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Chapter 56 - GI

Chapter 56 - GI

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Chapter 56: Assessment of the Gastrointestinal System MULTIPLE CHOICE A. B. C. D. 1.

Parasympathetic stimulation of the gastrointestinal tract Increases motor and secretory activity and relaxation of sphincters. Maintains the tone of smooth muscles to stimulate movement. Slows movement, inhibits secretion and contracts sphincters. Decreases blood supplied to the gastrointestinal tract.

ANS: A Parasympathetic stimulation of the GI tract is provided by the vagus nerve causing increases in motor and secretory activity and relaxation of sphincters. 2. cavity? A. B. C. D. Which problem should the nurse anticipate in the client undergoing radiation for cancer of the oral

The client will fail to absorb most nutrients. The client will be able to digest carbohydrates but not proteins. The client will have an impairment in the softening and breaking down of food. The client will have difficulty propelling food from the mouth to the esophagus.

ANS: C Saliva is responsible for the softening of food in the mouth and contains an enzyme (ptyalin) that assists in the breakdown of carbohydrates. 3. A client with damage to cranial nerve X describes difficulty in moving food toward the rear of the mouth for swallowing. With which phase of swallowing is this client experiencing difficulty? A. Esophageal B. Pharyngeal C. Propulsant D. Voluntary ANS: D The movement of the tongue forcing food towards the pharynx is called the voluntary phase of swallowing. Paralysis of cranial nerve X would impede this function. 4. What alteration in function can be expected if parietal cells of the stomach become impaired? Gastric motility will be decreased. Secretion of gastrin will be increased. Secretion of pepsinogen will be increased. Absorption of vitamin B12 will be decreased.

A. B. C. D.

ANS: D Parietal cells of the stomach secrete hydrochloric acid and produce intrinsic factor, which aids in the absorption of vitamin B12. 5. A client has developed diabetes mellitus type 1 and no longer produces insulin. What cells of the pancreas have become dysfunctional?

A. B. C. D.

Beta cells Alpha cells Acinar cells Kupffer cells

ANS: A The endocrine part of the pancreas is composed of the islets of Langerhans, with alpha cells producing glucagon and beta cells producing insulin. 6. What is the role of the liver in response to increased energy requirements? Storage of fatty acids and triglycerides Activation of Kupffer cells Storage and release of glycogen Removal of ammonia

A. B. C. D.

ANS: C The liver’s role in carbohydrate metabolism involves the storage and release of glycogen as energy requirements change. An increase in energy requirements results in the release of glycogen. 7. What statement regarding changes to the gastric mucosa in an older adult is true? Peristalsis decreases and nerve impulses are dulled. Atrophy of gastric mucosa results in hypochlorhydria. Lipase production is decreased. Protein synthesis is decreased.

A. B. C. D.

ANS: B In older adults, the gastric mucosa atrophies. There is a decrease in the number of gastrin-secreting cells, which leads to hypochlorhydria. 8. Which of the following questions would be appropriate to ask the client in order to collect data concerning the Nutritional-Metabolic Pattern, according to Gordon’s Functional Health Patterns? A. “Have you noticed a change in the amount of urine passed?” B. “Have you experienced any recent changes in weight?” C. “What is your usual bowel elimination pattern?” D. “When was your last rectal examination?” ANS: B Data about changes in weight, food intake, and difficulties chewing or swallowing are reflective of the NutritionalMetabolic Pattern. All other choices reflect questions posed to collect data concerning the Elimination Pattern. 9. days? A. B. C. D. What question should the nurse ask to obtain information as to the origin of acute diarrhea times 4

“Have you traveled out of the country recently?” “Are you taking any anti-inflammatory drugs?” “Have you had a colonoscopy recently?” “Do you have trouble swallowing?”

ANS: A A history of travel may help pinpoint an infectious source of symptoms such as diarrhea. 10. During an initial assessment, a client with gastrointestinal problems reports the use of nonsteroidal anti-inflammatory drugs (NSAIDs) three times a day for arthritis pain. What would be the nurse’s best response? A. “NSAIDs are not helpful for arthritis pain.” B. “NSAIDs should be taken only twice daily.” C. “NSAIDs can interfere with the absorption of nutrients.” D. “NSAIDs can result in ulcers or bleeding.” ANS: D Long-term use of NSAIDs for chronic pain can precipitate peptic ulcer formation through the inhibition of prostaglandins. 11. Which of the following clients is most at risk of developing colon cancer? 54-year-old white female client with irritable bowel syndrome 60-year-old African American male who smokes occasionally 42-year-old Asian male who travels and eats out frequently 22-year-old female taking oral contraceptives

