patho phys ch. 28-29

The gastrointestinal laboratory nurse is learning about small intestine secretions. Which explanation is most accurate?

"An extensive array of mucus-producing glands, called Brunner glands, is concentrated where contents from the stomach and secretions from the liver and pancreas enter the duodenum."

A client with diabetes mellitus states, "I can eat as many carbohydrates as I want and it will not affect my blood sugar." What is the nurse's best response?

"Carbohydrates are broken down into monosaccharides before being absorbed."

Which statement would help a nurse best explain an "incretin effect"?

"It is an increase in insulin release after ingestion of food."

A student is comparing the two patterns of contractions in the small intestine. Which statement is most accurate?

"Segmentation waves function mainly to mix the chyme with the digestive enzymes from the pancreas."

A gastroenterologist is teaching a group of students about the enteric nervous system in preparation for a consult with a client who has experienced a spinal cord injury. Which teaching point is most accurate?

"The enteric nervous system is made up of the myenteric and submucosal plexuses; these are located in the wall of the gastrointestinal (GI) tract."

A student is studying the esophagus. Which statement made by this student to a faculty member is a correct one?

"The smooth muscle layers provide the peristaltic movements needed to move food along the length of the esophagus."

A client takes 650 mg of aspirin every 4 hours daily for reports of joint pain. Which statement should be included in the client's teaching plan?

"This medication can damage gastric mucosa."

A 71-year-old male has been recently diagnosed with a stage III tumor of colorectal cancer, and is attempting to increase his knowledge base of his diagnosis. Which statement about colorectal cancer demonstrates a sound understanding of the disease?

"While diet is thought to play a role in the development of colorectal cancer, the ultimate causes are largely unknown."

Following a history of gastric pain and an endoscopy, a client has been diagnosed with a duodenal peptic ulcer. Which teaching point should his caregiver provide?

"Your family history, your smoking history, and NSAID use may all have contributed to this problem."

A client is diagnosed with pernicious anemia and asks, "Why is my body not able to absorb vitamin B12?" Which response by the nurse is most accurate?

"Your stomach is not secreting a substance known as intrinsic factor, which is needed to absorb vitamin B12."

Which client is most clearly displaying the signs and symptoms of irritable bowel disease (IBD)?

A 51-year-old male who states that his stomach pain is in his lower abdomen, "comes and goes" and "feels more like a cramp than a dull ache."

Select the client at greatest risk for developing colorectal cancer.

A 64-year-old female whose mother had colorectal cancer

The nurse is reviewing the medical history of four clients. The nurse determines that the client at greatest risk for developing peptic ulcer disease is:

A client with a prior diagnosis of Helicobacter pylori and refused treatment

Irritable bowel syndrome is thought to be present in 10% to 15% of the population in the United States. What is its hallmark symptom?

Abdominal pain relieved by defecation with a change in consistency or frequency of stools

Absorption is a major function of the GI tract. How is absorption accomplished in the GI tract?

Active transport and diffusion

An older adult client has been diagnosed with pernicious anemia as a result of the aging process. Which nursing intervention is appropriate to treat pernicious anemia?

Administering an intramuscular injection of cobalamin, a form of B12.

The mother of a 19-week-old infant has brought her baby in for assessment to a pediatrician because of the baby's persistent weight loss and diarrhea. An intestinal biopsy has confirmed a diagnosis of celiac disease, and the child's mother is anxious to know what caused the disease. What aspect of the etiology of celiac disease would underlie the explanation that the physician provides?

An inappropriate T-cell mediated response results in increased levels of antibodies and an inflammatory response.

A nurse is reviewing the admission assessment data of a client diagnosed with acute gastritis. The nurse determines that the condition most likely occurred as a result of:

Arthritis treated with high levels of nonsteroidal anti-inflammatory (NSAIDs) agents

An older adult client presents with loose mucousy stools. The nurse suspects the client has Clostridium difficile. What is a priority assessment for the nurse?

Ask the client about his or her antibiotic use.

A client has experienced a stroke affecting the reticular formation of the medulla and lower pons. The nurse tells the client's wife that care must be taken with eating to prevent:

Aspiration pneumonia

A client presents with a perforated peptic ulcer. Which complication would be a priority for the nurse to assess for?

