Deck 43: Assessment of Digestive and Gastrointestinal Function

Question 1

A nurse is caring for a patient who is scheduled for a colonoscopy and whose bowel preparation will include polyethylene glycol electrolyte lavage prior to the procedure. The presence of what health problem would contraindicate the use of this form of bowel preparation?

A) Inflammatory bowel disease
B) Intestinal polyps
C) Diverticulitis
D) Colon cancer

Answer 1

Inflammatory bowel disease

Question 2

A nurse is promoting increased protein intake to enhance a patients wound healing. The nurse knows that enzymes are essential in the digestion of nutrients such as protein. What is the enzyme that initiates the digestion of protein?

A) Pepsin
B) Intrinsic factor
C) Lipase
D) Amylase

Answer 2

Pepsin

Question 3

A patient has been brought to the emergency department with abdominal pain and is subsequently diagnosed with appendicitis. The patient is scheduled for an appendectomy but questions the nurse about how his health will be affected by the absence of an appendix. How should the nurse best respond?

A) Your appendix doesnt play a major role, so you wont notice any difference after you recovery from surgery.
B) The surgeon will encourage you to limit your fat intake for a few weeks after the surgery, but your body will then begin to compensate.
C) Your body will absorb slightly fewer nutrients from the food you eat, but you wont be aware of this.
D) Your large intestine will adapt over time to the absence of your appendix.

Answer 3

Your appendix doesnt play a major role, so you wont notice any difference after you recovery from surgery.

Question 4

A patient asks the nursing assistant for a bedpan. When the patient is finished, the nursing assistant notifies the nurse that the patient has bright red streaking of blood in the stool. What is this most likely a result of?

A) Diet high in red meat
B) Upper GI bleed
C) Hemorrhoids
D) Use of iron supplements

Question 5

An adult patient is scheduled for an upper GI series that will use a barium swallow. What teaching should the nurse include when the patient has completed the test?

A) Stool will be yellow for the first 24 hours postprocedure.
B) The barium may cause diarrhea for the next 24 hours.
C) Fluids must be increased to facilitate the evacuation of the stool.
D) Slight anal bleeding may be noted as the barium is passed.

Question 6

A patient has come to the outpatient radiology department for diagnostic testing. Which of the following diagnostic procedures will allow the care team to evaluate and remove polyps?

A) Colonoscopy
B) Barium enema
C) ERCP
D) Upper gastrointestinal fibroscopy

Question 7

A nurse is caring for a patient with recurrent hematemesis who is scheduled for upper gastrointestinal fibroscopy (UGF). How should the nurse in the radiology department prepare this patient?

A) Insert a nasogastric tube.
B) Administer a micro Fleet enema at least 3 hours before the procedure.
C) Have the patient lie in a supine position for the procedure.
D) Apply local anesthetic to the back of the patients throat.

Question 8

The nurse is providing health education to a patient scheduled for a colonoscopy. The nurse should explain that she will be placed in what position during this diagnostic test?

A) In a knee-chest position (lithotomy position)
B) Lying prone with legs drawn toward the chest
C) Lying on the left side with legs drawn toward the chest
D) In a prone position with two pillows elevating the buttocks

Question 9

A patient has sought care because of recent dark-colored stools. As a result, a fecal occult blood test has been ordered. The nurse should instruct the patient to avoid which of the following prior to collecting a stool sample?

A) NSAIDs
B) Acetaminophen
C) OTC vitamin D supplements
D) Fiber supplements

Question 10

A patient who has been experiencing changes in his bowel function is scheduled for a barium enema. What instruction should the nurse provide for postprocedure recovery?

A) Remain NPO for 6 hours postprocedure.
B) Administer a Fleet enema to cleanse the bowel of the barium.
C) Increase fluid intake to evacuate the barium.
D) Avoid dairy products for 24 hours postprocedure.

Question 11

A nurse is caring for a newly admitted patient with a suspected GI bleed. The nurse assesses the patients stool after a bowel movement and notes it to be a tarry-black color. This finding is suggestive of bleeding from what location?

A) Sigmoid colon
B) Upper GI tract
C) Large intestine
D) Anus or rectum

Question 12

A nursing student has auscultated a patients abdomen and noted one or two bowel sounds in a 2-minute period of time. How would you tell the student to document the patients bowel sounds?

A) Normal
B) Hypoactive
C) Hyperactive
D) Paralytic ileus

Question 13

An advanced practice nurse is assessing the size and density of a patients abdominal organs. If the results of palpation are unclear to the nurse, what assessment technique should be implemented?

A) Percussion
B) Auscultation
C) Inspection
D) Rectal examination

Question 14

A nurse is caring for a patient with biliary colic and is aware that the patient may experience referred abdominal pain. Where would the nurse most likely expect this patient to experience referred pain?

