Porth's Patho: GI Chapter 37

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? -"Jogging usually increases acid in the stomach." -"Exercise increases acid build-up in the stomach." -"You should not eat before you exercise." -"There is backward movement of gastric contents into the esophagus that occurs soon after eating."

"There is backward movement of gastric contents into the esophagus that occurs soon after eating." The term 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.

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 who overeats excessive amounts of fatty foods -A client diagnosed with arthritis who takes acetaminophen twice per day -A client who has a history of a ruptured appendix -A client with a prior diagnosis of Helicobacter pylori and refused treatment

A client with a prior diagnosis of Helicobacter pylori and refused treatment The two most important risk factors for peptic ulcer disease are infection with the bacteria H. pylori and use of aspirin and/or NSAIDs. Acetaminophen does not place the client at risk for liver injury. A history of a ruptured appendix will not cause peptic ulcer. The high fat intake may contribute to the development of atherosclerosis.

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. -Ask the client about the foods he or she has consumed. -Ask the client about his or her fluid intake. -Ask the client about his or her normal bowel pattern.

Ask the client about his or her antibiotic use. The diagnosis of C. difficile-associated diarrhea requires a careful history, with particular emphasis on antibiotic use.

A child is experiencing frequent vomiting over the past 24 hours. What site in the neurologic system is responsible for vomiting? -Myenteric plexus -Vagus nerve -Intramural plexus -Chemoreceptor trigger zone

Chemoreceptor trigger zone The act of vomiting is integrated in the vomiting center, which is located in the dorsal portion of the reticular formation of the medulla near the sensory nuclei of the vagus. The vomiting center can be activated directly by irritants or indirectly following input from four different sources, one of which is the chemoreceptor trigger zone (which is activated by chemical agents such as drugs and toxins).

A nurse is conducting a health promotion class on healthy cooking. The nurse includes the importance of ensuring that all hamburgers are cooked completely before ingesting to prevent: -Escherichia coli -Entamoeba histolytica -Clostridium difficile -Rotavirus

Escherichia coli E. coli is found in the feces and contaminated milk of healthy dairy and beef cattle. Infection is by food-borne transmission, often by ingesting undercooked hamburger.

In the balance of secretions in the gastric mucosa by the parietal cells, which ion is produced to buffer the production of hydrochloric acid? -OH- -HCO3- -H2O -K+

HCO3- Normally the secretion of hydrochloric acid by the parietal cells of the stomach is accompanied by secretion of bicarbonate ions (HCO3-), which protects the mucosa from injury, as long as they are produced in equal amounts.

The nurse caring for a client with diverticulitis should assess for which clinical manifestation? -Increased abdominal distention -Frequent rectal bleeding -Lower left quadrant pain -Large-volume diarrhea

Lower left quadrant pain Diverticulitis is a complication of diverticulosis in which there is inflammation and gross or microscopic perforation of the diverticulum with possible abscess formation and without bleeding. One of the most common reports with diverticulitis is pain in the lower left quadrant, accompanied by nausea and vomiting. Appendicitis has an abrupt onset of general pain referred to the epigastric or periumbilical area. The large-volume form of diarrhea usually is a painless, watery type without blood or pus in the stools. Acute abdominal distention is associated with acute bowel obstruction or peritonitis.

Crohn disease not only affects adults but also can occur in children. The nurse assesses for which major manifestation in children with Crohn disease? -Dental caries -Malnutrition -Halitosis -Weight gain

Malnutrition When Crohn disease occurs in children, one of the major manifestations may be retardation of growth and significant malnutrition.

While assessing a client diagnosed with inflammatory bowel disease, the nurse should assess for which systemic manifestations? Select all that apply. -Thrombocytopenia -Mouth inflammation -Autoimmune anemia -Hypercoagulability of blood -Rheumatoid arthritis

Mouth inflammation Autoimmune anemia Hypercoagulability of blood Inflammatory bowel diseases produce inflammation of the bowel, with a lack of confirming evidence of a proven causative agent, have a pattern of familial occurrence, and can be accompanied by systemic manifestations. A number of systemic manifestations have been identified: osteoarthritis affecting the spine, sacroiliac joints, large joints of the arms and legs; inflammatory conditions of the eye; skin lesions, especially erythema nodosum; stomatitis; and autoimmune anemia, hypercoagulability of blood (rather than thrombocytopenia), and sclerosing cholangitis.

