Disorders of GI Function

Select the client at greatest risk for developing colorectal cancer. A. A 64-year-old female whose mother had colorectal cancer B. A 26-year-old male with a history of irritable bowel syndrome C. A 45-year-old female who takes four to six aspirin per week for arthritis D. A 40-year-old male with a history of peptic ulcer disease

Answer: A. A 64-year-old female whose mother had colorectal cancer Rationale: Colorectal cancer peaks at 60 to 70 years of age, and fewer than 20% of cases occur before age 50. Its incidence is increased among persons with a family history of cancer, persons with Crohn disease or ulcerative colitis, and those with familial adenomatous polyposis of the colon. Aspirin or other NSAIDs may protect against colorectal cancer. IBS and peptic ulcers are not risk factors.

The nurse has been providing dietary teaching to a client diagnosed with irritable bowel syndrome. The nurse determines that the teaching was effective when the client selects: A. a bran muffin, fruit, and orange juice. B. bacon, eggs, and coffee. C. grilled steak, green beans, and a Coke. D. fried fish and a glass of wine.

Answer: A. A bran muffin, fruit, and orange juice Rationale: Clients with irritable bowel syndrome should have adequate intake of fiber. All other options contain foods that should be avoided. Substances that should be avoided include fatty and gas-producing foods, caffeine, and alcohol.

A client admitted to the emergency department with early symptoms of appendicitis should be assessed for which manifestation? A. Vague pain that is referred to the epigastric or periumbilical area B. Severe, sharp pain in the upper quadrants of the abdomen C. Left-sided abdominal pain relieved by rest that is not associated with nausea D. Lower right quadrant pain that is relieved with movement

Answer: A. Vague pain that is referred to the epigastric or periumbilical area Rationale: Appendicitis usually has an abrupt onset, with pain that is referred to the epigastric or periumbilical area and the client experiences nausea. In the later stage, the pain becomes more severe and localizes to the right lower quadrant.

A nurse caring for a client with an intestinal obstruction anticipates which assessment findings? Select all that apply. - Diarrhea - Abdominal distension - Abdominal pain - Vomiting

Answer: Abdominal distension, Abdominal pain, Vomiting Rationale: The nurse would anticipate the following when assessing a client with an intestinal obstruction: constipation, abdominal distension, vomiting, pain, and signs of fluid volume deficit.

A client who is diagnosed with Zollinger-Ellison syndrome will exhibit which symptoms? A. Chronic constipation B. Diarrhea with fat deposits C. Elevated blood sugar D. Nausea with vomiting

Answer: B. Diarrhea with fat deposits Rationale: Zollinger-Ellison syndrome causes clients to have diarrhea from hypersecretion or from the inactivation of intestinal lipase and impaired fat digestion. Diseases associated with chronic constipation include neurologic diseases; endocrine disorders, and obstructive lesions in the gastrointestinal tract. Elevated blood sugar may be the result of diabetes or stress, and nausea with vomiting may result for obstruction or GI upset.

The nurse is teaching her client with hepatobiliary disease about her diet. She tells her that she may have steatorrhea, which is the malabsorption of which dietary component? A. Protein B. Fat C. Calcium D. Starch

Answer: B. Fat Rationale: The condidtions that impair one or more steps involved in digestion and absorption of nutrients can be divided into three broad categories: intraluminal maldigestion, disorders of transepithelial transport, and lymphatic obstruction. Hepatobiliary disease is a common cause of intraluminal maldigestion. Fats are not absorbed in the upper jejunum and the excretion of fat in the stool is steatorrhea.

A nurse is teaching a client diagnosed with Crohn disease about potential complications. The most appropriate information for the nurse to include would be: A. Excessive weight gain B. Fistula formation C. Chronic constipation D. Difficulty swallowing

Answer: B. Fistula formation Rationale: Complications of Crohn disease include fistula formation, abdominal abscess formation, and intestinal obstruction. Clients with Crohn disease are at risk for weight loss and/or diarrhea. The disease does not cause difficulty swallowing as it typically is in the bowel.

