CH 44 - GI ASSESSMENT(2)

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?

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.

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?

"Having a bowel movement is a spinal reflex requiring intact nerve fibers. Yours are not intact."

A client recently started a new medication to treat a suspected ulcer. She asks the nurse how this medicine is helping. Which of the following would be the best response by the nurse regarding anti-ulcerative medications?

"This medication reduces the acid secretion in your stomach."

When completing a nutritional assessment of a patient who is admitted for a GI disorder, the nurse notes a recent history of dietary intake. This is based on the knowledge that a portion of digested waste products can remain in the rectum for how many days after a meal is digested?

3 days As much as 25% of the waste products from a meal may still be in the rectum 3 days after a meal is ingested.

Which of the following digestive enzymes aids in the digesting of starch?

Amylase

When assisting with preparing a client scheduled for a barium swallow, which of the following would be appropriate to include?

Avoid smoking for at least 12 to 24 hoursbefore the procedure.

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?

Bowel perforation 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).

A patient is scheduled for a fiberoptic colonoscopy. What does the nurse know that fiberoptic colonoscopy is most frequently used to diagnose?

Cancer screening

A client is scheduled for an esophagogastroduodenoscopy (EGD) to detect lesions in the gastrointestinal tract. The nurse would observe for which of the following while assessing the client during the procedure?

Client's tolerance for pain and discomfort

A few hours after eating hot and spicy chicken wings, a client presents with lower chest pain. He wonders if he is having a heart attack. How should the nurse proceed first?

Further investigate the initial complaint

The nurse preparing a patient for a colostomy is preparing to administer the lavage solution. The nurse stops and notifies the physician when the nurse notes that the patient has which of the following?

Inflammatory bowel disease

After 20 seconds of auscultating for bowel sounds on a client recovering from abdominal surgery, the nurse hears nothing. Which of the following should the nurse do based on the assessment findings?

Listen longer for the sounds.

The nurse is assisting the physician with a gastric acid stimulation test for a patient. What medication should the nurse prepare to administer subcutaneously to stimulate gastric secretions?

Pentagastrin The gastric acid stimulation test usually is performed in conjunction with gastric analysis. Histamine or pentagastrin is administered subcutaneously to stimulate gastric secretions.

Which diagnostic produces images of the body by detecting the radiation emitted from radioactive substances?

Positron emission tomography (PET)

The hydrogen breath test was developed to evaluate which type of absorption?

Carbohydrate

A patient tells the nurse that his stool was colored yellow. The nurse assesses for which of the following?

Recent foods ingested The nurse should assess for recent foods that the patient ingested, as ingestion of senna can cause the stool to turn yellow. Ingestion of bismuth can turn the stool black and, when occult blood is present, the stool can appear to be tarry black.

A client presented with gastrointestinal bleeding 2 days ago and continues to have problems. The physician has ordered a visualization of the small intestine via a capsule endoscopy. Which of the following will the nurse include in the client education about this procedure?

"You will need to swallow a capsule." A capsule endoscopy allows for noninvasive visualization of the small intestinal mucosa. The technique consists of the client swallowing a capsule that is embedded with a wireless miniature camera, which is propelled through the intestine by peristalsis. The capsule passes from the rectum in 1 to 2 days.

A patient receives a local anesthetic to suppress the gag reflex for a diagnostic procedure of the upper GI tract. Which of the following nursing interventions is advised for this patient?

Do not give any food and fluids until the gag reflex returns.

Which nursing instruction is correct to provide the client following a barium enema?

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

The nurse is assisting the physician with a colonoscopy for a patient with rectal bleeding. The physician requests the nurse to administer glucagon during the procedure. Why is the nurse administering this medication during the procedure?

To relax colonic musculature and reduce spasm Glucagon may be administered, if needed, to relax the colonic musculature and to reduce spasm during the colonoscopy.

Which of the following is true statement regarding older patients, considering the age-related effects on their GI system?

They tend usually to have less control of the rectal sphincter.

The nurse is caring for a client who is scheduled for a percutaneous liver biopsy. Which diagnostic test is obtained prior?

Prothrombin time (PT) The client must have coagulation studies before the procedure such as a PT or PTT because a major complication after a liver biopsy is bleeding. Clients at risk for serious bleeding may receive precautionary vitamin K. A complete blood count and blood chemistry may be completed for baseline values. Typically, an ESR is not associated with the procedure.

The nurse is instructing the client who was newly diagnosed with peptic ulcers. Which of the following diagnostic studies would the nurse anticipate reviewing with the client?

Serum antibodies for H. pylori Helicobacter pylori, a bacterium, is believed to be responsible for the majority of peptic ulcers. Blood tests are used to determine whether there are antibodies to H. pylori in the blood. A complete blood count with differential can indicate bleeding and infection associated with a bleeding ulcer. A sigmoidoscopy assesses the lower gastrointestinal tract. Gastric analysis is more common in analyzing gastric fluid in determining problems with the secretory activity of the gastric mucosa.

Which of the following is an age-related change in the esophagus?

Weakened gag reflex Age-related changes that are associated with the esophagus include a weakened gag reflex, decreased motility and emptying, decreased muscle tone, and weakness in the lower esophageal sphincter.

The patient is describing to the nurse a test that he underwent to detect a small bowel obstruction prior to admission to the hospital. The patient states that the test involved insertion of a tube through the nose and lasted over 6 hours. The nurse documents the name of the test as which of the following?

Upper GI enteroclysis 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.

The nurse is talking with a client who is scheduled for a computed tomography (CT) colonography. Which client statement would indicate to the nurse that the client needs additional teaching about this procedure?