Assessment of a rigid, boardlike abdomen

Which enzymes adhere to the border of the villus structures to allow access to carbohydrate and protein molecules?

Brush border

Which statement is true concerning the digestion of carbohydrates?

Carbohydrates are broken down into monosaccharides before being absorbed.

The nurse assesses a client who is vomiting to ensure that which protective physiologic change is occurring during the act of vomiting?

Cessation of respiration

The incidence of stomach cancer has significantly decreased in the United States, yet it remains the leading cause of death worldwide. The nurse understands the reason for the high mortality rate in stomach cancer is because of which reason?

Clients have few early symptoms of the disease.

A health care provider suspects a client has developed diverticular disease. Which diagnostic test is usually prescribed to confirm the diagnosis?

Computed tomography (CT) scan

An older adult client expresses concern about straining to pass stools that are small and hard. What term will the health care provider use to document this in this client's chart?

Constipation

A nurse reading a sigmoidoscopy report notes that a client was found to have skip lesions. The nurse interprets this as an indication of:

Crohn disease

A young man presents reporting diarrhea, fecal urgency, and weight loss. His stool is light-colored and malodorous, and it tends to float and be difficult to flush. He has also noted tender, red bumps on his shins and reports pain and stiffness in his elbows and knees. Sigmoidoscopy reveals discontinuous, granulomatous lesions; no blood is detected in his stool. Which diagnosis would his care team first suspect?

Crohn disease

Which disorders are grouped under the category of inflammatory bowel disease? Select all that apply.

Crohn disease Ulcerative colitis

When discussing pathogens that can invade the gastrointestinal tract, the nurse will likely discuss which type of cell that signals the gastrointestinal immune system to attack pathogens to kill them before they can cause manifestations of an illness?

Cytotoxic T cells

A nurse is concerned about a client's continual use of nonsteroidal anti-inflammatory drugs (NSAIDs). Which problematic occurrence is the nurse concerned about?

Damage to the gastric mucosa

When maltose is not broken down into two glucose molecules in the gastrointestinal tract, which of the following may occur?

Diarrhea

A client is admitted with chronic gastritis. The nurse expects which invasive test to be performed to establish the presence of Helicobacter pylori (H. pylori)?

Endoscopic biopsy

The cause of gastric carcinomas has been influenced by which factors? Select all that apply.

Environmental factors Family history Strain of Helicobacter pylori (H. pylori)

Parents of a 20-month-old infant report that he refuses food or eats poorly and that he grimaces when he swallows. He also is irritable and cries a lot. The mother is worried that he ate something inappropriate this morning, because he vomited something that looked like coffee grounds. Which health problem would the care team first suspect?

Esophagitis from gastrointestinal reflux

Good hand-washing techniques are important in health care. The nurse knows that bacterial infections can be prevented by good hand washing techniques. Which route of transmission is most common for Clostridium difficile?

Fecal-oral transmission

The colon is home to between 300 and 500 different species of bacteria. What is their main metabolic function?

Fermentation of undigestible dietary residue

A nurse is teaching a client diagnosed with Crohn disease about potential complications. The most appropriate information for the nurse to include would be:

Fistula formation

Crohn disease has a distinguishing pattern in the gastrointestinal (GI) tract. The surface has granulomatous lesions surrounded by normal-appearing mucosal tissue. A complication of the pattern includes:

Fistula formation

In clients with acute diarrhea, many require no treatment. However, the nurse knows the priority assessment in all clients with diarrhea is:

Fluid and electrolyte status

A client is experiencing reflux of stomach contents into the esophagus. The nurse determines that the problem may result from:

Gastroesophageal sphincter

A student is comparing the actions of the gastrointestinal hormones. Which hormone acts as an appetite-stimulating signal?

Ghrelin

A nurse practitioner is examining an obese client. Which structure can contain considerable amounts of fat?

Greater omentum

In the balance of secretions in the gastric mucosa by the parietal cells, which ion is produced to buffer the production of hydrochloric acid?

HCO3-

A client is diagnosed with Crohn disease. The nurse instructs the client on which type of dietary needs?

High-calorie, vitamin, and protein diet

A client asks the nurse what part of the brain regulates appetite. Which is the best response by the nurse?

Hypothalamus

A resident of a long-term care facility has contracted Clostridium difficile with frequent diarrhea and hyperactive bowel sounds. What process in the small intestine is most likely accompanying the current status?

