GI ch 44

In what order does the nurse prepare and perform an abdominal examination of a patient? 1. Ask the patient to empty the bladder. 2. Place the patient in a supine position with the knees bent. 3. Place the patient's arms at the sides. 4. Assess the right upper quadrant region

1. Ask the patient to empty the bladder. 2. Place the patient in a supine position with the knees bent. 3. Place the patient's arms at the sides. 4. Assess the right upper quadrant region In preparation for abdominal examination, the patient is first asked to empty the bladder to prevent any discomfort during abdominal assessment. Then the patient is asked to lie down in a supine position with the knees bent and arms at the sides to avoid tensing of abdominal muscles. Finally, the nurse proceeds with abdominal assessment from the right side starting with the right upper quadrant region.

In assessing the abdomen, a sound of dullness is expected to be assessed over which organ? 1 Intestines 2 Stomach 3 Bladder 4 Liver

4 Liver When percussing, a sound of dullness will be heard over the liver. Tympanic sounds are heard over hollow organs such as the stomach, bladder, and intestines.

The nurse is preparing a patient for sigmoidoscopy. What does the nurse tell the patient about this procedure? 1 "You must consume only a clear liquid diet for 24 hours before the test." 2 "Tissue biopsies are not performed during this procedure." 3 "You must report any gas pain and flatulence after the procedure." 4 "This examination will last for about an hour."

1 "You must consume only a clear liquid diet for 24 hours before the test." The patient must consume only a clear liquid diet for at least 24 hours before the test to ensure that the rectum and colon are clear for examination. The patient is also given a cleansing enema to ensure clear passage for the flexible scope. After the procedure, the patient may experience mild gas pain and flatulence from air that was instilled into the rectum during the examination. The examination usually lasts about 30 minutes.

The nurse is assessing the abdomen of a 40-year-old patient who reports acute tenderness and pain in the right upper quadrant (RUQ). What organ does the nurse consider as the plausible origin? 1 Liver 2 Spleen 3 Stomach 4 Sigmoid colon

1 Liver Most of the liver is located in the RUQ of the abdomen. The stomach and spleen are in the left upper quadrant (LUQ), and the sigmoid colon is in the left lower quadrant (LLQ).

When palpating the right upper quadrant (RUQ) of the abdomen, what is the nurse assessing? 1 Liver 2 Stomach 3 Appendix 4 Sigmoid colon

1 Liver The liver is located in the RUQ of the abdomen. The stomach is in the left upper quadrant (LUQ), the appendix is in the right lower quadrant (RLQ), and the sigmoid colon is in the left lower quadrant (LLQ).

A patient is prescribed a liver-spleen scan to evaluate the liver and spleen for tumors. What teaching does the nurse provide the patient about this procedure? 1 Radioactive injection is administered through an IV access. 2 It takes an hour for radionuclide uptake. 3 Radionuclide is eliminated from the body through the stool. 4 No special care is required after toileting.

1 Radioactive injection is administered through an IV access. In a liver-spleen scan, a radioactive injection is administered via IV access. The technician or primary health provider waits for 15 minutes for radionuclide uptake. Radionuclide is eliminated from the body through urine. Careful handwashing is required to limit exposure to any radiation present in the urine.

To prevent atrophic gastritis in a patient with hypochlorhydria, what action should the nurse take? 1 Assess the frequency of diarrhea. 2 Assess the presence of epigastric pain. 3 Encourage the intake of bland foods rich in vitamins and iron. 4 Encourage a high-fiber diet and 1500 mL of fluid intake daily.

3 Encourage the intake of bland foods rich in vitamins and iron. Hypochlorhydria is a decrease in levels of hydrochloric acid, which leads to decreased absorption of iron and proliferation of bacteria. This bacterial growth causes atrophic gastritis; therefore, the nurse encourages the patient to eat foods rich in vitamins and iron to help prevent atrophic gastritis. Assessing the frequency of diarrhea may be helpful in determining the need for fluid therapy, but not preventing atrophic gastritis. Assessing epigastric pain will help detect gastritis but will not prevent it. Encouraging a high-fiber diet and 1500 mL of fluid intake daily is helpful for a patient with constipation.