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? -Ulcerative colitis -Intussusception -Peritonitis -Peptic ulcer

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.

Rotavirus is most severe in children under 24 months of age. What is a typical symptom of rotavirus infection? -Fever that disappears after 7 days following antibiotic treatment -Projectile vomiting that lasts for the course of the disease -Vomiting that disappears around the second day but diarrhea continues -Mild to moderate fever that gets higher after the second day

Vomiting that disappears around the second day but diarrhea continues Rotavirus infection typically begins after an incubation period of less than 24 hours, with mild to moderate fever, and vomiting, followed by onset of frequent watery, stools. The fever and vomiting usually disappear on about the second day, but the diarrhea continues for 5 to 7 days. Dehydration may develop rapidly, particularly in infants.

A young adult male presents to the emergency department with a new onset of lower abdominal pain that has worsened significantly over the past 12 hours. Admission blood work shows stable electrolyte levels but leukocytosis. What nursing action is most appropriate? -Perform a fecal occult blood test -Assess the client's recent bowel patterns -Administer intravenous antibiotics as ordered -Withhold food and drinks in anticipation of surgery

Withhold food and drinks in anticipation of surgery The client's age and presentation are suggestive of appendicitis, which necessitates surgical removal. Antibiotics are insufficient on their own. Bowel involvement or GI bleeding is unlikely.

A rare condition caused by gastrin-secreting tumors most commonly found in the small intestine or pancreas is called: -Creutzfeldt-Jakob disease -Zollinger-Ellison syndrome -Stevens-Johnson syndrome -Sickle cell anemia

Zollinger-Ellison syndrome Zollinger-Ellison syndrome is a rare condition caused by a gastrin-secreting tumor (gastrinoma).

A middle-aged adult is diagnosed with diverticular disease based on recent history and the results of a computed tomography (CT) scan. Which statement demonstrates an accurate understanding of this diagnosis? -"I suppose I should try to eat a bit more fiber in my diet." -"I have always struggled with heartburn and indigestion, and I guess I should not have ignored those warning signs." -"From now on, I'm going to stick to an organic diet and start taking more supplements." -"I think this might have happened because I have used enemas and laxatives too much."

"I suppose I should try to eat a bit more fiber in my diet." Increased bulk/fiber is important in both the prevention and treatment of diverticular disease. Overuse of laxatives is not linked to diverticular disease, and heartburn and indigestion are not specific signs of the problem. An organic diet and the use of dietary supplements are not key treatments.

Select the client at greatest risk for developing colorectal cancer. -A 40-year-old male with a history of peptic ulcer disease -A 64-year-old female whose mother had colorectal cancer -A 26-year-old male with a history of irritable bowel syndrome -A 45-year-old female who takes four to six aspirin per week for arthritis

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.

Which individual most likely faces the greatest risk of developing Clostridium difficile colitis? -A premature neonate who has developed hyperbilirubinemia and is receiving phototherapy -A 30-year-old client who has a history of Crohn disease and has been admitted to a hospital to treat a recent flare-up -A 79-year-old hospital client who is being treated with broad-spectrum antibiotics -A 55-year-old client who takes proton pump inhibitors for the treatment of peptic ulcers

A 79-year-old hospital client who is being treated with broad-spectrum antibiotics C. difficile colitis is associated with antibiotic therapy; C. difficile is noninvasive, and development of C. difficile colitis requires disruption of normal intestinal flora. Peptic ulcers, hyperbilirubinemia, and Crohn disease are not common risk factors for the development of C. difficile colitis.

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 -A client with a long-standing diagnosis of irritable bowel syndrome -An obese client who refuses to ambulate because he reports shortness of breath -A client whose acute diarrhea has necessitated the use of antidiarrheal medications

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.

Irritable bowel syndrome is thought to be present in 10% to 15% of the population in the United States. What is its hallmark symptom? -Diarrhea and abdominal pain unrelieved by defection -Abdominal pain relieved by defecation with a change in consistency or frequency of stools -Nausea and abdominal pain unrelieved by defecation -Abdominal pain relieved by defecation and bowel impaction

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.

