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Chapter 32. Gastrointestinal, Hepatobiliary, and Pancreatic Systems Function, Assessment, and Therapeutic Measures Multiple Choice Identify the choice that best completes the statement or answers the question. ____

1. The nurse is caring for a 30-year-old patient who has ulcerative colitis and is scheduled to have a proctosigmoidoscopy. Which of the following would cause the nurse to clarify routine preparation orders with the physician? a. The patient’s age b. Complaints of abdominal cramping c. Patient’s weight is 10% below ideal body weight d. Presence of severe diarrhea

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2. The nurse is caring for a patient who is placed on a modified bland diet. Which of the following should be removed before serving the patient’s dinner tray? a. Mayonnaise b. Pepper c. Salt d. Sugar

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3. Prior to initiating a tube feeding via nasogastric (NG) tube, the nurse irrigates the tube with which of the following? a. Cranberry juice b. Normal saline c. Sterile water d. Carbonated water

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4. The nurse is inspecting a patient’s oral cavity. What is the most important safety reason to inspect for loose teeth when collecting data on the oral cavity of a patient? a. Loose teeth are unsightly to the patient. b. Loose teeth can cause dental abscesses. c. Loose teeth can prevent the patient from eating. d. Loose teeth can be aspirated into the airway.

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5. The nurse is assisting a patient who is scheduled for an ileostomy. Which of the following data collection techniques would the nurse use to help identify optimal stoma placement? a. Auscultation b. Inspection c. Palpation d. Percussion

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6. An LPN who typically works on a medical unit has been pulled to cover staffing deficits on a surgical unit. After obtaining report, the nurse realizes that one of the assigned patients is currently receiving total parenteral nutrition (TPN). Which of the following actions should the nurse take? a. Provide patient care as assigned. b. Notify the supervisor that another nurse will need to be pulled. c. Ask another nurse to trade patients for the shift. d. Notify the charge nurse that an adjustment in the patient assignment is necessary.

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7. The nurse is collecting data for a patient who reports right upper abdominal quadrant warmth and tenderness. When the nurse touches the area lightly to assess for warmth and tenderness, what data collection technique is being used? a. Auscultation b. Inspection c. Palpation d. Percussion

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8. The nurse is caring for a patient whose nasogastric (NG) tube, attached to low intermittent suction to decompress a bowel obstruction, is not draining. After checking placement, which of these actions should the nurse take? a. Irrigate the NG tube with 30 milliliters of normal saline. b. Change the suction setting to high. c. Reinsert the NG tube in the other nare. d. Advance the NG tube 2 inches.

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9. The nurse is checking tube feeding residual amounts and obtains 120 mL of residual. The patient is receiving 70 milliliter per hour of feeding. What action should the nurse take? a. Continue the feeding as ordered. b. Slow the feeding to 35 mL/hr. c. Increase the feeding to 100 mL/hr. d. Hold the feeding, and notify the physician.

____ 10. The nurse is auscultating bowel sounds and hears two bowel sounds over 5 minutes. How should the nurse document this finding? a. Absent bowel sounds b. Hyperactive bowel sounds c. Hypoactive bowel sounds d. Normal bowel sounds ____ 11. The nurse is checking tube feeding residual amounts and obtains 10 mL of residual. The patient is receiving 60 mL/hour of feeding. What action should the nurse take? a. Continue the feeding as ordered. b. Slow the feeding to 35 mL/hour. c. Decrease the feeding to 10 mL/hour. d. Hold the feeding, and notify the physician. ____ 12. While providing care for a patient who has recently completed chemotherapy for colorectal cancer, the nurse notes the patient has an elevated carcinoembryonic antigen (CEA) level. Which of the following interpretations of this test result, by the nurse, is best? a. The patient has a residual or recurrent tumor. b. The liver has been damaged by chemotherapy. c. The patient is cured. d. The patient should be placed in protective isolation. ____ 13. The nurse is reinforcing teaching for a patient who has upper abdominal pain and is scheduled for an upper gastrointestinal (GI) series. Which of the following statements by the patient would indicate a correct understanding of the teaching? a. “It is an estimated rectal cholangiopancreatophonography.” b. “It is a sigmoidoscopy with radiography after injection of dye.” c. “It is an x-ray of the esophagus, stomach, and duodenum using barium.” d. “It is a scope inserted into the duodenum with dye injection.”

