MEDSURG I CH 43 DIGESTIVE/GI
Test Taking Tip:
You have at least a 25 percent chance of selecting the correct response in multiple-choice items. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses.
ascites
abnormal accumulation of fluid in the abdomen
Which of the following is the primary function of the small intestine?
absorption
occult blood
blood that cannot be seen in the stool but is positive on a fecal occult blood test
colonoscopy
clear liquid diet night before, laxitive GoLytle, then NPO 8 hours before position; knees to chest
Which test as not requiring the use of a contrast medium?
colonoscopy
dyspepsia
difficult digestion; indigestion high fat foods + seasoned foods cause it
Tymphany
drum like- hear over air filled areas
The nurse auscultates the abdomen to assess bowel sounds. She documents five to six sounds heard in less than 30 seconds. How does the nurse document the bowel sounds?
hyperactive *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
peritonitis
inflammation of the peritoneum (membrane lining the abdominal cavity and surrounding the organs within it)
PET scan (positron emission tomography)
injects radioactive form of glucose to highlight areas
bright red stools
lower GI bleeding
scintigraphy
nuclear medicine procedure that visualizes various tissues and organs after administration of a radionuclide
Murphy's sign
pain with palpation of the RUQ during inspiration, indicative of cholecystitis
Which of the following is an enzyme secreted by the gastric mucosa?
pepsin
Greasy stool or fat in the stools
steatorrhea
black/dark red stool
upper GI bleeding
barium study
use of barium sulfate as a liquid contrast medium for fluoroscopic or radiographic study of the digestive tract; can show obstruction, tumors, ulcers, hiatal hernia, and motility disorders, among other conditions
fluoroscopy
visualization of body parts in motion by projecting x-ray images on a luminous fluorescent screen
The nurse recognizes which change of the GI system is an age-related change?
weakened gag reflex *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.
A client asks the nurse why the physician ordered the blood test carcinoembryonic antigen (CEA). The nurse answers:
"It indicates if a cancer is present." *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.
The nurse is instructing a client prior to a colonoscopy. The client states, "Why do I have to drink this disgusting liquid?" The nurse is most correct to verbalize the goal of the oral preparation as which of the following?
"To cleanse the bowel to promote clear visualization of structures" *The goal of the oral preparation is to eliminate fecal matter to visualize the colon structures. Having a clean colon free of fecal matter does allow for easy of passage of the scope and eliminates gas. The client is sedated throughout the procedure so does not experience pain.
A client presented with gastrointestinal bleeding 2 days ago and continues to have problems. The health care provider has ordered a visualization of the small intestine via a capsule endoscopy. What will the nurse include in the client education about this procedure?
"You will need to swallow a capsule."
Which of the following digestive enzymes aids in the digesting of starch? Bile Trypsin Amylase Lipase
Amylase *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 examining the skin of a client who is dehydrated due to fluid losses from the gastrointestinal tract, which of the following would be most important?
Checking if the mucous membranes are dry
A nurse is aware that both the sympathetic and parasympathetic portions of the autonomic nervous system affect GI motility. What are the actions of the sympathetic nervous system? Select all that apply.
Decreases gastric motility Causes blood vessel constriction Creates an inhibitory effect on the GI tract *Generally, the sympathetic nervous system inhibits the gastrointestinal tract and the parasympathetic nerve stimulates the tract, increasing peristalsis and secretary activities.
peptic ulcer disease causes
H. pylori or NSAIDS
A client is diagnosed with megaloblastic anemia caused by vitamin B12 deficiency. The health care provider begins the client on cyanocobalamin (Betalin-12), 100 mcg I.M. daily. Which substance influences vitamin B12 absorption? Liver enzyme Intrinsic factor Histamine Hydrochloric acid
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.
Blood that is shed in sufficient quantities from the upper GI tract produces a tarry-black stool. Blood from the lower portion of the GI tract will appear bright or dark red. A milky white stool is indicative of a client who received barium. A green stool is indicative of a client who has eaten spinach.
Liver
Gastrin has which of the following effects on gastrointestinal (GI) motility? -Relaxation of gastroesophageal sphincter -Increased motility of the stomach -Contraction of the ileocecal sphincter -Relaxation of the colon
Increased motility of the stomach *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.
Which diagnostic produces images of the body by detecting the radiation emitted from radioactive substances?
Positron emission tomography (PET) *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.
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
The nurses assesses the client for blood in the stool due to an upper GI condition. The nurse understands that if there is blood in the stool, the stool will be which color?
Tarry-black *Blood that is shed in sufficient quantities from the upper GI tract produces a tarry-black stool. Blood from the lower portion of the GI tract will appear bright or dark red. A milky white stool is indicative of a client who received barium. A green stool is indicative of a client who has eaten spinach.
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?
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.
The nurse is assisting the health care provider with a colonoscopy for a client with rectal bleeding. The health care provider requests the nurse to administer glucagon during the procedure. Why is the nurse administering this medication during the procedure?
To relax colonic musculature and reduce spasm. *Glucagon may be administered, if needed, to relax the colonic musculature and to reduce spasm during the colonoscopy.
The nurse is assessing a client who is stating gastrointestinal upset and a feeling of bloating. Which type of meal would the nurse anticipate causing these types of symptoms?
hamburger and fries *Fatty foods delay stomach emptying (bloating) and can cause symptoms of gastrointestinal upset. Fried and deep fried foods contain elevated amounts of fat. The other options have a lower fat content.
pyrosis
heartburn; burning sensation in upper abdomen due to reflux of gastric acid
gastric bypass surgery
surgically makes the stomach smaller and causes food to bypass the first part of the small intestine; make patient feel fuller faster
Which enzyme aids in the digestion of protein?
trypsin *Trypsin, amylase, and lipase are digestive enzymes secreted by the pancreas. Trypsin aids in digesting protein; amylase aids in digesting starch; and lipase aids in digesting fats. 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. Amylase is an enzyme that aids in the digestion of starch.
A client comes into the emergency department with reports of abdominal pain. What should the nurse ask first?
Characteristics and duration of pain *A focused abdominal assessment begins with a complete history. The nurse must obtain information about abdominal pain. Pain can be a major symptom of gastrointestinal disease. The character, duration, pattern, frequency, location, distribution, and timing of the pain vary but require investigation immediately.
The nurse determines one or two bowel sounds in 2 minutes should be documented as
hypoactive *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.
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? Acetylcysteine Glycopyrronium bromide Atropine Pentagastrin
Pentagastrin *The gastric acid stimulation test usually is performed in conjunction with gastric analysis. Histamine or pentagastrin is administered subcutaneously to stimulate gastric secretions.
Which of the following digestive enzymes aids in the digesting of starch? Lipase Amylase Bile
Amylase *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.
Specific disease processes and ingestion of certain foods and medications may change the appearance of the stool. If blood is shed in sufficient quantities into the upper gastrointestinal (GI) tract, it produces which change in the stool appearance?
Tarry-black *If the blood is shed in sufficient quantities into the upper GI tract, it produces a tarry-black color, whereas blood entering the lower portion of the GI tract or passing rapidly though will cause the stool to appear bright or dark red. Lower rectal or anal bleeding is suspected if there is streaking of the blood on the surface of the stool or if blood is noted on toilet tissue. Stool is normally light or dark brown.
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? Pyloric sphincter Cardiac sphincter Hypopharyngeal sphincter Ileocecal valve
Pyloric sphincter *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.