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? -Gastric cancer -Staphylococcal infection -Helicobacter pylori infection -Acute gastritis

Acute gastritis Aspirin is often implicated in cases of acute gastritis. H. pylori, gastric cancer, and staphylococcus infections do not normally cause reflux (heartburn) and are not directly linked to aspirin use.

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: -A sinus infection that causes severe headaches -Drinking a glass of red wine once a week -Consuming a diet that is high in fiber and prepared with multiple spices -Arthritis treated with high levels of nonsteroidal anti-inflammatory (NSAIDs) agents

Arthritis treated with high levels of nonsteroidal anti-inflammatory (NSAIDs) agents Acute gastritis is most commonly associated with local irritants such as aspirin or other NSAIDs, alcohol, or bacterial toxins. A high-fiber diet and occasional alcohol consumption are not causes. The severe headache may cause stress or nausea but does not cause gastritis.

A client presents with a perforated peptic ulcer. Which complication would be a priority for the nurse to assess for? -Blood pressure of 120/80 mm Hg -Assessment of a rigid, boardlike abdomen -Complaint of burning pain on an empty stomach -Flatulence with bouts of diarrhea

Assessment of a rigid, boardlike abdomen Perforation occurs when an ulcer erodes through all the layers of the stomach or duodenum wall. With perforation, gastrointestinal contents enter the peritoneum and cause peritonitis. Assessment of peritonitis is a rigid, boardlike abdomen.

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? -Occult blood -Chemotherapy -Barium x-ray -Blood test

Barium x-ray Diagnosis of gastric cancer is accomplished by a variety of techniques, including barium x-ray studies, endoscopic studies with biopsy, and cytologic studies of gastric secretions. Cytologic studies can prove particularly useful as routine screening tests for persons with atrophic gastritis or gastric polyps. Computed tomography and endoscopic ultrasonography often are used to delineate the spread of a diagnosed stomach cancer. Treatment of choice, depending on location and extent, are surgery, irradiation, and chemotherapy.

A nurse is reviewing common causes of constipation with a client. Select all that apply. -Increased dietary fiber -Bed rest -Pregnancy -Increased physical exercise -Hemorrhoids -Inadequate fluid intake -Weakness of abdominal muscles

Bed rest Pregnancy Hemorrhoids Inadequate fluid intake Weakness of abdominal muscles Common causes of constipation are failure to respond to the urge to defecate, inadequate fiber in the diet, inadequate fluid intake, weakness of the abdominal muscles, inactivity and bed rest, pregnancy, and hemorrhoids. Moderate physical exercise is essential in treatment, as is bulk in the diet.

A client is diagnosed with Zollinger-Ellison syndrome. Which clinical manifestations confirm this diagnosis? Select all that apply. -Burning, gnawing pain when the stomach is empty -Continuous vomiting lasting many days at a time -Pain located near the midline close to the xiphoid process -Excessive belching and burping following meals

Burning, gnawing pain when the stomach is empty Pain located near the midline close to the xiphoid process Zollinger-Ellison syndrome is a rare condition caused by gastrin-secreting tumors that are most commonly found in the small intestine or pancreas. Gastric acid secretions reach levels that ulceration becomes inevitable. Excessive belching and burping following meals are associated with GERD. Continuous vomiting lasting many days at a time may be associated with a neurologic event or may be drug related (e.g., chemotherapy).

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? -M. tuberculosis -S. aureus -C. difficile -H. pylori

C. difficile Inflammatory diarrhea is usually characterized by the presence of fever and bloody diarrhea. It is caused by bacterial invasion of intestinal cells (e.g., Shigella, Salmonella, Yersinia, and Campylobacter) or the toxins associated with C. difficile or E. coli O157:H7 infection. H. pylori can cause gastritis, and M. tuberculosis can result in the development of tuberculosis. S. aureus can cause noninflammatory diarrhea.

A health care provider suspects a client has developed diverticular disease. Which diagnostic test is usually prescribed to confirm the diagnosis? -Barium enema -Positron-emission tomography (PET) scan -Computed tomography (CT) scan -Flat-plate of the abdomen

CT Diverticular disease may be determined by CT scan or ultrasound. CT scans are the safest and most cost-effective. Due to the risk of peritonitis, barium enema studies should be avoided, and flat-plate radiographs may be used to detect complications. A PET scan measures important body functions, such as blood flow, oxygen use, and sugar (glucose) metabolism.