____ 14. The nurse reinforces teaching for a patient who has been scheduled for an upper gastrointestinal (GI) series. Which of the following statements, by the patient, indicates teaching has been effective? a. “I must not eat or drink for 4 hours after the procedure.” b. “I can’t have anything to eat or drink for 6 to 8 hours before the procedure.” c. “I should eat a soft diet the night before the procedure.” d. “I’ll be given a clear liquid diet the night after the procedure.” ____ 15. The nurse is ready to begin a tube feeding via a nasogastric feeding tube for a patient who is comatose. Which of the following actions should the nurse take? a. Place the patient onto the left side with knees flexed. b. Elevate the head of the bed 10 degrees. c. Lay the patient supine. d. Place the patient in high Fowler’s position. ____ 16. The nurse is ready to begin a tube feeding via a nasogastric (NG) feeding tube for a patient who is comatose. What is the priority action the nurse should take before starting the feeding? a. Secure the NG tube with additional tape. b. Check the pH of gastric aspirate. c. Irrigate the tube with 10 mL of sterile water. d. Listen to bowel sounds. ____ 17. The nurse is caring for a patient with cultural dietary needs. Which of the following questions should the nurse include in a cultural dietary assessment? a. “What foods are available in the country where you lived?” b. “Which unavailable cultural foods do you prefer to eat?” c. “Which foods do you most commonly eat?” d. “What restaurants do you go to?” ____ 18. The nurse is administering a tube feeding to a patient who has been receiving feedings at 50 mL/hour for 1 day. The nurse is checking placement and residual volume and is able to aspirate back 250 mL of undigested tube feeding. What action should the nurse take? a. Return aspirated tube feeding to the patient, and run feeding at a slower rate of 20 mL/hour. b. Discard aspirated tube feeding, and run tube feeding as ordered by the physician. c. Report amount of aspirated tube feeding to the RN for consultation with the physician. d. Return aspirated tube feeding to the patient, and wait 2 hours before restarting tube feeding at 50 mL/hr. ____ 19. The nurse is reviewing gastrointestinal function. Mechanical digestion in the stomach is accomplished by which of these? a. Mucosa b. Smooth muscle layers c. Striated muscle layers d. Gastric glands ____ 20. The nurse is reinforcing teaching for a patient who has a peptic ulcer. Which of the following statements by the patient would indicate a correct understanding of function of hydrochloric acid in gastric juice? a. Digestion of starch b. Inactivation of pepsin c. Destruction of pathogens d. Maintenance of a pH of 7 to 8

____ 21. The nurse is caring for a patient who has a nonvented nasogastric tube. Which of the following suction settings must the nurse select? a. Low intermittent suction b. High intermittent suction c. Low continuous suction d. High continuous suction ____ 22. The nurse is assisting with the care of a patient who has total parenteral nutrition (TPN) infusing. Which of the following would be most concerning to the nurse? a. Urine output 60 mL in the past hour b. Blood glucose 260 mg/dL c. Heart rate 92 beats/min d. Respiratory rate 16/min ____ 23. The nurse is assisting with the care of a patient who has total parenteral nutrition (TPN) containing dextrose 50% infusing. The patient asks why the rate keeps being increased. Which of the following statements, by the nurse, is best? a. “It is important to increase the TPN whenever your blood sugar is low.” b. “It is started slowly and increased slowly to allow your pancreas to adjust insulin levels.” c. “By changing the rate, it helps your body increase absorption of the electrolytes.” d. “It is important to do this to help reduce bile secretion and prevent heartburn.” ____ 24. The nurse is caring for a patient who develops difficulty swallowing and has a permanent gastric feeding tube inserted. What nursing action would be most helpful to prevent aspiration during feedings? a. Check placement of the tube hourly. b. Administer careful oral care daily. c. Elevate head of bed at least 30 degrees. d. Ask the physician to order daily x-rays. ____ 25. A patient’s Levin nasogastric tube inserted for decompression of the bowel, which is connected to low intermittent suction, is not draining. The patient reports feeling full, uncomfortable, and nauseous. After verifying tube placement, what action should the nurse take next? a. Provide an antiemetic. b. Remove the nasogastric tube. c. Notify the physician immediately. d. Gently irrigate tube with normal saline. ____ 26. The nurse is reinforcing teaching for a patient who is scheduled for an esophagogastroduodenoscopy. Which of these, if stated by a patient, indicates to the nurse correct understanding of preprocedure diet instructions? a. “I can drink only clear liquids 2 hours before the procedure.” b. “I will have nothing to eat or drink 8 to 12 hours before the procedure.” c. “I may have a full liquid breakfast.” d. “I will not eat or drink 12 hours before the procedure.” ____ 27. The nurse is preparing a patient for a nasogastric tube insertion. To decrease the patient’s anxiety about insertion of a nasogastric tube, what should the nurse do? a. Explain the procedure. b. Administer a narcotic. c. Administer a sedative. d. Assess the patient’s gag reflex. ____ 28. The nurse is caring for a patient on a clear liquid diet. The nurse would recognize that the patient required further teaching if the patient requested which of these foods?

a. b. c. d.

