Chapter 43
Blood flow to the GI tract is approximately what percentage of the total cardiac output? 10% 20% 30% 40%
20% Explanation: Blood flow to the GI tract is about 20% of the total cardiac output and increases significantly after eating.
The nurse is working on a general medical unit. A client is scheduled for an upper gastrointestinal series. Upon return to the nursing unit, what does the nurse identify as the client goal? Recover from the general anesthesia Decrease nausea and vomiting Increase the amount of fluids Ambulate independently
Increase the amount of fluids Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 43: Assessment of Digestive and Gastrointestinal Function, Nursing Interventions, p. 1235. Chapter 43: Assessment of Digestive and Gastrointestinal Function - Page 1235
A focused GI assessment begins with a complete history and physical examination. Identify the quadrant of the abdomen to be palpated or percussed for a patient with pancreatitis. Right upper Right lower Left upper Left lower
Left upper Explanation: The pancreas, which is about 6 inches long, is located behind the stomach in the upper left side of the body.
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? The small bowel The stomach The large bowel The cecum
The small bowel Explanation: The nurse is correct in instructing the client that water and electrolytes are mainly absorbed in the small bowel. The other options are not the best site for absorption
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? "It is not going to happen. Your nerve cells are too damaged." "Having a bowel movement is a spinal reflex requiring intact nerve fibers. Yours are not intact." "Over time, the nerve fibers will regrow new tracts, and you can have bowel movements again." "Wearing an undergarment will become more comfortable over time."
"Having a bowel movement is a spinal reflex requiring intact nerve fibers. Yours are not intact." Explanation: The act of defecation is a spinal reflex involving the parasympathetic nerve fibers. Normally, the external anal sphincter is maintained in a state of tonic contraction. With a spinal cord injury, the client no longer has this nervous system control and is often incontinent.
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. Document that the client is constipated. Call the physician to report absent bowel sounds. Return in 1 hour and listen again to confirm findings.
Listen longer for the sounds. Explanation: Auscultation is used to determine the character, location, and frequency of bowel sounds. The frequency and character of sounds are usually heard as clicks and gurgles that occur irregularly and range from 5 to 35 per minutes. Normal sounds are heard about every 5 to 20 seconds, whereas hypoactive sounds can be one or two sounds in 2 minutes. Postoperatively, it is common for sounds to be reduced; therefore, the nurse needs to listen at least 3 to 5 minutes to verify absent or no bowel sounds.
The nurse is scheduling gastrointestinal (GI) diagnostic testing for a client. Which GI test should be scheduled first? Radiography of the gallbladder Barium enema Small bowel series Barium swallow
Radiography of the gallbladder Explanation: Radiography of the gallbladder should be performed before other GI exams in which barium is used because residual barium tends to obscure the images of the gallbladder and its duct. Reference:
Which procedure is performed to examine and visualize the lumen of the small bowel? small bowel enteroscopy colonoscopy panendoscopy peritoneoscopy
small bowel enteroscopy Explanation: Small bowel enteroscopy is the endoscopic examination and visualization of the lumen of the small bowel. Colonoscopy is the examination of the entire large intestine with a flexible fiberoptic colonoscope. Panendoscopy is the examination of both the upper and lower GI tracts. Peritoneoscopy is the examination of GI structures through an endoscope inserted percutaneously through a small incision in the abdominal wall.
The nurse recognizes which change of the gastrointestinal system is an age-related change? increased motility hypertrophy of the small intestine weakened gag reflex increased mucus secretion
weakened gag reflex Explanation: 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.
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? Infection Bowel perforation Colonic polyp Rectal fissure
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).
A patient is scheduled for a fiberoptic colonoscopy. What does the nurse know that fiberoptic colonoscopy is most frequently used to diagnose? Bowel disease of unknown origin Cancer Inflammatory bowel disease Occult bleeding
Cancer Explanation: This procedure is used commonly as a diagnostic aid and screening device. It is most frequently used for cancer screening and for surveillance in patients with previous colon cancer or polyps. In addition, tissue biopsies can be obtained as needed, and polyps can be removed and evaluated. Other uses of colonoscopy include the evaluation of patients with diarrhea of unknown cause, occult bleeding, or anemia; further study of abnormalities detected on barium enema; and diagnosis, clarification, and determination of the extent of inflammatory or other bowel disease.
