GI exam 3

An older adult client presents with a perforation of a peptic ulcer. The nurse will monitor for signs and symptoms of which problem? a. Peritonitis b. Fecal impaction c. Vomiting d. Diarrhea

a. Peritonitis Perforation occurs when an ulcer erodes through all the layers of the stomach or duodenum wall. With perforation, gastrointestinal contents enter the peritoneum and cause peritonitis

When assessing the client during the icteric phase of viral hepatitis, which of these findings does the nurse anticipate observing? a. Increased energy b. Blood in the stool c. Yellow-tinged blood d. Yellow-tinged sclera

d. Yellow-tinged sclera The icterus phase is reflected by development of jaundice of skin and sclera, liver tenderness, and worsened prodromal symptoms.

A nurse caring for a client with an intestinal obstruction anticipates which assessment findings? Select all that apply. a. Abdominal distension b. Vomiting c. Abdominal pain d. Diarrhea

A,B,C The nurse would anticipate the following when assessing a client with an intestinal obstruction: constipation, abdominal distension, vomiting, pain, and signs of fluid volume deficit.

Your patient, Alex, has Acute Pancreatitis. Which of the following labs are most important to monitor? (select all that apply) a. serum amylase b. glucose c. serum calcium d. serum potassium e. serum lipase f. Red blood cells

A,B,E Amylase and lipase are key digestive enzymes produced by the pancreas. Amylase helps the body break down starches. Lipase helps the body digest fats. Pancreatitis commonly causes high levels of amylase and lipase in the bloodstream. Pancreatitis also damages the cells that produce insulin and glucagon, which are the hormones that control the amount of sugar in the blood. This can lead to an increase in blood sugar levels (hyperglycemia). About 45 percent of people with chronic pancreatitis will get diabetes.

Which of the following patients are at risk of experiencing gastroesophageal reflux? a. John, 38 years old, BMI of 36, eats fast food in bed while lying down in bed playing video games. b. Sophie, 26 years old, BMI of 20, mother of twins c. Anna, 24 years old, has scoliosis and asthma, and studies at her desk for 3 hours after dinner each night d. Jackie, 32 years old, justifies eating White Castle and smoking a half-pack a day by weight lifting for 3 hours a day 5x a week #balance e. Danny, 40 years old, only wears sweatpants and can't stand salty foods

A,C,D Greasy meals, large meals, poor posture, smoking, excessive exercise, asthma, and laying down after meals can contribute to GERD symptoms. Obesity and pregnancy are factors, but Sophie is in a normal weight range and not currently pregnant. Tight fitting clothing is contraindicated in patients with GERD.

Which diagnosis causes an increased risk of developing intrahepatic jaundice? Select all that apply. a. Cirrhosis b. Bile duct malformation c. Hepatitis d. Liver cancer e. Cholelithiasis

A,C,D Hepatitis, cirrhosis, and liver cancer are considered risk factors for intrahepatic jaundice. Cholelithiasis and bile duct malformations are risks for post-hepatic jaundice.

A client has been admitted to the hospital with an exacerbation of peptic ulcer disease. The nurse is aware the client is at risk for: Select all that apply. a. Hemorrhage b. Weight gain c. Perforation d. Obstruction e. Increased urinary output

A,C,D The most common complications of peptic ulcer are hemorrhage, perforation, and gastric outlet obstruction. Weight gain and increased urinary output would not occur as the client may experience volume loss.

. A patient reports frequent heartburn twice a week for the past 4 months. What other symptoms reported by the patient may indicate the patient has GERD? Select all that apply a. Dry cough b. Melena c. Difficulty swallowing d. Smooth, red tongue e. Murphy's Sign f. Bitter taste in mouth

A,C,F These are signs and symptoms seen with GERD. Melena is seen with gastrointestinal bleeding as in peptic ulcer disease. Smooth, red tongue is seen with vitamin B12 deficiency, and Murphy's Signs is seen with cholecystitis. Murphy's sign is elicited in patients with acute cholecystitis by asking the patient to take in and hold a deep breath while palpating the right subcostal area. If pain occurs on inspiration, when the inflamed gallbladder comes into contact with the examiner's hand, Murphy's sign is positive.

The client with ulcerative colitis should be assessed by the health care provider for which clinical manifestations associated with this disease? Select all that apply. a. Steatorrhea b. Persistent diarrhea c. Stool containing blood (hematochezia) d. Prolapsed colon e. External hemorrhoids

B,C Unlike Crohn disease, which can affect various sites in the gastrointestinal tract, ulcerative colitis is confined to the rectum and colon. Ulcerative colitis typically presents as a relapsing disorder marked by attacks of diarrhea. The diarrhea may persist for days, weeks, or months and then subside, only to recur after an asymptomatic interval of several months to years or even decades. Because ulcerative colitis affects the mucosal layer of the bowel, the stools typically contain blood and mucus. Nutritional deficiencies are common in Crohn disease because of diarrhea, steatorrhea (fatty stools), and other malabsorption problems. Crohn disease causes granulomatous changes, often referred to as skip lesions because they are interspersed between what appear to be normal segments of the bowel. External hemorrhoids and prolapsed colon are not associated with ulcerative colitis.

Which disorders are grouped under the category of inflammatory bowel disease? Select all that apply. a. Shigellosis b. Crohn disease c. Salmonellosis d. Ulcerative colitis e. Celiac disease

B,D The term inflammatory bowel disease is used to designate two inflammatory conditions: Crohn disease, which affects the small and large bowel, and ulcerative colitis, which affects the colon and rectum. Salmonellosis and Shigellosis are infectious diseases. Celiac disease is an immune mediated disorder.

