Med SurgChapter 38

Chapter 38: Digestive Tract Disorders
MULTIPLE CHOICE
1. The nurse is preparing to give a brevity Ilow tube Ieeding using a large syringe. Prior to
inIusion, the nurse should:
1. roll the patient Ilat.
2. check Ior residual and return to the stomach.
3. place the end oI tube in water and check Ior bubbles.
4. Ilush tube.
ANS: 2
VeriIying tube placement and residual is a standard oI care Ior a tube Ieeding.
PTS: 1 DIF: Cognitive Level: Application REF: 740
OBJ: 3 TOP: Tube Feeding
KEY: Nursing Process Step: Implementation
MSC: NCLEX: SaIe, EIIective Care Environment
2. The nurse explains that the newest endoscopic procedure Ior examining the small intestine
is the:
1. capsule camera.
2. Iiberoptic light probe.
3. rigid lighted tubes.
4. Ilat plate.
ANS: 1
The capsule camera is swallowed and transmits inIormation about the small bowel to a
receiver on a belt around the patient`s waist.
PTS: 1 DIF: Cognitive Level: Comprehension REF: 739
OBJ: 1 TOP: Endoscopy KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity
3. AIter receiving a tube Ieeding, the patient becomes sweaty and has abdominal distention
with diarrhea. The nurse assesses that this is because oI:
1. an expected reaction to the tube Ieeding.
2. dumping syndrome.
3. gastric reIlux syndrome.
4. onset oI gastroenteritis.
ANS: 2
Dumping syndrome is caused by inIusing a tube Ieeding too Iast or inIusing a tube Ieeding
that is too rich a Iormula.
PTS: 1 DIF: Cognitive Level: Analysis REF: 742
OBJ: 2 TOP: Dumping Syndrome
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity
4. The nurse assesses a risk Iactor that increases the chances oI developing oral cancer, which
is:
1. alcohol consumption.
2. chewing gum.
3. environmental pollution.
4. consumption oI a high-Iat diet.
ANS: 1
Alcohol is statistically proven to be a Iactor because oI irritation oI the oral mucosa.
PTS: 1 DIF: Cognitive Level: Knowledge REF: 733
OBJ: 1 TOP: Oral Cancer KEY: Nursing Process Step: Assessment
5. The nurse caring Ior a postoperative patient who has had lesions removed Irom his mouth
has just returned to the unit. The initial care will Iocus on:
1. giving pain medication.
2. regulating Iluid intake.
3. monitoring vital signs.
4. suctioning secretions.
ANS: 4
Suctioning must be done to ensure a patent airway. All other options should be addressed,
but not as an initial implementation.
OBJ: 5 TOP: Postoperative Care Ior Oral Cancer
6. The home health nurse observes the patient with esophageal cancer tilt his head back while
eating, which could result in:
1. narrowing oI the esophagus.
2. limit in types oI Iood that can be consumed.
3. increased risk oI aspiration.
4. neck injury.
ANS: 3
Tilting the head back not only makes it more diIIicult to eat but increases the risk oI
aspiration.
OBJ: 2 TOP: Feeding Technique with Esophageal Cancer
KEY: Nursing Process Step: Planning
MSC: NCLEX: Health Promotion and Maintenance
7. The nurse caring Ior a patient with esophageal surgery who has had stents placed in the
esophagus instructs the patient how best to avoid regurgitation. The instruction should
include:
1. keep the bed Ilat.
2. eat only small meals.
3. lie on the right side aIter meals.
4. drink three glasses oI Iluid with each meal.
ANS: 2
Eating small meals will help with reIlux. Keeping the head oI the bed raised and not taking
in excessive Iluid with meals should be practiced.
OBJ: 3 TOP: Gastroesophageal ReIlux
8. AIter administering promethazine (Phenergan) Ior nausea, the nurse takes extra
precautionary implementations because oI the common side eIIect oI antiemetics, which is:
1. check vital signs Ior erratic blood pressure.
2. add a blanket to prevent chilling.
3. provide extra water to combat thirst.
