Chapter 28: The Gastrointestinal System My Nursing Test Banks

Chapter 28: The Gastrointestinal System

MULTIPLE CHOICE

1. The nurse cautions that constant stress can cause an alteration to the GI system, which can result in:

a.

slowed GI mobility resulting in constipation.

b.

reversed peristalsis resulting in projectile vomiting.

c.

increased digestive juices resulting in a gastric ulcer.

d.

decreased digestive juices resulting in ineffective metabolism.

ANS: C

Stress increases the gastric secretions, which irritate and finally ulcerate the gastric mucosal lining.

DIF: Cognitive Level: Application REF: 623 OBJ: 2 (theory)

TOP: Stress: Gastric Ulcer KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

2. In reviewing the physical assessments of several patients, the nurse recognizes that the patient most likely to have gallstones would be the:

a.

37-year-old white man of normal weight on long-term corticosteroids for asthma.

b.

42-year-old African American man of normal weight who has smoked for 25 years.

c.

46-year-old Indonesian woman who is under normal weight and has recently had radiation treatments.

d.

50-year-old obese Mexican American woman who has type 1 diabetes.

ANS: D

Obesity, diabetes mellitus, rapid weight loss, and Crohns disease increase the risk for the development of gallstones. Native Americans and Mexican Americans have an ethnic predisposition to gallstones.

DIF: Cognitive Level: Analysis REF: 623 OBJ: 1 (theory)

TOP: Gallstones: Risk Factors KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance

3. The home health nurse caring for the patient with tuberculosis who is taking rifampin and isoniazid (INH) will be alert for an indication of a common side effect of these drugs, which is:

a.

gallstones.

b.

liver disorders.

c.

bleeding ulcers.

d.

esophagitis.

ANS: B

Rifampin and INH are both hepatotoxic.

DIF: Cognitive Level: Application REF: 624 OBJ: 2 (theory)

TOP: Liver Disorders: Etiology KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

4. In taking the history of a person with hepatitis A, an appropriate question for the nurse to ask is:

a.

If using drugs, do you share needles?

b.

Do you always practice safe sex?

c.

Have you traveled to Canada in the last month?

d.

Do you eat shellfish or oysters often?

ANS: D

Shellfish and mollusks can be contaminated by living in feces-contaminated water. Drug use and unprotected sex are not part of the etiology of hepatitis A but are for hepatitis B. Travel to Canada is not associated with hepatitis A.

DIF: Cognitive Level: Application REF: 625 OBJ: 1 (clinical)

TOP: Hepatitis A: Etiology KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance

5. When the patient complains, I dont see why I cant have a CT scan instead of the expensive MRI, the nurse clarifies that the magnetic resonance imaging (MRI) study:

a.

provides better contrast between normal and pathologic tissue.

b.

requires less analysis and is easier to read.

c.

produces a digital image that can be transmitted via e-mail.

d.

exposes the patient to less radiation.

ANS: A

The MRI uses radiofrequency signals to determine how hydrogen atoms behave in the magnetic field. In addition, the MRI provides a better contrast between healthy tissues and pathologic tissues.

DIF: Cognitive Level: Comprehension REF: 626 OBJ: 3 (theory)

TOP: MRI: Advantages KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

6. The multiple doses of liquid laxative that are given before a colonoscopy can be made more palatable by:

a.

heating them slightly.

b.

diluting them with milk.

c.

offering a small snack with them.

d.

pouring them over ice.

ANS: D

Chilling the laxative or pouring it over ice makes the drink more palatable and easier to swallow.

DIF: Cognitive Level: Comprehension REF: 631 OBJ: 3 (theory)

TOP: Oral Laxative: Techniques of Administration

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

7. The nurse caring for an 80-year-old woman who is undergoing the extensive bowel preparation for a colonoscopy will assess the patient closely for:

a.

diarrhea.

b.

metabolic acidosis.

c.

fluid retention.

d.

increased urinary output.

ANS: B

Metabolic acidosis can occur when there is a large volume loss of bowel content. Bowel preparation causes diarrhea and does not cause fluid retention or increase in urinary output.

DIF: Cognitive Level: Analysis REF: 631 OBJ: 3 (theory)

TOP: Bowel Preparation: Side Effects KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance

8. When the patient returns to the floor at 12:30 PM after having had an upper GI (UGI) series, which action should the nurse complete first?

a.

Offer liquids and a snack immediately.

b.

Delay the meal tray until the bowel is clear of contrast media.

c.

Turn the patient on the right side to enhance evacuation of contrast media.

d.

Provide oral care.

