patho chapter 36, 37, 38

A nurse is teaching a client about diabetic complications of the gastrointestinal tract. What could the client develop if he or she has poor diabetic control?

Gastric atony

An anatomy student explains that the funnel-shaped portion of the stomach that connects with the intestine is called which region?

Pyloric region

While reviewing the colonic absorption and role of flora in the GI system, the instructor will stress that the large intestine contains:

a complex microbial system that contains hundreds of different species.

The swallowing reflex is an entirely voluntary activity.

False

Which layer of the digestive tract constitutes the outer wall of the intestine and contains a serous fluid between its two layers?

Peritoneum

A client with diabetes mellitus states, "I can eat as many carbohydrates as I want and it will not affect my blood sugar." What is the nurse's best response?

"Carbohydrates are broken down into monosaccharides before being absorbed."

A client with a gastrointestinal disorder is having the number and quality of stool monitored by the nursing staff. The nurse notes an abnormal amount of fatty substances in the stool sample. Which term should the nurse use when documenting this assessment finding in the medical record?

Steatorrhea

Serous fluid is contained in the:

Peritoneal cavity

Which nerve plexus controls the motility along the length of the gut?

Myenteric

Which clinical manifestation would lead the nurse to suspect the client has malabsorption syndrome with a deficiency in fat absorption? (37)

Steatorrhea

Which meal choice is most likely to exacerbate an individual's celiac disease?

Spaghetti with meatballs and garlic bread

A teenager who has a history of achalasia will likely complain of which clinical manifestation?

Feeling like there is food stuck in the back of the throat

After several months of persistent heartburn, an adult client has been diagnosed with gastroesophageal reflux disease (GERD). Which treatment regimen is likely to be prescribed for this client's GERD?

Proton pump inhibitors; avoiding large meals; remaining upright after meals

Crohn disease has a distinguishing pattern in the gastrointestinal (GI) tract. The surface has granulomatous lesions surrounded by normal-appearing mucosal tissue. A complication of the pattern includes:

Fistula formation

Crohn disease is treated by several measures. Treatment with sulfasalazine will focus on which aspect of this disease?

Inflammatory suppression

Select the client at greatest risk for developing colorectal cancer.

A 64-year-old female whose mother had colorectal cancer

The nurse is teaching her client with hepatobiliary disease about her diet. She tells her that she may have steatorrhea, which is the malabsorption of which dietary component?

Fat

In the balance of secretions in the gastric mucosa by the parietal cells, which ion is produced to buffer the production of hydrochloric acid?

HCO3–

The incidence of stomach cancer has significantly decreased in the United States, yet it remains the leading cause of death worldwide. The nurse understands the reason for the high mortality rate in stomach cancer is because of which reason?

Clients have few early symptoms of the disease.

The nurse assesses a client in the emergency department with reports of abdominal pain. Which assessment finding will the nurse interpret as supporting appendicitis?

increased pain when pressure to the lower right quandrant is released

A rare condition caused by gastrin-secreting tumors most commonly found in the small intestine or pancreas is called:

Zollinger-Ellison syndrome

The client who has experienced third-degree burns is susceptible to which specific type of gastrointestinal (GI) ulceration?

Stress

The nurse caring for a client with diverticulitis should assess for which clinical manifestation?

Lower left quadrant pain

When caring for the client with portal hypertension and ascites, which dietary intervention does the nurse suggest to prevent the progression of fluid accumulation? (39)

Limit intake of sodium.

A client with chronic pancreatitis is experiencing an episode of recurring epigastric pain. The nurse teaches the client to limit which type of meal to avoid further episodes?

fried chicken and french fries

While teaching a family member about the development of hepatic encephalopathy, which cause is likely to be mentioned?

Neurotoxin accumulation

The client has right upper quadrant pain caused by acute choledocholithiasis. The health care provider suspects the common bile duct is obstructed, based on which flowing lab value?