A) Midline near the umbilicus
B) Below the right nipple
C) Left groin area
D) Right lower abdominal quadrant

Question 15

An inpatient has returned to the medical unit after a barium enema. When assessing the patients subsequent bowel patterns and stools, what finding should the nurse report to the physician?

A) Large, wide stools
B) Milky white stools
C) Three stools during an 8-hour period of time
D) Streaks of blood present in the stool

Question 16

A nurse in a stroke rehabilitation facility recognizes that the brain regulates swallowing. Damage to what area of the brain will most affect the patients ability to swallow?

A) Temporal lobe
B) Medulla oblongata
C) Cerebellum
D) Pons

Question 17

A patient is being assessed for a suspected deficit in intrinsic factor synthesis. What diagnostic or assessment finding is the most likely rationale for this examination of intrinsic factor production?

A) Muscle wasting
B) Chronic jaundice in the absence of liver disease
C) The presence of fat in the patients stool
D) Persistently low hemoglobin and hematocrit

Question 18

A patient with a recent history of intermittent bleeding is undergoing capsule endoscopy to determine the source of the bleeding. When explaining this diagnostic test to the patient, what advantage should the nurse describe?

A) The test allows visualization of the entire peritoneal cavity.
B) The test allows for painless biopsy collection.
C) The test does not require fasting.
D) The test is noninvasive.

Question 19

A nurse is caring for a patient admitted with a suspected malabsorption disorder. The nurse knows that one of the accessory organs of the digestive system is the pancreas. What digestive enzymes does the pancreas secrete? Select all that apply.

A) Pepsin
B) Lipase
C) Amylase
D) Trypsin
E) Ptyalin

Question 20

The nurse is caring for a patient with a duodenal ulcer and is relating the patients symptoms to the physiologic functions of the small intestine. What do these functions include? Select all that apply.

A) Secretion of hydrochloric acid $(\mathrm{HCl})$
B) Reabsorption of water
C) Secretion of mucus
D) Absorption of nutrients
E) Movement of nutrients into the bloodstream

Question 21

A nurse is performing an abdominal assessment of an older adult patient. When collecting and analyzing data, the nurse should be cognizant of what age-related change in gastrointestinal structure and function?

A) Increased gastric motility
B) Decreased gastric $\mathrm{pH}$
C) Increased gag reflex
D) Decreased mucus secretion

Question 22

The nurse educator is reviewing the blood supply of the GI tract with a group of medical nurses. The nurse is explaining the fact that the veins that return blood from the digestive organs and the spleen form the portal venous system. What large veins will the nurse list when describing this system? Select all that apply.

A) Splenic vein
B) Inferior mesenteric vein
C) Gastric vein
D) Inferior vena cava
E) Saphenous vein

Question 23

The physiology instructor is discussing the GI system with the pre-nursing class. What should the instructor describe as a major function of the GI tract?

A) The breakdown of food particles into cell form for digestion
B) The maintenance of fluid and acid-base balance
C) The absorption into the bloodstream of nutrient molecules produced by digestion
D) The control of absorption and elimination of electrolytes

Question 24

A nurse is providing preprocedure education for a patient who will undergo a lower GI tract study the following week. What should the nurse teach the patient about bowel preparation?

A) Youll need to fast for at least 18 hours prior to your test.
B) Starting today, take over-the-counter stool softeners twice daily.
C) Youll need to have enemas the day before the test.
D) For 24 hours before the test, insert a glycerin suppository every 4 hours.

Question 25

A patient presents at the walk-in clinic complaining of recurrent sharp stomach pain that is relieved by eating. The nurse suspects that the patient may have an ulcer. How would the nurse explain the formation and role of acid in the stomach to the patient?

A) Hydrochloric acid is secreted by glands in the stomach in response to the actual or anticipated presence of food.
B) As digestion occurs in the stomach, the stomach combines free hydrogen ions from the food to form acid.
C) The body requires an acidic environment in order to synthesize pancreatic digestive enzymes; the stomach provides this environment.
D) The acidic environment in the stomach exists to buffer the highly alkaline environment in the esophagus.

Question 26

Results of a patients preliminary assessment prompted an examination of the patients carcinoembryonic antigen (CEA) levels, which have come back positive. What is the nurses most appropriate response to this finding?

A) Perform a focused abdominal assessment.
B) Prepare to meet the patients psychosocial needs.
C) Liaise with the nurse practitioner to perform an anorectal examination.
D) Encourage the patient to adhere to recommended screening protocols.

Question 27

A clinic patient has described recent dark-colored stools; the nurse recognizes the need for fecal occult blood testing (FOBT). What aspect of the patients current health status would contraindicate FOBT?

A) Gastroesophageal reflux disease (GERD)
B) Peptic ulcers
C) Hemorrhoids
D) Recurrent nausea and vomiting

Question 28

A patient will be undergoing abdominal computed tomography (CT) with contrast. The nurse has administered IV sodium bicarbonate and oral acetylcysteine (Mucomyst) before the study as ordered. What would indicate that these medications have had the desired therapeutic effect?

