Chapter 34: Alterations of Digestive Function My Nursing Test Banks

Huether and McCance: Understanding Pathophysiology, 5th Edition

Chapter 34: Alterations of Digestive Function

Test Bank

MULTIPLE CHOICE

1. A 34-year-old male was diagnosed with a bacterial GI infection. Which of the following types of diarrhea would most likely occur with his condition?

a.

Osmotic

b.

Secretory

c.

Hypotonic

d.

Motility

ANS: B

Infections lead to secretory diarrhea.

A nonabsorbable substance in the intestine leads to osmotic diarrhea.

Hypotonic diarrhea is not a form of diarrhea.

Food is not mixed properly, digestion and absorption is impaired, and motility is increased, leading to motility diarrhea.

REF: p. 896

2. A 20-year-old male was recently diagnosed with lactose intolerance. He eats an ice cream cone and develops diarrhea. His diarrhea can be classified as _____ diarrhea.

a.

Osmotic

b.

Secretory

c.

Hypotonic

d.

Motility

ANS: A

A nonabsorbable substance in the intestine leads to osmotic diarrhea.

Infections lead to secretory diarrhea.

Hypotonic diarrhea is not a form of diarrhea.

Food is not mixed properly, digestion and absorption is impaired, and motility is increased leading to motility diarrhea.

REF: p. 896

3. A 40-year-old female presents complaining of pain near the midline in the epigastrium. Assuming the pain is caused by a stimulus acting on an abdominal organ, the pain felt is classified as:

a.

Visceral

b.

Somatic

c.

Parietal

d.

Referred

ANS: A

Visceral pain arises from a stimulus (distention, inflammation, ischemia) acting on an abdominal organ.

Somatic is a form of parietal pain.

Parietal pain, from the parietal peritoneum, is more localized and intense than visceral pain, which arises from the organs themselves.

Referred pain is visceral pain felt at some distance from a diseased or affected organ.

REF: p. 896

4. The most common disorder associated with upper GI bleeding is:

a.

Diverticulosis

b.

Hemorrhoids

c.

Esophageal varices

d.

Cancer

ANS: C

Esophageal varices is the most common disorder associated with upper GI bleeding.

Diverticulosis could lead to bleeding, but it would be lower GI rather than upper.

Hemorrhoids can lead to bleeding, but they would be upper GI.

Duodenal ulcers could lead to upper GI bleeding, but peptic ulcers and varices are identified as more common.

REF: p. 897

5. A 52-year-old presents with bleeding from the rectum. This condition is referred to as:

a.

Melena

b.

Occult bleeding

c.

Hematochezia

d.

Hematemesis

ANS: C

Hematochezia is bleeding from the rectum.

Melena is a black or tarry stool.

Occult bleeding is hidden bleeding.

Hematemesis is vomiting blood.

REF: p. 898

6. A 50-year-old male is experiencing reflux of chyme from the stomach. He is diagnosed with gastroesophageal reflux. This condition is caused by:

a.

Fibrosis of the lower third of the esophagus

b.

Sympathetic nerve stimulation

c.

Loss of muscle tone at the lower esophageal sphincter

d.

Reverse peristalsis of the stomach

ANS: C

Gastroesophageal reflux is due to loss of muscle tone at the lower esophageal sphincter.

Gastroesophageal reflux is due to loss of muscle tone at the lower esophageal sphincter; it is not due to fibrosis.

Gastroesophageal reflux is due to loss of muscle tone at the lower esophageal sphincter, not stimulation of sympathetic nerves.

Gastroesophageal reflux is due to loss of muscle tone at the lower esophageal sphincter, not reverse peristalsis.

REF: p. 898

7. Reflux esophagitis is defined as a(n):

a.

Immune response to gastroesophageal reflux

b.

Inflammatory response to gastroesophageal reflux

c.

Congenital anomaly

d.

Secretory response to hiatal hernia

ANS: B

When gastroesophageal reflux leads to an inflammatory response, it is termed reflux esophagitis.

Esophagitis is due to an inflammatory response, not immune.

Esophagitis is due to an inflammatory response, not a congenital anomaly.

Esophagitis is due to an inflammatory response, not a secretory response.

REF: p. 899

8. A 45-year-old male complains of heartburn after eating and difficulty swallowing. He probably has:

a.

Pyloric stenosis

b.

Gastric cancer

c.

Achalasia

d.

Hiatal hernia

ANS: D

Regurgitation, dysphagia, and substernal discomfort after eating are common in individuals with hiatal hernia.

Pyloric stenosis is manifested by projectile vomiting.

Gastric cancer is not manifested by heartburn.

Achalasia is a form of functional dysphagia caused by loss of esophageal innervation.

REF: p. 899

9. A serious complication of paraesophageal hiatal hernia is:

a.

Hemorrhage

b.

Strangulation

c.

Peritonitis

d.