When assessing the client with acute pancreatitis, which of these diagnostic tests—consistent with the disease— does the nurse anticipate will be altered? a. Amylase and lipase b. Creatine kinase c. Glucose values d. The transaminases

a. Amylase and lipase Serum amylase and lipase are the laboratory markers most commonly used to establish a diagnosis of acute pancreatitis.

You are assessing a patient who came to the ER for asthma exacerbations. Which questions would be appropriate to ask them? Select all that apply a. "are you lactose intolerant?" b. "Earlier you said you take TUMS. How often do you experience heartburn?" c. "Did your last bowel movement look like tar?" d. "Do your symptoms ever worsen after meals or at nighttime?" e. "How many pillows do you sleep with at night?"

B,D,E Acid reflux can make asthma symptoms worse by irritating the airways and lungs. This, in turn, can lead to progressively worsened asthma. Heartburn is a hallmark symptom of GERD. GERD symptoms are at their worst 30-60 minutes after meals and at nighttime. Elevating the head of the bed can help relieve nighttime symptoms. Lactose intolerance is more commonly associated with IBS. Black tarry stools are more characteristic of peptic ulcer disease.

The nurse is caring for a client with liver disease who has edema throughout the body. When reviewing the medical record, the nurse recognizes that which altered diagnostic test is consistent with development of edema? a. Decreased albumin b. Decreased prothrombin c. Elevated cholesterol d. Elevated ammonia

a. Decreased albumin Altered function of the liver causes decreased levels of plasma proteins, particularly albumin, which contributes to edema formation. Albumin is responsible for water retention as the negative charges surrounding the protein molecules attract sodium ions.

A client who ate a large meal and then went to weightlifting class states "feeling very uncomfortable" and reports gastric reflux. What is the nurse's best response to the client? a. "There is backward movement of gastric contents into the esophagus that occurs soon after eating." b. "Exercise increases acid build-up in the stomach." c. "Jogging usually increases acid in the stomach." d. "You should not eat before you exercise."

a. "There is backward movement of gastric contents into the esophagus that occurs soon after eating." The term reflux refers to backward movement of gastric contents into the esophagus that occurs soon after eating, is short lived, and seldom causes more serious problems. As the blood is shunted away from the gastrointestinal tract toward the skeletal muscles during activities such as jogging, the gastrointestinal system activity is decreased. Food is not digested as rapidly, and heartburn and reflux are common. Vomiting, bloating and stomach pain can also result. The client should be encouraged to wait a while after eating before starting strenuous exercise so that digestion is not impaired.

A client presents with a perforated peptic ulcer. Which complication would be a priority for the nurse to assess for? a. Assessment of a rigid, boardlike abdomen b. Flatulence with bouts of diarrhea c. Blood pressure of 120/80 mm Hg d. Complaint of burning pain on an empty stomach

a. Assessment of a rigid, boardlike abdomen Perforation occurs when an ulcer erodes through all the layers of the stomach or duodenum wall. With perforation, gastrointestinal contents enter the peritoneum and cause peritonitis. Assessment of peritonitis is a rigid, boardlike abdomen.

John Doe has Peptic Ulcer Disease. You would anticipate the ulcer to be a slow-bleeding ulcer based on his presentation of: a. Black, tar-like stools b. Weak stream of urine, with urine that appears cloudy and red. c. Vomiting large amounts of bright red blood between meals d. Productive cough with sputum tinged with blood

a. Black, tar-like stools Peptic ulcers are open sores in the lining of the stomach or duodenum which can lead to bloody stools. The blood is not fresh, so it would not appear as bright red. Over time the ulcers enlarge and may erode through a blood vessel, causing bleeding. Coffee ground emesis may be seen with gastric ulcers in PUD.

A client presents with epigastric pain, a mild fever, nausea, and vomiting. His history shows a previous episode with similar symptoms that reverted in 24 hours. This time the pain is not subsiding. What diagnosis is the most likely? a. Calculous cholecystitis b. Cirrhosis c. Hepatitis C virus (HCV) d. Pancreatic cancer

a. Calculous cholecystitis Calculous cholecystitis develops when the main opening to the gallbladder, called the cystic duct, gets blocked by a gallstone or by a substance known as biliary sludge. Persons with calculous cholecystitis usually, but not always, have experienced previous episodes of biliary pain. Hepatitis, pancreatic cancer, and cirrhosis have very different symptoms.

A client with persistent, recurring episodes of epigastric and upper left quadrant pain and anorexia, nausea, vomiting, constipation, and flatulence has been diagnosed with chronic pancreatitis. What is the cause of the symptoms of chronic pancreatitis? a. Destruction of both the endocrine and exocrine pancreas b. Destruction of the endocrine pancreas c. Blockage of the common bile duct d. Destruction of the common bile duct

a. Destruction of both the endocrine and exocrine pancreas Chronic pancreatitis is characterized by progressive destruction of the exocrine pancreas, fibrosis, and, in the later stages, by destruction of the endocrine pancreas. Blockage of the bile duct would cause acute pancreatitis.

A nurse is completing a history and physical assessment on a client admitted with ulcerative colitis. Which symptoms would the nurse anticipate? Select all that apply. a. Diarrhea b. Rectal bleeding c. Fistulas d. Perianal abscesses

a. Diarrhea b. Rectal bleeding Symptoms of ulcerative colitis include diarrhea and rectal bleeding. Fistulas and perianal abscesses are associated with Crohn disease, not ulcerative colitis,

The nurse teaches that viral hepatitis damages the liver by which mechanism? a. Direct cellular injury b. Disrupted bile flow c. Fatty liver changes d. Bile duct inflammation

a. Direct cellular injury There are two mechanisms of liver injury in viral hepatitis: direct hepatocellular injury and induction of immune responses against the viral antigens. Intrahepatic biliary diseases disrupt the flow of bile through the liver, causing cholestasis and biliary cirrhosis. Cholangitis involves inflammation of hepatic bile ducts. Fatty liver is characterized by the accumulation of fat in hepatocytes, a condition called steatosis.

