Exam 4 (Chapter 44) Assessment of Digestive and GI Function

C. Norepinephrine

1. The nurse is performing an initial assessment of a patient complaining of increase stomach acid related to stress. The nurse knows that the physician will want to consider the influence of what neuro regulator? A. Gastrin B. Cholecystokinin C. Norepinephrine D. Secretion

Follow the dietary and fluid restrictions and bowel preparation procedures- for a patient due to have a colonoscopy, it is essential that the patient follows the dietary and fluid restrictions and bowel preparation procedures. For the patient having an esophagogastoduodenoscopy (EGD), it is necessary for the patient to spray or gargle with a local anesthetic. The patient is not advised to consume 3 quarts of water not to void before the test. These interventions may be essential for tests that involve ultrasonographic procedures.

1.) The nurse is teaching a patient scheduled for a colonoscopy. Which of the following should be included as part of the preparation for the procedure? a. Follow the dietary and fluid restrictions and bowel preparation procedures b. Consume at least 3 quarts of water before the test c. Do not void for at least 30 minutes before the test d. Spray or gargle with a local anesthetic

B. Cancer screening

10. A patient is scheduled for a fiberoptic colonoscopy. What does the nurse know that fiberoptic colonoscopy is most frequently used to diagnose? A. Bowel disease of Unknown origin B. Cancer screening C. Inflammatory bowel disease D. Occult bleeding

Tarry black- blood that is shed in sufficient quantities from the upper GI tract produces a tarry black stool. Blood from the lower portion of the GI tract will appear bright or dark red. A milky white stool is indicative of a patient who received barium. A green stool is indicative of a patient who has eaten spinach.

10.) The nurse is assessing for blood in the stool due to an upper GI condition. The nurse understands that if there is blood in the stool, the stool will be which of the following colors? a. Green b. Milky white c. Bright red d. Tarry black

C. Aspirin

11. A patient is being prepared for esophageal manometry. The nurse should inform the patient to withhold what medication for 48 hours prior to the procedure? A. Amiodarone (Cordarone) B. Calan (Verapamil) C. Aspirin D. Metoprolol (Lopressor)

Hypoactive- hypoactive bowel sound is the description given to auscultation of one to two bowel sounds in 2 minutes. Normal bowel sounds are heard every 5 to 20 seconds. Hyperactive bowel sounds occur when five or six sounds are heard in less than 30 seconds. The nurse records that bowel sounds are absent when no sound is heard in 3 to 5 minutes.

11.) The nurse is assessing bowel sounds and hears one to two bowel sounds in 2 minutes. The nurse documents the bowel sounds as being which of the following? a. Absent b. Hyperactive c. Normal d. Hypoactive

A. Pentagastrin

12. The nurse is assisting the physician with a gastric acid stimulation test for a patient. What medication should the nurse prepare to administer subcutaneously to stimulate gastric secretions? A. Pentagastrin B. Atropin C. Robinul (glycopyrrolate) D. Mucomyst

20- blood flow to the GI tract is about 20% of the total cardiac output and increases significantly after eating.

12.) Blood flow to the GI tract is approximately what percentage of the total cardiac output? a. 30 b. 10 c. 40 d. 20

D. To relax colonic masculature and reduce spasm

13. The nurse is assisting the physician with a colonoscopy for a patient with rectal bleeding. The Physician requests the nurse to administer glucagon during the procedure. Why is the nurse administering this medication during the procedure? A. The patient is probably hypoglycemic and requires the glucagon B. To relieve anxiety during the procedure for moderate sedation C. To reduce air accumulation in the colon D. To relax colonic masculature and reduce spasm

Glucose- glucose is the major carbohydrate that tissue cells use as fuel. Proteins ate a source of energy after they are broken down into amino acids and peptides. Chyme stays in the small intestine for 3 to 6 hours, allowing for continued breakdown and absorption of nutrients. Ingested fats become monoglycerides and fatty acids by the process of emulsification.

