Chapter20 GastroInterstinal Flashcards
An older resident is complaining of being constipated. Which action should the nurse take first when caring for this patient?
- Assess the diet for adequacy of fiber and fluids.
- Determine what the patient means by constipation.
- Obtain an order for a laxative and an enema if needed.
- Encourage the patient to increase fluid intake and activity.
Correct Answer: 2
Rationale 1: Assessing the diet for adequacy of fiber and fluids might be appropriate after the nurse determines how the patient defines constipation.
Reference: Page 574
Rationale 2: The nurse should first carefully evaluate the patients concern and question the person as to what is considered as being constipation. Determining the patients normal frequency of bowel movement, consistency of stool, and effort in passing stool is important before deciding to act.
Reference: Page 574
Rationale 3: Obtaining an order for a laxative and enema might be appropriate after the nurse determines how the patient defines constipation.
Reference: Page 574
Rationale 4: Encouraging the patient to increase fluid intake and activity might be appropriate after the nurse determines how the patient defines constipation.
Reference: Page 574
After an assessment the nurse is concerned that an older patient is at risk for liver cancer. What did the nurse assess in this patient?
Standard Text: Select all that apply.
- History of colon polyps
- Diagnosis of diverticulitis
- 50 year history of smoking
- History of hepatitis B infection
- Previous treatment for alcoholism
Correct Answer: 3,4,5
Rationale 1: A history of colon polyps is not a risk factor for liver cancer.
Reference: Page 579
Rationale 2: A diagnosis of diverticulitis is not a risk factor for liver cancer.
Reference: Page 579
Rationale 3: Smoking is a predisposing factor for liver cancer.
Reference: Page 579
Rationale 4: History of hepatitis B infection is a risk factor for liver cancer.
Reference: Page 579
Rationale 5: Excessive alcohol intake is a predisposing factor for liver cancer.
Reference: Page 579
An older patient is experiencing diarrhea. Which assessment finding supports that the patients diarrhea is caused by Clostridium difficile?
- The patient has a history of ulcerative colitis.
- The patient has been taking prescribed steroids for several months.
- The patient recently completed a course of antibiotics for pneumonia.
- The patient rarely eats fresh fruits and vegetables and self-restricts fluid intake.
Correct Answer: 3
Rationale 1: A history of ulcerative colitis would not necessarily be associated with Clostridium difficile.
Reference: Page 572
Rationale 2: Steroid use is not associated with the development of a Clostridium difficile infection.
Reference: Page 572
Rationale 3: Clostridium difficile can be the cause of diarrhea in an older patient who has recently completed antibiotic use.
Reference: Page 572
Rationale 4: A diet poor in fresh fruits and vegetables and limited fluid intake would contribute to the development of constipation and not diarrhea caused by Clostridium difficile.
Reference: Page 572
Which gastrointestinal change in an older patient does the nurse recognize as being associated with aging?
- Decreased esophageal motility
- Decreased incidence of cholelithiasis
- Increase in hydrochloric acid in the stomach
- Increased absorption of nutrients in the intestines
Correct Answer: 1
Rationale 1: Changes in the gastrointestinal system that occur with the aging process include a decrease in esophageal motility.
Reference: Page 558
Rationale 2: Older patients experience an increase in the occurrence of cholelithiasis (gallstones).
Reference: Page 558
Rationale 3: There is a decrease in the amount of hydrochloric acid in the stomach with aging.
Reference: Page 558
Rationale 4: A lessening of nutrient absorption occurs in the intestines with aging.
Reference: Page 558
- Monitor during meals for a change in respirations.
- Maintain an upright position for 1 hour after eating.
- Raise the head of the bed to a 90 degree angle during meals.
- Provide pureed solid foods and thin clear liquids during meals.
- Ensure that one bite has been swallowed before providing another.
Correct Answer: 1,2,3,5
Rationale 1: An intervention to reduce the risk of aspiration in an older patient with dysphagia is to monitor the patient during meals for a change in respirations. This could indicate that the patient is aspirating food or fluids.
Reference: Page 561
Rationale 2: An intervention to reduce the risk of aspiration in an older patient with dysphagia is to maintain the patient in an upright position for 1 hour after eating.
Reference: Page 561
Rationale 3: An intervention to reduce the risk of aspiration in an older patient with dysphagia is to raise the head of the bed to a 90 degree angle during meals.
Reference: Page 561
Rationale 4: Offer food and liquid consistencies according to the speech pathologists and dietitians recommendations. Pureed foods and thin liquids could encourage aspiration.
Reference: Page 561
Rationale 5: An intervention to reduce the risk of aspiration in an older patient with dysphagia is to ensure that one bite has been swallowed before providing another.