Beef broth Cranberry juice Coffee with cream Gelatin

____ 29. The nurse is caring for a patient on a full liquid diet. The nurse would recognize that the patient understands teaching if the patient requests which of these foods? a. Hamburger b. Milkshake c. Cheese d. Salad ____ 30. The nurse enters the room of a patient who returned from gastrointestinal surgery 4 hours ago. The patient is alert and oriented and complains of feeling thirsty. Diet orders read, “clear liquids, advance as tolerated.” Which of the following actions should the nurse take? a. Allow the patient to take small sips of water. b. Inform the patient she must remain NPO until she has bowel sounds. c. Ask the patient if she has passed any flatus. d. Notify the registered nurse. Multiple Response Identify one or more choices that best complete the statement or answer the question. ____ 31. The nurse is reinforcing teaching for a patient who is on a clear liquid diet. Which of these patient statements indicates correct understanding of the foods that would be appropriate on this diet? (Select all that apply.) a. Beef broth b. Apple juice c. Tea with sugar d. Vanilla ice cream e. Grape juice f. Orange gelatin ____ 32. The nurse is contributing to the teaching plan for the nurse’s team of patients. Which of the following patients would the nurse expect to be scheduled for an upper gastrointestinal (GI) series? (Select all that apply.) a. A 65-year-old who is receiving treatment for hemorrhoids b. A 45-year-old with a suspected hiatal hernia c. A 19-year-old with symptoms of appendicitis d. A 78-year-old who has frank blood in his stool e. A 33-year-old who is experiencing symptoms of pyloric stricture f. A 52-year-old with a family history of polyps ____ 33. The nurse is contributing to a patient’s plan of care. Which of these patients would the nurse recommend could benefit from total parenteral nutrition (TPN)? (Select all that apply.) a. A patient who has esophageal cancer b. A patient who has just had an appendectomy c. A patient who has been admitted with chest pain d. A patient who has respiratory distress from emphysema e. A patient scheduled for toe amputation f. A patient with severe burns across the face and chest

____ 34. The nurse is reinforcing teaching for a patient who has hepatitis. Which of the following are functions of the liver to include in the teaching? (Select all that apply.) a. Phagocytize worn red blood cells b. Produce white blood cells c. Form bilirubin d. Synthesize clotting factors e. Store sodium and potassium f. Synthesize essential amino acids ____ 35. The nurse is reinforcing teaching for a patient who has a small bowel obstruction. Which of the following processes occur in the small intestine and should be included? (Select all that apply.) a. Production of enzymes to complete carbohydrate metabolism b. Production of bile c. Production of peptides to complete the digestion of proteins to amino acids d. Mechanical digestion of food to chyme e. Absorption of water f. Production of insulin ____ 36. The nurse is reviewing structures in the hepatobiliary system. Which of these structures are found in this system? (Select all that apply.) a. Bile duct b. Colon c. Esophagus d. Gallbladder e. Liver f. Jejunum ____ 37. The nurse is participating in a local health fair. Which of the following would be included in a presentation on aging changes associated with the gastrointestinal (GI) system? (Select all that apply.) a. Increased constipation b. Decreased sense of taste c. Decreased risk of colon cancer d. Increased periodontal disease e. Increased peristalsis Completion Complete each statement. 38. Total parenteral nutrition (TPN) dextrose greater than ____________________% should be administered through a central venous catheter into a large vein to prevent vein irritation and thrombophlebitis. 39. When palpating the abdomen of a patient reporting mild abdominal pain in the upper right quadrant, the nurse should depress the abdomen no more than ____________________ inch(es). 40. A person who is 5 feet 6 inches tall and weighs 225 pounds has a body mass index of ____________________.

