GI ch. 44

The nurse is investigating a patient's complaint 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.

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

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. Atropine c. Robinul (Glycopyrrolate) d. Mucomyst

a. Pentagastrin

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 positioned 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 knees flexed to relax the abdominal muscles d. Reverse Trendelenburg position to facilitate the natural propulsion of intestinal contents

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

Carl is a 54-year-old patient who comes to the clinic and informs the nurse that he has been having blood in his stools for the past 2 weeks. He states that he has no pain or discomfort and has never had any trouble with his bowel movements. The physician schedules Carl for a colonoscopy with moderate sedation. 1) The nurse is giving Carl instructions about preparation of the bowel prior to the procedure. What is the importance of the bowel preparation for a colonoscopy? 2) What information should the nurse provide with regard to the position Carl will be placed in during the procedure? 3) The nurse informs Carl that he will be monitored during the entire procedure. What monitoring will occur during the procedure? 4) During the colonoscopy, for what complications should Carl be continuously monitored?

1) Adequate colon cleansing provides optimal visualization and decreases the time needed for the procedure. 2) Colonoscopy is performed while the patient is lying on the left side with the legs drawn up toward the chest. The patient's position may be changed during the test to facilitate advancement of the scope. 3) The patient's cardiac and respiratory function and oxygen saturation are monitored continuously, with supplemental oxygen used as necessary. 4) Complications during and after the procedure can include cardiac dysrhythmias and respiratory depression resulting from the medications administered, vasovagal reactions, and circulatory overload or hypotension resulting from overhydration or underhydration during bowel preparation.

_____ digests protein and helps form polypeptides.

Pepsin

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

B12

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

Bile

When the patient is to perform a Hemoccult II test, what should the nurse inform the patient to avoid in order to prevent a false-positive result?

Red meats, aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), turnips, and horseradish should be avoided for 72 hours prior to the study, because they may cause a false-positive result. * Also, ingestion of vitamin C from supplements or foods can cause a false-negative result.

_____ digests carbohydrates and helps form fructose.

Sucrase

_____ helps convert protein into amino acids.

Trypsin

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 local anesthetic. c. Afterwards, 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.

a, b, c a. The patient must fast for 8 hours before the examination. b. The throat will be sprayed with local anesthetic. c. Afterwards, the patient cannot eat or drink until the gag reflex returns (1-2 hours).

A patient is complaining of abdominal pain associated with indigestion. What is characteristic of this type of pain? a. Described as crampy or burning b. In the left lower quadrant c. Less severe after an intake of fatty foods d. Relieved by the intake of coarse vegetables, which stimulate peristalsis

a. Described as crampy or burning

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

b. Bowel perforation

A patient is scheduled for a fiberoptic colonoscopy. What does the nurse know that this procedure is most frequently used to diagnose? a. Bowel disease of unknown origin b. Cancer screening c. Inflammatory bowel disease d. Occult bleeding

b. Cancer screening

During the nurse's 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

b. Dyspepsia

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)

c. Aspirin

The nurse auscultates the abdomen to assess bowel sounds; she documents 5-6 sounds heard in less than 30 seconds. How does the nurse document the bowel sounds? a. Normal b. Hypoactive c. Hyperctive d. Borborygmi

c. Hyperctive

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? a. Gastrin b. Cholecystokinin c. Norepinephrine d. Secretin

c. Norepinephrine

The nurse is collecting a stool specimen from a patient. What characteristic 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

c. Tarry and black

Chyme, partially digested food that is mixed with gastric contents, stimulates segmented contractions, which are _____, and intestinal peristalsis, which is _____.

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

The stomach has four anatomic regions: the _____, _____, _____, and _____.

- cardia - fundus - body - pylorus

Structural changes in the esophagus that occur as a result of aging include: _____, _____, and _____.

- decreased motility and emptying - weakened gag reflex - decreased resting pressure of the lower sphincter

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

1.0

A flexible sigmoidoscope permits how much of the lower bowel to be viewed?

16-20 inches.

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

4 hours 12 hours

_____ facilitates the production of dextrins and maltose.

Amylase

What role do the sympathetic and parasympathetic portions of the autonomic nervous system play in GI function?

Both the sympathetic and parasympathetic portions of the autonomic nervous system innervate the GI tract. In general, sympathetic nerves exert an inhibitory effect, decreasing gastric secretion and motility and causing the sphincters and blood vessels to constrict. Parasympathetic nerve stimulation causes peristalsis and increases secretory activities. The sphincters relax under the influence of parasympathetic stimulation, except for sphincter of the upper esophagus and the external anal sphincter, which are under voluntary control.

What will occur if there is a lack of intrinsic factor secreted by the gastric mucosa?

Intrinsic factor, also secreted by the gastric mucosa, combines with dietary vitamin B12 so that the vitamin can be absorbed by the ileum. In the absence of intrinsic factor, vitamin B12 cannot be absorbed, and pernicious anemia results.

_____ helps form galactose.

Lactase

When is a magnetic resonance imaging (MRI) test contraindicated?

MRI is contraindicated when the patient has any of the following: permanent pacemakers, artificial heart valves, and implanted insulin pumps.

Glucose is a product of this enzyme's action.

Maltase

Describe what results from obstruction of the GI tract.

Obstruction of the GI tract increases the force of intestinal contraction. Distention occurs above the point of obstruction, causing pain and a sense of bloating.

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

cardiac sphincter

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 physician and let him know. He may have put too much air in your colon." c. I will call the physician 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."

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

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

d. Inspection

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? 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 musculature and reduce spasm.

d. To relax colonic musculature and reduce spasm.

The major carbohydrate that tissues use for fuel is _____.

glucose

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

ptyalin

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

secretin

Three pancreatic secretions that contain digestive enzymes are _____, ______, and _____.

trypsin, amylase, lipase