MS2 - GI - Questions Flashcards
True/False
PEG tube and radiologically placed placed gastronomy procedures have more risks than surgical placement.
False.
PEG and radiologically placed gastronomy tubes have less risks than surgical placement.
Enteral feedings can be started within ___ to ___ hours after a surgically placed gastronomy or jejunostomy tube without waiting for flatus or a bowel movement.
- 12 to 24
- 24 to 72
- 24 to 48
- 48 to 72
- 24 to 48 hours
PEG tube feeding can be started within ____ hour(s) of insertion (though may vary by institution policy).
- 1
- 2
- 4
- 8
- 2 hours
A patient is admitted to the hospital with a diagnosis of diarrhea with dehydration. The nurse recognizes that increased peristalsis resulting in diarrhea can be related to
a. sympathetic inhibition.
b. mixing and propulsion.
c. sympathetic stimulation.
d. parasympathetic stimulation.
d. parasympathetic stimulation.
Peristalsis is increased by parasympathetic stimulation.
A patient has an elevated blood level of indirect (unconjugated) bilirubin. One cause of this finding is that
a. the gallbladder is unable to contract to release stored bile.
b. bilirubin is not being conjugated and excreted into the bile by the liver.
c. the Kupffer cells in the liver are unable to remove bilirubin from the blood.
d. there is an obstruction in the bilirary tract preventing flow of bile into the small intestine.
b. bilirubin is not being conjugated and excreted into the bile by the liver.
Bilirubin is a pigment derived from the breakdown of hemoglobin and is insoluble in water. Bilirubin is bound to albumin for transport to the liver and is referred to as unconjugated. An indirect bilirubin determination is a measurement of unconjugated bilirubin, and the level may be elevated in hepatocellular and hemolytic conditions.
As gastric contents move into the small intestine, the bowel is normally protected from the acidity of gastric contents by the
a. inhibition of secretin release.
b. release of bicarbonate by the pancreas.
c. release of pancreatic digestive enzymes.
d. release of gastrin by the duodenal mucosa.
b. release of bicarbonate by the pancreas.
The hormone secretin stimulates the pancreas to secrete fluid with a high concentration of bicarbonate. This alkaline secretion enters the duodenum and neutralizes acid in the chyme.
A patient is jaundiced and her stools are clay colored (gray). This is most likely related to
a. decreased bile flow into the intestine.
b. increased production of urobilinogen.
c. increased production of cholecystokinin.
d. increased bile and bilirubin in the blood.
a. decreased bile flow into the intestine.
Bile is produced by the hepatocytes and is stored and concentrated in the gallbladder. When bile is released from the common bile duct, it enters the duodenum. In the intestines, bilirubin is reduced to stercobilinogen and urobilinogen by bacterial action. Stercobilinogen accounts for the brown color of stool. Stools may be clay-colored if bile is not released from the common bile duct into the duodenum. Jaundice may result if the bilirubin level in the blood is elevated.
An 80-year-old man states that, although he adds a lot of salt to his food, it still does not have much taste. The nurse’s response is based on the knowledge that the older adult
a. should not experience changes in taste.
b. has a loss of taste buds, especially for sweet and salt.
c. has some lost of taste but no difficulty chewing food.
d. loses the sense of taste because the ability to smell is decreased.
b. has a loss of taste buds, especially for sweet and salt.
Older adults have decreased numbers of taste buds and a decreased sense of smell. These age-related changes diminish the sense of taste (especially of salty and sweet substances).
When the nurse is assessing the health perception-health maintenance pattern as related to GI function, an appropriate question to ask is
a. “What is your usual bowel elimination pattern?”
b. “What percentage of your income is spent on food?”
c. “Have you traveled to a foreign country in the last year?”
d. “Do you have any diarrhea when you are under a lot of stress?”
c. “Have you traveled to a foreign country in the last year?”
When assessing gastrointestinal function in relation to the health perception–health management pattern, the nurse should ask the patient about recent foreign travel with possible exposure to hepatitis, parasitic infestation, or bacterial infection.
