Chapter 24: Gastrointestinal Function My Nursing Test Banks

Chapter 24: Gastrointestinal Function

Meiner: Gerontologic Nursing, 5th Edition

MULTIPLE CHOICE

1. An 80-year-old patient has nausea and vomiting related to a gastrointestinal disorder. The nursing intervention most likely to help the patient is to:

a.

offer sips of soda every 15 minutes until more is tolerated.

b.

encourage the patient to lie in a prone position while nauseated.

c.

encourage the intake of high-calorie foods such as milkshakes.

d.

keep the patient on a nothing-by-mouth (NPO) order until the nausea subsides.

ANS: A

Nursing interventions for nausea and vomiting include many self-help measures, including drinking clear liquids, progressing from eating bland foods to solid foods, and small frequent feedings. If vomiting occurs, fluid replacement should be a priority. Sips of fluids every 15 minutes until more can be tolerated may decrease episodes of dehydration. The position of the patient is unimportant. The patient should avoid nonclear liquids such as milkshakes. If the patient cannot keep even sips down, he or she may be prescribed NPO status.

DIF: Understanding (Comprehension) REF: Page 480 OBJ: 24-6

TOP: Nursing Process: Implementation MSC: Physiologic Integrity

2. When preparing to discharge an older patient with mild dysphagia, the nurse suggests that the patient can minimize symptoms by:

a.

eating small meals every 2 to 3 hours

b.

cutting a sandwich into bite-sized peicees.

c.

eating less but choosing nutrient-dense foods.

d.

drinking thin liquids instead of eating solids.

ANS: A

Instruction regarding eating habits and maintaining weight and nutrition is important. For example, small, frequent meals, pureed or soft foods, and high-protein, high-calorie foods are helpful. Thin liquids are often harder to swallow than thickened ones. Nutrient-dense foods are important, but so is maintaining calorie requirements.

DIF: Understanding (Comprehension) REF: Page 488 OBJ: 24-6

TOP: Teaching-Learning MSC: Health Promotion

3. An older patient is being taught about oral gingivitis. The nurse has included instruction about maintaining an oral hygiene program, signs and symptoms of oral infection, and the importance of maintaining regular professional dental care. What important teaching has been missed?

a.

Information about when to have teeth removed and dentures made

b.

The necessity of using a hard-bristled toothbrush to maintain cleanliness

c.

The importance of avoiding meat and caffeine-containing products

d.

The importance of adequate nutrition for maintaining oral health

ANS: D

Nursing management of an older patient with gingivitis or periodontitis includes promotion of regular oral hygiene, regular preventive dental care, and maintenance of nutritional status. In addition, instructing the patient on the signs and symptoms of oral infections is also an important component of patient education. The other topics are not warranted.

DIF: Understanding (Comprehension) REF: Page 487 OBJ: 24-6

TOP: Teaching-Learning MSC: Health Promotion

4. An older adult patient has recently diagnosed gastritis. What statement made by this patient indicates the need for further teaching?

a.

The abdominal pain is caused by acidity.

b.

I should avoid taking aspirin.

c.

Smoking has little effect on my stomach problem.

d.

I could develop pernicious anemia.

ANS: C

Acute gastritis causes transient inflammation, hemorrhages, and erosion into the gastric mucosal lining. Although the cause may be undetermined, it is frequently associated with alcoholism, aspirin or nonsteroidal antiinflammatory drug (NSAID) ingestion, smoking, and severely stressful conditions such as burns, trauma, central nervous system damage, chemotherapy, and radiotherapy. It can cause abdominal pain. Smoking is a risk factor. The patient could develop pernicious anemia.

DIF: Evaluating (Evaluation) REF: N/A OBJ: 24-6

TOP: Nursing Process: Evaluation MSC: Physiologic Integrity

5. The nurse is planning to teach an older patient about diverticulitis. What topic does the nurse include?

a.

Dietary fiber and fluids will reduce the symptoms.

b.

It is unusual to see diverticula in older persons.

c.

Abdominal cramping and severe diarrhea should be reported.

d.

Diverticulosis rarely reoccurs once it has been treated.

ANS: A

Teaching should include the need to eat high-fiber foods and the importance of achieving and maintaining adequate fluid status. Patients should be encouraged to consume up to 2000 mL of fluids each day, unless contraindicated by cardiac status. Older people have diverticulitis commonly. Abdominal cramping and diarrhea are expected findings. Diverticulitis usually reoccurs.

