Chp. 37 all Disorders of Gastrointestinal Function
The nurse is teaching the client about dietary factors that increase risks for colon cancer. The most important information for the nurse to include would be: Select all that apply.
"Increasing your daily amount of sugar intake does influence your risk." "Decrease your daily intake of vitamins A and E."
A male patient has just been diagnosed with esophageal cancer. He knew he was losing weight and fatigued most days, but he just attributed it to aging and working. The physician recommends chemotherapy and irradiation. However, the cancer has already metastasized. The patient asks the nurse what he can expect if he agrees to the treatments. The nurse responds:
"The therapies may shrink the cancer in an effort to increase survival of the cancer."
A 71 year-old male has been recently diagnosed with a stage III tumor of colorectal cancer, and is attempting to increase his knowledge base of his diagnosis. Which of the following statements about colorectal cancer demonstrates a sound understanding of the disease?
"While diet is thought to play a role in the development of colorectal cancer, the ultimate causes are largely unknown."
Following a history of gastric pain and an endoscopy, a client has been diagnosed with a duodenal peptic ulcer. Which of the following teaching points should his caregiver provide?
"Your family history, your smoking history and NSAID use may all have contributed to this problem."
During a lecture discussing nausea and vomiting, the nurse reviews the role of the chemoreceptor trigger zone which may be stimulated (causing vomiting) by which factors? Select all that apply.
-Chemotherapeutic agents -Salmanella food poisoning -Increased intracranial pressure
Which of the following clients is most clearly displaying the signs and symptoms of irritable bowel disease (IBD)?
A 51 year-old male who states that his stomach pain is in his lower abdomen, "comes and goes" and "feels more like a cramp than a dull ache."
Select the client at greatest risk for developing colorectal cancer.
A 64-year-old female whose mother had colorectal cancer
Which individual 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 is assessing a client who has just developed peritonitis. The nurse would expect the client to manifest:
A board-like abdomen
What manifestations would a nurse expect while assessing a client who has recently developed peritonitis?
A board-like abdomen
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:
A bran muffin, fruit, and orange juice.
Which client should the nurse observe most closely for the signs and symptoms of paralytic ileus? A. client who is first day postoperative following gallbladder surgery B. client whose acute diarrhea has necessitated the use of antidiarrheal medications C. An obese client who refuses to ambulate because he reports shortness of breath D. client with a long-standing diagnosis of irritable bowel syndrome
A client who is first day postoperative following gallbladder surgery Paralytic ileus is a significant complication of abdominal surgery. The problem is not associated with the use of antidiarrheal medications, obesity, or irritable bowel syndrome.
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:
A client with a prior diagnosis of Helicobacter pylori and refused treatment
Select the client at greatest risk for developing colorectal cancer. A. 64-year-old female whose mother had colorectal cancer B. 45-year-old female who takes six aspirin per week for arthritis C. 40-year-old male with a history of peptic ulcer disease D. 26-year-old male with a history of irritable bowel syndrome
A. 64-year-old female whose mother had colorectal cancer Colorectal cancer peaks at 60 to 70 years of age, and fewer than 20% of cases occur before age 50. Its incidence is increased among persons with a family history of cancer, persons with Crohn disease or ulcerative colitis, and those with familial adenomatous polyposis of the colon. Aspirin or other NSAIDs may protect against colorectal cancer. IBS and peptic ulcers are not risk factors.paralytic ileus?
A client diagnosed with ulcerative colitis has been experiencing more than six bloody stools daily with evidence of toxicity. The nurse should question which order from the physician? A. Colonoscopy B. Stool specimen C. Ova and parasite examination D. Physical examination
A. Colonoscopy Diagnosis of ulcerative colitis is based on history and physical examination. The diagnosis usually is confirmed by sigmoidoscopy, colonoscopy, biopsy, and by negative stool examinations for infectious or other causes. Colonoscopy should not be performed on people with severe disease because of the danger of perforation; however, it may be performed after demonstrated improvement to determine the extent of disease and need for subsequent cancer surveillance.