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 Hypogastrium in the right or left lower quadrant Left lower quadrant Periumbilical area, followed by the right lower quadrant
Epigastric area and consider possible radiation of pain to the right subscapular region Explanation: 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).
When gastric analysis testing reveals excess secretion of gastric acid, the nurse recognizes which medical diagnoses is supported? chronic atrophic gastritis duodenal ulcer gastric cancer pernicious anemia
duodenal ulcer Explanation: Clients with duodenal ulcers usually secrete an excess amount of hydrochloric acid. Clients with chronic atrophic gastritis secrete little or no acid. Clients with gastric cancer secrete little or no acid. Clients with pernicious anemia secrete no acid under basal conditions or after stimulation.
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 a day before the procedure. Take vitamin K before the procedure. Take three cleansing enemas before the procedure. Avoid the intake of red meat before the procedure.
Avoid smoking for at least a day before the procedure. Explanation: The nurse should instruct the client to avoid smoking for at least a day before the procedure of barium swallow because smoking stimulates gastric motility. The client is advised to take vitamin K before a liver biopsy and instructed to take three cleansing enemas before a barium enema. Instruction to avoid red meat would be appropriate for a client who is having a Hemoccult test. Reference:
A client is scheduled for bowel resection with anastomosis involving the large intestine. Because of the surgical site, the nurse formulates the nursing diagnosis of Risk for infection. To complete the nursing diagnosis statement, the nurse should add which "related-to" phrase? Related to major surgery required by bowel resection Related to the presence of bacteria at the surgical site Related to malnutrition secondary to bowel resection with anastomosis Related to the presence of a nasogastric (NG) tube postoperatively
Related to the presence of bacteria at the surgical site Explanation: The nurse should add "Related to the presence of bacteria at the surgical site" to the diagnosis of Risk for infection. The large intestine normally contains bacteria because its alkaline environment permits growth of organisms that putrefy and break down remaining proteins and indigestible residue. These organisms include Escherichia coli, Aerobacter aerogenes, Clostridium perfringens, and Lactobacillus. Although bowel resection with anastomosis is considered major surgery, it poses no greater risk of infection than any other type of major surgery. Malnutrition seldom follows bowel resection with anastomosis because nutritional absorption (except for some water, sodium, and chloride) is completed in the small intestine. An NG tube is placed through a natural opening, not a wound, and therefore doesn't increase the client's risk of infection.
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? Supine with knees flexed Knee-chest Lithotomy Left Sim's lateral
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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 43: Assessment of Digestive and Gastrointestinal Function, Abdominal Inspection, Auscultation, Percussion, and Palpation, p. 1231.
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? The nerve fibers of the intestinal lining are experiencing neuropathy. The pancreas secretes digestive enzymes. Elevated glucose levels cause bacteria overgrowth in the large intestine. Insulin has an adverse effect of constipation.
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.
A physician 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 of the following medications while collecting stool for the test? ibuprofen (Advil) acetaminophen (Tylenol) docusate sodium (Colace) ciprofloxacin (Cipro XR)
ibuprofen (Advil) Explanation: 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. Advil is an anti-inflammatory drug and should be avoided with FOBT.
The nurse prepares to administer the lavage solution to a client having a colostomy completed. The nurse stops and notifies the physician when noting that the client has which condition? inflammatory bowel disease chronc obstructive pulmonary disease congestive heart failure pulmonary hypertension
inflammatory bowel disease Explanation: The nurse stops administering the lavage solution and notifies the physician when the nurse notes that the client has inflammatory bowel disease. Another contraindication for use of lavage solution is intestinal obstruction. Chronic obstructive pulmonary disease (COPD), congestive heart failure, and pulmonary hypertension are not contraindications to administration of lavage solution in preparation for a colonoscopy.