During an examination of the abdomen the nurse should
a. position the patient in the supine position with the bed flat and knees straight.
b. listen in the epigastrum and all four quadrants for 2 minutes for bowel sounds.
c. use the following order of techniques: inspection, palpation, percussion, auscultation.
d. describe bowel sounds as absent if no sound is heard in the lower right quadrant after 2 minutes.
b. listen in the epigastrum and all four quadrants for 2 minutes for bowel sounds.
The nurse should listen in the epigastrium and all four quadrants for bowel sounds for at least 2 minutes. The patient should be in the supine position and should slightly flex the knees; the head of the bed should be raised slightly. During examination of the abdomen, the nurse auscultates before performing percussion and palpation because the latter procedures may alter the bowel sounds. Bowel sounds cannot be described as absent until no sound is heard for 5 minutes in each quadrant.
A normal physical assessment finding of the GI system is/are (select all that apply)
a. nonpalpable liver and spleen.
b. borborygmi in upper right quadrant.
c. tympany on percussion of the abdomen.
d. liver edge 2 to 4 cm below the costal margin.
e. finding of a firm, nodular edge on the rectal examination.
a. nonpalpable liver and spleen.
c. tympany on percussion of the abdomen.
Normal assessment findings for the gastrointestinal system include a nonpalpable liver and spleen and generalized tympany on percussion. Normally, bowel sounds are high pitched and gurgling; loud gurgles indicate hyperperistalsis and are called borborygmi (stomach growling). If the patient has chronic obstructive pulmonary disease, large lungs, or a low-set diaphragm, the liver may be palpated 0.4 to 0.8 inch (1 to 2 cm) below the right costal margin. On palpation, the rectal wall should be soft and smooth and should have no nodules.
In preparing a patient for a colonoscopy, the nurse explains that
a. a signed permit is not necessary.
b. sedation may be used during the procedure.
c. only one cleansing enema is necessary for the preparation.
d. a light meal should be eaten the day before the procedure.
b. sedation may be used during the procedure.
Sedation is induced during a colonoscopy. A signed consent form is necessary for a colonoscopy. A cathartic or enema is administered the night before the procedure, and more than one enema may be necessary. Patients may need to be kept on clear liquids 1 to 2 days before the procedure.
An 85-year-old woman seen in the primary care provider’s office for a well check complains of difficulty swallowing. What common effect of aging should the nurse assess for as a possible cause?
a. Anosmia
b. Xerostomia
c. Hypochlorhydria
d. Salivary gland tumor
b. Xerostomia
Xerostomia (decreased saliva production), or dry mouth, affects many older adults and may be associated with difficulty swallowing (dysphagia). Anosmia is loss of sense of smell. Hypochlorhydria, a decrease in stomach acid, does not affect swallowing. Salivary gland tumors are not common.
The nurse is reviewing the home medication list for a 44-year-old man admitted with suspected hepatic failure. Which medication could cause hepatotoxicity?
a. Nitroglycerin
b. Digoxin (Lanoxin)
c. Ciprofloxacin (Cipro)
d. Acetaminophen (Tylenol)
d. Acetaminophen (Tylenol)
Many chemicals and drugs are potentially hepatotoxic (see Table 39-6) and result in significant patient harm unless monitored closely. For example, chronic high doses of acetaminophen and nonsteroidal antiinflammatory drugs (NSAIDs) may be hepatotoxic.
The nurse is assessing a 50-year-old woman admitted with a possible bowel obstruction. Which assessment finding would be expected in this patient?
a. Tympany to abdominal percussion
b. Aortic pulsation visible in epigastric region
c. High-pitched sounds on abdominal auscultation
d. Liver border palpable 1 cm below the right costal margin
c. High-pitched sounds on abdominal auscultation
The bowel sounds are more high pitched (rushes and tinkling) when the intestines are under tension, as in intestinal obstruction. Bowel sounds may also be diminished or absent with an intestinal obstruction. Normal findings include aortic pulsations on inspection and tympany with percussion, and the liver may be palpable 1 to 2 cm along the right costal margin.
A 62-year-old woman patient is scheduled for a percutaneous transhepatic cholangiography to restore biliary drainage. The nurse discusses the patient’s health history and is most concerned if the patient makes which statement?
a. “I am allergic to bee stings.”
b. “My tongue swells when I eat shrimp.”
c. “I have had epigastric pain for 2 months.”
d. “I have a pacemaker because my heart rate was slow.”
b. “My tongue swells when I eat shrimp.”
