chapter 44 exam 1
A client, age 82, is admitted to an acute care facility for treatment of an acute flare-up of a chronic GI condition. In addition to assessing the client for complications of the current illness, the nurse monitors for age-related changes in the GI tract. Which age-related change increases the risk of anemia? Atrophy of the gastric mucosa Decrease in intestinal flora Increase in bile secretion Dulling of nerve impulses
Atrophy of the gastric mucosa Explanation: Atrophy of the gastric mucosa reduces hydrochloric acid secretion; this, in turn, impairs absorption of iron and vitamin B12, increasing the risk of anemia as a person ages. A decrease in hydrochloric acid increases, not decreases, intestinal flora; as a result, the client is at increased risk for infection, not anemia. A reduction, not increase, in bile secretion may lead to malabsorption of fats and fat-soluble vitamins. Dulling of nerve impulses associated with aging increases the risk of constipation, not anemia.
A client is scheduled for several diagnostic tests to evaluate her gastrointestinal function. After teaching the client about these tests, the nurse determines that the client has understood the teaching when she identifies which test as not requiring the use of a contrast medium? Small bowel series Computer tomography Colonoscopy Upper GI series
Colonoscopy Explanation: A colonoscopy is a direct visual examination of the entire large intestine. It does not involve the use of a contrast agent. Contrast medium may be used with a small bowel series, computed tomography, and upper GI series.
The nurse is assessing a 50-year-old, dark-skinned African American man and has noted that he appears jaundice. Most likely, the nurse made this observation by assessing which part of his body? Mucous membranes Nail beds Skin Top of the hands and feet
Mucous membranes Explanation: In very dark-skinned clients, inspect the hard palate, gums, conjunctiva, and surrounding tissues for discoloration.
A patient tells the nurse that his stool was colored yellow. The nurse assesses for which of the following? Recent foods ingested Occult blood Ingestion of bismuth Pilonidal cyst
Recent foods ingested Explanation: 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
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? Both tests need to be done before breakfast. The ultrasonography should be scheduled before the GI procedure. The upper GI should be scheduled before the ultrasonography. The client may eat a light meal before either test.
The ultrasonography should be scheduled before the GI procedure. Explanation: Both an upper GI procedure with barium ingestion and an ultrasonography may be completed on the same day. The ultrasonography test should be completed first, because the barium solution could interfere with the transmission of the sound waves. The ultrasonography test uses sound waves that are passed into internal body structures, and the echoes are recorded as they strike tissues. Fluid in the abdomen prevents transmission of ultrasound.
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? Upper GI enteroclysis Abdominal ultrasound Magnetic resonance imaging Positron emission tomography
Upper GI enteroclysis Explanation: 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.
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? Monitor for any breathing-related disorder or discomforts. Measure fluid output for at least 24 hours after the procedure. Monitor for cramping or abdominal distention. Do not give any food and fluids until the gag reflex returns
Do not give any food and fluids until the gag reflex returns. Explanation: For a patient receiving a local anesthetic that suppresses the gag reflex, the nurse is advised to withhold food 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.
The nurse is performing an initial assessment of a patient complaining of increased stomach acid related to stress. The nurse knows that the physician will want to consider the influence of what neuroregulator? Gastrin Cholecystokinin Norepinephrine Secretin
Norepinephrine Explanation: Release of the neuroregulator norepinephrine is stimulated by stress, and this substance has an inhibitory effect on gastric secretions. Gastrin increases gastric juice, cholecystokinin increases gastric secretions, and secretin inhibits gastric secretion somewhat; all three of these substances are hormonal regulators, not neuroregulators.
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? Pentagastrin Atropine Robinul (glycopyrrolate) Mucomyst
Pentagastrin Explanation: The gastric acid stimulation test usually is performed in conjunction with gastric analysis. Histamine or pentagastrin is administered subcutaneously to stimulate gastric secretions.
Which of the following is an enzyme secreted by the gastric mucosa? Pepsin Trypsin Ptyalin Bile
Pepsin is secreted by the gastric mucosa. Trypsin is secreted by the pancreas. The salivary glands secrete ptyalin. The liver and gallbladder secrete bile
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? Instruct the client to have low-residue meals. Allow the client to ingest fat-free meal. Permit the client to drink only clear liquids. Provide saline gargles to the client.