Which action does the nurse perform first when assessing a patient's abdomen? 1 Auscultation 2 Percussion 3 Inspection 4 Light palpation

3 Inspection The abdomen is assessed by using the four techniques of examination, but in a sequence different from that used for other body systems: inspection, auscultation, percussion, and then palpation. This sequence is preferred so that palpation and percussion do not increase intestinal activity and bowel sounds.

The nurse is assessing a patient who has come to the emergency department with acute abdominal pain. The patient is very thin and the nurse observes visible peristaltic movements when inspecting the abdomen. What does the nurse suspect? 1 Acute diarrhea 2 Aortic aneurysm 3 Intestinal obstruction 4 Pancreatitis

3 Intestinal obstruction Peristaltic movements are rarely seen except in thin patients and should be reported since the finding may indicate an intestinal obstruction. Acute diarrhea does not cause visible peristaltic movements. An aortic aneurysm may cause a bulging, pulsatile mass. Pancreatitis is characterized by severe pain

Pernicious anemia is caused by a lack of intrinsic factor, which prevents the absorption of which element? 1 Iron 2 Vitamin B₆ 3 Vitamin B₁₂ 4 Folic acid

3 Vitamin B₁₂ The parietal cells of the stomach produce intrinsic factor, which aids in the absorption of vitamin B12. An absence of intrinsic factor leads to pernicious anemia.

A patient is scheduled for a colonoscopy. What does the nurse tell the patient to do before the procedure is performed? 1 "Begin a clear liquid diet 12-24 hours before the test." 2 "Do not eat or drink anything for 12 hours before the test." 3 "Give yourself tap water enemas until the fluid returns are clear." 4 "You will have to drink a contrast liquid 2 hours before the test."

1 "Begin a clear liquid diet 12-24 hours before the test." The patient is instructed to be on a liquid diet for 12-24 hours to cleanse the bowel before a colonoscopy. The patient must be NPO (except for water) 4-6 hours before a colonoscopy. The patient is instructed to drink a liquid preparation for cleaning the bowel (such as sodium phosphate) the evening before the colonoscopy, and may repeat that procedure on the morning of the test. In some cases, the patient may require laxatives, suppositories, or one or more small-volume (i.e., Fleet) cleansing enemas. The patient is not given an oral contrast liquid to swallow for a colonoscopy.

The nurse is auscultating a patient's abdomen and hears a "swooshing" sound known as a bruit. What is the nurse's best response? 1 Notify the health care provider. 2 Document the finding as normal. 3 Encourage the patient to walk to promote intestinal motility. 4 Continue with the assessment by percussing and palpating.

1 Notify the health care provider. If a bruit is heard in the abdomen over the aorta, it usually indicates the presence of an aneurysm. If this sound is heard, the health care provider should be notified. A bruit is not a normal finding and the abdomen should not be percussed or palpated if this sound is assessed. The finding should be documented, but only after the provider is notified. The patient should not be encouraged to walk. Continuing with the assessment is not appropriate because a bruit must be addressed immediately.

An older patient reports delayed bowel movements leading to constipation. What nonpharmacologic intervention does the nurse teach the patient to alleviate this problem? 1 Perform physical activity as tolerated. 2 Avoid caffeine and alcohol intake. 3 Consume a high-protein diet. 4 Perform range of motion exercises.

1 Perform physical activity as tolerated. The nurse should encourage the patient to perform as much physical activity as tolerated. Physical activity helps to increase peristaltic movement and increase the sensation of needing to defecate. Excessive intake of caffeine and alcohol can lead to gastritis and peptic ulcers. A high-protein diet does not alter peristaltic movement. Range of motion exercises help to maintain flexibility of the extremities, neck, and shoulders, but it does not affect bowel movement.

