Chapter 9: GI Flashcards
- If a patient with multiple sclerosis starts coughing frequently during meals and starts to eat significantly less food than normal, the patient may have
a. pneumonia.
b. gastroesophageal reflux disease.
c. peptic ulcer.
d. dysphagia.
ANS: D
Patients with multiple sclerosis may develop dysphagia; coughing during meals and eating less than usual are common symptoms. Dysphagia may cause pneumonia if food enters the lungs and causes infection. Gastroesophageal reflux disease causes burning and pain but typically not coughing. Peptic ulcer causes intestinal pain but not coughing.
- The most acute risk for patients with dysphagia is
a. constipation.
b. dehydration.
c. dry mouth.
d. panic attacks.
ANS: B
An acute daily concern for patients with dysphagia is dehydration. Patients are not usually allowed to drink fluids without supervision, and so fluid intake must be monitored throughout the day. Constipation and dry mouth may occur with poor fluid and food intake but are less acute. Patients with dysphagia may experience feelings of panic, but this is not the most acute concern.
- The most helpful recommendation for a client who often experiences heartburn at night would be to
a. avoid eating within 4 hours of going to bed.
b. increase the fiber content of the diet.
c. decrease the fiber content of the diet.
d. take antacid medications before going to bed.
ANS: A
Gastroesophageal reflux disease (GERD) usually occurs 1 to 4 hours after eating; therefore, waiting at least 4 hours after eating before going to bed would help prevent heartburn at night. Antacid medications may be helpful but should not be used on a regular basis before other strategies have been tried. Fiber content of the diet does not affect heartburn
- An example of a meal that is likely to relax the lower esophageal sphincter and allow gastroesophageal reflux is
a. pasta with marinara sauce and sourdough bread.
b. ham with rice pilaf.
c. fried chicken and pasta salad.
d. chicken and spinach tortilla wrap and salsa.
ANS: C
High-fat foods and beverages relax the lower esophageal sphincter (allowing stomach contents to back up). Both fried chicken and pasta salad are high in fat and would exacerbate gastroesophageal reflux. The other meals are relatively low in fat and would be much less likely to cause reflux.
- An appropriate meal for someone with dumping syndrome would be
a. a small vanilla milkshake.
b. cream of mushroom soup.
c. half a turkey sandwich.
d. popcorn and sugar-free soda.
ANS: C
Individual tolerances vary, but the turkey half-sandwich would probably be tolerated best. Half a sandwich is probably small enough not to cause symptoms. A milkshake is high in sugar and probably too cold. Cream of mushroom soup is probably too hot, and liquids should be taken between rather than with meals. The carbonation in the soda may increase gastrointestinal distention because of gas.
11. If a patient has
- If a patient has esophagitis and also has worn tooth enamel, he or she may have
a. a hiatal hernia.
b. fluoride deficiency.
c. an eating disorder.
d. gastroesophageal reflux disease.
ANS: C
The eating disorder bulimia nervosa causes esophagitis and eroded tooth enamel because of the effects of stomach acid being vomited back into the esophagus and mouth. A hiatal hernia and GERD may cause esophagitis, but stomach contents would enter only the esophagus, not the mouth, and so the teeth would not be worn. Fluoride deficiency may cause loss of tooth enamel but would not cause esophagitis.
- For patients with inflammatory bowel disease, nutrition therapy is
a. the primary mode of treatment.
b. rarely necessary.
c. an important adjunct to drugs and surgery.
d. highly specialized.
ANS: C
Nutrition therapy is important to help maintain nutritional status of patients with inflammatory bowel disease, but is used in conjunction with drug and surgical treatments; it is not the primary mode of treatment. Nutrition therapy is often needed to maintain weight and micronutrient status
- Because patients with active Crohns disease have intestinal inflammation, they benefit from high intake of
a. fat.
b. dietary fiber.
c. simple sugars.
d. protein.
ANS: D
Patients with inflammatory bowel disease benefit from a diet high in protein to compensate for malabsorption. Fat intake should be moderate to provide adequate kilocalories within a healthful diet; high fat intake may cause steatorrhea. Dietary fiber may irritate the inflamed gut. Simple sugars provide a readily digested and absorbed source of energy but no other nutrients.
- Patients with inflammatory bowel disease may benefit from a high-fiber diet during
a. acute episodes.
b. times of remission.
c. recovery from surgery.
d. preparation for surgery.
ANS: B
A high-fiber diet may help stimulate peristalsis during times of remission in patients with inflammatory bowel disease. During acute episodes, the diet should be low in fiber and should promote bowel rest. In general, the diet should be high calorie, high protein, and nutrient dense to compensate for malabsorption.
- If a patient has had a large portion of their small intestine removed because of cancer and is unable to maintain a stable weight, a feeding regimen that would be most appropriate is
a. enteral feedings into the stomach.
b. enteral feedings into the jejunum.
c. parenteral nutrition only.
d. supplemental parenteral nutrition.
ANS: D
Patients who have undergone removal of large portions of the small intestine and are unable to maintain their weight should receive supplemental parenteral nutrition. Enteral feedings would not be more effective than oral feedings because these patients have a limited amount of gut to absorb the nutrients. Parenteral nutrition should not be used alone because some oral feeding helps stimulate recovery of gut function and maintain gut integrity.