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 reason? -Clients are afraid to talk about their symptoms. -The progression of the disease is rapid. -Diagnostic testing is not available for detection of the disease. -Clients have few early symptoms of the disease.

Clients have few early symptoms of the disease. Although the incidence of cancer of the stomach has declined over the past 50 years in the United States, it remains the leading cause of death worldwide. Because there are few early symptoms with this form of cancer, the disease is often far advanced at the time of diagnosis. Diagnosis of gastric cancer is accomplished by a variety of techniques, including barium x-ray studies, endoscopic studies with biopsy, and cytologic studies (e.g., Papanicolaou smear) of gastric secretions. Chronic infection with Helicobacter pylori appears to serve as a cofactor in some types of gastric carcinomas. The bacterial infection causes gastritis, followed by atrophy, intestinal metaplasia, and carcinoma.

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? -Dehydration -Inability to eat -Colonization of Clostridium difficile -Transmission of Escherichia coli

Colonization of Clostridium difficile Clostridium difficile colitis is associated with antibiotic therapy. Almost any antibiotic may cause C. difficile colitis, but broad-spectrum antibiotics with activity against Gram-negative enteric bacteria are the most frequent agents. After antibiotic therapy has made the bowel susceptible to infection, colonization by C. difficile occurs by the oral-fecal route.

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? -Stool specimen -Ova and parasite examination -Colonoscopy -Physical examination

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.

A young man presents reporting 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 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 -Ulcerative colitis -Diverticulitis -Colon cancer

Crohn disease Crohn disease, like ulcerative colitis, causes diarrhea, fecal urgency, weight loss, and systemic symptoms such as erythema nodosum and arthritis. Unlike ulcerative colitis, it also causes steatorrhea but is not as likely to cause blood in the stool. The granulomatous "skip" lesions confirm the diagnosis of Crohn disease. Neither diverticulitis nor colon cancer would cause this combination of symptoms and signs.

A nurse reading a sigmoidoscopy report notes that a client was found to have skip lesions. The nurse interprets this as an indication of: -Zollinger-Ellison syndrome -Ulcerative colitis -Peptic ulcer -Crohn disease

Crohn disease Skip lesions, demarcated granulomatous lesions that are surrounded by normal-appearing mucosal tissue, are a characteristic feature of Crohn disease.

A client who is diagnosed with Zollinger-Ellison syndrome will exhibit which symptoms? -Nausea with vomiting -Elevated blood sugar -Chronic constipation -Diarrhea with fat deposits

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 client with quadriplegia adheres to a regular bowel protocol. Which action performed by the client's caregiver is likely to promote defecation? -Digital stimulation of the client's rectum -Massage of the client's abdomen -Administration of large amounts of free water -Seating the client in an upright position

Digital stimulation of the client's rectum When the nerve endings in the rectum are stimulated, signals are transmitted first to the sacral cord and then reflexively back to the descending colon, sigmoid colon, rectum, and anus by the pelvic nerves. These impulses greatly increase peristaltic movements as well as relax the internal sphincter, resulting in defecation. Massage, increased fluid intake, and upright positioning are less likely to promote defecation.

A client complains of having bouts of diarrhea. The client wants to know which antidiarrheal would be best to use. Which antidiarrheal does the nurse know will help stimulate water and electrolyte absorption? -Sucralfate -Sodium polystyrene -Diphenoxylate -Bismuth subsalicylate

Diphenoxylate Drugs in the treatment of diarrhea include diphenoxylate and loperamide, which are opium-like drugs. These drugs decrease gastrointestinal motility and stimulate water and electrolyte absorption. Bismuth subsalicylate can be used to reduce the frequency of unformed stools and increase stool consistency, particularly in cases of traveler's diarrhea.

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)? -Endoscopic biopsy -Carbon urea breath test -Radiographic test -Stool antigen 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: -Increasing acid production -Promoting special diet -Eradicating Helicobacter pylori (H. pylori) -Neutralizing blood count

Eradicating Helicobacter pylori (H. pylori) Treatment of peptic ulcer is aimed at eradicating the cause and promoting a permanent cure for the disease. Pharmacologic treatment focuses on eradicating H. pylori, relieving ulcer symptoms, and healing the ulcer crater. Acid-neutralizing, acid-inhibiting drugs and mucosa-protective agents are used to relieve symptoms and promote healing of the ulcer crater. There is no evidence that special diets are beneficial in treating peptic ulcer.