What does the nurse instruct the patient about barium elimination after a barium enema examination? Select all that apply. 1 Take a mild laxative. 2 Drink plenty of fluids. 3 Observe that the stool is chalky white. 4 Observe brown stools after 12 hours. 5 Report abdominal fullness or pain.

1 Take a mild laxative. 2 Drink plenty of fluids. 3 Observe that the stool is chalky white. The patient should be instructed to take a mild laxative or stool softener and drink plenty of fluids after the examination to help eliminate the barium. The stool will be chalky white due to the excretion of barium for about 24 to 72 hours; brown stools are excreted after all the barium is excreted. The patient should be instructed to report to the provider any abdominal fullness, pain, or delay in the return of brown stools to prevent complications.

The nurse is assessing a patient who comes to the emergency department with acute abdominal pain. The nurse notes a bulging, pulsating mass when inspecting the abdomen. Which action by the nurse is correct? 1 Auscultate the abdomen to determine the presence of bowel sounds. 2 Notify the provider about this finding immediately. 3 Palpate the patient's abdomen to determine the outlines of the mass. 4 Question the patient about recent stool habits.

2 Notify the provider about this finding immediately. A bulging, pulsating mass may indicate an abdominal aortic aneurysm and the nurse should notify the provider immediately. Palpating the abdomen or even touching the abdomen with a stethoscope may cause this to rupture, which would be a life-threatening emergency. Because this is a potential life-threatening situation, questioning the patient about stool habits is not appropriate.

After abdominal surgery, what are the most reliable methods of assessing a patient for the return of peristalsis? Select all that apply. 1 Report of an appetite 2 Passing flatus within 8 hours 3 Reporting abdominal pains that "travel" 4 Having a bowel movement within the past 12-24 hours 5 Producing a urinary output of greater than 1000 mL 6 Having auscultated bowel sounds in all four abdominal areas

2 Passing flatus within 8 hours 4 Having a bowel movement within the past 12-24 hours A report of "passing gas" [flatulence] within 8 hours or a bowel movement within the past 12-24 hours are now the accepted most reliable methods of ascertaining the return of peristalsis. Appetite, abdominal pain, and urinary output are not indicators of bowel function. Counting the number of auscultated bowel sounds is no longer the most accurate or reliable method for determining the resumption of peristalsis following abdominal surgery.

While performing an abdominal assessment, where does the nurse expect to locate the liver? 1 Left upper quadrant (LUQ) 2 Right upper quadrant (RUQ) 3 Right lower quadrant (RLQ) 4 Left lower quadrant (LLQ)

2 Right upper quadrant (RUQ) Most of the liver is situated in the RUQ region of the abdomen. Although a small portion of the left lobe of the liver is situated in the LUQ, it is not easily palpable on abdominal examination. Other structures in the LUQ are the stomach, spleen, pancreas, and parts of the colon. Structures in the RLQ are the cecum, appendix, right ureter, right ovary and fallopian tube, and right spermatic cord. Structures in the LLQ are part of the descending colon, sigmoid colon, left ureter, left ovary and fallopian tube, and left spermatic cord.

The nurse is auscultating the abdomen of a patient. What would be a normal finding with this assessment? 1 Loud gurgling sounds 2 Bruits or "swooshing" sounds 3 High-pitched irregular gurgles 4 Diminished or absent sounds

3 High-pitched irregular gurgles It is normal to hear bowel sounds (high-pitched, irregular gurgles) when auscultating the patient. Bowel sounds are created as air and fluid move through the gastrointestinal (GI) tract. Borborygmus or loud, gurgling sounds result from increased motility of the bowel; these sounds are usually heard in the patient with diarrhea, gastroenteritis, or above a complete intestinal obstruction. Bruits or "swooshing" sounds heard over the abdominal aorta indicate the presence of an aneurysm. Diminished or absent bowel sounds occur after abdominal surgery in patients with peritonitis or paralytic ileus.

