The parasympathetic nervous system increasing motility and secretions and relaxing sphincters to promote movement of contents. A drug that blocks this activity decreases secretions and peristalsis, slows gastric emptying, and contracts sphincters. The enteric nervous system of the GI tract is modulated by sympathetic and parasympathetic influence

What parts make up the large intestine? a. Ileum, ascending colon, transverse colon, descending colon, sigmoid colon, rectum and anus b. Jejunum, ileum, duodenum, cecum c. Cecum with vermiform appendix, ascending colon, transverse colon, descending colon, sigmoid colon, rectum and anus d. Appendix, cecum, ileum, jejunum, duodenum, rectum and anus

c. Cecum with vermiform appendix, ascending colon, transverse colon, descending colon, sigmoid colon, rectum and anus

After eating, a patient with an inflamed gallbladder experiences pain caused by contraction of the gallbladdder. The mechanism responsible for this action is a) production of bile by the liver b) production of secretin by the duodenum c) release of gastrin from the stomach antrum d) production of cholecystokinin by the duodenum

d) production of cholecystokinin by the duodenum Cholecystokinin is secreted by the duodenal mucosa when fats and amino acids enter the duodenum and stimulates the gallbladder to release bile and emulsify the fats for digestion. The bile is produced by the liver but stored in the gallbladder. Secretin is responsible for stimulating pancreatic bicarbonate secretion, and gastrin increases gastric motility and acid secretion.

Bile empties into the duodenum through what structure? a. Biliary artery b. Common hepatic duct c. Pyloric sphincter d. Common bile duct

d. Common bile duct

Which of the following terms is used to refer to intestinal rumbling? a) Diverticulitis b) Tenesmus c) Borborygmus d) Azotorrhea

C) BorborygmusBorborygmus is the intestinal rumbling that accompanies diarrhea. Tenesmus is the term used to refer to ineffectual straining at stool. Azotorrhea is the term used to refer to excess of nitrogenous matter in the feces or urine. Diverticulitis refers to inflammation of a diverticulum from obstruction (by fecal matter) resulting in abscess formation.

After assessing a client with peritonitis, the nurse most likely would document the client's bowel sounds as: a) Absent b) High-pitched. c) Mild. d) Hyperactive.

A) Absent Since lack of bowel motility typically accompanies peritonitis, bowel sounds are absent. Therefore, the nurse will not observe mild, high-pitched, or hyperactive bowel sounds.

When caring for a patient with a biliary obstruction, the nurse will anticipate administering which of the following vitamin supplements (select all that apply)? A) Vitamin A B) Vitamin D C) Vitamin E D) Vitamin K

A,B,C,DBiliary obstruction prevents bile from entering the small intestine and thus prevents the absorption of fat-soluble vitamins. Vitamins A, D, E, and K are all fat soluble and thus would need to be supplemented in a patient with biliary obstruction.

Which condition is most likely to have a nursing diagnosis of fluid volume deficit? a. Appendicitis b. Pancreatitis c. Cholecystitis d. Gastric ulcer

Answer B. Hypovolemic shock from fluid shifts is a major factor in acute pancreatitis. The other conditions are less likely to exhibit fluid volume deficit.

The nurse is preparing to interview a client with cirrhosis. Based on an understanding of this disorder, which question would be most important to include? a) "What type of over-the-counter pain reliever do you use?" b) "How often do you drink alcohol?" c) "Have you had an infection recently?" d) "Does your work expose you to chemicals?

B) How often do you drink alcohol? The most common type of cirrhosis results from chronic alcohol intake and is frequently associated with poor nutrition. Although it can follow chronic poisoning with chemicals or ingestion of hepatotoxic drugs such as acetaminophen, asking about alcohol intake would be most important. Asking about an infection or exposure to hepatotoxins or industrial chemicals would be important if the client had postnecrotic cirrhosis.

A client is evaluated for severe pain in the right upper abdominal quadrant, which is accompanied by nausea and vomiting. The physician diagnoses acute cholecystitis and cholelithiasis. For this client, which nursing diagnosis takes top priority? a) Imbalanced nutrition: Less than body requirements related to biliary inflammation b) Anxiety related to unknown outcome of hospitalization c) Deficient knowledge related to prevention of disease recurrence d) Acute pain related to biliary spasms

D) Acute pain related to biliary spasms The chief symptom of cholecystitis is abdominal pain or biliary colic. Typically, the pain is so severe that the client is restless and changes positions frequently to find relief. Therefore, the nursing diagnosis of Acute pain related to biliary spasms takes highest priority. Until the acute pain is relieved, the client can't learn about prevention, may continue to experience anxiety, and can't address nutritional concerns.

