CHAPTER 37: DISORDERS OF GI FUNCTION

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

A 64-year-old female whose mother had colorectal cancer EXPLANATION: 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.

Which client likely faces the greatest risk of a gastrointestinal bleed? A client whose hypertension requires taking a diuretic, an ACE inhibitor, and a beta-adrenergic blocker A client who is taking a broad-spectrum antibiotic to treat a urinary tract infection A client with a history of anxiety who takes benzodiazepines several times daily A client who takes aspirin with each meal to control symptoms of osteoarthritis

A client who takes aspirin with each meal to control symptoms of osteoarthritis EXPLANATION: The gastric mucosa can be easily damaged by drugs such as aspirin, other NSAIDs, alcohol, or bacterial toxins, resulting in local ischemia, vascular stasis, hypoxia, and tissue necrosis. Antihypertensives, diuretics, antibiotics, and benzodiazepines do not pose such a significant threat to the integrity of the gastric mucosa.

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 Consuming a diet that is high in fiber and prepared with multiple spices Drinking a glass of red wine once a week A sinus infection that causes severe headaches

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

An older adult client presents with loose mucus-filled 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. Ask the client about his or her normal bowel pattern. Ask the client about his or her fluid intake. Ask the client about the foods he or she has consumed.

Ask the client about his or her antibiotic use EXPLANATION: The diagnosis of C. difficile-associated diarrhea requires a careful history, with particular emphasis on antibiotic use.

An older adult in a rehabilitation unit is at risk for constipation. Which interventions would be appropriate for the nurse to take? Select all that apply. Assess the client's current medication regimen Ensure that the client's fluid intake is sufficient Schedule the client's physical activity shortly after meals Encourage the client to attempt a bowel movement after a meal Administer a cleansing enema every second day

Assess the client's current medication regimen Ensure that the client's fluid intake is sufficient Encourage the client to attempt a bowel movement after a meal EXPLANATION: Medications can profoundly affect bowel motility and should be assessed for this effect. Adequate fluid intake is important and bowel movements should be attempted after eating. Scheduling physical activity after a meal is not an action that is commonly used to promote bowel motility. Enemas should not be used as a preventive measure.

One of the accepted methods of screening for colorectal cancer is testing for occult blood in the stool. To reduce the likelihood of a false-positive result on these tests, what instructions will the nurse provide? Eat lots of red meat for 3 or 4 days before the test is done. Take 1000 mg of vitamin C in supplement form for 1 week prior to testing. Eat citrus fruits at least five times a day for 2 days prior to testing. Avoid nonsteroidal anti-inflammatory drugs (NSAIDs) for 1 week prior to testing.

Avoid nonsteroidal anti-inflammatory drugs (NSAIDs) for 1 week prior to testing. EXPLANATION: To reduce the likelihood of false-positive tests, persons are instructed to avoid NSAIDs, such as ibuprofen and aspirin, for 7 days prior to testing because these drugs can lead to localized bleeding from the mucosa. Other foods or substances that can interfere with the accuracy of the test are vitamin C in excess of 250 mg from either supplements or citrus fruits or red meat ingested within 3 days of testing.

A 40-year-old client tells the nurse that a parent died of gastric cancer and that the client wants to do everything one can do to avoid the disease. Which recommendation should the nurse provide? Avoid artificial sweeteners. Eat a high-fiber diet. Eat a low-carbohydrate diet. Avoid smoked and preserved foods.

Avoid smoked and preserved foods. EXPLANATION: Research has demonstrated a correlation between genetic factors, consumption of smoked and preserved foods, autoimmune gastritis, and gastric adenomas or polyps as key risk factors for gastric cancer. Decreased consumption of salted, smoked, and preserved foods in populations has seen a decrease in the incidence of gastric cancer. Increasing fiber intake is beneficial for general health but does not specifically protect against gastric cancer. A low-carbohydrate diet does not confer protection. There has been no widely accepted scientific evidence linking artificial sweeteners to gastric cancer.