Which substance, produced in the stomach, facilitates the absorption of vitamin B12? 1 Glucagon 2 Hydrochloric acid 3 Intrinsic factor 4 Pepsinogen

3 Intrinsic factor Parietal cells in the stomach produce intrinsic factor, a substance that facilitates the absorption of vitamin B12. Absence of the intrinsic factor causes pernicious anemia. Glucagon, which is produced by the alpha cells in the pancreas, is essential for the regulation of metabolism. Parietal cells secrete hydrochloric acid, but this does not facilitate the absorption of vitamin B12. Pepsinogen is secreted by the chief cells; pepsinogen is a precursor to pepsin, a digestive enzyme.

When a patient has gastroenteritis, what type of sound is heard during auscultation of the abdomen? 1 Soft swooshing sounds 2 High-pitched musical sounds 3 Loud, gurgling sounds 4 Low-pitched thud-like sound

3 Loud, gurgling sounds Loud, gurgling sounds, or borborygmus, result from increased motility of the bowel. These sounds are usually heard in the patient with gastroenteritis, diarrhea, or above a complete intestinal obstruction. Bruits or "swooshing" sounds heard over the abdominal aorta indicate the presence of an aneurysm. High-pitched musical sounds and low-pitched thud-like sounds are heard during percussion.

What is the purpose of a stool cytotoxic assay test? 1 Detect colorectal cancer. 2 Detect steatorrhea. 3 Test for parasitic infection. 4 Detect <i>Clostridium difficile.</i>

4 Detect <i>Clostridium difficile.</i> The test determines the presence of C. difficile. Prolonged antibiotic therapy depresses the natural intestinal flora, causing an overgrowth of the pathogen. The bacterium releases a toxin that causes colonic epithelium necrosis, resulting in severe diarrhea that is easily transmitted from person to person via the fecal-oral route. A stool DNA test is used to detect changes in the vimentin gene in colorectal cancer. Stool samples are tested for steatorrhea when malabsorption of fat in the small intestine is suspected. Microscopic studies for the presence of ova and parasites in the stool detect parasitic infections.

A patient reports pain in the right upper quadrant (RUQ) after a high-fat meal. Which organ does the nurse expect to be affected? 1 Appendix 2 Spleen 3 Stomach 4 Gallbladder

4 Gallbladder The patient may be experiencing gallbladder pain, which is located in the RUQ, after a high-fat meal. The appendix is affected when the patient experiences pain due to appendicitis in the right lower quadrant (RLQ). The spleen and stomach lie in the left upper quadrant (LUQ); a patient with an inflamed spleen or gastritis would experience pain in the LUQ.

What is the correct sequence of steps for assessing a patient's abdomen? 1 Palpation, percussion, inspection, auscultation 2 Auscultation, inspection, percussion, palpation 3 Inspection, percussion, palpation, auscultation 4 Inspection, auscultation, percussion, palpation

4 Inspection, auscultation, percussion, palpation The correct sequence for assessing the abdomen is inspection, auscultation, percussion, and palpation. If palpation and percussion are performed before auscultation, there can be an artificial increase in intestinal activity and bowel sounds due to the pressure.

A patient is prescribed an esophagogastroduodenoscopy (EGD), which is a visualization of the esophagus, stomach and duodenum. What does the nurse instruct the patient about this examination? Select all that apply 1 "You must withhold foods and liquids for 6-8 hours before the test." 2 "You may take your medications on the morning of the exam." 3 "The initial preparation for the test will take about 10 minutes." 4 "You may have a dry mouth after the exam." 5 "The entire series will take about 1 hour."

1 "You must withhold foods and liquids for 6-8 hours before the test." 2 "You may take your medications on the morning of the exam." 4 "You may have a dry mouth after the exam." The patient must withhold all foods and liquids for 6-8 hours before an EGD. Usual drug therapy for hypertension or other diseases may be taken the morning of the test. The procedure takes about 20-30 minutes. A flexible tube will be passed down the esophagus while the patient is under moderate sedation. Atropine is given to dry secretions which may cause dry mouth after the procedure.

