Chapter 43: Assessment of Digestive and Gastrointestinal Function

The nurse recognizes which change of the GI system is an age-related change? A.) increased motility B.) hypertrophy of the small intestine C.) weakened gag reflex D.) increased mucus secretion

Answer: C.) weakened gag reflex

The nurse prepares a client for a barium enema. The nurse should place the client on which diet prior to the procedure? A.) high-fiber diet 1 to 2 days prior B.) soft diet 1 day prior C.) nothing by mouth (NPO) 2 days prior D.) clear liquids day before

Answer: D.) clear liquids day before

Which of the following digestive enzymes aids in the digesting of starch? A.) Amylase B.) Lipase C.) Trypsin D.) Bile

Answer: A.) Amylase Rationale: 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.

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? A.) Further investigate the initial complaint. B.) Explain that fatty foods can mimic chest pain. C.) Call for an immediate electrocardiogram. D.) Administer an over-the-counter antacid tablet.

Answer: A.) Further investigate the initial complaint. Rationale: While fatty foods can cause discomfort similar to chest pain, the nurse must fully assess all the client's symptoms. Investigation of chief complaint begins with a complete history. The underlying cause of pain influences the characteristics, duration, pattern, location, and distribution of pain.

Gastrin has which of the following effects on gastrointestinal (GI) motility? A.) Increased motility of the stomach B.) Relaxation of the colon C.) Contraction of the ileocecal sphincter D.) Relaxation of gastroesophageal sphincter

Answer: A.) Increased motility of the stomach

The nurse determines one or two bowel sounds in 2 minutes should be documented as A.) normal. B.) hyperactive. C.) hypoactive. D.) absent.

Answer; C.) hypoactive. Rationale: 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 5 or 6 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 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

Answer: A.) Intrinsic factor Rationale: 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.

After 20 seconds of auscultating for bowel sounds on a client recovering from abdominal surgery, the nurse hears nothing. What should the nurse do based on the assessment findings? A.) Listen longer for the sounds. B.) Document that the client is constipated. C.) Call the health care provider to report absent bowel sounds. D.) Return in 1 hour and listen again to confirm findings.

Answer: A.) Listen longer for the sounds.

The nurse is scheduling gastrointestinal (GI) diagnostic testing for a client. Which GI test should be scheduled first? A.) Radiography of the gallbladder B.) Barium enema C.) Small bowel series D.) Barium swallow

Answer: A.) Radiography of the gallbladder Rationale: 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.

Following ingestion of carrots or beets, the nurse would expect which alteration in stool color? A.) Red B.) Black C.) Yellow D.) Milky white

Answer: A.) Red Rationale: Carrots or beets will tend to change the stool color to red. Black stools are associated with iron, licorice, and charcoal. Senna is associated with yellow stools. A milky white stool is associated with administration of barium.

The nurse is preparing to examine the abdomen of a client who reports a change in bowel pattern. The nurse would place the client in which position? A.) Supine with knees flexed B.) Knee-chest C.) Lithotomy D.) Left Sim's lateral

Answer: A.) Supine with knees flexed

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? A.) A complete blood count including differential B.) Serum antibodies for H. pylori C.) A sigmoidoscopy D.) Gastric analysis

Answer: B.) Serum antibodies for H. pylori Rationale: 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.

The nurse determines which is a true statement regarding older clients, considering the age-related effects on the gastrointestinal (GI) system? A.) They tend to have higher physiologic reserves to compensate for fluid loss. B.) They usually have less control of the rectal sphincter. C.) They have no awareness of the filling reflex. D.) They tend to have increased muscle tone and mass.

Answer: B.) They usually have less control of the rectal sphincter.

A client was diagnosed with pernicious anemia. Which vitamin cannot be absorbed without an intrinsic factor? A.) Vitamin A B.) Vitamin B12 C.) Vitamin C D.) Vitamin D

Answer: B.) Vitamin B12

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

Answer: A.) Tarry-black Rationale: 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.

What would the nurse recognize as preventing a client from being able to take a fecal occult blood test (FOBT)? A.) The client has hemorrhoidal bleeding B.) The client had a hamburger for dinner the night before C.) The client took an ibuprofen tablet this morning D.) The client regularly takes aspirin

Answer: A.) The client has hemorrhoidal bleeding Rationale: FOBT should not be performed when there is hemorrhoidal bleeding. In the past, clients were taught to avoid aspirin, red meats, nonsteroidal anti-inflammatory agents, and horseradish for 72 hours prior to the examination. However, these restrictions are no longer advised as the actual effects on testing have not been established.

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

Answer: A.) duodenum Rationale; 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.

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.

Answer: A.) normal.

A client tells the nurse that the stool was colored yellow. The nurse assesses the client for A.) recent foods ingested. B.) occult blood. C.) ingestion of bismuth. D.) pilonidal cyst.