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? a) Hydrochloric acid b) Histamine c) Liver enzyme d) Intrinsic factor

D) Intrinsic factor 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.

A nurse is reviewing laboratory test results from a client. The report indicates that the client has jaundice. What serum bilirubin level must the client's finding exceed? Enter the correct number only.

Jaundice becomes clinically evident when the serum bilirubin level exceeds 2.5 mg/dL (43 fmol/L).

True or False? The nurse encourages that patient with chronic constipation to attempt defecation after the first meal of the day because gastrocolic and duodenocolic reflexes increase colon peristalsis at that time.

True

True or False? The structure that prevents reflux of stomach contents into the esophagus is the upper esophageal sphincter.

True or False? The structure that prevents reflux of stomach contents into the esophagus is the upper esophageal sphincter.

An adult is admitted with a duodenal ulcer. On the second day after admission, the client develops severe, persistent pain radiating to the shoulder. What action should the nurse take first? 1. Notify the physician. 2. Place client in a high-Fowler's position to decrease pressure on the gastric area and shoulder. 3. Examine the client for board-like rigidity of the abdomen. 4. Administer ordered prn pain medication.

(3) The nurse should first do a quick assessment to determine if the cause of the pain is more apt to be perforation of the ulcer or something else such as cardiac pain. If the ulcer has perforated the client's abdomen will be tender and rigid - board like.

An adult male is admitted to the hospital complaining of burning epigastric pain. He reports to the nurse that he has gained 14 pounds over the last two months. Which nursing response is best? 1. "Why were you eating more?" 2. "Has the weight gain been intentional?" 3. "Does your weight usually fluctuate this much?" 4. "How did your eating habits change?"

(4) Weight gain may occur due to increased consumption of food as the client tries to feed a duodenal ulcer. "Why" questions are threatening to clients. #3 asks for a yes or no answer. This will not give as much information as asking about the eating habits.

A barium enema is ordered for an adult male client. The nurse is teaching him what to expect regarding the procedure. Which statement should be included in the teaching? 1. Fecal matter must be cleansed from the bowel for good visualization. 2. There will be no food restrictions before the test. 3. He will not have to change positions during the procedure. 4. He will be asked to drink barium during the procedure.

1) The bowel must be free of fecal material for good visualization of the bowel. He will be on a clear liquid or low residue diet for the day preceding the exam. The client is put in several positions during the test. Barium is given by enema. It is given by mouth in an upper GI series.

The nurse caring for a client with small-bowel obstruction would plan to implement which nursing intervention first? a. Administering pain medication b. Obtaining a blood sample for laboratory studies c. Preparing to insert a nasogastric (NG) tube d. Administering I.V. fluids

Answer D. I.V. infusions containing normal saline solution and potassium should be given first to maintain fluid and electrolyte balance. For the client's comfort and to assist in bowel decompression, the nurse should prepare to insert an NG tube next. A blood sample is then obtained for laboratory studies to aid in the diagnosis of bowel obstruction and guide treatment. Blood studies usually include a complete blood count, serum electrolyte levels, and blood urea nitrogen level. Pain medication often is withheld until obstruction is diagnosed because analgesics can decrease intestinal motility

. During preparation for bowel surgery, a male client receives an antibiotic to reduce intestinal bacteria. Antibiotic therapy may interfere with synthesis of which vitamin and may lead to hypoprothrombinemia? a. vitamin A b. vitamin D c. vitamin E d. vitamin K

Answer D. Intestinal bacteria synthesize such nutritional substances as vitamin K, thiamine, riboflavin, vitamin B12, folic acid, biotin, and nicotinic acid. Therefore, antibiotic therapy may interfere with synthesis of these substances, including vitamin K. Intestinal bacteria don't synthesize vitamins A, D, or E.