Permit the client to drink only clear liquids. Explanation: After polyethylene glycol/electrolyte solution is administered, the client should have clear liquids because this ensures watery stools, which are necessary for procedures like a barium enema. Allowing the client to ingest a fat-free meal is used in preparation for oral cholecystography. Instructing the client to have low-residue meals is a pretest procedure for barium enema. A client is offered saline gargles after esophagogastroduodenoscopy.
Following ingestion of carrots or beets, the nurse would expect which alteration in stool color? Red Black Yellow Milky white
Red Explanation: Carrots or beets will tend to change the stool color to red. Black stools are associated with iron, licorice, and charcoal. Senna is associated with yellow stools. A milky white stool is associated with administration of barium.
A client has recently obtained a set of dentures. Which of the following will the nurse do during a complete physical examination? Brush the dentures before examining the oral cavity. Remove the plates and rinse under hot water to remove bacteria. Remove the plates to visualize the oral cavity. Have the client rinse with warm salt water before assessing the oral cavity.
Remove the plates to visualize the oral cavity. Explanation: A complete physical examination includes an assessment of the mouth. It is necessary to remove the dentures to allow good visualization of the entire oral cavity.
A nurse is providing postprocedure instructions for a client who had an esophagogastroduodenoscopy. The nurse should perform which action? Give instructions to the client immediately before discharge. Review the instructions with the person accompanying the client home. Tell the client to call back in the morning so she can give him instructions over the phone. Tell the client there aren't specific instructions for after the procedure.
Review the instructions with the person accompanying the client home.
Which of the following is an age-related change of the GI system? Increased motility Hypertrophy of the small intestine Weakened gag reflex Increased mucus secretion
Weakened gag reflex Explanation: 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.
A physician plans to send a client home with supplies to complete a hemoccult test on all stools for 3 days. During the client education, the nurse informs the client to avoid which of the following medications while collecting stool for the test? ibuprofen (Advil) acetaminophen (Tylenol) docusate sodium (Colace) ciprofloxacin (Cipro XR)
ibuprofen (Advil) Explanation: Fecal occult blood testing (FOBT) is one of the most commonly performed stool tests. FOBT can be done at the bedside, in the physician's office, or at home. The client is taught to avoid aspirin, red meats, nonsteroidal antiinflammatory agents, and horseradish for 72 hours prior to the examination. Advil is an anti-inflammatory drug and should be avoided with FOBT.
The nurse is assisting the physician in a percutaneous liver biopsy. In which position would the nurse assist the client to assume? A high Fowler's position Lithotomy position Dorsal recumbent position Supine position
supine position Explanation: The nurse is correct to instruct the client to assume the supine position. Also the nurse places a rolled towel beneath the right lower ribs.
When preparing a client for magnetic resonance imaging (MRI) of the abdomen, which statement would indicate the need to notify the physician? "I haven't had anything to eat or drink since midnight last night." "I really don't like to be in small, enclosed spaces." "I left all my jewelry and my watch at home." "I brought earphones to shut out the loud noise."
"I really don't like to be in small, enclosed spaces." Explanation: An MRI scanner is a narrow, tunnel-like machine that will enclose the client during the test. Clients who are claustrophobic (fear enclosed spaces) may need sedation because it is imperative that they lie still and not panic during the test. Therefore, the nurse should notify the physician about the client's statement. Typically, the client is NPO for 6 to 8 hours before the test, and he or she must remove any metal objects, credit cards, jewelry, and watch before the test. The machine makes loud repetitive noises while the test is in progress, so earphones may be helpful.
A home care nurse is caring for a client with complaints of epigastric discomfort who is scheduled for a barium swallow. Which statement by the client indicates an understanding of the test? "I'll avoid eating or drinking anything 6 to 8 hours before the test." "I'll drink full liquids the day before the test." "There is no need for special preparation before the test." "I'll take a laxative to clear my bowels before the test."