Chapter 32. Gastrointestinal, Hepatobiliary, and Pancreatic Systems Function, Assessment, and Therapeutic Measures Answer Section MULTIPLE CHOICE 1. ANS: D Routine preparation with severe diarrhea can result in electrolyte imbalance. Bowel preparation may not be ordered for patients with bleeding or severe diarrhea. PTS: 1 DIF: Medium REF: Page 690 KEY: Client Need: PHYS—Reduction of Risk Potential | Cognitive Level: Application | Integrated Processes: Clinical Problem-Solving Process | Question to Guide Your Learning: 6 2. ANS: B Pepper, which is spicy, would not be included in a bland diet. PTS: 1 DIF: Easy REF: Page 691 KEY: Client Need: PHYS—Basic Care and Comfort | Cognitive Level: Application | Integrated Processes: Clinical Problem-Solving Process | Question to Guide Your Learning: 9 3. ANS: B Normal saline is used for NG tube irrigation to prevent loss of electrolytes. PTS: 1 DIF: Easy REF: Page 709 KEY: Client Need: PHYS—Pharmacological Therapies | Cognitive Level: Application | Integrated Processes: Clinical Problem-Solving Process | Question to Guide Your Learning: 8 4. ANS: D Loose teeth can be aspirated into the airway and become a choking risk. PTS: 1 DIF: Medium REF: Page 694 KEY: Client Need: PHYS—Reduction of Risk Potential | Cognitive Level: Comprehension | Integrated Processes: Clinical Problem-Solving Process | Question to Guide Your Learning: 4 5. ANS: B Inspection is observation. The abdomen is visually inspected to note the condition of the skin, the contour, belt line, and other factors that would affect optimal stoma placement. PTS: 1 DIF: Easy REF: Page 695 KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Application | Integrated Processes: Clinical Problem-Solving Process | Question to Guide Your Learning: 5 6. ANS: D Usually, registered nurses are responsible for administering TPN. Therefore, the LPN should discuss the assignment with the charge nurse and seek a possible adjustment. PTS: 1 DIF: Hard REF: Page 712 KEY: Client Need: Coordinated Care | Cognitive Level: Application | Integrated Processes: Communication and Documentation | Question to Guide Your Learning: 5 7. ANS: C Light palpation uses touch and depresses the abdomen

to 1 inch.

PTS: 1 DIF: Easy REF: Page 697 KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Comprehension | Integrated Processes: Clinical Problem-Solving Process | Question to Guide Your Learning: 5 8. ANS: A Irrigate the NG tube with 30 mL of normal saline to see if it is obstructed or on the stomach wall. Suction should remain on a low setting to prevent damage to the lining of the stomach. PTS: 1 DIF: Medium REF: Page 706 KEY: Client Need: PHYS—Basic Care and Comfort | Cognitive Level: Application | Integrated Processes: Clinical Problem-Solving Process | Question to Guide Your Learning: 7 9. ANS: D If the residual amount is more than 100 mL or the amount specified by the agency or physician, the feeding should be stopped to prevent vomiting or aspiration and the physician notified. PTS: 1 DIF: Medium REF: Page 711 KEY: Client Need: PHYS—Reduction of Risk Potential | Cognitive Level: Analysis | Integrated Processes: Clinical Problem-Solving Process | Question to Guide Your Learning: 8 10. ANS: C Hypoactive bowel sounds are bowel sounds that are infrequent (normal is 5 to 30) over a 5-minute period and can occur in patients with a paralytic ileus or following abdominal surgery. PTS: 1 DIF: Easy REF: Page 695 KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Application | Integrated Processes: Communication and Documentation | Question to Guide Your Learning: 4 11. ANS: A If the residual amount is more than 100 mL or the amount specified by the agency or physician, the feeding should be stopped to prevent vomiting or aspiration and the physician notified. This feeding can be continued as ordered, as the residual amount is only 10 mL. PTS: 1 DIF: Medium REF: Page 711 KEY: Client Need: PHYS—Reduction of Risk Potential | Cognitive Level: Application | Integrated Processes: Clinical Problem-Solving Process | Question to Guide Your Learning: 8 12. ANS: A CEA and carbohydrate antigen 19-9 are markers used to monitor gastrointestinal (GI) cancer treatment effectiveness and detect recurrence. An elevated CEA level would not be seen in the absence of disease and does not indicate liver function. Extremely low white blood cell counts would be used to determine if the patient needed to be placed in protective isolation. PTS: 1 DIF: Medium REF: Page 698 KEY: Client Need: PHYS—Reduction of Risk Potential | Cognitive Level: Analysis | Integrated Processes: Clinical Problem-Solving Process | Question to Guide Your Learning: 4 13. ANS: C An upper GI is an x-ray of the esophagus, stomach, and duodenum using barium. PTS: 1 DIF: Easy REF: Page 698-701 KEY: Client Need: PHYS—Physiological Adaptation|Cognitive Level: Analysis| Integrated Processes: Teaching and Learning| Question to Guide Your Learning: 6 14. ANS: B

An appropriate patient diet preparation for an upper GI series is placing the patient on NPO restriction 6 to 8 hours before the procedure for best visualization. PTS: 1 DIF: Medium REF: Page 701 KEY: Client Need: PHYS—Reduction of Risk Potential | Cognitive Level: Application | Integrated Processes: Clinical Problem-Solving Process | Question to Guide Your Learning: 6 15. ANS: D When feedings are administered, patients must be positioned in a sitting or high Fowler’s position to reduce the risk of aspiration. PTS: 1 DIF: Medium REF: Page 709 KEY: Client Need: PHYS—Basic C...