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. A client who overeats excessive amounts of fatty foods B. A client who has a history of a ruptured appendix C. A client with a prior diagnosis of Helicobacter pylori and refused treatment D. A client diagnosed with arthritis who takes acetaminophen twice per day

Answer: C. A client with a prior diagnosis of Helicobacter pylori and refused treatment Rationale: The two most important risk factors for peptic ulcer disease are infection with the bacteria H. pylori and use of aspirin and/or NSAIDs. Acetaminophen does not place the client at risk for liver injury. A history of a ruptured appendix will not cause peptic ulcer. The high fat intake may contribute to the development of atherosclerosis.

A client diagnosed with inflammatory diarrhea is having multiple small, bloody stools with a fever. Which could be a likely cause of this inflammatory diarrhea? A. H. pylori B. C. difficile C. M. tuberculosis D. S. aureus

Answer: C. difficile Rationale: Inflammatory diarrhea is usually characterized by the presence of fever and bloody diarrhea. It is caused by bacterial invasion of intestinal cells (e.g., Shigella, Salmonella, Yersinia, and Campylobacter) or the toxins associated with C. difficile or E. coli O157:H7 infection. H. pylori can cause gastritis, and M. tuberculosis can result in the development of tuberculosis. S. aureus can cause noninflammatory diarrhea.

An older adult client is reporting chronic constipation. When evaluating the client's medication regimen, the nurse will note that which medications may contribute to this constipation? Select all that apply. - Calcium channel blockers for his hypertension - Diuretics for his heart failure - Propylthiouracil for his hyperthyroidism - Antacids for his heartburn

Answer: Calcium channel blockers for his hypertension, Diuretics for his heart failure, Antacids for his heartburn Rationale: Drugs such as narcotics, anticholinergic agents, calcium channel blockers, diuretics, calcium (antacids and supplements), iron supplements, and aluminum antacids tend to cause constipation. Propylthiouracil is indicated for hyperthyroidism. Hypothyroidism can be associated with constipation.

Which disorders are grouped under the category of inflammatory bowel disease? Select all that apply. - Crohn disease - Salmonellosis - Ulcerative colitis - Celiac disease - Shigellosis

Answer: Crohn disease, Ulcerative colitis Rationale: The term inflammatory bowel disease is used to designate two inflammatory conditions: Crohn disease, which affects the small and large bowel, and ulcerative colitis, which affects the colon and rectum. Salmonellosis and Shigellosis are infectious diseases. Celiac disease is an immune mediated disorder.

Which client should the nurse observe most closely for the signs and symptoms of paralytic ileus? A. A client whose acute diarrhea has necessitated the use of antidiarrheal medications B. A client with a long-standing diagnosis of irritable bowel syndrome C. An obese client who refuses to ambulate because he reports shortness of breath D. A client who is first day postoperative following gallbladder surgery

Answer: D. A client who is first day postoperative following gallbladder surgery Rationale: Paralytic ileus is a significant complication of abdominal surgery. The problem is not associated with the use of antidiarrheal medications, obesity, or irritable bowel syndrome.

Which symptom is often observed in cases of peritonitis? A. Bradycardia B. Decreased white blood cell count C. Deep, rhythmic breathing D. Abdominal rigidity

Answer: D. Abdominal rigidity Rationale: The abdomen is rigid and becomes boardlike because of reflex muscle guarding. The client typically becomes tachycardic, has increased WBC count, and breathes in a shallow way to avoid movement of the abdomen related to the pain.

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: A sinus infection that causes severe headaches Consuming a diet that is high in fiber and prepared with multiple spices Drinking a glass of red wine once a week Arthritis treated with high levels of nonsteroidal anti-inflammatory (NSAIDs) agents

Answer: D. Arthritis treated with high levels of nonsteroidal anti-inflammatory (NSAIDs) agents Rationale: Acute gastritis is most commonly associated with local irritants such as aspirin or other NSAIDs, alcohol, or bacterial toxins. A high-fiber diet and occasional alcohol consumption are not causes. The severe headache may cause stress or nausea but does not cause gastritis.