Which patient does the charge nurse assign to an experienced LPN/LVN working on the adult medical unit? 1 32-year-old who needs a nasogastric tube inserted for gastric acid analysis 2 36-year-old who needs teaching about an endoscopic retrograde cholangiopancreatography (ERCP) 3 40-year-old who will need administration of IV midazolam hydrochloride during an upper endoscopy 4 46-year-old who was recently admitted with abdominal cramping and diarrhea of unknown causes

1 32-year-old who needs a nasogastric tube inserted for gastric acid analysis Nasogastric tube insertion is included in LPN/LVN education and is an appropriate task for an experienced LPN/LVN. Assessment and patient teaching should be done by an RN. IV hypnotic medications should be administered by an RN.

While working in the outpatient procedure unit, the RN is assigned to these patients. Which patient does the nurse assess first? 1 51-year-old who recently had an endoscopic retrograde cholangiopancreatography (ERCP) 2 54-year-old who is ready for discharge following a colonoscopy 3 58-year-old who has just arrived for basal gastric secretion and gastric acid stimulation testing 4 60-year-old with questions about an endoscopic ultrasound examination

1 51-year-old who recently had an endoscopic retrograde cholangiopancreatography (ERCP) ERCP requires conscious sedation, so the patient needs immediate assessment of respiratory and cardiovascular status. The other patients are not at risk for depressed respiratory status.

The nurse is preparing to perform an abdominal examination on a patient. What action does the nurse take in regards to the assessment? 1 Asks the patient to empty the bladder before the exam. 2 Places the patient straight in a supine position. 3 Assesses the right lower quadrant (RLQ) first. 4 Examines the area of pain first.

1 Asks the patient to empty the bladder before the exam. Before an abdominal examination takes place, the patient should first empty the bladder to prevent the patient from experiencing any discomfort during the examination. The patient is placed in a supine position with the knees bent and arms at the sides to prevent tensing of the abdominal muscles. The nurse usually assesses the right upper quadrant (RUQ) first and proceeds in a clockwise pattern. Any area of pain noted in the patient's history must be assessed last to prevent the patient from tensing the abdominal muscles, which makes the examination difficult.

What screening tests are recommended to determine the presence of colorectal cancer? Select all that apply. 1 Colonoscopy every 10 years 2 Flexible sigmoidoscopy every 5 years 3 Endoscopic retrograde cholangiopancreatography (ERCP) every 10 years 4 Double-contrast barium enema every 5 years 5 Small bowel capsule endoscopy every 5 years 6 Computed tomography (CT) colonoscopy every 5 years

1 Colonoscopy every 10 years 2 Flexible sigmoidoscopy every 5 years 4 Double-contrast barium enema every 5 years 6 Computed tomography (CT) colonoscopy every 5 years In people older than 50 years, recommended screening options include colonoscopy every 10 years, flexible sigmoidoscopy every 5 years, double-contrast barium enema every 5 years, and CT colonoscopy every 5 years. ERCP is used to detect obstruction and examine the liver, gallbladder, bile ducts, and pancreas. However, this procedure is not recommended as a screening tool to detect colorectal cancer. Small bowel capsule endoscopy is used to evaluate and locate the source of gastrointestinal bleeding in the small intestine.

What is a common gastrointestinal problem that older adults experience more frequently as they age? 1 Decreased hydrochloric acid 2 Excess lipase production 3 Increased liver enzymes 4 Increased peristalsis

1 Decreased hydrochloric acid Atrophy of the gastric mucosa causes a decreased ratio of gastrin-secreting cells to somatostatin-secreting cells. This results in a decrease in hydrochloric acid, causing decreased absorption of iron and vitamin B12. In the pancreas, calcification of pancreatic vessels occurs, with a decrease in lipase production. The decrease in lipase results in decreased fat absorption and digestion. Steatorrhea and diarrhea can subsequently occur. The number and size of hepatic cells are decreased, which results in decreased enzyme activity; decreased enzyme activity depresses drug metabolism, and therefore may cause accumulation of drugs or toxic levels. In the large intestine, peristalsis is decreased and nerve impulses are dulled, which can result in postponement of bowel movements in older adults.