A. B. C. D.

ANS: B Colon cancer is more prevalent among African American men. 12. While examining the oral cavity of a client, the nurse detects a fruity odor to the client’s breath. The nurse should do which of the following? A. Instruct the client to use mouthwash after all meals. B. Instruct the client in good oral hygiene. C. Document the finding as the only action. D. Notify the physician. ANS: D A fruity odor to the breath may indicate uncontrolled or undiagnosed diabetes mellitus. The nurse should notify the physician or health care provider so that the appropriate steps to investigate this finding can be taken. 13. The nurse is preparing to perform an abdominal assessment on a client with a complaint of right upper quadrant tenderness. In what sequence should palpation be performed? A. Lower quadrants only B. Right upper quadrant first C. Right upper quadrant last D. Lower quadrants and left upper quadrant only ANS: C The sequence of palpation should be to palpate any tender or painful areas last to prevent the client from tensing abdominal muscles because of pain, thereby making the examination more difficult. 14. On inspection of the abdominal contour of a client with upper left quadrant pain, the nurse notes that the left abdominal contour appears asymmetric. What conclusion should the nurse draw from this finding?

A. B. C. D.

Left upper quadrant asymmetry is a normal finding. Left upper quadrant asymmetry can be caused by pregnancy. Left upper quadrant asymmetry can be indicative of a tumor or cyst. Left upper quadrant asymmetry is indicative of peristaltic movements.

ANS: C Left upper quadrant asymmetry can be indicative of a tumor or pancreatic cyst. 15. While auscultating the abdomen of a client, the nurse notes increased, loud, gurgling bowel sounds. What would be the nurse’s best action? A. Palpate the abdomen. B. Percuss the abdomen. C. Notify the physician. D. Document the finding as the only action. ANS: C The presence of increased, loud, gurgling bowel sounds is associated with hypermotility, which can be associated with diarrhea or gastroenteritis. This sound also is heard above a complete intestinal obstruction, and the physician should be notified because the client requires measures to relieve the obstruction, if present. 16. Which technique should the nurse use to measure the liver span of a client admitted with cirrhosis? A. Auscultation B. Percussion C. Inspection D. Palpation ANS: B Although the liver edge can be felt on palpation, percussion is used to determine the span of the liver and other solid organs. The nurse percusses down the midclavicular line below the right nipple until resonance changes to dullness. The nurse marks this area as the upper border of the liver. The nurse then percusses up from the iliac crest in the midclavicular line until the percussion notes change from tympany to dullness, indicating the lower border of the liver. The nurse marks this area and measures the distance between the two marks (the liver span), which is normally 5 to 10 cm. 17. The nurse is performing an abdominal assessment of a client and, during percussion, notes the presence of dullness forward of the tenth intercostal space at the left midaxillary line. What conclusion can the nurse draw from this finding? A. The client has splenomegaly. B. The client’s spleen is of normal size. C. The client’s spleen and pancreas are enlarged. D. The client’s spleen is obstructed by an enlarged heart. ANS: A The spleen is located at the tenth intercostal space in the left midaxillary line. If dullness is heard forward of the midaxillary line or in the left anterior axillary line, this is indicative of splenomegaly. 18. While performing an examination for rebound tenderness on a client with upper right quadrant

abdominal pain, the nurse notes a positive Blumberg’s sign. What action should the nurse take? A. Document this normal finding. B. Report this finding to the health care provider. C. Immediately follow with auscultation to detect bowel obstruction. D. Repeat the maneuver with the client in a supine position with the knees flexed. ANS: B A positive Blumberg’s sign is indicative of rebound tenderness and should be reported to the health care provider. 19. In a client admitted with cirrhosis of the liver, which serum levels would the nurse expect to be elevated? A. Serum amylase and lipase B. Serum ammonia C. Serum calcium D. Serum CEA ANS: B Serum ammonia levels are elevated in conditions that incur hepatocellular injury, such as cirrhosis of the liver. Increased serum amylase and lipase levels are indicators of pancreatitis. CEA levels are useful in assessing the success of cancer therapy or the recurrence of cancer.

20. On assessment of the abdomen of a client 24 hours post–barium swallow, the nurse notes decreased bowel sounds. The client reports having had no bowel movement for 2 days. What conclusion can be drawn from these findings? A. This is a normal finding following a barium swallow. B. These findings may indicate a barium impaction. C. The client requires an order for milk of magnesia. D. The client’s diet may need advancement to stimulate peristalsis. ANS: B Clinical manifestations such as decreased or absent bowel sounds, constipation, or obstipation after barium swallow are indicative of barium impaction and could lead to obstruction. These symptoms should be reported to the physician immediately. 21. What client instructions would be appropriate after a barium swallow? “Sit in bed with your head elevated to allow the barium to pass through.” “You may have stools that are darker in appearance for a few days.” “You may not eat or drink anything for 6 hours after the test.” “Drink plenty of fluids.”