4. put side rails up to prevent Ialls.
ANS: 4
Most antiemetics cause drowsiness because oI eIIects on the central nervous system,
resulting in dizziness and conIusion.
PTS: 1 DIF: Cognitive Level: Application
REF: 748, Drug Therapy table OBJ: 3 TOP: Antiemetics
9. The patient with a hiatal hernia should have a teaching plan to help with the reduction oI the
complaints oI heartburn, regurgitation, and eructation. This would include instruction about:
1. eating three well-balanced meals.
2. lying down 1 hour aIter eating.
3. sleeping without pillows.
4. eating nothing Ior several hours prior to bedtime.
ANS: 4
Eating just prior to bedtime encourages reIlux into the hernia and possible aspiration.
OBJ: 5 TOP: Hiatal Hernia
10. Your patient is to receive cimetidine IV, 300 mg, diluted in 20 mL oI 0.9 normal saline
solution. This is to be administered over 30 minutes. The delivery system is 15 gtt/mL. The
IV controlling machine should be set Ior how many mL/hour?
1. 300
2. 400
3. 500
4. 600
ANS: 4
Set the machine Ior 600 mL/hour. To give 300 mL in 30 minutes requires that the machine
be set Ior 600 mL/hour.
OBJ: 3 TOP: Drug Ior Gastroesophageal ReIlux Disease (GERD)
11. The 60-year-old patient who has just been diagnosed with cancer oI the stomach says, 'I
Ieel blank and numb. The nurse`s best response would be:
1. 'Shock aIIects everyone that way.
2. 'I`m sure you are considering what you should do now that you have cancer.
3. 'Would you like me to bring you a sedative?
4. 'What do you mean when you say blank and numb`?
ANS: 4
Patients who may seem overwhelmed need to talk and express their Ieelings, even iI they
are not sure oI what they are.
OBJ: 5 TOP: IneIIective Coping
MSC: NCLEX: Psychosocial Integrity
12. On assessment at an intake examination, the nurse notes a characteristic oI an inguinal
hernia that should be reported immediately, which is:
1. hernia oI 25 years` duration, easily reduced to abdomen.
2. hernia oI 5 months` duration, reduced by abdominal truss.
3. hernia oI 2 weeks` duration, no bowel movement in 2 days
4. hernia oI 2 days` duration, cannot be reduced.
ANS: 4
A hernia that cannot be reduced is at risk Ior strangulation and should be addressed
immediately.
PTS: 1 DIF: Cognitive Level: Assessment REF: 784
OBJ: 2 TOP: Strangulated Hernia
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity
13. The goal Ior your patient with gastritis who has experienced nausea, vomiting, and diarrhea
is to have a return oI normal elimination patterns. Which oI the Iollowing best reIlects this
goal in a measurable manner?
1. The patient will have Iewer stools.
2. Diarrhea will be controlled and not return.
3. The patient will have no more than one stool per day.
4. The patient`s bowel pattern will return to normal.
ANS: 4
Goals are to be speciIic and measurable. The patient knows his normal pattern.
PTS: 1 DIF: Cognitive Level: Synthesis REF: 764
OBJ: 4 TOP: Gastritis KEY: Nursing Process Step: Planning
14. The nurse is caring Ior a patient hemorrhaging Irom a peptic ulcer when the patient
complains oI sharp sudden pain, with a rapidly deteriorating condition. Initially, the nurse
should:
1. roll the patient Ilat and assess the vital signs.
2. notiIy the charge nurse.
3. suction the mouth.
4. prepare Ior IV inIusions.
ANS: 1
With a rapidly deteriorating patient, the nurse should collect all the inIormation that will
need to be reported.
OBJ: 3 TOP: PerIorated Ulcer
15. The nurse has collected several stool specimens that are to go to the laboratory. The nurse
should:
1. take the specimens Ior parasites and ova to the laboratory immediately.
2. take the specimens Ior culture and sensitivity, and leave Ior later pickup.
3. take the specimens Ior parasites and ova to the reIrigerator.