A client is admitted to the hospital with a suspected diagnosis of strangulated bowel. The nurse anticipates the client will need: A. Low fiber diet for 24 hours. B. Lower abdominal massage. C. Insertion of a nasogastric tube. D. Surgery to release the bowel.

Answer: D. Surgery to release the bowel Rationale: Strangulation and complete bowel obstruction require surgical intervention. Nasogastric tubes are used for adynamic obstructions that result from neurogenic or muscular impairment of peristalsis. Massage or diet would not relieve strangulation.

When comparing the symptomology of Crohn disease with that of ulcerative colitis, which symptoms are generally characteristic of only Crohn disease? Select all that apply. - Risk for cancer of the colon - Bloody diarrhea - Fistulas - Perianal ulcers - Toxic megacolon

Answer: Fistulas, Perianal ulcers Rationale: Fistulas, strictures, and perianal ulcers are generally associated with Crohn disease, while bloody diarrhea, toxic megacolon, and the increased risk of colon cancer are associated only with ulcerative colitis.

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: Select all that apply. - Hemorrhage - Obstruction - Perforation - Increased urinary output - Weight gain

Answer: Hemorrhage, Obstruction, Perforation Rationale: The most common complications of peptic ulcer are hemorrhage, perforation, and gastric outlet obstruction. Weight gain and increased urinary output would not occur as the client may experience volume loss.

Which clinical manifestations would lead the nurse to suspect the postoperative client has developed a mechanical bowel obstruction? Select all that apply. - Rectal bleeding - Increased abdominal distention - High-pitched bowel sounds - Severe, colicky pain - Extreme restlessness

Answer: Increased abdominal distention, High-pitched bowel sounds, Severe, colicky pain, Extreme restlessness Rationale: Major inciting causes of mechanical bowel obstruction include external hernia (i.e., inguinal, femoral, or umbilical) and postoperative adhesions. The major symptoms of acute intestinal obstruction are pain, absolute constipation, abdominal distention, and vomiting. With mechanical obstruction, the pain is severe and colicky, in contrast with the continuous pain and silent abdomen of paralytic ileus. There are also rumbling sounds made by propulsion of gas in the intestine. Audible, high-pitched peristalsis and peristaltic rushes are associated with abdominal pain. Visible peristalsis may appear along the course of the distended intestine. Extreme restlessness and conscious awareness of intestinal movements are also experienced.

A client in rehabilitation is recovering from a recent stroke and experiencing difficulty swallowing. The nurse would anticipate which diagnostic procedure or treatment approach to be prescribed to assess swallowing difficulty? Select all that apply. - Multidisciplinary approach - Barium esophagoscopy - Esophageal biopsy - pH monitoring - Endoscopy

Answer: Multidisciplinary approach, Barium esophagoscopy, Endoscopy Rationale: Dysphagia refers to difficulty in swallowing. Dysphagia can result from neuromuscular or structural causes. An example of a neuromuscular cause involves lesions of the central nervous system, such as stroke, which often involve the cranial nerves that control swallowing. Endoscopy, barium esophagoscopy, and videoradiography may be used to determine the site and extent of a swallowing disorder. Esophageal manometry, a procedure in which a small pressure-sensing catheter is inserted into the esophagus, may be done to measure pressures in different parts of the esophagus. Treatment of dysphagia often involves a multidisciplinary team of health professionals, including a speech pathologist.

The nurse is caring for a client with chronic diarrhea. She knows that diarrhea could be caused by which condition? Select all that apply. - Ulcerative colitis - Crohn disease - Lactase deficiency - Fecal impaction - Intestinal obstruction

Answer: Ulcerative colitis, Crohn disease, Lactase deficiency, Fecal impaction Rationale: All of the disorders except intestinal obstruction will result in chronic diarrhea.