Bilirubin 15 mg/dL (256.56 µmol/L) (high)

The nurse is caring for the client with hepatocellular carcinoma. What does the nurse recognize is a cause of this disease?

Illness with hepatitis B or C

What should the nurse teach a client who is diagnosed with chronic hepatitis B infection about treatment?

“The treatment is effective if your liver enzymes return to normal.”

What laboratory markers are most commonly used to diagnose acute pancreatitis?

Lipase and amylase

The nurse teaches the client that which of these contributed to the development of acute cholelithiasis?

Stasis of bile

When explaining acute pancreatitis to a newly diagnosed client, the nurse will emphasize that the pathogenesis begins with an inflammatory process whereby:

activated pancreatic enzymes escape into surrounding tissues, causing autodigestion of pancreatic tissue.

When assessing a client with acute cholecystitis, the nurse anticipates the client's report of pain will be consistent with which description?

Pain in the right upper quadrant referred to the same shoulder

The production of chyme occurs in which organ?

Stomach

A middle-aged adult is diagnosed with diverticular disease based on recent history and the results of a computed tomography (CT) scan. Which statement demonstrates an accurate understanding of this diagnosis?

“I suppose I should try to eat a bit more fiber in my diet.”

The nurse is implementing a plan of care for a client who has developed acute pancreatitis. It is most important for the nurse to:

initiate gastric suctioning to prevent the synthesis of pancreatic enzymes.

The liver has many jobs. One of the most important functions of the liver is to cleanse the portal blood of old and defective blood cells, bacteria in the bloodstream, and any foreign material. Which cells in the liver are capable of removing bacteria and foreign material from the portal blood?

Kupffer cells

Gastrin production, a task that is performed by the stomach, results in which effect?

Stimulation of gastric acid secretion by parietal cells

Digestion of starch begins in which structure?

Mouth

Which layer of the digestive tract consists of connective tissue and contains nerves, blood vessels, and structures for secreting the digestive juices?

Submucosal

A client has been diagnosed with alcohol-induced liver disease. He admits to the nurse, “I know what the lungs do, and I know what the heart does, but honestly, I have no idea what the liver does in the body.” The nurse should tell the client that the liver:

metabolizes most components of food and also cleans the blood of bacteria and drugs.

A client has been diagnosed with a defect in the pyloric sphincter. How will the nurse explain the likely consequence of a dysfunctional pyloric sphincter?

Contents from the small intestine may flow back into the stomach.

Given the fact that acute pancreatitis can result in severe, life-threatening complications, the nurse should be assessing the client for which complication?

Acute tubular necrosis

A nurse is teaching a client about the difference between digestion and absorption. Which action should the nurse describe as absorption?

Moving nutrients from the external environment of the GI tract into the internal environment

The nurse is caring for a client with advanced liver disease who has ascites. Which treatment will the nurse anticipate being used for the daily management of ascites

diuretics

Rotavirus is most severe in children under 24 months of age. What is a typical symptom of rotavirus infection?

Vomiting that disappears around the second day but diarrhea continues

A nurse reading a sigmoidoscopy report notes that a client was found to have skip lesions. The nurse interprets this as an indication of:

Crohn disease

Pharmacologic treatment for peptic ulcers has changed over the past several decades. The nurse knows that the goal for pharmacologic treatment is focused on:

Eradicating Helicobacter pylori (H. pylori)

The nurse is performing a physical assessment of the gastrointestinal tract. In which area does the nurse place the hands for palpation of the liver?

Right upper quadrant

A nurse explains to her client that food is moved along the gastrointestinal (GI) tract with intermittent contractions that mix the food and move it along. These movements are found in which organ?

Small intestine

The nurse is caring for a client who is a carrier of hepatitis B. Which of these does the nurse teach the family?

"Your loved one may not look ill, but the virus is present in his blood."

Which assessment does the nurse recognize is consistent with signs and symptoms of acute pancreatitis?

Periumbilical pain

Which individual most likely faces the greatest risk of developing Clostridium difficile colitis?