Crohn disease is recognized by sharply demarcated, granulomatous lesions that are surrounded by normal-appearing mucosal tissue. The nurse recognizes these lesions to be defined by which description? Mosaic Pyramidal Cobblestone Triangular

Cobblestone EXPLANATION: A characteristic feature of Crohn disease is the sharply demarcated, granulomatous lesions that are surrounded by normal-appearing mucosal tissue. When there are multiple lesions, they are often referred to as "skip lesions" because they are interspersed between what appear to be normal segments of the bowel. The surface of the inflamed bowel usually has a characteristic "cobblestone" appearance resulting from the fissures and crevices that develop, surrounded by areas of submucosal edema.

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

Crohn disease EXPLANATION: Crohn disease, like ulcerative colitis, causes diarrhea, fecal urgency, weight loss, and systemic symptoms such as erythema nodosum and arthritis. Unlike ulcerative colitis, it also causes steatorrhea but is not as likely to cause blood in the stool. The granulomatous "skip" lesions confirm the diagnosis of Crohn disease. Neither diverticulitis nor colon cancer would cause this combination of symptoms and signs.

Pharmacologic treatment for peptic ulcers has changed over the past several decades. The nurse knows that the goal for pharmacologic treatment is focused on: Increasing acid production Neutralizing blood count Promoting special diet Eradicating Helicobacter pylori (H. pylori)

Eradicating Helicobacter pylori (H. pylori) EXPLANATION: Treatment of peptic ulcer is aimed at eradicating the cause and promoting a permanent cure for the disease. Pharmacologic treatment focuses on eradicating H. pylori, relieving ulcer symptoms, and healing the ulcer crater. Acid-neutralizing, acid-inhibiting drugs and mucosa-protective agents are used to relieve symptoms and promote healing of the ulcer crater. There is no evidence that special diets are beneficial in treating peptic ulcer.

A teenager has been diagnosed with failure to thrive possibly due to malabsorption syndrome. In addition to having diarrhea and bloating, the client more than likely has what hallmark manifestation of malabsorption? Feeling there is incomplete emptying of the bowel Abdominal distention Esophageal reflux with heartburn Fatty, yellow-gray, foul-smelling stools

Fatty, yellow-gray, foul-smelling stools EXPLANATION: General symptoms of malabsorption syndrome include diarrhea, flatulence, bloating, cramping, and weight loss. A hallmark of malabsorption is steatorrhea, characterized by fatty, yellow-gray, and foul-smelling stools. Feeling there is incomplete emptying of the bowel is one of the signs and symptoms of colon cancer. Abdominal distention occurs with many gastrointestinal diseases and is not specific to malabsorption syndrome. Esophageal reflux with heartburn is usually associated with gastroesophageal reflux disease.

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 Sexual transmission Vertical transmission Iatrogenic transmission

Fecal-oral transmission EXPLANATION: After antibiotic therapy has made the bowel susceptible to infection, colonization by C. difficile occurs by the oral-fecal route. C. difficile infection usually is acquired in the hospital, where the organism is most commonly encountered.

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 Rectal bleeding Constipation Dysphagia

Fistula formation EXPLANATION: In Crohn disease all layers of the bowel are involved. Complications of Crohn disease include fistula formation, abdominal abscess formation, and intestinal obstruction. Fistulas are tubelike passages that form connections between different sites in the GI tract.

In the balance of secretions in the gastric mucosa by the parietal cells, which ion is produced to buffer the production of hydrochloric acid? OH- HCO3- K+ H2O

HCO3- EXPLANATION: Normally the secretion of hydrochloric acid by the parietal cells of the stomach is accompanied by secretion of bicarbonate ions (HCO3-), which protects the mucosa from injury, as long as they are produced in equal amounts.

The most common forms of peptic ulcer are duodenal and gastric ulcers. What are the most common risk factors for peptic ulcer disease? Antibiotic Sucralfate Helicobacter pylori (H. pylori) Spicy foods

Helicobacter pylori (H. pylori) EXPLANATION: Perforation occurs when an ulcer erodes through all the layers of the stomach or duodenum wall. H. pylori promotes the development of peptic ulcers by inducing inflammation and stimulation of cytokines and other mediators of inflammation that contribute to mucosal damage. There is no convincing evidence that dietary factors play a role in development of peptic ulcers.

