Lewis 38: Assessment of Gastrointestinal System
What is the hormone responsible for maintaining lower esophageal sphincter tone?
gastrin
What is the hormone responsible for appetite stimulation?
ghrelin
Which gastrointestinal secretion is essential for cobalamin absorption in the ileum?
intrinsic factor
The nurse is providing care to a patient who underwent an endoscopic retrograde cholangiopancreatography (ERCP) examination. Which is the most common post-procedure complication?
pancreatitis
When reviewing the gastrointestinal (GI) system, the nurse recalls that protein digestion begins with the release of what substance from chief cells?
pepsinogen
Which sphincter, or valve, controls food movement from the stomach into the small intestine?
pyloric
A patient is experiencing cheilosis (painful inflammation and cracking of the corners of the mouth). The nurse suspects that what deficiency is the cause of the patient's condition?
riboflavin
Dryness of the mouth caused by reduction of saliva
xerostomia
The nurse will plan to monitor a patient with an obstructed common bile duct for a. melena. b. steatorrhea. c. decreased serum cholesterol level. d. increased serum indirect bilirubin level.
b
Which information about an 80-yr-old male patient at the senior center is of most concern to the nurse? a. Decreased appetite b. Unintended weight loss c. Difficulty chewing food d. Complaints of indigestion
b
A patient is diagnosed with chronic liver cirrhosis. The nurse expects what assessment finding when examining the abdomen? a. Liver dullness b. Hard, enlarged liver c. Rebound tenderness d. Absence of liver dullness
b
A patient experiences an increase in parasympathetic stimulation. The nurse expects what clinical manifestation? a. Diarrhea b. Dysphagia c. Loss of appetite d. Reduced sensitivity to pain
a
After reviewing a patient's laboratory report the nurse finds that the blood glucose level is 140 mg/dL. Which cellular function of the islets of Langerhans is impaired in the patient?
beta
Which substance stimulates secretion during the intestinal phase of gastric secretion?
chyme
An older patient reports chronic constipation. To promote bowel evacuation, the nurse will suggest that the patient attempt defecation a. in the mid-afternoon. b. after eating breakfast. c. right after getting up in the morning. d. immediately before the first daily meal.
b
A patient's assessment findings include an elevated alkaline phosphatase (ALP) level. The nurse recalls that the level rises because of what conditions? Select all that apply. a. Pancreatitis b. Hepatic mass c. Pancreatic mass d. Biliary tract obstruction e. Stones in common bile duct
de
The nurse recognizes that which test is performed to diagnose celiac disease in a patient? a. Fibro test b. Sigmoidoscopy c. Video capsule endoscopy (VCE) d. Endoscopic retrograde cholangiopancreatography (ERCP)
c
The nurse reviews the gastrointestinal (GI) process and recalls that the stomach performs what functions? Select all that apply. a. Secretion of bile b. Secretion of saliva c. Absorption of proteins d. Secretion of pepsinogen e. Secretion of hydrochloric acid
de
When assessing the cecum and appendix, the nurse palpates the ___ ___ abdominal quadrant in a patient.
right lower
A 58-yr-old patient has just returned to the nursing unit after an esophagogastroduodenoscopy (EGD). Which action by unlicensed assistive personnel (UAP) requires that the registered nurse (RN) intervene? a. Offering the patient a pitcher of water b. Positioning the patient on the right side c. Checking the vital signs every 30 minutes d. Swabbing the patient's mouth with a wet cloth
a
A patient is being scheduled for endoscopic retrograde cholangiopancreatography (ERCP) as soon as possible. Which prescribed action should the nurse take first? a. Place the patient on NPO status. b. Administer sedative medications. c. Ensure the consent form is signed. d. Teach the patient about the procedure.
a
A patient's blood test report reveals lipase levels of 200 U/L, fasting gastrin levels of 120 pg/mL, and amylase levels of 150 U/L. Which complication does the nurse suspect based on the findings? a. Acute pancreatitis b. Hemolytic problem c. Obstructive jaundice d. Hepatic encephalopathy
a
The nurse expects that a magnetic resonance imaging (MRI) study will be prescribed for a patient with what history? a. Colorectal cancer b. Pacemaker surgery c. Symptoms of gallstones d. Symptoms of hepatitis C
a
The nurse suspects a cobalamin deficiency in a patient based on what assessment finding? a. Smooth, red, and slick tongue b. Deposition of calcium on the teeth c. Reddened, ulcerated, and swollen tongue d. White, curdlike lesions surrounded by erythematous oral mucosa
a
A 42-yr-old patient is admitted to the outpatient testing area for an ultrasound of the gallbladder. Which information obtained by the nurse indicates that the ultrasound may need to be rescheduled? a. The patient took a laxative the previous evening. b. The patient had a high-fat meal the previous evening. c. The patient has a permanent gastrostomy tube in place. d. The patient ate a low-fat bagel 4 hours ago for breakfast.
d
Aspartate aminotransferase levels increase due to liver damage. The normal levels of aspartate aminotransferase are in the range of 10 to __ U/L.
