Module 15: Alterations of Digestive Function

outpouchings of the colon's mucosa Feedback: Diverticula are sac-like outpouchings of the mucosa through the muscle layers of the digestive tract.

A nurse is asked to describe diverticula. How should the nurse respond? Diverticula are:

Small-volume

A patient has diarrhea from ulcerative colitis. The nurse will create a plan of care based on which type of diarrhea?

Protein Feedback: A diet that lacks protein but contains carbohydrates can lead to protein malnutrition, which is a condition called kwashiorkor.

The nurse is assisting the patient with kwashiorko plan a diet. The diet should include high levels of which of the following?

alcoholism. Feedback: High alcohol consumption causes liver injury and inflammation resulting in fibrosis and scarring of the liver.

A nurse is asked what can cause liver cirrhosis. What is the nurse's best response? Common causes of liver cirrhosis are hepatitis C and:

back-up of blood in the intra-abdominal veins occurs. Feedback: In portal hypertension, the back-up of blood in the abdominal (mesenteric) veins causes an increase in capillary hydrostatic pressures and the leakage of fluid into the peritoneal cavity, which is called ascites.

A nurse is describing the pathophysiology of ascites and portal hypertension. Which information should the nurse include? Portal hypertension leads to ascites because:

H. pylori releases toxins and enzymes that promote inflammation.

A nurse is describing the pathophysiology of duodenal ulcers. Which information should the nurse include?

stomach; diaphragm Feedback: A hiatal hernia is a protrusion of the stomach through the esophageal hiatus of the diaphragm.

A nurse is describing the pathophysiology of hiatal hernias. Which information should the nurse include? A hiatal hernia is a protrusion of the _____ through the ______.

Postgastrectomy and dumping syndrome Feedback: The postgastrectomy syndromes include dumping syndrome, alkaline reflux gastritis, afferent loop obstruction, diarrhea, weight loss, and anemia.

A nurse is describing the pathophysiology of several diseases. Which association is accurate?

Pancreatic cancer arises in the exocrine cells and has a high mortality rate. Feedback: Treatment is palliative; most cancers arise in the exocrine cells and mortality is nearly 100% for pancreatic cancer.

A nurse is discussing the pathophysiology of cancers of the digestive system. Which information should the nurse include together?

the accumulation of gallstones in the gallbladder.

A nurse observes cholelithiasis documented on the chart. The nurse will be caring for a patient with:

an esophageal stricture. Feedback: Intrinsic obstructions originate in the wall of the esophageal lumen and include tumors, strictures, and diverticular herniations (outpouchings).

A patient has a mechanical intrinsic obstruction of the esophagus. The nurse will be providing care to a patient with:

Bulimia nervosa

A patient has a nutritional disorder that is characterized by consumption of large amounts of food (binging) followed by self-induced vomiting and/or the use of laxatives (purging). Which diagnosis will the nurse observe documented on the chart?

Vomiting, colicky abdominal pain, and abdominal distension

A patient has a small bowel obstruction. Which classic symptoms should the nurse assess for in this patient?

Osmotic Feedback: When an individual is unable to digest lactose, the unabsorbed molecules draw water into the lumen, resulting in osmotic diarrhea.

A patient has diarrhea caused by an inability to digest lactose in dairy products. Which type of diarrhea is the patient experiencing?

Referred Feedback: Referred pain is visceral pain felt at some distance from a diseased or affected organ. For example, acute cholecystitis may have pain referred to the right shoulder or scapula.

A patient has gallbladder pain that is felt in the right shoulder. The nurse explains to the patient that the issue is the gallbladder, and that the pain in the shoulder is the result of which type of pain?

Heartburn, dysphagia, and pain within 1 hour of eating

A patient has gastroesophageal reflux disease (GERD). Which common manifestations should the nurse expect to detect when assessing this patient?

Ammonia Feedback: When the liver is severely injured, hepatocytes are unable to convert ammonia to urea. The result is toxic accumulation of ammonia in the blood, a condition known as hepatic encephalopathy.

A patient has hepatic encephalopathy. When the nurse is checking the laboratory results, which of the following will be elevated?

Viral infection

A patient has hepatitis. Which of the following does the nurse suspect most likely caused the hepatitis?

Iron deficiency anemia Feedback: Blood loss in gastrointestinal bleeding can result in an iron deficiency due to the loss of iron in the hemoglobin.

A patient is positive for occult gastrointestinal bleeding. Which complication should the nurse expect?

gastrin. Feedback: Zollinger-Ellison syndrome is a rare syndrome that is also associated with peptic ulcers caused by a gastrin-secreting neuroendocrine tumor or multiple tumors (gastrinoma) of the pancreas or duodenum.

A patient newly diagnosed with Zollinger-Ellison syndrome asks the nurse about the disease. In explaining the disease, the nurse should identify that Zollinger-Ellison occurs with the secretion of excessive:

an inflammatory response to gastroesophageal reflux. Feedback: Reflux esophagitis is an inflammatory response to the mucosal injury from acid and enzymes that occur with gastroesophageal reflux.

