Chapter 37: Disorders of Gastrointestinal Function #1

A 66-year-old woman has been diagnosed with diverticular disease based on her recent complaints and the results of a computed tomography (CT) scan. Which of the client's following statements demonstrates an accurate understanding of this diagnosis? Diverticular disease is the general name for a common condition that causes small bulges (diverticula) or sacs to form in the wall of the large intestine (colon). Although these sacs can form anywhere in the colon, they are most common in the sigmoid colon (part of the large intestine closest to the rectum).

"I suppose I should try to eat a bit more fiber in my diet." Eat a high-fiber diet when you have diverticulosis. Fiber softens the stool and helps prevent constipation. It also can help decrease pressure in the colon and help prevent flare-ups of diverticulitis

Select the client at greatest risk for developing colorectal cancer

A 64-year-old female whose mother had colorectal cancer

Which of the following individuals most likely faces the greatest risk of developing Clostridium difficile colitis?

A 79-year-old hospital client who is being treated with broad-spectrum antibiotics

The nurse has been providing dietary teaching to a client diagnosed with irritable bowel syndrome. The nurse determines that the teaching was effective when the client selects what foods? - 3 Irritable bowel syndrome (IBS) is a common disorder that affects the large intestine. Signs and symptoms include cramping, abdominal pain, bloating, gas, and diarrhea or constipation, or both. IBS is a chronic condition that you'll need to manage long term. The cause of irritable bowel syndrome isn't well understood. A diagnosis is often made based on symptoms.

A bran muffin, fruit, and orange juice.

The nurse is reviewing the medical history of four clients. The nurse determines that the client at greatest risk for developing peptic ulcer disease is: Ulcers occur when stomach acid damages the lining of the digestive tract.

A client with a prior diagnosis of Helicobacter pylori and refused treatment Helicobacter pylori (H. pylori) is a type of bacteria. These germs can enter your body and live in your digestive tract. After many years, they can cause sores, called ulcers, in the lining of your stomach or the upper part of your small intestine. For some people, an infection can lead to stomach cancer.

A 79-year-old woman reports a recent onset of "nearly constant heartburn." During the assessment interview, she states that she has "lots of aches and pains." She states that she is not on any prescription medications but often takes aspirin for pain. The nurse should suspect what diagnosis?

Acute gastritis Acute gastritis is a sudden inflammation or swelling in the lining of the stomach. Gastritis only directly affects the stomach, while gastroenteritis affects both the stomach and the intestines. The most common causes of acute gastritis are nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids.

An elderly patient presents with loose mucousy stools. The nurse suspects the patient has Clostridium difficile. What is a priority assessment for the nurse?

Ask the patient about his or her antibiotic use

One of the accepted methods of screening for colorectal cancer is testing for occult blood in the stool. Because it is possible to get a false-positive result on these tests, the nurse would instruct the client to do what? Colorectal cancer is a cancer that starts in the colon or the rectum. These cancers can also be named colon cancer or rectal cancer Doctors aren't certain what causes most colon cancers. In general, colon cancer begins when healthy cells in the colon develop changes (mutations) in their DNA

Avoid nonsteroidal anti-inflammatory drugs for 1 week prior to testing Among long-term colorectal cancer survivors, use of nonsteroidal anti-inflammatory drugs, or NSAIDs, is associated with about a 25 percent reduction in all-cause mortality, according to new research

Symptoms of gastric cancer include vague epigastric pain, which makes early detection difficult. The nurse would expect a patient to undergo which of the following diagnostic examinations to determine the location of the gastric cancer? Gastric cancer is a disease in which malignant (cancer) cells form in the lining of the stomach. Age, diet, and stomach disease can affect the risk of developing gastric cancer. Symptoms of gastric cancer include indigestion and stomach discomfort or pain.

Barium x-ray A barium X-ray is a radiographic (X-ray) examination of the gastrointestinal (GI) tract. Barium X-rays (also called upper and lower GI series) are used to diagnose abnormalities of the GI tract, such as tumors, ulcers and other inflammatory conditions, polyps, hernias, and strictures.

