Ch 32 Assessing the Gastrointestinal System

3. The chemical breakdown of starches begins in the mouth by which enzyme? a. ptyalin b. peptidase c. hydrochloric acid d. sucrase

ANS: A Chemical breakdown of cooked starches begins in the mouth by the enzyme ptyalin, a salivary amylase.

2. What is the acidic, semifluid paste that is part of chemical digestion? a. chyme b. insulin c. saliva d. bile

ANS: A Chemical digestion is the process of changing food (by enzymes; gastric, intestinal, and pancreatic juices; and bile) into individual nutrients that can be used by the body. The peristaltic movement of the stomach mixes the partially digested food and digestive enzymes into a semiliquid mass called chyme.

2. As a client ages, what oral changes would the nurse expect to see upon an oral assessment? (Select all that apply.) a. decrease in saliva b. decreased gag reflex c. tooth loss d. difficulty chewing e. number of taste buds decreases f. eating and drinking time prolonged g. reduced risk for aspiration h. malnutrition may occur

ANS: A, B, C, D, E, F, H As the body ages, several changes occur in the digestive system. Key oral changes include a decrease in saliva, a decreased gag reflex, tooth loss, gingival retraction. Chewing is more difficult, eating and drinking time may be prolonged, the number of taste buds decreases, client may have weight loss, swallowing becomes difficult, there is a risk for aspiration, malnutrition may occur, and there is an increase in oral and colon cancer risk.

19. The client has been scheduled for an endoscopic retrograde cholangiopancreatography (ERCP) next week. This test is used to detect abnormalities of which organ(s)? a. colon b. rectum and anus c. esophagus d. liver, gallbladder, or pancreas

ANS: D An endoscopic retrograde cholangiopancreatography (ERCP) is an endoscopic procedure that permits the physician to visualize the liver, gallbladder, and pancreas. Contract media may be used. An endoscope is passed through the esophagus to the duodenum, where dye is injected that outlines the bile and pancreatic ducts.

6. What solution creates the acidic environment in the stomach, kills most microorganisms that enter the mouth, and assists with the breakdown of proteins to polypeptides? a. mucus b. pepsinogen c. gastric lipase d. hydrochloric acid (HCl)

ANS: D Hydrochloride acid (HCl) creates the acidic environment of a pH of 1 to 2. HCl kills most microorganisms that enter the stomach and assists with the breakdown of proteins to polypeptides.

20. The client calls the physician's office because there is confusion about the type of diet that should be taken before a barium enema. Which diet is indicated for the two days prior to a barium enema? a. normal diet b. full liquid diet c. soft diet d. clear liquid diet

ANS: D The bowel needs to be cleansed for adequate visualization during the test. Client is placed on low residue or clear liquid diet for two days before the test.

7. Most nutrients are water soluble and can be absorbed directly through: a. loops b. filaments c. polyps d. villi

ANS: D The fingerlike projections that line the small intestines and can directly absorb water-soluble nutrients are called villi.

5. An 83-year-old client tells the nurse, "My food doesn't taste as good anymore." Which of these responses by the nurse is correct? a. "As we age our taste buds decrease. Experiment with various seasonings, but avoid salt." b. "If your dentures don't fit well, improper chewing could affect your ability to taste food." c. "Try holding your food in your mouth longer to provide increased taste." d. "You may find smaller, more frequent meals to be more satisfying."

ANS: A As the body ages, several changes occur in the digestive system: peristalsis decreases, chewing is more difficult, eating and drinking may take longer, and the number of taste buds decreases.

21. The client reports to the physician that the antacids are not helping his heartburn. The physician recommends a test that will detect ulcers, strictures, polyps, tumors, motility problems and hiatal hernias. The nurse knows this test to be called a(n): a. Upper GI series b. HIDA scan c. radiological flat plate d. proctosigmoidoscopy

ANS: A An Upper GI series is X-ray examination of the esophagus, stomach, duodenum, and jejunum. Oral liquid radiopaque contract medium (barium) is used. A fluoroscope is used to outline the contours of the organs as the medium passes through the system. Normal findings should identify normal anatomic structures and organs.

1. The liver is a vital organ to the gastrointestinal system. What are the essential functions of the liver? (Select all that apply.) a. produce and secrete bile b. break down nitrogenous wastes to urea c. convert proteins into amino acids d. produce prothrombin and fibrinogen e. deactivate Vitamin D f. detoxify poisonous substances

ANS: A, B, D, F The many functions of the liver are to produce and secrete bile by the hepatocytes (liver cells), convert glucose into glycogen for storage (glycogenesis), convert glycogen to glucose when blood sugar level drops (glycogenolysis), metabolize hormones, break down nitrogenous wastes to urea, incorporate nonessential amino acids into proteins, the Kupffer Cells filter blood and destroy bacteria by phagocytosis, produce prothrombin and fibrinogen, which are necessary for blood clotting, forms lipoproteins for the transport of lipids in the blood to other tissues, manufacture cholesterol and excretes excess cholesterol into bile to be eliminated into the feces, produce bilirubin formed by the fixed macrophages of the liver that phagocytize worn red blood cells and are eliminated in the feces, synthesizes albumin and clotting factors (prothrombin and fibrinogen), and globulins, store vitamin B12 and fat-soluble vitamins A, D, E, and K, assist the skin and kidneys with the activation of Vitamin D and detoxify poisonous substances.

