AHN CH 5: Care Of The Patient With a Gastrointestinal Disorder

The nurse clarifies that the end product of food is absorbed and put into the bloodstream by which anatomical feature?

a. gastric lining of the stomach.

b. villi of the small intestine.

c. bile of the liver in the large intestine.

d. excretion from the cecum.

b. villi of the small intestine.

ANS: B

The inner surface of the small intestine contains millions of tiny, fingerlike projections called villi, which contain small blood

vessels. They are responsible for absorbing the products of digestion.

A 56 -year-old man is admitted to the emergency room with an acute attack of diverticulitis. The patient has a temperature of

102°F, and has an elevated white count. Which assessment would alert the nurse to impending septic shock?

a. Chest pain

b. Seizure

c. Tachycardia

d. Massive diarrhea

c. Tachycardia

ANS: C

The patient with diverticulitis who has fever and an elevated white count has an infection that could lead to septic shock, which will present as tachycardia and hypotension.

Because bowel contents from an ileostomy are virtually liquid, which does the nurse expect to see in the plan of care?

a. Evaluation and assessment of dietary intake of fiber

b. Evaluation and assessment of patient cleanliness

c. Evaluation and assessment of peristomal skin integrity

d. Evaluation and assessment of the adequacy of the collection device

c. Evaluation and assessment of peristomal skin integrity

ANS: C

The nurse should assess the peristomal skin for impairment of integrity. The fecal material is liquid and has a potential for severe skin excoriation from the digestive enzymes.

The home health nurse caring for a patient who has dysarthria related to radiation therapy for an oral cancer would recommend that

the family provide which device?

a. a tablet and pencil as a communication aid.

b. a TV for diversion.

c. a bell to summon help.

d. a walkie-talkie.

a. a tablet and pencil as a communication aid.

ANS: A

The provision of an alternative method of communicating will lessen the frustration of the patient who has trouble speaking

understandably. The call bell would be helpful also, but without a way to communicate, the bell is not as essential as a method of

communication.

Which recommendation is most appropriate for a patient who has had an esophageal dilation related to achalasia?

a. Consume only liquid.

b. Avoid fruit juices.

c. Drink 10 oz of fluid with each meal.

d. Lie down for 30 minutes after each meal.

c. Drink 10 oz of fluid with each meal.

ANS: C

The patient should drink fluid with each meal to increase lower esophageal pressure to push food into the stomach.

A patient who is being evaluated for episodes of hematemesis and dyspepsia tells the nurse that pain occurs when he eats, but pain

does not waken him. The nurse recognizes a diagnostic sign of which condition?

a. Duodenal ulcer

b. Gastritis

c. Achalasia

d. Peptic ulcer

d. Peptic ulcer

ANS: D

A significant subjective data assessment for a peptic ulcer is the patient report that pain is associated with eating. With duodenal ulcers the patient often complains of pain 1 to 2 hours after eating.

The nurse anticipates that the patient who has had a subtotal gastrectomy will need which type of supplement?

a. protein due to the loss of some of the digestive processes.

b. vitamin B12 due to the loss of the intrinsic factor.

c. bulk to prevent constipation.

d. vitamin A due to the loss of the gastric lining.

b. vitamin B12 due to the loss of the intrinsic factor.

ANS: B

It is recommended that all patients with a gastrectomy have a blood serum vitamin B12 level measured every 1 to 2 years.

Decreased absorption of vitamin B12 may cause pernicious anemia.

The home health nurse is caring for a patient who has frequent bouts of diverticulitis accompanied by increased flatulence,

diarrhea, and nausea. Which is the most appropriate suggestion to lessen these symptoms?

a. Eat a diet high in fiber content.

b. Increase dietary fat intake.

c. Exercise to increase intraabdominal pressure.

d. Take daily laxatives.

a. Eat a diet high in fiber content.

ANS: A

The symptoms of diverticulitis can be reduced or prevented by eating a high-fiber diet, reduction of meat and fats in the diet, and avoiding activities that increase intraabdominal pressure. Although laxatives might be prescribed sparingly, daily laxatives are not recommended.

