Chapter 25: GI Flashcards
- What test is used to screen for carbohydrate malabsorption?
a. Stool pH
b. Urine ketones
c. C urea breath test
d. ELISA stool assay
ANS: A Stool pH
The anticipated pH of a stool specimen is 7.0. A stool pH of less than 5.0 is indicative of carbohydrate
malabsorption. The bacterial fermentation of carbohydrates in the colon produces short-chain fatty acids, which lower the stool pH. Urine ketones detect the presence of ketones in the urine, which indicates the use of
alternative sources of energy to glucose. The C urea breath test measures the amount of carbon dioxide
exhaled. It is used to determine the presence of Helicobacter pylori. ELISA (enzyme-linked immunosorbent
assay) detects the presence of antigens and antibodies. It is not useful for disorders of metabolism.
- A toddlers mother calls the nurse because she thinks her son has swallowed a button type of battery. He has
no signs of respiratory distress. The nurses response should be based on which premise?
a. An emergency laparotomy is very likely.
b. The location needs to be confirmed by radiographic examination.
c. Surgery will be necessary if the battery has not passed in the stool in 48 hours.
d. Careful observation is essential because an ingested battery cannot be accurately detected.
ANS: B. The location needs to be confirmed by radiographic examination.
Button batteries can cause severe damage if lodged in the esophagus. If both poles of the battery come in
contact with the wall of the esophagus, acid burns, necrosis, and perforation can occur. If the battery is in the
stomach, it will most likely be passed without incident. Surgery is not indicated. The battery is metallic and is
readily seen on radiologic examination
- The mother of a child with cognitive impairment calls the nurse because her son has been gagging and
drooling all morning. The nurse suspects foreign body ingestion. What physiologic occurrence is most likely
responsible for the presenting signs?
a. Gastrointestinal perforation may have occurred.
b. The object may have been aspirated.
c. The object may be lodged in the esophagus.
d. The object may be embedded in stomach wall
ANS: C. The object may be lodged in the esophagus.
Gagging and drooling may be signs of esophageal obstruction. The child is unable to swallow saliva, which
contributes to the drooling. Signs of gastrointestinal (GI) perforation include chest or abdominal pain and
evidence of bleeding in the GI tract. If the object was aspirated, the child would most likely have coughing, choking, inability to speak, or difficulty breathing. If the object was embedded in the stomach wall, it would
not result in symptoms of gagging and drooling.
- What is a high-fiber food that the nurse should recommend for a child with chronic constipation?
a. White rice
b. Popcorn
c. Fruit juice
d. Ripe bananas
ANS: B. Popcorn
Popcorn is a high-fiber food. Refined rice is not a significant source of fiber. Unrefined brown rice is a fiber
source. Fruit juices are not a significant source of fiber. Raw fruits, especially those with skins and seeds, other
than ripe bananas, have high fiber.
- A 2-year-old child has a chronic history of constipation and is brought to the clinic for evaluation. What
should the therapeutic plan initially include?
a. Bowel cleansing
b. Dietary modification
c. Structured toilet training
d. Behavior modification
ANS: A. Bowel cleansing
The first step in the treatment of chronic constipation is to empty the bowel and allow the distended rectum to
return to normal size. Dietary modification is an important part of the treatment. Increased fiber and fluids
should be gradually added to the childs diet. A 2-year-old child is too young for structured toilet training. For
an older child, a regular schedule for toileting should be established. Behavior modification is part of the
overall treatment plan. The child practices releasing the anal sphincter and recognizing cues for defecation.
- What statement best describes Hirschsprung disease?
a. The colon has an aganglionic segment.
b. It results in frequent evacuation of solids, liquid, and gas.
c. The neonate passes excessive amounts of meconium.
d. It results in excessive peristaltic movements within the gastrointestinal tract.
ANS: A. The colon has an aganglionic segment
Mechanical obstruction in the colon results from a lack of innervation. In most cases, the aganglionic segment
includes the rectum and some portion of the distal colon. There is decreased evacuation of the large intestine
secondary to the aganglionic segment. Liquid stool may ooze around the blockage. The obstruction does not
affect meconium production. The infant may not be able to pass the meconium stool. There is decreased
movement in the colon
- What procedure is most appropriate for assessment of an abdominal circumference related to a bowel
obstruction?
a. Measuring the abdomen after feedings
b. Marking the point of measurement with a pen
c. Measuring the circumference at the symphysis pubis
d. Using a new tape measure with each assessment to ensure accuracy
ANS: B. Marking the point of measurement with a pen
Pen marks on either side of the tape measure allow the nurse to measure the same spot on the childs abdomen
at each assessment. The child most likely will be kept NPO (nothing by mouth) if a bowel obstruction is present. If the child is being fed, the assessment should be done before feedings. The symphysis pubis is too
low. Usually the largest part of the abdomen is at the umbilicus. Leaving the tape measure in place reduces the trauma to the child.