15. The nurse is inspecting a client's abdomen and sees a protruding umbilicus. The nurse thinks the client may have a(n): a. asymmetrical abdomen b. hernia c. colon cancer d. adhesion

ANS: B With the client in the supine position, observe the contour of the abdomen. Normal adult abdominal contours are flat and rounded. The shape of the abdomen indicates the nutritional status of the client. Observe the abdomen for symmetry, same coloration and pigmentation, and for the presence of masses or nodules. Surgical scars may indicate the presence of adhesions. A normal umbilicus is depressed into the abdomen. The umbilicus should not be discolored or elevated. A protruding umbilicus indicates the possible presence of a hernia.

9. Bile is released into the duodenum via which duct? a. hepatic duct b. common bile duct c. cystic duct d. pancreatic duct

ANS: B Bile travels from the liver to the gallbladder via the hepatic and cystic ducts. The bile is released into the duodenum via the common bile duct.

12. In which quadrant on the abdomen are bowel sounds usually present? a. right upper b. right lower c. left upper d. left lower

ANS: B Bowel sounds are usually present at the ileocecal valve in the right lower quadrant. The clinician should first listen to the right lower quadrant (RLQ), then move clockwise to the right upper quadrant (RUQ), then the left upper quadrant (LUQ), and finally the left lower quadrant (LLQ).

4. What closes over the glottis to prevent food from entering the trachea and causing aspiration? a. uvula b. epiglottis c. larynx d. soft palate

ANS: B During swallowing, the uvula and soft palate close the pathway to the nasopharynx. The larynx pulls upwards as the epiglottis closes over the glottis, thus preventing food from entering the trachea.

13. Borborygmi is the term used to describe what type of bowel sounds? a. barely audible b. hyperactive c. normal d. hypoactive

ANS: B Hyperactive sounds, also called borborygmi, are loud, high-pitched gurgling sounds that occur every three seconds. Hyperactive sounds may be the result of gastroenteritis, diarrhea or laxative use.

14. One function of cholecystokinin is to: a. transport bile to gallbladder b. stimulate contraction of the gallbladder wall c. synthesize albumin d. produce bilirubin

ANS: B One function of cholecystokinin is to stimulate contraction of the smooth muscle of the wall of the gallbladder. Contraction of the gallbladder releases the bile through the cystic duct into the common bile duct and finally into the duodenum.

8. Which one of these is an accessory organ that aids in the digestion of food? a. duodenum b. pancreas c. spleen d. jejunum

ANS: B The accessory organs include the pancreas, liver, and gallbladder.These aid in the digestion of food. They produce or store digestive secretions and are not sites of the digestive process.

11. What is the first step in the assessment of the abdomen? a. auscultation b. visual inspection c. measuring d. palpation

ANS: B When assessing the abdomen, the nurse first inspects the abdomen, then auscultates before palpating. Palpating the abdomen before auscultating may cause increased peristaltic activity.

16. The nurse receives a report from the lab regarding a client's stool. The report confirms steatorrhea. This is defined as what in the stool? a. blood b. protein c. fat d. sugar

ANS: C A stool for lipids is a test that measures the fat content in the stool. It is used to confirm such conditions as steatorrhea.

18. The nurse is caring for a client who has just completed a colonoscopy. What serious complication should the nurse be monitoring for in the recovery room? a. cramping b. blood in stool c. hemorrhage d. excessive gas

ANS: C After a colonoscopy, the nurse should assess the client for complications such as hemorrhage and severe pain. Report abnormal findings immediately. Explain to the client that cramping will last for several hours after the exam and small amounts of blood may be present in the stool.

17. The nurse is teaching the client about the upcoming angiography that has been scheduled in the radiology suite. The nurse explains that contrast media will be injected into the client one hour before the exam to identify abnormalities of vascular structures and function and to detect any masses. The organ that this test will be examining is the: a. colon b. small intestine c. gallbladder d. spleen

ANS: C Angiography is used to identify neoplasms of gallbladder, liver, or pancreas and abnormal vasculature of these organs.

1. Which of the following is an example of the process of mechanical digestion? a. deglutition b. ingestion c. mastication d. peristalsis

ANS: C Mechanical digestion entails mastication (chewing), breaking food into small particles and mixing it with enzymes in saliva, and deglutition (swallowing food), the peristaltic waves and mucous secretions that move the food down the esophagus.

10. One of the many functions of the liver is to convert glucose into glycogen for storage. This is called: a. peristalsis b. glycogenolysis c. glycogenesis d. phagocytosis

ANS: C One of the functions of the liver is to convert glucose into glycogen for storage (glycogenesis).