Diverticulitis is the herniation of tissue of the large intestine through the muscularis layer of the colon. It is often asymptomatic and is found in approximately 80% of people over the age of 85. Diverticulitis is often asymptomatic, but when symptoms do occur, what is the most common complaint of the client? A. Lower left quadrant pain with nausea and vomiting B. Right lower quadrant pain with nausea and vomiting C. Mid-epigastric pain with nausea and vomiting D. Right lower quadrant pain with rebound tenderness on the left
A. Lower left quadrant pain with nausea and vomiting One of the most common complaints of diverticulitis is pain in the lower left quadrant, accompanied by nausea and vomiting, tenderness in the lower left quadrant, a slight fever, and an elevated white blood cell count. Right lower quadrant pain with nausea and vomiting describes a suspected appendicitis, as does right lower quadrant pain with rebound tenderness on the left. Mid-epigastric pain with nausea and vomiting describes symptoms of a peptic ulcer.
A client 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 client is lying still and taking shallow breaths, with a rigid abdomen. Which problem is the client experiencing? A. Peritonitis B. Intussusception C. Peptic ulcer D. Ulcerative colitis
A. Peritonitis The onset of peritonitis may be acute, as with a ruptured appendix, or it may have a more gradual onset, as occurs in pelvic inflammatory disease. The pain usually is more intense over the inflamed area. The person with peritonitis usually lies still because any movement aggravates the pain. Breathing often is shallow to prevent movement of the abdominal muscles. The abdomen usually is rigid and sometimes described as boardlike because of reflex muscle guarding.
Inflammatory bowel disease (IBD) is used to designate two related inflammatory intestinal disorders: Crohn disease and ulcerative colitis. The nurse recognizes the difference between the distribution pattern between Crohn disease and ulcerative colitis. Which pattern describes Crohn's disease? A. Skip lesions B. Continuous involvement of the colon starting at the rectum C. Primarily rectum and colon involvement D. Development of cancer
A. Skip lesions Distribution patterns of disease manifest with skip lesions in Crohn disease and continuous involvement of the colon starting at the rectum in ulcerative colitis. Crohn disease primarily affects the ileum and secondarily the colon, and the development of cancer is uncommon. Ulcerative colitis primarily affects the rectum and left colon, and development of cancer is relatively common.
A nurse caring for a patient with an intestinal obstruction anticipates which of the following assessment findings? Select all that apply.
Abdominal pain Abdominal distension Vomiting
Which symptom is often observed in cases of peritonitis?
Abdominal rigidity
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
A 43 year-old male client has presented to the emergency department with vomiting that he claims is of a sudden onset. The client also states that the emesis has often contained frank blood in the hours prior to admission. His vital signs are stable with temperature 98.30 F, pulse 88, BP 140/87, and respiratory rate 18. Which of the following potential contributing factors would the health care team suspect first?
Alcohol consumption
The mother of a 19 week-old infant has brought her baby in for assessment to a pediatrician because of the baby's persistent weight loss and diarrhea. An intestinal biopsy has confirmed a diagnosis of celiac disease, and the child's mother is anxious to know what caused the disease. Which of the following aspects of the etiology of celiac disease would underlie the explanation that the physician provides?
An inappropriate T-cell mediated response results in increased levels of antibodies and an inflammatory response.
A nurse is reviewing the admission assessment data of a client diagnosed with acute gastritis. The nurse determines that the condition most likely occurred as a result of:
Arthritis treated with high levels of nonsteroidal anti-inflammatory (NSAIDs) agents
An older adult client presents with loose mucus-filled stools. The nurse suspects the client has Clostridium difficile. What is a priority assessment for the nurse?
Ask the client about his or her antibiotic use.
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.
A patient is being screened for colorectal cancer with the fecal occult test. The nurse instructs the patient to avoid ingesting which of the following 3-7 days prior to the test? Select all that apply.
Aspirin Citrus fruits Red meats
A patient presents with a perforated peptic ulcer. Which of the following complications would be a priority for the nurse?