- A 3-year-old child with Hirschsprung disease is hospitalized for surgery. A temporary colostomy will be
necessary. How should the nurse prepare this child?
a. It is unnecessary because of childs age.
b. It is essential because it will be an adjustment.
c. Preparation is not needed because the colostomy is temporary.
d. Preparation is important because the child needs to deal with negative body image.
ANS: B. It is essential because it will be an adjustment.
The childs age dictates the type and extent of psychologic preparation. When a colostomy is performed, it is
necessary to prepare the child who is at least preschool age by telling him or her about the procedure and what
to expect in concrete terms, with the use of visual aids. The preschooler is not yet concerned with body image.
- A child has a nasogastric (NG) tube after surgery for Hirschsprung disease. What is the purpose of the NG
tube?
a. Prevent spread of infection.
b. Monitor electrolyte balance.
c. Prevent abdominal distention.
d. Maintain accurate record of output
ANS: C. Prevent abdominal distention.
The NG tube is placed to suction out gastrointestinal secretions and prevent abdominal distention. The NG tube
would not affect infection. Electrolyte content of the NG drainage can be monitored. Without the NG tube,
there would be no drainage. After the NG tube is placed, it is important to maintain an accurate record of
intake and output. This is not the reason for placement of the tube.
- A parent of an infant with gastroesophageal reflux asks how to decrease the number and total volume of
emesis. What recommendation should the nurse include in teaching this parent?
a. Surgical therapy is indicated.
b. Place in prone position for sleep
after feeding.
c. Thicken feedings and enlarge the nipple hole.
d. Reduce the frequency of feeding by encouraging larger volumes of formula.
ANS: C. Thicken feedings and enlarge the nipple hole.
Thickened feedings decrease the childs crying and increase the caloric density of the feeding. Although it does
not decrease the pH, the number and volume of emesis are reduced. Surgical therapy is reserved for children
who have failed to respond to medical therapy or who have an anatomic abnormality. The prone position is not
recommended because of the risk of sudden infant death syndrome. Smaller, more frequent feedings are more
effective than less frequent, larger volumes of formula.
11. After surgery yesterday for gastroesophageal reflux, the nurse finds that the infant has somehow removed the nasogastric (NG) tube. What nursing action is most appropriate to perform at this time?
a. Notify the practitioner.
b. Insert the NG tube so feedings can be given.
c. Replace the NG tube to maintain gastric decompression.
d. Leave the NG tube out because it has probably been in long enough.
ANS: A. Notify the practitioner.
When surgery is performed on the upper gastrointestinal tract, usually the surgical team replaces the NG tube
because of potential injury to the operative site. The decision to replace the tube or leave it out is made by the
surgical team. Replacing the tube is also usually done by the practitioner because of the surgical site.
- An adolescent with irritable bowel syndrome comes to see the school nurse. What information should the
nurse share with the adolescent?
a. A low-fiber diet is required
b. Stress management may be helpful.
c. Milk products are a contributing factor.
d. Pantoprazole (a proton pump inhibitor) is effective in treatment.
ANS: B. Stress management may be helpful.
Irritable bowel syndrome is believed to involve motor, autonomic, and psychologic factors. Stress
management, environmental modification, and psychosocial intervention may reduce stress and gastrointestinal
symptoms. A high-fiber diet with psyllium supplement is often beneficial. Milk products can exacerbate bowel
problems caused by lactose intolerance. Antispasmodic drugs, antidiarrheal drugs, and simethicone are
beneficial for some individuals. Proton pump inhibitors have no effect.
- What clinical manifestation should be the most suggestive of acute appendicitis?
a. Rebound tenderness
b. Bright red or dark red rectal bleeding
c. Abdominal pain that is relieved by eating
d. Colicky, cramping, abdominal pain around the umbilicus
ANS: D. Colicky, cramping, abdominal pain around the umbilicus
Pain is the cardinal feature. It is initially generalized, usually periumbilical. The pain becomes constant and
may shift to the right lower quadrant. Rebound tenderness is not a reliable sign and is extremely painful to the
child. Bright or dark red rectal bleeding and abdominal pain that is relieved by eating are not signs of acute
appendicitis.
