Chapter 43: Assessment of Digestive and Gastrointestinal Function PREP-U

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 magnetic resonance imaging (MRI). During the client teaching, what will the nurse discuss? "You must be NPO for the day before the examination." "The examination will take only 15 minutes." "You must remove all jewelry but can wear your wedding ring." "Do you experience any claustrophobia?"

"Do you experience any claustrophobia?" Explanation: MRI is a noninvasive technique that uses magnetic fields and radio waves to produce images of the area being studied. Clients must be NPO for 6 to 8 hours before the study and remove all jewelry and other metals. The examination takes 60 to 90 minutes and can induce feelings of claustrophobia, because the scanner is close fitting.

The nurse provides client education to a client about to undergo hydrogen breath testing. The nurse evaluates that the client understands the test when the client makes which statement? "The test will detect the presence of oral cancer." "First, I will drink a cherry flavored liquid." "I should avoid antibiotics for 1 month before the test." "The test will detect the presence of staph."

"I should avoid antibiotics for 1 month before the test." Explanation: The nurse evaluates that the client understands the education when the client states antibiotics should be avoided one month before the test. In addition, the client should avoid loperamide, sucralfate, and omeprazole for 1 week prior to the test, and cimetidine, famotidine, and nizatidine for 24 hours before the test. During the test, the client swallows a capsule of carbon-labeled urea and a breath sample is obtained 10 to 20 minutes later. The hydrogen breath test detects the presence of <italic>Helicobacter pylori, the bacteria that causes peptic ulcer disease.

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 medications to reduce gastric acid before the test." "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 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.

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 drink full liquids the day before the test." "There is no need for special preparation before the test." "I'll avoid eating or drinking anything 6 to 8 hours 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.

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

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 determines functionality of the liver." "It detects a protein normally found in the blood." "It indicates if a cancer is present."

"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.

The nurse asks a client to point to where pain is felt. The client asks why this is important. What is the nurse's best response? "If the health care provider massages over the exact painful area, the pain will disappear." "Often the area of pain is referred from another area." "The area may determine the severity of the pain." "This determines the pain medication to be ordered."

"Often the area of pain is referred from another area." Explanation: Pain 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 digestive enzymes aids in the digesting of starch? Lipase Trypsin Bile Amylase

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 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? 3 days 1 day 2 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.

The nurse is caring for a client recovering from an esophagogastroduodenoscopy (EGD). Which of the following client symptoms would require further nursing assessment? Abdominal distention Thirst Drowsiness Sore throat

Abdominal distention Explanation: The nurse is correct to fully assess the client experiencing abdominal distention following an esophagogastroduodenoscopy (EGD). Abdominal distention could indicate complications such as perforation and bleeding. The client experiences drowsiness from the sedative during the early recovery process and a sore throat from passage of the scope. The client may also experience thirst because the client has not had liquids for a period of time.

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 Dulling of nerve impulses Decrease in intestinal flora Increase in bile secretion

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.

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. Avoid the intake of red meat before the procedure. Take three cleansing enemas before the procedure. Take vitamin K 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? Cholecystography Paracentesis Biopsy 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.

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

A client comes into the emergency department with reports of abdominal pain. What should the nurse ask first? Medications taken in the last 8 hours Concerns about impending hospital stay Characteristics and duration of pain Family history of ruptured appendix

Characteristics and duration of pain Explanation: 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.

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? Upper GI series Computer tomography Small bowel series Colonoscopy

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.

The nurse is performing an assessment of a patient. During the assessment the patient informs the nurse of some recent "stomach trouble." What does the nurse know is the most common symptom of patients with GI dysfunction? Abdominal bloating Dyspepsia Diffuse pain Constipation

Dyspepsia Explanation: Dyspepsia, upper abdominal discomfort associated with eating (commonly called indigestion), is the most common symptom of patients with GI dysfunction. Indigestion is an imprecise term that refers to a host of upper abdominal or epigastric symptoms such as pain, discomfort, fullness, bloating, early satiety, belching, heartburn, or regurgitation; it occurs in approximately 25% of the adult population (Harmon & Peura, 2010).

