Hinkle Ch 38: Assessment of Digestive and Gastrointestinal Function

After 20 seconds of auscultating for bowel sounds on a client recovering from abdominal surgery, the nurse hears nothing. What should the nurse do based on the assessment findings? - Listen longer for the sounds. - Document that the client is constipated. - Call the health care provider to report absent bowel sounds. - Return in 1 hour and listen again to confirm findings.

- Listen longer for the sounds. Explanation: Auscultation 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.

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

- duodenal ulcer Explanation: Clients with duodenal ulcers usually secrete an excess amount of hydrochloric acid. Clients with chronic atrophic gastritis secrete little or no acid. Clients with gastric cancer secrete little or no acid. Clients with pernicious anemia secrete no acid under basal conditions or after stimulation.

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." - "I'll drink full liquids the day before the test." - "There is no need for special preparation before the test." - "I'll take a laxative to clear my bowels before the test."

- "I'll avoid eating or drinking anything 6 to 8 hours before the test." Explanation: The client demonstrates understanding of a barium swallow when stating he or she must refrain from eating or drinking for 6 to 8 hours before the test. No other preparation is needed. Before a lower GI series, the client should eat a low-residue or clear liquid diet for 2 days and take a potent laxative and an oral liquid preparation.

When completing a nutritional assessment of a patient who is admitted for a GI disorder, the nurse notes a recent history of dietary intake. This is based on the knowledge that a portion of digested waste products can remain in the rectum for how many days after a meal is digested? - 1 day - 2 days - 3 days - 4 days

- 3 days Explanation: As much as 25% of the waste products from a meal may still be in the rectum 3 days after a meal is ingested.

Which of the following digestive enzymes aids in the digesting of starch? - Amylase - Lipase - Trypsin - Bile

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

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

- Avoid smoking for at least 12 to 24 hours before the procedure. Explanation: The nurse should instruct the client to avoid smoking for at least a day before the procedure of barium swallow because smoking stimulates gastric motility. The client is advised to take vitamin K before a liver biopsy and instructed to take three cleansing enemas before a barium enema. Instruction to avoid red meat would be appropriate for a client who is having a Hemoccult test.

Which of the following is the most definitive means of assessing for liver disease? - Biopsy - Paracentesis - Cholecystography - Ultrasonography

- Biopsy Explanation: Liver biopsy is the most effective means of diagnosing liver disease. Guided liver biopsy can be conducted using laparoscopy, the insertion of a fiberoptic endoscope through a small abdominal incision. Paracentesis is the removal of fluid (ascites) from the peritoneal cavity through a puncture or a small surgical incision through the abdominal wall under sterile conditions. Cholecystography and ultrasonography may be used to detect gallstones. Ultrasonography may also be used to visualize the liver and diagnose conditions such as liver fibrosis; noninvasive techniques such as this can reduce the need for liver biopsy.

The nurse is to obtain a stool specimen from a client who reported that he is taking iron supplements. The nurse would expect the stool to be which color? - Dark brown - Green - Red - Black

- Black Explanation: Ingestion of iron can cause the stool to turn black. Meat protein causes stool to appear dark brown. Ingestion of large amounts of spinach may turn stool green while ingestion of carrots and beets may cause stool to turn red.

A client reports a history of bleeding hemorrhoids to the nurse. Which observation supports the client's statement? - Hard, dry stool - Dark red stool - Black tarry stool - Blood streaks on stool

- Blood streaks on stool Explanation: 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 if blood is noted on toilet tissue. Hard, dry stool occurs in constipation. If blood is shed in sufficient quantities into the upper GI tract, it produces a dark red color, a tarry-black color, or melena.

Which response is a parasympathetic response in the GI tract? - decreased gastric secretion - blood vessel constriction - increased peristalsis - decreased motility

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

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

- Increased motility of the stomach Explanation: Gastrin has the following effects on GI motility: increased motility of the stomach, excitation of the colon, relaxation of ileocecal sphincter, and contraction of the gastroesophageal sphincter.