Reference: Page 561
The nurse instructs a family member on how to feed an older patient. Which observation indicates that the family member needs additional instruction?
- Checks to make sure the patients dentures are in place
- Makes sure that each bite is swallowed before providing the next bite
- Reminds the patient to chew the food after being placed in the patients mouth
- Tries to insert a utensil in the patients mouth and the patient bites down tightly
Correct Answer: 4
Rationale 1: The family member should ensure that the patients dentures are in place and in good repair.
Reference: Page 561
Rationale 2: Patients being fed must be given time to swallow what is in the mouth before being fed another bite.
Reference: Page 561
Rationale 3: Focusing attention on the task at hand and verbally reinforcing the expected activity may prove effective when feeding the patient.
Reference: Page 561
Rationale 4: The nurse should reinforce that forceful feeding techniques should not be used. Family members may feel frustrated if the patient does not cooperate with eating. Forcing the issue will likely lead to more power struggles at mealtime and the patient may simply not feel like eating.
Reference: Page 561
Which assessment finding should the nurse realize as being a cause for gastroesophageal reflux disease (GERD) occurring more commonly in older adults?
- Increased amounts of saliva
- Increased incidence of hiatal hernia
- Tightening of the lower esophageal sphincter
- The increase in peristalsis that occurs in the esophagus
Rationale 1: There is a decrease in the amount of saliva available to lubricate the food with aging.
Reference: Page 562
Rationale 2: There is an increased incidence of hiatal hernia that occurs with aging. Hiatal hernia occurs when a small portion of the stomach slides into the chest cavity trapping some of the stomach and its contents.
Reference: Page 562
Rationale 3: The lower esophageal sphincter muscle weakens with aging, increasing the likelihood of reflux.
Reference: Page 562
Rationale 4: Aging usually affects the esophagus with a decrease in peristalsis.
Reference: Page 562
How should the nurse instruct an older patient with gastroesophageal reflux disease (GERD) about heartburn?
- It improves when lying flat or bending over.
- It is unaffected by the size of meals eaten or the types of food.
- It will not put the older patient at increased risk for esophageal cancer.
- It may cause severe chest pain that causes the patient to fear a heart attack.
Correct Answer: 4
Rationale 1: Heartburn will become worse when lying flat or bending over.
Reference: Page 563
Rationale 2: The heartburn is worsened by eating large meals and eating specific foods or beverages, which are often those high in fat or caffeine.
Reference: Page 563
Rationale 3: Approximately 10 to 15% of older patients with GERD develop Barretts esophagus, which is a precancerous inflammation of the cells lining the esophagus resulting from chronic exposure to the acid reflux.
Reference: Page 563
Rationale 4: The heartburn associated with gastroesophageal reflux disease (GERD) can cause chest pain that is so severe and persistent that the older patient is unable to distinguish the pain from cardiac pain and may seek emergency medical attention.
Reference: Page 563
An older patient with gastroesophageal reflux disease (GERD) is prescribed ranitidine (Zantac). What should the nurse instruct as the mechanism of action of this medication?
- Neutralizes stomach acid
- Decreases acid production in the stomach
- Creates a coating that acts as a protective barrier
- Increases motility in the esophagus and stomach
Correct Answer: 2
Rationale 1: Antacids are medications that neutralize the stomach acid already produced.
Reference: Page 564
Rationale 2: Histamine blocker medications, such as ranitidine (Zantac), act by reducing acid production by blocking the histamine-2 receptor in the stomach.
Reference: Page 564
Rationale 3: Sucralfate (Carafate) is given to create a protective barrier on the mucous lining of the esophagus and stomach.
Reference: Page 564
Rationale 4: Medications that increase peristalsis include metoclopramide (Reglan).
Reference: Page 564
Which manifestations that an older patient is exhibiting should the nurse investigate as possibly being caused by peptic ulcer disease?
Standard Text: Select all that apply.
- Diarrhea
- Clay-colored stools
- Abdominal distention
- Indigestion with bloating
- Vague and diffuse abdominal pain
Correct Answer: 3,4,5
Rationale 1: Diarrhea is not a manifestation of peptic ulcer disease.
Reference: Page 568
Rationale 2: Clay-colored stools are not a manifestation of peptic ulcer disease.
Reference: Page 568
Rationale 3: Abdominal distention is a common symptom but is often not vigorously investigated.
Reference: Page 568
Rationale 4: Indigestion with bloating is a common symptom but is often not vigorously investigated.
Reference: Page 568
Rationale 5: When abdominal pain is present it is often vague and diffuse throughout the abdomen.
Reference: Page 568
An older patient is diagnosed with a large peptic ulcer. Which information will the nurse use from the patients history to help identify the cause for this ulcer?