Assessment of a rigid, boardlike abdomen
A 40-year-old man tells the nurse that his father died of gastric cancer and that he wants to do everything he can do to avoid the disease. Which recommendation should the physician provide?
Avoid smoked and preserved foods
Irritable bowel syndrome is thought to be present in 10% to 15% of the population in the United States. What is its hallmark symptom? A. Nausea and abdominal pain unrelieved by defecation B. Abdominal pain relieved by defecation with a change in consistency or frequency of stools C. Diarrhea and abdominal pain unrelieved by defection D. Abdominal pain relieved by defecation and bowel impaction
B. Abdominal pain relieved by defecation with a change in consistency or frequency of stools A hallmark of irritable bowel syndrome is abdominal pain that is relieved by defecation and associated with a change in consistency or frequency of stools. Nausea, altered bowel function, and diarrhea are also symptoms of irritable bowel syndrome but not combined with abdominal pain that is unrelieved by defecation. A bowel impaction is not a symptom of irritable bowel syndrome.
Which manifestations most clearly suggest the need for endoscopy to rule out esophageal cancer? A. Heartburn after an individual consumes high-fat meals B. Dysphagia in an individual with no history of neurologic disease C. New onset of gastroesophageal reflux in a previously healthy individual D. Recurrent episodes of gastritis that do not respond to changes in diet
B. Dysphagia in an individual with no history of neurologic disease Dysphagia is by far the most frequent report of persons with esophageal cancer. It is apparent first with ingestion of bulky food, later with soft food, and finally with liquids. Heartburn, reflux, and gastritis are not health problems that are closely associated with the development of esophageal cancer.
A nurse is assessing an older adult with reports of constipation, for which the client often takes over-the-counter medications. What assessment should the nurse perform to address the etiology of the client's problem? A. Signs and symptoms of diverticula B. Medication regimen for drugs like anticholinergic agents or calcium C. History of hemorrhoids or rectal fissures D. History of cesarean birth or other abdominal surgery
B. Medication regimen for drugs like anticholinergic agents or calcium Constipation is attributable to numerous factors, including low fluid intake and medications. Drugs such as opioids, anticholinergic agents, calcium channel blockers, diuretics, calcium, iron supplements and aluminum antacids tend to cause constipation. Diverticula, rectal fissures, and hemorrhoids are consequences rather than causes of constipation. Abdominal surgery rarely causes constipation unless it is comparatively recent.
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: A. a hiatal hernia. B. squamous cell carcinoma of the esophagus. C. dysphagia secondary to scleroderma. D. gastrointestinal reflux disease.
B. squamous cell carcinoma of the esophagus. Alcohol and tobacco use are the main risk factors for squamous cell carcinoma of the esophagus and dysphagia is a common presenting complaint. Hiatal hernias and GERD do not cause dysphagia. Scleroderma is unrelated to the client's presentation or history.
Symptoms of gastric cancer include vague epigastric pain, which makes early detection difficult. The nurse would expect a client to undergo which diagnostic examination to determine the location of the gastric cancer?
Barium x-ray
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?
Barium x-ray
Treatment for Helicobacter pylori (H. pylori) requires combination therapy that includes administration of which medications? Select all that apply. Levofloxacin Bismuth salts Omeprazole Acetaminophen Amoxicillin
Bismuth salts Omeprazole Amoxicillin Eradication of H. pylori is has proven difficult. Treatment requires combination therapy that includes antibiotics (e.g., amoxicillin, tetracycline, aminoglycoside) and bismuth salts in combination with proton pump inhibitors (e.g., lansoprazole and omeprazole). The combination of two or more antimicrobial properties work against H. pylori, and by raising the intragastric pH they suppress bacterial growth and optimize antibiotic efficacy. Bismuth has a direct antibacterial effect against H. pylori.
Which characteristic differentiates inflammatory diarrhea from the non-inflammatory type?