The nurse is working with clients with digestive tract disorders. Which of the following organs does the nurse realize has effects as an exocrine gland and an endocrine gland? - Gallbladder - Pancreas - Stomach - Liver

- Pancreas Explanation: The pancreas is both an exocrine gland, one that releases secretions into a duct or channel, and an endocrine gland, one that releases substances directly into the bloodstream. The other organs have a variety of functions but do not have a combination function such as the pancreas.

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 - Atropine - Glycopyrronium bromide - Acetylcysteine

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

The nurse determines a client scheduled to undergo an abdominal ultrasonography should receive which instruction? - Do not undertake any strenuous exercise for 24 hours before the test. - Do not consume anything sweet for 24 hours before the test. - Avoid exposure to sunlight for at least 6 to 8 hours before the test. - Restrict eating of solid food for 6 to 8 hours before the test.

- Restrict eating of solid food for 6 to 8 hours before the test. Explanation: A client scheduled to undergo an abdominal ultrasonography should restrict eating of all 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.

The instructor has just finished 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 structure as possibly being affected? - Liver - Ileum - Stomach - Large Intestine

- Stomach Explanation: 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.

The nurse is preparing to examine the abdomen of a client who reports a change in bowel pattern. The nurse would place the client in which position? - Supine with knees flexed - Knee-chest - Lithotomy - Left Sim's lateral

- Supine with knees flexed Explanation: When examining the abdomen, the client lies supine with knees flexed. This position assists in relaxing the abdominal muscles. The lithotomy position commonly is used for a female pelvic examination and to examine the rectum. The knee-chest position can be used for a variety of examinations, most commonly the anus and rectum. The left Sim's lateral position may be used to assess the rectum or vagina and to administer an enema.

The nurse performs an abdominal assessment. The nurse should perform the assessment in which order? - inspection, palpation, percussion, auscultation - inspection, auscultation, percussion, palpation - auscultation, percussion, inspection, palpation - auscultation, inspection, percussion, palpitation

- inspection, auscultation, percussion, palpation Explanation: The correct order for the abdominal assessment is inspection, auscultation, percussion, and palpation.

A client is scheduled for several diagnostic tests to evaluate gastrointestinal function. After teaching the client about these tests, the nurse determines that the client has understood the teaching when the client identifies which test as not requiring the use of a contrast medium? - Small bowel series - Computer tomography - Colonoscopy - Upper GI series

- Colonoscopy Explanation: A colonoscopy is a direct visual examination of the entire large intestine. It does not involve the use of a contrast agent. Contrast medium may be used with a small bowel series, computed tomography, and upper GI series.

A few hours after eating hot and spicy chicken wings, a client presents with lower chest pain. He wonders if he is having a heart attack. How should the nurse proceed first? - Further investigate the initial complaint. - Explain that fatty foods can mimic chest pain. - Call for an immediate electrocardiogram. - Administer an over-the-counter antacid tablet.

- Further investigate the initial complaint. Explanation: While fatty foods can cause discomfort similar to chest pain, the nurse must fully assess all the client's symptoms. Investigation of chief complaint begins with a complete history. The underlying cause of pain influences the characteristics, duration, pattern, location, and distribution of pain.

A client is scheduled for an upper gastrointestinal barium study. Which teaching will the nurse provide for the client to prepare for this diagnostic test? - Ingest nothing by mouth after midnight. - Eat a clear liquid breakfast before the test. - Withhold oral medications for 24 hours before the test. - Avoid products containing aspirin for a week before the test.

- Ingest nothing by mouth after midnight. Explanation: An upper GI fluoroscopy delineates the entire GI tract after the introduction of a contrast agent such as barium. To prepare for the test, the client should be instructed to ingest nothing after midnight before the test. Clear liquids are not permitted the morning of the test. Most oral medications are withheld the morning of the test, but not for 24 hours before. There is no reason to avoid products containing aspirin for a week before the test.

What part of the GI tract begins the digestion of food? - Mouth - Duodenum - Esophagus - Stomach

- Mouth Explanation: Food that contains starch undergoes partial digestion in the mouth when it mixes with the enzyme salivary amylase, which the salivary glands secrete. Food that contains starch undergoes partial digestion in the mouth.

