Ch. 44 Digestive and GI Function

What part of the GI tract begins the digestion of food? a) Mouth b) Esophagus c) Duodenum d) Stomach

Mouth Explanation: Food that contains starch undergoes partial digestion in the mouth when it mixes with the enzyme salivary amylase, which the salivary glands secrete. Food that contains starch undergoes partial digestion in the mouth.

Which of the following would indicate to the nurse that a client who has received three cleansing enemas in preparation for a barium enema is experiencing dehydration? a) Signs of anxiety b) Change in bowel sounds c) Change in color of stool d) Signs of dizziness and confusion

Signs of dizziness and confusion Explanation: The three cleansing enemas used as preparation for a barium enema may lead to fluid loss. Because signs of dizziness and confusion indicate dehydration, the nurse should report these signs immediately. Signs of change in the color of stool and the bowel sounds would be indicated if barium is retained. The client most likely will show signs of anxiety before any diagnostic procedure.

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? a) The upper GI should be scheduled before the ultrasonography. b) The client may eat a light meal before either test. c) Both tests need to be done before breakfast. d) The ultrasonography should be scheduled before the GI procedure.

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.

A nurse assesses the abdomen of a newly admitted client. Which finding would necessitate further investigation? a) Striae of lateral abdomen b) Flat appearance below the umbilicus c) Asymmetrical upper quadrants d) Rounded contour

Asymmetrical upper quadrants Explanation: The client lies supine with knees flexed for the abdominal assessment. Upon inspection the nurse notes any skin changes, nodules, lesions, inflammation, or striae. Lesions are of particular importance and require further investigation, as do irregular contours or asymmetry of the abdomen.

The hydrogen breath test was developed to evaluate which type of absorption? a) Fat b) Vitamin B12 c) Protein d) Carbohydrate

Carbohydrate Explanation: The hydrogen breath test that is used to evaluate carbohydrate absorption is performed if carbohydrate malabsorption is suspected. The hydrogen test does not evaluate fat, protein, or vitamin B12 absorption.

Which of the following is an enzyme secreted by the gastric mucosa? a) Bile b) Pepsin c) Ptyalin d) Trypsin

Pepsin Explanation: 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 is scheduled for magnetic resonance imaging (MRI). During the client teaching, the nurse will discuss which of the following? a) "The examination will take only 15 minutes." b) "You must be NPO for the day before the examination." c) "Do you experience any claustrophobia?" d) "You must remove all jewelry but can wear your wedding ring."

"Do you experience any claustrophobia?" Explanation: MRI is a noninvasive technique that uses magnetic fields and radio waves to produce images of the area being studied. Clients must be NPO for 6 to 8 hours before the study and remove all jewelry and other metals. The examination takes 60 to 90 minutes and can induce feelings of claustrophobia, because the scanner is close fitting.

Which of the following digestive enzymes aids in the digesting of starch? a) Amylase b) Trypsin c) Bile d) Lipase

Amylase Explanation: Digestive enzymes secreted by the pancreas include trypsin, which aids in digesting protein; amylase, which aids in digesting starch; and lipase, which aids in digesting fats. Bile is secreted by the liver and is not considered a digestive enzyme.

Which of the following is considered the gold standard for the diagnosis of liver disease? a) Paracentesis b) Ultrasonography c) Cholecystography d) Biopsy

Biopsy Explanation: Liver biopsy is considered the gold standard for the diagnosis of liver disease. Paracentesis is the removal of fluid (ascites) from the peritoneal cavity through a puncture or a small surgical incision through the abdominal wall under sterile conditions. Cholecystography and ultrasonography may be used to detect gallstones.

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) Rectal fissure c) Bowel perforation d) Colonic polyp

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).

The nurse is assessing bowel sounds and hears one to two bowel sounds in 2 minutes. The nurse documents the bowel sounds as being which of the following? a) Hypoactive b) Absent c) Normal d) Hyperactive

Hypoactive Explanation: Hypoactive bowel sound is the description given to auscultation of one to two bowel sounds in 2 minutes. Normal bowel sounds are heard every 5 to 20 seconds. Hyperactive bowel sounds occur when five or six sounds are heard in less than 30 seconds. The nurse records that bowel sounds are absent when no sound is heard in 3 to 5 minutes.