Ascites

ANS: B

Strangulation of the hernia is a major complication.

Strangulation of the hernia, not hemorrhage, is a major complication.

Strangulation of the hernia, not peritonitis, is a major complication.

Strangulation of the hernia, not ascites, is a major complication.

REF: p. 899

10. A 38-year-old female complains of epigastric fullness following a meal, nausea, and epigastric pain. Tests reveal narrowing of the opening between the stomach and the duodenum. This condition is referred to as:

a.

Ileocecal obstruction

b.

Hiatal hernia

c.

Pyloric obstruction

d.

Hiatal obstruction

ANS: C

The pylorus is the opening between the esophagus and the duodenum; the obstruction is pyloric.

Ileocecal obstruction is in the small intestine.

Hiatal hernia is related to the esophagus.

Hiatal obstruction is related to the esophagus.

REF: p. 900

11. The cardinal sign of pyloric stenosis caused by ulceration or tumors is:

a.

Constipation

b.

Diarrhea

c.

Vomiting

d.

Heartburn

ANS: C

The cardinal sign of pyloric stenosis is vomiting.

The cardinal sign of pyloric stenosis is vomiting, not constipation.

The cardinal sign of pyloric stenosis is vomiting, not diarrhea.

The cardinal sign of pyloric stenosis is vomiting, not heartburn.

REF: p. 900

12. A 10-month-old is brought to the pediatrician by the mother who states the baby has been experiencing colicky pain followed by vomiting, sweating, nausea, and irritability. Testing reveals a condition in which one part of the intestine telescopes into another. From which type of intestinal obstruction is he suffering?

a.

Hernia

b.

Ileus

c.

Torsion

d.

Intussusception

ANS: D

Telescoping of one part of the intestine into another; this usually causes strangulation of the blood supply and is more common in infants 10 to 15 months of age than in adults.

A hernia does not involve telescoping of the intestines.

An ileus could lead to bowel obstruction, but it does not involve telescoping.

Torsion can lead to pain and vomiting, but it does not involve telescoping.

REF: p. 900

13. A 40-year-old male develops an intestinal obstruction related to protrusion of the intestine through the inguinal ring. This condition is referred to as:

a.

Intussusception

b.

A volvulus

c.

A hernia

d.

Adhesions

ANS: C

A hernia is a protrusion of the intestine through a weakness in the abdominal muscles or through the inguinal ring.

Intussusception is telescoping of one part of the intestine into another; this usually causes strangulation of the blood supply and is more common in infants 10 to15 months of age than in adults.

A volvulus is a twisting of the intestine on its mesenteric pedicle, with occlusion of the blood supply, often associated with fibrous adhesions. It occurs most often in middle-aged and elderly men.

Adhesions are irritation from surgery or trauma that leads to formation of fibrin and adhesions that attach to intestine, omentum, or peritoneum and can cause obstruction; they are most common in small intestine.

REF: p. 900

14. Chronic gastritis is classified according to the:

a.

Severity

b.

Location of lesions

c.

Patients age

d.

Signs and symptoms

ANS: B

Chronic gastritis is classified as type A (fundal) or type B (antral), depending on the pathogenesis and location of the lesions.

Gastritis is not classified by severity but by location.

Gastritis is not classified by age, but by location.

Gastritis is not classified by symptoms, but by location.

REF: p. 903

15. A 42-year-old female presents with abdominal discomfort, epigastric tenderness, and bleeding. Gastroscopy reveals degeneration of the gastric mucosa in the body and fundus of the stomach. Which of the following would most likely follow?

a.

Pernicious anemia

b.

Osmotic diarrhea

c.

Increased acid secretion

d.

Decreased gastrin secretion

ANS: A

Pernicious anemia can develop because the damage to the mucosa makes the intrinsic factor less available to facilitate vitamin B12 absorption in the ileum.

Osmotic diarrhea would not occur as a portion of the damage to the mucosa, but pernicious anemia could.

Increased acid secretion would not occur as a portion of the damage to the mucosa, but pernicious anemia could.

Decreased gastrin secretion would not occur as a portion of the damage to the mucosa, but pernicious anemia could.

REF: p. 903

16. A 54-year-old male is diagnosed with peptic ulcer disease. This condition is most likely caused by:

a.

Hereditary hormonal imbalances with high gastrin levels

b.

Breaks in the mucosa and presence of corrosive secretions

c.

Decreased vagal activity and vascular engorgement

d.

Gastric erosions related to high ammonia levels and bile reflux

ANS: B

Peptic ulcer disease is caused by breaks in the mucosa and the presence of corrosive substances.

High gastrin occurs, but the disease is due to breaks in the mucosa.

Vagal activity increases.

Gastric erosions occur, but they are not due to high ammonia.

REF: p. 903

17. A 60-year-old male presents with GI bleeding and abdominal pain. He reports that he takes NSAIDs daily to prevent heart attack. Tests reveal that he has a peptic ulcer. The most likely cause of this disease is:

a.