The nurse is caring for a client with cirrhosis. Which assessment findings indicate that the client has deficient vitamin K absorption caused by this hepatic disease? a) Dyspnea and fatigue b) Ascites and orthopnea c) Purpura and petechiae d) Gynecomastia and testicular atrophy

C) Purpura and petechiaeA hepatic disorder, such as cirrhosis, may disrupt the liver's normal use of vitamin K to produce prothrombin (a clotting factor). Consequently, the nurse should monitor the client for signs of bleeding, including purpura and petechiae. Dyspnea and fatigue suggest anemia. Ascites and orthopnea are unrelated to vitamin K absorption. Gynecomastia and testicular atrophy result from decreased estrogen metabolism by the diseased liver. Which type of jaundice seen in adults is the result of increased destruction of red blood cells?a) Obstructiveb) Nonobstructivec) Hepatocellulard) Hemolytic D) Hemolytic Hemolytic jaundice results because, although the liver is functioning normally, it cannot excrete the bilirubin as quickly as it is formed. Obstructive jaundice is the result of liver disease. Nonobstructive jaundice occurs with hepatitis. Hepatocellular jaundice is the result of liver disease.

A group of students are studying for an examination on the gastrointestinal (GI) system and are reviewing the structures of the esophagus and stomach. The students demonstrate understanding of the material when they identify which of the following as the opening between the stomach and duodenum? a) Hypoharyngeal sphincter b) Cardiac sphincter c) Pyloric sphincter d) Ileocecal valve

C) Pyloric SphincterThe pyloric sphincter is the opening between the stomach and duodenum. The cardiac sphincter is the opening between the esophagus and the stomach. The hypopharyngeal sphincter or upper esophageal sphincter prevents food or fluids from re-entering the pharynx. The ileocecal valve is located at the distal end of the small intestine and regulates flow of intestinal contents into the large intestine.

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) Large intestine b) Ileum c) Stomach d) Liver

C) Stomach The upper gastrointestinal (GI) tract begins at the mouth and ends at the jejunum. Therefore, the stomach would be a component of the upper GI tract. The lower GI tract begins at the ileum and ends at the anus. The liver is considered an accessory structure.

Which of the following would a nurse expect to assess in a client with peritonitis? a) Decreased pulse rate b) Deep slow respirations c) Hyperactive bowel sounds d) Board-like abdomen

D) Board-like abdomenThe client with peritonitis would typically exhibit a rigid, board-like abdomen, with absent bowel sounds, elevated pulse rate, and rapid, shallow respirations.

The client is experiencing swallowing difficulties and is now scheduled to receive a gastric feeding. She has the following oral medications prescribed: furosemide (Lasix), digoxin, enteric coated aspirin (Ecotrin), and vitamin E. The nurse withholds a) furosemide b) digoxin c) vitamin E d) enteric coated aspirin

D) Enteric coated aspirin Simple compressed tablets (furosemide, digoxin) may be crushed and dissolved in water. Soft gelatin capsules filled with liquid (vitamin E) may be opened, and the contents squeezed out. Enteric coated tablets (enteric coated aspirin) are not to be crushed and a change in the form of the medications is required.

Which of the following is the major carbohydrate that tissue cells use as fuel? a) Proteins b) Fats c) Chyme d) Glucose

D) GlucoseGlucose is the major carbohydrate that tissue cells use as fuel. Proteins are a source of energy after they are broken down into amino acids and peptides. Chyme stays in the small intestine for 3 to 6 hours, allowing for continued breakdown and absorption of nutrients. Ingested fats become monoglycerides and fatty acids by the process of emulsification.

Which type of jaundice seen in adults is the result of increased destruction of red blood cells? a) Obstructive b) Nonobstructive c) Hepatocellular d) Hemolytic

D) Hemolytic Hemolytic jaundice results because, although the liver is functioning normally, it cannot excrete the bilirubin as quickly as it is formed. Obstructive jaundice is the result of liver disease. Nonobstructive jaundice occurs with hepatitis. Hepatocellular jaundice is the result of liver disease.

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 drink full liquids the day before the test. "b) "There is no need for special preparation before the test." c) "I'll take a laxative to clear my bowels before the test." d) "I'll avoid eating or drinking anything 6 to 8 hours before the test."

D) I'll avoid eating or drinking anything 6 to 8 hours before the test The client demonstrates understanding of a barium swallow when 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.