A patient newly diagnosed with reflux esophagitis asks the nurse what this disease is. The nurse should identify that reflux esophagitis is defined as:

Hepatitis A Feedback: Hepatitis A is acquired from ingesting contaminated food and manifests acutely with fever, abdominal pain, and jaundice. Individuals with hepatitis A generally make a full recovery.

A patient presents with fever, abdominal pain, and jaundice from ingesting contaminated food. Which of the following types of hepatitis does the nurse suspect the patient has?

Bile salt deficiency Feedback: Night blindness, osteopathy, and clotting disorders are caused by bile salt deficiency and the resulting malabsorption of fat-soluble vitamins A, D, and K.

A patient presents with night blindness, osteopathy, and clotting disorders. Which disorder does the nurse suspect?

steatorrhea (fat in the stools), bloating and diarrhea.

Common signs of malabsorption syndromes include:

Increased conjugated bilirubin Feedback: In cases of bile duct obstruction, the liver conjugates bilirubin but is unable to secrete it into the bile that is backed up. The conjugated bile seeps back into the plasma and deposits in the skin and other surface tissues, causing jaundice.

Jaundice related to biliary duct obstruction is supported by which of the following laboratory alterations?

inhibiting mucosal prostaglandin synthesis. FEedback: NSAIDS are used to treat inflammatory pain and can increase the risk of duodenal ulcers by inhibiting prostaglandin synthesis, which normally stimulates the production of gastric mucus.

Non-steroidal anti-inflammatory agents (NSAIDS) can cause duodenal ulcers by:

bacterial infection. Feedback: The most common cause of chronic (antral) gastritis is chronic bacterial infection by Helicobacter pylori.

The most common cause of chronic (antral) gastritis is:

alcohol abuse. Feedback: Chronic pancreatitis is most often associated with chronic alcohol abuse.

The most common cause of chronic pancreatitis is:

prostaglandins. Feedback: Prostaglandins stimulate the production of mucus in the stomach. Medications that block prostaglandins, such as anti-inflammatory agents, increase the risk of developing an ulceration of the gastric mucosa.

The nurse caring for the patient with gastrointestinal pain must consider certain medications such as aspirin that block the release of:

Bilirubin Feedback: Jaundice, or icterus, is a yellow or greenish pigmentation of the skin caused by hyperbilirubinemia.

The nurse is analyzing the morning laboratory results of her patient with jaundice. Which serum levels are expected to be elevated?

A patient with postoperative abdominal surgery Feedback: Paralytic ileus is a functional bowel obstruction caused by failure of motility and often occurs after abdominal surgery.

The nurse is caring for a variety of patients. Which patient is most at risk for a paralytic ileus?

Adipokines/Adipocytokines Feedback: Some of the most significant recent findings describe the role of hormones secreted by fat cells called adipokines/adipocytokines, which include leptin, adiponectin, and resistin.

The nurse is discussing leptin, adiponectin, and resistin. Which type of hormones are being discussed?

Esophageal cancer Feedback: Esophageal ulcerations, strictures, and cancer are all complications associated with gastroesophageal reflux disease.

The nurse recalls that which complication is associated with gastroesophageal reflux disease (GERD)?

anorexia nervosa.

The nurse reviews the chart of the patient and notices that the patient is refusing to eat and is 15% below normal body weight for her age and height. The nurse will need to create a care plan that includes interventions for:

Administer lactulose Feedback: Management includes careful fluid and electrolyte monitoring, restriction of dietary protein, sterilization of the bowel with neomycin, and administration of lactulose to decrease intestinal ammonia absorption.

The patient is exhibiting signs of hepatic encephalopathy. The nurse should prepare to:

melena Feedback: Melena is black, tarry stool that occurs when blood components are digested in the upper gastrointestinal tract.

The patient's stool is black and positive for blood. This finding should be documented by the nurse as:

smokes and drinks alcohol. Feedback: Risk factors for PUD are factors that decrease the ability of the upper gastrointestinal mucosa to defend itself against acid-mediated injury, such as infection with H. pylori, non-steroidal anti-inflammatory drug (NSAID) use, smoking, advanced age, or alcohol consumption.

Which patient is most at risk for peptic ulcer disease? One who:

pain immediately after eating. Feedback: Gastric ulcers are often associated with pain on eating because the presence of food stimulates acid and enzyme secretion, which causes further damage to the gastric mucosa and underlying tissue. The pattern of pain is different from that of duodenal ulcers because pain frequently occurs immediately after eating.

Which principle should the nurse remember when providing nursing care to a patient who has a gastric ulcer? Gastric ulcers are characterized by:

liver cirrhosis.

Which statement indicates that the nurse has a good understanding of portal hypertension? The most common cause of portal hypertension is:

laxative use. Feedback: Laxatives are used to treat constipation and can cause diarrhea.

Which statement indicates that the patient is confused about constipation? One common cause of constipation includes:

Hematochezia Feedback: Blood from the distal colon and rectum usually manifests itself as bright red blood in the stool (hematochezia).

