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Chapter 05: Care of the Patient with a Gastrointestinal Disorder
Test Bank
MULTIPLE CHOICE
1.The end-products of carbohydrate and protein digestion are absorbed by the
a. | bloodstream. |
b. | blood vessels in the villi. |
c. | lymphatic system. |
d. | lymph vessels in the villi. |
ANS: B
The inner surface of the small intestine contains millions of tiny, fingerlike projections called villi, which contain small blood vessels. They are responsible for absorbing the products of digestion.
DIF: Cognitive Level: Knowledge REF: Page 178 OBJ: 2
TOP:DigestiveKEY:Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity
2.A 56-year-old patient with diverticulitis has been admitted to the medical unit. The nurse will most likely document which assessment in the charting?
a. | Chest pain |
b. | Pain in the upper right quadrant |
c. | Pain in the left lower quadrant |
d. | Progressive weight loss |
ANS: C
Patients with diverticulitis will complain of mild to severe pain in the left lower quadrant.
DIF: Cognitive Level: Comprehension REF: Page 213 OBJ: 8
TOP: Diverticulitis KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
3.An ileostomy was performed on a patient for the treatment of debilitating ulcerative colitis disease. A problem the nurse should watch for in patients after this surgery is
a. | fluid imbalance. |
b. | sexual activity restriction. |
c. | skin excoriation. |
d. | the collecting appliance being bulky and large. |
ANS: C
The nurse should assess the peristomal skin for impairment of integrity.
DIF:Cognitive Level: AnalysisREF:Page 209, Box 5-5
OBJ:11TOP:Ulcerative colitis
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity
4.A patient with cancer of the esophagus has been receiving radiation therapy. The nurse realizes that this patient should be assessed for
a. | aspiration from fistula formation. |
b. | hemorrhage. |
c. | incompetence of the suture line. |
d. | dumping syndrome. |
ANS: A
Radiation therapy may be curative or palliative. Special problems associated with radiation therapy include the development of an esophagotracheal fistula. Aspiration from the fistula and edema from the radiation must be anticipated.
DIF: Cognitive Level: Analysis REF: Page 188 OBJ: 5
TOP: Cancer of esophagus KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity
5.A patient has been admitted for diagnostic procedures including an esophagogastroduodenoscopy. The nurse explains to this patient that during this procedure, the physician will
a. | use a long, rigid, fiberoptic scope. |
b. | order NPO status 1 hour before the procedure. |
c. | view the esophagus, stomach, and upper small intestine. |
d. | visualize the intestine but cannot remove polyps. |
ANS: C
The esophagus, stomach, and duodenum can be evaluated not only by endoscopy, but also by the use of a longer flexible fiberoptic scope. This procedure is called an esophagogastroduodenoscopy.
DIF: Cognitive Level: Comprehension REF: Page 192 OBJ: 5
TOP: Diagnostic procedures KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
6.The nurse determines that a patient has a knowledge deficit regarding her diagnosis of achalasia. The nurse begins patient teaching by explaining that achalasia is
a. | a white patch on the mouth or tongue mucosa. |
b. | caused by frequent ulceration on the lip. |
c. | caused by excess exposure to sun and wind. |
d. | caused by the inability of a muscle to relax. |
ANS: D
The abnormal condition characterized by the inability of a muscle to relax is achalasia.
DIF:Cognitive Level: KnowledgeREF:Pages 188-189
OBJ: 5 TOP: Achalasia KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
7.Following a gastrectomy, the nurse would anticipate that the patient would need to be assessed for
a. | renal failure. |
b. | vitamin B12 deficiency. |
c. | obesity complications. |
d. | continuing his routine diet. |
ANS: B
It is recommended that all patients with a gastrectomy have a blood serum vitamin B12 level measured every 1 to 2 years. Decreased absorption of vitamin B12 may cause pernicious anemia.
DIF:Cognitive Level: ApplicationREF:Pages 178, 196
OBJ: 6 TOP: Gastrectomy KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity
8.A 63-year-old patient is admitted with acute diverticulitis. The most appropriate nursing intervention to lessen this patient’s signs and symptoms of increased flatus and chronic constipation alternating with diarrhea, anorexia, and nausea would be to
a. | encourage a diet high in fiber content. |
b. | reduce oral intake to rest the bowel. |
c. | encourage fluids to prevent dehydration. |
d. | administer laxatives to prevent secondary constipation. |
ANS: A
A high-fiber diet of bran, fruits, and vegetables is recommended.