Increasing subepithelial bicarbonate production

b.

Accelerating the H+ (proton) pump in parietal cells

c.

Inhibiting mucosal prostaglandin synthesis

d.

Stimulating a shunt of mucosal blood flow

ANS: C

Use of NSAIDs inhibit prostaglandins and maintenance of the mucosal barrier and decrease bicarbonate secretion.

NSAIDs decrease bicarbonate production.

H. pylori increases hydrogen secretion.

NSAIDs do not affect mucosal blood flow.

REF: p. 904

18. A 39-year-old female with chronic intermittent pain in the epigastric area 2 to 3 hours after eating is diagnosed with a duodenal ulcer. Which of the following behaviors may have contributed to the development of the ulcer?

a.

Cigarette smoking

b.

Drinking caffeinated beverages

c.

Consuming limited fiber

d.

Antacid consumption

ANS: A

Acid production is stimulated by cigarette smoking.

Caffeinated beverages do not contribute to ulcer formation.

Fiber is important, but consuming limited fiber will not contribute to ulcer formation.

Antacids may relieve pain, but they do not contribute to ulcer formation.

REF: p. 904

19. A 22-year-old male underwent brain surgery to remove a tumor. Following surgery, he experienced a peptic ulcer. His ulcer is referred to as a(n) _____ ulcer.

a.

Infectious

b.

Cushing

c.

Ischemic

d.

Curling

ANS: B

A Cushing ulcer is a stress ulcer associated with severe head trauma or brain surgery that results from decreased mucosal blood flow and hypersecretion of acid caused by overstimulation of the vagal nerve.

The stress ulcer is termed Cushing, not infectious.

The stress ulcer is termed Cushing, not ischemic.

Curling ulcers develop secondary to burns.

REF: p. 907

20. A 24-year-old male who sustained a head injury and fractured femur develops a stress ulcer. A common clinical manifestation of this ulcer is:

a.

Bowel obstruction

b.

Bleeding

c.

Pulmonary embolism

d.

Hepatomegaly

ANS: B

The most common clinical manifestation is bleeding.

The most common clinical manifestation is bleeding; bowel obstruction would occur much later and would not be expected.

The most common clinical manifestation is bleeding, not pulmonary embolism.

The most common clinical manifestation is bleeding; hepatomegaly is not associated with stress ulcers.

REF: p. 907

21. A 3-month-old female develops colicky pain, abdominal distention, and diarrhea after drinking cows milk. The best explanation for her symptoms is:

a.

Deficiency of bile that stimulates digestive secretions and bowel motility

b.

Excess of amylase, which increases the breakdown of starch and causes an osmotic diarrhea

c.

Overgrowth of bacteria from undigested fat molecules, which leads to gas formation and decreased bowel motility

d.

Excess of undigested lactose in her digestive tract, resulting in increased fluid movement into the digestive lumen and increased bowel motility

ANS: D

Undigested lactose increases the osmotic gradient in the intestine, causing irritation and osmotic diarrhea.

The child is experiencing lactose intolerance, not bile deficiency.

This child is experiencing lactose intolerance, not an excess of amylase.

The child is experiencing lactose intolerance, not in infectious process.

REF: p. 908

22. Clinical manifestations of bile salt deficiencies are related to poor absorption of:

a.

Fats and fat-soluble vitamins

b.

Water-soluble vitamins

c.

Proteins

d.

Minerals

ANS: A

Clinical manifestations of bile salt deficiency are related to poor intestinal absorption of fat and fat-soluble vitamins (A, D, E, K).

Water-soluble vitamins do not require bile salts for absorption; thus, they are not affected.

Protein breakdown is facilitated by bile, but its absorption is not dependent upon it; thus, the correct answer is the fat soluble vitamins.

Absorption of minerals do not require bile salts for absorption; thus, they are not affected.

REF: p. 908

23. A 30-year-old obese female underwent gastric resection in an attempt to lose weight. Which of the following complications could the surgery cause?

a.

Constipation

b.

Acid reflux gastritis

c.

Anemia

d.

Hiccups

ANS: C

One of the complications is anemia due to iron malabsorption, which may result from decreased acid secretion.

Diarrhea, not constipation, occurs.

The reflux would be alkaline, not acidic.

Hiccups are not associated with gastrectomy.

REF: p. 907

24. A 50-year-old male complains of frequently recurring abdominal pain, diarrhea, and bloody stools. A possible diagnosis would be:

a.

Ulcerative colitis

b.

Hiatal hernia

c.

Pyloric obstruction

d.

Achalasia

ANS: A

Ulcerative colitis is manifested by fever, elevated pulse rate, frequent diarrhea (10 to 20 stools/day), urgency, obviously bloody stools, and continuous lesions present in the colon.

Hiatal hernia is most often asymptomatic and would not be manifested by abdominal pain.