A 79-year-old hospital client who is being treated with broad-spectrum antibiotics

The nurse is caring for a female client with cholelithiasis. When teaching the client about the disease, the nurse includes which of these points?

"Gallstones have developed, which are typically composed of cholesterol."

The gastrointestinal laboratory nurse is learning about small intestine secretions. Which explanation is most accurate?

"An extensive array of mucus-producing glands, called Brunner glands, is concentrated where contents from the stomach and secretions from the liver and pancreas enter the duodenum."

When caring for the client with Laennec cirrhosis, the nurse recognizes which pathophysiologic finding to be an expected etiology of jaundice?

Impaired uptake of bilirubin

The nurse is caring for the client with pancreatic cancer. The nurse monitors the client for which complication?

Hyperglycemia due to inability to synthesize insulin

Good hand-washing techniques are important in health care. The nurse knows that bacterial infections can be prevented by good hand washing techniques. Which route of transmission is most common for Clostridium difficile?

Fecal–oral transmission

A nurse is teaching a client about the difference between digestion and absorption. Which action should the nurse describe as absorption?

Moving nutrients from the external environment of the GI tract into the internal environment

The nurse is assessing a client with a suspected food poisoning. The nurse provides which explanation to the client related to the cause of the vomiting?

Noxious substances in the stomach activate the nervous system to trigger vomiting.

A hospitalized older adult asks the nurse how he acquired Clostridium difficile while taking an antibiotic medication. Which is the best response by the nurse?

“The administration of broad-spectrum antibiotics can disrupt the normal microbial balance and allow overgrowth of species.”

A client is admitted to the hospital for further evaluation of problems experienced with gastrointestinal digestion and absorption. The nurse anticipates the health care provider will further assess the:

Small intestine

Which symptom is often observed in cases of peritonitis?

Abdominal rigidity

A client is diagnosed with choledocholithiasis and acute suppurative cholangitis and is being rushed to surgery to prevent which possible complication?

The accumulation of purulent bile, which can cause sepsis.

A client with a history of cancer that metastasized to the liver has arrived at the outpatient clinic to have a paracentesis performed. The physician anticipates that the client will have more than 5 L of fluid removed. The physician has prescribed intravenous albumin following the procedure. The client asks why she needs "more fluids in my vein." The nurse responds:

"Albumin is a volume expander. Since a lot of fluid was removed, you have a decrease in your vascular volume, so without this albumin, your kidneys will try to reabsorb and hold onto water."

A client asks the nurse what part of the brain regulates appetite. Which is the best response by the nurse?

Hypothalamus

A client is not able to absorb vitamin B12. The nurse determines that the client is deficient in:

parietal (oxyntic) cells, which secrete HCl and intrinsic factor.

An older adult client expresses concern about straining to pass stools that are small and hard. What term will the health care provider use to document this in this client's chart?

Constipation

Which carbohydrate is matched to its correct enzyme needed for digestion?

Sucrose and sucrase

A 79-year-old woman reports a recent onset of “nearly constant heartburn.” During the assessment interview, she states that she has “lots of aches and pains.” She states that she is not on any prescription medications but often takes aspirin for pain. The nurse should suspect what diagnosis?

Acute gastritis

A student is studying gallbladder function. Which gastrointestinal hormone stimulates contraction of the gallbladder?

Cholecystokinin

The nurse is reviewing laboratory results of a client who has liver failure. Which finding would place the client at increased risk for bleeding?

Increased prothrombin time

An older adult client presents with loose mucus-filled stools. The nurse suspects the client has Clostridium difficile. What is a priority assessment for the nurse?

Ask the client about his or her antibiotic use.

A client is admitted to the hospital with a suspected diagnosis of strangulated bowel. The nurse anticipates the client will need:

surgery to release the bowel.

An older adult client has been placed on a broad-spectrum antibiotic for a recurrent urinary tract infection. Which potential problem would the nurse anticipate in this client?