Standard Text: Select all that apply.
- Allergy to penicillin
- History of cataract surgery several months ago
- Taking prescribed medication for hypertension
- Taking ibuprofen (Motrin) for chronic bursitis pain
- Prescribed warfarin (Coumadin) for chronic atrial fibrillation
Correct Answer: 4,5
Rationale 1: An allergy to penicillin would not contribute to the development of a peptic ulcer.
Reference: Page 567
Rationale 2: Cataract surgery would not contribute to the development of a peptic ulcer.
Reference: Page 567
Rationale 3: Taking prescribed medication for hypertension would not contribute to the development of a peptic ulcer.
Reference: Page 567
Rationale 4: NSAID use increases the incidence of peptic ulcer disease.
Reference: Page 567
Rationale 5: Concurrent use of NSAIDs with an anticoagulant such as warfarin (Coumadin) predisposes older adults to peptic ulcer development.
Reference: Page 567
The nurse is concerned that an older patient is at risk for developing diverticulosis. What did the nurse assess in the patient?
Standard Text: Select all that apply.
- History of constipation
- Low intake of dietary fiber
- Intake high in protein and calcium
- Diet high in refined carbohydrates
- Physically inactive for many years
Correct Answer: 1,2,4,5
Rationale 1: Constipation is an aggravating factor for diverticulosis.
Reference: Page 570
Rationale 2: Low intake of dietary fiber can encourage the development of diverticulosis.
Reference: Page 570
Rationale 3: An intake that is high in protein and calcium are not aggravating factors for diverticulosis.
Reference: Page 570
Rationale 4: A diet high in refined carbohydrates can encourage the development of diverticulosis.
Reference: Page 570
Rationale 5: Physical inactivity is an aggravating factor for diverticulosis.
Reference: Page 570
An older patient with diverticular disease is experiencing abdominal pain and fever. For which diagnostic test will the nurse most likely prepare this patient?
- Colonoscopy
- Barium enema
- Upper GI endoscopy
- CT scan of the abdomen
Correct Answer: 4
Rationale 1: Invasive studies such as colonoscopy should be delayed until the inflammation and infection resolve with treatment because of the increased risk of bowel perforation.
Reference: Page 571
Rationale 2: Invasive studies such as barium enema should be delayed until the inflammation and infection resolve with treatment because of the increased risk of bowel perforation.
Reference: Page 571
Rationale 3: The upper GI endoscopy is not indicated.
Reference: Page 571
Rationale 4: An abdominal computerized tomography (CT) scan will most likely be obtained to assess colonic wall thickness and extra luminal structures for suspected diverticulitis.
Reference: Page 571
An older patient is experiencing abdominal discomfort. What should the nurse do when examining this patients abdominal area?
Standard Text: Select all that apply.
- Warm the hands.
- Begin with very light palpation.
- Use moderate pressure on the painful area.
- Palpate in areas farther away from the pain.
- Begin the assessment with the area of most pain.
Correct Answer: 1,2,4
Rationale 1: When palpating the abdomen of an older person with abdominal discomfort or pain, always begin with warm hands.
Reference: Page 571
Rationale 2: When palpating the abdomen of an older person with abdominal discomfort or pain, always begin with very light palpation.
Reference: Page 571
Rationale 3: Moderate pressure on painful areas should not be done since this could cause unnecessary discomfort for the older patient.
Reference: Page 571
Rationale 4: When palpating the abdomen of an older person with abdominal discomfort or pain, always begin in an area as remote from the area of pain as possible.
Reference: Page 571
Rationale 5: The painful abdominal area should be assessed last.
Reference: Page 571
What should the nurse teach an older patient about colorectal cancer?
- The risk of colorectal cancer decreases with age.
- Colorectal cancer can be detected by measuring carcinoembryonic antigen (CEA).
- Colorectal cancer occurs less frequently in those with a history of ulcerative colitis.
- Colorectal cancer has no symptoms but can be detected by fecal occult blood testing.
Correct Answer: 4
Rationale 1: The risk of colorectal cancer rises with age and is the most common cancer after the age of 65.
Reference: Page 573
Rationale 2: Carcinoembryonic antigen (CEA) is not considered a diagnostic test but is used as a tumor marker to follow and manage the disease in patients diagnosed with the disease.
Reference: Page 573
Rationale 3: The incidence of colorectal cancer is increased in patients with a history of ulcerative colitis.
Reference: Page 573
Rationale 4: Colorectal cancer is asymptomatic in the early stages. Screening tools, such as annual fecal occult blood testing can detect the cancer when it is still in the curable stage.
Reference: Page 573