Crohn's 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 of the following descriptions? Crohn's disease is an inflammatory bowel disease (IBD). It causes inflammation of your digestive tract, which can lead to abdominal pain, severe diarrhea, fatigue, weight loss and malnutrition

Cobblestone cobblestoning. Noun. (uncountable) (medicine) Any lumpy appearance of the trachea, lungs, etc. caused by regular nodules.

An elderly patient has been placed on a broad-spectrum antibiotic for a recurrent urinary tract infection. Which of the following potential problems would the nurse anticipate in this patient?

Colonization of Clostridium difficile Clostridium difficile colitis results from disruption of normal healthy bacteria in the colon, often from antibiotics. C. difficile can also be transmitted from person to person by spores. It can cause severe damage to the colon and even be fatal.

The nurse is caring for a patient with chronic diarrhea. She knows that this condition could be caused by which of the following? - 4

Crohn disease Ulcerative colitis Lactase deficiency Fecal impaction

A nurse reading a sigmoidoscopy report notes that a patient was found to have skip lesions. The nurse interprets this as an indication of which of the following? A sigmoidoscopy, also called a flexible sigmoidoscopy, is a procedure that lets your doctor look inside your sigmoid colon by using a flexible tube with a light on it. It helps your doctor check for: ulcers. abnormal cells. polyps. A skip lesion is a wound or inflammation that is clearly patchy, "skipping" areas that thereby are unharmed. may also be the kind of damage to the renal tubules in acute tubular necrosis

Crohn's disease

A nurse caring for a patient who is vomiting assesses for accompanying signs and symptoms including which of the following? Select all that apply. - 3

Decreased blood pressure Dizziness Lightheadedness

A patient is admitted with chronic gastritis. The nurse expects which of the following invasive tests to be performed to establish the presence of Helicobacter pylori (H. pylori)? Chronic gastritis occurs when your stomach lining becomes inflamed. Bacteria, consuming too much alcohol, certain medications, chronic stress, or other immune system problems can lead to inflammation. When inflammation occurs, your stomach lining changes and loses some of its protective cells.

Endoscopic biopsy Endoscopic biopsies are used to reach tissue inside the body in order to gather samples from places like the bladder, colon, or lung. During this procedure, your doctor uses a flexible thin tube called an endoscope. The endoscope has a tiny camera and a light at the end.

Pharmacologic treatment for peptic ulcers has changed over the past several decades. The nurse knows that the goal for pharmacologic treatment is focused on which of the following?

Eradicating Helicobacter pylori (H. pylori)

The nurse is teaching her patient with hepatobiliary disease about her diet. She tells her that she may have steatorrhea, which is the malabsorption of which dietary component? Hepatobiliary disease includes a heterogeneous group of diseases of the liver and biliary system caused by viral, bacterial, and parasitic infections, neoplasia, toxic chemicals, alcohol consumption, poor nutrition, metabolic disorders, and cardiac failure

Fat

Good hand-washing techniques are important in healthcare. The nurse knows that bacterial infections can be prevented by good hand-washing techniques. Which of the following routes of transmission is most common for Clostridium difficile? Clostridium difficile, also known as Clostridioides difficile and often referred to as C. difficile or C. diff, is a bacterium that can cause symptoms ranging from diarrhea to life-threatening inflammation of the colon.

Fecal-oral transmission

A teenager who has a history of achalasia will likely complain of which of the following clinical manifestations? Achalasia is a serious condition that affects your esophagus. The lower esophageal sphincter (LES) is a muscular ring that closes off the esophagus from the stomach. If you have achalasia, your LES fails to open up during swallowing, which it's supposed to do. This leads to a backup of food within your esophagus.

Feeling like there is food stuck in the back of the throat

A nurse is teaching a client diagnosed with Crohn disease about potential complications. The most appropriate information for the nurse to include would be:

Fistula formation

Crohn's 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 which of the following? Crohn's disease is an inflammatory bowel disease (IBD). It causes inflammation of your digestive tract, which can lead to abdominal pain, severe diarrhea, fatigue, weight loss and malnutrition

Fistula formation Fistulas form when inflammation causes sores, or ulcers, to form on the inside wall of the intestine or nearby organs. Those ulcers can extend through the entire thickness of the bowel wall, creating a tunnel to drain the pus from the infected area. An abcess, or a collection of pus, can also cause a fistula to form.