Pyloric obstruction would be manifested by forceful or projectile vomiting.

Achalasia would be manifested by difficulty or uncomfortable swallowing.

REF: p. 908

25. Which of the following symptoms would help a health care provider distinguish between ulcerative colitis and Crohn disease?

a.

Abdominal pain

b.

Pattern of remission/exacerbations

c.

Diarrhea

d.

Malabsorption

ANS: D

Malabsorption is common in Crohn disease and is rare in ulcerative colitis.

Both disorders can lead to abdominal pain.

Both disorders have a clinical course of remissions and exacerbations.

Both disorders lead to diarrhea.

REF: pp. 908-909

26. A 16-year-old female presents with abdominal pain in the right lower quadrant. Physical examination reveals rebound tenderness and a low-grade fever. A possible diagnosis would be:

a.

Colon cancer

b.

Pancreatitis

c.

Appendicitis

d.

Hepatitis

ANS: C

Appendicitis is manifested by right lower quadrant pain with rebound tenderness.

Colon cancer may be asymptomatic, followed by bleeding.

Pancreatitis is manifested by vomiting.

Hepatitis would be manifested by upper abdominal pain, not lower.

REF: p. 910

27. The most common cause of chronic vascular insufficiency among the elderly is:

a.

Anemia

b.

Aneurysm

c.

Lack of nutrition in gut lumen

d.

Atherosclerosis

ANS: D

The most common cause of chronic vascular insufficiency is atherosclerosis, especially in the elderly.

Anemia does not lead to vascular insufficiency.

An aneurysm would lead to acute vascular insufficiency.

Lack of nutrition does not lead to vascular insufficiency; it is due to atherosclerosis.

REF: p. 911

28. Which of the following characteristics is associated with an acute occlusion of mesenteric blood flow to the small intestine?

a.

Often precipitated by an embolism

b.

Commonly associated with disease such as pancreatitis and gallstones

c.

Caused by chronic malnutrition and mucosal atrophy

d.

Often a complication of hypovolemic shock

ANS: A

Occlusion of blood flow is often precipitated by embolism.

Occlusion of blood flow is often precipitated by embolism; it is not associated with pancreatitis.

Occlusion of blood flow is often precipitated by embolism, even if chronic malnutrition is present.

Occlusion of blood flow is often precipitated by embolism; it is not a complication of hypovolemic shock.

REF: p. 911

29. The risk of hypovolemic shock is high with acute mesenteric arterial insufficiency because:

a.

The resulting liver failure causes a deficit of plasma proteins and a loss of oncotic pressure.

b.

Ischemia alters mucosal membrane permeability, and fluid is shifted to the bowel wall and peritoneum.

c.

Massive bleeding occurs in the GI tract.

d.

Overstimulation of the parasympathetic nervous system results in ischemic injury to the intestinal wall.

ANS: B

Fluid shifts lead to hypovolemia.

Arterial insufficiency is not related to liver failure.

Bleeding may occur, but hypovolemia is related to fluid shifts.

Fluid shifts lead to hypovolemia; it is not due to overstimulation of the parasympathetic nerves.

REF: p. 911

30. Which of the following conditions is thought to contribute to the development of obesity?

a.

Insulin excess

b.

Leptin resistance

c.

Adipocyte failure

d.

Malabsorption

ANS: B

Leptin resistance disrupts hypothalamic satiety signaling and promotes overeating and excessive weight gain and is a factor in the development of obesity.

Insulin becomes resistant, not present in excess.

Leptin resistance, not adipocyte failure, leads to obesity.

Malabsorption does not lead to obesity, but primarily to weight loss.

REF: p. 912

31. A 13-year-old female confides to her mother that she binge eats and induces vomiting to prevent weight gain. This disease is referred to as:

a.

Anorexia nervosa

b.

Bulimia nervosa

c.

Long-term starvation

d.

Laxative abuse

ANS: B

Binge eating and vomiting is characteristic of bulimia nervosa.

Anorexia nervosa is starvation eating.

Binge eating and vomiting is characteristic of bulimia nervosa, not long-term starvation.

Binge eating and vomiting is characteristic of bulimia nervosa, not laxative abuse.

REF: p. 914

32. A 54-year-old male complains that he has been vomiting blood. Tests reveal portal hypertension. Which of the following is the most likely cause of his condition?

a.

Thrombosis in the spleen

b.

Cirrhosis of the liver

c.

Left ventricular failure

d.

Renal stenosis

ANS: B

Portal hypertension occurs secondarily to cirrhosis of the liver.

Portal hypertension occurs secondarily to cirrhosis of the liver, not thrombosis of the spleen.

Portal hypertension occurs secondarily to cirrhosis of the liver, not left ventricular failure.

Portal hypertension occurs secondarily to cirrhosis of the liver, not renal stenosis.