Which of the following is an enzyme secreted by the gastric mucosa? - Pepsin - Trypsin - Ptyalin - Bile

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

The nurse is caring for a client who is scheduled for a percutaneous liver biopsy. Which diagnostic test is obtained prior? - Complete blood count (CBC) - Prothrombin time (PT) - Blood chemistry - Erythrocyte sedimentation rate (ESR)

- Prothrombin time (PT) Explanation: The client must have coagulation studies (PT, aPTT, INR, platelet count) before the procedure 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.

What would the nurse recognize as preventing a client from being able to take a fecal occult blood test (FOBT)? - The client has hemorrhoidal bleeding - The client had a hamburger for dinner the night before - The client took an ibuprofen tablet this morning - The client regularly takes aspirin

- The client has hemorrhoidal bleeding Explanation: FOBT should not be performed when there is hemorrhoidal bleeding. In the past, clients were taught to avoid aspirin, red meats, nonsteroidal anti-inflammatory agents, and horseradish for 72 hours prior to the examination. However, these restrictions are no longer advised as the actual effects on testing have not been established.

The nurse 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? - The client is probably hypoglycemic and requires the glucagon. - To relieve anxiety during the procedure for moderate sedation. - To reduce air accumulation in the colon. - To relax colonic musculature and reduce spasm.

- To relax colonic musculature and reduce spasm. Explanation: Glucagon may be administered, if needed, to relax the colonic musculature and to reduce spasm during the colonoscopy.

The nurse is scheduling a client for a gastrointestinal motility study. The nurse knows that this type of diagnostic test will aid in determine which of the following alterations? - Esophageal varices - Dumping syndrome - Diabetic gastroparesis - Duodenal disease - Disorders of gastric motility

- Dumping syndrome - Diabetic gastroparesis - Disorders of gastric motility Explanation: Radionuclide testing is used to assess gastric emptying and colonic transit time. During gastric emptying studies, the liquid and solid components of a meal are tagged with radionuclide markers. After ingestion of the meal, the client is positioned under a scintiscanner, which measures the rate of passage of the radioactive substance from the stomach. This is useful in diagnosing disorders of gastric motility, diabetic gastroparesis, and dumping syndrome. A gastrointestinal motility study is not used to diagnose esophageal varices or a duodenal disease. Duodenal disease is diagnosed using fibroscopy.

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

- Permit the client to drink only clear liquids. Explanation: After polyethylene glycol/electrolyte solution is administered, the client should have clear liquids because this ensures watery stools, which are necessary for procedures like a barium enema. Allowing the client to ingest a fat-free meal is used in preparation for oral cholecystography. Instructing the client to have low-residue meals is a pretest procedure for barium enema. A client is offered saline gargles after esophagogastroduodenoscopy.

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

- Positron emission tomography (PET) Explanation: PET produces images of the body by detecting the radiation emitted from radioactive substances. CT provides cross-sectional images of abdominal organs and structures. MRI uses magnetic fields and radio waves to produce an image of the area being studied. Fibroscopy of the upper GI tract allows direct visualization of the esophageal, gastric, and duodenal mucosa through a lighted endoscope.

When describing the role of the pancreas to a client with a pancreatic dysfunction, the nurse would identify which substance as being acted on by pancreatic lipase? - Starch - Protein - Triglycerides - Glucose

- Triglycerides Explanation: Pancreatic lipase acts on lipids, especially triglycerides. Salivary amylase and pancreatic amylase act on starch. Pepsin and hydrochloric acid in the stomach and trypsin from the pancreas act on proteins. Insulin acts on glucose.

A client asks the nurse why the physician ordered the blood test carcinoembryonic antigen (CEA). The nurse answers: - "It tells the physician what type of cancer is present." - "It indicates if a cancer is present." - "It determines functionality of the liver." - "It detects a protein normally found in the blood."