The nurse caring for a patient with a peptic ulcer who has had a nasogastric tube inserted notes bright blood in the tube; the patient

complains of pain and has become hypotensive. Which condition should the nurse recognize these as signs of?

a. Hiatal hernia

b. Gastritis

c. Perforation

d. Bowel obstruction

c. Perforation

ANS: C

Perforation of the gastric wall causes pain, hypotension, and hematemesis. Immediate reporting to the charge nurse/physician is essential as peritonitis, potentially lethal, is the result of a perforation.

Dumping syndrome after a Billroth II procedure occurs when high-carbohydrate foods are ingested over a period of less than 20

minutes. Which will the nurse suggest to reduce the risk of dumping syndrome?

a. Eating a high-carbohydrate diet

b. Drinking 10 oz of fluids with meals

c. Remaining upright for 2 hours after meals

d. Eating six small daily meals high in protein and fat

d. Eating six small daily meals high in protein and fat

ANS: D

Treatment for dumping syndrome includes eating six small meals daily that are high in protein and fat, and low in carbohydrates. Fluids should be avoided during meals. If possible, the patient should lie down for 1 hour after meals.

The patient has come to the PACU following an ileostomy for the treatment of ulcerative colitis. The patient is conscious and has a

nasogastric tube in place and a pouch over the stoma. What should be the nurse's initial action?

a. Turn patient to right side.

b. Give patient ice chips to moisten mouth.

c. Attach NG tube to suction.

d. Irrigate NG tube.

c. Attach NG tube to suction.

ANS: C

Initially, the NG tube should be attached to suction to decompress the stomach and prevent nausea. Assessing the tube for the need

of future irrigation will be part of the postoperative care.

The home health nurse evaluates a patient being treated for a peptic ulcer with an antacid and famotidine (histamine receptor

blocker). Which statement made by the patient indicates a need for further instruction?

a. "I know famotidine will not interfere with my Coumadin."

b. "I take the antacid at least 2 hours after any of my other drugs."

c. "Boy! That antacid keeps my stomach happy!"

d. "I take both those meds at the same time every morning."

d. "I take both those meds at the same time every morning."

ANS: D

Antacids should not be taken with other drugs, because the absorption of the other drugs may be affected.

What should a nurse do when obtaining a stool specimen to be examined for ova and parasites?

a. Use an oil retention enema to facilitate collection.

b. Refrigerate the specimen immediately.

c. Obtain three different stool specimens on subsequent days.

d. Check the specimen for the presence of occult blood.

c. Obtain three different stool specimens on subsequent days.

ANS: C

Diagnosing a parasitic infection requires three different stool specimens on subsequent days. Use only normal saline or tap water

enemas to prevent alteration of results.

The nurse explains to the patient with Crohn disease that the tube feedings are placed for which reason?

a. rapid absorption in the upper GI tract.

b. decompression of the stomach.

c. reduction of diarrheic episodes.

d. a permanent nutritional support.

a. rapid absorption in the upper GI tract.

ANS: A

The tube feedings allow for rapid absorption of the nutrients in the upper GI tract. The tube feedings are not permanent and will be

followed by oral intake of a low-residue, high-protein, high-calorie diet.

A patient with a large inguinal hernia has abdominal distention and inguinal pain. The nurse recognizes these as indicators of which

type of hernia?

a. Strangulated

b. Hiatal

c. Ventral

d. Umbilical

a. Strangulated

ANS: A

The hernia is strangulated when the blood supply and intestinal flow are occluded, which results in pain and distention.

Analyzing

For which patient is misoprostol contraindicated?

a. An older adult

b. A pregnant female

c. A patient taking daily aspirin

d. A patient taking a proton pump inhibitor

b. A pregnant female

ANS: B

Misoprostol is a prostaglandin analog that acts as a gastric mucosal protectant against NSAID-induced ulcers. A patient who is

pregnant cannot take misoprostol, because it will cause miscarriage.