DIF: Understanding (Comprehension) REF: Page 497 OBJ: 24-5

TOP: Teaching-Learning MSC: Physiologic Integrity

6. The nurse caring for an older adult diagnosed with hyperplastic polyps instructs him that:

a.

this type of polyp is rarely malignant and usually does not require treatment.

b.

follow-up colonoscopies should be performed every 3 to 4 years after diagnosis.

c.

stool should be guaiac tested every week for 1 year after diagnosis.

d.

the presence of blood in the stool requires a repeat sigmoidoscopy examination.

ANS: D

This type of polyp is rarely cancerous and rarely causes symptoms; however, they occasionally bleed, leaving bright red blood in the stool. A colonoscopy every 3 to 4 years is not indicated nor is testing the stool for blood for 1 year.

DIF: Applying (Application) REF: N/A OBJ: 24-6

TOP: Teaching-Learning MSC: Physiologic Integrity

7. An older adult reports chronic constipation. When asked why this problem has gotten worse with age, the nurse responds:

a.

As we age, our bodies require more fiber to bring about healthy bowel function.

b.

We need to discuss the proper use of laxatives to minimize constipation.

c.

Its possible that you have lost the ability to feel when you need to move your bowels.

d.

Aging brings about decreased gastric motility that often results in constipation.

ANS: A

The most widespread cause of constipation in older adults is diet. Diets need to include 20 to 30 mg of fiber a day and plenty of water. Some changes in nerve function and gastric motility are also possible causes, but the major cause is diet. Laxatives should only be used as a last resort.

DIF: Understanding (Comprehension) REF: Page 482 OBJ: 24-6

TOP: Teaching-Learning MSC: Health Promotion

8. An older adult patient reports episodes of fecal incontinence. The nurse provides appropriate emotional support when assuring the patient that:

a.

it is a common problem that occurs in response to normal aging.

b.

the incontinence is rarely a result of a serious problem.

c.

disposable absorbent underwear will help manage the problem.

d.

the problem generally responds well to bowel control programs.

ANS: D

It is important to reassure older patients that control and retraining are achievable because many older adults believe that fecal incontinence is the first step on the road to permanent institutionalization. Disposable garments may be used temporarily or long term if the patient cannot complete bowel retraining. It is not a normal response to aging.

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TOP: Teaching-Learning MSC: Physiologic Integrity

9. The daughter of a dependent older patient reports to the nurse that the patient requires regular soapsud enemas to manage chronic constipation. The nurse responds that:

a.

an alternative management technique should be discussed.

b.

enemas are generally the most effective interventions for the older adult.

c.

chronic constipation is best managed with oral medications.

d.

her mothers diet is the most likely cause of the constipation.

ANS: A

Soapsud enemas lead to mucosal irritation and should not be used. Alternative methods to managing constipation include dietary changes and medications when needed.

DIF: Understanding (Comprehension) REF: Page 482 OBJ: 24-6

TOP: Teaching-Learning MSC: Physiologic Integrity

10. A 74-year-old adult is experiencing dumping syndrome after gastric resection surgery. The nurse caring for the patient instructs the patient to:

a.

stop smoking.

b.

abstain from beverages that contain caffeine.

c.

eat three low-carbohydrate meals daily.

d.

drink only between meals.

ANS: D

The institution of small, frequent meals that are low in carbohydrates will diminish the incidence of these symptoms. Resting after eating and drinking fluids between (rather than during) meals will also help alleviate these symptoms. Smoking and caffeine are not related, and eating only three meals a day is not warranted.

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TOP: Teaching-Learning MSC: Physiologic Integrity

11. A 68-year-old patient is reporting symptoms that suggest a peptic ulcer. The nurse asks the patient if:

a.

the pain exacerbates when he eats fatty food.

b.

there is a family history of peptic ulcers.

c.

he smokes either cigars or cigarettes.

d.

he uses acetaminophen (Tylenol) for minor pain.

ANS: B

Both genetic and environmental factors have been proposed as the cause of peptic ulcers because both gastric ulcers and duodenal ulcers tend to occur in families. At present, no direct evidence exists that indicates dietary or occupational factors as causes of ulcer disease. Acetaminophen generally does not cause gastric ulcers.

DIF: Understanding (Comprehension) REF: Page 491 OBJ: 24-6

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

12. What dietary suggestion does the nurse give the older patient to manage age-related changes in taste?

a.

Add more salt to foods.

b.

