Chapters 38&39: GI and Oral Disorders
A client has come to the outpatient radiology department for diagnostic testing that will allow the care team to evaluate and remove polyps. The nurse should prepare the client for what procedure? A) Colonoscopy B) Barium enema C) ERCP D) Upper gastrointestinal fibroscopy
A
A client presents at the ambulatory clinic reporting recurrent sharp stomach pain that is relieved by eating. The nurse suspects that the client may have an ulcer. How should the nurse explain the formation and role of acid in the stomach to the client? A) "Hydrochloric acid is secreted by glands in the stomach in response to the actual or anticipated presence of food." B) "As digestion occurs in the stomach, the stomach combines free hydrogen ions from the food to form acid." C) "The body requires an acidic environment in order to synthesize pancreatic digestive enzymes; the stomach provides this environment." D) "The acidic environment in the stomach exists to buffer the highly alkaline environment in the esophagus."
A
A client with GERD has undergone diagnostic testing and it has been determined that increasing the pace of gastric emptying may help alleviate symptoms. The nurse should anticipate that the client may be prescribed what drug? A. Metoclopramide B. Omeprazole C. Lansoprazole D. Calcium carbonate
A
A client with gastroesophageal reflux disease (GERD) has a diagnosis of Barrett esophagus with minor cell changes. What principle should be integrated into the client's subsequent care? A) The client will be monitored closely to detect malignant changes. B) Liver enzymes must be checked regularly, as H2 receptor antagonists may cause hepatic damage. C) Small amounts of blood are likely to be present in the stools and are not cause for concern. D) Antacids may be discontinued when symptoms of heartburn subside.
A
A client's neck dissection surgery resulted in damage to the client's superior laryngeal nerve. What area of assessment should the nurse consequently prioritize? A) The client's swallowing ability B) The client's ability to speak C) The client's management of secretions D) The client's airway patency
A
A medical nurse who is caring for a client being discharged home after a radical neck dissection has collaborated with the home health nurse to develop a plan of care for this client. What is a priority psychosocial outcome for this client? A) Indicates acceptance of altered appearance and demonstrates positive self-image B) Freely expresses needs and concerns related to postoperative pain management C) Compensates effectively for alteration in ability to communicate related to dysarthria D) Demonstrates effective stress management techniques to promote muscle relaxation
A
A nurse is caring for an 83-year-old client who is being assessed for recurrent and intractable nausea. What age-related change to the GI system may be a contributor to the client's health issues? A) Stomach emptying takes place more slowly. B) The villi and epithelium of the small intestine become thinner. C) The esophageal sphincter becomes incompetent. D) Saliva production decreases.
A
A nurse is promoting increased protein intake to enhance a client's wound healing. What is the enzyme that will initiate the digestion of the protein that the client consumes? A) Pepsin B) Intrinsic factor C) Lipase D) Amylase
A
A nurse who provides care in an ambulatory clinic integrates basic cancer screening into admission assessments. What client most likely faces the highest immediate risk of oral cancer? A) A 65-year-old man with alcoholism who smokes B) A 45-year-old woman who has type 1 diabetes and who wears dentures C) A 32-year-old man who is obese and uses smokeless tobacco D) A 57-year-old man with GERD and dental caries
A
The nurse determines that a client who has undergone skin, tissue, and muscle grafting following a modified radical neck dissection requires suctioning. What is the nurse's priority when suctioning this client? A) Avoid applying suction on or near the suture line. B) Position client on the non-operative side with the head of the bed down. C) Assess the client's ability to perform self-suctioning. D) Evaluate the client's ability to swallow saliva and clear fluids.
A
A nurse is caring for a client in the late stages of esophageal cancer. The nurse should plan to prevent or address what characteristic(s) of this stage of the disease? Select all that apply. A) Perforation into the mediastinum B) Development of an esophageal lesion C) Erosion into the great vessels D) Painful swallowing E) Obstruction of the esophagus
A,C,E
A client's sigmoidoscopy has been successfully completed and the client is preparing to return home. What teaching point should the nurse include in the client's discharge education? A) The client should drink at least 2 liters of fluid in the next 12 hours. B) The client can resume a normal routine immediately. C) The client should expect fecal urgency for several hours. D) The client can expect some scant rectal bleeding.