Bloody stools caused by invasion of intestinal cells
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? A. Rotavirus infection B. Irritable bowel syndrome C. Gastrointestinal reflux D. Peptic ulcer disease
C. Gastrointestinal reflux Esophagitis secondary to reflux can cause feeding problems, early satiety, and hematemesis. Infants may demonstrate signs of pain when swallowing and may be irritable and cry frequently. Rotavirus causes diarrhea and vomiting but not the other symptoms. IBS does not cause esophagitis. Peptic ulcer disease would not cause difficulty swallowing.
A client is admitted to the medical surgical unit with a history of inflammatory bowel disease. The nurse knows that the clinical manifestations of both Crohn disease and ulcerative colitis are the result of activation of which cells? A. Beta B. Alpha C. Inflammatory D. Parietal
C. Inflammatory The term "inflammatory bowel disease" is used to designate two related inflammatory intestinal disorders: Crohn disease and ulcerative colitis. Both diseases produce inflammation of the bowel. The clinical manifestations of both Crohn disease and ulcerative colitis are ultimately the result of inflammatory cells with elaboration of inflammatory mediators that cause nonspecific tissue damage.
A client diagnosed with inflammatory diarrhea is having multiple small, bloody stools with a fever. Which could be a likely cause of this inflammatory diarrhea?
C. difficile
A nurse has just completed the assessment of a client diagnosed with inflammatory diarrhea who is having multiple small stools that are bloody and has a fever. The client asks the nurse what is causing the diarrhea. The best response by the nurse would be:
C. difficile
Crohn 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 description?
Cobblestone
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?
Cobblestone
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
An older adult client has been placed on a broad-spectrum antibiotic for a recurrent urinary tract infection. Which potential problem would the nurse anticipate in this client?
Colonization of Clostridium difficile
An older adult client expresses concern about straining to pass stools that are small and hard. What term will the health care provider use to document this in this client's chart?
Constipation
A 28-year-old man presents with complaints of diarrhea, fecal urgency, and weight loss. His stool is light-colored and malodorous, and it tends to float and be difficult to flush. He has also noted tender, red bumps on his shins and complains of pain and stiffness in his elbows and knees. Sigmoidoscopy reveals discontinuous, granulomatous lesions; no blood is detected in his stool. Which of the following diagnoses would his care team first suspect?
Crohn disease
A young man presents reporting diarrhea, fecal urgency, and weight loss. His stool is light-coloured and malodorous, and it tends to float and be difficult to flush. He has also noted tender, red bumps on his shins and reports pain and stiffness in his elbows and knees. Sigmoidoscopy reveals discontinuous, granulomatous lesions; no blood is detected in his stool. Which diagnosis would his care team first suspect?
Crohn disease
Which disorders are grouped under the category of inflammatory bowel disease? Select all that apply. Crohn disease Ulcerative colitis Celiac disease Salmonellosis Shigellosis
Crohn disease Ulcerative colitis
The nurse is caring for a patient with chronic diarrhea. She knows that this condition could be caused by which of the following? Select all that apply.
Crohn disease, Ulcerative colitis, Lactase deficiency, and 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?
Crohn's disease
A client who ate a large meal and then went to weightlifting class states "feeling very uncomfortable" and reports gastric reflux. What is the nurse's best response to the client? A. "You should not eat before you exercise." B. "Jogging usually increases acid in the stomach." C. "Exercise increases acid build-up in the stomach." D. "There is backward movement of gastric contents into the esophagus that occurs soon after eating."
D. "There is backward movement of gastric contents into the esophagus that occurs soon after eating." Reflux refers to backward movement of gastric contents into the esophagus that occurs soon after eating, is short lived, and seldom causes more serious problems. As the blood is shunted away from the gastrointestinal tract toward the skeletal muscles during activities such as jogging, the gastrointestinal system activity is decreased. Food is not digested as rapidly, and heartburn and reflux are common. Vomiting, bloating and stomach pain can also result. The client should be encouraged to wait a while after eating before starting strenuous exercise so that digestion is not impaired.