A nurse is preparing a client with Crohn's disease for a barium enema. What should the nurse do the day before the test? Encourage plenty of fluids. Order a high-fiber diet. Serve dairy products. Serve the client his usual diet.

Encourage plenty of fluids. Explanation: 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.

The nurse teaches a client scheduled for a colonoscopy. Which instruction should be included as part of the preparation for the procedure? Spray or gargle with a local anesthetic. Follow the dietary and fluid restrictions and bowel preparation procedures. Do not void for at least 30 minutes before the test. Consume at least 3 quarts of water 30 minutes before the test.

Follow the dietary and fluid restrictions and bowel preparation procedures. Explanation: For a client due to have a colonoscopy, it is essential that the client follow the dietary and fluid restrictions and bowel preparation procedures. For the client having an esophagogastroduodenoscopy (EGD), it is necessary for the client to spray or gargle with a local anesthetic. The client is not advised to consume 3 quarts of water nor to void before the test. These interventions may be essential for tests that involve ultrasonographic procedures.

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? Explain that fatty foods can mimic chest pain. Call for an immediate electrocardiogram. Further investigate the initial complaint. 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.

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 French fries Salmon with cheddar mashed potatoes Steamed rice with pork and broccoli Grilled chicken on a spinach salad

Hamburger and French fries Explanation: 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.

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? Presence of a cochlear implant History of allergies 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? Borborygmi Hyperactive Hypoactive Normal

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).

The nurse is working on a general medical unit. A client is scheduled for an upper gastrointestinal series. Upon returning to the nursing unit, what does the nurse identify as the client goal? Decrease in nausea and vomiting Ambulates independently Recovery from the general anesthesia Increase in the amount of fluids

Increase in the amount of fluids Explanation: The client, returning from an upper gastrointestinal series, needs to increase fluids in an effort to eliminate the barium from the body through a bowel movement. General anesthesia is not used. The client typically does not have nausea and vomiting following the procedure. If the client is able to ambulate independently prior to the procedure, the client will be able to ambulate independently following.

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

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. Withhold oral medications for 24 hours before the test. Avoid products containing aspirin for a week before the test. Eat a clear liquid breakfast 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.

The nurse is preparing to examine the abdomen of a client with reports of nausea and vomiting. What action would the nurse perform first? Percussion Palpation Auscultation Inspection

Inspection Explanation: When assessing the abdomen, the nurse would first inspect or observe the abdomen. This would be followed by auscultation, percussion, and lastly, palpation.

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

Liver Explanation: 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.

The nurse is caring for a client who is having gastrointestinal symptoms. The nurse knows that a scintigraphy is used as a diagnostic tool for what purpose? Determine areas of gastric inflammation. Validate the presence of a tumor. Locate the source of internal bleeding. Analyze small bowel obstructions.

Locate the source of internal bleeding. Explanation: Scintigraphy (radionuclide testing) relies on the use of radioactive isotopes to reveal displaced anatomic structures, changes in organ size, and the presence of neoplasms or other focal lesions such as cysts or abscesses. Scintigraphic scanning is also used to measure the uptake of tagged red blood cells and leukocytes. Tagging of red blood cells and leukocytes by injection of a radionuclide is performed to define areas of inflammation, abscess, blood loss, or neoplasm. Tagged red cell studies are useful in determining the source of internal bleeding when all other studies have returned a negative result. Scintigraphy is not used to validate the presence of a tumor, analyze a small bowel obstruction, or determine areas of gastric inflammation.

An older client reports difficulty chewing and swallowing. Which age-related changes will the nurse suspect as the reasons for the client's symptoms? Select all that apply. Weakened gag reflex Loss of teeth Reduced saliva production Less ptyalin and amylase in saliva Atrophy of taste buds

Loss of teeth Weakened gag reflex Atrophy of taste buds Reduced saliva production Less ptyalin and amylase in saliva Explanation: Age-related changes to the oral cavity and pharynx can cause difficulty chewing and swallowing. These changes include a loss of teeth, atrophy of taste buds, reduced saliva production, less ptyalin and amylase in saliva, and a weakened gag reflex.