Crohn disease is treated by several measures. Treatment with sulfasalazine will focus on which aspect of this disease? Immune suppression Inflammatory suppression Increased appetite Decreased bleeding tendency

Inflammatory suppression EXPLANATION: Treatment methods focus on terminating the inflammatory response and promoting healing, maintaining adequate nutrition, and preventing and treating complications. Several medications have been successful in suppressing the inflammatory reaction, including corticosteroids, sulfasalazine, metronidazole, azathioprine, 6-mercaptopurine, methotrexate, and infliximab.

Treatment for diverticular disease includes increasing bulk in the diet to promote regular defecation. The nurse understands that increasing bulk will assist the colon to perform which function? Lowers the intraluminal pressure in the haustra Increases the intraluminal pressure in the haustra Stimulates the colon to evacuate content quicker Constricts the lumen of the colon

Lowers the intraluminal pressure in the haustra EXPLANATION: The combined contraction of the circular muscle and the lack of a continuous longitudinal muscle layer cause the intestine to bulge outward into pouches called haustra. Diverticula develop between the longitudinal muscle bands of the haustra in the area where the blood vessels pierce the circular muscle layer to bring blood to the mucosal layer. An increase in intraluminal pressure in the haustra provides the force for creating these herniations. The increase in pressure is thought to be related to the volume of the colonic contents. The scantier the contents, the more vigorous are the contractions and the greater is the pressure in the haustra. The increased bulk promotes regular defecation and increases colonic contents and colon diameter, thereby decreasing intraluminal pressure.

A nurse is assessing an older adult with reports of constipation, for which the client often takes over-the-counter medications. What assessment should the nurse perform to address the etiology of the client's problem? Signs and symptoms of diverticula Medication regimen for drugs like anticholinergic agents or calcium History of hemorrhoids or rectal fissures History of cesarean birth or other abdominal surgery

Medication regimen for drugs like anticholinergic agents or calcium EXPLANATION: Constipation is attributable to numerous factors, including low fluid intake and medications. Drugs such as opioids, anticholinergic agents, calcium channel blockers, diuretics, calcium, iron supplements and aluminum antacids tend to cause constipation. Diverticula, rectal fissures, and hemorrhoids are consequences rather than causes of constipation. Abdominal surgery rarely causes constipation unless it is comparatively recent.

A client is admitted to an acute care facility with a Clostridium difficile infection. The nurse anticipates administering which medication? Metronidazole Vancomycin Amoxicillin Proton pump inhibitor

Metronidazole EXPLANATION: Metronidazole is the medication of choice for treatment of C. difficile infections. It may be given intravenously or orally. Vancomycin is reserved for people who cannot tolerate metronidazole. Proton pump inhibitors are administered for prevention/treatment of ulcers. Amoxicillin and other antibiotic treatment is discontinued when a client is diagnosed with C. difficile.

An ultrasound confirms appendicitis as the cause of a client's sudden abdominal pain. Which etiologic process is implicated in the development of appendicitis? Obstruction of the intestinal lumen Elimination of normal intestinal flora Sloughing of the intestinal mucosa Increased osmolality of intestinal contents

Obstruction of the intestinal lumen EXPLANATION: Appendicitis is thought to be related to intraluminal obstruction with a fecalith, gallstones, tumors, parasites, or lymphatic tissue. Osmotic and bacterial changes are not thought to induce appendicitis, and the intestinal mucosa does not slough off either before or during episodes of appendicitis.

A client is admitted with an abrupt onset of referred pain to the epigastric area, with an episode of nausea. On the nurse's initial assessment, the client is lying still and taking shallow breaths, with a rigid abdomen. Which problem is the client experiencing? Peritonitis Intussusception Peptic ulcer Ulcerative colitis

Peritonitis EXPLANATION: The onset of peritonitis may be acute, as with a ruptured appendix, or it may have a more gradual onset, as occurs in pelvic inflammatory disease. The pain usually is more intense over the inflamed area. The person with peritonitis usually lies still because any movement aggravates the pain. Breathing often is shallow to prevent movement of the abdominal muscles. The abdomen usually is rigid and sometimes described as boardlike because of reflex muscle guarding.

