CH 21: Digestive, gastrointestinal, and metabolic function
The nurse is instructing the client on frequent sensations experienced when a contrast agent is injected into the body during diagnostic studies. Which sensation is most common? A) Light-headedness B) A warm sensation C) Heart palpitations D) Chills
B) A warm sensation The nurse informs the client that he or she may experience a warm sensation and nausea when the contrast agent is instilled. The client is instructed to take a couple of deep breaths, and, many times, the sensation will go away. The other options are not frequently encountered.
A patient has come into the radiology department to undergo testing for possible polyps. What diagnostic test may be done to diagnose this type of lesion? A)Gastric analysis B)Barium enema C)Barium swallow D)Gastroscopy
B) Barium enema The purpose of the barium enema is to detect the presence of polyps, tumors, and other lesions of the large intestine and to demonstrate any abnormal anatomy or malfunction of the bowel.
The nurse is caring for a geriatric client and notices polypharmacy. Which diagnostic studies are anticipated? A) Complete blood count B)Urinalysis C)Liver function studies D) Blood chemistry
C) liver function studies The liver metabolizes and biotransforms the medications ingested. Geriatric clients who experience polypharmacy or multiple medications have an elevated risk of liver impairment. Routine liver function studies monitor the status of the liver and its ability to metabolize.
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? A)duodenum B)jejunum C) ileum D) cecum
A) duodenum 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.
Swallowing is regulated by which area of the central nervous system (CNS)? a)Medulla oblongata B) Pons C) Cerebellum D) Hypothalamus
A) medulla oblongata Swallowing begins as a voluntary act that is regulated by the swallowing center in the medulla oblongata of the CNS. The act of swallowing requires the innervations of five cranial nerves (CNs), especially CN V, VII, IX, X, and XII. Swallowing is not regulated by the pons, cerebellum, or hypothalamus.
Which nursing instruction is correct to provide the client following a barium enema? A)The client will maintain a low residue diet. B)The stools may be a white or clay colored. C)Sips of fluid may be increased if tolerated. D) An enema will be used to clear the bowel.
B) the stools may be a white or clay colored It is important to instruct the client that it is normal to have a white- or clay-colored stool following the barium enema. The client should report the color of the stool to the nurse. A progression of clay colored stools to brown-colored stools should be noted. The client is prescribed a low-residue diet before the procedure. An increased fluid intake is offered to eliminate the barium from the bowel. The client is encouraged to move the bowel independently.
Which of the following is the primary function of the small intestine? A)Absorption B) Digestion C) Peristalsis D) Secretion
A) Absorption
An older adult client is admitted to an acute care facility for treatment of an acute flare-up of a chronic gastrointestinal condition. In addition to assessing the client for complications of the current illness, the nurse monitors for age-related changes in the gastrointestinal tract. Which age-related change increases the risk of anemia? a) Atrophy of the gastric mucosa B) Decrease in intestinal flora C) Increase in bile secretion D) Dulling of nerve impulses
A) Atrophy of the gastric mucosa
A client is diagnosed with megaloblastic anemia caused by vitamin B12 deficiency. The health care provider begins the client on cyanocobalamin (Betalin-12), 100 mcg I.M. daily. Which substance influences vitamin B12 absorption? A) Intrinsic factor B) Hydrochloric acid C)Histamine D) Liver enzyme
A) Intrinsic factor Vitamin B12 absorption depends on intrinsic factor, which is secreted by parietal cells in the stomach. The vitamin binds with intrinsic factor and is absorbed in the ileum. Hydrochloric acid, histamine, and liver enzymes don't influence vitamin B12 absorption.
When bowel sounds are heard about every 15 seconds, the nurse would record that the bowel sounds are A) normal. B)hypoactive. C)sluggish. D)absent.
A) Normal
Which of the following is an enzyme secreted by the gastric mucosa? A)Pepsin B)Trypsin C)Ptyalin D)Bile
A) Pepsin Pepsin is secreted by the gastric mucosa. Trypsin is secreted by the pancreas. The salivary glands secrete ptyalin. The liver and gallbladder secrete bile.
