Into to GI System
The nurse is scheduling gastrointestinal (GI) diagnostic testing for a client. Which GI test should be scheduled first? A) Radiography of the gallbladder B) Barium enema C) Small bowel series D) Barium swallow
A Radiography of the gallbladder should be performed before other GI exams in which barium is used because residual barium tends to obscure the images of the gallbladder and its duct.
When assisting with preparing a client scheduled for a barium swallow, which of the following would be appropriate to include? A) Avoid smoking for at least 12 to 24 hours before the procedure. B) Take vitamin K before the procedure. C) Take three cleansing enemas before the procedure. D) Avoid the intake of red meat before the procedure.
A 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.
The nurse is assessing the abdomen of the client with an undiagnosed disorder. In which sequence would the nurse conduct the abdominal assessment? (Use all options.) A) Palpation B) Inspection C) Auscultation D) Percussion
A, B, C, D The nurse is correct to assess the abdomen in a specific order to be able to judge the undisturbed status of the abdominal region. Begin with inspection of the abdomen using the nurse's assessment skills. Next, auscultate the abdomen before percussing and finally palpating.
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) A complete blood count including differential B) Serum antibodies for H. pylori C) A sigmoidoscopy D) Gastric analysis
B 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.
The nurse is preparing to measure the client's abdominal girth as part of the physical examination. At which location would the nurse most likely measure? A) In the right upper quadrant B) At the umbilicus C) At the lower border of the liver D) Just below the last rib
B Measurement of abdominal girth is done at the widest point, which is usually the umbilicus. The right upper quadrant, lower border of the liver, or just below the last rib would be inappropriate sites for abdominal girth measurement.
Which of the following would be most important to ensure that a client does not retain any barium after a barium swallow? A) Placing any stool passed in a specific preservative B) Monitoring the stool passage and its color C) Observing the color of urine D) Monitoring the volume of urine
B 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 caring for a client following a colonoscopy. During the procedure, two medium-sized polyps were removed. Which nursing assessment in the recovery area is a priority? A) Assessment of level of consciousness B) Hemoccult test of stool C) Vital signs D) Ability to tolerate liquids
The nurse is correct in assessing vital signs following a colonoscopy with polyp removal as a priority. Vital signs of an increases pulse rate and falling blood pressure can indicate a perforation and bleeding. If a perforation occurs and is not addressed at an early stage, the level of consciousness can become affected. There would be no reliable stool present in the bowel to Hemoccult test due to the cleansing agent and potential bleeding from the polyp removal. The ability to tolerate fluids relates to the sedation process and is not as high of a priority.
The nurse is providing care to a client who has had a percutaneous liver biopsy. The nurse would monitor the client for which of the following? A) Signs and symptoms of bleeding B) Return of the gag reflex C) Passage of stool D) Intake and output
A A major complication after a liver biopsy is bleeding, so it would be important for the nurse to monitor the client for signs and symptoms of bleeding. Return of the gag reflex would be important for the client who had an esophagogastroduodenoscopy to prevent aspiration. Monitoring the passage of stool would be important for a client who had a barium enema or colonoscopy. Monitoring intake and output is a general measure indicated for any client. It is not specific to a liver biopsy.
The nurse is caring for a geriatric client experiencing diarrhea. When instructing on the body site where water and electrolytes are absorbed, the nurse is most correct to instruct on which location? A) The small bowel B) The stomach C) The large bowel D) The cecum
A The nurse is correct in instructing the client that water and electrolytes are mainly absorbed in the small bowel. The other options are not the best site for absorption.
The nurse is working in a diagnostic testing unit focusing on gastrointestinal studies. For which testing procedure is the nurse correct to assess the gag reflex before offering fluids? A) Esophagogastroduodenoscopy B) Sigmoidoscopy C) Peritoneoscopy D) Colonoscopy
A The nurse is correct to assess the gag reflex prior to offering fluids for a client having an esophagogastroduodenoscopy (EGD). The other options are lower gastrointestinal studies typically requiring a bowel preparation.
The nurse is caring for a client following gastrointestinal diagnostic testing. The client verbalizes being ashamed because he is having frequent gas. Which nursing suggestion is best? A) "Having gas following the procedure is normal. Expel the gas to decrease discomfort." B) "Do not be ashamed. Everyone has gas following the procedure." C) "The nursing staff is used to having clients with gas due to the procedure completed." D) "Nurses anticipate that client will have gas following the procedure and provide privacy."
A The nurse is correct to tell the client that what he is experiencing is normal and encourage the client to release the gas to decrease pain and discomfort. Proving information relieving the embarrassment and stating the benefit of the action is most helpful.
The nurse is assessing a client of color for jaundice. In which location would the nurse assess for discoloration? Select all that apply. A) The sclera B) The gums C) The hands D) The nails E) The hard palate F) The conjunctiva
A, B, E, F In very dark-skinned clients, the nurse inspects the hard palate, gums, conjunctiva, and surrounding tissues for discoloration. If the skin appears jaundiced, the nurse inspects the sclera if it is yellow.