An adult client has been diagnosed with gastroesophageal reflux disease (GERD) after reporting ongoing "heartburn" unrelieved with antacids. Which medication should the nurse anticipate being prescribed for this client? Lactulose Proton pump inhibitor (PPI) Antibiotic Nonsteroidal anti-inflammatory drug (NSAID)

Proton pump inhibitor (PPI) EXPLANATION: PPIs act by inhibiting the gastric proton pump, which regulates the final pathway for acid secretion. Lactulose is prescribed to treat or prevent complications of liver disease (hepatic encephalopathy). It does not cure the problem, but may help to improve mental status. Lactulose is a colonic acidifier that works by decreasing the amount of ammonia in the blood. Antibiotics are used to treat Helicobacter pylori infections commonly found in peptic ulcer disease. NSAID use should be avoided when possible.

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? Surgical correction of the incompetent pylorus and limiting physical exercise Anti-inflammatory medications; avoiding positions that exacerbate reflux; a soft-textured diet Weight loss and administration of calcium channel blocking medications Proton pump inhibitors; avoiding large meals; remaining upright after meals

Proton pump inhibitors; avoiding large meals; remaining upright after meals EXPLANATION: Proton pump inhibitors block the final stage of gastric acid production, effectively controlling the root cause of the esophageal damage associated with GERD. The pylorus is not involved, and a soft diet is not indicated. Calcium channel blocking drugs would not address the problem.

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 Referred tenderness Periumbilical tenderness Perforated appendix

Rebound tenderness EXPLANATION: The nurse documents the presence of rebound tenderness, defined as tenderness that occurs when the nurse applies and then releases pressure to an area.

When educating residents of a senior citizen living facility, the nurse should review which information about colorectal cancer? Select all that apply. Aspirin and NSAIDs are implicated in the etiology of colorectal cancer. Seek out medication attention for any blood in the stool. Most cases are quite advanced before symptoms become apparent. Survival rates for colorectal cancer are less than 20% but are increasing. Yearly colonoscopy is recommended for early detection after age 40.

Seek out medication attention for any blood in the stool. Most cases are quite advanced before symptoms become apparent. EXPLANATION: Clinical manifestations of colorectal cancer are often not apparent until later stages. Almost all cancers of the colon and rectum bleed intermittently, although the amount of blood is small and usually is not apparent in the stools. It therefore is feasible to screen for colorectal cancers using commercially prepared tests for occult blood in the stool. Aspirin and NSAIDs may protect against colorectal cancer; it does not have an infectious etiology. Five-year survival rates are close to 90% to 100% if the cancer is found in the early (stage I) stages. It is recommended that persons at average risk for colonic adenomatous polyps or cancer should undergo colonoscopy every 10 years or alternative screening tests at periodically prescribed intervals beginning at age 50.

Inflammatory bowel disease (IBD) is used to designate two related inflammatory intestinal disorders: Crohn disease and ulcerative colitis. The nurse recognizes the difference between the distribution pattern between Crohn disease and ulcerative colitis. Which pattern describes Crohn's disease? Skip lesions Continuous involvement of the colon starting at the rectum Primarily rectum and colon involvement Development of cancer

Skip lesions EXPLANATION: Distribution patterns of disease manifest with skip lesions in Crohn disease and continuous involvement of the colon starting at the rectum in ulcerative colitis. Crohn disease primarily affects the ileum and secondarily the colon, and the development of cancer is uncommon. Ulcerative colitis primarily affects the rectum and left colon, and development of cancer is relatively common.

Which clinical manifestation would lead the nurse to suspect the client has malabsorption syndrome with a deficiency in fat absorption? Steatorrhea Abdominal cramping Dry eyes Glossitis

Steatorrhea EXPLANATION: In malabsorption syndrome, there is loss of fat in the stools and failure to absorb the fat-soluble vitamins. This can result in weight loss, steatorrhea, and fat-soluble vitamin deficiency. Cramping is associated with water/electrolyte imbalances. Eye problems like dry eyes is due to malabsorption of vitamin A. Glossitis is associated with folic acid deficiency.

A nurse administering a client's medication tells the client that a proton pump inhibitor has been added. When the client asks the purpose of the medication, the nurse responds that it is to prevent: Stress ulcer Crohn disease Ulcerative colitis Malabsorption syndrome

Stress Ulcer EXPLANATION: Proton pump inhibitors are the first line of medications used in the prevention of stress ulcers.