Which of the following is considered the gold standard for the diagnosis of liver disease? A) Biopsy B)Paracentesis C) Cholecystography D) Ultrasonography
A) biopsy
A client is scheduled to have an endoscopic retrograde cholangiopancreatography. Which structures are visualized during this procedure? A) common bile duct, pancreatic duct, and biliary tree B)common bile duct, portal vein, and gallbladder C)portal vein, pancreatic duct, and biliary tree portal D)vein, gallbladder, and pancreatic duct
A) common bile duct, pancreatic duct, and biliary tree
A nurse is giving a client barium swallow test. What is the most important assessment a nurse would make to ensure that a client does not retain any barium after a barium swallow? A) Placing any stool passed in a specific preservative. B) Monitoring the stool passage and its color. C)Observing the color of urine. D) Monitoring the volume of urine.
B) Monitoring the stool passage and its color. Monitoring stool passage and its color will ensure that the client remains barium free following a barium swallow test. The white or clay color of the stool would indicate barium retention. The stool should be placed in a special preservative if the client undergoes a stool analysis. Observing the color and volume of urine will not ensure that the client is barium free because barium is not eliminated through urine but through stool.
The nurse is caring for a man who has experienced a spinal cord injury. Throughout his recovery, the client expects to gain control of his bowels. The nurse's best response to this client would be which of the following? A)"It is not going to happen. Your nerve cells are too damaged." B)"Having a bowel movement is a spinal reflex requiring intact nerve fibers. Yours are not intact." C) "Over time, the nerve fibers will regrow new tracts, and you can have bowel movements again." D)"Wearing an undergarment will become more comfortable over time."
B)"Having a bowel movement is a spinal reflex requiring intact nerve fibers. Yours are not intact."
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? A) Ileum B) Cecum C) Sigmoid colon D) Duodenum
C) Sigmoid colon 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.
The nurse recognizes which change of the gastrointestinal system is an age-related change? a)increased motility B)hypertrophy of the small intestine C)weakened gag reflex D) increased mucus secretion
C) weakened gag reflex
The nurse is teaching the client about the upcoming endoscopic retrograde cholangiopancreatography (ERCP). Although the nurse instructs on several pertinent points of care, which is emphasized? A)The client will fast prior to the procedure. B) The client will have moderate sedation. C)The client will receive antibiotics before and after the procedure. D) The client will change positions frequently throughout the procedure.
D) The client will change positions frequently throughout the procedure. It is essential that the client understands that cooperation is essential in changing positions throughout the procedure to prevent injury of the gastrointestinal tract. All of the other options are also correct but do not carry a risk for injury if not completed.
An older adult client is admitted to an acute care facility for treatment of an acute flare-up of a chronic gastrointestinal condition. In addition to assessing the client for complications of the current illness, the nurse monitors for age-related changes in the gastrointestinal tract. Which age-related change increases the risk of anemia? A) Atrophy of the gastric mucosa B)Decrease in intestinal flora C)Increase in bile secretion D) Dulling of nerve impulses
A) atrophy of the gastric mucosa 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.
The nurse is assisting the health care provider with a gastric acid stimulation test for a client. What medication should the nurse prepare to administer subcutaneously to stimulate gastric secretions? A)Pentagastrin B)Atropine C)Glycopyrronium bromide D) Acetylcysteine
A) pentagastrin The gastric acid stimulation test usually is performed in conjunction with gastric analysis. Histamine or pentagastrin is administered subcutaneously to stimulate gastric secretions.
The nurse is caring for a geriatric client experiencing diarrhea. When teaching about the site in the body where water and electrolytes are absorbed, the nurse is most correct to instruct on which location? A) The small bowel B)The stomach C) The large bowel D)The cecum
A) the small bowel
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 client with diabetes begins to have digestive problems and is told by the physician that they are a complication of the diabetes. Which of the following explanations from the nurse is most accurate? A)The nerve fibers of the intestinal lining are experiencing neuropathy. B)The pancreas secretes digestive enzymes. C)Elevated glucose levels cause bacteria overgrowth in the large intestine. D)Insulin has an adverse effect of constipation.