A teenager has been diagnosed with failure to thrive possibly due to malabsorption syndrome. In addition to having diarrhea and bloating, the client more than likely has what hallmark manifestation of malabsorption? -Feeling there is incomplete emptying of the bowel -Abdominal distention -Esophageal reflux with heartburn -Fatty, yellow-gray, foul-smelling stools

Fatty, yellow-gray, foul-smelling stools General symptoms of malabsorption syndrome include diarrhea, flatulence, bloating, cramping, and weight loss. A hallmark of malabsorption is steatorrhea, characterized by fatty, yellow-gray, and foul-smelling stools. Feeling there is incomplete emptying of the bowel is one of the signs and symptoms of colon cancer. Abdominal distention occurs with many gastrointestinal diseases and is not specific to malabsorption syndrome. Esophageal reflux with heartburn is usually associated with gastroesophageal reflux disease.

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? -Sexual transmission -Iatrogenic transmission -Vertical transmission -Fecal-oral transmission

Fecal-oral transmission After antibiotic therapy has made the bowel susceptible to infection, colonization by C. difficile occurs by the oral-fecal route. C. difficile infection usually is acquired in the hospital, where the organism is most commonly encountered.

A teenager who has a history of achalasia will likely complain of which clinical manifestation? -Vomiting large amounts of bright red emesis -Feeling like there is food stuck in the back of the throat -Excessive heartburn following a high-fat meal of french fries -Projectile vomiting across the room unrelated to meals

Feeling like there is food stuck in the back of the throat Achalasia produces functional obstruction of the esophagus so that food has difficulty passing into the stomach, and the esophagus above the lower esophageal sphincter becomes distended. Symptoms following high-fat intake are usually associated with gallbladder disease. Projectile vomiting is usually related to increased intracranial pressure. Vomiting blood can be associated with esophagitis, erosion of the esophagus, bleeding esophageal varices, or esophageal cancer.

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 -Constipation -Rectal bleeding -Dysphagia

Fistula formation In Crohn disease all layers of the bowel are involved. Complications of Crohn disease include fistula formation, abdominal abscess formation, and intestinal obstruction. Fistulas are tubelike passages that form connections between different sites in the GI tract.

Helicobacter pylori gastritis is thought to be caused by a previous infection when the client was younger. Chronic gastritis caused by H. pylori can lead to which possible condition? -Gastric atrophy -Decreased risk of multiple myeloma -Decreased risk of gastric adenocarcinoma -Duodenal ulcer formation

Gastric atrophy Helicobacter pylori gastritis can be a chronic infection that can lead to gastric atrophy and peptic ulcer and is associated with increased risk of gastric adenocarcinoma and low-grade B-cell gastric lymphoma (mucosa-associated lymphoid tissue [MALToma]).

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? -Gastrointestinal reflux -Rotavirus infection -Peptic ulcer disease -Irritable bowel syndrome

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.

Which type of inflammation is characteristic of Crohn disease? -Ulcerative erosions -Fibrotic smooth muscle -Granulomatous lesions -Necrotic crypt abscesses

Granulomatous lesions Crohn disease is a recurrent, granulomatous type of inflammatory response with formation of multiple sharply demarcated, granulomatous lesions that are surrounded by normal-appearing mucosal tissue. There is usually a relative sparing of the smooth muscle layers of the bowel, with marked submucosal layer inflammatory and fibrotic changes. Characteristic of ulcerative colitis (rather than Crohn disease) are crypts of Lieberkuhn lesions in the base of the mucosal layer, formation of pinpoint mucosal hemorrhages, and development of crypt abscesses that become necrotic.

The most common forms of peptic ulcer are duodenal and gastric ulcers. What are the most common risk factors for peptic ulcer disease? -Antibiotic -Spicy foods -Sucralfate -Helicobacter pylori (H. pylori)

Helicobacter pylori (H. pylori) Perforation occurs when an ulcer erodes through all the layers of the stomach or duodenum wall. H. pylori promotes the development of peptic ulcers by inducing inflammation and stimulation of cytokines and other mediators of inflammation that contribute to mucosal damage. There is no convincing evidence that dietary factors play a role in development of peptic ulcers.

