Chapter 21: PrepU - Nursing Assessment: Digestive, Gastrointestinal, and Metabolic Function

A client asks the nurse why the physician ordered the blood test carcinoembryonic antigen (CEA). The nurse answers: 1- "It tells the physician what type of cancer is present." 2- "It indicates if a cancer is present." 3- "It determines functionality of the liver." 4- "It detects a protein normally found in the blood."

1

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? 1- Ileum 2- Cecum 3- Sigmoid colon 4- Duodenum

3

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? 1- Grilled chicken on a spinach salad 2- Steamed rice with pork and broccoli 3- Hamburger and French fries 4- Salmon with cheddar mashed potatoes

3

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? 1- Colonoscopy 2- Barium enema 3- ERCP 4- Upper gastrointestinal fibroscopy

1

A group of students are studying for an examination on the gastrointestinal (GI) system and are reviewing the structures of the esophagus and stomach. The students demonstrate understanding of the material when they identify which of the following as the opening between the stomach and duodenum? 1- Cardiac sphincter 2- Hypoharyngeal sphincter 3- Ileocecal valve 4- Pyloric sphincter

4

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? 1- Further investigate the initial complaint. 2- Explain that fatty foods can mimic chest pain. 3- Call for an immediate electrocardiogram. 4- Administer an over-the-counter antacid tablet.

1

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? 1- duodenum 2- jejunum 3- ileum 4- cecum

1

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? 1- "I'll avoid eating or drinking anything 6 to 8 hours before the test." 2- "I'll drink full liquids the day before the test." 3- "There is no need for special preparation before the test." 4- "I'll take a laxative to clear my bowels before the test."

1

Specific disease processes and ingestion of certain foods and medications may change the appearance of the stool. If blood is shed in sufficient quantities into the upper gastrointestinal (GI) tract, it produces which change in the stool appearance? 1- Tarry-black 2- Bright red 3- Blood-streaked 4- Dark brown

1

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? 1- Pentagastrin 2- Atropine 3- Glycopyrronium bromide 4- Acetylcysteine

1

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? 1- Supine with knees flexed 2- Knee-chest 3- Lithotomy 4- Left Sim's lateral

1

What part of the GI tract begins the digestion of food? 1- Mouth 2- Duodenum 3- Esophagus 4- Stomach

1

An adult patient is scheduled for an upper GI series that will use a barium swallow. What teaching should the nurse include when the patient has completed the test? 1- Stool will be yellow for the first 24 hours postprocedure. 2- The barium may cause diarrhea. 3- Fluids must be increased to facilitate the evacuation of the stool. 4- This series includes analysis of gastric secretions.

3

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? 1- 1 day 2- 2 days 3- 3 days 4- 4 days

3

Blood flow to the GI tract is approximately what percentage of the total cardiac output? 1- 10% 2- 20% 3- 30% 4- 40%

2

The nurse is to obtain a stool specimen from a client who reported that he is taking iron supplements. The nurse would expect the stool to be which color? 1- Dark brown 2- Green 3- Red 4- Black

4

The nurse prepares to administer the lavage solution to a client having a colostomy completed. The nurse stops and notifies the physician when noting that the client has which condition? 1- inflammatory bowel disease 2- chronic obstructive pulmonary disease 3- congestive heart failure 4- pulmonary hypertension

1

When bowel sounds are heard about every 15 seconds, the nurse would record that the bowel sounds are 1- normal. 2- hypoactive. 3- sluggish. 4- absent.

1

Which of the following is an enzyme secreted by the gastric mucosa? 1- Pepsin 2- Trypsin 3- Ptyalin 4- Bile

1

Which of the following is the primary function of the small intestine? 1- Absorption 2- Digestion 3- Peristalsis 4- Secretion

1

Which procedure is performed to examine and visualize the lumen of the small bowel? 1- small bowel enteroscopy 2- colonoscopy 3- panendoscopy 4- peritoneoscopy

1

A 56-year-old presented to her nurse practitioner because she had been experiencing unprecedented constipation and the passage of pencil-like stools despite her high fluid and fiber intake. The nurse recognized the need to assess the patient for colorectal cancer and ordered diagnostic evaluations. What component of the patient's blood work would be most indicative of the presence of cancer? 1- C-reactive protein (CRP) 2- Carcinoembryonic antigen (CEA) 3- Ceruloplasmin 4- Coproporphyrin

2

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? 1- Both tests need to be done before breakfast. 2- The ultrasonography should be scheduled before the GI procedure. 3- The upper GI should be scheduled before the ultrasonography. 4- The client may eat a light meal before either test.

2

The nurse is providing instructions to a client scheduled for a gastroscopy. What should the nurse be sure to include in the instructions? Select all that apply. 1- The client must fast for 8 hours before the examination. 2- The throat will be sprayed with a local anesthetic. 3- After gastroscopy, the client cannot eat or drink until the gag reflex returns (1 to 2 hours). 4- The health care provider will be able to determine if there is a presence of bowel disease. 5- The client must have bowel cleansing prior to the procedure.

1,2,3

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? 1- A complete blood count including differential 2- Serum antibodies for H. pylori 3- A sigmoidoscopy 4- Gastric analysis

2

The nurse is preparing the client for an assessment of the abdomen. What should the nurse complete piror to this assessment? 1- Prepare for a prostate examination. 2- Ask the client to empty the bladder. 3- Assist the client to a Fowler's position. 4- Dim the lights for privacy.

2

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? 1- Gallbladder 2- Pancreas 3- Stomach 4- Liver

2

Which nursing instruction is correct to provide the client following a barium enema? 1- The client will maintain a low residue diet. 2- The stools may be a white or clay colored. 3- Sips of fluid may be increased if tolerated. 4- An enema will be used to clear the bowel.