A male patient reports that he will never adjust to his colostomy. Which is the best action for the nurse in this situation?

a. Encourage him to express his concern.

b. Suggest that he discuss his concerns with his physician.

c. Counsel him that everything will be all right.

d. Assure him that his concerns will diminish when he is able to care for his

colostomy.

a. Encourage him to express his concern.

ANS: A

When a colostomy is performed, the patient or significant other should be able to verbalize concerns about the ostomy to the nurse.

In caring for a patient with gastric bleeding who has a nasogastric (NG) tube in place, the nurse expects to see which intervention

for the nasogastric tube included in the plan of care?

a. clamp for 10 minutes every hour.

b. keep the patent with irrigation.

c. frequently reposition to the opposite nostril.

d. change every 72 hours.

b. keep the patent with irrigation.

ANS: B

Irrigating the NG tube as needed will keep the tube patent and ensure effective decompression.

Which will the nurse include when reinforcing the teaching plan for a patient with a hiatal hernia to reduce the frequency of

heartburn?

a. Drinking 10 oz of milk with every meal

b. Lie down after eating

c. Panting through mouth when symptoms begin

d. Eating small meals

d. Eating small meals

ANS: D

Taking care not to overeat is the best defense again pyrosis (heartburn) for the person with a hiatal hernia.

The nurse points out which is an example of a nonmechanical bowel obstruction?

a. A paralytic ileus

b. Narrowed bowel lumen from an inflammatory process

c. Tumor of the bowel

d. Fecal impaction

a. A paralytic ileus

ANS: A

A nonmechanical bowel obstruction can be caused by a paralytic ileus.

Bowel sound assessment on a patient with an early bowel obstruction who has distention, nausea, and visible peristaltic waves will

demonstrate which type of bowel sound?

a. loud and clearly audible.

b. high pitched.

c. hyperactive.

d. absent.

b. high pitched.

ANS: B

Because there are visible peristaltic waves, there will be bowel sounds that will be faint and high pitched.

The patient with a peptic ulcer has been placed on regular doses of bismuth salicylate to combat Helicobacter pylori. What color

will this drug turn the stool?

a. Gray-black

b. Dark green

c. Red-orange

d. Yellow

a. Gray-black

ANS: A

Bismuth products turn the stool gray-black.

Which will the nurse reinforce in the patient teaching of a patient who had a gastrectomy to treat a severely bleeding peptic ulcer?

a. Introducing irritating foods in minute amounts to desensitize the stomach

b. Restricting fluid to 1000 mL per day

c. Eating 6 small meals a day

d. Drinking alcohol and caffeine in moderation

c. Eating 6 small meals a day

ANS: C

The patient who had a gastrectomy to treat a bleeding peptic ulcer should eat small meals daily. Restriction of fluid is not necessary

and irritating foods, alcohol, and caffeine should be discouraged.

Which will be the most helpful nursing intervention to increase the comfort of a patient with appendicitis?

a. Applying of ice bag

b. Administration of small tap water enema

c. Warm compress over entire abdomen

d. Ambulate for short periods in the room

a. Applying of ice bag

ANS: A

Applying of an ice bag will decrease the flow of blood to the area and impede the inflammatory process.

To assist a family with a bowel-training program to reduce fecal incontinence, the nurse would suggest the use of which item at an

optimal time to stimulate defecation?

a. warm bath

b. a tap water enema

c. glycerin suppository

d. large glass of warm lemonade

c. glycerin suppository

ANS: C

The use of a glycerin suppository for fecal stimulation is a helpful aid in a bowel-training program. The suppository is administered

at what the family and patient have determined is the optimal time for a bowel movement.

What is the most lethal complication of a peptic ulcer?

a. Bleeding

b. Perforation

c. Severe pain

d. Gastric outlet obstruction

b. Perforation

ANS: B

Perforation is considered the most lethal complication of peptic ulcer. Bleeding may occur when the ulcer erodes into a blood

vessel; however, perforation occurs when the ulcer crater penetrates the entire thickness of the wall of the stomach or duodenum.

Gastric outlet obstruction can occur at any time and can be relieved by NG aspiration of stomach contents.