13.) Which of the following is the major carbohydrate that tissue cells use as fuel? a. Fats b. Proteins c. Glucose d. Chyme

D. "The cramping is caused by the air insufflated in the colon during the procedure"

14. A patient is in the outpatient recovery area after having a colonoscopy and informs the nurse of abdominal cramping. What is the best response by the nurse? A. "We may need to go back in and see what is wrong. You shouldn't have discomfort" B. "I will call the position and let him know. He may have put too much air in your colon" C. "I will call the position and see if I can give you pain medication. Sometimes the pain can be caused by having a biopsy" D. "The cramping is caused by the air insufflated in the colon during the procedure"

Restrict eating of solid food for 8 to 12 hours before the test- for a patient who is scheduled to undergo an abdominal ultrasonography, the patient should restrict him- or herself from solid food for 6 to 8 hours to avoid having images of the test obscured with gas and intestinal contents. Ultrasonography records the reflection of sound waves. Strenuous exercises, the consumption of sweets, and exposure to sunlight do not affect the results of the test in any way.

14.) The nurse is conducting education relating to test preparation for a patient scheduled to undergo an abdominal ultrasonography. The nurse instructs the patient to do which of the following? a. Restrict eating of solid food for 8 to 12 hours before the test b. Do not consume anything sweet for 24 hours before the test c. Avoid exposure to sunlight for at least 6 to 8 hours before the test d. Do not undertake any strenuous exercise for 24 hours before the test

B. Bowel perforation

15. During a colonoscopy with moderate sedation, the patient groans with obvious discomfort and begins bleeding from the rectum. The patient is diaphoretic and has an increase in abdominal girth from distention. What complication of this procedure is the nurse aware may be occurring? A. Infection B. Bowel perforation C. Colonic polyp D. Rectal fissure

Trypsin- trypsin, amylase, and lipase are digestive enzymes secreted by the pancreas. Trypsin aids in digesting protein; amylase aids in digesting starch; and lipase aids in digesting fats. Pepsin, an important enzyme for protein digestion, is the end product of the conversion of pepsinogen from the chief cells. Digestive enzymes secreted by the pancreas, include trypsin, which aids in digesting protein. Amylase is an enzyme that aids in the digestion of starch.

15.) Which enzyme aids in the digestion of protein? a. Pepsin b. Lipase c. Ptyalin d. Trypsin

Red plaque on undersurface of tongue- red or white plaque located on the undersurface of the tongue can be indicative of oral cancer. A thin, white coating on the dorsum of the tongue and large vallate papillae that form a V on the distal portion of the tongue are normal findings.

16.) The nurse is inspecting a patient's tongue. Which of the following findings would the nurse evaluate as an indication of potential oral cancer? a. V formation on dorsum of tongue b. Thin, white coating on dorsum of tongue c. Red plaque on undersurface of tongue d. Large, vallate papillae on dorsum of tongue

Inspection, auscultation, percussion, palpation- The correct order for the abdominal assessment is inspection, auscultation, percussion, and palpation.

17.) The nurse is performing an abdominal assessment. The nurse should perform the assessment in which of the following orders? a. Inspection, auscultation, percussion, palpation b. Inspection, palpation, percussion, auscultation c. Auscultation, percussion, inspection, palpation d. Auscultation, inspection, percussion, palpation

"It indicates if a cancer is present."- The CEA blood test detects the presence of cancer by detecting the presence of a protein not normally detected in the blood of a healthy person. However, it does not indicate what type of cancer is present nor does it detect the functionality of the liver.

18.) A patient asks the nurse why the physician ordered the blood test carcinoembryonic antigen (CEA). The nurse answers: a. "It indicates a protein normally found in the blood." b. "It indicates if a cancer is present." c. "It determines the functionality of the liver." d. "It tells the physician what type of cancer is present."

"I should avoid antibiotics for 1 month before the test."- the nurse evaluates that the patient understands the education when he states that he should avoid antibiotics one month before the test. In addition, the patient should avoid loperamide (Pepto Bismol), sucralfate (Carafate), and omeprazole (Prilosec), for 1 week prior to the test, and cimetidine (Tagamet), famotidine (Pepcid), and rantidine (Zantac) for 24 hours before the test. During the test, the patient swallows a capsule of carbon-labeled urea and a breath sample is obtained 10 to 20 minutes later. The hydrogen breath test detects the presence of Helicobacter pylori, the bacteria that causes peptic ulcer disease.