DIF:Cognitive Level: AnalysisREF:Pages 214-215
OBJ:8TOP:Diverticulitis
KEY:Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
9.The patient, age 32, has ulcerative colitis, and his condition is deteriorating. An ileostomy is scheduled. After the procedure, this patient may be at risk for
a. | Activity intolerance. |
b. | Sexual dysfunction. |
c. | Disturbed body image. |
d. | Ineffective thermoregulation. |
ANS: C
Nursing diagnoses for the surgical patient may be focused on potential Ineffective coping, Situational low self-esteem, and Disturbed body image.
DIF: Cognitive Level: Analysis REF: Page 208 OBJ: 5
TOP: Ulcerative colitis KEY: Nursing Process Step: Planning
MSC: NCLEX: Psychosocial Integrity
10.Dumping syndrome after a Billroth II procedure occurs when high-carbohydrate foods are ingested over a period of less than 20 minutes. A nursing measure that will prevent or minimize dumping syndrome is to administer the feeding
a. | by bolus to prevent continuous intestinal distention. |
b. | with large amounts of fluids to maintain hydration. |
c. | high in carbohydrates and protein. |
d. | in six small daily meals high in protein and fat. |
ANS: D
Treatment for dumping syndrome includes eating six small meals daily that are high in protein and fat and low in carbohydrates. Fluids should be avoided during meals.
DIF:Cognitive Level: AnalysisREF:Pages 196-199
OBJ:6TOP:Dumping syndrome
KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity
11.The emergency room staff is caring for a patient with an acute inflammatory intestinal disorder who is being observed to rule out appendicitis. Which intervention is contraindicated?
a. | Give nothing by mouth until seen by a health care provider |
b. | Measure intake and output |
c. | Apply heat to the abdomen |
d. | Encourage bed rest |
ANS: C
No heat is applied because this may increase circulation to the appendix and lead to rupture.
DIF: Cognitive Level: Application REF: Page 213 OBJ: 8
TOP:AppendicitisKEY:Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity
12.After barium swallow contrast studies are performed, the nurse should ensure that the patient
a. | drinks adequate amounts of water. |
b. | remains in bed for 6 hours. |
c. | eats nothing until the gag reflex returns. |
d. | expels all barium rectally. |
ANS: D
The nurse should explain to the patient the importance of rectally expelling all barium. Large amounts of fluids should be taken to prevent constipation.
DIF: Cognitive Level: Application REF: Page 181 OBJ: 4
TOP: Diagnostic studies KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
13.A patient, age 36, is admitted with diarrhea and dehydration. The physician has ordered several diagnostic studies of the patient’s stools. When obtaining a stool specimen to be examined for ova and parasites, the nurse should
a. | use an oil retention enema to facilitate collection. |
b. | refrigerate the specimen immediately. |
c. | instruct the patient to obtain three different stool specimens on subsequent days. |
d. | check the specimen for the presence of occult blood. |
ANS: C
Diagnosing a parasitic infection requires three different stool specimens on subsequent days. Use only normal saline or tap water enemas to prevent alteration of results.
DIF: Cognitive Level: Knowledge REF: Page 183 OBJ: 4
TOP: Diagnostic studies KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
14.The patient, age 32, is admitted with possible appendicitis after being evaluated by the physician. It is appropriate for the nurse to administer
a. | fluid and electrolyte replacement. |
b. | heat to decrease discomfort. |
c. | a cleansing enema. |
d. | an oral laxative. |
ANS: A
Other interventions for possible appendicitis may include bed rest and fluid and electrolyte replacement. Dehydration and anorexia causes fluid and electrolyte imbalances. Laxatives and enemas may cause perforation of the appendix. Heat can cause the appendix to rupture.
DIF: Cognitive Level: Comprehension REF: Page 213 OBJ: 8
TOP:AppendicitisKEY:Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
15.A patient, age 84, has a history of a large left inguinal hernia. He is complaining of nausea, vomiting, abdominal distention, and inguinal pain. A serious complication of a hernia in which the blood supply to the tissue becomes occluded is called a(n)
a. | strangulated hernia. |
b. | hiatal hernia. |
c. | incarcerated hernia. |
d. | sliding hernia. |
ANS: A
The hernia is strangulated when the blood supply and intestinal flow are occluded.
