Chapter 43: Assessment of Digestive and Gastrointestinal Function

x 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? "I'll avoid eating or drinking anything 6 to 8 hours before the test." "I'll drink full liquids the day before the test." "There is no need for special preparation before the test." "I'll take a laxative to clear my bowels before the test."

"I'll avoid eating or drinking anything 6 to 8 hours before the test." 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 asks the nurse why the physician ordered the blood test carcinoembryonic antigen (CEA). The nurse answers: "It tells the physician what type of cancer is present." "It indicates if a cancer is present." "It determines functionality of the liver." "It detects a protein normally found in the blood."

"It indicates if a cancer is present." The carcinoembryonic antigen (CEA) blood test detects the presence of cancer by identifying the presence of a protein not normally detected in the blood of a healthy person. However, it does not indicate what type of cancer is present nor does it detect the functionality of the liver.

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

Ask the client to empty the bladder. 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.

Which of the following is the most definitive means of assessing for liver disease? Biopsy Paracentesis Cholecystography Ultrasonography

Biopsy Liver biopsy is the most effective means of diagnosing liver disease. Guided liver biopsy can be conducted using laparoscopy, the insertion of a fiberoptic endoscope through a small abdominal incision. 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. Ultrasonography may also be used to visualize the liver and diagnose conditions such as liver fibrosis; noninvasive techniques such as this can reduce the need for liver biopsy.

A nurse is preparing a client with Crohn's disease for a barium enema. What should the nurse do the day before the test? Serve the client his usual diet. Order a high-fiber diet. Encourage plenty of fluids. Serve dairy products.

Encourage plenty of fluids. The nurse should encourage plenty of fluids because adequate fluid intake is necessary to avoid dehydration that may be caused by the bowel preparation and to prevent fecal impaction after the procedure. The client may be placed on a low-residue diet 1 to 2 days before the procedure to reduce the contents in the GI tract. Fiber intake is limited in a low-residue diet. Because dairy products leave a residue, they aren't allowed the evening before the test. Clear liquids only are allowed the evening before the test.

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

Increased motility of the stomach Gastrin has the following effects on GI motility: increased motility of the stomach, excitation of the colon, relaxation of ileocecal sphincter, and contraction of the gastroesophageal sphincter.

When examining the abdomen of a client with reports of nausea and vomiting, what would the nurse do first? Palpation Inspection Auscultation Percussion

Inspection When assessing the abdomen, the nurse would first inspect or observe the abdomen. This would be followed by auscultation, percussion, and lastly, palpation.

An examiner is performing the physical assessment of the rectum, perianal region, and anus. While this examination can be uncomfortable for many clients, health care providers must approach it in a prepared, confident manner. Which of the following considerations will help this examination flow smoothly and efficiently for both provider and client? Select all that apply. Position the client on the right side with the knees up to the chest. Ask the client to bear down for visual inspection. Cleanse gloved fingers with water to allow for easy insertion. Dim the lights to decrease the client's embarrassment. Ask the client to produce a bowel movement after the procedure.

Position the client on the right side with the knees up to the chest. Ask the client to bear down for visual inspection. While examination of the rectum, perineum, and anus may be uncomfortable for the client, it is necessary for a thorough examination. The examiner will position the client on the right side with the knees up. He or she will use a gloved finger lubricated with a water-soluble lubricant for ease of insertion. The health care provider will encourage deep breathing during the procedure and ask the client to bear down while inspecting the anal area. The examination requires appropriate lighting for thorough inspection.

A group of students are studying for an examination on the gastrointestinal (GI) system and are reviewing the structures of the esophagus and stomach. The students demonstrate understanding of the material when they identify which of the following as the opening between the stomach and duodenum? Cardiac sphincter Hypopharyngeal sphincter Ileocecal valve Pyloric sphincter

Pyloric sphincter The pyloric sphincter is the opening between the stomach and duodenum. The cardiac sphincter is the opening between the esophagus and the stomach. The hypopharyngeal sphincter or upper esophageal sphincter prevents food or fluids from re-entering the pharynx. The ileocecal valve is located at the distal end of the small intestine and regulates flow of intestinal contents into the large intestine.

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 complete blood count including differential Serum antibodies for H. pylori A sigmoidoscopy Gastric analysis

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.

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

The client has hemorrhoidal bleeding 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.

Which neuroregulator increase gastric acid secretion? norepinephrine acetylcholine gastrin secretin

acetylcholine Acetylcholine causes increased gastric acid. Norepinephrine inhibits secretions of the GI tract. Gastrin increases secretion of gastric juice, which is rich in HCL. Secretin in the stomach inhibits gastric secretion somewhat.

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? duodenum jejunum ileum cecum

duodenum 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.

The major carbohydrate that tissue cells use as fuel is chyme. proteins. glucose. fats.

glucose. Glucose is the major carbohydrate that tissue cells use as fuel. Proteins are a source of energy after they are broken down into amino acids and peptides. Chyme stays in the small intestine for 3 to 6 hours, allowing for continued breakdown and absorption of nutrients. Ingested fats become monoglycerides and fatty acids by the process of emulsification.

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

recent foods ingested. 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? small bowel enteroscopy colonoscopy panendoscopy peritoneoscopy

small bowel enteroscopy 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.

Blood flow to the GI tract is approximately what percentage of the total cardiac output? 10% 20% 30% 40%

20% Blood flow to the GI tract is about 20% of the total cardiac output and increases significantly after eating.

The nurse is to obtain a stool specimen from a client who reported that he is taking iron supplements. The nurse would expect the stool to be which color? Dark brown Green Red Black

Black Ingestion of iron can cause the stool to turn black. Meat protein causes stool to appear dark brown. Ingestion of large amounts of spinach may turn stool green while ingestion of carrots and beets may cause stool to turn red.

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 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).

When examining the skin of a client who is dehydrated due to fluid losses from the gastrointestinal tract, which of the following would be most important? Checking if the skin is discolored Checking if the mucous membranes are dry Examining the sclera if it is yellow Observing for distended abdominal veins

Checking if the mucous membranes are dry Mucous membranes may be dry, and skin turgor may be poor in clients suffering from dehydration as a result of fluid losses from the GI tract. Checking the skin for discoloration and inspecting the sclera if it is yellow is taken into consideration when the client could have symptoms of jaundice, not fluid losses. Distended abdominal veins are not associated with dehydration.

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? Small bowel series Computer tomography Colonoscopy Upper GI series

Colonoscopy 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.

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? Intrinsic factor Hydrochloric acid Histamine] Liver enzyme 0

Intrinsic factor 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.

Which of the following is an enzyme secreted by the gastric mucosa? Pepsin Trypsin Ptyalin Bile

Pepsin Pepsin is secreted by the gastric mucosa. Trypsin is secreted by the pancreas. The salivary glands secrete ptyalin. The liver and gallbladder secrete bile.

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? Liver Ileum Stomach Large Intestine

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 preparing to examine the abdomen of a client who reports a change in 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 When examining the abdomen, the client lies supine with 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.

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

normal. 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.

An enzyme that begins the digestion of starches is ptyalin. pepsin. trypsin. bile.

ptyalin. Ptyalin, or salivary amylase, is an enzyme that begins digestion of starches. Pepsin, an important enzyme for protein digestion, is the end product of the conversion of pepsinogen from the chief cells. Digestive enzymes secreted by the pancreas include trypsin, which aids in digesting protein. Bile is an enzyme secreted by the liver and gallbladder.

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

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.