A client is diagnosed with Crohn disease. The nurse instructs the client on which type of dietary needs? -High-residue diet -High-fruit and vegetable intake -High-calorie, vitamin, and protein diet -High-fat diet, low calorie

High-calorie, vitamin, and protein diet Nutritional deficiencies are common in Crohn disease because of diarrhea, steatorrhea, and other malabsorption problems. A nutritious diet that is high in calories, vitamins, and proteins is recommended. Because fats often aggravate the diarrhea, it is recommended they be avoided. Elemental diets, which are nutritionally balanced but residue-free and bulk-free, may be given during the acute phase of the illness.

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? -Decrease in gastrointestinal motility -Enhancement of sphincter function -Increase in parasympathetic nervous system activity -Increase in smooth muscle tone

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 provider is counseling an older adult client who is having difficulty passing stool regularly. Which interventions should the provider recommend? Select all that apply. -Decrease the amount of whole grains and vegetables. -Increase the amount of potassium in the diet. -Increase the amount of milk and cheese in the diet. -Increase the amount of water intake. -Include more walking in the daily routine.

Increase the amount of water intake. Include more walking in the daily routine. Constipation, or infrequent passage of hard stool, is a frequently occurring phenomenon in older adults. It often is attributed to immobility and decreased physical activity, a low fiber diet, decreased fluid intake, and medications. Increasing the amount of water and walking may help to alleviate constipation.

Crohn disease is treated by several measures. Treatment with sulfasalazine will focus on which aspect of this disease? -Increased appetite -Decreased bleeding tendency -Immune suppression -Inflammatory suppression

Inflammatory suppression Treatment methods focus on terminating the inflammatory response and promoting healing, maintaining adequate nutrition, and preventing and treating complications. Several medications have been successful in suppressing the inflammatory reaction, including corticosteroids, sulfasalazine, metronidazole, azathioprine, 6-mercaptopurine, methotrexate, and infliximab.

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? -Increasing the rate of gastric emptying -Increasing muscle tone of the cardiac sphincter -Promoting hypertrophy of the gastric mucosa -Inhibiting gastric acid production

Inhibiting gastric acid production Current therapies for peptic ulcer disease are aimed at neutralization of gastric acid, inhibition of gastric acid (H2 antagonists and proton pump inhibitors), and promotion of mucosal protection. Growth of the mucosa itself, strengthening the gastrointestinal (GI) sphincters, and changing the rate of stomach emptying are not goals of the usual pharmacologic treatments for peptic ulcers.

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 -Right lower quadrant pain with nausea and vomiting -Mid-epigastric pain with nausea and vomiting -Right lower quadrant pain with rebound tenderness on the left

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 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? -Signs and symptoms of diverticula -History of cesarean birth or other abdominal surgery -History of hemorrhoids or rectal fissures -Medication regimen for drugs like anticholinergic agents or calcium

Medication regimen for drugs like anticholinergic agents or calcium Constipation is attributable to numerous factors, including low fluid intake and medications. Drugs such as narcotics, 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 client 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 problem? -Obstruction -Obtrusion -Perforation -Penetration

Obstruction Outlet obstruction is caused by edema, spasm, or contraction of scar tissue and interference with the free passage of gastric contents through the pylorus or adjacent areas. The presentation of an obstruction is typically insidious, with symptoms of early satiety, feeling of epigastric fullness and heaviness after meals, gastroesophageal reflux, weight loss, and abdominal pain. With severe obstruction, there is vomiting of undigested food.

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. -Obstruction -Hemorrhage -Increased urinary output -Weight gain -Perforation

Obstruction Hemorrhage Perforation The most common complications of peptic ulcer are hemorrhage, perforation, and gastric outlet obstruction. Weight gain and increased urinary output would not occur as the client may experience volume loss.

An ultrasound confirms appendicitis as the cause of a client's sudden abdominal pain. Which etiologic process is implicated in the development of appendicitis? -Elimination of normal intestinal flora -Increased osmolality of intestinal contents -Obstruction of the intestinal lumen -Sloughing of the intestinal mucosa

Obstruction of the intestinal lumen Appendicitis is thought to be related to intraluminal obstruction with a fecalith, gallstones, tumors, parasites, or lymphatic tissue. Osmotic and bacterial changes are not thought to induce appendicitis, and the intestinal mucosa does not slough off either before or during episodes of appendicitis.

