Deck 20: The Gastrointestinal System

Question 1

Which manifestations should the nurse investigate as possibly being caused by peptic ulcer disease in an older client? Select all that apply.
1) Diarrhea
2) Clay-colored stools
3) Abdominal distention
4) Indigestion with bloating
5) Vague and diffuse abdominal pain

Answer 1

3, 4, 5

Question 2

The nurse is concerned that an older patient is experiencing dysphagia. What assessment findings lead the nurse to this concern in this patient? Select all that apply.
1) Slurred speech
2) Extreme lethargy
3) Talking while eating
4) Weak voice and cough
5) Drooling saliva from the mouth

Answer 2

1, 2, 4, 5

Question 3

An older patient is experiencing abdominal discomfort. What should the nurse do when examining this patient's abdominal area? Select all that apply.
1) Warm the hands.
2) Palpate in areas closest to the pain first.
3) Use moderate pressure on the painful area.
4) Auscultate bowel sounds prior to palpation.
5) Examine the abdomen for abnormal peristaltic waves prior to palpation.

Answer 3

1, 4, 5

Question 4

An older patient is experiencing diarrhea and has recently been diagnosed with Clostridium difficile? This tends to occur in which type of patient?
1) A patient with a history of ulcerative colitis
2) A patient who has had a recent bout of pneumonia
3) A patient who has been on steroids for several months
4) A patient who has consistently had a nutrient poor diet

Question 5

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?
1) Neutralizes stomach acid
2) Decreases acid production in the stomach
3) Creates a coating that acts as a protective barrier
4) Increases motility in the esophagus and stomach

Question 6

What should the nurse teach an older patient about colorectal cancer?
1) Colorectal cancer can be detected by fecal occult blood testing.
2) Colorectal cancer risk in older clients decreases with NSAIDS use.
3) Colorectal cancer can be detected by measuring carcinoembryonic antigen (CEA).
4) Colorectal cancer occurs less frequently in those with a history of ulcerative colitis.

Question 7

The nurse is caring for an older patient newly diagnosed with gastroesophageal reflux disease. The nurse should explain to the client that this diagnosis occurs more frequently in older adults due to which normal aging change?
1) An increased amount of saliva
2) An increase in esophageal peristalsis
3) An increased incidence of hiatal hernia
4) A tightening of the lower esophageal sphincter

Question 8

An older client is newly diagnosed with gastroesophageal reflux disease. What education should the nurse give them about this disease and heartburn issues?
1) If symptoms are felt, it is best to lie down.
2) It should not put the older patient at increased risk for cancer.
3) It may cause severe chest pain that mimics cardiac symptoms.
4) It is best to eat three times a day; food restrictions are not necessary.

Question 9

Which patient is at most risk for liver cancer and needs education regarding liver cancer signs and symptoms? Select the best answer.
1) A client with a history of colon polyps
2) A client with a diagnosis of diverticulitis
3) A client with a past history of smoking
4) A client with a history of hepatitis B infection

Question 10

The nurse is assessing an older patient diagnosed with diverticulosis. What assessment findings are congruent with this diagnosis? Select all that apply.
1) Fever
2) Diarrhea
3) Leukocytosis
4) Abdominal tenderness
5) Right lower quadrant pain

Question 11

An older patient is diagnosed with peptic ulcer disease. The nurse knows that this condition can be precipitated by? Select all that apply.
1) Taking prescribed warfarin
2) Allergic reactions to penicillin
3) Taking over the counter ibuprofen
4) Taking prescribed medications for hypertension
5) A history of cataract surgery several months ago

Question 12

The nurse is assisting an older patient with dysphagia to eat an evening meal. Which foods on the patient's tray can be safely eaten? Select all that apply.
1) Hot tea
2) Custard
3) Pudding
4) Milkshake
5) Clear broth

Question 13

Which interventions should the nurse use to reduce the risk of aspiration for an older patient with dysphagia? Select all that apply.
1) Monitor respirations during meals.
2) Maintain an upright position for 1 hour after eating.
3) Raise the head of the bed to a 90 degree angle during meals.
4) Provide pureed solid foods and thin clear liquids during meals.
5) Ensure that one bite has been swallowed before providing another.