- "It indicates if a cancer is present." Explanation: The carcinoembryonic antigen (CEA) blood test detects the presence of cancer by identifying the presence of a protein not normally detected in the blood of a healthy person. However, it does not indicate what type of cancer is present nor does it detect the functionality of the liver.

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 - jejunum - ileum - cecum

- duodenum Explanation: The duodenum, which is approximately 10 inches long, is the first region of the small intestine and the site where bile and pancreatic enzymes enter.

An older adult client is admitted to an acute care facility for treatment of an acute flare-up of a chronic gastrointestinal condition. In addition to assessing the client for complications of the current illness, the nurse monitors for age-related changes in the gastrointestinal tract. Which age-related change increases the risk of anemia? - Atrophy of the gastric mucosa - Decrease in intestinal flora - Increase in bile secretion - Dulling of nerve impulses

- Atrophy of the gastric mucosa Explanation: Atrophy of the gastric mucosa reduces hydrochloric acid secretion; this, in turn, impairs absorption of iron and vitamin B12, increasing the risk of anemia as a person ages. A decrease in hydrochloric acid increases, not decreases, intestinal flora; as a result, the client is at increased risk for infection, not anemia. A reduction, not increase, in bile secretion may lead to malabsorption of fats and fat-soluble vitamins. Dulling of nerve impulses associated with aging increases the risk of constipation, not anemia.

The major carbohydrate that tissue cells use as fuel is - chyme. - proteins. - glucose. - fats.

- glucose. Explanation: Glucose 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 nursing instruction is correct to provide the client following a barium enema? - The client will maintain a low residue diet. - The stools may be a white or clay colored. - Sips of fluid may be increased if tolerated. - An enema will be used to clear the bowel.

- The stools may be a white or clay colored. Explanation: It is important to instruct the client that it is normal to have a white- or clay-colored stool following the barium enema. The client should report the color of the stool to the nurse. A progression of clay colored stools to brown-colored stools should be noted. The client is prescribed a low-residue diet before the procedure. An increased fluid intake is offered to eliminate the barium from the bowel. The client is encouraged to move the bowel independently.

The nurse prepares to administer the lavage solution to a client having a colonoscopy completed. The nurse stops and notifies the physician when noting that the client has which condition? - inflammatory bowel disease - chronic obstructive pulmonary disease - congestive heart failure - pulmonary hypertension

- inflammatory bowel disease Explanation: The nurse stops administering the lavage solution and notifies the physician when the nurse notes that the client has inflammatory bowel disease. Another contraindication for use of lavage solution is intestinal obstruction. Chronic obstructive pulmonary disease (COPD), congestive heart failure, and pulmonary hypertension are not contraindications to administration of lavage solution in preparation for a colonoscopy.

When bowel sounds are heard about every 15 seconds, the nurse would record that the bowel sounds are - normal. - hypoactive. - sluggish. - absent.

- normal. Explanation: 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.

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

- recent foods ingested. Explanation: The nurse should assess for recent foods that the client ingested, as ingestion of senna can cause the stool to turn yellow. Ingestion of bismuth can turn the stool black and, when occult blood is present, the stool can appear to be tarry black.

The nurse is reviewing the results of a Hemoccult test with the client. Which question asked by the nurse is important in screening for the potential of a false-positive result. Select all that apply. - "Do you take an iron supplement on a daily basis?" - "Does your diet include a moderate amount of vitamin C?" - "Are you prescribed regular strength aspirin daily?" - "Can you tell me the amount of alcohol that you drink on an average week?" - "When was the last time that you included red meat in your diet?"

- "Are you prescribed regular strength aspirin daily?" - "Can you tell me the amount of alcohol that you drink on an average week?" - "When was the last time that you included red meat in your diet?" Explanation: When obtaining a positive Hemoccult test, the client needs to be screened for a false-positive test result. Substances that may cause a false-positive include red meat, aspirin, and excessive alcohol. Screening for the frequency and amount of these are important. False-negative results are screened in individuals who ingest ascorbic acid and iron supplements.

A client with a gastrointestinal condition asks why the mouth needs to be examined. Which response will the nurse make? - "It is a body part that is least examined." - "It is a part of the assessment of every client." - "Your problem is in your mouth and not your abdomen." - "Changes in the mouth can help explain why your condition is occurring."