The percutaneous transhepatic cholangiography procedure will include the use of radiopaque contrast medium. Patients allergic to shellfish and iodine are also allergic to contrast medium. Having a pacemaker will not affect the patient during this procedure. It would be expected that the patient would have some epigastric pain given the patient’s condition.
A 35-year-old man with a family history of adenomatous polyposis had a colonoscopy with removal of multiple polyps. Which signs and symptoms should the nurse teach the patient to report immediately?
a. Fever and abdominal pain
b. Flatulence and liquid stool
c. Loudly audible bowel sounds
d. Sleepiness and abdominal cramps
a. Fever and abdominal pain
The patient should be taught to observe for signs of rectal bleeding and peritonitis. Fever, malaise, and abdominal pain and distention could indicate a perforated bowel with peritonitis.
Which statement regarding the factors responsible for the development of esophageal reflux disease is true?
A. Esophageal reflux occurs with decreased lower esophageal sphincter tone.
B. Esophageal reflux occurs with increased lower esophageal sphincter tone.
C. Esophageal reflux occurs when the lower esophageal sphincter tenses.
D. Esophageal reflux occurs with decreased intraabdominal pressure.
A. Esophageal reflux occurs with decreased lower esophageal sphincter tone.
Esophageal reflux can occur when intraabdominal pressure is elevated or when the sphincter tone of the LES is decreased.
Which of the following clients is most at risk for gastroesophageal influx?
A. A client who drinks decaffeinated beverages
B. A client who has a nasogastric tube placed
C. A client taking oral hypoglycemic agents
D. A client who eats small, frequent meals
B. A client who has a nasogastric tube placed
A nasogastric tube keeps the cardiac sphincter open allowing acidic contents from the stomach to enter the esophagus.
Which assessment should you perform for a client experiencing regurgitation?
A. Auscultation for crackles
B. Inspection of the oral cavity
C. Palpation of the cervical lymph nodes
D. Culture of the throat for bacterial infection
A. Auscultation for crackles
The client with regurgitation is at risk of aspiration, pneumonia, and bronchitis. The nurse should auscultate the lungs for crackles, an indication of aspiration.
You are preparing a teaching plan for a client with gastroesophageal reflux. Which of the following instructions should you include in a dietary guide for this client?
A. “Eat four to six small meals each day.”
B. “Eat a small evening snack 1 to 2 hours before bed.”
C. “Drink carbonated beverages between meals only.”
D. “You may include orange or tomato juice with your breakfast.”
A. “Eat four to six small meals each day.”
The client is instructed to eat four to six small meals rather than three larger meals to avoid pressure in the stomach and delayed gastric emptying, which can increase reflux. Evening snacks, carbonated beverages, and acidic foods also should be avoided.
You are taking the history of a client with a sliding hernia. Which of the following symptoms should you inquire about in this client? A. Reflux B. Bleeding C. Dysphagia D. Early satiety
A. Reflux
Clients with sliding hernias often experience symptoms of reflux; therefore, this client should be evaluated for GERD.
Which of the following statements made by the client indicates an understanding of the management of hiatal hernia?
A. “I will lie flat for 30 minutes after each meal.”
B. “I will remain upright for several hours after each meal.”
C. “I will have my blood count done in 2 weeks to check for anemia.”
D. “I will sleep at night lying on my left side to prevent nighttime reflux.”
B. “I will remain upright for several hours after each meal.”
Clients with a sliding hernia experience GERD, and positioning, for these clients, is an important intervention. The client should be taught to sleep with the head of the bed elevated, to remain upright after meals, and to avoid straining or restrictive clothing.
A client who has undergone a fundoplication wrap for hernia repair has returned from the postanesthesia care unit with a nasogastric tube draining dark brown fluid. What is your best action at this time?
A. Notify the physician.
B. Document the finding as the only action.
C. Clamp the nasogastric tube for 30 minutes.
D. Irrigate the nasogastric tube with normal saline.
B. Document the finding as the only action.
After fundoplication, drainage from the nasogastric tube is initially dark brown with old blood. This finding is expected and requires only documentation. The drainage should become yellow-green within 8 hours after surgery.