In patients with acute diarrhea, many require no treatment. However, the nurse knows the priority assessment in all patients with diarrhea is which of the following?

Fluid and electrolyte status

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?

Gastrointestinal reflux

In the balance of secretions in the gastric mucosa by the parietal cells, which of the following ions is produced to buffer the production of hydrochloric acid?

HCO3-

The most common forms of peptic ulcer are duodenal and gastric ulcers. What bacteria are the most common risk factors for peptic ulcer disease?

Helicobacter pylori (H. pylori)

Crohn's disease is treated by several measures. Treatment with corticosteroids focuses on which of the following? Corticosteroids are synthetic drugs that are used to treat a wide variety of disorders, including asthma, arthritis, skin conditions and autoimmune diseases. Corticosteroids (cortisone-like medicines) are used to provide relief for inflamed areas of the body.

Inflammatory suppression

A 60-year-old male client has presented to his primary care provider to follow up with his ongoing treatment for peptic ulcer disease. What is the most likely goal of this client's pharmacologic treatment? Peptic ulcer disease is a condition in which painful sores or ulcers develop in the lining of the stomach or the first part of the small intestine (the duodenum). Normally, a thick layer of mucus protects the stomach lining from the effect of its digestive juices.

Inhibiting gastric acid production

Crohn's disease not only affects adults but also can occur in children. The nurse assesses for which of the following major manifestations in children with Crohn's disease? Crohn's disease is an inflammatory bowel disease (IBD). It causes inflammation of your digestive tract, which can lead to abdominal pain, severe diarrhea, fatigue, weight loss and malnutrition. Inflammation caused by Crohn's disease can involve different areas of the digestive tract in different people.

Malnutrition

An ultrasound has confirmed appendicitis as the cause of a 20-year-old man's sudden abdominal pain. Which of the following etiologic processes is implicated in the development of appendicitis?

Obstruction of the intestinal lumen In the intestines, the lumen is the opening inside the bowels and is surrounded by the other parts of the intestinal wall: the mucosa, the submucosa, the muscularis, and the serosa.

The incidence of stomach cancer has significantly decreased in the United States, yet it remains the leading cause of death worldwide. The nurse understands the reason for the high mortality rate in stomach cancer is because of which of the following reasons?

Patients have few early symptoms of the disease.

Upon admission, a patient tells the nurse that he takes aspirin every 4 hours every day. The nurse determines that this patient is at risk for which of the following?

Peptic ulcer

A patient 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 patient is lying still and taking shallow breaths, with a rigid abdomen. Which of the following problems is the patient experiencing?

Peritonitis Peritonitis is usually infectious and often life-threatening. It's caused by leakage or a hole in the intestines, such as from a burst appendix. Symptoms usually include pain, tenderness, rigid abdominal muscles, fever, nausea, and vomiting.

An older patient presents with a perforation of a peptic ulcer. The nurse will monitor for signs and symptoms of which of the following problems?

Peritonitis Peritonitis is usually infectious and often life-threatening. It's caused by leakage or a hole in the intestines, such as from a burst appendix. Symptoms usually include pain, tenderness, rigid abdominal muscles, fever, nausea, and vomiting.

A client has developed a ruptured appendix. The nurse is aware the client is at high risk for: Appendicitis can cause serious complications, such as: A ruptured appendix. A rupture spreads infection throughout your abdomen (peritonitis). Possibly life-threatening, this condition requires immediate surgery to remove the appendix and clean your abdominal cavity. The appendix is a pouch on the colon that has no known purpose. Appendicitis begins with pain near the belly button and then moves to the right side. This is often accompanied by nausea, vomiting, poor appetite, fever, and chills.

Peritonitis Peritonitis is usually infectious and often life-threatening. It's caused by leakage or a hole in the intestines, such as from a burst appendix. Even if the fluid is sterile, inflammation can occur. Symptoms usually include pain, tenderness, rigid abdominal muscles, fever, nausea, and vomiting. Antibiotics are almost always needed, along with surgery or drainage.