REF: p. 915

33. The most common clinical manifestation of portal hypertension is _____ bleeding.

a.

Rectal

b.

Duodenal

c.

Esophageal

d.

Intestinal

ANS: C

Vomiting of blood from bleeding esophageal varices is the most common clinical manifestation of portal hypertension.

Esophageal bleeding, not rectal bleeding, is the most common clinical manifestation of portal hypertension.

Esophageal bleeding, not duodenal bleeding, is the most common clinical manifestation of portal hypertension.

Esophageal bleeding, not intestinal bleeding, is the most common clinical manifestation of portal hypertension.

REF: p. 915

34. A 60-year-old female with a history of alcoholism complains of recent weight gain and right flank pain. Physical examination reveals severe ascites. This condition is caused by decreased:

a.

Albumin and lack of cellular integrity

b.

Capillary filtration pressure

c.

Capillary permeability

d.

Antidiuretic hormone secretion

ANS: A

Ascites is due to decreased albumin and lack of cellular integrity.

Ascites is due to decreased albumin and lack of cellular integrity, not capillary filtration pressure.

Ascites is due to decreased albumin and lack of cellular integrity, not decreased capillary permeability.

Ascites is due to decreased albumin and lack of cellular integrity, not antidiuretic hormone secretion.

REF: p. 916

35. Manifestations associated with hepatic encephalopathy from chronic liver disease are the result of:

a.

Hyperbilirubinemia and jaundice

b.

Fluid and electrolyte imbalances

c.

Impaired ammonia metabolism

d.

Decreased cerebral blood flow

ANS: C

Impaired ammonia metabolism leads to the symptoms of hepatic encephalopathy.

Impaired ammonia metabolism leads to the symptoms of hepatic encephalopathy. Symptoms are primarily neurologic, not jaundice oriented.

Impaired ammonia metabolism leads to the symptoms of hepatic encephalopathy. Fluid and electrolyte changes that occur would not lead to the manifestations seen in hepatic encephalopathy.

Impaired ammonia metabolism leads to the symptoms of hepatic encephalopathy. Cerebral blood flow is not affected.

REF: p. 917

36. An increase in the rate of red blood cell breakdown causes which form of jaundice?

a.

Obstructive

b.

Hemolytic

c.

Hepatocellular

d.

Metabolic

ANS: B

Excessive hemolysis (breakdown) of red blood cells can cause hemolytic jaundice (prehepatic jaundice).

Excessive hemolysis (breakdown) of red blood cells can cause hemolytic jaundice (prehepatic jaundice). It is not due to obstruction.

Excessive hemolysis (breakdown) of red blood cells can cause hemolytic jaundice (prehepatic jaundice). It is not hepatocellular.

Excessive hemolysis (breakdown) of red blood cells can cause hemolytic jaundice (prehepatic jaundice). It is not metabolic.

REF: p. 918

37. Complete obstruction of bile flow to the liver would be manifested by:

a.

Elevated hemoglobin and hematocrit

b.

Lower-leg edema

c.

Clay-colored stools

d.

Hypotension

ANS: C

Complete obstruction of bile flow leads to clay-colored stools.

Complete obstruction of bile flow leads to clay-colored stools, not elevated hemoglobin and hematocrit.

Complete obstruction of bile flow leads to clay-colored stools, not lower-leg edema.

Complete obstruction of bile flow leads to clay-colored stools, not hypotension.

REF: p. 920

38. The icteric phase of hepatitis is characterized by which of the following clinical manifestations?

a.

Fatigue, malaise, vomiting

b.

Jaundice, dark urine, enlarged liver

c.

Resolution of jaundice, liver function returns to normal

d.

Fulminant liver failure, hepatorenal syndrome

ANS: B

The icteric phase is manifested by jaundice, dark urine, and clay-colored stools. The liver is enlarged, smooth, and tender, and percussion causes pain; this is the actual phase of illness.

Fatigue and vomiting occur during the prodromal stage.

Resolution occurs in the recovery phase.

Fulminant liver failure does not involve icterus.

REF: p. 920

39. A 55-year-old male died in a motor vehicle accident. Autopsy revealed an enlarged liver caused by fatty infiltration, testicular atrophy, and mild jaundice secondary to cirrhosis. The most likely cause of his condition is:

a.

Bacterial infection

b.

Viral infection

c.

Alcoholism

d.

Drug overdose

ANS: C

The most common cause of cirrhosis is alcoholism.

The most common cause of cirrhosis is alcoholism, not a bacterial infection.

The most common cause of cirrhosis is alcoholism, not a viral infection.

The most common cause of cirrhosis is alcoholism, not drug overdose.

REF: p. 921

40. In alcoholic cirrhosis, hepatocellular damage is caused by:

a.

Acetaldehyde accumulation

b.

Bile toxicity

c.

Acidosis

d.