The nurse takes into consideration that a proton pump inhibitor drug, such as which drug, will completely eradicate gastric acid

production?

a. omeprazole

b. misoprostol

c. sucralfate

d. olsalazine

a. omeprazole

ANS: A

Omeprazole is a proton pump inhibitor that interferes with the production of gastric acid.

Which is the purpose of antibiotic therapy in treating peptic ulcers?

a. It eradicates H. pylori.

b. It inhibits gastric acid secretion.

c. It protects the gastric mucosa.

d. It neutralizes or reduces the acidity of stomach contents.

a. It eradicates H. pylori.

ANS: A

Antibiotic therapy eradicates H. pylori.

Why are peptic ulcers a common problem of aging?

a. Older adults develop esophageal diverticula

b. Older adults have a higher incidence of hiatal hernia

c. Older adults use nonsteroidal anti-inflammatory drugs to treat chronic joint

conditions

d. Older adults have decreased secretion of hydrochloric acid from the parietal cells

of the stomach.

c. Older adults use nonsteroidal anti-inflammatory drugs to treat chronic joint

conditions

ANS: C

Medications such as aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) taken for arthritis or degenerative joint conditions

may contribute to ulcer formation.

The patient with irritable bowel syndrome tells the home health nurse she is going to an acupuncturist for therapy for her condition.

Which will be the best nursing response?

a. "Go for it. Alternative medicine does great things."

b. "YIKES! An acupuncturist?"

c. "Some people have found relief from nausea and colon muscle spasms"."

d. "You should confirm that the acupuncturist and facility are state licensed."

c. "Some people have found relief from nausea and colon muscle spasms"."

ANS: C

Some people find that acupuncture provides relief from nausea, vomiting and relaxation of muscle spasms in the colon. However,

clinical trial data are inadequate to determine efficacy.

During the annual physical examination, the nurse will assess for which risk factor for the development of diverticulosis?

a. Chronic diarrhea

b. Excessive fiber intake

c. Increased intake of refined carbohydrates

d. Aging related increased elasticity of the colon

c. Increased intake of refined carbohydrates

ANS: C

Refined carbohydrates, when eaten in large amounts, have been associated with the development of diverticulosis.

Which change in the body leads to poor absorption of nutrients in a patient who has celiac disease?

a. Development of diverticuli

b. Anaphylactic reaction to wheat

c. Destruction of the intestinal villi

d. Reduced intestinal mucosal output

c. Destruction of the intestinal villi

ANS: C

The ingestion of gluten in the small intestine damages the villi, which leads to malabsorption and diarrhea. Weight loss and vitamin

deficiency, which occur from altered nutrition, can expand into systemic involvement.

Which are indicators of colorectal cancer? (Select all that apply.)

a. Constant diarrhea

b. Abdominal pain

c. Cachexia

d. Cramps

e. Rectal bleeding

f. Anemia

b. Abdominal pain

c. Cachexia

d. Cramps

e. Rectal bleeding

f. Anemia

ANS: B, C, D, E, F

The indicators for colorectal cancer are changing bowel habits between diarrhea and constipation abdominal pain, cachexia,

cramps, rectal bleeding, and anemia.

How will the nurse counsel the 34-year-old woman who has been prescribed sulfasalazine for Crohn disease? (Select all that

apply.)

a. Expose her to sunlight at least 30 minutes a day for vitamin D synthesis.

b. Tell her to drink at least 1500 mL of fluid a day.

c. Advise assessing self for rash.

d. Use alternate birth control methods to oral contraception.

e. Take drug on an empty stomach.

b. Tell her to drink at least 1500 mL of fluid a day.

c. Advise assessing self for rash.

d. Use alternate birth control methods to oral contraception.

ANS: B, C, D

Cautionary information about sulfasalazine include having adequate fluid intake to prevent crystallization in the kidneys, avoiding

exposure to the sun, and using alternate birth control methods as oral contraception is made unreliable by this drug. The drug

should be taken with meals and the patient should be assessing for rash.