Inflammation is accompanied by an increase in peristaltic movements of the small intestine.

A client is admitted to the medical surgical unit with a history of inflammatory bowel disease. The nurse knows that the clinical manifestations of both Crohn disease and ulcerative colitis are the result of activation of which cells?

Inflammatory

A 22 year-old student has developed a fever and diarrhea while on a backpacking trip in Southeast Asia. His oral temperature is 101.4°F (38.6°C). The diarrhea is bloody, frequent, and small in volume. These clinical manifestations are distressing enough that he is visiting a local medical clinic in the area. Which diagnosis best characterizes this health problem?

Inflammatory diarrhea

Crohn disease is treated by several measures. Treatment with sulfasalazine will focus on which aspect of this disease?

Inflammatory suppression

What is true regarding the process of absorption? Select all that apply.

It is the process by which nutrients are moved through the GI tract. The process involves active transport. The process involves diffusion.

Colonic microorganisms play a role in the synthesis of which vitamin?

K

Crohn disease not only affects adults but also can occur in children. The nurse assesses for which major manifestation in children with Crohn disease?

Malnutrition

Place the components to the gastrointestinal tract in descending order, describing the route food would take through the body.

Mouth Esophagus Stomach Pyloric region Duodenum Rectum

Select the correct structural sequence of the GI tract.

Mouth, esophagus, stomach, duodenum, jejunum, ileum, cecum, colon, rectum

A speech therapist is performing a swallowing assessment on a client who had a stroke, because the health care team is considering the introduction of oral food. The client will most likely have conscious control over which process?

Moving a bolus to the posterior wall of the pharynx

A nurse is teaching a client about the difference between digestion and absorption. Which action should the nurse describe as absorption?

Moving nutrients from the external environment of the GI tract into the internal environment

Ulcerative colitis is an inflammatory bowel disease. The nurse identifies which of the following as a common sign of ulcerative colitis?

Mucus and blood stools

The layer of the gastrointestinal (GI) tract that facilitates movement of contents in the GI tract is known as:

Muscularis externa

Which nerve plexus controls the motility along the length of the gut?

Myenteric

A client with a history of peptic ulcer disease presents to the emergency department with the following symptoms: early satiety, feeling of epigastric fullness and heaviness after meals, weight loss, and vomiting. The nurse suspects that the peptic ulcer has caused which problem?

Obstruction

A client has been admitted to the hospital with an exacerbation of peptic ulcer disease. The nurse is aware the client is at risk for:

Obstruction Hemorrhage Perforation

An older adult client presents with a perforation of a peptic ulcer. The nurse will monitor for signs and symptoms of which problem?

Peritonitis

Select the phase of swallowing that prevents food from entering the nasopharynx when a client is eating.

Pharyngeal

The swallowing reflex is an ordered sequence of events. In which phase is the epiglottis moved so that it covers the larynx?

Pharyngeal phase

What is the primary purpose of the mucosal barrier in the gastrointestinal tract?

Protection from acid secretion

Which statement is true concerning food digestion?

Protein digestion begins in the stomach.

After several months of persistent heartburn, an adult client has been diagnosed with gastroesophageal reflux disease (GERD). Which treatment regimen is likely to be prescribed for this client's GERD?

Proton pump inhibitors; avoiding large meals; remaining upright after meals

An adult has been diagnosed with gastroesophageal reflux disease, in which the function of the lower esophageal sphincter is compromised. Which consequence of this condition is most likely?

Protrusion of the stomach or regurgitation of stomach contents into the esophagus.

Saliva contains which enzyme that initiates the digestion of dietary starches?

Ptyalin

An anatomy student explains that the funnel-shaped portion of the stomach that connects with the intestine is called which region?

Pyloric region

A nurse is completing an abdominal assessment on a client suspected to have appendicitis. When the nurse applies and then releases pressure in the client's right lower quadrant, the client experiences tenderness. The nurse is documenting the presence of:

Rebound tenderness

Celiac disease commonly presents in infancy as failure to thrive. It is an inappropriate T-cell-mediated immune response, and there is no cure for it. What is the treatment of choice for celiac disease?