19.) The nurse is educating a patient about to undergo hydrogen breath testing about the test. The nurse evaluates that the patient understands the test when he states which of the following? a. "The test will detect the presence of oral cancer." b. "First I will drink a cherry flavored liquid." c. "The test will detect the presence of staph." d. "I should avoid antibiotics for 1 month before the test."

B. Dyspepsia: Dyspepsia is a common condition and usually describes a group of symptoms rather than one predominant symptom. These symptoms include: Belly pain or discomfort. Bloating. Feeling uncomfortably full after eating. Nausea. Loss of appetite. Heartburn. Burping up food or liquid (regurgitation). Burping.

2. The nurse is performing an assessment of a patient. During the assessment the patient informs the nurse of some recent "stomach trouble". What does the nurse know is the most common symptom of patients with GI dysfunction? A. Diffuse pain B. Dyspepsia C. Constipation D. Abdominal bloating

They tend to usually have less control of the rectal sphincter- Older adults tend to have fewer reserves to compensate for fluid loss. The older adult usually has less control of the rectal sphincter than a younger adult because of age-related changes in innervations, a diminished awareness of the filling reflex, and decreased muscle tone.

2.) Which of the following is a true statement regarding older patients, considering the age-related effects on their gastrointestinal (GI) system? a. They have no awareness of the filling reflex b. They tend to have increased muscle tone and mass c. They tend to have higher physiologic reserves to compensate for fluid loss d. They tend to usually have less control of the rectal sphincter

Upper GI Enteroclysis- the nurse documents the test as enteroclysis. Enteroclysis is a double contrast study where a duodenal tube is inserted and 500 to 1000 mL of thin barium sulfate suspension and then methylcellulose is infused. Fluoroscopy is used to visualize the filling of the intestinal loops over a period of up to 6 hours. The test is used for detection of small bowel obstruction and diverticuli. Abdominal ultrasound, magnetic resonance imaging, and positron emission tomography do not involve insertion of a duodenal tube.

20.) The patient is describing to the nurse a test that he underwent to detect a small bowel obstruction prior to admission to the hospital. The patient states that the test involved insertion of a tube through the nose and lasted over 6 hours. The nurse documents the name of the test as which of the following? a. Magnetic Resonance Imaging b. Abdominal Ultrasound c. Positron Emission Tomography d. Upper GI Enteroclysis

Clear liquids day before- the nurse should place the patient on clear liquids the evening before the procedure, a low-residue diet 1 to 2 days before the test, and NPO at midnight in preparation for the barium enema.

21.) The nurse is preparing a patient for a barium enema. The nurse should place the patient on which of the following prior to the procedure? a. High-fiber diet 1 to 2 days prior b. Soft diet 1 day prior c. Nothing by mouth (NPO) 2 days prior d. Clear liquids day before

Difficulty swallowing- the nurse should report difficulty swallowing to the physician as this may be a sign of perforation. Loss of gag reflex, minor throat pain, and drowsiness are expected findings after a gastroscopy for which the patient received sedation and therefore no need to report to the physician.

22.) The nurse is caring for a patient after a gastroscopy for which the patient received sedation. The nurse should report which of the following findings to the physician? a. Drowsiness b. Loss of gag reflex c. Difficulty swallowing d. Minor throat pain

Inflammatory bowel disease- the nurse stops administering the lavage solution and notifies the physician when the nurse notes that the patient has inflammatory bowel disease. Another contraindication for use of lavage solution is intestinal obstruction. COPD, congestive heart failure, and pulmonary hypertension are not contraindications to administration of lavage solution in preparation for a colonoscopy.

23.) The nurse preparing a patient for a colostomy is preparing to administer the lavage solution. The nurse stops and notifies the physician when the nurse notes that the patient has which of the following? a. Inflammatory bowel disease b. Pulmonary hypertension c. Chronic obstructive pulmonary disease (COPD) d. Congestive heart failure

Recent foods ingested- the nurse should assess for recent foods that the patient ingested, as ingestion of senna can cause the stool to turn yellow. Ingestion of bismuth can turn the stool black, and when occult blood is present, the stool can appear to be tarry black.