The health care provider thinks a teenager is having clinical manifestations of irritable bowel syndrome. Which complaints would support this diagnosis? Select all that apply. -Pain is relieved by defecation. -Belching makes the pain go away. -Pain is worse after and between meals. -Pain is most severe at night. -Pain is described as "cramping" in the lower abdomen.

Pain is relieved by defecation Pain is described as "cramping" in the lower abdomen. 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. Irritable bowel disease is characterized by persistent or recurrent symptoms of abdominal pain, altered bowel function, and varying complaints of flatulence, bloating, nausea and anorexia, constipation or diarrhea, and anxiety or depression. Abdominal pain usually is intermittent, is described as cramping in the lower abdomen, and does not usually occur at night or interfere with sleep. Inflammatory bowel disease is characterized by blood in stool. Peptic ulceration pain occurs when the stomach is empty.

An older adult client presents with a perforation of a peptic ulcer. The nurse will monitor for signs and symptoms of which problem? -Vomiting -Diarrhea -Fecal impaction -Peritonitis

Peritonitis Perforation occurs when an ulcer erodes through all the layers of the stomach or duodenum wall. With perforation, gastrointestinal contents enter the peritoneum and cause peritonitis.

The nurse knows that the student understands the major causes of mechanical bowel obstruction when the student states that _____ is a possible cause? -Postoperative adhesions -Abdominal distention -Ruptured appendix -Chemical irritation

Postoperative adhesions Major triggering causes of 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 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: -Perforated appendix -Periumbilical tenderness -Rebound tenderness -Referred tenderness

Rebound tenderness The nurse documents the presence of rebound tenderness, defined as tenderness that occurs when the nurse applies and then releases pressure to an area.

Which protective measure of the peritoneum helps keep abdominal inflammation and infection localized? -Causes abdominal vasoconstriction -Increases intestinal motility -Constricts bowel contents -Secretes fibrinous substance

Secretes fibrinous substance The peritoneum produces an inflammatory response as a means of controlling infection. It tends, for example, to exude a thick, sticky, and fibrinous substance that adheres to other structures, such as the mesentery and omentum, as a means of sealing off the perforation and localizing the process. Localization is enhanced by sympathetic stimulation that limits/decreases intestinal motility. The peritoneum is connective tissue without the ability to constrict. The vasoconstriction can decrease dissemination of the bacteria in the blood but also causes ischemic bowel damage that may be irreversible.

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? -Primarily rectum and colon involvement -Skip lesions -Development of cancer -Continuous involvement of the colon starting at the rectum

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.

Which meal choice is most likely to exacerbate an individual's celiac disease? -Spaghetti with meatballs and garlic bread -Barbecued steak and a baked potato with sour cream -Oatmeal with milk, brown sugar, and walnuts -Stir-fried chicken and vegetables with rice

Spaghetti with meatballs and garlic bread Celiac disease is treated by the removal of wheat, barley, and rye from the diet, all of which contain gluten. Both spaghetti and garlic bread are wheat based and would exacerbate celiac disease. The other noted meals do not contain these grains.

Which clinical manifestation would lead the nurse to suspect the client has malabsorption syndrome with a deficiency in fat absorption? -Glossitis -Dry eyes -Abdominal cramping -Steatorrhea

Steatorrhea In malabsorption syndrome, there is loss of fat in the stools and failure to absorb the fat-soluble vitamins. This can result in weight loss, steatorrhea, and fat-soluble vitamin deficiency. Cramping is associated with water/electrolyte imbalances. Eye problems like dry eyes is due to malabsorption of vitamin A. Glossitis is associated with folic acid deficiency.

The client who has experienced third-degree burns is susceptible to which specific type of gastrointestinal (GI) ulceration? -Duodenal -Stress -Peptic -Gastric

Stress Stress ulcers refer to GI ulcerations that develop in people with large-surface-area burns.

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: -Ulcerative colitis -Stress ulcer -Malabsorption syndrome -Crohn disease

Stress ulcer Proton pump inhibitors are the first line of medications used in the prevention of stress ulcers.