A client is newly diagnosed with irritable bowel syndrome (IBS). The nurse explains how the nervous system affects gastrointestinal (GI) disorders. The nurse mentions which statement in regard to IBS? A. Increase in smooth muscle tone B. Enhancement of sphincter function C. Decrease in gastrointestinal motility D. Increase in parasympathetic nervous system activity
D. Increase in parasympathetic nervous system activity Stimulation of the parasympathetic nervous system causes a general increase in motility of the bowel. Sympathetic stimulation inhibits activity, causing many effects opposite to those of the parasympathetic system, including enhancement of sphincter function, decreased motility, and increased smooth muscle tone.
The nurse knows that the student understands the major causes of mechanical bowel obstruction when the student states that _____ is a possible cause? A. Chemical irritation B. Ruptured appendix C. Abdominal distention D. Postoperative adhesions
D. Postoperative adhesions Causes mechanical bowel obstruction include external hernia (e.g., inguinal, femoral, or umbilical) and postoperative adhesions. Paralytic (adynamic) obstruction accompanies inflammatory conditions of the abdomen, occurs early in the course of peritonitis, and can result from chemical irritation caused by bile, bacterial toxins, electrolyte imbalances as in hypokalemia, and vascular insufficiency. The major effects (rather than causes) of both types of intestinal obstruction are abdominal distention and loss of fluids and electrolytes. The most common direct causes of peritonitis include a ruptured appendix.
A client tells the doctor that every time he eats something made with wheat, barley, and/or rye, he gets sick. The doctors suspects the client has celiac sprue. The physician should further assess the client for: Select all that apply.
Diarrhea Abdominal pain Iron deficiency
A nurse is completing a history and physical assessment on a patient admitted with ulcerative colitis. Which of the following symptoms would the nurse anticipate? Select all that apply.
Diarrhea Rectal bleeding
A client who is diagnosed with Zollinger-Ellison syndrome will exhibit which symptoms?
Diarrhea with fat deposits Zollinger-Ellison syndrome causes clients to have diarrhea from hypersecretion or from the inactivation of intestinal lipase and impaired fat digestion. Diseases associated with chronic constipation include neurologic diseases; endocrine disorders, and obstructive lesions in the gastrointestinal tract. Elevated blood sugar may be the result of diabetes or stress, and nausea with vomiting may result for obstruction or GI upset.
A geriatric client is having infrequent stools with a history of watery diarrhea, fecal soiling, and fecal incontinence. Which intervention would be a priority assessment for nurse to perform?
Digital rectal examination
A patient complains of having bouts of diarrhea. The patient wants to know which antidiarrheal would be best to use. Which of the following antidiarrheals does the nurse know will help stimulate water and electrolyte absorption?
Diphenoxylate (Lomotil)
A client is admitted with chronic gastritis. The nurse expects which invasive test to be performed to establish the presence of Helicobacter pylori (H. pylori)? Carbon urea breath test Stool antigen test Endoscopic biopsy Radiographic test
Endoscopic biopsy
A client is admitted with chronic gastritis. The nurse expects which invasive test to be performed to establish the presence of Helicobacter pylori (H. pylori)? Carbon urea breath test Stool antigen test Endoscopic biopsy Radiographic test
Endoscopic biopsy Methods for establishing the presence of H. pylori infection include the carbon urea breath test, the stool antigen test, and an endoscopic biopsy for urease testing. The invasive test is the endoscopic biopsy, which removes a tissue sample from the lining of the stomach.
Pharmacologic treatment for peptic ulcers has changed over the past several decades. The nurse knows that the goal for pharmacologic treatment is focused on:
Eradicating Helicobacter pylori (H. pylori)
Parents of a 20-month-old infant report that he refuses food or eats poorly and that he grimaces when he swallows. He also is irritable and cries a lot. The mother is worried that he ate something inappropriate this morning, because he vomited something that looked like coffee grounds. Which of the following health problems would the care team first suspect?
Esophagitis from gastrointestinal reflux
The nurse is teaching her client with hepatobiliary disease about her diet. She tells her that she may have steatorrhea, which is the malabsorption of which dietary component?
Fat
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?
Fat
Good hand-washing techniques are important in health care. The nurse knows that bacterial infections can be prevented by good hand washing techniques. Which route of transmission is most common for Clostridium difficile?