- "Changes in the mouth can help explain why your condition is occurring." Explanation: A complete assessment of the oral cavity is essential because many disorders, such as cancer, diabetes, and immunosuppressive conditions resulting from medication therapy or acquired immunodeficiency syndrome, may be manifested by changes in the oral cavity, including stomatitis. Assessment of the mouth is not done because it is the body part least examined. It is not assessed because it is a part of every assessment. The nurse has no way of knowing if the client's gastrointestinal problem is in the client's mouth.

A client is scheduled for an ultrasound of the abdomen. Which statement indicates that teaching provided to the client to prepare for the test was effective? - "I will take an over-the-counter enema before the test." - "I will not eat or drink for 8 to 12 hours before the test." - "I will ingest a clear liquid diet for 3 days before the test." - "I will take medications to reduce gastric acid before the test."

- "I will not eat or drink for 8 to 12 hours before the test." Explanation: Ultrasonography is a noninvasive diagnostic technique in which high-frequency sound waves are passed into internal body structures, and the ultrasonic echoes are recorded on an oscilloscope as they strike tissues of different densities. It is particularly useful in the detection of an enlarged gallbladder or pancreas, or the presence of gallstones, an enlarged ovary, an ectopic pregnancy, or appendicitis. The client should be instructed to fast for 8 to 12 hours before the test to decrease the amount of gas in the bowel. Enemas are not needed before an abdominal ultrasound. A clear liquid diet is not needed before the test. Medications to reduce gastric acid are not required before the test.

The nurse is preparing the client for an assessment of the abdomen. What should the nurse complete prior to this assessment? - Prepare for a prostate examination. - Ask the client to empty the bladder. - Assist the client to a Fowler's position. - Dim the lights for privacy.

- Ask the client to empty the bladder. Explanation: The physical examination of the gastrointestinal system includes assessment of the mouth, abdomen, and rectum. It requires good light, full exposure of the abdomen, warm hands with short nails, and a relaxed client with an empty bladder. A full bladder will interfere with inspection and may elicit discomfort with palpation and percussion, thereby altering results.

A client is having a colonic transit study to diagnose a gastrointestinal disorder. Which instruction will the nurse provide to the client after taking a capsule containing radionuclide markers? - Follow a regular diet and usual daily activities. - Ingest a clear liquid diet and take over-the-counter laxatives. - Maintain nothing by mouth status and take oral medications. - Eat a low-fat diet and take proton pump inhibitor medication.

- Follow a regular diet and usual daily activities. Explanation: Colonic transit studies are used to evaluate colonic motility and obstructive defecation syndromes. The client is given a capsule containing 20 radionuclide markers and instructed to follow a regular diet and usual daily activities. There is no reason for the client to follow a clear liquid diet, take over-the-counter laxatives, maintain nothing by mouth status, take oral medications, eat a low-fat diet, or take proton pump inhibitor medications.

A client with abdominal pain is scheduled for a CT scan of the abdomen with contrast. Which assessment will the nurse complete before transporting the client for the diagnostic test? - History of allergies - Presence of a cochlear implant - Last use of an oral laxative - Current list of prescribed medications

- History of allergies Explanation: A CT scan provides cross-sectional images of abdominal organs and structures. A CT scan may be performed with or without oral or intravenous (IV) contrast, but the enhancement of the study is greater with the use of a contrast agent. A common risk from IV contrast agents is allergic reactions; therefore, the client must be screened for this risk. Any allergies to contrast agents, iodine, or shellfish must be determined before administration of a contrast agent. Clients allergic to the contrast agent may be premedicated with a corticosteroid and antihistamine. Therefore, a history of allergies must be completed before the test. Assessing for the presence of a cochlear implant is recommended before magnetic resonance imaging (MRI), but not before a CT scan. The last use of an oral laxative and current list of prescribed medications are not required before a CT scan of the abdomen.