Fatty infiltrations

ANS: A

Alcoholic cirrhosis is caused by the toxic effects of alcohol metabolism on the liver. Alcohol is transformed to acetaldehyde, and excessive amounts significantly alter hepatocyte function and activate hepatic stellate cells, a primary cell involved in liver fibrosis.

Bile toxicity does not cause alcoholic cirrhosis.

Acidosis does not cause alcoholic cirrhosis.

Fatty infiltrations do not cause alcoholic cirrhosis.

REF: p. 922

41. A 39-year-old female presents with abdominal pain and jaundice. She is diagnosed with gallstones and undergoes cholecystectomy. An analysis of her gallstones would most likely reveal a high concentration of:

a.

Phosphate

b.

Bilirubin

c.

Urate

d.

Cholesterol

ANS: D

The majority of gallstones are composed of cholesterol.

The majority of gallstones are composed of cholesterol, not phosphate.

The majority of gallstones are composed of cholesterol, not bilirubin.

The majority of gallstones are composed of cholesterol, not urea.

REF: p. 923

42. A 55-year-old female has general symptoms of gallstones but is also jaundiced. IV cholangiography would most likely reveal that the gallstones are obstructing the:

a.

Intrahepatic bile canaliculi

b.

Gallbladder

c.

Cystic duct

d.

Common bile duct

ANS: D

Jaundice is due to obstruction of the common bile duct.

Jaundice is due to obstruction of the common bile duct, not the intrahepatic canaliculi.

Jaundice is due to obstruction of the common bile duct, not the gallbladder.

Jaundice is due to obstruction of the common bile duct, not the cystic duct.

REF: p. 923

43. Cholecystitis is inflammation of the gallbladder wall usually caused by:

a.

Accumulation of bile in the hepatic duct

b.

Obstruction of the cystic duct by a gallstone

c.

Accumulation of fat in the wall of the gallbladder

d.

Viral infection of the gallbladder

ANS: B

Cholecystitis can be acute or chronic, but both forms are almost always caused by a gallstone lodged in the cystic duct.

Accumulation of bile in the hepatic duct would not lead to cholecystitis.

Accumulation of fat does not lead to cholecystitis.

A viral infection does not cause cholecystitis; obstruction of the cystic duct does.

REF: p. 923

44. Tissue damage in pancreatitis is caused by:

a.

Insulin toxicity

b.

Autoimmune destruction of the pancreas

c.

Leakage of pancreatic enzymes

d.

Hydrochloric acid reflux into the pancreatic duct

ANS: C

Leaked enzymes become activated, initiating autodigestion, inflammation, oxidative stress, and acute pancreatitis.

Tissue damage is caused by leaked enzymes that become activated, initiating autodigestion, inflammation, oxidative stress, and acute pancreatitis. It is not due to insulin toxicity.

Tissue damage is caused by leaked enzymes that become activated, initiating autodigestion, inflammation, oxidative stress, and acute pancreatitis. It is not due to autoimmune destruction. The cause is unknown.

Tissue damage is caused by leaked enzymes that become activated, initiating autodigestion, inflammation, oxidative stress, and acute pancreatitis. It is not due to hydrochloric acid reflux.

REF: p. 924

45. A 40-year-old male presents with epigastric pain. Tests reveal acute pancreatitis. The most likely cause of his condition is:

a.

Pancreatic duct obstruction by a malignant tumor

b.

Surgical trauma to the pancreas

c.

Obstruction of the biliary tract by a gallstone

d.

Toxic injury to the pancreas from nonprescription medications

ANS: C

Biliary tract obstruction by gallstones is one of the known causes of pancreatitis.

Malignancies can occur in the pancreas, but the most common cause of the epigastric pain associated with pancreatitis is biliary tract obstruction.

Trauma from surgery can occur in the pancreas, but the most common cause of the epigastric pain associated with pancreatitis is biliary tract obstruction.

Nonprescription medications usually do not result in pancreatitis, the most common cause of the epigastric pain associated with pancreatitis is biliary tract obstruction.

REF: p. 924

46. Acute pancreatitis often manifests with pain to which of the following regions?

a.

Right lower quadrant

b.

Right upper quadrant

c.

Epigastric

d.

Suprapubic

ANS: C

Epigastric or midabdominal pain ranging from mild abdominal discomfort to severe, incapacitating pain is one of the manifestations of pancreatitis.

Right lower pain would be a symptom of appendicitis.

Right upper quadrant pain would be manifestation of liver inflammation.

Suprapubic pain would be related to a full bladder or colon problems.

REF: p. 924

47. Pancreatic insufficiency is manifested by deficient production of:

a.

Insulin

b.

Amylase

c.

Lipase

d.

Bile

ANS: C

Pancreatic insufficiency is the deficient production of lipase by the pancreas.

Pancreatic insufficiency is the deficient production of lipase, not insulin, by the pancreas.

Pancreatic insufficiency is the deficient production of lipase, not amylase, by the pancreas.