- The best way to prevent formation of diverticula in the colon is to
a. eat plenty of fruits, vegetables, and whole grains.
b. avoid foods with rough hulls, such as nuts and seeds.
c. use stool softeners to promote daily bowel movements.
d. avoid foods that cause gas and increase pressure in the colon.
ANS: A
Diverticula are caused by high pressure in the colon, often in association with straining to have a bowel movement; they can be prevented by intake of high-fiber foods, such as fruits, vegetables, and whole grains. There is no evidence that nuts, seeds, or other foods with hulls increase risk of diverticula. Using stool softeners to promote daily bowel movements may help prevent diverticula, but eating a high-fiber diet is preferable because of other nutritional benefits. Foods that cause gas are not associated with formation of diverticula.
- Where in the brain is the vomiting center located?
a. Hypothalamus c. Pons
b. Medulla oblongata d. Midbrain
ANS: B
The vomiting center of the brain lies in the medulla oblongata. The other locations listed are not related to vomiting.
- Antiemetic agents, such as domperidone and haloperidol, are antagonists for which receptors?
a. 5-Hydroxytryptamine (5-HT) serotonin
b. Histamine-2
c. Acetylcholine
d. Dopamine
ANS: D
Metoclopramide, domperidone, and haloperidol are dopamine antagonists, making them effective antiemetic agents. This selection is the only option that identifies a receptor that is involved in the process of vomiting.
- Which statement is false concerning how abdominal pain is produced?
a. Chemical mediators, such as histamine, bradykinin, and serotonin, produce abdominal pain.
b. Edema and vascular congestion produce abdominal pain by stretching.
c. Ischemia, caused by distention of bowel obstruction or mesenteric vessel thrombosis, produces abdominal pain.
d. Low concentrations of anaerobes, such as Streptococci, Lactobacilli, Staphylococci, Enterobacteria, and Bacteroides, produce abdominal pain.
ANS: D
Low concentrations of anaerobes are not typically a cause of abdominal pain.
- What is the cause of functional dysphagia?
a. Intrinsic mechanical obstruction c. Tumor
b. Extrinsic mechanical obstruction d. Neural or muscular disorders
ANS: D
Neural or muscular disorders that interfere with voluntary swallowing or peristalsis cause functional dysphagia. This selection is the only option that accurately identifies a cause of functional dysphagia.
- What are the cardinal symptoms of small intestinal obstruction?
a. Constant, dull pain in the lower abdomen relieved by defecation
b. Acute, intermittent pain 30 minutes to 2 hours after eating
c. Colicky pain caused by distention, followed by vomiting
d. Excruciating pain in the hypogastric area caused by ischemia
ANS: C
Of the options available, only colicky pain caused by distention followed by vomiting are considered the cardinal symptoms of a small intestinal obstruction.
- Which hormones are natural appetite suppressants? (Select all that apply.)
a. Insulin
b. Cortisol
c. Galanin
d. Calcitonin
e. Serotonin
ANS: A, D, E
Insulin, calcitonin, and serotonin are natural appetite suppressants, whereas cortisol and galanin are natural appetite stimulants.
- Food enters the stomach via which sphincter?
a. Cardiac c. Gastric
b. Upper esophageal d. Fundal
ANS: A
Each end of the esophagus is opened and closed by a sphincter. The upper esophageal sphincter (cricopharyngeal muscle) prevents entry of air into the esophagus during respiration. The lower esophageal sphincter (cardiac sphincter) prevents regurgitation from the stomach. The lower esophageal sphincter is located near the esophageal hiatus—the opening in the diaphragm where the esophagus ends at the stomach. The cardiac sphincter is the only option that fulfills the function described in the question
- Which gastric cells secrete hydrochloric acid and intrinsic factor?
a. Parietal c. G
b. Chief d. H
ANS: A
Of the available options, only the parietal cells (oxyntic cells) secrete hydrochloric acid and intrinsic factor.
- Which cells in the stomach secrete histamine?
a. Oxyntic c. D
b. Chief d. Enterochromaffin-like
ANS: D
Of the available options, only enterochromaffin-like cells secrete histamine.
- Exposure to which substance protects the mucosal barrier of the stomach?
a. Prostaglandins c. Helicobacter pylori
b. Aspirin d. Regurgitated bile
ANS: A
Prostaglandins and enterogastrones, such as gastric inhibitory peptide, somatostatin, and secretin, inhibit acid secretion. This selection is the only option that accurately identifies a substance that protects the mucosal barrier of the stomach.
S&S of diverticulitis
fever, nausea, achy pain, occult blood, tender abdominal mass, pericolonic fat stranding (abnormal increase in fat attenuation)
Why does diverticulitis occur?
weak muscularis layer/abnormal connective tissue, high pressure gradient between colon/peritoneal space d/t increased pressure needed to propel stool (low fiber)
layers of the GI tract.
mucosa - innermost, produces mucus, high cell turnover rate
submucosa - connective tissue (blood vessels, nerves, lymph, secretory glands)
muscular - circular, then longitudinal (allows for peristalsis)
serosa - outer layer that connects to other structures