24.) A patient tells the nurse that his stool was colored yellow. The nurse assesses for which of the following? a. Ingestion of bismuth b. Recent foods ingested c. Occult blood d. Pilonidal cyst

Resume regular diet- the nurse includes resumption of regular diet in the patient's discharge instructions as the patient is able to resume activities and diet after an endoscopic exam. There is no need to adhere to a clear liquid diet or to increase fluid intake. As sedation is not usually involved for endoscopic examinations, the patient does not need to avoid driving.

25.) The nurse working in the GI lab is caring for a patient after an endoscopic examination and preparing the patient for discharge. The nurse includes which of the following in the instructions? a. Continue clear liquid diet b. Increase fluid intake c. Avoid driving for 24 hours d. Resume regular diet

A. Epigastric area and consider possible radiation of pain to the right subscapular region

3. The nurse is investigating a patient complained of pain in the duodenal area. Where should the nurse perform the assessment? A. Epigastric area and consider possible radiation of pain to the right subscapular region B. Hypogastrium in the right or left lower quadrant C. Left lower quadrant D. Periumbilical area, followed by the right lower quadrant

Do not give any food and fluids until the gag reflex returns- For a patient receiving a local anesthetic that suppresses the gag reflex, the nurse is advised to withhold foods and fluids until the reflex returns. The patient is monitored for other symptoms specifically related to the procedure, but may not be monitored for cramping or abdominal distention or breathing-related discomforts unless he or she complains about them. It is also not essential to monitor the patient's fluid output for 24 hours, because the patient is advised to avoid fluid or food intake until the reflex returns. However, the patient may be monitored for any dehydration related to not consuming any fluids or food before the procedure.

3.) A patient receives a local anesthetic to suppress the gag reflex for a diagnostic procedure of the upper GI tract. Which of the following nursing interventions is advised for this patient? a. Do not give any food and fluids until the gag reflex returns b. Monitor for cramping or abdominal distention c. Monitor for any breathing-related disorders or discomforts d. Measure fluid output for at least 24 hours after the procedure

A. Describe is crampy or burning

4. A patient is complaining of abdominal pain associated with indigestion. What is the characteristic of this type of pain? A. Describe is crampy or burning B. In the left lower quadrant C. Less severe after an intake of fatty foods D. Relieved by the intake of course vegetables, which stimulate peristalsis

Intrinsic factor- intrinsic factor, secreted by the gastric mucosa, combines with dietary vitamin B12 so that the vitamin can be absorbed in the ileum. In the absence of intrinsic factor, vitamin B12 cannot be absorbed and pernicious anemia results. Amylase is an enzyme that aids in the digestion of starch. Pepsin, an important enzyme for protein digestion, is the end product of the conversion of pepsinogen from the chief cells. Digestive enzymes secreted by the pancreas include trypsin, which aids in digesting protein.

4.) Which of the following terms describes a gastric secretion that combines with vitamin B12 so that it can be absorbed? a. Pepsin b. Amylase c. Intrinsic factor d. Trypsin

C. Tarry and black

5. The nurse is collecting a stool specimen from a patient. What characteristics of the stool indicates to the nurse that the patient may have an upper GI bleed? A. Clay colored B. Greasy and foamy C. Tarry and black D. Threaded with mucus

Food allergy- a patient with a food allergy complains of abdominal bloating, distention, and feeling full of gas. These are not symptoms related to small bowel obstruction or rectal cancer. Dyspepsia is abdominal discomfort associated with eating.

5.) The nurse is caring for a patient who complains of abdominal bloating, distention, and feeling full of gas. These could be symptoms of which of the following? a. Dyspepsia b. Food allergy c. Small bowel obstruction d. Rectal cancer

D. Inspection

6. The nurse is performing an abdominal assessment for a patient in the hospital with complaints of abdominal pain. What part of the assessment should the nurse perform first A. Percussion B. Palpation C. Auscultation D. Inspection

Duodenal ulcer- patients with duodenal ulcers, usually secrete an excess amount of hydrochloric acid. Patients with chronic atrophic gastritis secrete little or no acid. Patients with gastric cancer secrete little or no acid. Patients with pernicious anemia secrete no acid under basal conditions or after stimulation.