DIF: Cognitive Level: Knowledge REF: Page 216 OBJ: 9
TOP: Inguinal hernia KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity
16.A patient had a ruptured diverticulum in his descending colon. He has undergone a transverse loop colostomy. He asks the nurse the purpose of this procedure, and the nurse tells him that it is
a. | a temporary colostomy to allow healing of the bowel by diverting feces. |
b. | to allow for more thorough irrigations. |
c. | to provide two stomas for fecal elimination. |
d. | to prevent chronic constipation. |
ANS: A
The second procedure is the double-barrel colostomy, where the bowel is brought up through the abdominal surface, or loop colostomy.
DIF:Cognitive Level: ComprehensionREF:Page 214, Figure 5-14
OBJ:12TOP:Diverticulum
KEY:Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity
17.The patient complains that he will never adjust to his colostomy. In this situation, it would be best for the nurse to
a. | encourage him to express his concern. |
b. | suggest that he discuss his concerns with his physician. |
c. | counsel him that everything will be all right. |
d. | explain that his concerns will be dealt with when he is taught how to care for his colostomy. |
ANS: A
When a colostomy is performed, the patient or significant other should be able to verbalize and demonstrate understanding of ostomy care to the nurse.
DIF: Cognitive Level: Analysis REF: Page 215 OBJ: 12
TOP:ColostomyKEY:Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity
18.The most important nursing intervention to assure the patency of a nasogastric tube (NG) is to:
a. | Clamp nasogastric tube 30 minutes twice a day. |
b. | Monitor NG for patency and irrigate with sterile normal saline PRN as ordered. |
c. | Cleanse nares at least once each shift; lubricate with a petrolatum ointment. |
d. | Administer mouth care every 24 hours. |
ANS: B
Irrigate NG tube PRN will keep the tube patent and assure effective decompression.
DIF:Cognitive Level: ApplicationREF:Page 199, Box 5-5
OBJ: 6 TOP: NG tube KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
19.A progressive wavelike movement that occurs involuntarily in hollow tubes of the body, especially in the alimentary canal, to propel fluids, gas, and digestive substances forward is called
a. | perisclerium. |
b. | periprostatic. |
c. | pleurolysis. |
d. | peristalsis. |
ANS: D
Peristalsis, a progressive wavelike movement, moves fluid, gas, and digestive substances (often called a bolus) through the esophagus to the stomach.
DIF: Cognitive Level: Knowledge REF: Page 175 OBJ: 1
TOP:AnatomyKEY:Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity
20.A NANDA-accepted nursing diagnosis that could be written for a patient with an abdominoperineal resection and a permanent colostomy would include
a. | Disturbed body image. |
b. | Ineffective thermoregulation. |
c. | Ineffective protection. |
d. | Autonomic dysreflexia. |
ANS: A
Nursing diagnoses for the patient with cancer of the colon include, but are not limited to, Disturbed body image.
DIF:Cognitive Level: AnalysisREF:Pages 223-224
OBJ: 12 TOP: Cancer KEY: Nursing Process Step: Planning
MSC: NCLEX: Psychosocial Integrity
21.Bowel sound assessment is especially important for a postoperative patient who has had abdominal surgery as it can determine the:
a. | need for a cathartic. |
b. | return of peristalsis. |
c. | presence of singultus. |
d. | presence of eructation. |
ANS: B
The patient should be assessed for stable vital signs and return of bowel sounds.
DIF:Cognitive Level: ComprehensionREF:Pages 218, 220
OBJ:6TOP:Postoperative care
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity
22.A NANDA-accepted nursing diagnosis that could be written for the patient who is hemorrhaging and in hypovolemic shock from a bleeding peptic ulcer would include
a. | Ineffective tissue perfusion (gastrointestinal). |
b. | Unilateral neglect. |
c. | Constipation. |
d. | Disuse syndrome (gastrointestinal). |
ANS: A
Hemorrhage, with accompanying symptoms of shock, occurs when the ulcer erodes into a blood vessel.
DIF: Cognitive Level: Analysis REF: Page 192 OBJ: 5
TOP:ShockKEY:Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity
23.The goals of diet management in a patient with inflammatory bowel disease are: (Select all that apply.)
a. Restrict fluids to decrease peristalsis.
b. Prevent weight loss.
c. Correct and prevent malnutrition.
d. Provide adequate nutrition.
e. Replace fluid and electrolyte losses.
f. Limit high-caloric foods.
a. | a,b,c |
b. | b,c,d,e |
c. | a,c,f |
d. | b,c,d,f |
ANS: B
The goals of diet management for inflammatory bowel disease are to provide adequate nutrition, correct and prevent malnutrition, replace fluid and electrolyte losses, and prevent weight loss. The diet for each patient is individualized.