30
To palpate the liver during a head-to-toe physical assessment, the nurse a. places one hand on the patient's back and presses upward and inward with the other hand below the patient's right costal margin. b. places one hand on top of the other and uses the upper fingers to apply pressure and the bottom fingers to feel for the liver edge. c. presses slowly and firmly over the right costal margin with one hand and withdraws the fingers quickly after the liver edge is felt. d. places one hand under the patient's lower ribs and presses the left lower rib cage forward, palpating below the costal margin with the other hand.
a
The nurse is providing immediate post-procedural care to a patient who underwent a fluoroscopic x-ray examination of the colon. What is appropriate to be included in the patient's plan of care? Select all that apply. a. Offering fluids to the patient b. Giving laxatives to the patient c. Administering antibiotics to the patient d. Asking the patient to lie on the right side e. Keeping the patient on nothing by mouth (NPO) status
ab
The nurse is caring for patient who is scheduled for a liver biopsy. Which interventions are appropriate to be included on the patient's plan of care? Select all that apply. a. Check the bleeding time. b. Check the prothrombin time. c. Instruct the patient to avoid red meat for 48 hours before the test. d. Maintain nothing by mouth (NPO) status for eight hours before the test. e. Instruct the patient to expire fully and not breathe when the needle is inserted.
abe
A patient with a family history of colon cancer undergoes a screening colonoscopy. After the procedure, the nurse should perform which interventions? Select all that apply. a. Obtain vital signs b. Check for return of gag reflex c. Assess for abdominal cramping d. Assess for abdominal distention e. Administer enema to empty bowel f. Monitor for signs of rectal bleeding
acdf
A patient with liver fibrosis is scheduled for a closed biopsy procedure. What should the nurse include in the procedural plan of care? Select all that apply. a. Assessing the vital signs b. Administering aspirin before the test c. Instructing the patient to not breathe during needle insertion d. Instructing the patient to lie in the supine position during the procedure e. Informing the patient that an incision will be made to remove a tissue sample f. Instructing the patient to raise the right arm over the head during the procedure
acdf
The nurse observes an accumulation of fluid within the abdominal cavity in a patient known as what condition?
ascites
A 30-yr-old male patient with a body mass index (BMI) of 22 kg/m2 is being admitted to the hospital for elective knee surgery. Which assessment finding is important to report to the health care provider? a. Tympany on percussion of the abdomen b. Liver edge 3 cm below the costal margin c. Bowel sounds of 20/minute in each quadrant d. Aortic pulsations visible in the epigastric area
b
A patient is scheduled for a radiologic study of the upper gastrointestinal tract. When preparing the patient for the test, what is the most important nursing action? a. Explain the procedure to the patient b. Ask the patient about allergies to drugs, iodine, or other contrast media c. Tell the patient that the stool might be white up to 72 hours after the test d. Explain that the patient may be placed in various positions on the x-ray table
b
The nurse educator provides education to a group of nursing students about age-related changes in the gastrointestinal system. Which statement by a student indicates the need for further teaching? a. "Increased transit time occurs with aging." b. "Increased salivary volume occurs with aging." c. "Decreased protein synthesis occurs with aging." d. "Decreased blood flow to the stomach occurs with aging."
b
The nurse identifies that age-related changes are associated with which part of the gastrointestinal (GI) system? a. Liver b. Stomach c. Esophagus d. Small intestine
b
The nurse is assessing an alert and independent 78-yr-old patient for malnutrition risk. Which is the most appropriate initial question? a. "How do you get to the store to buy your food?" b. "Can you tell me the food that you ate yesterday?" c. "Do you have any difficulty in preparing or eating food?" d. "Are you taking any medications that alter your taste for food?"
b
The nurse is performing an abdominal examination of a patient. The nurse auscultates relatively high pitched and loud gurgling sounds in the stomach and recognizes that this is indicative of what? a. Paralytic ileus b. Normal finding c. Intestinal obstruction d. Abdominal artery obstruction
b
The nurse provides information to a patient related to obtaining a stool specimen for occult blood. The instructions should include keeping the diet free of what item for 24-48 hours before the test? a. Shellfish b. Red meat c. Fatty foods d. Iron supplements
b
A patient is scheduled to undergo a lower GI series examination. The nurse should include what information in the education provided to the patient? Select all that apply. a. Keep patient NPO for 4 hours before the test. b. Explain that cramping may occur during the procedure. c. After the procedure, observe the stool for passage of a contrast medium. d. After the procedure, give laxatives or suppositories to assist barium expulsion. e. On the evening before the procedure, administer laxatives and enemas until the colon is clear of stool.