Removal of gluten from the diet

A client reports chronic cramping, bloating, and diarrhea and is diagnosed with a deficiency in brush border enzymes within the small intestine. Which meal/snack, high in carbohydrates and protein, will likely exacerbate the client's signs and symptoms?

Roast beef and a baked potato

Several neurotransmitters have been identified with nausea and vomiting. In this capacity, they act as neuromediators. What neuromediator is thought to be involved in the nausea and vomiting that accompanies chemotherapy?

Serotonin

A client is admitted to the hospital for further evaluation of problems experienced with gastrointestinal digestion and absorption. The nurse anticipates the health care provider will further assess the:

Small intestine

A nurse explains to her client that food is moved along the gastrointestinal (GI) tract with intermittent contractions that mix the food and move it along. These movements are found in which organ?

Small intestine

Villi are anatomic features that contribute to the enlarged surface area of the:

Small intestine

A client with a gastrointestinal disorder is having the number and quality of stool monitored by the nursing staff. The nurse notes an abnormal amount of fatty substances in the stool sample. Which term should the nurse use when documenting this assessment finding in the medical record?

Steatorrhea

The results of a client's 24-hour stool specimen indicate 20 g or more of fat. The nurse would interpret this as:

Steatorrhea

A client with a systemic infection has been given strong doses of broad-spectrum antibiotics for a period of 10 days. The infection recedes and he is taken off the antibiotic therapy. Two days later he presents with a Clostridium difficile infection. How should the nurse best interpret this situation?

The client's antibiotics disrupted the microbial balance and allowed overgrowth.

A busy 45-year-old female executive has been diagnosed with diverticulitis. Her primary treatment is an increase in the fiber content of her diet. What effect will the fiber have on the diverticula?

The fiber increases bulk, promotes regular defecation, and increases colonic contents and colon diameter, thereby decreasing intraluminal pressure.

Which statement is true concerning gastric enterocytes?

They secrete enzymes that aid in digestion of proteins.

What is a clinical manifestation in infants/children with severe gastroesophageal reflux disease?

Tilting of the head to one side and arching of the back

Which substance is broken down by the emulsification process?

Triglycerides

Which statement best captures an aspect of the process of fat digestion and absorption?

Triglycerides are digested with the aid of bile salts.

Which are functions of the digestive system? Select all that apply.

Wastes are collected. Nutrients are absorbed. Wastes are eliminated. Vitamins are synthesized.

The nurse is assessing a client who has been diagnosed with gastroesophageal reflux disease (GERD). The nurse recognizes which sign/symptom may be associated with GERD? Select all that apply.

Wheezing Retrosternal pain Hoarseness Epigastric pain

A student is studying gallbladder function. Which gastrointestinal hormone stimulates contraction of the gallbladder?

cholecystokinin

The client tells the nurse that she is very anxious and that her pulse is racing. What will the nurse expect to see?

dry mouth

The dietitian explains to the client that food is digested and absorbed in the:

jejunum

A client who suffered a stroke is having difficulty swallowing food and beverages. The client complains that it feels like "the food is sticking to the back of my throat." Given this information, the priority nursing interventions would be to:

make the client "nothing per os" (NPO) and call the physician.

Digestion of starch begins in which structure?

mouth

A client is not able to absorb vitamin B12. The nurse determines that the client is deficient in:

parietal (oxyntic) cells, which secrete HCl and intrinsic factor.

A client has recently been diagnosed with H. pylori gastritis. The nurse knows that this form of gastritis is usually treated with a combination of an antibiotic and:

proton pump inhibitors.

Which functions apply to gastrointestinal secretions? Select all that apply.

reabsorption of fluid in the small and large intestines Protection of the mucosal layer Secretion of enzymes and fluids

A 68-year-old man who has smoked for at least 50 years reports that lately he feels as though food is "getting stuck" in his throat. At first this was a problem just with dry food, but now his morning oatmeal is getting stuck. On questioning, he reports drinking at least five alcoholic beverages nearly every day. His problem is most likely:

squamous cell carcinoma of the esophagus.

During a lecture about the function of the intestine related to food digestion, the faculty mentions that when the students consume foods high in acid, the intestines will:

stimulate the release of secretin, which then inhibits release of gastrin.

A client is admitted to the hospital with a suspected diagnosis of strangulated bowel. The nurse anticipates the client will need:

surgery to release the bowel.