- When caring for a child with probable appendicitis, the nurse should be alert to recognize which sign or
symptom as a manifestation of perforation?
a. Anorexia
b. Bradycardia
c. Sudden relief from pain
d. Decreased abdominal distention
ANS: C. Sudden relief from pain
Signs of peritonitis, in addition to fever, include sudden relief from pain after perforation. Anorexia is already
a clinical manifestation of appendicitis. Tachycardia, not bradycardia, is a manifestation of peritonitis. Abdominal distention usually increases in addition to an increase in pain (usually diffuse and accompanied by
rigid guarding of the abdomen).
- The nurse is caring for a child admitted with acute abdominal pain and possible appendicitis. What
intervention is appropriate to relieve the abdominal discomfort during the evaluation?
a. Place in the Trendelenburg position.
b. Apply moist heat to the abdomen.
c. Allow the child to assume a position
of comfort.
d. Administer a saline enema to cleanse the bowel.
ANS: C. Allow the child to assume a position
of comfort.
The child should be allowed to take a position of comfort, usually with the legs flexed. The Trendelenburg
position will not help with the discomfort. If appendicitis is a possibility, administering laxative or enemas or
applying heat to the area is dangerous. Such measures stimulate bowel motility and increase the risk of
perforation
- What statement is most descriptive of Meckel diverticulum?
a. It is acquired during childhood.
b. Intestinal bleeding may be mild or profuse.
c. It occurs more frequently in females than in males.
d. Medical interventions are usually sufficient to treat the problem.
ANS: B. Intestinal bleeding may be mild or profuse.
Bloody stools are often a presenting sign of Meckel diverticulum. It is associated with mild to profuse
intestinal bleeding. Meckel diverticulum is the most common congenital malformation of the gastrointestinal
tract and is present in 1% to 4% of the general population. It is more common in males than in females. The
standard therapy is surgical removal of the diverticulum.
- One of the major differences in clinical presentation between Crohn disease (CD) and ulcerative colitis
(UC) is that UC is more likely to cause which clinical manifestation?
a. Pain
b. Rectal bleeding
c. Perianal lesions
d. Growth retardation
ANS: B. Rectal bleeding
Rectal bleeding is more common in UC than CD. Pain, perianal lesions, and growth retardation are common
manifestations of CD
- Nutritional management of the child with Crohn disease includes a diet that has which component?
a. High fiber
b. Increased protein
c. Reduced calories
d. Herbal supplements
ANS: B. Increased protein
The child with Crohn disease often has growth failure. Nutritional support is planned to reduce ongoing losses
and provide adequate energy and protein for healing. Fiber is mechanically hard to digest. Foods containing
seeds may contribute to obstruction. A high-calorie diet is necessary to minimize growth failure. Herbal
supplements should not be used unless discussed with the practitioner. Vitamin supplementation with folic
acid, iron, and multivitamins is recommended.
- What information should the nurse include when teaching an adolescent with Crohn disease (CD)?
a. How to cope with stress and adjust to chronic illness
b. Preparation for surgical treatment and cure of CD
c. Nutritional guidance and prevention of constipation
d. Prevention of spread of illness to others and principles of high-fiber diet
ANS: A. How to cope with stress and adjust to chronic illness
CD is a chronic illness with a variable course and many potential complications. Guidance about living with
chronic illness is essential for adolescents. Stress management techniques can help with exacerbations and
possible limitations caused by the illness. At this time, there is no cure for CD. Surgical intervention may be
indicated for complications that cannot be controlled by medical and nutritional therapy. Nutritional guidance
is an essential part of management. Constipation is not usually an issue with CD. CD is not infectious, so
transmission is not a concern. A low-fiber diet is indicated.
- A child with pyloric stenosis is having excessive vomiting. The nurse should assess for what potential
complication?
a. Hyperkalemia
b. Hyperchloremia
c. Metabolic acidosis
d. Metabolic alkalosis
ANS: D. Metabolic alkalosis
Infants with excessive vomiting are prone to metabolic alkalosis from the loss of hydrogen ions. Potassium and
chloride ions are lost with vomiting. Metabolic alkalosis, not acidosis, is likely.