Use a salt substitute.

c.

Add sugar when possible.

d.

Use a variety of herbs.

ANS: D

Older adults experience a decrease in taste discrimination. Various herbs can be used to spice up foods. More salt should not be added, as older adults generally should eat low-salt diets. Salt substitutes often contain potassium, a problem for older adults who have an age-related decrease in kidney function and the ability to excrete potassium. Adding sugar is not healthy.

DIF: Applying (Application) REF: N/A OBJ: 24-1

TOP: Teaching-Learning MSC: Health Promotion

13. An older patient has been admitted with nausea and vomiting. What assessment takes priority?

a.

Respiratory system

b.

Urine output

c.

Blood pressure and pulse

d.

Skin integrity

ANS: C

All assessments are appropriate; however, the concern in this older patient is dehydration, so assessment of cardiovascular status comes first. Urine output reflects cardiac output but it does not reflect as up-to-date information as do vital signs. Respiratory system and skin integrity are lower priorities for this patient.

DIF: Applying (Application) REF: N/A OBJ: 24-6

TOP: Nursing Process: Assessment MSC: Safe Effective Care Environment

14. A patient is admitted with copious diarrhea. The patient is dizzy when standing, and skin assessment reveals abrasions around the perianal area. What assessment finding demonstrates that goals for the priority nursing diagnosis have been met?

a.

Perianal skin abrasions are smaller in size.

b.

Patient does not fall while hospitalized.

c.

Patient sits up without dizziness.

d.

Patient is able to tolerate oral fluids.

ANS: D

The priority diagnosis for this patient is decreased cardiac output or fluid volume deficit, either of which is evaluated with the lack of dizziness. Falling indicates dehydration or weakness, both brought about by the cardiac output situation. Skin integrity is important but not the priority. Being able to tolerate fluids indicates treatment is going well. However, the priority diagnosis relates to cardiac output and fluid volume.

DIF: Analyzing (Analysis) REF: N/A OBJ: 24-7

TOP: Nursing Process: Evaluation MSC: Physiologic Integrity

15. A patient has pernicious anemia. What action by the patient and family indicates teaching for this condition has been effective?

a.

Proper administration of oral vitamin B12

b.

Correct technique for intramuscular (IM) injections

c.

Choosing aspirin over ibuprofen (Motrin) for pain

d.

Preparing a low-carbohydrate meal

ANS: B

Pernicious anemia is typically treated with IM injections of vitamin B12. Oral preparations are not absorbed in the gastrointestinal tract. Aspirin or ibuprofen are not related, nor is a low carbohydrate diet.

DIF: Evaluating (Evaluation) REF: N/A OBJ: 24-7

TOP: Nursing Process: Evaluation MSC: Physiologic Integrity

16. A patient is admitted with infectious diarrhea. What action by the nurse is best?

a.

Place the patient in contact precautions.

b.

Place the patient on droplet precautions.

c.

Use standard precautions to care for the patient.

d.

Prepare staff to take prophylactic antibiotics.

ANS: A

Contact precautions should be used when caring for a patient with infectious diarrhea. The other options are not warranted.

DIF: Applying (Application) REF: N/A OBJ: 24-7

TOP: Nursing Process: Implementation MSC: Safe Effective Care Environment

17. An older patient with hepatitis has pruritus. What advise does the nurse provide this patient?

a.

Keep your fingernails cut short.

b.

Use diphenhydramine (Benadryl).

c.

Hot soapy showers will help.

d.

Butter is a good home remedy for itching.

ANS: A

Pruritus is intense itching. The patients nails should be kept short to avoid injury to the skin and possible infection. Diphenhydramine is not recommended in older patients. Tepid water with little soap is best. Butter is not a home remedy for itching.

DIF: Applying (Application) REF: N/A OBJ: 24-7

TOP: Teaching-Learning MSC: Physiologic Integrity

18. An older patient had a stroke several months ago. The patient begins to exhibit dysphagia. What action by the nurse is best?

a.

Consult with a speech-language therapist.

b.

Discuss the need for enteral feedings.

c.

Provide the patient swallowing exercises.

d.

Arrange for a physical exam.

ANS: D

This patient has started exhibiting difficulty swallowing months after a stroke, so the stroke is probably not the cause. Difficulty swallowing is a sign of esophageal cancer, however, so the nurse should arrange for the patient to have a physical exam. The patient may still need speech language therapy and swallowing exercises, but this is not the priority.