4. leave the specimens in the reIrigerator until convenient.
ANS: 1
Parasite and ova specimens should be taken to the laboratory immediately while the
parasites are still alive. Specimens Ior evaluation oI pathogenic organisms should be kept
cool.
OBJ: 1 TOP: Care oI Stool Specimens
MSC: NCLEX: SaIe, EIIective Care Environment
16. Your 34-year-old patient is admitted with severe diarrhea and Iatigue, which has been going
on Ior several days. Why might continued diarrhea cause chronic Iatigue?
1. Lack oI interest in anything but selI
2. Decreased appetite because oI diarrhea
3. Use oI over-the-counter (OTC) antidiarrheals
4. Malnutrition because oI malabsorption oI nutrients
ANS: 4
Rapid transition oI Ioods through the GI tract prevents absorption oI nutrients.
OBJ: 4 TOP: Diarrhea KEY: Nursing Process Step: Assessment
17. The patient inquires iI the new type oI gastric analysis is going to require multiple
withdrawals oI gastric content Ior evaluation oI the presence oI hydrochloric acid
throughout the day. The nurse replies:
1. 'Yes, there will be about 14 in all.
2. 'No. You take a dye orally, which will be excreted in the urine in about 2 hours.
3. 'Yes. You will take the dye orally and then the several gastric withdrawals will
show the dye.
4. 'No. Only one withdrawal will be treated with dye and read in about 2 hours.
ANS: 2
Dye is given orally and, iI there is hydrochloric acid, the dye will be excreted in the urine in
about 2 hours.
REF: 737, Diagnostic Tests and Procedures table OBJ: 5
TOP: Gastric Analysis KEY: Nursing Process Step: Implementation
18. Stool soIteners are prescribed to promote normal elimination oI Ieces. The most appropriate
way to ensure eIIectiveness oI this type oI drug is:
1. mouth care.
2. ambulation.
3. adequate Iluid intake.
4. high-Iiber diet.
ANS: 3
Adequate Iluids must be maintained so the liquid is available; otherwise, the Iecal mass will
remain hard.
REF: 747, Drug Therapy table OBJ: 3 TOP: Constipation
19. The set oI Iindings that best indicate that the patient with intestinal obstruction has achieved
normal hydration is:
1. pulse and blood pressure within patient`s norms, moist mucous membranes, equal
Iluid intake and output.
2. strong pulse rate oI at least 60, normal bowel sounds, respiratory rate oI 16.
3. blood pressure within patient`s norms, temperature below normal, adequate tissue
turgor.
4. moist mucous membranes, 24-hour Iluid intake higher than the 24-hour output,
elevated pulse rate.
ANS: 1
These are all indications oI Iluid balance.
OBJ: 2 TOP: Hydration KEY: Nursing Process Step: Evaluation
20. The nurse caring Ior a patient with a 3-day postoperative bowel resection observes that the
suction apparatus is not working and the patient is becoming distended. The initial
implementation should be to:
1. pull tube outward 6 inches.
2. push tube Iurther 3 inches.
3. change the patient`s position.
4. irrigate with 60 mL oI normal saline.
ANS: 3
The simplest Implementation is always best to do initially. Change the patient`s position.
Any tube adjustment is done later and with very small amounts. Irrigation may also be done
later, but with 30 to 40 mL oI saline.
OBJ: 3 TOP: GI Suction KEY: Nursing Process Step: Implementation
21. Following abdominal surgery, your patient must cough and take deep breaths. How can you
best achieve this with your patient?
1. Withhold analgesics until the patient perIorms this task.
2. Help the patient splint the incision with a pillow.
3. Explain that pneumonia occurs iI deep breathing is not carried out every 4 hours.
4. Ambulate the patient 40 Ieet to increase his need Ior oxygen.
ANS: 2
Splinting decreases pain by supporting the muscles, thereby allowing better lung expansion.
OBJ: 3 TOP: Abdominal Surgery
22. The nurse describes a patient as 'morbidly obese because, with a weight oI 387 pounds and
a height oI 2 meters, the patient`s body mass index (BMI) is:
1. 218.7.