Colonization of Clostridium difficile

A client is experiencing reflux of stomach contents into the esophagus. The nurse determines that the problem may result from:

Gastroesophageal sphincter

Symptoms of gastric cancer include vague epigastric pain, which makes early detection difficult. The nurse would expect a client to undergo which diagnostic examination to determine the location of the gastric cancer?

Barium x-ray

A client has been diagnosed with an incompetent pyloric sphincter. The nurse educating the client mentions that this is due to abnormal communication between which components of the gastrointestinal tract?

Stomach and duodenum

Villi are anatomic features that contribute to the enlarged surface area of the:

Small intestine

Some smooth muscle cells in the GI tract serve as pacemakers. What are the cells called that display rhythmic spontaneous oscillations in membrane potentials ?

Slow waves

The client who has experienced third-degree burns is susceptible to which specific type of gastrointestinal (GI) ulceration?

Stress

The nurse is caring for a client with liver disease who has edema throughout the body. When reviewing the medical record, the nurse recognizes that which altered diagnostic test is consistent with development of edema?

Decreased albumin

The swallowing reflex is an ordered sequence of events. In which phase is the epiglottis moved so that it covers the larynx?

Pharyngeal phase

During assessment of a recently admitted client with right-sided heart failure, the nurse notes that the liver is enlarged and verifies by palpation and percussion. A student asks the nurse to explain how the liver and heart failure are related. Which is the nurse's best response?

In right-sided heart failure, there is high pressure in the inferior vena cava that backlogs blood into the liver.

The common bile duct and the pancreatic duct release their products into which section of the intestines?

Duodenum

A client is experiencing reflux of stomach contents into the esophagus. The nurse determines that the problem may result from:

Gastroesophageal sphincter

Which aspect of gastrointestinal function is performed by the brush border enzymes of the villus structures?

Digestion of carbohydrates

A 24-year-old woman undergoing a screening test is found to have elevated levels of AST, ALT, and IgG, but no antibody-specific markers for viral hepatitis. A liver biopsy reveals inflammation and cellular damage. Which treatment is most likely to be effective for her?

Corticosteroids and immunosuppressant drugs

Which client likely faces the greatest risk of a gastrointestinal bleed?

A client who takes aspirin with each meal to control symptoms of osteoarthritis

Rotavirus is most severe in children under 24 months of age. What is a typical symptom of rotavirus infection?

Vomiting that disappears around the second day but diarrhea continues

The nurse is caring for a client with right upper quadrant pain secondary to acute choledocholithiasis. If the common bile duct becomes obstructed, which manifestation will the nurse expect?

Hyperbilirubinemia

The nurse is reviewing the medical history of four clients. Which client is at highest risk for developing peptic ulcer disease?

client with a prior diagnosis of Helicobacter pylori who refused treatment

Crohn disease is treated by several measures. Treatment with sulfasalazine will focus on which aspect of this disease?

Inflammatory suppression

A client is admitted to a nursing unit with severe edema. The nursing student caring for this client overhears the physician and a medical student talking about the client's albumin level. When discussing the flow of fluids into and out of cells, albumin plays a significant role in which pressure gradient?

Colloidal osmotic

Regurgitation of bile salts and duodenal contents can lead to gastric ulcers. Which structure prevents this from happening?

Pyloric sphincter

A client is admitted to the medical surgical unit with a history of inflammatory bowel disease. The nurse knows that the clinical manifestations of both Crohn disease and ulcerative colitis are the result of activation of which cells?

Inflammatory

The nurse is caring for a client with asterixis. Which assessment should the nurse make to help a diagnosis of hepatic encephalopathy?

Mental status

The nurse is teaching about prevention of hepatitis A. Which group does the nurse suggest will benefit from this vaccine?

people who live in or travel to areas with high rates of hepatitis A infections

A nurse is teaching a client diagnosed with Crohn disease about potential complications. The most appropriate information for the nurse to include would be:

Fistula formation

Which substance necessary for vitamin B12 absorption is produced by the parietal cells in the stomach?

Intrinsic factor