Pancreatic insufficiency is the deficient production of lipase, not bile, by the pancreas.

REF: p. 908

48. A 60-year-old male is diagnosed with cancer of the esophagus. Which of the following factors most likely contributed to his disease?

a.

Reflux esophagitis

b.

Intestinal parasites

c.

Ingestion of salty foods

d.

Frequent use of antacids

ANS: A

Reflux is a factor in the development of esophageal cancer.

Intestinal parasites do not lead to the development of cancer of the esophagus.

Ingestion of salty foods does not lead to cancer of the esophagus.

Frequent use of antacids does not lead to cancer of the esophagus.

REF: p. 925

49. Which of the GI cancers has the highest rate of incidence and is responsible for the highest number of deaths?

a.

Esophageal

b.

Stomach

c.

Pancreatic

d.

Colorectal

ANS: D

Colorectal cancer (CRC) is the third most common cause of cancer and cancer death in the United States for both men and women.

Esophageal cancer does not have the highest incidence.

Stomach cancer does not have the highest incidence.

Pancreatic cancer does not have the highest incidence.

REF: p. 927

50. A 40-year-old male who consumes a diet high in fat and low in fiber is at risk for:

a.

Cancer of the stomach

b.

Cancer of the liver and biliary ducts

c.

Cancer of the small intestine

d.

CRC

ANS: D

CRC is associated with dietary intake, primarily lack of fiber and high fat content.

It is CRC, not the stomach, that is most generally associated with dietary intake.

It is CRC, not the liver, that is most generally associated with dietary intake.

It is CRC, not the small intestine, that is most generally associated with dietary intake.

REF: p. 927

51. The cardinal signs of small bowel obstruction are:

a.

Vomiting and distention

b.

Diarrhea and excessive thirst

c.

Dehydration and epigastric pain

d.

Abdominal pain and rectal bleeding

ANS: A

Colicky pains followed by vomiting and distention are the cardinal symptoms of small bowel obstruction.

Colicky pains followed by vomiting and distention are the cardinal symptoms of small bowel obstruction. Diarrhea does not occur.

Colicky pains followed by vomiting and distention are the cardinal symptoms of small bowel obstruction. Epigastric pain does not occur.

Colicky pains followed by vomiting and distention are the cardinal symptoms of small bowel obstruction. Abdominal pain may occur, but rectal bleeding does not.

REF: p. 902

MULTIPLE RESPONSE

1. Which of the following gastrointestinal (GI) clinical manifestations is subjective? (Select all that apply.)

a.

Retching

b.

Anorexia

c.

Nausea

d.

Vomiting

e.

Diarrhea

ANS: B, C

Anorexia is lack of the desire for food intake and is a subjective experience. Nausea is a subjective experience. Retching is a forceful form of vomiting and is observable. Vomiting and diarrhea are observable.

REF: p. 894

2. A patient presents to the physician with complaints of constipation. Which of the following could be the cause? (Select all that apply.)

a.

Neurogenic disorder of the large intestine

b.

Sedentary lifestyle

c.

Low residue diet

d.

Aging

e.

Use of antacids

ANS: A, B, C, D, E

Constipation can be caused by neurogenic disorders of the large intestine in which neural pathways or neurotransmitters are altered and colon transit time delayed. A low-residue diet (the habitual consumption of highly refined foods) decreases the volume and number of stools and causes constipation. A sedentary lifestyle and lack of regular exercise are other common causes of constipation. Lack of access to toilet facilities and consistent suppression of the urge to empty the bowel are other causes. Excessive use of antacids containing calcium carbonate or aluminum hydroxide often results in constipation. Opiates, particularly codeine, tend to inhibit bowel motility. Conditions associated with constipation include congenital megacolon, hypothyroidism, pelvic hiatal hernia, multiple sclerosis, spinal cord trauma, cancer, cerebrovascular disease, and irritable bowel syndrome-constipation predominant. Aging may result in changes in neuromuscular function, causing constipation.

REF: p. 895

3. A 62-year-old male presents with difficulty swallowing. Tests reveal a loss of esophageal peristalsis and failure of the lower esophageal sphincter to relax. Functional dysphasia is the diagnosis. A history of which of the following could be the most likely cause? (Select all that apply.)

a.

Parkinson disease

b.

Cerebrovascular accident

c.

Achalasia

d.

Peptic ulcer disease

e.

Pyloric stenosis

ANS: A, B, C

Functional dysphasia is caused by neural or muscular disorders that interfere with voluntary swallowing or peristalsis. Disorders that affect the striated muscles of the upper esophagus interfere with the oropharyngeal (voluntary) phase of swallowing. Typical causes are dermatomyositis (a muscle disease) and neurologic impairments caused by cerebrovascular accidents, Parkinson disease, or achalasia. Peptic ulcer disease or pyloric stenosis would not cause functional dysphasia.

