Ch 43 Assessment of Digestive and Gastrointestinal Function PDF

Preview

Summary

Chapter 43: Assessment of Digestive and Gastrointestinal Function A nurse is caring for a patient who is scheduled for a colonoscopy and whose bowel preparation wilinclude polyethylene glycol electrolyte lavage prior to the procedure. The presence of what health l problem would contraindicate the us...

Description

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

820

Chapter43:AssessmentofDigestiveandGastrointestinalFunction  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

Ans:

A Feedback: Theuseofalavagesolutioniscontraindicatedinpatientswithintestinalobstructionorinflammatory boweldisease.Itcansafelybeusedwithpatientswhohavepolyps,coloncancer,ordiverticulitis.

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

Ans:

A Feedback: Theenzymethatinitiatesthedigestionofproteinispepsin.IntrinsicfactorcombineswithvitaminB12 forabsorptionbytheileum.Lipaseaidsinthedigestionoffatsandamylaseaidsinthedigestionof starch.

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?

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

821

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.

Ans:

A Feedback: Theappendixisanappendageofthececum(notthelargeintestine)thathaslittleornophysiologic function.Itsabsencedoesnotaffectdigestionorabsorption.

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

Ans:

C Feedback: Lowerrectaloranalbleedingissuspectedifthereisstreakingofbloodonthesurfaceofthestool. Hemorrhoidsareoftenacauseofanalbleedingsincetheyoccurintherectum.BloodfromanupperGI bleedwouldbedarkratherthanfrank.Ironsupplementsmakethestooldark,butnotbloodyandred meatconsumptionwouldnotcausefrankblood.

5.

A)

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? Stoolwillbeyellowforthefirst24hourspostprocedure.

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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.

Ans:

C

822

Feedback: Postproceduralpatienteducationincludesinformationaboutincreasingfluidintake;evaluatingbowel movementsforevacuationofbarium;andnotingincreasednumberofbowelmovements,because barium,duetoitshighosmolarity,maydrawfluidintothebowel,thusincreasingtheintraluminal contentsandresultingingreateroutput.Yellowstool,diarrhea,andanalbleedingarenotexpected. 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

Ans:

A Feedback: Duringcolonoscopy,tissuebiopsiescanbeobtainedasneeded,andpolypscanberemovedand evaluated.Thisisnotpossibleduringabariumenema,ERCP,orgastroscopy.

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.

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

Ans:

823

D Feedback: PreparationforUGFincludessprayingorgarglingwithalocalanesthetic.Anasogastrictubeoramicro Fleetenemaisnotrequiredforthisprocedure.Thepatientshouldbepositionedinaside-lyingposition incaseofemesis.

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

Ans:

C Feedback: Forbestvisualization,colonoscopyisperformedwhilethepatientislyingontheleftsidewiththelegs drawnuptowardthechest.Akneechestposition,lyingonthestomachwithlegsdrawntothechest,and apronepositionwithtwopillowselevatingthelegsdonotallowforthebestvisualization.

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

Ans:

A Feedback: NSAIDscancauseafalse-positivefecaloccultbloodtest.Acetaminophen,vitaminDsupplements,and fibersupplementsdonothavethiseffect.

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

824

10. Thenurseispreparingtoperformapatientsabdominalassessment.Whatexaminationsequenceshould thenursefollow? A)

Inspection,auscultation,percussion,andpalpation

B)

Inspection,palpation,auscultation,andpercussion

C)

Inspection,percussion,palpation,andauscultation

D)

Inspection,palpation,percussion,andauscultation

Ans:

A Feedback: Whenperformingafocusedassessmentofthepatientsabdomen,auscultationshouldalwaysprecede percussionandpalpationbecausetheymayalterbowelsounds.Thetraditionalsequenceforallother focusedassessmentsisinspection,palpation,percussion,andauscultation.

11. 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.

Ans:

C Feedback: AdequatefluidintakeisnecessarytoridtheGItractofbarium.ThepatientmustnotremainNPOafter thetestandenemasarenotusedtocleansethebowelofbarium.Thereisnoneedtoavoiddairy products.

12. 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

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

B)

UpperGItract

C)

Largeintestine

D)

Anusorrectum

Ans:

B

825

Feedback: BloodshedinsufficientquantitiesintheupperGItractwillproduceatarry-blackcolor(melena).Blood enteringthelowerportionoftheGItractorpassingrapidlythroughitwillappearbrightordarkred. Lowerrectaloranalbleedingissuspectedifthereisstreakingofbloodonthesurfaceofthestoolorif bloodisnotedontoilettissue. 13. 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

Ans:

B Feedback: Documentingbowelsoundsisbasedonassessmentfindings.Thetermsnormal(soundsheardabout every5to20seconds),hypoactive(oneortwosoundsin2minutes),hyperactive(5to6soundsheardin lessthan30seconds),orabsent(nosoundsin3to5minutes)arefrequentlyusedindocumentation. Paralyticileusisamedicaldiagnosisthatmaycauseabsentorhypoactivebowelsounds,butthenurse wouldnotindependentlydocumentthisdiagnosis.