Question 14

A nurse is performing a gastrointestinal assessment on an older adult. What assessment finding would the nurse be concerned with?
1) Dyspepsia
2) Hiatal hernia
3) Hyperactive bowel sounds
4) Decreased ability to taste foods

Question 15

An older patient with a history of GERD has been directed to use over-the-counter medications to help manage symptoms of gastroesophageal reflux by buffering the gastric pH. What education should the nurse provide to the patient in regards to these types of medications?
1) They need to supplement with Vitamin C.
2) They may continue taking their dietary supplements.
3) They do not need to take these medications with food.
4) These medications may cause constipation and diarrhea.

Question 16

An older resident is complaining of being constipated. Which action should the nurse take first when caring for this patient?
1) Assess the diet for adequacy of fiber and fluids.
2) Determine what the patient means by constipation.
3) Obtain an order for a laxative and an enema if needed.
4) Encourage the patient to increase fluid intake and activity.

Question 17

An older patient with diverticulitis is being discharged home following treatment. Which statement from the patient suggests to the nurse that they may need more educational information to prevent recurrence of diverticulitis and manage the disease?
1) "I can eat bran cereals."
2) "I should avoid certain muffins."
3) "I should avoid exercising for 2 weeks."
4) "It is alright to postpone the urge to have a bowel movement."

Question 18

The nurse is planning a teaching session regarding gastrointestinal ulcers for the residents of an assisted living complex. What content should the nurse include in the presentation?
1) Gastric ulcers are more common than duodenal ulcers.
2) The first sign of a peptic ulcer may be serious gastrointestinal bleeding.
3) A colonoscopy is the test used to diagnose the presence of a gastric ulcer.
4) With peptic ulcer disease, pain will be felt when the stomach is empty.

Question 19

An older patient with gastroesophageal reflux disease has complications caused by exposure of tissue to gastric acids. The patient is prescribed Tagamet to promote healing. What statement by the patient indicates they need further teaching by the nurse regarding taking this medication?
1) "I may experience extreme sleepiness."
2) "This medication may cause impotence."
3) "I may experience some mild confusion."
4) "I may have a shorter temper taking this medication."

Question 20

The nurse is educating a daughter on how to properly feed her older mother. Following education, which observation by the nurse, indicates that the daughter still needs additional instruction?
1) She checks to make sure the patient's dentures are in place.
2) She makes sure that each bite is swallowed before providing the next bite.
3) She reminds the patient to chew the food after being placed in the patient's mouth.
4) She makes sure that the patient remains in an upright position for 15 minutes after eating.

Question 21

The nurse is teaching an older patient with diverticulitis on foods that could precipitate a painful attack. How should the nurse instruct this patient?
1) They should limit whole grains.
2) It is important to avoid foods with seeds.
3) They should restrict the intake of high fiber foods.
4) They should limit the intake of eggs and dairy products.

Question 22

An older patient with a newly diagnosed peptic ulcer asks why lifestyle alterations are necessary. What should the nurse explain to the patient about their new diagnosis?
1) "It is important to reduce alcohol; it stimulates gastric acid secretion."
2) "It is important to reduce alcohol; it acts to suppress gastric immunity."
3) "It is important to eat two large meals per day; this will reduce abdominal pain."
4) "It is important to reduce smoking because tobacco reduces the effectiveness of gastric ulcer medications."

Question 23

The nurse is preparing discharge instructions for an older patient with chronic pancreatitis. What information should the nurse include in their teaching?
1) The importance of avoiding dairy
2) Initiation of a plan to stop smoking
3) Limiting fluid intake to 8 glasses of water per day
4) The importance of avoiding any alcoholic beverages

Question 24

An older patient with intermittent diarrhea has been advised to increase the amount of soluble fiber in their diet. What should the nurse suggest to this patient?
1) They should restrict the intake of oranges.
2) They should eat whole-grain cereals.
3) It is important to limit eating frozen vegetables.
4) They should limit eating the peels of apples or pears.

Question 25

An older patient beginning antibiotic therapy for a leg wound has a history of Clostridium difficile. What should the nurse instruct the patient to do to reduce a reoccurrence?
1) Eat yogurt daily.
2) Eat large amount of fresh fruits and vegetables.
3) Restrict the amount of meat and calcium products.
4) Decrease the amount of fluid taken while on the medication.