Answer: A.) recent foods ingested. Rationale: The nurse should assess for recent foods that the client 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.

Which procedure is performed to examine and visualize the lumen of the small bowel? A.) small bowel enteroscopy B.) colonoscopy C.) panendoscopy D.) peritoneoscopy

Answer: A.) small bowel enteroscopy

A client asks the nurse why the physician ordered the blood test carcinoembryonic antigen (CEA). The nurse answers: A.) "It tells the physician what type of cancer is present." B.) "It indicates if a cancer is present." C.) "It determines functionality of the liver." D.) "It detects a protein normally found in the blood."

Answer: B.) "It indicates if a cancer is present."

The nurse is preparing the client for an assessment of the abdomen. What should the nurse complete prior to this assessment? A.) Prepare for a prostate examination. B.) Ask the client to empty the bladder. C.) Assist the client to a Fowler's position. D.) Dim the lights for privacy.

Answer: B.) Ask the client to empty the bladder. Rationale: The physical examination of the gastrointestinal system includes assessment of the mouth, abdomen, and rectum. It requires good light, full exposure of the abdomen, warm hands with short nails, and a relaxed client with an empty bladder. A full bladder will interfere with inspection and may elicit discomfort with palpation and percussion, thereby altering results.

When examining the abdomen of a client with reports of nausea and vomiting, what would the nurse do first? A.) Palpation B.) Inspection C.) Auscultation D.) Percussion

Answer: B.) Inspection

A nurse is assessing a client who reports abdominal pain, nausea, and diarrhea. When examining the client's abdomen, which sequence should the nurse use? A.) Inspection, palpation, percussion, and auscultation B.) Inspection, auscultation, percussion, and palpation C.) Auscultation, inspection, percussion, and palpation D.) Palpation, auscultation, percussion, and inspection

Answer: B.) Inspection, auscultation, percussion, and palpation

A client with a recent history of rectal bleeding is being prepared for a colonoscopy. Initially, how should the nurse position the client for this test? A.) Lying on the right side with legs straight B.) Lying on the left side with knees bent C.) Prone with the torso elevated D.) Bent over with hands touching the floor

Answer: B.) Lying on the left side with knees bent Rationale: For a colonoscopy, the nurse initially should position the client on the left side with knees bent. Placing the client on the right side with legs straight, prone with the torso elevated, or bent over with hands touching the floor wouldn't allow proper visualization of the large intestine.

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.

Answer: B.) Monitoring the stool passage and its color. Rationale: 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 working with clients with digestive tract disorders. Which of the following organs does the nurse realize has effects as an exocrine gland and an endocrine gland? A.) Gallbladder B.) Pancreas C.) Stomach D.) Liver

Answer: B.) Pancreas

Which of the following is an enzyme secreted by the gastric mucosa? A.) Trypsin B.) Pepsin C.) Ptyalin D.) Bile

Answer: B.) Pepsin Rationale: 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 to have an upper GI procedure with barium ingestion and abdominal ultrasonography. While scheduling these diagnostic tests, the nurse must consider which factor? A.) Both tests need to be done before breakfast. B.) The ultrasonography should be scheduled before the GI procedure. C.) The upper GI should be scheduled before the ultrasonography. D.) The client may eat a light meal before either test.

Answer: B.) The ultrasonography should be scheduled before the GI procedure. Rationale: 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 home care nurse is caring for a client with reports of epigastric discomfort who is scheduled for a barium swallow. Which statement by the client indicates an understanding of the test? A.) "I'll drink full liquids the day before the test." B.) "There is no need for special preparation before the test." C.) "I'll avoid eating or drinking anything 6 to 8 hours before the test." D.) "I'll take a laxative to clear my bowels before the test."

Answer: C.) "I'll avoid eating or drinking anything 6 to 8 hours before the test." Rationale: The client demonstrates understanding of a barium swallow when stating he or she must refrain from eating or drinking for 6 to 8 hours before the test. No other preparation is needed. Before a lower GI series, the client should eat a low-residue or clear liquid diet for 2 days and take a potent laxative and an oral liquid preparation.

A client is scheduled for several diagnostic tests to evaluate gastrointestinal function. After teaching the client about these tests, the nurse determines that the client has understood the teaching when the client identifies which test as not requiring the use of a contrast medium? A.) Small bowel series B.) Computer tomography C.) Colonoscopy D.) Upper GI series

Answer: C.) Colonoscopy Rationale: A colonoscopy is a direct visual examination of the entire large intestine. It does not involve the use of a contrast agent. Contrast medium may be used with a small bowel series, computed tomography, and upper GI series.

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? A.) Normal B.) Hypoactive C.) Hyperactive D.) Borborygmi

Answer: C.) Hyperactive

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

Answer: C.) Stomach Rationale: 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.