Which of the following is a parasympathetic response in the GI tract? a) Blood vessel constriction b) Decreased gastric secretion c) Decreased motility d) Increased peristalsis

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

A client is admitted with a diagnosis of acute appendicitis. When assessing the abdomen, the nurse would expect to find rebound tenderness at which location? a) Left lower quadrant b) Left upper quadrant c) Right upper quadrant d) Right lower quadrant

D) Right lower quadrant The pain of acute appendicitis localizes in the right lower quadrant (RLQ) at McBurney's point, an area midway between the umbilicus and the right iliac crest. Often, the pain is worse when manual pressure near the region is suddenly released, a condition called rebound tenderness.

Atropine 0.5 mg is ordered for a client having an acute attack of cholecystitis. What is the primary purpose of this drug for this client? 1. decrease skeletal muscle spasms. 2. increase gastrointestinal peristalsis 3. decrease smooth muscle contractions 4. decrease anxiety

(3) Atropine is an anticholinergic drug , which will decrease contractions of the gallbladder.

1. An adult who has cholecystitis reports clay colored stools and moderate jaundice. Which is the best explanation for the presence of clay colored stools and jaundice? 1. There is an obstruction in the pancreatic duct. 2. There are gallstones in the gallbladder. 3. Bile is no longer produced by the gallbladder. 4. There is an obstruction in the common bile duct.

(4) Clay colored stools means bile is not getting through to the duodenum. The bile duct is obstructed so bile backs up into the bloodstream causing jaundice

Which of the following sequence should be used to assess the abdomen? a) Palpation, inspection, percussion, auscultation b) Auscultation, inspection, percussion, palpation c) Inspection, auscultation, percussion, palpation d) Percussion, auscultation, palpation, inspection

A Inspection, auscultation, percussion, palpationExplanation: Assessment begins with an overall visual inspection of the abdomen followed by auscultation, which always precedes percussion and palpation since manipulation of the abdomen may alter the frequency and intensity of bowel sounds. Inspection allows the nurse to visualize the skin, umbilicus, contour, and symmetry of abdomen and any movement or pulsations.

After 20 seconds of auscultating for bowel sounds on a client recovering from abdominal surgery, the nurse hears nothing. Which of the following should the nurse do based on the assessment findings? a) Listen longer for the sounds. b) Call the physician to report absent bowel sounds. c) Document that the client is constipated. d) Return in 1 hour and listen again to confirm findings.

A nurse is reviewing the history and physical of a client admitted for a hemorrhoidectomy. Which predisposing condition does the nurse expect to see?a) Constipationb) Hypoglycemiac) Lactic acidosisd) Hyperkalemia A) ConstipationOrthostatic hypertension and other conditions associated with persistently high intra-abdominal pressure (such as pregnancy) can lead to hemorrhoids. The passing of hard stools, not diarrhea, can aggravate hemorrhoids. Diverticulosis has no relationship to hemorrhoids. Rectal bleeding is a symptom of hemorrhoids, not a predisposing condition. After 20 seconds of auscultating for bowel sounds on a client recovering from abdominal surgery, the nurse hears nothing. Which of the following should the nurse do based on the assessment findings?a) Listen longer for the sounds.b) Call the physician to report absent bowel sounds.c) Document that the client is constipated.d) Return in 1 hour and listen again to confirm findings. A) Listen longer for soundsAuscultation is used to determine the character, location, and frequency of bowel sounds. The frequency and character of sounds are usually heard as clicks and gurgles that occur irregularly and range from 5 to 35 per minutes. Normal sounds are heard about every 5 to 20 seconds, whereas hypoactive sounds can be one or two sounds in 2 minutes. Postoperatively, it is common for sounds to be reduced; therefore, the nurse needs to listen at least 3 to 5 minutes to verify absent or no bowel sounds.

A client with liver and renal failure has severe ascites. On initial shift rounds, his primary nurse finds his indwelling urinary catheter collection bag too full to store more urine. The nurse empties more than 2,000 ml from the collection bag. One hour later, she finds the collection bag full again. The nurse notifies the physician, who suspects that a bladder rupture is allowing the drainage of peritoneal fluid. The physician orders a urinalysis to be obtained immediately. The presence of which substance is considered abnormal? a) Albumin b) Chloride c) Urobilinogen d) Creatinine

A) AlbuminAlbumin is an abnormal finding in a routine urine specimen. Ascites present in liver failure contain albumin; therefore, if the bladder ruptured, ascites containing albumin would drain from the indwelling urinary catheter because the catheter is no longer contained in the bladder. Creatinine, urobilinogen, and chloride are normally found in urine.