A client has just been diagnosed with cirrhosis and has been told he needs a transplant. What changes have occurred in the liver due to cirrhosis that results in an inability to heal and require transplant? a. Fibrosis has occurred and there are constrictive bands that disrupt biliary flow. b. Liver ischemia has occurred, resulting in anoxic damage to the liver. c. The client's hepatocytes have necrotized. d. Apoptosis is induced, resulting in total loss of hepatic tissue.

a. Fibrosis has occurred and there are constrictive bands that disrupt biliary flow. Cirrhosis is characterized by diffuse fibrosis and conversion of normal liver architecture into nodules containing proliferating hepatocytes encircled by fibrosis. The fibrous tissue that replaces normally functioning liver tissue forms constrictive bands that disrupt flow in the vascular channels and biliary duct systems of the liver. The loss of tissue is not caused by apoptosis or anoxic conditions. The liver does not become necrotic during cirrhosis.

A client with chronic pancreatitis is experiencing an episode of recurring epigastric pain. The dietitian knows that the client's diet should limit which type of meal to avoid further episodes? a. Fried chicken and french fries b. Fruit salad and banana bread c. Romaine salad with olive oil and vinegar dressing d. Pancakes and coffee

a. Fried chicken and french fries Of the meal options, fried chicken and french fries should be avoided since a low-fat diet is usually prescribed for clients with chronic pancreatitis.

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

a. HCO3- 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.

A client tells the nurse that he is concerned about developing hepatitis after being exposed to contaminated feces, saliva, and food. The nurse is aware that the client is at risk for: a. Hepatitis A b. Hepatitis B c. Hepatitis C d. Hepatitis D

a. Hepatitis A Hepatitis A is normally transmitted through the fecal-oral route by drinking contaminated milk or water and eating shellfish from infected waters. Hepatitis B is transmitted through infected blood or serum. Hepatitis C is transmitted by recreational injection drug use. Hepatitis D occurs largely to persons at high risk for HBV infection.

The nurse is reviewing laboratory results of a client who has liver failure. Which finding would place the client at increased risk for bleeding? a. Increased prothrombin time b. Decreased number of red blood cells c. Increased platelet count d. Increased levels of vitamin K

a. Increased prothrombin time Clients with liver failure have malabsorption of vitamin K (decrease), which impairs the synthesis of clotting factors. An increased prothrombin time (a coagulation factor) places the client at risk for bleeding. Factors V, VII, IX, and X, prothrombin, and fibrinogen are synthesized by the liver; their decline in liver disease contribute to bleeding disorders. A decrease in RBC will not cause an increase in bleeding. An increased platelet count will cause the blood to clot.

A nurse is reviewing laboratory results of a client with impaired liver function and anticipating which abnormal result indicating injury to liver cells? a. Liver enzymes b. Plasma proteins c. Blood clotting factors d. Serum bilirubin

a. Liver enzymes Serum liver enzymes, especially alanine aminotransferase (ALT) and aspartate aminotransferase (AST), are used to assess injury to liver cells; plasma proteins (e.g., serum albumin) and blood clotting factors (prothrombin time) provide information related to the liver's synthetic capacity; and serum bilirubin, serum gamma-glutamyltransferase (GGT), and alkaline phosphatase (ALP) are used as measures of hepatic excretory function.

The nurse is caring for a client with asterixis. Which assessment should the nurse make to help a diagnosis of hepatic encephalopathy? a. Mental status b. Vital signs c. Prothrombin time d. Serum albumin

a. Mental status Hepatic encephalopathy refers to the totality of central nervous system manifestations of liver failure. It is characterized by neural disturbances ranging from a lack of mental alertness to confusion, coma, and convulsions. In this condition, the liver can't adequately remove toxins from the blood. Ammonia is one of these toxins and is highly toxic to the brain. Although ammonia is generally accepted to a play a role in hepatic encephalopathy, some individuals with elevated ammonia levels do not develop these symptoms, suggesting that additional factors play a role in the development of the disorder. A very early sign of hepatic encephalopathy is a flapping tremor called asterixis.

A client presents to the emergency department with some vague symptoms. After history and physical exam, the physician is suspecting the client may have viral hepatitis. Which clinical manifestation leads the nurse to suspect the client is in the prodromal period of viral hepatitis? a. Muscle aches and pain along with fatigue b. Onset of severe itching with skin breakdown c. Liver tenderness on palpation d. Slight jaundice in the sclera of the eyes

a. Muscle aches and pain along with fatigue The prodromal period may vary from abrupt to insidious, with general malaise, myalgia, arthralgias, easy fatigability, and severe anorexia out of proportion to the degree of illness. The icterus phase usually follows the prodromal phase within 5 to 10 days. The icterus phase can have the onset of jaundice, followed by severe pruritus and liver tenderness.

When assessing a client with acute cholecystitis, the nurse anticipates the client's report of pain will be consistent with which description? a. Pain in the right upper quadrant referred to the same shoulder b. Pain in the back, radiating to the groin c. Pain that starts as a diffuse ache and localizes over 24 to 48 hours d. Pain in the left lower quadrant, radiating to the back

a. Pain in the right upper quadrant referred to the same shoulder The pain of biliary colic begins abruptly and increases in intensity. It is usually located in the upper right quadrant or epigastric area and may be referred to the upper back, the right shoulder, or midscapular region.