Fecal-oral transmission
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?
Fecal-oral transmission
A teenager who has a history of achalasia will likely complain of which clinical manifestation?
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 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:
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?
Fistula formation
When comparing the symptomology of Crohn disease with that of ulcerative colitis, which symptoms are generally characteristic of only Crohn disease? Select all that apply.
Fistulas. Perianal ulcers.
In the balance of secretions in the gastric mucosa by the parietal cells, which ion is produced to buffer the production of hydrochloric acid?
HCO3-
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 are the most common risk factors for peptic ulcer disease?
Helicobacter pylori (H. pylori)
A client is diagnosed with Crohn disease. The nurse instructs the client on which type of dietary needs?
High-calorie, vitamin, and protein diet
A patient is diagnosed with Crohn's disease. The nurse instructs the patient on which of the following types of dietary needs?
High-calorie, vitamin, and protein diet
A patient is admitted to the medical surgical unit with a history of inflammatory bowel disease. The nurse knows that the clinical manifestations of both Crohn's disease and ulcerative colitis are the result of activation of which of the following cells?
Inflammatory
A 22 year-old student has developed a fever and diarrhea while on a backpacking trip in Southeast Asia. His oral temperature is 101.40 F. The diarrhea is bloody, frequent, and small in volume. These clinical manifestations are sufficiently distressing that he/she is visiting a local medical clinic in the area. Which of the following diagnoses best characterizes this health problem?
Inflammatory diarrhea
Crohn's disease is treated by several measures. Treatment with corticosteroids focuses on which of the following?
Inflammatory suppression
Crohn disease is a recurrent inflammatory disease that can affect any area of the bowel. Characteristic of Crohn disease are granulomatous lesions that are sharply demarcated from the surrounding tissue. The nurse caring for a client with newly diagnosed Crohn disease would know to include what in the teaching?
Information on sulfasalazine including dosage, route, frequency, and side effects of the drug
Crohn disease is a recurrent inflammatory disease that can affect any area of the bowel. Characteristic of Crohn disease are granulomatous lesions that are sharply demarcated from the surrounding tissue. The nurse caring for a client with newly diagnosed Crohn disease would know to include what in the teaching?
Information on sulfasalazine, including dosage, route, frequency, and side effects of the drug
A client presents for follow-up with ongoing treatment for peptic ulcer disease. What is the most likely goal of this client's pharmacologic treatment?
Inhibiting gastric acid production
Diverticulitis is the herniation of tissue of the large intestine through the muscularis layer of the colon. It is often asymptomatic and is found in approximately 80% of people over the age of 85. Diverticulitis is often asymptomatic, but when symptoms do occur, what is the most common complaint of the client?
Lower left quadrant pain with nausea and vomiting
A stroke patient is having difficulty swallowing food and beverages. The patient complains that it feels like "the food is sticking to the back of their throat." Given this information, the priority nursing interventions would be to:
Make the patient "nothing per os" (NPO) and call the physician.
Crohn disease not only affects adults but also can occur in children. The nurse assesses for which major manifestation in children with Crohn disease?
Malnutrition
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?
Malnutrition
A 20 year-old woman has visited her family physician due to occasional bouts of bloody diarrhea over the past several weeks, a phenomenon that she experienced two years prior as well. Her physician has diagnosed her with ulcerative colitis based on her history and visualization of the affected region by colonoscopy and sigmoidoscopy. Which of the following pathophysiological phenomena is most likely to underlie the client's health problem?
Mucosal hemorrhages that have developed into crypt abscesses, which have in turn necrotized and ulcerated.
Ulcerative colitis is an inflammatory bowel disease. The nurse identifies which of the following as a common sign of ulcerative colitis? Mucus and blood stools Periods of exacerbations and remissions Formation of fistula Lesions surrounded by normal-appearing mucosal tissue
Mucus and blood stools Ulcerative colitis is a nonspecific inflammatory condition of the colon and rectum. Unlike Crohn disease, which can affect various sites in the GI tract, ulcerative colitis is confined to the rectum and the colon. Ulcerative colitis presents as a relapsing disorder that affects the mucosal layer of the bowel; the stools typically contain blood and mucus. Ulcerative colitis has continuous involvement of the colon, beginning with the rectum. Fistula formation is common in Crohn disease, which is characterized by periods of exacerbations and remission.