A client is admitted for suspected GI disease. Assessment data reveal muscle wasting, a decrease in chest and axillary hair, and increased bleeding tendency. The nurse suspects the client has: a) cirrhosis. b) cholelithiasis. c) appendicitis. d) peptic ulcer disease.

A) Cirrhosis Muscle wasting, a decrease in chest and axillary hair, and increased bleeding tendencies are all symptoms of cirrhosis. The client may also have mild fever, edema, abdominal pain, and an enlarged liver. Clients with peptic ulcer disease complain of a dull, gnawing epigastric pain that's relieved by eating. Appendicitis is characterized by a periumbilical pain that moves to the right lower quadrant and rebound tenderness. Cholelithiasis is characterized by severe abdominal pain that presents several hours after a large meal.

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) Encourage plenty of fluids. b) Order a high-fiber diet. c) Serve dairy products. d) Serve the client his usual diet.

A) Encourage plenty of fluidsThe 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.

Which outcome indicates effective client teaching to prevent constipation? a) The client reports engaging in a regular exercise regimen. b) The client limits water intake to three glasses per day. c) The client verbalizes consumption of low-fiber foods. d) The client maintains a sedentary lifestyle.

A) The client reports engaging in a regular exercise regimen. The client having a regular exercise program indicates effective teaching. A regular exercise regimen promotes peristalsis and contributes to regular bowel elimination patterns. A low-fiber diet, a sedentary lifestyle, and limited water intake would predispose the client to constipation.

One or two bowel sounds in 2 minutes would be documented as which of the following? a) Hypoactive b) Hyperactive c) Normal d) Absent

ANSWER:A HypoactiveExplanation: 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.

Choice Multiple question - Select all answer choices that apply.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) Dim the lights to decrease the client's embarrassment. c) Cleanse gloved fingers with water to allow for easy insertion. d) Ask the client to produce a bowel movement after the procedure. e) Ask the client to bear down for visual inspection.

ANSWER:A & D 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.

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) Cecum b) Jejunum c) Duodenum d) Ileum

ANSWER:C 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.

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

ANswer C Increased motility of the stomachExplanation: 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.

While a female client is being prepared for discharge, the nasogastric (NG) feeding tube becomes clogged. To remedy this problem and teach the client's family how to deal with it at home, what should the nurse do? a. Irrigate the tube with cola. b. Advance the tube into the intestine. c. Apply intermittent suction to the tube. d. Withdraw the obstruction with a 30-ml syringe.

Answer A. The nurse should irrigate the tube with cola because its effervescence and acidity are suited to the purpose, it's inexpensive, and it's readily available in most homes. Advancing the NG tube is inappropriate because the tube is designed to stay in the stomach and isn't long enough to reach the intestines. Applying intermittent suction or using a syringe for aspiration is unlikely to dislodge the material clogging the tube but may create excess pressure. Intermittent suction may even collapse the tube.

The nurse is caring for a male client with cirrhosis. Which assessment findings indicate that the client has deficient vitamin K absorption caused by this hepatic disease? a. Dyspnea and fatigue b. Ascites and orthopnea c. Purpura and petechiae d. Gynecomastia and testicular atrophy

Answer C. A hepatic disorder, such as cirrhosis, may disrupt the liver's normal use of vitamin K to produce prothrombin (a clotting factor). Consequently, the nurse should monitor the client for signs of bleeding, including purpura and petechiae. Dyspnea and fatigue suggest anemia. Ascites and orthopnea are unrelated to vitamin K absorption. Gynecomastia and testicular atrophy result from decreased estrogen metabolism by the diseased liver.

A male client with cholelithiasis has a gallstone lodged in the common bile duct. When assessing this client, the nurse expects to note: a. yellow sclerae. b. light amber urine. c. circumoral pallor. d. black, tarry stools

Answer D. The RUQ contains the liver, gallbladder, duodenum, head of the pancreas, hepatic flexure of the colon, portions of the ascending and transverse colon, and a portion of the right kidney. The sigmoid colon is located in the left lower quadrant; the appendix, in the right lower quadrant; and the spleen, in the left upper quadrant.