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TOP: Nursing Process: Implementation MSC: Physiologic Integrity

19. An older patient is having a colostomy as part of surgery for colon cancer. What assessment by the nurse is most important in this patient?

a.

Manual dexterity

b.

Body image

c.

Fear of dying

d.

Fluid volume status

ANS: A

The older adult with diminished manual dexterity may need assistance with ostomy care. The other assessments are appropriate for patients of all ages.

DIF: Applying (Application) REF: N/A OBJ: 24-7

TOP: Nursing Process: Assessment MSC: Health Promotion

MULTIPLE RESPONSE

1. A 70-year-old patient has lost 25 pounds since being diagnosed with hepatitis A. To best manage the patients anorexia, what does the nurse suggest? (Select all that apply.)

a.

A protein powder supplement added to liquids

b.

Several meals eaten during the day

c.

Megavitamins that include iron and folic acid

d.

A dietary assessment to identify favorite foods

e.

A high-carbohydrate, low-fat diet

ANS: B, E

A patient with hepatitis best tolerates a high-carbohydrate, low-fat diet. Several small feedings throughout the day will help alleviate the effect of anorexia. Favorite foods can be assessed but should not be encouraged unless they meet the dietary restrictions. Protein powder may be useful but is not necessary. Megavitamins are also not warranted.

DIF: Understanding (Comprehension) REF: Page 501 OBJ: 24-6

TOP: Teaching-Learning MSC: Physiologic Integrity

2. Because of a knowledge of age-related changes in the gastrointestinal system, the nurse encourages regular screenings for which of the following? (Select all that apply.)

a.

Osteoporosis

b.

Vitamin B deficiency

c.

Pernicious anemia

d.

Enlarged liver

e.

Iron deficiency anemia

ANS: A, B, C, E

By the age of 60, a persons gastric secretions decrease to 70% to 80% of those of the average adult. A decrease in pepsin may hinder protein digestion, whereas a decrease in hydrochloric acid and intrinsic factor may lead to malabsorption of iron, vitamin B12, calcium, and folic acid. This, combined with atrophy of the mucosa and a decrease in gastric secretions, increases the incidence of pernicious anemia, osteoporosis, vitamin B deficiency, and iron deficiency anemia.

DIF: Applying (Application) REF: N/A OBJ: 24-2

TOP: Nursing process: Assessment MSC: Physiologic Integrity

3. An older adult patient is being evaluated for a possible duodenal ulcer (DU). Which of the following assessments supports the diagnoses? (Select all that apply.)

a.

Passing a moderate amount of dark reddish-brown stool

b.

Reporting a stabbing pain in the epigastric region

c.

Asking for some crackers to stop my stomach cramps

d.

Reporting the need to take antacid tablets most days

e.

Having a rigid abdomen about 2 hours after eating

ANS: A, C, D

Typically the symptoms of DU are patterned by periods of exacerbation and remission and follow a pain-food-relief pattern. The pain begins 2 to 4 hours after meals, is immediately relieved by food or antacids, is located in the mid epigastrium, and may be described as a burning or cramplike pain. On physical examination, the only abnormality is possibly a tender epigastrium. A rigid abdomen could indicate a perforation of the ulcer. Stabbing epigastric pain is not a manifestation.

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TOP: Nursing Process: Assessment MSC: Physiologic Integrity

4. An 82-year-old patient with a history of chronic heart and respiratory problems asks the nurse, What can I do to keep my hemorrhoids from acting up? Which of the following responses made by the nurse are appropriate?(Select all that apply.)

a.

Ask if he experiences constipation with any regularity.

b.

Encourage him to increase his fluid intake to 2000 mL daily.

c.

Suggest he eat more whole grains and fresh fruits.

d.

Discuss how he should include a walk into his daily routine.

e.

Ask if he has a history of rectal bleeding.

ANS: A, C, D, E

Nursing management of an older patient with hemorrhoids includes the prevention and elimination of constipation. This includes a review of high-fiber, high-roughage foods, including indigestible fiber like whole grains, legumes, and fresh fruits and vegetables. An adequate intake of fluids is also important. Older patients should be encouraged to consume up to 2000 mL of fluids each day unless contraindicated. This patient has heart disease and possibly should not take in that much fluid. The nurse should encourage light exercise on a regular basis and review the importance of a regular toileting routine. Rectal bleeding should be investigated.

DIF: Applying (Application) REF: N/A OBJ: 24-4

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

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