You are collecting the initial history from a client with suspected esophageal cancer. What factor in this client's history increases the risk of developing esophageal cancer? A. A high stress occupation B. A preference for high-fat foods C. A 20 pack-year smoking history D. A history of myocardial infarction
C. A 20 pack-year smoking history
In the United States, the two most important factors in the development of esophageal cancer are tobacco use and alcohol ingestion.
Which nursing diagnosis would be considered a priority in planning the care of a client with esophageal cancer?
A. Imbalanced Nutrition: Less than Body Requirements
B. Anticipatory Grieving
C. Risk of Aspiration
D. Acute Pain
A. Imbalanced Nutrition: Less than Body Requirements
The priority for care of a client with esophageal cancer is Imbalanced Nutrition: Less than Body Requirements related to impaired swallowing. Fear of choking and inability to take adequate nutrition because of tumor obstruction contributes to weight loss.
A client with a gastric ulcer develops a sudden, sharp pain in the mid-epigastric region. Upon assessment, you note the abdomen is tender and rigid. What is your best first action?
A. Increase the IV fluid rate.
B. Notify the health care provider.
C. Place the client in a knee-chest position.
D. Prepare to administer an H2 antagonist.
B. Notify the health care provider.
A client with a gastric or duodenal ulcer who is presenting with sudden onset of sharp mid-epigastric pain and a tender and board-like abdomen has most likely developed perforation, a surgical emergency. Notify the health care provider immediately.
A client being treated for peptic ulcer disease reports drinking four cups of decaffeinated coffee each day. What is your best response?
A. “You may drink decaffeinated coffee only with meals.”
B. “You should avoid both caffeinated and decaffeinated coffee.”
C. “Drinking decaffeinated coffee is correct, but limit your intake to two cups per day.”
D. “You should drink coffee only within 1 hour of taking your antiulcer medication.”
B. “You should avoid both caffeinated and decaffeinated coffee.”
The client is instructed to eliminate both caffeinated and decaffeinated coffee because they contain peptides that stimulate gastrin release.
A client underwent a Billroth II procedure 1 week ago for the treatment of a duodenal ulcer. Which of the following clinical manifestations should alert you to the late manifestations of dumping syndrome?
A. Severe abdominal pain and a strong desire to defecate
B. Epigastric distention and abdominal cramping
C. Mouth dryness and palpitations
D. Dizziness and palpitations
D. Dizziness and palpitations
The late manifestations of dumping syndrome include dizziness, lightheadedness, palpitations, diaphoresis, and confusion occurring 90 minutes to 3 hours after eating.
Which statement made by the client indicates an understanding of dietary management for dumping syndrome?
A. “I will eat a low-fat, low-carbohydrate, high-protein diet.”
B. “I will eat a high-fat, high-carbohydrate, low-protein diet.”
C. “I will eat a high-fat, low-carbohydrate, high-protein diet.”
D. “I will eat a high-fat, high-carbohydrate, high-protein diet.”
C. “I will eat a high-fat, low-carbohydrate, high-protein diet.”
A high-fat, low-carbohydrate, high-protein diet is recommended, because decreasing the carbohydrate content of meals minimizes the early symptoms associated with the syndrome.
You are preparing a dietary guide for a client with irritable bowel syndrome. Which of the following meals is appropriate for this client?
A. Tuna salad on white bread and a diet cola
B. Grilled steak, green beans, dinner roll, and coffee
C. Broiled chicken, brown rice, salad, and a glass of water
D. Fried shrimps, salad, baked potato, and a glass of wine
C. Broiled chicken, brown rice, salad, and a glass of water
Clients with irritable bowel syndrome are advised to eat a high-fiber diet, with 8 to 10 cups of liquid daily. They should avoid alcohol, caffeine, and other gastric irritants.
Which client would be at highest risk for the development of colorectal cancer?
A. 55-year-old woman whose father was treated for colon cancer
B. 45-year-old woman with irritable bowel syndrome
C. 33-year-old man who drinks four cups of coffee daily
D. 70-year-old man with peptic ulcer disease
A. 55-year-old woman whose father was treated for colon cancer
Individuals with a first-degree relative diagnosed with colorectal cancer have a three- to fourfold risk of developing the disease. In addition, 95% of colorectal cancers are diagnosed in people over the age of 50.