Which layer of the digestive tract constitutes the outer wall of the intestine and contains a serous fluid between its two layers? a. Peritoneum b. Haustration c. Mesentery d. Omentum

a. Peritoneum The peritoneum is the largest serous membrane and constitutes the outer wall of the intestine, continuous with the mesentery. The greater omentum helps to prevent infection from entering the peritoneal cavity, and protects the intestines from cold. Haustration is the segmental mixing of movements of the large intestine (colon).

The nurse is caring for a client with viral hepatitis who has general malaise, easy fatigability, arthralgia, and anorexia. These manifestations correspond with what stage of the disease? a. Prodromal period b. Icterus phase c. Convalescent phase d. Chronic period

a. Prodromal period Acute symptomatic viral hepatitis can be divided into three phases: the prodromal period, icterus phase, and the convalescent phase. The prodromal period includes general malaise, myalgia, arthralgia, easy fatigability, and severe anorexia. There may also be nausea, vomiting, and diarrhea with mild, right-sided abdominal pain. The icterus phase usually follows the first phase by 5 to 10 days. Jaundice may accompany a temporary worsening of the initial symptoms. In the convalescent phase the client begins to feel better, regains the appetite, and jaundice subsides. The acute illness subsides gradually over 2 to 3 weeks.

A patient who received treatment for pancreatitis is being discharged home. You're providing lifestyle modification teaching to the patient. Which statement by the patient requires immediate re-education about the diet restrictions? a. "It will be hard but I will eat a diet low in fat and avoid greasy foods." b. "It is very important I limit my alcohol intake to no more than 2-3 glasses of wine a week." c. "I will concentrate on eating complex carbohydrates rather than refined carbohydrates." d. "I will try to stop smoking, but it is okay if I stretch a pack out over a week for now."

b. "It is very important I limit my alcohol intake to no more than 2-3 glasses of wine a week." A patient with pancreatitis should AVOID any amount of alcohol because of its effects on the pancreas. Remember alcohol is a cause of both acute and chronic pancreatitis. Smoking cessation is preferred, but not as much of a priority as alcohol cessation.

Irritable bowel syndrome is thought to be present in 10% to 15% of the population in the United States. What is its hallmark symptom? a. Diarrhea and abdominal pain unrelieved by defection b. Abdominal pain relieved by defecation with a change in consistency or frequency of stools c. Nausea and abdominal pain unrelieved by defecation d. Abdominal pain relieved by defecation and bowel impaction

b. Abdominal pain relieved by defecation with a change in consistency or frequency of stools A hallmark of irritable bowel syndrome is abdominal pain that is relieved by defecation and associated with a change in consistency or frequency of stools. Nausea, altered bowel function, and diarrhea are also symptoms of irritable bowel syndrome but not combined with abdominal pain that is unrelieved by defecation. A bowel impaction is not a symptom of irritable bowel syndrome.

Mr. Jackson is admitted to your unit for treatment of a duodenal ulcer. You are assigned to perform his admission assessment. Which of the following would you expect to find in the assessment? a. Dehydration from frequent vomiting. b. Burning pain several hours after eating a meal. c. Anorexia and weight loss over the past few months d. Retrosternal pain that radiates down the left arm.

b. Burning pain several hours after eating a meal. Duodenal ulcers cause pain that is described as burning or gnawing. This pain occurs between meals and at night. Eating meals helps relieve pain. Retrosternal pain is the heartburn that is common in GERD. Anorexia, weight loss, and vomiting are more common with gastric ulcers.

A patient with acute pancreatitis is reporting excessive thirst, excessive urination, excessive hunger, and blurred vision. As the nurse, it is priority you do what? a. Reassure the patient this is normal with pancreatitis, and tell them to ring the call light if they need anything. b. Check the patient's blood glucose c. Give them 8 ounces of orange juice and check on them in 15 minutes d. Call the doctor to get an order for Tylenol

b. Check the patient's blood glucose Patients with acute pancreatitis are at risk for hyperglycemia (the signs and symptoms the patient are reporting are classic symptoms of hyperglycemia). Remember the endocrine function of the pancreas (which is to release insulin/glucagon etc. is insufficient) so the nurse must monitor the patient's blood glucose levels even if the patient is not diabetic.

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? a. Triangular b. Cobblestone c. Pyramidal d. Mosaic

b. Cobblestone 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 man presents reporting diarrhea, fecal urgency, and weight loss. His stool is light-colored and malodorous, and it tends to float and be difficult to flush. Sigmoidoscopy reveals discontinuous, granulomatous lesions; no blood is detected in his stool. Which diagnosis would his care team first suspect? a. Colon cancer b. Crohn disease c. Diverticulitis d. Ulcerative colitis

b. Crohn disease 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.

Janet has strong epigastric pain, and feels much better after eating. She finds herself eating even when she is not hungry because it helps the gnawing pain in her stomach subside. Which type of ulcer does Janet have? a. Esophageal ulcer b. Duodenal Ulcer c. Gastric Ulcer d. Pancreatic Ulcer

b. Duodenal Ulcer Duodenal ulcers are characterized by relief with meals. Duodenal ulcers tend to cause abdominal pain that comes on several hours after eating (often during the night); this is due to the presence of acid in the digestive tract without a food "buffer." Eating or taking an acid-reducing medication may relieve symptoms. While some patients with gastric ulcers may find relief with eating, it is not as common because of the gastric acids involved in digestion.