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 cleans out the diverticula, allowing for a remittance of inflammation. The fiber pulls water into the colon, increasing the intraluminal pressure, ensuring that fecal material will not become stagnant. The fiber increases bulk, promotes regular defecation, and increases colonic contents and colon diameter, thereby decreasing intraluminal pressure. The fiber stimulates a myogenic muscle contraction in the wall of the intestines that will force the forward movement of fecal material, thereby preventing diverticula formation.

The fiber increases bulk, promotes regular defecation, and increases colonic contents and colon diameter, thereby decreasing intraluminal pressure. EXPLANATION: The treatment for diverticulitis includes increasing the bulk in the diet and bowel retraining so that the person has at least one bowel movement each day. The increased bulk promotes regular defecation and increases colonic contents and colon diameter, thereby decreasing intraluminal pressure. Increases in pressure will make the condition worse.

Rotavirus is most severe in children under 24 months of age. What is a typical symptom of rotavirus infection? Mild to moderate fever that gets higher after the second day Projectile vomiting that lasts for the course of the disease Fever that disappears after 7 days following antibiotic treatment Vomiting that disappears around the second day but diarrhea continues

Vomiting that disappears around the second day but diarrhea continues EXPLANATION: Rotavirus infection typically begins after an incubation period of less than 24 hours, with mild to moderate fever, and vomiting, followed by onset of frequent watery, stools. The fever and vomiting usually disappear on about the second day, but the diarrhea continues for 5 to 7 days. Dehydration may develop rapidly, particularly in infants.

A nurse providing dietary guidance to a client with celiac disease tells the client that which food should be avoided? Wheat bread Watermelon Homogenized milk Pork products

Wheat bread EXPLANATION: Clients with celiac disease should avoid ingesting gluten, which is the primary protein in wheat, barley, and rye. The nurse should tell the client to avoid wheat bread. Watermelon, homogenized milk, and pork products do not contain gluten and therefore do not need to be avoided by a client with celiac disease.

A rare condition caused by gastrin-secreting tumors most commonly found in the small intestine or pancreas is called: Zollinger-Ellison syndrome Creutzfeldt-Jakob disease Sickle cell anemia Stevens-Johnson syndrome

Zollinger-Ellison syndrome EXPLANATION: Zollinger-Ellison syndrome is a rare condition caused by a gastrin-secreting tumor (gastrinoma).

The nurse is reviewing the medical history of four clients. Which client is at highest risk for developing peptic ulcer disease? client with a prior diagnosis of Helicobacter pylori who refused treatment client diagnosed with arthritis who takes acetaminophen twice per day client who has a history of a ruptured appendix client who eats excessive amounts of carbohydrates

client with a prior diagnosis of Helicobacter pylori who refused treatment EXPLANATION: The two most important risk factors for peptic ulcer disease (PUD) are infection with the bacteria H. pylori and use of aspirin and/or nonsterioidal anti-inflammatory drugs (NSAIDs). Acetaminophen is not an NSAID, so it does not place the client at risk increased risk for PUD. A history of a ruptured appendix will not cause PUD. A high fat intake can be linked to increased risk for gastritis, but a diet high in carbohydrates is not linked to increased risk for PUD.

The nurse assesses a client in the emergency department with reports of abdominal pain. Which assessment finding will the nurse interpret as supporting appendicitis? increased pain when pressure to the lower right quandrant is released increased abdominal pain when the client passes urine client reports several days of intermittent nausea and vomiting severe, sharp pain in the upper quadrants of the abdomen

increased pain when pressure to the lower right quandrant is released EXPLANATION: Appendicitis usually has an abrupt onset, with pain referred to the epigastric or periumbilical area that becomes more localized to the right lower quadrant over 2 to 12 hours. The nurse will interpret rebound tenderness, which is pain that occurs when pressure is applied to the area and then released, as supporting appendicitis. Although nausea can accompany the pain, it should not be intermittent over several days as the symptoms progress quickly. Palpation of the abdomen usually reveals a deep tenderness in the lower right quadrant, which is confined to a small area. Urination should not alter the pain and appendicitis pain does not typically occur the upper quadrants.