A client receives a local anesthetic to suppress the gag reflex for a diagnostic procedure of the upper GI tract. Which of the following nursing interventions is advised for this patient? a) The client should be monitored for any breathing related disorder or discomforts b) The client should not be given any food and fluids until the gag reflex returns c) The client should be monitored for cramping or abdominal distention d) The client's fluid output should be measured for at least 24 hours after the procedure

B) Drink liquids only between meals.A client who experiences dumping syndrome after a subtotal gastrectomy should be advised to ingest liquids between meals rather than with meals. Taking fluids between meals allows for adequate hydration, reduces the amount of bulk ingested with meals, and aids in the prevention of rapid gastric emptying. There is no need to restrict the amount of fluids, just the time when the client drinks fluids. Drinking liquids with meals increases the risk of dumping syndrome by increasing the amount of bulk and stimulating rapid gastric emptying. Small amounts of water are allowable before meals.

Nursing assessment of a client with peritonitis reveals hypotension, tachycardia, and signs and symptoms of dehydration. The nurse also expects to find: a) tenderness and pain in the right upper abdominal quadrant. b) severe abdominal pain with direct palpation or rebound tenderness. c) jaundice and vomiting. d) rectal bleeding and a change in bowel habits.

B) Severe abdominal pain with direct palpation or rebound tendernessPeritonitis decreases intestinal motility and causes intestinal distention. A classic sign of peritonitis is a sudden, diffuse, severe abdominal pain that intensifies in the area of the underlying causative disorder (such as appendicitis, diverticulitis, ulcerative colitis, or a strangulated obstruction). The client may also have rebound tenderness. Tenderness and pain in the right upper abdominal quadrant suggest cholecystitis. Jaundice and vomiting are signs of cirrhosis of the liver. Rectal bleeding or a change in bowel habits may indicate colorectal cancer.

A nurse is providing care for a client recovering from gastric bypass surgery. During assessment, the client exhibits pallor, perspiration, palpitations, headache, and feelings of warmth, dizziness, and drowsiness. The client reports eating 90 minutes ago. The nurse suspects: a) Peritonitis b) A normal reaction to surgery c) Dehiscence of the surgical wound d) Vasomotor symptoms associated with dumping syndrome

D) Vasomotor symptoms associated with dumping syndromeEarly manifestations of dumping syndrome occur 15 to 30 minutes after eating. Signs and symptoms include vertigo, tachycardia, syncope, sweating, pallor, palpitations, diarrhea, nausea, and the desire to lie down. Dehiscence of the surgical wound is characterized by pain and a pulling or popping feeling at the surgical site. Peritonitis presents with a rigid, boardlike abdomen, tenderness, and fever. The client's signs and symptoms aren't a normal reaction to surgery. A nurse is caring for a client with active upper GI bleeding. What is the appropriate diet for this client during the first 24 hours after admission?a) Skim milkb) Nothing by mouthc) Regular dietd) Clear liquids B) NPO Shock and bleeding must be controlled before oral intake, so the client should receive nothing by mouth. When the bleeding is controlled, the diet is gradually increased, starting with ice chips and then clear liquids. Skim milk shouldn't be given because it increases gastric acid production, which could prolong bleeding. A clear liquid diet is the first diet offered after bleeding and shock are controlled.

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

STUDY PLAY A client presents with complaints of blood in her stools. Upon inspection, the nurse notes streaks of bright red blood visible on the outer surface of formed stool. Which of the following will the nurse further investigate with this client? a) Ingestion of cherry sodab) Ingestion of cocoac) Presence or history of hemorrhoidsd) Recent barium studies C) Presence or history of hemorrhoids Stool is normally light to dark brown. Blood in the stool can present in various ways and must be investigated. Lower rectal or anal bleeding is suspected if there is streaking of blood on the surface of the stool or blood is noted on toilet tissue. 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 client may eat a light meal before either test.b) Both tests need to be done before breakfast.c) The upper GI should be scheduled before the ultrasonography.d) The ultrasonography should be scheduled before the GI procedure. d) 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.