2. 130.
3. 92.6.
4. 87.5.
ANS: 4
Body mass index is calculated by dividing the weight in kilograms by the height in meters.
Anyone weighing more than 30 kg is considered obese. 387 pounds/2.2 pounds/kg 175 kg.
175 kg/2 meters BMI oI 87.5.
OBJ: 2 TOP: Inguinal Hernia
KEY: Nursing Process Step: Assessment
23. The cause oI inIlammatory bowel disease (IBD) is unknown. One Iactor being considered is
an autoimmune reaction. A medication commonly used to treat IBD according to this theory
is:
1. multivitamins.
2. anticoagulants.
3. diuretics.
4. steroids.
ANS: 4
Steroids decrease the autoimmune response and lessen the inIlammation.
OBJ: 4 TOP: InIlammatory Bowel Disease
24. The nurse identiIies a risk Iactor in an older man that puts him at risk Ior developing
diverticulosis, which is:
1. eating a low-Iiber diet.
2. chronic diarrhea.
3. history oI nonsteroidal anti-inIlammatory drug (NSAID) use.
4. Iamily history oI colon cancer.
ANS: 1
A low-Iiber diet increases the risk Ior diverticulitis.
OBJ: 4 TOP: Diverticulitis
KEY: Nursing Process Step: Assessment
25. Patient teaching to promote selI-care Ior the patient with diverticulosis should include
avoidance oI:
1. peanuts and raspberries.
2. apples and pears.
3. red meat and dairy products.
4. bran and whole grains.
ANS: 1
Foods containing seeds or small hard particles could become lodged in small pouches.
OBJ: 1 TOP: Diverticulosis
MULTIPLE RESPONSE
1. The nurse includes in the teaching plan inIormation about when and where speciIic
digestion oI Iood takes place (select all that apply):
1. Renin breaks down milk protein in the stomach.
2. Lipase breaks down Iats in the stomach.
3. Pepsin begins breakdown oI proteins in the stomach.
4. Liver and pancreatic secretions break down Iats in the small bowel.
5. Ptyalin (amylase) breaks down carbohydrates in the mouth.
ANS: 1, 2, 3, 4, 5
All options are correct Ior process and location.
PTS: 1 DIF: Cognitive Level: Comprehension REF: 730-732
OBJ: 5 TOP: Digestive Process
2. The home health nurse suggests dietary changes to an older woman to help prevent
constipation, which include (select all that apply):
1. addition oI whole-grain cereal.
2. cessation oI laxative use.
3. increase in liquid intake.
4. decrease in sugar intake.
5. eating Iresh vegetables.
ANS: 1, 2, 3, 4, 5
All options not only improve nutrition, but reduce the risk oI constipation.
PTS: 1 DIF: Cognitive Level: Application REF: 732-733
OBJ: 2 TOP: Nutrition to Avoid Constipation
3. The nurse caring Ior a patient with achalasia can help the patient reduce swallowing
diIIiculty by (select all that apply):
1. identiIy Ioods that cause a problem.
2. experiment with diIIerent eating positions.
3. elevate the head oI the bed at night.
4. suggest eating more rapidly.
5. oIIer small bites oI Iresh vegetables.
ANS: 1, 2, 3
Eating rapidly and eating small bites increase swallowing diIIiculties.
OBJ: 2 TOP: Achalasia KEY: Nursing Process Step: Implementation
4. The 92-year-old patient dehydrated Irom diarrhea exhibits anorexia and has lost 1 pound
since yesterday. To help stimulate intake, the nurse would (select all that apply):
1. moisten patient`s mouth with mouthwash.
2. put away bedpans, urinals, and so Iorth.
3. socialize with the patient during mealtime.
4. check the Iit oI dentures.
5. oIIer Iavorite Ioods.
ANS: 1, 2, 3, 4, 5
All options are eIIective.
OBJ: 2 TOP: Anorexia KEY: Nursing Process Step: Implementation

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Chapter 38: Digestive Tract Disorders

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