ANS: A

Patients who have had a UGI series have been NPO for 12 hours and may be dehydrated. Fluids should be given generously to help evacuate the contrast media, and the meal tray should be given as quickly as possible.

DIF: Cognitive Level: Application REF: 631 OBJ: 3 (theory)

TOP: UGI Series: Aftercare KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

9. The nurse is assessing a patients bowel sounds. The nurse documents that the bowel sounds were hypoactive. This indicates that the bowel sounds were heard every _____ seconds.

a.

15

b.

20

c.

30

d.

60

ANS: D

Bowel sounds are caused by air and fluid moving through the intestinal tract, and are heard as soft gurgles and clicks every 5 to 15 seconds. The normal frequency for these sounds is about 5 to 30 in 1 minute. Hypoactive bowel sounds can be noted in the medical record when no sounds are heard after listening in each of the four quadrants for 30 seconds.

DIF: Cognitive Level: Comprehension REF: 632 OBJ: 1 (clinical)

TOP: Bowel Sounds: Assessment KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance

10. The nurse is auscultating bowel sounds in the patient. The nurse notes the presence of loud bowel sounds in each quadrant every 3 seconds. The nurse correctly associates these findings as an indication of:

a.

diarrhea.

b.

paralytic ileus.

c.

normal sounds.

d.

constipation.

ANS: A

Loud, rapid bowel sounds are indicative of the hypermobility that results in diarrhea. Bowel sounds are absent in the paralytic ileus. Normal bowel sounds present as soft gurgles and clicks every 5 to 15 seconds.

DIF: Cognitive Level: Comprehension REF: 632 OBJ: 1 (clinical)

TOP: Bowel Sounds: Assessment KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance

11. The nurse is reviewing the charting of a student nurse. The student has documented that bowel sounds are absent. The nurse recognizes that each quadrant must be auscultated for _____ minutes before this is correct.

a.

2

b.

3

c.

4

d.

5

ANS: D

The criterion for the documentation of absent bowel sounds is that each quadrant is auscultated for 5 minutes.

DIF: Cognitive Level: Comprehension REF: 632 OBJ: 1 (clinical)

TOP: Bowel Sounds: Assessment KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance

12. The nurse percussing a patients abdomen hears a dull thud in the right upper quadrant. This finding indicates that the area being percussed is:

a.

over the liver.

b.

adipose tissue.

c.

filled with air.

d.

over a rib.

ANS: A

Percussion is performed by placing the middle finger of one hand on the abdomen and striking the finger lightly below the knuckle and listening for the pitch of sound produced. A resonant sound is heard over areas filled with air and a dull, thudding sound is heard over solid organs.

DIF: Cognitive Level: Application REF: 632 OBJ: 1 (clinical)

TOP: Abdominal Assessment: Percussion

KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance

13. The assessment of bulging flanks on a patient who is supine with knees flexed leads the nurse to assess further for:

a.

ascites.

b.

bowel obstruction.

c.

liver disorder.

d.

gallstones.

ANS: A

Bulging flanks in the supine person with flexed knees is indicative for ascites. Further assessment should follow.

DIF: Cognitive Level: Comprehension REF: 632 OBJ: 1 (clinical)

TOP: Ascites: Assessment KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance

14. The nurse is reviewing the laboratory results of an assigned patient. The serum bilirubin is 2.8 mg/dL. The nurse would anticipate which finding in the patients urine?

a.

Dark color

b.

Low specific gravity

c.

Very scant amount

d.

Foul odor

ANS: A

Normal serum bilirubin is 0.1 to 1.2 mg/dL. Jaundice is present at readings above 2.5 mg/dL. The patient who is jaundiced will have dark, tea-colored urine. Specific gravity refers to the concentration of the urine. The amount and odor of urine will not be directly influenced by the bilirubin level.

DIF: Cognitive Level: Application REF: 632 OBJ: 4 (theory)

TOP: Liver Disorder: Assessment KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance

15. The nurse is caring for a patient who is complaining of postoperative gas pain. What intervention can the nurse implement to aid the patient in passing flatus?

a.

Assist the patient to ambulate.

b.

Place a cold compress on the abdomen.

c.

Offer a cup of coffee or tea.

d.

Offer chilled vegetable juice.

ANS: A

Ambulation is the most effective method for helping a patient expel gas. Hot or cold beverages and cold compresses will increase gas.

DIF: Cognitive Level: Comprehension REF: 637 OBJ: 1 (theory)

TOP: Flatus: Interventions KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

16. The nurse is caring for a patient experiencing moderate diarrhea for the past 3 days. Which will most likely be incorporated into the patients plan of care?

a.

Place the patient on NPO status.

b.