"I'll avoid eating or drinking anything 6 to 8 hours before the test." Explanation: The client demonstrates understanding of a barium swallow when he states that he must refrain from eating or drinking for 6 to 8 hours before the test. No other preparation is needed. Before a lower GI series, the client should eat a low-residue or clear liquid diet for 2 days and take a potent laxative and an oral liquid preparation.
A nursing instructor tells the class that review of oral hygiene is an important component during assessment of the gastrointestinal system. One of the students questions this statement. Which of the following explanations from the nurse educator is most appropriate? "Decaying teeth secrete toxins that decrease the absorption of nutrients." "Bad breath will encourage ingestion of fatty foods to mask odor." "Injury to oral mucosa or tooth decay can lead to difficulty in chewing food." "Mouth sores are caused by bacteria that can thin the villi of the small intestine."
"Injury to oral mucosa or tooth decay can lead to difficulty in chewing food." Explanation: Poor oral hygiene can result in injury to the oral mucosa, lip, or palate; tooth decay; or loss of teeth. Such problems may lead to disruption in the digestive system. The ability to chew food or even swallow may be hindered.
A patient asks the nurse why the physician ordered the blood test carcinoembryonic antigen (CEA). The nurse answers: "It tells the physician what type of cancer is present." "It indicates if a cancer is present." "It determines functionality of the liver." "It detects a protein normally found in the blood."
"It indicates if a cancer is present." Explanation: 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.
A client who had a colonoscopy with removal of a polyp is being prepared for discharge. Which of the following would the nurse include in the discharge instructions? "You might feel some cramping and gas but these usually go away in about a day." "Call your physician if there is even slight bleeding with your first bowel movement." "You might experience some nausea and vomiting for a day or so. This is normal." "Be sure to eat high fiber foods when you get home to help you move your bowels."
"You might feel some cramping and gas but these usually go away in about a day." Explanation: After a colonoscopy, a client may experience mild cramping and flatulence which usually resolve within n 24 hours. If the client has a small growth or polyp removed, there may be a slight amount of bleeding that resolves on its own. The client should notify his physician if he experiences nausea, vomiting, fever, or excessive bleeding. The client also should avoid high-fat and high-fiber foods for at least 24 hours after the procedure.
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 day 2 days 3 days 4 days
3 days Explanation: As much as 25% of the waste products from a meal may still be in the rectum 3 days after a meal is ingested.
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? Dark brown Green Red Black
Black Explanation: Ingestion of iron can cause the stool to turn black. Meat protein causes stool to appear dark brown. Ingestion of large amounts of spinach may turn stool green while ingestion of carrots and beets may cause stool to turn red. Reference:
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? Infection Bowel perforation Colonic polyp Rectal fissure
Bowel perforation Explanation: Immediately after the test, the patient is monitored for signs and symptoms of bowel perforation (e.g., rectal bleeding, abdominal pain or distention, fever, focal peritoneal signs).
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? Duodenum Jejunum Ileum Cecum
Duodenum Explanation: The duodenum, which is approximately 10 inches long, is the first region of the small intestine and the site where bile and pancreatic enzymes enter. The duodenum is the site where bile and pancreatic enzymes enter the GI system.
A nurse is preparing a client with Crohn's disease for a barium enema. What should the nurse do the day before the test? Serve the client his usual diet. Order a high-fiber diet. Encourage plenty of fluids. Serve dairy products.
Encourage plenty of fluids. Explanation: The nurse should encourage plenty of fluids because adequate fluid intake is necessary to avoid dehydration that may be caused by the bowel preparation and to prevent fecal impaction after the procedure. The client may be placed on a low-residue diet 1 to 2 days before the procedure to reduce the contents in the GI tract. Fiber intake is limited in a low-residue diet. Because dairy products leave a residue, they aren't allowed the evening before the test. Clear liquids only are allowed the evening before the test.
The nurse is investigating a patient's complaint of pain in the duodenal area. Where should the nurse perform the assessment? Epigastric area and consider possible radiation of pain to the right subscapular region Hypogastrium in the right or left lower quadrant Left lower quadrant Periumbilical area, followed by the right lower quadrant
Epigastric area and consider possible radiation of pain to the right subscapular region Explanation: Indigestion is an imprecise term that refers to a host of upper abdominal or epigastric symptoms such as pain, discomfort, fullness, bloating, early satiety, belching, heartburn, or regurgitation; it occurs in approximately 25% of the adult population (Harmon & Peura, 2010).