A client is newly diagnosed with irritable bowel syndrome (IBS). The nurse explains how the nervous system affects gastrointestinal (GI) disorders. The nurse mentions which statement in regard to IBS? a. Decrease in gastrointestinal motility b. Increase in parasympathetic nervous system activity c. Enhancement of sphincter function d. Increase in smooth muscle tone

b. Increase in parasympathetic nervous system activity Stimulation of the parasympathetic nervous system causes a general increase in motility of the bowel. Sympathetic stimulation inhibits activity, causing many effects opposite to those of the parasympathetic system, including enhancement of sphincter function, decreased motility, and increased smooth muscle tone.

The client reports something "wrong" with his gallbladder. Which manifestation does the nurse recognize that supports the client's concern? a. Abrupt onset of right lower quadrant pain and chills b. Intolerance to greasy food; burping c. Fluid retention and edema of the hands and feet d. Craving for carbohydrates

b. Intolerance to greasy food; burping The manifestations of chronic cholecystitis are more vague than those of acute cholecystitis. There may be intolerance to fatty foods, belching, and other indications of discomfort.

Evelyn has GERD. You would recommend she do all of the following except: a. Take an over-the-counter antacid b. Limit caffeine intake to 1 8oz cup a day c. Quit smoking and drinking d. Lose weight e. Avoid large meals and eat 3-6 small meals throughout the day

b. Limit caffeine intake to 1 8oz cup a day Caffeine consumption exacerbates GERD and is recommended to be cut out of the diet as much as possible.

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

b. Obstruction of the intestinal lumen 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 in liver failure asks, "How does the liver process ammonia in healthy individuals?" Which explanation from the health care provider explains the mechanism how ammonia is removed from the blood by the liver? a. Processes ammonia into nitrogen and hydrogen ions for excretion b. Processes ammonia into urea, releasing it into the circulation c. Converts ammonia into bilirubin, which is then excreted intestinally d. Combines ammonia with oxygen to create ammonium oxide

b. Processes ammonia into urea, releasing it into the circulation The ammonia that is released during the deamination process is rapidly removed from the blood by the liver and converted to urea, which is then released into circulation for removal by the kidneys.

When teaching a client about chronic pancreatitis, which of these does the nurse relate is the long term result of this condition? a. Weight gain b. Progressive destruction of the organ c. Alcohol abuse d. Easily cured with antibiotic therapy

b. Progressive destruction of the organ The chief distinction between acute and chronic pancreatitis is the irreversibility of pancreatic function with chronic pancreatitis. Chronic pancreatitis is characterized by progressive destruction of the exocrine pancreas, by fibrosis, and, in the later stages, by destruction of the endocrine pancreas. While the most common cause of chronic pancreatitis is alcohol abuse, it is not the consequence.

When teaching a client about chronic pancreatitis, which of these does the nurse relate is the long term result of this condition? a. Alcohol abuse b. Progressive destruction of the organ c. Easily cured with antibiotic therapy d. Weight gain

b. Progressive destruction of the organ The chief distinction between acute and chronic pancreatitis is the irreversibility of pancreatic function with chronic pancreatitis. Chronic pancreatitis is characterized by progressive destruction of the exocrine pancreas, by fibrosis, and, in the later stages, by destruction of the endocrine pancreas. While the most common cause of chronic pancreatitis is alcohol abuse, it is not the consequence.

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

b. Proton pump inhibitors; avoiding large meals; remaining upright after meals 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.

The body uses common physiologic responses that are common to gastrointestinal (GI) disorders. A nurse would expect to see which physiologic response known to be protective by removing noxious agents from the body? a. Anorexia b. Vomiting c. Nausea d. Diarrhea

b. Vomiting Vomiting is the only protective response that removes noxious agents from the GI tract, although anorexia, nausea, and diarrhea are common physiologic responses to many GI disorders.

When explaining acute pancreatitis to a newly diagnosed client, the nurse will emphasize that the pathogenesis begins with an inflammatory process whereby: a. stones will develop in the common bile duct, resulting in acute jaundice. b. activated pancreatic enzymes escape into surrounding tissues, causing autodigestion of pancreatic tissue. c. the pancreas is irreversibly damaged and will not recover to normal functioning (chronic). d. the pancreas will hypertrophy (enlarge) to the point of causing bowel obstruction.

b. activated pancreatic enzymes escape into surrounding tissues, causing autodigestion of pancreatic tissue. Acute pancreatitis is associated with the escape of activated pancreatic enzymes into the pancreas and surrounding tissues. These enzymes cause fat necrosis, or autodigestion, of the pancreas. Alcohol is known to be a potent stimulator of pancreatic secretions, and it also is known to cause partial obstruction of the sphincter of the pancreatic duct, rather than bowel obstruction. The pancreas is irreversibly damaged and will not recover to normal functioning results from chronic pancreatitis. Acute pancreatitis also is associated with viral infections. The pancreas will hypertrophy (enlarge) to the point of causing bowel obstruction occurring with cancer of the pancreas. Presence of stones in the common bile duct with jaundice is primarily a result of gallstones.

A client has had severe heartburn associated with persistent gastroesophageal reflux for many years. Which statement made by the client leads the nurse to suspect the client is having a complication related to his reflux? The client is having: a. substernal chest pain that radiates to the shoulder and arm. b. difficulty in swallowing with feelings that food is "stuck" in the throat. c. "hoarseness" unrelieved by coughing or taking a drink of water. d. burning sensation a half-hour after a meal.

b. difficulty in swallowing with feelings that food is "stuck" in the throat. Complications can result from persistent reflux, which produces a cycle of mucosal damage that causes hyperemia, edema, and erosion of the luminal surface. Strictures are caused by a combination of scar tissue, spasm, and edema, which narrow the esophagus. The most frequent symptom of gastroesophageal reflux is heartburn. Other symptoms include belching, wheezing, chronic cough, hoarseness, and epigastric or retrosternal area chest pain, radiating to the throat, shoulder, or back. Because of its location, the pain may be confused with angina.