A client is diagnosed with megaloblastic anemia caused by vitamin B12 deficiency. The physician begins the client on cyanocobalamin (Betalin-12), 100 mcg I.M. daily. Which substance influences vitamin B12 absorption? a) Hydrochloric acid b) Intrinsic factor c) Histamine d) Liver enzyme

Intrinsic factor Explanation: 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.

While palpating a client's right upper quadrant (RUQ), the nurse would expect to find which structure? a) Spleen b) Appendix c) Sigmoid colon d) Liver

Liver Explanation: The RUQ contains the liver, gallbladder, duodenum, head of the pancreas, hepatic flexure of the colon, portions of the ascending and transverse colon, and a portion of the right kidney. The sigmoid colon is located in the left lower quadrant; the appendix, in the right lower quadrant; and the spleen, in the left upper quadrant.

The nurse is preparing to examine the abdomen of a client complaining of a change in his bowel pattern. The nurse would place the client in which position? a) Lithotomy b) Left Sim's lateral c) Supine with knees flexed d) Knee-chest

Supine with knees flexed Explanation: When examining the abdomen, the client lies supine with his knees flexed. This position assists in relaxing the abdominal muscles. The lithotomy position commonly is used for a female pelvic examination and to examine the rectum. The knee-chest position can be used for a variety of examinations, most commonly the anus and rectum. The left Sim's lateral position may be used to assess the rectum or vagina and to administer an enema.

Blood shed in sufficient quantities into the upper GI tract, produces which color of stool? a) Milky white b) Tarry-black c) Green d) Bright red

Tarry-black Explanation: Blood shed in sufficient quantities into the upper GI tract produces a tarry-black stool. Blood entering the lower portion of the GI tract or passing rapidly through it will appear bright or dark red. A milky white stool is indicative "of" a patient who received barium. A green stool is indicative of a patient who has eaten spinach.

When bowel sounds are heard about every 15 seconds, the nurse would record that the bowel sounds are a) normal. b) absent. c) hypoactive. d) sluggish.

normal. Explanation: Normal bowel sounds are heard every 5 to 20 seconds. Hypoactive bowel sound is the description given to auscultation of one to two bowel sounds in 2 minutes. Sluggish is not a term a nurse would use to accurately describe bowel sounds. The nurse records that bowel sounds are absent when no sound is heard in 3 to 5 minutes.

During assessment of a patient complaining of dyspepsia, the nurse is aware that abdominal pain associated with indigestion is usually which of the following? a) Relieved by the intake of coarse vegetables, which stimulate peristalsis b) Less severe after an intake of fatty foods c) In the left lower quadrant d) Described as cramping or burning

Described as cramping or burning Explanation: Abdominal pain associated with indigestion (dyspepsia) is described as burning, cramping, and bloating. Also, there is abdominal fullness and heartburn. Fatty foods cause the most discomfort, as do coarse vegetables and highly seasoned foods. The pain is in the upper left quadrant.

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) Dark brown c) Blood-streaked d) Bright red

Tarry-black Explanation: 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 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? a) Upper GI enteroclysis b) Positron emission tomography c) Abdominal ultrasound d) Magnetic resonance imaging

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 nurse is teaching a client with malabsorption syndrome about the disorder and its treatment. The client asks which part of the GI tract absorbs food. The nurse tells the client that products of digestion are absorbed mainly in the: a) small intestine. b) large intestine. c) stomach. d) rectum.

small intestine. Explanation: The small intestine absorbs products of digestion, completes food digestion, and secretes hormones that help control the secretion of bile, pancreatic juice, and intestinal secretions. The stomach stores, mixes, and liquefies the food bolus into chyme and controls food passage into the duodenum; it doesn't absorb products of digestion. Although the large intestine completes the absorption of water, chloride, and sodium, it plays no part in absorbing food. The rectum is the portion of the large intestine that forms and expels feces from the body; its functions don't include absorption.