In reinforcing a teaching plan to present to a group of older adults regarding the prevention of esophageal cancer, the nurse would

include which significant information? (Select all that apply.)

a. cessation of smoking.

b. Frequent monitoring for Barrett's esophagus

c. regular checkups if dysphagia is present.

d. reducing excessive weight.

e. limiting alcohol consumption.

f. reduction of consumption of citrus fruits.

a. cessation of smoking.

b. Frequent monitoring for Barrett's esophagus

c. regular checkups if dysphagia is present.

e. limiting alcohol consumption.

ANS: A, B, C, E

Preventive measures include cessation of smoking and alcohol consumption, monitoring for Barrett's esophagus, and medical

evaluation of dysphagia. Weight and reduction of citrus fruits are noncontributory to prevention of esophageal cancer.

Which activities should the home health nurse suggest to an older adult patient to avoid constipation? (Select all that apply.)

a. Schedule toileting after meals

b. Taking bulk-forming laxatives

c. Increasing fiber intake

d. Drinking at least 1000 mL fluid

e. Taking a daily stool softener

f. Using tap water enemas for persons with altered mobility

a. Schedule toileting after meals

b. Taking bulk-forming laxatives

c. Increasing fiber intake

d. Drinking at least 1000 mL fluid

ANS: A, B, C, D

Inactivity and changes in diet and fluid intake can contribute to constipation. A nutritional diet high in fiber and bulk-forming foods

can promote normal elimination. Increasing fluids to 8 to 10 glasses per day will be beneficial in preventing constipation. A daily

bowel routine will also benefit elimination. Use of daily stool softeners is no longer recommended for the older adult. Tap water

enemas for persons with altered mobility are not routine.

The home health nurse is caring for a patient who has frequent abdominal pain and diarrhea. The nurse uses the Rome Criteria to

direct data collection for irritable bowel syndrome. What is included in the Rome Criteria? (Select all that apply.)

a. Discomfort at least 3 days a month

b. Blood in stool

c. Pain relieved by defecation

d. Excessive flatulence

e. Nausea and vomiting associated with onset

f. Onset associated with change in stool consistency or frequency

a. Discomfort at least 3 days a month

c. Pain relieved by defecation

f. Onset associated with change in stool consistency or frequency

ANS: A, C, F

The Rome Criteria include that the patient experience discomfort at least 3 days a month within the last 3 months, pain relieved by

defecation, onset associated with change in stool frequency, and onset in association with a change in stool appearance. Although

increased flatus is associated with diverticulitis, it is not part of the Rome Criteria.

Flexible sigmoidoscopy should be performed every ________ years.

5

ANS:

5

five

Flexible sigmoidoscopy should be performed every 5 years. Endoscopy of the lower GI tract allows visualization and, if indicated,

access to obtain biopsy specimens of tumors, polyps, or ulcerations of the anus, rectum, and sigmoid colon. The lower GI tract is

difficult to visualize radiographically, but sigmoidoscopy allows direct visualization.

The nurse explains that ___________, the chief enzyme of gastric juice, is activated by hydrochloric acid to begin digestion of

protein.

pepsin

ANS:

pepsin

Pepsin is activated by the hydrochloric acid to break down protein for digestion.

The nurse caring for a patient with Crohn disease will closely monitor the urinary output to ensure that the patient is excreting at

least _______ mL/day.

1500

ANS:

1500

The output of 1500 mL a day indicates good kidney perfusion. The disease allows such dramatic fluid loss that a constant watch on

I&O is a major nursing intervention.

The nurse takes into consideration that long-term use of antibiotics can cause an antibiotic-associated pseudomembranous colitis

from the organism ________.

Clostridium difficile

ANS:

Clostridium difficile

C. difficile causes a type of colitis from long-term antibiotic use to which older adults are extremely susceptible.

Due to frequent bouts of constipation, the nurse examines the bedfast nursing home resident for ulceration of the anus, called anal

__________________.

fissure

ANS:

fissure

Ulceration and laceration of the anal skin can occur because of overstretching with the passing of constipated stool.