B
A nurse is caring for clients in a stroke rehabilitation facility. Damage to what area of the brain will most affect a client's ability to swallow? A) Temporal lobe B) Medulla oblongata C) Cerebellum D) Pons
B
The nurse is caring for a client with gastrointestinal symptoms who reports being under a significant amount of stress at home and at work. Which gastrointestinal effect of stress should the nurse anticipate is affecting this client? A) Increased gastric acid secretion B) Slowed peristalsis C) Increased enteric blood flow D) Relaxed sphincter muscles
B
The nurse is preparing to check for tube placement in the client's stomach as well as measure the residual volume. What are these nursing actions attempting to prevent? A) Gastric ulcers B) Aspiration C) Abdominal distention D) Diarrhea
B
A nurse is caring for a client admitted with a suspected malabsorption disorder. The nurse knows that one of the accessory organs of the digestive system is the pancreas. What digestive enzymes does the pancreas secrete? Select all that apply. A. Pepsin B. Lipase C. Amylase D. Trypsin E. Ptyalin
B,C,D
A client asks the nursing assistant for a bedpan. When the client is finished, the nursing assistant notifies the nurse that the client has bright red streaking of blood in the stool. The nurse's assessment should focus on what potential cause? A) Diet high in red meat B) Upper GI bleed C) Hemorrhoids D) Use of iron supplements
C
A client has undergone surgery for oral cancer and has just been extubated in postanesthetic recovery. What nursing action best promotes comfort and facilitates spontaneous breathing for this client? A) Placing the client in a left lateral position B) Administering opioids as prescribed C) Placing the client in Fowler position D) Teaching the client to use the client-controlled analgesia( PCA)system
C
A client who has had a radical neck dissection is being prepared for discharge. The discharge plan includes referral to an outpatient rehabilitation center for physical therapy. What should the goals of physical therapy for this client include? A) Muscle training to relieve dysphagia B) Relieving nerve paralysis in the cervical plexus C) Promoting maximum shoulder function D) Alleviating achalasia by decreasing esophageal peristalsis
C
A client who underwent surgery for esophageal cancer is admitted to the critical care unit following postanesthetic recovery. What should the nurse include in the client's immediate postoperative plan of care? A) Teaching the client to self-suction B) Performing chest physiotherapy to promote oxygenation C) Positioning the client to prevent gastric reflux D) Providing a regular diet as tolerated
C
A nurse is addressing the prevention of esophageal cancer in response to a question posed by a participant in a health promotion workshop. What action should the nurse recommend as having the greatest potential to prevent esophageal cancer? A) Promotion of a nutrient-dense, low-fat diet B) Annual screening endoscopy for clients over 50 with a family history of esophageal cancer C) Early diagnosis and treatment of gastroesophageal reflux disease D) Adequate fluid intake and avoidance of spicy foods
C
A nurse is assessing a client who has just been admitted to the postsurgical unit following surgical resection for the treatment of oropharyngeal cancer. What assessment should the nurse prioritize? A) Assess ability to clear oral secretions. B) Assess for signs of infection. C) Assess for a patent airway. D) Assess for ability to communicate.
C
An adult client is scheduled for an upper GI series that will use a barium swallow. What teaching should the nurse include when the client has completed the test? A) Stool will be yellow for the first 24 hours' post procedure. B) The barium may cause diarrhea for the next 24 hours. C) Fluids must be increased to facilitate the evacuation of the stool. D) Slight anal bleeding may be noted as the barium is passed.
C
The nurse is providing health education to a client with a gastrointestinal disorder. What should the nurse describe as a major function of the GI tract? A) The breakdown of food particles into cell form for digestion B) The maintenance of fluid and acid-base balance C) The absorption into the bloodstream of nutrient molecules produced by digestion D) The control of absorption and elimination of electrolytes
C
The nurse is caring for a client with a duodenal ulcer and is relating the client's symptoms to the physiologic functions of the small intestine. What do these functions include? Select all that apply. A) Secretion of hydrochloric acid(HCl) B) Reabsorption of water C) Secretion of mucus D) Absorptionofnutrients E) Movement of nutrients into the bloodstream
C,D,E
A The client is experiencing painful oral lesions following radiation for oropharyngeal cancer. Which instruction should the nurse give this client? A) Spicy foods stimulate salivation and are soothing. B) Eat food while it is hot to enhance flavor. C) Avoid brushing teeth while lesions are present. D) Eat soft or liquid foods.
D
A client has been diagnosed with a malignancy of the oral cavity and is undergoing oncologic treatment. The oncologic nurse is aware that the prognosis for recovery from head and neck cancers is often poor because of what characteristic of these malignancies? A) Radiation therapy often results in secondary brain tumors. B) Surgical complications are exceedingly common. C) Diagnosis rarely occurs until the cancer is end stage. D) Metastases are common and respond poorly to treatment
D
A client has returned to the medical unit after a barium enema. When assessing the client's subsequent bowel patterns and stools, what finding would warrant reporting to the health care provider? A) Large, widestools B) Milky white stools C) Three stools during an 8-hour period of time D) Streaks of blood present in the stool
D
A client is being assessed for a suspected deficit in intrinsic factor synthesis. What diagnostic or assessment finding is the most likely rationale for this examination of intrinsic factor production? A) Muscle wasting B) Chronic jaundice in the absence of liver disease C) The presence of fat in the client's stool D) Persistently low hemoglobin and hematocrit
D
A client seeking care because of recurrent heartburn and regurgitation is subsequently diagnosed with a hiatal hernia. Which of the following should the nurse include in health education? A) "Drinking beverages after your meal, rather than with your meal, may bring some relief." B) "It's best to avoid dry foods, such as rice and chicken, because they're harder to swallow." C) "Many clients obtain relief by taking over-the-counter antacids 30 minutes before eating." D) "Instead of eating three meals a day, try eating smaller amounts more often."
D
A nurse is caring for a client who is postoperative day 1 following neck dissection surgery. The nurse is performing an assessment of the client and notes the presence of high-pitched adventitious sounds over the client's trachea on auscultation. The client's oxygen saturation is 90% by pulse oximetry with a respiratory rate of 31 breaths per minute. What is the nurse's most appropriate action? A) Encourage the client to perform deep breathing and coughing exercises hourly. B) Reposition the client into a prone or semi-Fowler position and apply supplementary oxygen by nasal cannula. C) Activate the emergency response system. D) Report this finding promptly to the health care provider and remain with the client.
D
A nurse is performing an abdominal assessment of an older adult client. When collecting and analyzing data, the nurse should be cognizant of what age-related change in gastrointestinal structure and function? A) Increased gastric motility B) Decreased gastric pH C) Increased gag reflex D) Decreased mucus secretion
D