A patient is prescribed a gastrointestinal (GI) endoscopic examination. What actions does the endoscopy nurse take after the examination? Select all that apply. 1 Monitor vital signs every 30 minutes. 2 Provide the patient with a call light. 3 Raise the siderails of the bed. 4 Maintain nothing by mouth (NPO) status until the gag reflex returns. 5 Monitor for signs of perforation.

1 Monitor vital signs every 30 minutes. 3 Raise the siderails of the bed. 4 Maintain nothing by mouth (NPO) status until the gag reflex returns. 5 Monitor for signs of perforation. The nurse should monitor the patient's vital signs every 30 minutes until the sedation wears off. The siderails of the bed are raised to prevent the risk for falls. The nurse must ensure that the patient is NPO until the gag reflux returns and the patient is able to swallow; this prevents the risk for aspiration. The nurse must monitor the patient for signs of perforation, such as pain, bleeding, or fever, so the provider can take remedial action. The patient is under sedation after this procedure so a call light would not be of much help.

The nurse administers midazolam hydrochloride to prepare a patient for an esophagogastroduodenoscopy. What outcome does the nurse expect after the administration of the medication? 1 The patient will become sedated. 2 The patient's secretions will dry up. 3 The patient's gag reflex will be depressed. 4 The patient's esophagus will facilitate the passage of the tube.

1 The patient will become sedated. Midazolam hydrochloride is a sedative-hypnotic benzodiazepine that is used before and during operative procedures to bring moderate sedation. Atropine is administered to dry secretions. Administrating an anesthetic inactivates the gag reflex and facilitates the passage of the tube.

The health care provider has ordered a fecal occult blood test (FOBT) for a patient. What does the nurse instruct the patient to avoid for a few days before and during the sample collection? Select all that apply. 1 Warfarin 2 Milk 3 Nonsteroidal anti-inflammatory drugs (NSAIDs) 4 Vitamin B₁₂ 5 Vitamin C 6 Red meat

1 Warfarin 3 Nonsteroidal anti-inflammatory drugs (NSAIDs) 5 Vitamin C 6 Red meat The FOBT is a guaiac-based test to detect blood in the feces that cannot be seen. Drugs such as warfarin and NSAIDs should be discontinued for 7 days before the test. Vitamin C-rich foods, juices, and supplements along with red meat, raw fruits, and vegetables are also avoided for few days before the test. These drugs and food products may interact with the guaiac in the FOBT causing false-positive or false-negative results. Milk and vitamin B12do not affect the FOBT.

A 49-year-old woman comes to the emergency department (ED) with reports of black tarry stools that started 2 weeks ago. In taking a gastrointestinal history, which questions does the nurse ask that pertain to Gordon's Functional Health Patterns? Select all that apply. 1 "Are you having any difficulty having sex? How frequently do you have sex?" 2 "Do you have any difficulty chewing or swallowing?" 3 "Do you have pain, diarrhea, gas, or any other problems? Do any specific foods cause these symptoms for you?" 4 "What is your usual bowel elimination pattern? Frequency? Character?" 5 "When was your last colonoscopy?"

2 "Do you have any difficulty chewing or swallowing?" 3 "Do you have pain, diarrhea, gas, or any other problems? Do any specific foods cause these symptoms for you?" 4 "What is your usual bowel elimination pattern? Frequency? Character?" 5 "When was your last colonoscopy?" Chewing or swallowing difficulties affect the patient's ability to get food into her GI system. Pain, diarrhea, gas, and foods that cause these symptoms constitute very important data for collection in the GI history. The patient needs to be questioned about usual bowel elimination patterns—frequency and character are two descriptors. Colonoscopy history is also elicited from the patient. Sexual difficulties and frequency are not generally affected by GI problems; this would not be a routine question in a GI problem inquiry.