bcde
A patient experiences difficulty in defecation due to constipation. A recommended treatment is the Valsalva maneuver. The nurse recognizes that it is important to obtain what history information prior to assisting the patient with this maneuver? Select all that apply. a. Cough b. Hemorrhoids c. Peptic ulcers d. Cardiac problems e. Abdominal surgery
bde
A patient reports a two-month history of dark tarry stools and occasional blood on the toilet paper after wiping. The patient experiences generalized weakness and tires easily. The patient denies a history of taking iron pills or blueberry consumption. The nurse anticipates that which diagnostic tests will be prescribed to determine the cause of the blood? Select all that apply. a. Cholangiography b. Virtual colonoscopy c. Abdominal ultrasound d. Guaiac stool test for occult blood e. Video capsule endoscopy (VCE) f. Magnetic resonance imaging (MRI)
bdef
A patient has just arrived in the recovery area after an upper endoscopy. Which information collected by the nurse is most important to communicate to the health care provider? a. The patient is very drowsy. b. The patient reports a sore throat. c. The oral temperature is 101.4°F. d. The apical pulse is 100 beats/minute.
c
A patient is scheduled for a barium swallow test to diagnose abnormalities in the esophagus. Which instruction should the nurse include when preparing the patient for this procedure? a. Avoid smoking 1 hour before the test. b. Maintain a clear liquid diet for 8 hours before the test. c. Stools may remain white for up to 72 hours after the test. d. It is important to lie still during the 30 minutes it will take for test to be completed.
c
A patient is suspected to have acute pancreatitis after presenting to the emergency department with severe abdominal pain. The nurse identifies that which important diagnostic laboratory value peaks in 24 hours and then drops to normal in 48 to 72 hours? a. Gastric pH b. Blood glucose c.Serum amylase d. Serum potassium
c
A patient reports severe pain in the upper right part of the abdomen. A nurse observes an enlarged abdomen and suspects a diagnosis of hepatocellular carcinoma. Which will be the first diagnostic test to be prescribed? a. Liver MRI b. Liver biopsy c. α-Fetoprotein test d. Abdominal ultrasound
c
A patient reports that a recent motor vehicle accident caused the patient to feel extremely scared. The patient reports being constipated since the day of the accident. The nurse suspects that what alteration in the function of the gastrointestinal (GI) system is causing the constipation? a. The patient is too nervous to eat or drink, causing less stool production. b. The circulation in the GI system was increased, so less waste is removed. c. The sympathetic nervous system (SNS) was activated, so the GI tract was slowed. d. The parasympathetic nervous system was stimulated, causing a decrease in peristalsis.
c
After assisting with a needle biopsy of the liver at a patient's bedside, the nurse should a. put pressure on the biopsy site using a sandbag. b. elevate the head of the bed to facilitate breathing. c. place the patient on the right side with the bed flat. d. check the patient's postbiopsy coagulation studies.
c
During an admission assessment, a patient states, "I had been having episodes of abdominal pain, so I had a surgery in which they made an opening into my common bile duct to remove stones." The nurse should document a history of what surgery? a. Colectomy b. Cholecystectomy c. Choledocholithotomy d. Choledochojejunostomy
c
The nurse finds that a patient's gallbladder is not functioning well due to cholelithiasis and sludge. Which function will primarily be affected in the patient? a. Secretion of insulin b. Secretion of somatostatin c. Concentration and storage of bile d. Stimulation of pancreatic bicarbonate secretion
c
Upon reviewing the laboratory reports of a patient, the nurse finds that the patient has decreased release of pancreatic digestive enzymes. Which hormone deficiency does the patient likely have? a. Gastrin b. Secretin c. Cholecystokinin d. Gastric inhibitory peptide
c
When caring for the patient with heart failure, the nurse recalls that the gastrointestinal (GI) tract and accessory organs receive approximately how much of the cardiac output at rest? a. 5-10% b. 15-20% c. 25-30% d. 50-55%
c
Which finding by the nurse during abdominal auscultation indicates a need for a focused abdominal assessment? a. Loud gurgles b. High-pitched gurgles c. Absent bowel sounds d. Frequent clicking sounds
c
Which gland secretes an alkaline fluid that contains bicarbonate? a. Parotid gland b. Adrenal gland c. Brunner's gland d. Sublingual gland
c
Which statement to the nurse from a patient with jaundice indicates a need for teaching? a. "I used cough syrup several times a day last week." b. "I take a baby aspirin every day to prevent strokes." c. "I use acetaminophen (Tylenol) every 4 hours for back pain." d. "I need to take an antacid for indigestion several times a week"
c
While interviewing a young adult patient, the nurse learns that the patient has a family history of familial adenomatous polyposis (FAP). The nurse will plan to assess the patient's knowledge about a. preventing noninfectious hepatitis. b. treating inflammatory bowel disease. c. risk for developing colorectal cancer. d. using antacids and proton pump inhibitors
c
The nurse receives the following information about a 51-yr-old female patient who is scheduled for a colonoscopy. Which information should be communicated to the health care provider before sending the patient for the procedure? a. The patient has a permanent pacemaker to prevent bradycardia. b. The patient is worried about discomfort during the examination. c. The patient has had an allergic reaction to both shellfish and iodine in the past. d. The patient declined to drink the prescribed polyethylene glycol (GoLYTELY).
d
When caring for a patient with a history of a total gastrectomy, the nurse will monitor for a. constipation. b. dehydration. c. elevated total serum cholesterol. d. cobalamin (vitamin B12) deficiency.
d