A) The patients BUN and creatinine levels are within reference range following the CT.
B) The CT yields high-quality images.
C) The patients electrolytes are stable in the 48 hours following the CT.
D) The patients intake and output are in balance on the day after the CT.

Question 29

A medical patients CA 19-9 levels have become available and they are significantly elevated. How should the nurse best interpret this diagnostic finding?

A) The patient may have cancer, but other GI disease must be ruled out.
B) The patient most likely has early-stage colorectal cancer.
C) The patient has a genetic predisposition to gastric cancer.
D) The patient has cancer, but the site is unknown.

Question 30

A patient has come to the clinic complaining of blood in his stool. A FOBT test is performed but is negative. Based on the patients history, the physician suggests a colonoscopy, but the patient refuses, citing a strong aversion to the invasive nature of the test. What other test might the physician order to check for blood in the stool?

A) A laparoscopic intestinal mucosa biopsy
B) A quantitative fecal immunochemical test
C) Computed tomography (CT)
D) Magnetic resonance imagery (MRI)

Question 31

A nurse is assessing the abdomen of a patient just admitted to the unit with a suspected GI disease. Inspection reveals several diverse lesions on the patients abdomen. How should the nurse best interpret this assessment finding?

A) Abdominal lesions are usually due to age-related skin changes.
B) Integumentary diseases often cause GI disorders.
C) GI diseases often produce skin changes.
D) The patient needs to be assessed for self-harm.

Question 32

Probably the most widely used in-office or at-home occult blood test is the Hemoccult II. The patient has come to the clinic because he thinks there is blood in his stool. When you reviewed his medications, you noted he is on antihypertensive drugs and NSAIDs for early arthritic pain. You are sending the patient home with the supplies necessary to perform 2 hemoccult tests on his stool and mail the samples back to the clinic. What instruction would you give this patient?

A) Take all your medications as usual.
B) Take all your medications except the antihypertensive medications.
C) Dont eat highly acidic foods 72 hours before you start the test.
D) Avoid vitamin $\mathrm{C}$ for 72 hours before you start the test.

Question 33

A patients sigmoidoscopy has been successfully completed and the patient is preparing to return home. Which of the following teaching points should the nurse include in the patients discharge education?

A) The patient should drink at least 2 liters of fluid in the next 12 hours.
B) The patient can resume a normal routine immediately.
C) The patient should expect fecal urgency for several hours.
D) The patient can expect some scant rectal bleeding.

Question 34

A nurse is caring for an 83-year-old patient who is being assessed for recurrent and intractable nausea. What age-related change to the GI system may be a contributor to the patients health complaint?

A) Stomach emptying takes place more slowly.
B) The villi and epithelium of the small intestine become thinner.
C) The esophageal sphincter becomes incompetent.
D) Saliva production decreases.

Question 35

A patient has been experiencing significant psychosocial stress in recent weeks. The nurse is aware of the hormonal effects of stress, including norepinephrine release. Release of this substance would have what effect on the patients gastrointestinal function? Select all that apply.

A) Decreased motility
B) Increased sphincter tone
C) Increased enzyme release
D) Inhibition of secretions
E) Increased peristalsis

Question 36

A patient with cystic fibrosis takes pancreatic enzyme replacements on a regular basis. The patients intake of trypsin facilitates what aspect of GI function?

A) Vitamin D synthesis
B) Digestion of fats
C) Maintenance of peristalsis
D) Digestion of proteins

Question 37

The nurse is caring for a patient who has a diagnosis of AIDS. Inspection of the patients mouth reveals the new presence of white lesions on the patients oral mucosa. What is the nurses most appropriate response?

A) Encourage the patient to gargle with salt water twice daily.
B) Attempt to remove the lesions with a tongue depressor.
C) Make a referral to the units dietitian.
D) Inform the primary care provider of this finding.

Question 38

A patient has been scheduled for a urea breath test in one months time. What nursing diagnosis most likely prompted this diagnostic test?

A) Impaired Dentition Related to Gingivitis
B)Risk For Impaired Skin Integrity Related to Peptic Ulcers
C)Imbalanced Nutrition: Less Than Body Requirements Related to Enzyme Deficiency
D) Diarrhea Related to Clostridium Difficile Infection

Question 39

A female patient has presented to the emergency department with right upper quadrant pain; the physician has ordered abdominal ultrasound to rule out cholecystitis (gallbladder infection). The patient expresses concern to the nurse about the safety of this diagnostic procedure. How should the nurse best respond?

A) Abdominal ultrasound is very safe, but it cant be performed if youre pregnant.
B) Abdominal ultrasound poses no known safety risks of any kind.
C) Current guidelines state that a person can have up to 3 ultrasounds per year.
D) Current guidelines state that a person can have up to 6 ultrasounds per year.