6.) When gastric analysis testing reveals excess secretion of gastric acid, which of the following medical diagnoses is supported? a. Pernicious anemia b. Gastric cancer c. Chronic atrophic gastritis d. Duodenal ulcer

C. Supine position with the knees flexed to relax the abdominal muscles

7. The nurse has been directed to position a patient for an examination of the abdomen. What position should the nurse place the patient in for the examination? A. Prone position with pillows position to alleviate pressure on the abdomen B. Semi Fowler's position with the left leg bent to minimize pressure on the abdomen C. Supine position with the knees flexed to relax the abdominal muscles D. Reverse Trendelenburg position to facilitate the natural propulsion of intestinal contents

Increased peristalsis- increased peristalsis is a parasympathetic response in the GI tract. Decreased gastric secretion, blood vessel constriction, and decreased motility are sympathetic responses in the GI tract.

7.) Which of the following is a parasympathetic response in the GI tract? a. Blood vessel constriction b. Increased peristalsis c. Decreased motility d. Decreased gastric secretion

C. Hyperactive

8. The nurse auscultate the abdomen to assess bowel sounds. She documents 5 to 6 sounds heard in less than 30 seconds. How does the nurse document the bowel sounds? A. Normal B. Hypoactive C. Hyperactive D. Borborygmi

Ptyalin- ptyalin, or salivary amylase is an enzyme that begins digestion of starches. Pepsin, an important enzyme for protein digestion, is the end product of the conversion of pepsinogen, from the chief cells. Digestive enzymes secreted by the pancreas include trypsin, which aids in digesting protein. Bile is an enzyme, secreted by the liver and gallbladder.

8.) Which of the following is an enzyme that begins the digestion of starches? a. Trypsin b. Pepsin c. Bile d. Ptyalin

A. The patient must fast for 8 hours before the examination B. The throat will be sprayed with a local antiseptic C. After a gastroscopy, the patient cannot eat or drink until the gag reflex returns (1 - 2 hours).

9. The nurse is providing instructions to a patient scheduled for a gastroscopy. What should the nurse be sure to include in the instructions? (Select all that apply.) A. The patient must fast for 8 hours before the examination B. The throat will be sprayed with a local antiseptic C. After a gastroscopy, the patient cannot eat or drink until the gag reflex returns (1 - 2 hours). D. The Physician will be able to determine if there is a presence of bowel disease E. The patient must have bowel cleansing prior to the procedure

Weakened gag reflex- a weakened gag reflex is an age-related change of the GI system. There is decreased motility, atrophy of the small intestine, and decreased mucus secretion.

9.) Which of the following is an age-related change of the GI system? a. Hypertrophy of the small intestine b. Increased mucus secretion c. Weakened gag reflex d. Increased motility

Secretin

A hormonal regulatory substance that inhibits its stomach contraction and gastric secretions is ____________.

Facilitates the production of dextrins and maltose

Amylase

B12

Intrinsic factor has a gastric secretion necessary for the intestinal absorption of vitamin ________, which prevents pernicious anemia.

4 hours, 12 hours

It takes ____________ hours after eating for food to pass into the terminal ileum. It takes __________ hours for food to reach and distend the rectum.

Helps form galactose

Lactase

Glucose is a product of this enzyme's action

Maltase

Digests protein and helps form polypeptides

Pepsin

Cardiac sphincter

Reflux of food into the esophagus from the stomach is prevented by contraction of the ___________.

Decreased motility and emptying, weakened gag reflex, decreased resting pressure of the lower spincter

Structural changes in the esophagus that occur as a result of Aging include _________, _____________, and _________________.

Digests carbohydrates and helps form fructose

Sucrase

Ptyalin

The digestion of starches begins in the mouth with the secretion of the enzyme ____________.

Glucose

The major carbohydrate that tissues use for fuel is_______________.

Cardia, fundus, body, pylorus

The stomach has four anatomic regions: the _________, ___________, _________ and ____________.

1.0

The stomach, which derives its acidity from hydrochloric acid, has a pH of approximately ____________.

trypsin, amylase, lipase

Three pancreatic secretions that contain digestive enzymes are:

Mixed waves that move the intestinal contents back and forth in a churning motion, movement that propels the contents of the small intestine toward the colon

Time, partially digested food that is mixed with gastric contents, stimulates segmented contractions, which are _________ intestinal paralysis, which is ___________.

Helps convert protein into amino acids

Trypsin

Bile

_________, which is secreted by the gallbladder, is responsible for fat emulsification.