DIF: Cognitive Level: Analysis REF: Page 207 OBJ: 6
TOP: Inflammatory bowel disease KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity
24.What nursing interventions would be appropriate for inflammatory bowel disease diagnoses of Imbalanced Nutrition: less than body requirements related to bowel hypermotility and decreased absorption?
a. | Provide three specific balanced meals a day. |
b. | Restrict fluid to 1000 mL per day. |
c. | Provide at least six small frequent meals per day. |
d. | Allow alcohol and caffeine products. |
ANS: C
Provide small frequent meals, which will help with poor appetite or intolerance to consume large amounts. Alcohol and caffeine should be restricted to decrease irritation.
DIF: Cognitive Level: Analysis REF: Page 208 OBJ: 6
TOP: Inflammatory bowel disease KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity
25.Which nursing intervention would be the highest priority in evaluating a patient with peritonitis from a ruptured appendix?
a. | Assessment of severity, location, and duration of pain |
b. | Assessment of vital signs |
c. | Preventing wound infection |
d. | Promoting balanced nutrition |
ANS: A
First priority is pain management. Assessment of vital signs, preventing wound infection, and promoting balanced nutrition are not the highest priority.
DIF: Cognitive Level: Analysis REF: Page 213 OBJ: 8
TOP:AppendicitisKEY:Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity
26.Sulfasalazine is the recommended medication for treatment of Crohn’s disease. Patient teaching should include:
a. | taking medication 2 hours before meals. |
b. | limiting fluid intake. |
c. | ensuring adequate hydration to prevent crystallization in kidneys. |
d. | increased effectiveness of oral contraceptives. |
ANS: C
The importance of adequate hydration to prevent kidney problems is high priority. Sulfasalazine should be taken with meals to reduce nausea and vomiting. Sulfasalazine decreases the effectiveness of oral contraceptives.
DIF:Cognitive Level: ComprehensionREF:Page 210, Table 5-1
OBJ:6TOP:Inflammatory bowel disease
KEY:Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
27.The most lethal complication of a peptic ulcer is
a. | bleeding. |
b. | perforation. |
c. | severe pain. |
d. | gastric outlet obstruction. |
ANS: B
Perforation is considered the most lethal complication of peptic ulcer. Bleeding may occur when the ulcer erodes into a blood vessel; however, perforation occurs when the ulcer crater penetrates the entire thickness of the wall of the stomach or duodenum. Gastric outlet obstruction can occur at any time and can be relieved by NG aspiration of stomach contents.
DIF: Cognitive Level: Comprehension REF: Page 192 OBJ: 4
TOP: Disorders of the stomach KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity
28.Symptoms of GERD (gastroesophageal reflux disease) can be modified or eliminated by which nursing interventions?
a. | Eat three large meals daily. |
b. | Follow a high-protein, high-fat diet. |
c. | Remain upright for 1 to 2 hours post meals. |
d. | Eat a snack 1 hour before bedtime. |
ANS: C
Remain upright for 1 to 2 hours after meals. Eat four to six small meals daily. Follow a low-fat, adequate protein diet. Avoid evening snacking 2 to 3 hours before bedtime.
DIF: Cognitive Level: Comprehension REF: Page 187 OBJ: 4
TOP: Disorders of the stomach KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
29.The purpose of antibiotic therapy in treating stomach disorders is that it
a. | eradicates H. pylori. |
b. | inhibits gastric acid secretion. |
c. | protects the gastric mucosa. |
d. | neutralizes or reduces the acidity of stomach contents. |
ANS: A
Antibiotic therapy eradicates H. pylori.
DIF: Cognitive Level: Knowledge REF: Page 195 OBJ: 4
TOP: Disorders of the stomach KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity
30.Peptic ulcers are often common in the aging population. Which medications should be taken with caution to help prevent this problem?
a. | Antibiotics |
b. | Antacids |
c. | NSAIDs |
d. | Laxatives |
ANS: C
Medications such as aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) taken for arthritis or degenerative joint conditions may contribute to ulcer formation.
DIF: Cognitive Level: Comprehension REF: Page 218, Life Span Considerations box
OBJ:4TOP:Disorders of the stomach
KEY:Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
31.You administered the medication GoLYTELY to a 78-year-old woman in preparation for diagnostic tests. In planning for her care, which would be most appropriate?
a. | Side rails up to prevent falling |
b. | Door closed for privacy |
c. | Available bedside commode for possible weakness |
d. | Monitor vital signs |
ANS: C
Provide a bedside commode for older or weak patients when giving GoLYTELY as this causes rapid and copious clearing of the bowel.