A. B. C. D.

ANS: D The client is encouraged to drink plenty of fluids after a barium swallow to help eliminate the barium from the colon. 22. Which statement made by the client indicates a need for further teaching regarding the client’s preparation for a barium enema? A. “I will take nothing by mouth after midnight on the day of the examination.”

B. C. D.

“I will be given a laxative to take the evening before the examination.” “I will be asked to retain the barium during the examination.” “I will eat soft foods only for 12 to 24 hours before the examination.”

ANS: D The client is instructed to take only clear liquids 12 to 24 hours before the examination to reduce the amount of fecal material in the bowel. 23. A client has just returned to the unit after having a percutaneous transhepatic cholangiography. Which of the following should be included in the plan of care? A. The client can be discharged after voiding. B. The client should be kept NPO for 6 hours postprocedure. C. Position the client on the right side with a sandbag against the lower ribs. D. The client should ambulate with assistance only for the first 2 hours postprocedure. ANS: C The client should be positioned on the right side with a sandbag against the lower ribs to prevent bleeding. The nurse assesses the client’s vital signs and the lower right rib cage area for signs of bleeding.

24. A client is preparing to undergo an intravenous cholangiography. What instructions should be given to the client before the procedure? A. “The entire test will take less than 30 minutes.” B. “You may feel the urge to defecate during the procedure.” C. “You will feel a warm or flushing sensation when the contrast medium is injected.” D. “The examination table will be tilted in several different positions to facilitate passage of the contrast medium.” ANS: C The client is instructed to expect a warm or flushing sensation with injection of the contrast medium. The test takes 2 to 4 hours to complete. 25. The nurse is preparing a client for a CT (computed tomography) scanning of the abdomen with contrast. What question should be asked before the examination? A. “Are you allergic to iodine or seafood?” B. “Have you had anything to eat or drink within the past 12 hours?” C. “Have you finished drinking all the required fluid?” D. “Can you tolerate being tilted from side to side during the procedure?” ANS: A Allergies to iodine or seafood can mean a cross-allergic reaction to the contrast dye used for CT scans. Clients reporting such allergies are scheduled for CT without contrast to avoid anaphylactic reactions. 26. A client has returned to the unit after having an EGD (esophagogastroduodenoscopy) to evaluate a gastric ulcer. What safety measure should be instituted for this client? A. The client should be placed in lithotomy position to prevent aspiration. B. The client should be supine for 8 hours after the examination. C. The client should be kept NPO until the gag reflex returns.

D.

The client should be given midazolam (Versed) to reverse the sedation.

ANS: C The client should be kept NPO until the gag reflex returns. For an EGD, the throat is anesthetized to facilitate passage of the tube. The client's gag reflex will therefore be relaxed, and aspiration could occur. 27. Twenty-four hours after endoscopic retrograde cholangiopancreatography (ERCP), a client develops left upper quadrant abdominal pain and has a temperature of 101° F (38.3° C). What is the nurse’s best action? A. Administer acetaminophen for control of fever and pain. B. Document the finding, because it is a normal postprocedure event. C. Notify the health care provider. D. Increase the IV fluid rate. ANS: C The client who has undergone an ERCP may develop complications such as perforation or sepsis manifested by fever and abdominal pain. The nurse should report these symptoms to the health care provider immediately. 28. A client undergoing a colonoscopy experiences a decrease in pulse rate from 76 beats/min to 50 beats/min. What medication should the nurse be prepared to administer? A. Atropine B. Lidocaine C. Epinephrine D. Procainamide ANS: A The nurse should prepare to administer atropine, because a vasovagal reflex can be stimulated during the procedure, leading to bradycardia. 29. After a colonoscopy, a client reports that he is experiencing abdominal fullness and cramping. What is the nurse’s best action? A. Insert a rectal tube to assist in passing of flatus. B. Notify the physician immediately because a bowel perforation is suspected. C. Have the client consume only liquids for 4 to 6 hours after the test. D. Explain to the client that this feeling can be expected for several hours after the test. ANS: D Feelings of abdominal fullness, cramping, and the passing of flatus are normally expected after a colonoscopy. 30. The nurse is preparing a client for an ultrasound of the abdomen. What statement by the client indicates a need for further teaching? A. “I will need to consume extra liquids.” B. “I will empty my bladder completely before the test.” C. “I will lie on my back during the test.” D. “I will lie still during the test.” ANS: B

A full bladder is necessary for accurate visualization.

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