B)The pancreas secretes digestive enzymes. Explanation: While the pancreas has the well-known function of secreting insulin, it also secretes digestive enzymes. These enzymes include trypsin, amylase, and lipase. If the secretion of these enzymes are affected by a diseased pancreas as foundi with diabetes, the digestive functioning may be impaired.
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? A)Liver B) Ileum C) Stomach D) Large Intestine
C) stomach 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.
An individual has had a snack consisting of half a bagel with cream cheese, lox (smoked salmon), red onions, and capers. Stimulation of the person's gastrointestinal tract has resulted in the secretion of numerous digestive enzymes into the small intestine, including trypsin. What component of this person's snack will be primarily digested by the action of trypsin? a)The bagel b) The lox c)The cream cheese d)The red onions and capers
b)The lox
A patient with gallbladder disease was being treated for blockage of the common bile duct due to a large gallstone. The nurse recognizes which of the following as an abnormal laboratory result? A) Total bilirubin level of 1.5 mg/dL B)Alkaline phosphatase level of 60 mg/dL C) Albumin level of 4.2 g/dL D) Aspirate aminotransferase level of 25 U/L
A) total bilirubin level of 1.5 mg/dl Gallstones form when the amount of bilirubin or cholesterol is high. As the stones mix with bile, they block the secretion of bile from the gallbladder. The normal total bilirubin level is 0 to 0.9 mg/dL. The other results are within normal ranges.
A health care provider 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 medication while collecting stool for the test? A) ibuprofen B)acetaminophen C)docusate sodium D) ciprofloxacin
A) Ibuprofen 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. Ibuprofen (Advil) is an anti-inflammatory drug and should be avoided with FOBT
Specific disease processes and ingestion of certain foods and medications may change the appearance of the stool. If blood is shed in sufficient quantities into the upper gastrointestinal (GI) tract, it produces which change in the stool appearance? A) Tarry-black B) Bright red C) Blood-streaked D) Dark brown
A) Tarry Black If the blood is shed in sufficient quantities into the upper GI tract, it produces a tarry-black color, whereas blood entering the lower portion of the GI tract or passing rapidly though will cause the stool to appear bright or dark red. Lower rectal or anal bleeding is suspected if there is streaking of the blood on the surface of the stool or if blood is noted on toilet tissue. Stool is normally light or dark brown.
The client describes a test previously completed to detect a small bowel obstruction prior to admission to the hospital. The client states that the test involved insertion of a tube through the nose and lasted over 6 hours. The nurse determines which test name should be documented? A)upper GI enteroclysis B) abdominal ultrasound C)magnetic resonance imaging D) positron emission tomography
A) Upper GI enetercolysis 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 56-year-old presented to her nurse practitioner because she had been experiencing unprecedented constipation and the passage of pencil-like stools despite her high fluid and fiber intake. The nurse recognized the need to assess the patient for colorectal cancer and ordered diagnostic evaluations. What component of the patient's blood work would be most indicative of the presence of cancer? A) C-reactive protein (CRP) B)Carcinoembryonic antigen (CEA) C) Ceruloplasmin D)Coproporphyrin
B)Carcinoembryonic antigen (CEA) CEA is a protein that is normally not detected in the blood of a healthy person; therefore, when detected it indicates that cancer is present. The other cited blood analyses are not associated with cancer.
A client has come to the outpatient radiology department for diagnostic testing that will allow the care team to evaluate and remove polyps. The nurse should prepare the client for what procedure? A)Colonoscopy B) Barium enema C) ERCP D) Upper gastrointestinal fibroscopy
A) Colonscopy
Which diagnostic produces images of the body by detecting the radiation emitted from radioactive substances? A)Positron emission tomography (PET) B) Computed tomography (CT) C)Magnetic resonance imaging (MRI) D) Fibroscopy
A) positron emission tomography 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 liver performs numerous functions that contribute to homeostasis, including the synthesis of bile. How is bile utilized in the processes of digestion and absorption? A)Bile is produced in the liver in response to meals that are high in protein. B)Bile is stored in the gallbladder until it is needed for carbohydrate metabolism. C)Bile is produced in the liver but released by the gallbladder when needed for digesting fats. D)Bile production increases when an individual's fat intake is reduced over several days.
C)Bile is produced in the liver but released by the gallbladder when needed for digesting fats.