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? Food allergy Small bowel obstruction Rectal cancer Dyspepsia
Food allergy Explanation: 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.
Gastrin has which of the following effects on gastrointestinal (GI) motility? Increased motility of the stomach Relaxation of the colon Contraction of the ileocecal sphincter Relaxation of gastroesophageal sphincter
Increased motility of the stomach Explanation: Gastrin has the following effects on GI motility: increased motility of the stomach, excitation of the colon, relaxation of ileocecal sphincter, and contraction of the gastroesophageal sphincter.
A client calls the nurse into her room and admits to peeking at her chart. She saw that she has borborygmi and is concerned. Which of the following explanations will the nurse give about this term? Severe boredom Loud, prolonged stomach growling Altered laboratory test result for bile Positive hydrogen breath test
Loud, prolonged stomach growling not a serious condition
Which diagnostic produces images of the body by detecting the radiation emitted from radioactive substances? Positron emission tomography (PET) Computed tomography (CT) Magnetic resonance imaging (MRI) Fibroscopy
Positron emission tomography (PET) Explanation: PET produces images of the body by detecting the radiation emitted from radioactive substances. CT provides cross-sectional images of abdominal organs and structures. MRI uses magnetic fields and radio waves to produce an image of the area being studied. Fibroscopy of the upper GI tract allows direct visualization of the esophageal, gastric, and duodenal mucosa through a lighted endoscope
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? A complete blood count including differential Serum antibodies for H. pylori A sigmoidoscopy Gastric analysis
Serum antibodies for H. pylori Explanation: Helicobacter pylori, a bacterium, is believed to be responsible for the majority of peptic ulcers. Blood tests are used to determine whether there are antibodies to H. pylori in the blood. A complete blood count with differential can indicate bleeding and infection associated with a bleeding ulcer. A sigmoidoscopy assesses the lower gastrointestinal tract. Gastric analysis is more common in analyzing gastric fluid in determining problems with the secretory activity of the gastric mucosa.
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? Ileum Cecum Sigmoid colon Duodenum
Sigmoid colon Explanation: Water is reabsorbed by means of diffusion across the intestinal membrane as the contents move through the colon. By the time the mixture reaches the descending and sigmoid colon, the portion of the bowel adjacent to the rectum, it is a formed mass. The ileum and duodenum are located in the small intestine. The cecum is located at the beginning of the large intestine.
It is important for a nurse to have an understanding of the major digestive enzymes and their actions. Choose the gastric mucosa secretion that plays an important role in the digestion of triglycerides. Ptyalin Trypsin Amylase Steapsin
Steapsin Explanation: Ptyalin and amylase work to digest starch; trypsin works on proteins and polypeptides. Triglycerides are digested by steapsin, and pharyngeal and pancreatic lipase.
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? Liver Ileum Stomach Large intestine
Stomach Explanation: The upper gastrointestinal (GI) tract begins at the mouth and ends at the jejunum. Therefore, the stomach would be a component of the upper GI tract. The lower GI tract begins at the ileum and ends at the anus. The liver is considered an accessory structure.
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? The patient is probably hypoglycemic and requires the glucagon. To relieve anxiety during the procedure for moderate sedation. To reduce air accumulation in the colon. To relax colonic musculature and reduce spasm.
To relax colonic musculature and reduce spasm. Explanation: Glucagon may be administered, if needed, to relax the colonic musculature and to reduce spasm during the colonoscopy.
Upon review of a client's chart, the nurse notes the client has been receiving antiemetics every 6 to 8 hours. What in this client's history may necessitate such frequency? Treatment for cancer Multiple leg fractures Pituitary tumor Adrenal gland removal 3 days ago
Treatment for cancer Explanation: Antiemetics are used to treat nausea and vomiting. Common causes of nausea and vomiting include visceral afferent stimulation, peritoneal irritation, infections, radiation or chemotherapy therapy, increased intracranial pressure, and vestibular disorders. Irritation of the chemoreceptor trigger zone from cancer treatment can induce nausea and lead to vomiting.