Which nursing instruction is correct to provide the client following a barium enema? A) The client will maintain a low residue diet. B) The stools may be a white or clay colored. C) Sips of fluid may be increased if tolerated. D) An enema will be used to clear the bowel.
B It is important to instruct the client that it is normal to have a white- or clay-colored stool following the barium enema. The client should report the color of the stool to the nurse. A progression of clay colored stools to brown-colored stools should be noted. The client is prescribed a low-residue diet before the procedure. An increased fluid intake is offered to eliminate the barium from the bowel. The client is encouraged to move the bowel independently.
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? A) Checking if the skin is discolored B) Checking if the mucous membranes are dry C) Examining the sclera if it is yellow D) Observing for distended abdominal veins
B Mucous membranes may be dry, and skin turgor may be poor in clients suffering from dehydration as a result of fluid losses from the GI tract. Checking the skin for discoloration and inspecting the sclera if it is yellow is taken into consideration when the client could have symptoms of jaundice, not fluid losses. Distended abdominal veins are not associated with dehydration.
The nurse is instructing the client on frequent sensations experienced when a contrast agent is injected into the body during diagnostic studies. Which sensation is most common? A) Light-headedness B) A warm sensation C) Heart palpitations D) Chills
B The nurse informs the client that he or she may experience a warm sensation and nausea when the contrast agent is instilled. The client is instructed to take a couple of deep breaths, and, many times, the sensation will go away. The other options are not frequently encountered.
The nurse is caring for a client recovering from an esophagogastroduodenoscopy (EGD). Which of the following client symptoms would require further nursing assessment? A) Drowsiness B) Abdominal distention C) Sore throat D) Thirst
B 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.
The nurse is working with clients with digestive tract disorders. Which of the following organs does the nurse realize has effects as an exocrine gland and an endocrine gland? A) Gallbladder B) Pancreas C) Stomach D) Liver
B The pancreas is both an exocrine gland, one that releases secretions into a duct or channel, and an endocrine gland, one that releases substances directly into the bloodstream. The other organs have a variety of functions but do not have a combination function such as the pancreas.
The nurse is teaching the client about the upcoming endoscopic retrograde cholangiopancreatography (ERCP). Although the nurse instructs on several pertinent points of care, which is emphasized? A) The client will fast prior to the procedure. B) The client will have moderate sedation. C) The client will receive antibiotics before and after the procedure. D) The client will change positions frequently throughout the procedure.
D It is essential that the client understands that the cooperation is essential in changing positions throughout the procedure to prevent injury of the gastrointestinal tract. All of the other options are also correct but do not carry a risk for injury if not completed.
The nurse is assisting the physician in a percutaneous liver biopsy. In which position would the nurse assist the client to assume? A) A high Fowler's position B) Lithotomy position C) Dorsal recumbent position D) Supine position
D The nurse is correct to instruct the client to assume the supine position. Also the nurse places a rolled towel beneath the right lower ribs.
The nurse is accompanying the client to the diagnostic imaging unit for a magnetic resonance imaging (MRI). Which action, by the nurse, is most important prior to the test? A) Instruct the client that the scanner makes loud clanging. B) Calculate drop per minute for intravenous fluids and infuse by gravity. C) Support client, if nervous, by words of encouragement. D) Ensure that the client does not ingest fluids in the waiting area.
B It is most important that the nurse calculate the drip rate of the intravenous fluids because the client will not be able to have an electrical or mechanical pump operating during the MRI. The MRI electrical charges during the test can affect the pump. It is also important to advise the client of the loud noises and offer support to the client. Water is typically not available in the waiting area prior to testing.
The nurse is caring for a client who is scheduled for a percutaneous liver biopsy. Which diagnostic test is obtained prior? A) Complete blood count (CBC) B) Prothrombin time (PT) C) Blood chemistry D) Erythrocyte sedimentation rate (ESR)
B The client must have coagulation studies before the procedure such as a PT or PTT because a major complication after a liver biopsy is bleeding. Clients at risk for serious bleeding may receive precautionary vitamin K. A complete blood count and blood chemistry may be completed for baseline values. Typically, an ESR is not associated with the procedure.
When preparing a client for magnetic resonance imaging (MRI) of the abdomen, which statement would indicate the need to notify the physician? A) "I haven't had anything to eat or drink since midnight last night." B) "I really don't like to be in small, enclosed spaces." C) "I left all my jewelry and my watch at home." D) "I brought earphones to shut out the loud noise."
B An MRI scanner is a narrow, tunnel-like machine that will enclose the client during the test. Clients who are claustrophobic (fear enclosed spaces) may need sedation because it is imperative that they lie still and not panic during the test. Therefore, the nurse should notify the physician about the client's statement. Typically, the client is NPO for 6 to 8 hours before the test, and he or she must remove any metal objects, credit cards, jewelry, and watch before the test. The machine makes loud repetitive noises while the test is in progress, so earphones may be helpful.
When examining the abdomen of a client with complaints of nausea and vomiting, which of the following would the nurse do first? A) Palpation B) Inspection C) Auscultation D) Percussion
B When assessing the abdomen, the nurse would first inspect or observe the abdomen. This would be followed by auscultation, percussion, and, lastly, palpation.