After several months of persistent heartburn, a 57-year-old female client has been diagnosed with gastroesophageal reflux disease (GERD). Which treatment regimen is likely to best address the woman's health problem?

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

A nurse is completing an abdominal assessment on a patient suspected to have appendicitis. When the nurse applies and then releases pressure in the patient's right lower quadrant, the patient experiences tenderness. The nurse is documenting the presence of which of the following? Appendicitis is an inflammation of the appendix, a finger-shaped pouch that projects from your colon on the lower right side of your abdomen. Appendicitis causes pain in your lower right abdomen. However, in most people, pain begins around the navel and then moves

Rebound tenderness

Hiatal hernias can cause severe pain if the hernia is large. Gastroesophageal reflux is a common comorbidity of hiatal hernia, and, when this occurs, what might the hernia do? A hiatal hernia occurs when the upper part of your stomach bulges through your diaphragm into your chest cavity Hiatal hernias can have no symptoms. In some cases, they may be associated with heartburn and abdominal discomfort. Hiatal hernias may not require any treatment. Some are treated with drugs and a few types need surgical repair

Retard esophageal acid clearance

The cause of gastric carcinomas has been influenced by which of the following factors? - 3 Stomach cancer, also known as gastric cancer, is a cancer that develops from the lining of the stomach. Most cases of stomach cancers are gastric carcinomas, which can be divided into a number of subtypes including gastric adenocarcinomas.

Strain of Helicobacter pylori (H. pylori) Environmental factors Family history

A nurse administering a patient's medication tells the patient that a proton pump inhibitor has been added. When the patient asks the purpose of the medication, the nurse responds that it is to prevent which of the following?

Stress ulcer A stress ulcer causes sores in the upper gastrointestinal tract. These sores damage the gastrointestinal lining and cause pain and a feeling of burning, as well as an increased risk of infection. The damage ranges from minor irritation to severe bleeding proton pump inhibitors, which cause your stomach to create less natural acid and help speed healing.

A client is admitted to the hospital with a suspected diagnosis of strangulated bowel. The nurse anticipates the client will need: strangulation results when part of the intestine becomes trapped in an abnormal opening (strangulated hernia), volvulus, or intussusception.

Surgery to release the bowel

In the treatment of Crohn's disease, many medications are used to mediate the inflammatory process. One specific medication that is used is infliximab, a monoclonal antibody. The nurse is aware that infliximab functions in which of the following ways?

Targets destruction of tumor necrosis factor (TNF)

Malabsorption syndrome results in loss of fat in the stool and failure to absorb fat-soluble vitamins.

True

A nurse providing dietary guidance to a patient with celiac disease tells the patient that which of the following foods should be avoided? Celiac disease is an immune disease in which people can't eat gluten because it will damage their small intestine. If you have celiac disease and eat foods with gluten, your immune system responds by damaging the small intestine.

Wheat bread

A rare condition caused by gastrin-secreting tumors most commonly found in the small intestine or pancreas is called which of the following? gastrinomas (tumors) secrete large amounts of the hormone gastrin, which causes your stomach to produce too much acid.

Zollinger-Ellison syndrome Zollinger-Ellison syndrome is a rare condition in which one or more tumors form in your pancreas or the upper part of your small intestine (duodenum). These tumors, called gastrinomas, secrete large amounts of the hormone gastrin, which causes your stomach to produce too much acid.Apr 3, 2020

A 68-year-old man who has smoked for at least 50 years reports that lately he feels as though food is "getting stuck" in his throat. At first this was a problem just with dry food, but now his morning oatmeal is getting stuck. On questioning, he reports drinking at least five alcoholic beverages nearly every day. His problem is most likely:

squamous cell carcinoma of the esophagus The squamous cells are flat, thin cells that line the surface of the esophagus. Squamous cell carcinoma occurs most often in the upper and middle portions of the esophagus. Squamous cell carcinoma is the most prevalent esophageal cancer worldwide