A client who has been diagnosed with acute symptomatic viral hepatitis is now in the icteric period. The nurse would expect the client to manifest: a. disappearance of jaundice. b. severe pruritus and liver tenderness. c. severe anorexia. d. chills and fever.

b. severe pruritus and liver tenderness. Severe pruritus and liver tenderness are common during the icterus period. Chills, fever, and severe anorexia occur during the prodromal period. The disappearance of jaundice occurs in the convalescent phase.

Which individual likely faces the highest risk of developing chronic pancreatitis? a. A man who has become profoundly ill during a tropical vacation b. An obese man who has a high-fat diet and has a sedentary lifestyle c. A woman who has 6 to 8 alcoholic beverages each evening d. A woman who takes 2 acetaminophen tablets 5 to 6 times a day

c. A woman who has 6 to 8 alcoholic beverages each evening By far, the most common cause of chronic pancreatitis is long-term alcohol use disorder. The other cited factors are not noted to contribute significantly to the pathogenesis of chronic pancreatitis.

Which factor is most strongly associated with the pathogenesis of gallstone formation? a. High-cholesterol diet b. Excess serum ammonia and urea levels c. Abnormalities or stasis of bile d. Portal hypertension

c. Abnormalities or stasis of bile Three factors contribute to the formation of gallstones: abnormalities in the composition of bile, stasis of bile, and inflammation of the gallbladder. Portal hypertension, a high-cholesterol diet, and excess ammonia and/or urea are not causative factors of cholelithiasis.

Given the fact that acute pancreatitis can result in severe, life-threatening complications, the nurse should be assessing the client for which complication? a. Complete heart block b. Bilateral pneumothorax c. Acute tubular necrosis d. Cerebral hemorrhage

c. Acute tubular necrosis Complications of acute pancreatitis include the systemic inflammatory response, acute respiratory distress syndrome, acute tubular necrosis, and organ failure. Cerebral hemorrhage, bilateral pneumothorax, and complete heart block are not associated with the complications of acute pancreatitis.

Which of these substances should the nurse teach the client with pancreatitis to absolutely avoid? a. Fatty foods b. Narcotic analgesics c. Alcohol d. Concentrated sweets

c. Alcohol Clients with chronic pancreatitis must be told alcohol is forbidden as it frequently precipitates attacks. The pancreatic acinar cells metabolize alcohol into toxic byproducts that damage pancreatic ducts, and enzymes that are normally released into the digestive tract build up and begin to digest the pancreas itself. The damaged pancreatic tissue promotes inflammation, which leads to further damage of the pancreas.

A client is admitted to a nursing unit with severe edema. The nursing student caring for this client overhears the physician and a medical student talking about the client's albumin level. When discussing the flow of fluids into and out of cells, albumin plays a significant role in which pressure gradient? a. Hydrostatic b. Transcellular c. Colloidal osmotic d. Diffusion

c. Colloidal osmotic One of the most important of these secretory proteins is albumin. Albumin contributes significantly to the plasma colloidal osmotic pressure and to the binding and transport of numerous substances such as hormones, fatty acids, and bilirubin. Hydrostatic pressure within the cells and surrounding interstitial fluid is ordinarily equal and remains stable. Diffusion is the net movement of a substance (e.g., an atom, ion, or molecule) from a region of high concentration to a region of low concentration. The transcellular compartment consists of those spaces in the body where fluid does not normally collect in larger amounts or where any significant fluid collection is physiologically nonfunctional. Examples of transcellular spaces include the eye and the central nervous system.

. Matt, a 26-year-old male, was diagnosed with Ulcerative Colitis. He has been having 12 loose bowel movements each day for the past week, his temperature is 101.9 F, and his abdomen is distended. Which order from the doctor for a diagnostic test would you question? a. Urinalysis b. CBC with differential c. Colonoscopy d. EKG

c. Colonoscopy Colonoscopy should not be performed on people with severe form of ulcerative colitis due to the danger of perforation. It may be performed after confirmed improvement, especially when cancer is suspected.

Parents of a toddler report that he often refuses food and grimaces when he swallows. The mother is worried that he ate something inappropriate this morning, because he vomited something that looked like coffee grounds. Which health problem would the care team first suspect? a. Peptic ulcer disease b. Rotavirus infection c. Gastrointestinal reflux d. Irritable bowel syndrome

c. Gastrointestinal reflux Esophagitis secondary to reflux can cause feeding problems, early satiety, and hematemesis. Infants may demonstrate signs of pain when swallowing and may be irritable and cry frequently. Rotavirus causes diarrhea and vomiting but not the other symptoms. IBS does not cause esophagitis. Peptic ulcer disease would not cause difficulty swallowing.