While assessing the patient s bowel movement, the nurse notes bright red blood in the stool. The nurse will chart this finding as:

Curling Feedback: Curling ulcers are ischemic ulcers that occur following severe burn injuries.

A burn patient develops a stress ulcer. Which type of ulcer diagnosis will the nurse observe documented on the chart?

an emboli.

A cause of acute mesenteric (vascular) insufficiency can be:

the disease begins in the rectum and may advance back through the colon in a continuous manner. Feedback: Ulcerative colitis begins in the rectum and advances up through the colon in a continuous manner and does not "skip" parts of the mucosa.

A characteristic of ulcerative colitis is:

decreased intrinsic factor production results in decreased vitamin B12 absorption in the ileum. Feedback: The stomach secretes intrinsic factor, which is required for vitamin B12 absorption in the ileum.

Gastrectomy surgery commonly leads to a vitamin B12 deficiency anemia because:

eating. Feedback: Dysphagia, or difficulty swallowing, can be caused by hiatal hernia, achalasia, or gastroesophageal reflux. In patients with dysphagia, the risk of aspiration when eating is a major nursing concern.

When caring for a patient with dysphagia,the nurse should be particularly vigilent when the patient is:

Right lower Feedback: Most individuals with appendicitis present with periumbilical pain that increases in intensity over several hours and then "moves" to the right lower quadrant.

Which abdominal quadrant is most typically affected when a patient has appendicitis?

Vitamin B12 deficiency Feedback: Vitamin B12 malabsorption due to injury to the mucosa of the ileum is a common characteristic of Crohn's disease.

Which assessment finding is common in a patient with Crohn's disease?

Gastric cancer Feedback: Chronic damage to the stomach mucosa can cause cellular changes that lead to gastric cancer, achlorhydria, and mucosal erosions that can result in gastrointestinal bleeding.

Which complication should the nurse assess for in a patient with chronic gastritis?

Peritonitis Feedback: Perotinitis from loss of bowel wall integrity and perforation is a potential complication of bowel obstruction.

Which complication will the nurse monitor for in a patient with intestinal obstruction?

Ulcerative colitis Feedback: Risks for colorectal cancer include smoking, high-fat diet, alcohol consumption, obesity, and ulcerative colitis.

Which disease/condition increases the risk for developing colorectal cancer?

leakage of pancreatic enzymes into pancreatic tissue. Feedback: Tissue damage in acute pancreatitis is caused by leakage of pancreatic enzymes into pancreatic tissue and the resulting autodigestion of the gland.

Which information should the nurse include when describing the pathophysiology of acute pancreatitis? Tissue damage in acute pancreatitis is caused by:

Strangulation

Which of the following complications will cause the most concern for a nurse who is caring for a patient with a paraesophageal hiatal hernia?

Diet high in refined foods Feedback: Diverticula form when there is not enough stool bulk, which is related to a diet high in refined foods, and when there is weakening of the wall of the colon.

Which of the following diets is most prone to contribute to diverticulosis in a patient?

Colorectal cancer Feedback: Colorectal cancer is a common cause of lower gastrointestinal bleeding.

Which of the following disorders is most commonly associated with bright red blood in the stools?

Pancreatic insufficiency Feedback: Because the pancreas secretes lipase, proteases, and amylase, a decrease in pancreatic enzymes results in an inability to digest fats, proteins, and carbohydrates.

Which of the following disorders will the nurse observe documented on a chart for a patient who cannot digest fat, carbohydrates, and protein?

Elevating the head of the bed Feedback: Weight reduction, smoking cessation, and elevating the head of the bed 6 inches help to alleviate symptoms.

Which of the following interventions will the nurse include in a plan of care for a patient with gastroesophageal reflux disease (GERD)?

who has a family member with ulcerative colitis. Feedback: Ulcerative colitis often runs in families. Symptoms are related to autoimmune injury to the mucosal lining and the resulting inflammation.

Which of the following patients is most prone to ulcerative colitis? A patient:

Gastroesophageal reflux Feedback: Smoking, alcohol, and gastroesophageal reflux leading to Barrett esophagus all increase the risk of developing esophageal cancer, which has very poor survival rates.

Which of the following risk factors increases a person's chance of developing esophageal cancer?

Memory loss and confusion, leading to coma and asterixis Feedback: Hepatic encephalopathy results in abnormal neurotransmitter function and neuronal injury. Manifestations include mental status changes such as memory loss and confusion. As the condition develops, the patient will become comatose.

Which of the following symptoms will the nurse find on assessment of a patient with hepatic encephalopathy?

Abdominal pain and hematochezia Feedback: Abdominal pain and hematochezia, along with weight loss, changes in bowel movements, and bowel obstruction, are symptoms of colon cancer.

Which of the following typical symptoms should the nurse find on assessment of a patient with colon cancer?

Gastrointestinal bleeding Feedback: The first sign of stress ulcers is often acute gastrointestinal bleeding.

Which of the following will be an initial assessment finding for a stress ulcer in a patient who sustained severe trauma?