Twenty-four hours after a client has had a hemicolectomy and temporary colostomy placement, you note the client’s stoma to appear dry and dark red in color. What would be your best action?
A. Notify the surgeon.
B. Document the finding as the only action.
C. Place a colostomy pouch system over the stoma.
D. Place petroleum gauze dressing over the stoma.
A. Notify the surgeon.
The stoma should appear reddish pink and moist. If the stoma takes on a dark red or purple hue and becomes dry, firm, or flaccid, the stoma has signs of ischemia. The surgeon should be notified immediately.
What postoperative nursing intervention would be a priority for the client who has undergone an abdominal-perineal resection for a rectal tumor?
A. Monitoring of perineal wound drainage
B. Assisting the client with a bowel training program
C. Administering corticosteroids to prevent rectal itching
D. Providing a high-fiber diet to ease the passage of stools
A. Monitoring of perineal wound drainage
Monitoring of drainage from the perineal wound and cavity is of primary importance in detecting infection or abscess formation.
A client is brought to the emergency unit with a strangulated obstruction. What complication of this type of obstruction should you be alert for in this client? A. Pulmonary edema B. Bacterial peritonitis C. Deep vein thrombosis D. Acute tubular necrosis
B. Bacterial peritonitis
A strangulated obstruction compromises blood flow to the area. Bacteria in intestinal contents stagnate and form an endotoxin, which is released into the peritoneum and circulatory system causing septic shock.
A client is being treated for an intestinal obstruction with decompression with a Cantor tube. What nursing intervention would be indicated in the care of this client?
A. Reposition the client every 2 hours to assist with advancement of the tube.
B. Tape the Cantor tube to the client’s nose to prevent dislodgement.
C. Instill normal saline into the Cantor tube to keep it patent.
D. Withdraw 10 mL of air if drainage from the tube stops.
A. Reposition the client every 2 hours to assist with advancement of the tube.
The Cantor tube has a mercury-filled tip. To assist in progression of the tube, the nurse repositions the client every 2 hours.
A client who underwent removal of a benign colonic polyp asks you why a follow-up colonoscopy is necessary. What would be your best response?
A. “You are at risk for developing more polyps in the future.”
B. “You may have other cancerous lesions that could not be seen right now.”
C. “A regular colonoscopy will prevent the development of malignant polyps.”
D. “This test will ensure healing has occurred where the polyp has been removed.”
A. “You are at risk for developing more polyps in the future.”
Once a person has developed a polyp, there is a risk of multiple polyps occurring.
You note that a client with extensive peritonitis has developed evidence of decreased circulatory volume. What physiologic parameter should you monitor as a result of this alteration? A. Heart rate B. Urine output C. Pedal pulses D. Temperature
B. Urine output
Decreased circulatory volume is the result of the shunting of fluid from the vascular space into the peritoneal cavity, GI tract, and connective tissue resulting in insufficient kidney perfusion and a low urine output.
What statement regarding the symptoms of ulcerative colitis is true?
A. The client may have 5 to 6 soft stools per day.
B. The client may have 10 to 20 steatorrheal stools per day.
C. The client may have 10 to 20 liquid, bloody stools per day.
D. The client may have abdominal pain, but stool appearance is normal.
C. The client may have 10 to 20 liquid, bloody stools per day.
Ulcerative colitis is characterized by 10 to 20 liquid, bloody stools per day. The colon appears red and hemorrhagic.
A client with an exacerbation of ulcerative colitis has been placed on total parenteral nutrition (TPN). The client asks you why foods or fluids may not be given by mouth. What is your best response?
A. “TPN contains a high percentage of glucose that is more readily absorbed in the bloodstream than in the ulcerated colon.”
B. “TPN will be given in addition to your meals to help you gain any weight that you may have lost through diarrhea.”
C. “TPN is considered an elemental formula and, as such, is easier to digest.”
D. “TPN will be given during this period to allow your bowel to rest.”
D. “TPN will be given during this period to allow your bowel to rest.”
Bowel rest during severe exacerbations of ulcerative colitis is part of the nonsurgical management of the disease.