Which patient does the charge nurse on the adult medical unit assign to an RN who has floated from the outpatient gastrointestinal (GI) unit? 1 38-year-old who needs discharge instructions after having an endoscopic retrograde cholangiopancreatography (ERCP) 2 40-year-old who needs laxatives administered and effectiveness monitored before a colonoscopy 3 43-year-old recently admitted with nausea, abdominal pain, and abdominal distention 4 50-year-old with epigastric pain who needs conscious sedation during a scheduled endoscopy procedure

2 40-year-old who needs laxatives administered and effectiveness monitored before a colonoscopy A nurse who has experience with chronic GI problems will have experience and training in instructing patients on colonoscopy preparation. Discharge instructions following an ERCP, assessment of an admitted acutely ill patient, and monitoring a patient who is receiving conscious sedation would be accomplished best by nurses with experience in caring for adults with acute GI problems.

An older patient has been diagnosed with gastritis. What diet adjustment does the nurse recommend to the patient and family to manage this disorder? 1 Small, frequent feedings 2 Bland foods high in iron 3 Diet high in fiber 4 Daily fluid intake of 1500 mL

2 Bland foods high in iron Aging causes atrophy of the gastric mucosa leading to decreased hydrochloric acid levels. This in turn leads to decreased absorption of vitamin B12and iron and proliferation of bacteria. Atrophic gastritis occurs due to bacterial overgrowth. The patient should therefore be encouraged to include bland foods high in iron and vitamins in the diet to help prevent gastritis. The patient with diarrhea must have small, frequent feedings to help prevent dehydration. A high-fiber diet and a 1500-mL daily fluid intake are recommended for the patient with constipation and impaction.

A patient with newly diagnosed irritable bowel syndrome (IBS) reports having five to six loose stools daily. What is the common psychological patient response to this gastrointestinal health problem? 1 Acceptance 2 Embarrassment 3 Euphoria 4 Grief

2 Embarrassment The patient who has a new onset of IBS with frequent stools most likely would be embarrassed. The patient normally would not react to a new onset of IBS with acceptance or grief. It would be an abnormal reaction for the patient to feel euphoria over a new onset of IBS.

Which is the most common test to determine the presence of Clostridium difficile? 1 Oncofetal antigens CA19-9 and CEA 2 Enzyme-linked immunosorbent assay (ELISA) 3 Fecal immunochemical test (FIT) 4 Fecal occult blood test (FOBT)

2 Enzyme-linked immunosorbent assay (ELISA) The ELISA test is the most common test to detect C. difficile. Oncofetal antigens CA19-9 and CEA are used to diagnose cancer. The FIT and FOBT are used to screen for colorectal cancer.

A patient is admitted to the hospital with severe right upper quadrant (RUQ) abdominal pain. Which assessment technique does the nurse use for this patient? 1 Assesses the abdomen in the following sequence: inspection, palpation, percussion, auscultation 2 Examines the RUQ of the abdomen last 3 Has the patient lie in a supine position with legs straight and arms at the sides 4 Views the abdomen by looking directly down while standing over the patient's abdominal area

2 Examines the RUQ of the abdomen last If the patient reports pain in the RUQ, the nurse would examine this area last in the examination sequence. This sequence prevents the patient from tensing abdominal muscles because of the pain, which would make the examination difficult. The sequence for examining the abdomen is inspection, auscultation, percussion, and then palpation. This sequence prevents the increase in intestinal activity and bowel sounds caused by palpation and percussion. The patient would be positioned supine with the knees bent, while keeping the arms at the sides to prevent tensing of the abdominal muscles. It is best to inspect the abdomen by standing at the side of the bed and then looking down on the abdomen, and also from the side at eye level.