During assessment of a recently admitted client with right-sided heart failure, the nurse notes that the liver is enlarged and verifies by palpation and percussion. A student asks the nurse to explain how the liver and heart failure are related. Which is the nurse's best response? a. Since the heart cannot pump effectively, blood is moving very slowing in both the arterial and venous vessels; therefore, blood cannot move out of the liver very fast. b. The liver is very vascular and is always filled with blood to maximum capacity. c. In right-sided heart failure, there is high pressure in the inferior vena cava that backlogs blood into the liver. d. The lobules, which are the functional unit of the liver, cannot move blood very rapidly out of the veins so it just pools there until BP is increased.

c. In right-sided heart failure, there is high pressure in the inferior vena cava that backlogs blood into the liver. In right-sided heart failure in which the pressure in the vena cava increases, blood backs up and accumulates in the liver. The pressure difference between the hepatic vein and the portal vein normally is such that the liver stores approximately 450 mL of blood. Right-sided heart failure backs up the venous side of circulation whereas left-sided failure backlogs blood into the lungs. The lobules are the functional units of the liver. The classic lobule consists of stacks of anastomosing plates of hepatocytes one cell thick. Each lobule is organized around a central vein that empties into the hepatic veins and from there into the inferior vena cava.

A client is admitted to the medical surgical unit with a history of inflammatory bowel disease. The nurse knows that the clinical manifestations of both Crohn disease and ulcerative colitis are the result of activation of which cells? a. Alpha b. Beta c. Inflammatory d. Parietal

c. Inflammatory The term "inflammatory bowel disease" is used to designate two related inflammatory intestinal disorders: Crohn disease and ulcerative colitis. Both diseases produce inflammation of the bowel. The clinical manifestations of both Crohn disease and ulcerative colitis are ultimately the result of inflammatory cells with elaboration of inflammatory mediators that cause nonspecific tissue damage.

Upon admission, a client tells the nurse that he takes aspirin every 4 hours every day. The nurse determines that this client is at risk for: a. Zollinger-Ellison syndrome b. Cancer of the stomach c. Peptic ulcer d. Crohn disease

c. Peptic ulcer Peptic ulcers occur in the areas of the upper gastrointestinal tract and are caused by Helicobacter pylori infection and aspirin or nonsteroidal anti-inflammatory drug use. Therefore, the nurse determines that a client taking aspirin every 4 hours daily is at risk for a peptic ulcer.

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? a. Continuous involvement of the colon starting at the rectum b. Development of cancer c. Skip lesions d. Primarily rectum and colon involvement

c. Skip lesions 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.

A client diagnosed with ulcerative colitis has been experiencing more than six bloody stools daily with evidence of toxicity. The nurse should question which order from the physician? a. Physical examination b. Stool specimen c. Ova and parasite examination d. Colonoscopy

d. Colonoscopy Diagnosis of ulcerative colitis is based on history and physical examination. The diagnosis usually is confirmed by sigmoidoscopy, colonoscopy, biopsy, and by negative stool examinations for infectious or other causes. Colonoscopy should not be performed on people with severe disease because of the danger of perforation; however, it may be performed after demonstrated improvement to determine the extent of disease and need for subsequent cancer surveillance.

A nurse reading a sigmoidoscopy report notes that a client was found to have skip lesions. The nurse interprets this as an indication of: a. Zollinger-Ellison syndrome b. Peptic ulcer c. Ulcerative colitis d. Crohn disease

d. Crohn disease Skip lesions, demarcated granulomatous lesions that are surrounded by normal-appearing mucosal tissue, are a characteristic feature of Crohn disease.

A health care provider has completed an assessment on a client diagnosed with cirrhosis. The client asks, "What, if any, serious complications are associated with cirrhosis?" Which response is the most accurate for the provider to relay to the client? a. Biliary colic b. Duodenal ulcers c. Dehydration d. Esophageal varices

d. Esophageal varices Most deaths from alcoholic cirrhosis are attributable to liver failure, bleeding esophageal varices, or kidney failure. Esophageal varices are a life-threatening complication of cirrhosis related to the risk of rupturing and producing a massive amount of hemorrhage. The remaining options may be irritating but are not life-threatening.

The nurse is caring for a client with hepatitis and jaundice. The nurse recognizes that without sufficient circulating bile salts the client will have intolerance to which ingested substance? a. Protein b. Amino acids c. Carbohydrates d. Fats

d. Fats Lack of production of bile salts causes malabsorption of fat and fat-soluble vitamins.

A nurse is teaching a client diagnosed with Crohn disease about potential complications. The most appropriate information for the nurse to include would be: a. Chronic constipation b. Difficulty swallowing c. Excessive weight gain d. Fistula formation

d. Fistula formation Complications of Crohn disease include fistula formation, abdominal abscess formation, and intestinal obstruction. Clients with Crohn disease are at risk for weight loss and/or diarrhea. The disease does not cause difficulty swallowing as it typically is in the bowel.

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: a. Constipation b. Rectal bleeding c. Dysphagia d. Fistula formation

d. Fistula formation 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.

You're caring for a 45 year old patient who is admitted with suspected acute pancreatitis. The patient reports having extreme mid-epigastric pain that radiates to the back. The patient states the pain started last night after eating McDonald's and drinking a few beers. As the nurse, you know the two most common causes of acute pancreatitis are: a. High cholesterol and heavy long-term alcohol abuse b. History of diabetes and smoking c. Pancreatic cancer and obesity d. Gallstones and alcohol consumption

d. Gallstones and alcohol consumption Main causes of acute pancreatitis are gallstones and alcohol consumption. Heavy, long-term alcohol abuse is the main cause of CHRONIC pancreatitis.

. The student nurse studying for patho keeps confusing IBS with IBD. They remember that IBS differs from IBD because: a. A clinical manifestation of IBS is skip lesions that only affect the esophageal lining by giving it a "cobblestone" appearance. b. H. Pylori infection coupled with stress is the most common cause of IBS c. IBS has a stronger genetic link than IBD d. IBS presents with periods of alternating diarrhea and constipation, and the pain associated with IBS is relieved with defecation.

d. IBS presents with periods of alternating diarrhea and constipation, and the pain associated with IBS is relieved with defecation. IBS presents with alternating diarrhea and constipation. Constipation is not common in IBD. Skip lesions are a manifestation of Chron Disease (IBD) and typically occur in the ileum and cecum. H. Pylori infection is a contributing factor to Peptic Ulcer Disease; stress and dairy are common contributing factors in IBS. A familial pattern is associated with IBD.