A patient is admitted with an intestinal obstruction with abdominal bloating. Which of the following types of treatment does the nurse know will help decompress the bowel?
Nasogastric tube to suction
Diarrhea is described as a change in frequency of stool passage to a point where it is excessively frequent. Diarrhea can be acute or chronic, inflammatory, or noninflammatory. What are the symptoms of noninflammatory diarrhea? (Select all that apply.)
Nonbloody stools, periumbilical cramps, and nausea and/or vomiting
A patient with a history of peptic ulcer disease presents to the emergency department with the following symptoms: early satiety, feeling of epigastric fullness and heaviness after meals, weight loss, and vomiting. The nurse suspects that the peptic ulcer has caused which of the following problems?
Obstruction
An ultrasound confirms appendicitis as the cause of a client's sudden abdominal pain. Which etiologic process is implicated in the development of appendicitis?
Obstruction of the intestinal lumen
The nurse is teaching an adult client about home treatment for uncomplicated diarrhea. The most appropriate information for the nurse to provide would be:
Oral replacement therapy (ORT)
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
Peptic ulcers can affect one or all layers of the stomach or duodenum. Ulcers that penetrate through the muscularis layer are classified as which of the following types of ulcer?
Perforation
A client has been admitted to the hospital with an exacerbation of peptic ulcer disease. The nurse is aware the client is at risk for: Select all that apply.
Perforation • Hemorrhage • Obstruction
Atrophic gastritis and decreased secretion of intrinsic factor are more common with aging. The subsequent deficiency of vitamin B12 can cause which condition to occur? Select all that apply.
Peripheral neuropathy Pernicious anemia
A client has developed a ruptured appendix. The nurse is aware the client is at high risk for:
Peritonitis
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
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
A patient has recently been diagnosed with H. pylori gastritis. The nurse knows that this form of gastritis is usually treated with a combination of an antibiotic and:
Proton pump inhibitors.
After several months of persistent heartburn, a 57 year-old female client has been diagnosed with gastroesophageal reflux disease (GERD). Which of the following treatment regimens is likely to best address the woman's health problem?
Proton pump inhibitors; avoiding large meals; remaining upright after meals
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
After several months of persistent heartburn, an adult client has been diagnosed with gastroesophageal reflux disease (GERD). Which treatment regimen is likely to be prescribed for this client's GERD?
Proton pump inhibitors; avoiding large meals; remaining upright after meals
A nurse is completing an abdominal assessment on a client suspected to have appendicitis. When the nurse applies and then releases pressure in the client's right lower quadrant, the client experiences tenderness. The nurse is documenting the presence of:
Rebound tenderness
Celiac disease commonly presents in infancy as failure to thrive. It is an inappropriate T-cell-mediated immune response, and there is no cure for it. What is the treatment of choice for celiac disease?
Removal of gluten from the diet
Inflammatory bowel disease (IBD) is used to designate two related inflammatory intestinal disorders: Crohn's disease and ulcerative colitis. The nurse recognizes the difference between the distribution pattern between Crohn's disease and ulcerative colitis. Which of the following patterns describes Crohn's disease?
Skip lesions
A patient is admitted with a peptic ulcer. The nurse's priority on admission is to assess for which of the following? Select all that apply.
Smoking history • Family history • Alcohol usage
Which meal choice is most likely to exacerbate an individual's celiac disease?
Spaghetti with meatballs and garlic bread
The cause of gastric carcinomas has been influenced by which of the following factors? Select all that apply.
Strain of Helicobacter pylori (H. pylori) • Environmental factors • Family history
The cause of gastric carcinomas has been influenced by which factors? Select all that apply.
Strain of Helicobacter pylori (H. pylori)• Environmental factors• Family history
The client who has experienced third-degree burns is susceptible to which specific type of gastrointestinal (GI) ulceration?