"My doctor will be able to remove any polyps he finds." With a computed tomography (CT) colonography, other procedures such as polyp removal or biopsy cannot be done. It requires the same preparation as a colonoscopy, but sedation is not required. In addition, there is less risk of bowel perforation.

Which of the following is the major carbohydrate that tissue cells use as fuel?

Glucose

A client, age 82, is admitted to an acute care facility for treatment of an acute flare-up of a chronic GI condition. In addition to assessing the client for complications of the current illness, the nurse monitors for age-related changes in the GI tract. Which age-related change increases the risk of anemia?

Atrophy of the gastric mucosa Atrophy of the gastric mucosa reduces hydrochloric acid secretion; this, in turn, impairs absorption of iron and vitamin B12, increasing the risk of anemia as a person ages. A decrease in hydrochloric acid increases, not decreases, intestinal flora; as a result, the client is at increased risk for infection, not anemia. A reduction, not increase, in bile secretion may lead to malabsorption of fats and fat-soluble vitamins. Dulling of nerve impulses associated with aging increases the risk of constipation, not anemia.

A client who had a colonoscopy with removal of a polyp is being prepared for discharge. Which of the following would the nurse include in the discharge instructions?

"You might feel some cramping and gas but these usually go away in about a day."

During assessment of a patient complaining of dyspepsia, the nurse is aware that abdominal pain associated with indigestion is usually which of the following?

Described as cramping or burning 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.

Swallowing is regulated by which area of the central nervous system (CNS)?

Medulla oblongata

When describing the role of the pancreas to a client with a pancreatic dysfunction, the nurse would identify which substance as being acted on by pancreatic lipase?

Triglycerides

A nurse is teaching a client what to expect following a barium enema. Which client statement indicates a need for further teaching?

"I should limit my fiber intake for 1 to 2 weeks following the procedure." There's no need to limit fiber intake after a barium enema. The client may resume his normal diet. Barium may increase stool elimination, so there's no need for a laxative after the procedure. The client should increase fluid intake to facilitate barium elimination. The client should report bowel movements so the nurse can ensure that barium elimination occurs.

The nurse is investigating a patient's complaint of pain in the duodenal area. Where should the nurse perform the assessment?

Epigastric area and consider possible radiation of pain to the right subscapular region Indigestion is an imprecise term that refers to a host of upper abdominal or epigastric symptoms such as pain, discomfort, fullness, bloating, early satiety, belching, heartburn, or regurgitation; it occurs in approximately 25% of the adult population (Harmon & Peura, 2010).

The nurse auscultates the abdomen to assess bowel sounds. She documents five to six sounds heard in less than 30 seconds. How does the nurse document the bowel sounds?

Hyperactive Bowel sounds are assessed using the diaphragm of the stethoscope for high-pitched and gurgling sounds (Gu, Lim, & Moser, 2010). The frequency and character of the sounds are usually heard as clicks and gurgles that occur irregularly and range from 5 to 35 per minute. The terms normal (sounds heard about every 5 to 20 seconds), hypoactive (one or two sounds in 2 minutes), hyperactive (5 to 6 sounds heard in less than 30 seconds), or absent (no sounds in 3 to 5 minutes) are frequently used in documentation, but these assessments are highly subjective

Which of the following is a parasympathetic response in the GI tract?

Increased peristalsis Increased peristalsis is a parasympathetic response in the GI tract. Decreased gastric secretion, blood vessel constriction, and decreased motility are sympathetic responses in the GI tract.

A client presents to the emergency department, reporting that he has been vomiting every 30 to 40 minutes for the past 8 hours. Frequent vomiting puts this client at risk for which imbalances?

Metabolic alkalosis and hypokalemia

The nurse is assessing a 50-year-old, dark-skinned African American man and has noted that he appears jaundice. Most likely, the nurse made this observation by assessing which part of his body?

Mucous membranes In very dark-skinned clients, inspect the hard palate, gums, conjunctiva, and surrounding tissues for discoloration.

During the initial assessment of a patient complaining of increased stomach acid related to stress, the nurse knew that the health care provider would want to consider the influence of which following neuroregulator?

Norepinephrine There are two major neuroregulators, acetylcholine and norepinephrine. Norepinephrine's effects on secretions are generally inhibitory. The other choices are hormonal regulators.

A client has recently obtained a set of dentures. Which of the following will the nurse do during a complete physical examination?

Remove the plates to visualize the oral cavity

Which of the following procedures are performed to examine and visualize the lumen of the small bowel?

Small bowel enteroscopy

The nurse is assisting the physician in a percutaneous liver biopsy. In which position would the nurse assist the client to assume?

Supine position

Which patient teaching component is important for the nurse to communicate regarding pain management prior to or during diagnostic testing for a disorder of the GI system?

The patient should inform the test personnel if he or she experiences pressure or cramping during the instillation of test fluids. To ensure that a patient who is to undergo a diagnostic test for a disorder of the gastrointestinal system experiences no or minimal discomfort during the test, the patient should be instructed to inform the test personnel if he or she experiences pressure or cramping during the instillation of test fluids. The test personnel can slow the instillation or take other measures to relieve discomfort. The patient should also be advised to expel gas and test fluids from the bowel when he or she experiences the urge. Ignoring the urge to expel the bowel contents increases pain and discomfort. The patient should be advised not to take any sedative or analgesic before the test, unless prescribed. Lying down in a supine position is not known to have any consequence on the level of discomfort experienced by a patient during a diagnostic test for a GI disorder.

Which of the following is an age-related change of the gastrointestinal system?

Weakened gag reflex A weakened gag reflex is an age-related change of the GI system. There is decreased motility, atrophy of the small intestine, and decreased mucus secretion.