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? - Normal - Hypoactive - Hyperactive - Borborygmi

- Hyperactive Explanation: Bowel sounds are assessed using the diaphragm of the stethoscope for high-pitched and gurgling sounds (Gu, Lim, & Moser, 2010). The frequency and character of the sounds are usually heard as clicks and gurgles that occur irregularly and range from 5 to 35 per minute. The terms normal (sounds heard about every 5 to 20 seconds), hypoactive (one or two sounds in 2 minutes), hyperactive (5 to 6 sounds heard in less than 30 seconds), or absent (no sounds in 3 to 5 minutes) are frequently used in documentation, but these assessments are highly subjective (Li, Wang, & Ma, 2012).

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. - Position the client on the right side with the knees up to the chest. - Ask the client to bear down for visual inspection. - Cleanse gloved fingers with water to allow for easy insertion. - Dim the lights to decrease the client's embarrassment. - Ask the client to produce a bowel movement after the procedure.

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

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? - Cardiac sphincter - Hypopharyngeal sphincter - Ileocecal valve - Pyloric sphincter

- Pyloric sphincter Explanation: The 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.

The nurse is instructing the client who was newly diagnosed with peptic ulcers. Which of the following diagnostic studies would the nurse anticipate reviewing with the client? - A complete blood count including differential - Serum antibodies for H. pylori - A sigmoidoscopy - Gastric analysis

- Serum antibodies for H. pylori Explanation: Helicobacter pylori, a bacterium, is believed to be responsible for the majority of peptic ulcers. Blood tests are used to determine whether there are antibodies to H. pylori in the blood. A complete blood count with differential can indicate bleeding and infection associated with a bleeding ulcer. A sigmoidoscopy assesses the lower gastrointestinal tract. Gastric analysis is more common in analyzing gastric fluid in determining problems with the secretory activity of the gastric mucosa.

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

- Tell the client he shouldn't eat or drink for 6 to 12 hours before the procedure. - Inform the client that he will receive a sedative before the procedure. Explanation: The client should be NPO for 8 hours prior to the examination. Before the introduction of the endoscope, the client is given a local anesthetic gargle or spray. Midazolam (Versed), a sedative that provides moderate sedation and relieves anxiety during the procedure, may be administered. Atropine may be administered to reduce secretions, and glucagon may be administered to relax smooth muscle.

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

- The ultrasonography should be scheduled before the GI procedure. Explanation: Both an upper GI procedure with barium ingestion and an ultrasonography may be completed on the same day. The ultrasonography test should be completed first, because the barium solution could interfere with the transmission of the sound waves. The ultrasonography test uses sound waves that are passed into internal body structures, and the echoes are recorded as they strike tissues. Fluid in the abdomen prevents transmission of ultrasound.

Which procedure is performed to examine and visualize the lumen of the small bowel? - small bowel enteroscopy - colonoscopy - panendoscopy - peritoneoscopy

- small bowel enteroscopy Explanation: Small bowel enteroscopy is the endoscopic examination and visualization of the lumen of the small bowel. Colonoscopy is the examination of the entire large intestine with a flexible fiberoptic colonoscope. Panendoscopy is the examination of both the upper and lower GI tracts. Peritoneoscopy is the examination of GI structures through an endoscope inserted percutaneously through a small incision in the abdominal wall.

The nurse recognizes which change of the GI system is an age-related change? - increased motility - hypertrophy of the small intestine - weakened gag reflex - increased mucus secretion

- weakened gag reflex Explanation: A weakened gag reflex is an age-related change of the GI system. There is decreased motility, atrophy of the small intestine, and decreased mucus secretion.

The nurse is preparing to assess the abdomen of a client experiencing a gastrointestinal condition. Place in order the actions the nurse will take to complete this assessment. Use all options. 1 Position supine. 2 Flex the knees. 3 Inspect the skin. 4 Auscultate bowel sounds. 5 Percuss abdominal organs. 6 Palpate for tenderness and masses.

1 Position supine. 2 Flex the knees. 3 Inspect the skin. 4 Auscultate bowel sounds. 5 Percuss abdominal organs. 6 Palpate for tenderness and masses.