The nurse is caring for a geriatric client at a long-term care facility. When administering the client's medications, which age-related changes of the client are anticipated? Select all that apply. A) Increased saliva causing drooling B) Decreased motility in the esophagus C) A weak gag reflex D) Increased amount of gastric secretions E) Decreased elasticity of the rectal wall
B, C, E Age-related considerations when administering medications to a geriatric client include administering medications slowly and allowing time between medications due to a decreased motility in the esophagus. Also the client has a weakened gag reflex, which may allow the client to choke. The client has a decrease elasticity of the rectal wall potentially causing fecal incontinence. Geriatric client has a decrease in saliva production requiring water with oral medication administration. There is also a decrease in the amount of gastric secretions, which could produce nausea.
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? A) Instruct the client to have low-residue meals. B) Allow the client to ingest fat-free meal. C) Permit the client to drink only clear liquids. D) Provide saline gargles to the client.
C 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.
The nurse is providing community education at the mall. The nurse is instructing on the muscular tube that connects the mouth to the stomach. The nurse outlines this structure on a drawing and labels it with which of the following? A) Pharynx B) Pylorus C) Esophagus D) Ileum
C The esophagus begins at the base of the pharynx and ends at the opening of the stomach. Layers of muscular tissue surround the esophagus. The pharynx is part of the throat situated immediately inferior to the mouth and nasal cavity. The pylorus is the region of the stomach that connects to the duodenum. The ileum is a portion of the small intestine.
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? A) "To allow ease of passage of the scope through the colon" B) "To decrease pain associated with fecal matter being pressed against the colon wall" C) "To cleanse the bowel to promote clear visualization of structures" D) "To eliminate gas from the internal portion of the colon"
C 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.
The nurse is caring for a geriatric client and notices polypharmacy. Which diagnostic studies are anticipated? A) Complete blood count B) Urinalysis C) Liver function studies D) Blood chemistry
C The liver metabolizes and biotransforms the medications ingested. Geriatric clients who experience polypharmacy or multiple medications have an elevated risk of liver impairment. Routine liver function studies monitor the status of the liver and its ability to metabolize.
A nurse is employed as a gastroenterologist's office nurse. When assessing the client, which objective data would provide useful information for diagnosis? A) Client verbalizing symptoms of nausea B) 22-lb weight loss in 2 months C) Patient verbalizes chills and fatigue D) Client seated and stating pain
B The best objective data with useful information is the fact that the client has lost 22 lb in 2 months, indicating significant weight loss in a short period of time. This is data that, with further questioning, could provide further details for diagnosis. A client verbalizing symptoms of nausea and pain are subjective data. The client's temperature is slightly elevated. Viewing the client's seated posture offers little data.
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? A) Grilled chicken on a spinach salad B) Steamed rice with pork and broccoli C) Hamburger and French fries D) Salmon with cheddar mashed potatoes
C 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.
After 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 of the following structures as possibly being affected? A) Liver B) Ileum C) Stomach D) Large intestine
C 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 working on a general medical unit. A client is scheduled for an upper gastrointestinal series. Upon return to the nursing unit, what does the nurse identify as the client goal? A) Recover from the general anesthesia B) Decrease nausea and vomiting C) Increase the amount of fluids D) Ambulate independently
C 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.
A client is scheduled for an esophagogastroduodenoscopy (EGD) to detect lesions in the gastrointestinal tract. The nurse would observe for which of the following while assessing the client during the procedure? A) Signs of perforation B) Client's ability to retain the barium C) Client's tolerance for pain and discomfort D) Gag reflex
C The nurse has to assess the client's tolerance for pain and discomfort during the procedure. The nurse should assess the signs of perforation and the gag reflex after the procedure of EGD and not during the procedure. Assessing the client's level for retaining barium is important for a diagnostic test that involves the use of barium. EGD does not involve the use of barium.
The nurse is answering questions regarding fecal matter for a client who is scheduled for a colon resection. The client is asking questions regarding the composition of the fecal matter and when it becomes a formed mass. The nurse is most correct to state at which location? A) Ileum B) Cecum C) Sigmoid colon D) Duodenum
C Water is reabsorbed by means of diffusion across the intestinal membrane as the contents move through the colon. By the time the mixture reaches the descending and sigmoid colon, the portion of the bowel adjacent to the rectum, it is a formed mass. The ileum and duodenum are located in the small intestine. The cecum is located at the beginning of the large intestine.
The nurse is reviewing the results of a Hemoccult test with the client. Which question, asked by the nurse, is important to screen for the potential of a false-positive result. Select all that apply. A) "Do you take an iron supplement on a daily basis?" B) "Does your diet include a moderate amount of vitamin C?" C) "Are you prescribed regular strength aspirin daily?" D) "Can you tell me the amount of alcohol that you drink on an average week?" E) "When was the last time that you included red meat in your diet?"
C, D, E When obtaining a positive Hemoccult test, the client needs to be screened for a false-positive test results. Substances that may cause a false-positive include red meat, aspirin, and excessive alcohol. Screening for the frequency and amount of these are important. False-negative results are screened in individuals who ingest ascorbic acid and iron supplements.