2

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? 1- Small bowel series 2- Computer tomography 3- Colonoscopy 4- Upper GI series

3

The major carbohydrate that tissue cells use as fuel is 1- chyme. 2- proteins. 3- glucose. 4- fats.

3

The nurse recognizes which change of the GI system is an age-related change? 1 -increased motility 2- hypertrophy of the small intestine 3- weakened gag reflex 4- increased mucus secretion

3

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? 1- Normal 2- Hypoactive 3- Hyperactive 4- Borborygmi

3

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? 1- "If the health care provider massages over the exact painful area, the pain will disappear." 2- "The area may determine the severity of the pain." 3- "This determines the pain medication to be ordered." 4- "Often the area of pain is referred from another area."

4

The nurse is assisting the physician in a percutaneous liver biopsy. In assisting with positioning, the nurse should assist the client into a: 1- high Fowler's position. 2- lithotomy position. 3- dorsal recumbent position. 4- supine position.

4

A client presented with gastrointestinal bleeding 2 days ago and continues to have problems. The health care provider has ordered a visualization of the small intestine via a capsule endoscopy. What will the nurse include in the client education about this procedure? 1- "A capsule will be inserted into your rectum." 2- "You will need to swallow a capsule." 3- "The health care provider will use a scope called a capsule to view your intestine." 4- "An x-ray machine will use a capsule ray to follow your intestinal tract."

2

The nurse determines a client scheduled to undergo an abdominal ultrasonography should receive which instruction? 1- Do not undertake any strenuous exercise for 24 hours before the test. 2- Do not consume anything sweet for 24 hours before the test. 3- Avoid exposure to sunlight for at least 6 to 8 hours before the test. 4- Restrict eating of solid food for 6 to 8 hours before the test.

4

The nurse is conducting an abdominal assessment of a patient who is postoperative day 1 following an open cholecystectomy. During auscultation of the patient's abdomen, the nurse has noted that clicks and gurgles are audible approximately every 10 seconds. How should the nurse follow up this assessment finding? 1- The nurse should administer a p.r.n. stool softener. 2- The nurse should contact the patient's care provider. 3- The nurse should assess the patient for paralytic ileus. 4- The nurse should document normoactive bowel sounds.

4

The nurse prepares a client for a barium enema. The nurse should place the client on which diet prior to the procedure? 1- high-fiber diet 1 to 2 days prior 2- soft diet 1 day prior 3- nothing by mouth (NPO) 2 days prior 4- clear liquids day before

4

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? 1- In the right upper quadrant 2- At the umbilicus 3- At the lower border of the liver 4- Just below the last rib

2

A client tells the nurse that the stool was colored yellow. The nurse assesses the client for 1- recent foods ingested. 2- occult blood. 3- ingestion of bismuth. 4- pilonidal cyst.

1

A nurse is caring for a newly admitted patient with a suspected gastrointestinal (GI) bleed. The nurse assesses the patient's stool after a bowel movement and notes it to be a tarry-black color. The nurse recognizes that the bleeding is likely occurring where? 1- The lower GI tract 2- The upper GI tract 3- The esophagus 4- The anal area

2

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? 1- Placing any stool passed in a specific preservative. 2- Monitoring the stool passage and its color. 3- Observing the color of urine. 4- Monitoring the volume of urine.

2

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? 1- Instruct the client to have low-residue meals. 2- Allow the client to ingest fat-free meal. 3- Permit the client to drink only clear liquids. 4- Provide saline gargles to the client.

3

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? 1- Liver 2- Ileum 3- Stomach 4- Large Intestine

3

An elderly patient has developed Clostridium difficile-related diarrhea, a problem that has led to dehydration and hypokalemia. The increased peristalsis that characterizes diarrhea has the potential to cause fluid volume deficit and electrolyte deficits because: 1- Increased peristalsis diverts energy away from the absorptive activities of the small intestine. 2- Increased peristalsis creates increased metabolic demand, which in turn depletes fluid and electrolyte reserves. 3- An increase in peristalsis means that the colon cannot absorb the substances that it normally absorbs. 4- An increase in peristalsis reduces the normal surface area of the villi and microvilli in the colon.

3

The nurse inspects a client's tongue. Which finding would the nurse evaluate as an indication of potential oral cancer? 1- V formation on dorsum of tongue 2- thin, white coating on dorsum of tongue 3- red plaque on undersurface of tongue 4- large, vallate papillae on dorsum of tongue

3

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? 1- Recover from the general anesthesia 2- Decrease nausea and vomiting 3- Increase the amount of fluids 4- Ambulate independently

3

The nurse is reviewing the results of a hemoccult test with the client. Which question asked by the nurse is important in screening for the potential of a false-positive result. Select all that apply. 1- "Do you take an iron supplement on a daily basis?" 2- "Does your diet include a moderate amount of vitamin C?" 3- "Are you prescribed regular strength aspirin daily?" 4- "Can you tell me the amount of alcohol that you drink on an average week?" 5- "When was the last time that you included red meat in your diet?"

3,4,5

A nurse practitioner examined a patient who had been diagnosed with hepatomegaly (enlarged liver) due to accumulated fat deposits in the liver, subsequent to obesity. The nurse would palpate the liver by placing: 1- One hand under the left lower rib cage and pressing upward toward the midline. 2- Both hands over the left lower quadrant and applying gentle pressure. 3- The left hand at the level of the umbilicus and the right hand at the base of the diaphragm. 4- One hand under the right lower rib cage and press downward with the other hand.

4