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 -Chemotherapy -Radiation therapy -Pharmacologic therapies

Surgery The only recognized treatment for cancer of the colon and rectum is surgical removal. Postoperative radiation therapy may be used and has in some cases demonstrated increased 5-year survival rates. Postoperative adjuvant chemotherapy may be used. Radiation therapy and chemotherapy are used as palliative treatment methods as well.

A busy 45-year-old female executive has been diagnosed with diverticulitis. Her primary treatment is an increase in the fiber content of her diet. What effect will the fiber have on the diverticula? -The fiber pulls water into the colon, increasing the intraluminal pressure, ensuring that fecal material will not become stagnant. -The fiber increases bulk, promotes regular defecation, and increases colonic contents and colon diameter, thereby decreasing intraluminal pressure. -The fiber cleans out the diverticula, allowing for a remittance of inflammation. -The fiber stimulates a myogenic muscle contraction in the wall of the intestines that will force the forward movement of fecal material, thereby preventing diverticula formation.

The fiber increases bulk, promotes regular defecation, and increases colonic contents and colon diameter, thereby decreasing intraluminal pressure. The treatment for diverticulitis includes increasing the bulk in the diet and bowel retraining so that the person has at least one bowel movement each day. The increased bulk promotes regular defecation and increases colonic contents and colon diameter, thereby decreasing intraluminal pressure. Increases in pressure will make the condition worse.

A physician's orders for a client to be started on total parenteral nutrition (TPN). The nurse knows that TPN is a hypertonic solution and must be administered in which way? -Through a peripheral line -Through a Dobhoff feeding tube -Through a large-diameter central line -Through a nasogastric tube

Through a large-diameter central line TPN consists of intravenous administration of hypertonic glucose solutions, to which amino acids and fats may be added. Because of the hypertonicity of these solutions, they must be administered through a large-diameter central vein.

Helicobacter pylori proteobacteria cause peptic ulceration by producing which substance that interferes with local protection of gastric acid? -Ischemia -Bleeding -Acids -Toxins

Toxins Most cases of peptic ulcer are caused by H. pylori, which is a small, curved, Gram-negative rod that can colonize the mucus-secreting epithelial cells of the stomach; these bacteria secrete urease, which enables them to produce ammonia to buffer the acidity of their immediate environment. H. pylori is nonerosive and produces enzymes and toxins that have the capacity to interfere with mucosal protection against gastric acid, produce intense inflammation, and elicit an immune response. The characteristic pain is relieved by food or antacids. Ischemia is a cause of stress ulcers, which is manifested by painless upper gastrointestinal tract bleeding.

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? -Urease -Trypsin -Glycine -Protease

Urease As the most common cause of chronic gastritis, H. pylori 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.

Which complication may result when a client has malabsorption syndrome? -Vitamin K deficiency -Impaired mucus production -Impaired immune system -Excessive release of pepsin

Vitamin K deficiency Malabsorption syndrome can result in a loss of fat in the stools, therefore causing failure to absorb the fat-soluble vitamins and resulting in vitamin K deficiency. It does not curtail mucus production or immune metabolism, and it does not precipitate excessive release of pepsin.

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? -Diarrhea -Nausea -Vomiting -Anorexia

Vomiting Vomiting is the only protective response that removes noxious agents from the GI tract, although anorexia, nausea, and diarrhea are common physiologic responses to many GI disorders.

A nurse caring for a client with an intestinal obstruction anticipates which assessment findings? Select all that apply. -Vomiting -Diarrhea -Abdominal pain -Abdominal distension

Vomiting Abdominal pain Abdominal distension The nurse would anticipate the following when assessing a client with an intestinal obstruction: constipation, abdominal distension, vomiting, pain, and signs of fluid volume deficit.

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: -dysphagia secondary to scleroderma. -a hiatal hernia. -gastrointestinal reflux disease. -squamous cell carcinoma of the esophagus.

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.

A client is admitted to the hospital with a suspected diagnosis of strangulated bowel. The nurse anticipates the client will need: -insertion of a nasogastric tube. -surgery to release the bowel. -low fiber diet for 24 hours. -lower abdominal massage

surgery to release the bowel. Strangulation and complete bowel obstruction require surgical intervention. Nasogastric tubes are used for adynamic obstructions that result from neurogenic or muscular impairment of peristalsis. Massage or diet would not relieve strangulation.