Swallowing is regulated by which area of the central nervous system (CNS)? Cerebellum Hypothalamus Medulla oblongata Pons

Medulla oblongata Explanation: Swallowing begins as a voluntary act that is regulated by the swallowing center in the medulla oblongata of the CNS. The act of swallowing requires the innervations of five cranial nerves (CNs), especially CN V, VII, IX, X, and XII. Swallowing is not regulated by the pons, cerebellum, or hypothalamus.

A nurse is giving a client barium swallow test. What is the most important assessment a nurse would make to ensure that a client does not retain any barium after a barium swallow? Observing the color of urine. Monitoring the stool passage and its color. Placing any stool passed in a specific preservative. Monitoring the volume of urine.

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.

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 Atropine Glycopyrronium bromide Pentagastrin

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.

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

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.

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

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? Fibroscopy Computed tomography (CT) Magnetic resonance imaging (MRI) Positron emission tomography (PET)

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.

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 sigmoidoscopy A complete blood count including differential Gastric analysis Serum antibodies for H. pylori

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.

It is important for a nurse to have an understanding of the major digestive enzymes and their actions. Choose the gastric mucosa secretion that plays an important role in the digestion of triglycerides. Steapsin Ptyalin Trypsin Amylase

Steapsin Explanation: Ptyalin and amylase work to digest starch; trypsin works on proteins and polypeptides. Triglycerides are digested by steapsin, and pharyngeal and pancreatic lipase.

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 Large Intestine Stomach Ileum

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? Left Sim's lateral Lithotomy Knee-chest Supine with knees flexed

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.

While preparing a client for an upper GI endoscopy (esophagogastroduodenoscopy), the nurse should implement which interventions? Choose all that apply. 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. Administer a preparation to cleanse the GI tract, such as Golytely or Fleets Phospha-Soda. Tell the client he must be on a clear liquid diet for 24 hours before 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.

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 regularly takes aspirin The client had a hamburger for dinner the night before The client took an ibuprofen tablet this morning

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.

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 client may eat a light meal before either test. The ultrasonography should be scheduled before the GI procedure. The upper GI should be scheduled before the ultrasonography.

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.

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

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.

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? Protein Glucose Starch Triglycerides

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.

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 ileum cecum jejunum

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.

The major carbohydrate that tissue cells use as fuel is glucose. proteins. chyme. 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 response is a parasympathetic response in the GI tract? increased peristalsis decreased motility blood vessel constriction decreased gastric secretion

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.

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? pulmonary hypertension chronic obstructive pulmonary disease congestive heart failure inflammatory bowel disease

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 sluggish. absent. hypoactive. normal.

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 occult blood. pilonidal cyst. ingestion of bismuth. recent foods ingested.

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.

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

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.

Which enzyme aids in the digestion of protein? lipase trypsin ptyalin steapsin

trypsin Explanation: 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. Digestive enzymes secreted by the pancreas include trypsin, which aids in digesting protein. Amylase is an enzyme that aids in the digestion of starch. Steapsin digests fats.

The client describes a test previously completed to detect a small bowel obstruction prior to admission to the hospital. The client states that the test involved insertion of a tube through the nose and lasted over 6 hours. The nurse determines which test name should be documented? positron emission tomography magnetic resonance imaging upper GI enteroclysis abdominal ultrasound

upper GI enteroclysis Explanation: Enteroclysis is a double contrast study where a duodenal tube is inserted and 500 to 1000 mL of thin barium sulfate suspension and then methylcellulose is infused. Fluoroscopy is used to visualize the filling of the intestinal loops over a period of up to 6 hours. The test is used for detection of small bowel obstruction and diverticuli. Abdominal ultrasound, magnetic resonance imaging, and positron emission tomography do not involve insertion of a duodenal tube.

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

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.