Limit the patients diet to clear liquids.

c.

Administer parenteral nutrition.

d.

Restrict the patients diet to soft foods only.

ANS: B

If the diarrhea is severe, nothing is given by mouth until it subsides. If diarrhea is moderate, only clear liquids are permitted by mouth. Severe, long-term diarrhea may require the use of total parenteral nutrition.

DIF: Cognitive Level: Application REF: 634 OBJ: 3 (clinical)

TOP: Diarrhea KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

17. The nurse is talking with a patient who has been experiencing nausea. The patient indicates an interest in using alternative therapies for the condition. Which product may be suggested to aid in the management of this condition?

a.

Ginger

b.

Ginseng

c.

Chamomile

d.

Soy

ANS: A

Ginger has been used for centuries in Asia to combat nausea and vomiting, motion sickness, and dyspepsia. It is available candied in capsules, fluid extract, and tablets, and tincture or as fresh ginger root that can be grated and used to make tea. Ginger may decrease the action of histamine (H2)-receptor antagonists and proton pump inhibitors and may increase absorption of medications taken orally.

DIF: Cognitive Level: Comprehension REF: 635 OBJ: 3 (clinical)

TOP: Ginger for Nausea KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

18. The nurse is discussing foods that will aid in thickening the consistency of the stool with a patient who has been having severe diarrhea. When the patient has the opportunity to make a menu selection, which choice indicates an understanding of the instructions?

a.

Whole-grain rice

b.

Wheat toast

c.

Applesauce

d.

Grapes

ANS: C

When a patient has severe diarrhea and is allowed to resume solid foods, the foods should be slowly introduced in order to help thicken the stool. Foods such as applesauce, pretzels, bananas, white rice, white toast, and yogurt are beneficial.

DIF: Cognitive Level: Application REF: 636 OBJ: 3 (theory)

TOP: Nutrition Considerations: Foods That Thicken Stool

KEY: Nursing Process Step: Evaluation MSC: NCLEX: Health Promotion and Maintenance

19. The nurse is reviewing the laboratory results from a patient who has been diagnosed with liver disease. Which finding would be consistent with this condition?

a.

Prothrombin time (PT) 12.4 seconds

b.

Prothrombin time (PT) 10 seconds

c.

Partial thromboplastin time (PTT) 64 seconds

d.

Partial thromboplastin time (PTT) 74 seconds

e.

Partial thromboplastin time (PTT) 55 seconds

ANS: B

Prothrombin is a protein produced by the liver and used in blood clotting. The normal value is 12 to 14 seconds. It is reduced in patients with liver disease, causing a prolonged clotting time. Partial thromboplastin time (PTT) is used to detect deficiencies of stage II clotting mechanisms. It is prolonged in liver disease.

DIF: Cognitive Level: Analysis REF: 630 OBJ: 4 (theory)

TOP: Diagnostic Tests for Gastrointestinal Disorders

KEY: Nursing Process Step: Diagnosis

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

MULTIPLE RESPONSE

20. The nurse explains that the older adult is prone to digestive disorders because of age-related changes that include: (Select all that apply.)

a.

decrease in hydrochloric acid.

b.

increase in enzyme levels.

c.

inadequate chewing of food.

d.

diminished intestinal motility.

e.

incompetent gastroesophageal sphincter.

ANS: A, C, D, E

There is no increase in digestive enzymes.

DIF: Cognitive Level: Comprehension REF: 621 OBJ: 1 (theory)

TOP: Age-Related Changes to GI System

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

21. The nurse is aware that risk factors for the development of pancreatic cancer include: (Select all that apply.)

a.

obesity.

b.

Jewish ethnicity.

c.

diabetes mellitus.

d.

hepatitis A.

e.

smoking.

ANS: A, C, E

Obesity, diabetes, and smoking are all risks for the development of pancreatic cancer. Jewish ethnicity and hepatitis are not contributory to the disease.

DIF: Cognitive Level: Comprehension REF: 624 OBJ: 1 (theory)

TOP: Pancreatic Cancer: Risk Factors KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance

22. To promote bowel health, the nurse recommends that the patient: (Select all that apply.)

a.

exercise regularly.

b.

include adequate bulk in the diet.

c.

drink adequate water.

d.

defecate at approximately the same time every day.

e.

take a laxative to maintain a regular defecation pattern.

ANS: A, B, C, D

Daily exercise and intake of adequate bulk and water are contributions to bowel health. Heeding the need to defecate and defecating at the same time daily will help to keep the gastrocolic reflex healthy. Taking daily laxatives is not conducive to good bowel health.