Stress
The patient who has experienced third-degree burns is susceptible to which of the following specific types of gastrointestinal (GI) ulceration?
Stress
A nurse administering a client's medication tells the client that a proton pump inhibitor has been added. When the client asks the purpose of the medication, the nurse responds that it is to prevent:
Stress ulcer
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
Following the analysis of colonoscopy with biopsy, a client is diagnosed with colorectal cancer. Which treatment modality will be the mainstay of this client's treatment regimen?
Surgery
A client is admitted to the hospital with a suspected diagnosis of strangulated bowel. The nurse anticipates the client will need:
Surgery to release the bowel
Parents have brought their seven year old child into the emergency room with abdominal pain. Which of the following clinical manifestations would lead the healthcare team to suspect the child has appendicitis? Select all that apply.
Tenderness in right lower quadrant with palpation.• Rebound tenderness in inguinal areas with palpation.
A busy 45-year-old female executive has been diagnosed with diverticulitis. Her primary treatment is an increase in the fibre content of her diet. What effect will the fibre have on the diverticula?
The fibre increases bulk, promotes regular defecation, and increases colonic contents and colon diameter, thereby decreasing intraluminal pressure.
A number of clients on a geriatric subacute medical floor of a hospital have developed foul-smelling diarrhea over the last several days, and subsequent culture of stool samples has confirmed the presence of Clostridium difficile in each case. The care team on the unit would recognize that which of the following factors likely contributed to the health problem and would anticipate which of the following treatments?
The use of broad spectrum antibiotics likely played a role in the developments of the infections, and most clients would likely receive metronidazole as a treatment.
A physician's orders for a patient to be started on total parenteral nutrition (TPN). The nurse knows that TPN is a hypertonic solution and must be administered in which of the following ways?
Through a large diameter central line
A client is admitted with an exacerbation of Crohn disease and has been experiencing a weight loss of 20 pounds in 2 weeks. The client is unable to absorb nutrients from the intestine. The nurse would expect which type of diet to be ordered for this client? High-fiber diet High-calorie, low-fat diet Total parenteral nutrition Low-residue diet
Total parenteral nutrition Total parenteral nutrition consists of intravenous administration of hypertonic glucose solutions to which amino acids and fats may be added. This form of nutritional therapy may be needed when food cannot be absorbed from the intestine.
A client experiencing fulminant disease of ulcerative colitis would be at risk for developing which complication associated with colonic dilation?
Toxic megacolon
Constipation is the infrequent or difficult passage of stools.
True
Malabsorption syndrome results in loss of fat in the stool and failure to absorb fat-soluble vitamins.
True
The parietal cells of the stomach produce hydrochloric acid to protect the mucosal covering from gastric erosion. The nurse understands that Helicobacter pylori (H. pylori) produces an enzyme that enables its survival in this acidic environment. Which enzyme does H. pylori produce? Protease Trypsin Urease Glycine
Urease H. pylori is the most common cause of chronic gastritis, and is able to buffer the acidity of their immediate environment by producing sufficient ammonia, which is created from secreting an enzyme called urease. These properties help to explain why the organism is able to survive in the acidic environment of the stomach.
A client is admitted to the emergency department with early symptoms of appendicitis. The nurse would assess the client for:
Vague pain that is referred to the epigastric or periumbilical area
The body uses common physiologic responses that are common to gastrointestinal (GI) disorders. A nurse would expect to see which physiologic response known to be protective by removing noxious agents from the body?
Vomiting
The nurse walks into a room and finds the patient forcefully expelling stomach contents into a wash basin. When documenting this occurrence, the nurse will use the term:
Vomiting.
A rare condition caused by gastrin-secreting tumors most commonly found in the small intestine or pancreas is called which of the following?
Zollinger-Ellison syndrome
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:
avoid nonsteroidal anti-inflammatory drugs (NSAIDs) for 1 week prior to testing.
A client is admitted to the hospital with a suspected diagnosis of strangulated bowel. The nurse anticipates the client will need:
surgery to release the bowel.