A patient has pernicious anemia secondary to atrophic gastritis. Which substance necessary for vitamin B12 absorption is produced by the parietal cells in the stomach? a. Pepsinogen b. Hydrochloric acid c. Carbonic anhydrase d. Intrinsic factor

d. Intrinsic factor Intrinsic factor is produced by the parietal cells in the stomach and is necessary for the absorption of vitamin B12. Hydrochloric acid activates pepsinogen into the enzyme pepsin, which then helps digestion by breaking the bonds linking amino acids, a process known as proteolysis. An enzyme present in red blood cells, carbonic anhydrase, aids in the conversion of carbon dioxide to carbonic acid and bicarbonate ions.

Ulcerative colitis is an inflammatory bowel disease. The nurse identifies which of the following as a common sign of ulcerative colitis? a. Formation of fistula b. Periods of exacerbations and remissions c. Lesions surrounded by normal-appearing mucosal tissue d. Mucus and blood stools

d. Mucus and blood stools Ulcerative colitis is a nonspecific inflammatory condition of the colon. Unlike Crohn disease, which can affect various sites in the GI tract, ulcerative colitis is confined to the rectum and the colon. Ulcerative colitis presents as a relapsing disorder that affects the mucosal layer of the bowel; the stools typically contain blood and mucus. Fistula formation is common in Crohn disease, which is characterized by periods of exacerbations and remission. Ulcerative colitis has continuous involvement of the colon, beginning with the rectum.

A client with a history of peptic ulcer disease presents to the emergency department with the following symptoms: early satiety, feeling of epigastric fullness and heaviness after meals, weight loss, and vomiting. The nurse suspects that the peptic ulcer has caused which problem? a. Penetration b. Obstruction c. Intrusion d. Perforation

d. Perforation Outlet obstruction is caused by edema, spasm, or contraction of scar tissue and interference with the free passage of gastric contents through the pylorus or adjacent areas. The presentation of an obstruction is typically insidious, with symptoms of early satiety, feeling of epigastric fullness and heaviness after meals, gastroesophageal reflux, weight loss, and abdominal pain. With severe obstruction, there is vomiting of undigested food.

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? a. Intussusception b. Peptic ulcer c. Ulcerative colitis d. Peritonitis

d. Peritonitis 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.

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: a. Referred tenderness b. Periumbilical tenderness c. Perforated appendix d. Rebound tenderness

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

The nurse teaches the client that which of these contributed to the development of acute cholelithiasis? a. Rapid elimination of bile b. Excessive alcohol consumption c. Chronic pancreatitis d. Stasis of bile

d. Stasis of bile Two primary factors contribute to the formation of gallstones: abnormalities in the composition of bile and the stasis of bile (rather than rapid elimination). Inflammation of the gallbladder alters the absorptive characteristics of the mucosal layer, allowing excessive absorption of water and bile salts. Although a number of factors are associated with the development of acute pancreatitis, most cases result from gallstones (rather than cause gallstone formation) or alcohol use disorder. Alcohol is known to be a potent stimulator of pancreatic secretions, and it also is known to cause partial obstruction of the sphincter of the pancreatic duct; alcohol intake is not a factor in the development of cholesterol or bilirubin stones.

The client who has experienced third-degree burns is susceptible to which specific type of gastrointestinal (GI) ulceration? a. Peptic b. Duodenal c. Gastric d. Stress

d. Stress Stress ulcers refer to GI ulcerations that develop in people with large-surface-area burns. Stress-induced ulcers of the stomach and duodenum in massively burned patients, otherwise known as Curling's ulcers, result from a defect in the mucosal barrier to secreted acid. The etiology of this defect is related, at least in part, to mucosal ischemia, which is aggravated by hypotension, sepsis, and hypoxia.

Which manifestation is considered a major complication of persistent gastroesophageal reflux? a. Hoarseness b. Chest pain c. Heartburn d. Strictures

d. Strictures Complications can result from persistent reflux, which produces a cycle of mucosal damage that causes hyperemia, edema, and erosion of the luminal surface. Strictures are caused by a combination of scar tissue, spasm, and edema, which narrow the esophagus. The most frequent symptom of gastroesophageal reflux is heartburn (so this is an expected manifestation and not a complication). Other symptoms include belching, wheezing, chronic cough, hoarseness, and epigastric or retrosternal area chest pain radiating to the throat, shoulder, or back. Because of its location, the pain may be confused with angina.

Which signs and symptoms are most suggestive of acute cholecystitis? a. Nausea resulting in greenish vomitus b. Fever and sudden abdominal distention c. Appearance of undigested fat in feces d. Upper right quadrant or epigastric pain

d. Upper right quadrant or epigastric pain Persons with acute cholecystitis usually experience an acute onset of upper right quadrant or epigastric pain. Nausea and vomiting are also common, although these are not specific to cholecystitis. Abdominal distention and steatorrhea are not key signs of acute cholecystitis.

Peptic ulcer disease is treated primarily with a. Antacids & PPI's b. Exercising 30 minutes a day 5 times a week c. Smoking cessation d. Avoiding spicy foods and chocolate e. All of the above

e. All of the above Pharmacological treatment and lifestyle changes are the best methods to manage peptic ulcer disease.