DIF: Cognitive Level: Application REF: 625 OBJ: 4 (clinical)

TOP: Bowel Health: Maintenance KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

23. The nurse is caring for a patient scheduled to have a magnetic resonance imaging (MRI) study. Which instructions will be included in the teaching? (Select all that apply.)

a.

There is only minimal radiation exposure.

b.

All metal objects, including dental bridges, jewelry, and body piercings, must be removed.

c.

It will be necessary to be NPO for 4 hours before the procedure.

d.

A radiopaque medium may be injected during the procedure.

e.

There may be a tingling sensation in metal alloy filling of the teeth.

ANS: B, D, E

The MRI places the patient in a magnetic field and uses radiofrequency signals to determine how hydrogen atoms behave in the field. All metal must be removed, contrast medium may be injected, and the patient may have a tingling sensation in the teeth with metal alloy fillings. There is no restriction on food or fluid intake in relation to the test. The test does not expose the patient to radiation.

DIF: Cognitive Level: Comprehension REF: 626 OBJ: 3 (theory)

TOP: MRI: Preparation and Teaching KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

24. Immediately following a liver biopsy, the nurse should: (Select all that apply.)

a.

turn the patient to the right side for 2 hours.

b.

provide sandbag support for pressure on puncture site.

c.

monitor vital signs every 15 minutes.

d.

instruct patient to cough and deep breathe.

e.

assess for hematoma at puncture site.

ANS: A, B, C, E

The liver biopsy is performed under local or general anesthesia. Postprocedural care will include positioning on the right side for the first 2 hours, the use of a sandbag to apply pressure to the site, and assessment of vital signs and the puncture site. The patient should not cough as it increases intra-abdominal pressure and may stimulate bleeding.

DIF: Cognitive Level: Application REF: 628 OBJ: 5 (theory)

TOP: Liver Biopsy: Aftercare KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

25. For the patient who is anorexic, the interventions the nurse might use to stimulate appetite would include: (Select all that apply.)

a.

offering oral care after meals.

b.

arranging for preferred foods to be served.

c.

encouraging family members to bring food from home.

d.

suggesting that family members or friends come and socialize during the meal.

e.

giving ample time to eat and enjoy the meal.

ANS: B, C, D, E

Oral care should be offered before meals to aid in stimulating the appetite.

DIF: Cognitive Level: Comprehension REF: 633 OBJ: 4 (theory)

TOP: Anorexia: Interventions KEY: Nursing Process Step: Planning

MSC: NCLEX: Health Promotion and Maintenance

26. Before a nurse can document the presence of diarrhea, the criteria for diarrhea should be met, which include: (Select all that apply.)

a.

one loose stool in a 24-hour period.

b.

multiple liquid or semiliquid stools in a 24-hour period.

c.

hyperactive bowel sounds.

d.

cramping.

e.

fever.

ANS: B, C, D

Multiple liquid or semiliquid stools in a 24-hour period with hyperactive bowel sounds with cramping are the criteria for diarrhea. There does not have to be fever associated with it. A single loose or liquid stool is documented as that, and not diarrhea.

DIF: Cognitive Level: Comprehension REF: 636 OBJ: 4 (theory)

TOP: Diarrhea: Criteria KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

COMPLETION

27. The nurse caring for the patient who has diarrhea from taking a protocol of oral amoxicillin will use __________ Precautions in the care.

ANS:

Standard

standard

The diarrhea caused by medications is not infectious and should be dealt with using Standard Precautions.

DIF: Cognitive Level: Comprehension REF: 637 OBJ: 3 (clinical)

TOP: Diarrhea: Standard Precautions KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

MATCHING

Match each term with its correct definition.

a.

Absorption

b.

Peristalsis

c.

Metabolism

d.

Anabolism

e.

Catabolism

28. Rhythmic squeezing action of intestinal tract

29. Chemical process to make substances needed by the body

30. Repair of body tissue

31. Breaking down larger molecules into smaller molecules

32. Transfer of nutrients from intestine to bloodstream

28. ANS: B DIF: Cognitive Level: Comprehension REF: 623

OBJ: 1 (clinical) TOP: Terminology

KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance

29. ANS: C DIF: Cognitive Level: Comprehension REF: 623

OBJ: 1 (clinical) TOP: Terminology

KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance

30. ANS: D DIF: Cognitive Level: Comprehension REF: 623

OBJ: 1 (clinical) TOP: Terminology

KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance

31. ANS: E DIF: Cognitive Level: Comprehension REF: 623

OBJ: 1 (clinical) TOP: Terminology

KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance

32. ANS: A DIF: Cognitive Level: Comprehension REF: 623

OBJ: 1 (clinical) TOP: Terminology

KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance

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