The clinic nurse is assessing an anemic adult patient. Why is it important for the nurse to advise the patient to seek follow-up care from a health care provider? 1 The patient may get dizzy and fall. 2 Gastrointestinal bleeding is the most frequent cause of anemia. 3 The patient needs instructions about how to increase fluid intake. 4 The link between anemia and many skin disorders is quite common

2 Gastrointestinal bleeding is the most frequent cause of anemia. In adults, anemia is most frequently caused by GI bleeding. It is associated with GI cancer, peptic ulcers, and inflammatory bowel diseases. Although low hemoglobin and hematocrit may lead to syncope, they are not the most important reasons to seek follow-up. Increased fluids will not cure anemia and there is no relationship between anemia and skin disorders.

Which gastrointestinal secretion influences vitamin B12absorption? 1 Pepsinogen 2 Intrinsic factor 3 Chymotrypsin 4 Amylase

2 Intrinsic factor Intrinsic factor, secreted by the parietal cells in the stomach, combines with dietary vitamin B12and aids in its absorption. In the absence of intrinsic factor, vitamin B12is not absorbed and results in pernicious anemia. Pepsinogen secreted by the chief cells in the stomach aids in digestion. Chymotrypsin and amylase are enzymes secreted by the pancreas to aid in digestion. Pepsinogen, chymotrypsin, and amylase do not influence the absorption of vitamin B12.

Which factors place a patient at risk for gastrointestinal (GI) problems? Select all that apply. 1 Eating a high-fiber diet 2 Smoking a half-pack of cigarettes per day 3 Socioeconomic status 4 Some herbal preparations 5 Use of nonsteroidal anti-inflammatory drugs (NSAIDs)

2 Smoking a half-pack of cigarettes per day 3 Socioeconomic status 4 Some herbal preparations 5 Use of nonsteroidal anti-inflammatory drugs (NSAIDs) Smoking or any tobacco use places a patient in a higher-risk category for GI problems. Socioeconomic status can also influence the risk for GI problems; patients may not be able to afford to seek care or treatment and may put off seeking help. Some herbal preparations contribute to GI problems such as Ayurvedic herbs which can affect appetite, absorption, and elimination. NSAIDs can predispose patients to peptic ulcer disease or GI bleeding. High-fiber diets are generally believed to be healthy for most patients.

A patient is admitted for a barium swallow study. Which actions does the nurse include in preparing the patient for the study? Select all that apply. 1 Instructing the patient to take a laxative 4 hours before the test 2 Withholding foods and fluids for 8 hours before the test 3 Obtaining IV access for the injection of contrast medium 4 Instructing the patient on laxative use after the exam. 5 Instructing the patient to drink plenty of fluids after the exam.

2 Withholding foods and fluids for 8 hours before the test 4 Instructing the patient on laxative use after the exam. 5 Instructing the patient to drink plenty of fluids after the exam. The radiology nurse or technician teaches the patient to drink plenty of fluids to assist in eliminating the barium and prevent an intestinal obstruction. A laxative is given to help remove the barium from the intestinal tract. Stools are chalky white for about 24 to 72 hours, until all barium is passed. The exam does not require an IV or laxative prior to the test.

After a colonoscopy, a patient reports severe abdominal pain. The nurse obtains these data: temperature 100.2° F (37.9° C), pulse 122, blood pressure 100/45, respirations 44, and O2 saturation 89%. Which request from the health care provider does the nurse implement first? 1 Give cefazolin 500 mg IV. 2 Infuse normal saline at 200 mL/hr. 3 Give morphine sulfate 2 mg IV. 4 Provide oxygen at 6 L/min per nasal cannula

4 Provide oxygen at 6 L/min per nasal cannula Based on the data given, the patient may be experiencing complications of colonoscopy such as bleeding or perforation. The most immediate concern involves respiratory status, so the patient should be placed on oxygen first. An antibiotic request is important, but is not the first priority. Fluid supplementation is important, but the patient's oxygen saturation level places the patient's respiratory status as the priority. The patient's need for analgesia should be delayed until respiratory status is addressed. Morphine depresses respiratory status and therefore might not be the right choice for this patient.