REF: p. 898

4. Complications obstruction in the lower bowel include (select all that apply):

a.

Metabolic acidosis

b.

Hypokalemia

c.

Tachycardia

d.

Hypovolemia

e.

Peritonitis

ANS: A, C, D, E

With obstruction lower in the intestine, metabolic acidosis is more likely to occur because bicarbonate from pancreatic secretions and bile cannot be reabsorbed. Hypokalemia can be extreme. Continued intestinal secretion and decreased absorption lead to decreased blood volume and elevates hematocrit, decreases central venous pressure, and causes tachycardia. Severe dehydration leads to hypovolemic shock. Bacteria also proliferate and may cross the mucosal barrier and cause peritonitis or sepsis.

REF: p. 901

5. The primary causes of duodenal ulcers include (select all that apply):

a.

Consumption of spicy foods

b.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

c.

H. pylori infection

d.

Trauma

e.

Side effects of antibiotics

ANS: B, C

Infection with H. pylori and chronic use of NSAIDs are the major causes of duodenal ulcer. Consuming spicy foods, trauma, and antibiotics do not lead to duodenal ulcer disease.

REF: p. 903

6. A 46-year-old female is diagnosed with gastric ulcers. Which of the following characterizes the disorder? (Select all that apply.)

a.

Pain occurs immediately after eating.

b.

Weight gain occurs.

c.

Bile is regurgitated.

d.

Occurrence is typically a single event.

e.

Duration of treatment is extended.

ANS: A, E

The pattern of pain is different from that of duodenal ulcers as it frequently occurs immediately after eating. Gastric ulcers cause more anorexia, vomiting, and weight loss than duodenal ulcers. Gastric ulcers also tend to be chronic rather than alternating between periods of remission and exacerbation. The evaluation and treatment of gastric ulcers are similar to the evaluation and treatment of duodenal ulcers, although duration of treatment is longer than with duodenal ulcers.

REF: p. 906

7. A 55-year-old male intravenous (IV) drug user with a history of advanced liver disease is diagnosed with hepatorenal syndrome. Which of the following clinical manifestations would be expected? (Select all that apply.)

a.

Oliguria

b.

Jaundice

c.

Ascites

d.

Hypertension

e.

Anorexia

ANS: A, B, C, E

Oliguria and complications of advanced liver disease, including jaundice, ascites, and GI bleeding, are usually present. Systolic blood pressure is usually below 100 mm Hg. Nonspecific symptoms of hepatorenal syndrome include anorexia, weakness, and fatigue.

REF: p. 922

8. Which of the following type(s) of hepatitis has an incubation period of up to 180 days? (Select al that apply.)

a.

A

b.

B

c.

C

d.

D

e.

E

ANS: A, D

Both hepatitis A and D have incubation periods of up to 180 days.

REF: p. 920

9. A 31-year-old female presents with midabdominal pain. She is expected to have acute pancreatitis. Which of the will be part of the treatment plan? (Select all that apply.)

a.

Narcotic analgesics

b.

Restriction of food intake

c.

Nasogastric suctioning

d.

Antibiotics

e.

IV fluids

ANS: A, B, C, D, E

Narcotic medications may be needed to relieve pain. To decrease pancreatic secretions and rest the gland, oral food and fluids may be withheld, and continuous gastric suction is instituted. Nasogastric suction may not be necessary with mild pancreatitis, but it helps to relieve pain and prevent paralytic ileus in individuals who are nauseated and vomiting. Parenteral fluids are essential to restore blood volume and prevent hypotension and shock. Antibiotics may control infection. The risk of mortality increases significantly with the development of infection or pulmonary, cardiac, and renal complications.

REF: pp. 924-925

10. A 52-year-old female presents with continuous abdominal pain that intensifies after eating. She is diagnosed with chronic pancreatitis. Contributing factors include: (Select all that apply.)

a.

Alcohol abuse

b.

Peptic ulcer disease

c.

Trauma

d.

Smoking

e.

Bulimia

ANS: B, C, D

Pancreatitis can be acute or chronic, and risk factors include alcoholism, obstructive biliary tract disease (particularly cholelithiasis), peptic ulcers, trauma, hyperlipidemia, and smoking, as well as certain drugs.

REF: p. 925

COMPLETION

1. The adult intestine processes approximately _____ liters of luminal content per day, of which 99% of the fluid is normally reabsorbed.

ANS:

9

nine

REF: p. 925

2. Obesity is define as a body mass index (BMI) greater than _____.

ANS:

30

thirty

REF: p. 912

3. A 16-year-old female is diagnosed with anorexia nervosa. By definition, the patient would weigh ____% less than normal for age and height:

ANS:

15

The definition of anorexia is body weight 15% less than normal for age and height because of refusal to eat.

REF: p. 914

Mosby items and derived items 2012 Mosby, Inc., an imprint of Elsevier Inc.

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