DIF:Cognitive Level: ComprehensionREF:Page 183, Box 5-2
OBJ: 4 TOP: Medication KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity
MULTIPLE RESPONSE
32.A patient is admitted with a diagnosis of Crohn’s disease. What nursing interventions would be appropriate when caring for this patient? (Select all that apply.)
a. | Daily weight |
b. | Monitor I & O every shift |
c. | Fluid restriction |
d. | Accessibility to bedside commode |
ANS: A, B, D
Weight is monitored for losses or gains. Oral diets of 2500 mL/day to replace fluids and electrolytes caused from diarrhea are not uncommon. When the person is hospitalized, a bedside commode or a bedpan must be accessible at all times because of the urgency and frequency of stools.
DIF: Cognitive Level: Analysis REF: Page 211 OBJ: 5
TOP: Crohn’s disease KEY: Nursing Process Step: Planning
MSC:NCLEX: Safe, Effective Care Environment
33.A patient was recently diagnosed with colorectal cancer. His wife asks the nurse, “What prevents colon cancer?” The nurse’s answer should include which factors? (Select all that apply.)
a. | A diet high in fiber |
b. | Familial predisposition of a cancer-causing gene |
c. | Regular checkups |
d. | A diet high in animal fats |
ANS: A, B, C
These factors encourage diet changes; decreased animal fat and increased high dietary fiber found in fruits, vegetables, and bran may have a protective effect and act as a primary preventive measure. Recent research has isolated a gene that causes colon cancer in certain families. History-taking and regular checkups are important preventive measures.
DIF: Cognitive Level: Comprehension REF: Page 221 OBJ: 11
TOP: Colorectal cancer KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance
34.Constipation is a problem for many older adults. The medical management to prevent constipation includes (Select all that apply):
a. | Decreasing physical activity |
b. | Decreasing fluid intake |
c. | Nutritional diet high in fiber |
d. | Increasing fluid intake |
e. | Increasing daily activity |
f. | Decreasing strict daily routines |
ANS: C, D, E
Inactivity and changes in diet and fluid intake can contribute to constipation. A nutritional diet high in fiber and bulk-forming foods can promote normal elimination. Increasing fluids to 8 to 10 glasses per day will be beneficial in preventing constipation. A daily bowel routine will also benefit elimination.
DIF:Cognitive Level: Analysis
REF: Pages 225-226, Evidence-Based Practice box OBJ: 10
TOP: Disorders of the intestine KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
MATCHING
Match the purpose of nasogastric tubes with its description.
a. | Internal application of pressure by means of inflated balloon to prevent GI bleeding |
b. | Irrigation of stomach to remove secretions |
c. | Relieve abdominal distention |
d. | Instillation of liquid nutritional supplements into stomach |
35.Decompression
36.Gavage
37.Compression
38.Lavage
35.ANS:CDIF:Cognitive Level: AnalysisREF:Page 197
OBJ:10TOP:Nasogastric intubation
KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity
36.ANS:DDIF:Cognitive Level: AnalysisREF:Page 197
OBJ:10TOP:Nasogastric intubation
KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity
37.ANS:ADIF:Cognitive Level: AnalysisREF:Page 197
OBJ:10TOP:Nasogastric intubation
KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity
38.ANS:BDIF:Cognitive Level: AnalysisREF:Page 197
OBJ:10TOP:Nasogastric intubation
KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity
COMPLETION
39.Flexible sigmoidoscopy should be performed every ________ years.
ANS:
5
five
Flexible sigmoidoscopy should be performed every 5 years. Endoscopy of the lower GI tract allows visualization and, if indicated, access to obtain biopsy specimens of tumors, polyps, or ulcerations of the anus, rectum, and sigmoid colon. The lower GI tract is difficult to visualize radiographically, but sigmoidoscopy allows direct visualization.
DIF: Cognitive Level: Knowledge REF: Page 221, Health Promotion box
OBJ:11TOP:Screening for colorectal cancer
KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity
40.Colonoscopy should be performed every ________ years.
ANS:
10
ten
Patients who have had cancer of the colon are at high risk for developing a subsequent colon cancer; patients who have a family history of colon cancer are also at high risk. For these patients, colonoscopy allows early detection of any primary or secondary tumors.
DIF: Cognitive Level: Knowledge REF: Page 221, Health Promotion box
OBJ:11TOP:Screening for colorectal cancer
KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity
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