14. 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

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

D)

Rectalexamination

Ans:

A

826

Feedback: Percussionisusedtoassessthesizeanddensityoftheabdominalorgansandtodetectthepresenceof air-filled,fluid-filled,orsolidmasses.Percussionisusedeitherindependentlyorconcurrentlywith palpationbecauseitcanvalidatepalpationfindings. 15. 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

Ans:

B Feedback: Patientswithreferredabdominalpainassociatedwithbiliarycoliccomplainofpainbelowtheright nipple.Referredpainabovetheleftnipplemaybeassociatedwiththeheart.Groinpainmaybereferred painfromureteralcolic.

16. 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

Ans:

D Feedback:

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

827

Bariumhasahighosmolarityandmaydrawfluidintothebowel,thusincreasingtheintraluminal contentsandresultingingreateroutput(largestools).Thebariumwillgivethestoolsamilkywhite appearance,anditisnotuncommonforthepatienttoexperienceanincreaseinthenumberofbowel movements.Bloodinfecalmatterisnotanexpectedfindingandthenurseshouldnotifythephysician. 17. 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

Ans:

B Feedback: Swallowingisavoluntaryactthatisregulatedbyaswallowingcenterinthemedullaoblongataofthe centralnervoussystem.Swallowingisnotregulatedbythetemporallobe,cerebellum,orpons.

18. 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

Ans:

D Feedback: Intheabsenceofintrinsicfactor,vitaminB12cannotbeabsorbed,andperniciousanemiaresults.This wouldresultinamarkedreductioninhemoglobinandhematocrit.

19. 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?

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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.

Ans:

D

828

Feedback: Capsuleendoscopyallowsthenoninvasivevisualizationofthemucosathroughouttheentiresmall intestine.Bowelpreparationisnecessaryandbiopsiescannotbecollected.Thisprocedureallows visualizationoftheentireGItract,butnottheperitonealcavity. 20. 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

Ans:

B,C,D Feedback: Digestiveenzymessecretedbythepancreasincludetrypsin,whichaidsindigestingprotein;amylase, whichaidsindigestingstarch;andlipase,whichaidsindigestingfats.Pepsinissecretedbythestomach andptyalinissecretedinthesaliva.

21. 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(HCl)

B)

Reabsorptionofwater

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

C)

Secretionofmucus

D)

Absorptionofnutrients

E)

Movementofnutrientsintothebloodstream

Ans:

C,D,E

829

Feedback: Thesmallintestinefoldsbackandforthonitself,providingapproximately7000cm2(70m2)ofsurface areaforsecretionandabsorption,theprocessbywhichnutrientsenterthebloodstreamthroughthe intestinalwalls.Waterreabsorptionprimarilytakesplaceinthelargebowel.HClissecretedbythe stomach. 22. 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pH

C)

Increasedgagreflex

D)

Decreasedmucussecretion

Ans:

D Feedback: Olderadultstendtosecretelessmucusthanyoungeradults.Gastricmotilityslowswithageandgastric pHrisesduetodecreasedsecretionofgastricacids.Olderadultstendtohaveabluntedgagreflex comparedtoyoungeradults.

ThenurseeducatorisreviewingthebloodsupplyoftheGItractwithagroupofmedicalnurses.The 23. 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

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

E)

Saphenousvein

Ans:

A,B,C

830

Feedback: Thisportalvenoussystemiscomposedoffivelargeveins:thesuperiormesenteric,inferiormesenteric, gastric,splenic,andcysticveins,whicheventuallyformthevenaportaethatenterstheliver.Theinferior venacavaisnotpartoftheportalsystem.Thesaphenousveinislocatedintheleg. 24. 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

Ans:

C Feedback: PrimaryfunctionsoftheGItractincludethebreakdownoffoodparticlesintomolecularformfor digestion;theabsorptionintothebloodstreamofsmallnutrientmoleculesproducedbydigestion;and theeliminationofundigestedunabsorbedfoodstuffsandotherwasteproducts.Nutrientsmustbebroken downintomolecularform,notcellform.Fluid,electrolyte,andacid-basebalanceareprimarilyunder thecontrolofthekidneys.

25. 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abou...