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Care of the Patient with a Gastrointestinal Disorder

Care of the Patient with a Gastrointestinal Disorder MULTIPLE CHOICE

1.The nurse clarifies that the end product of carbohydrate metabolism is absorbed and put into the blood

stream by the:

a.                          gastric lining of the stomach.

b.                          villi of the small intestine.

c.                          bile of the liver in the large intestine.

d.                          excretion from the cecum.

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.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 5-6 OBJ: 2 TOP: Digestive KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

2.A 56 -year-old man is admitted to the emergency room with an acute attack of diverticulitis. The patient has a temperature of 102° F, and has an elevated white count. Which assessment would alert the nurse to impending septic shock?

a.                                                    Chest pain

b.                                                    Seizure

c.                                                    Tachycardia

d.                                                    Massive diarrhea

ANS: C

The patient with diverticulitis who has fever and an elevated white count has an infection that could lead to septic shock, which will present as tachycardia and hypotension.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 5-98 OBJ:9TOP:Diverticulitis

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

3. Because bowel contents from an ileostomy are virtually liquid, what should the nurse include in the plan of care?

a.             Evaluation and assessment of dietary intake of fiber

b.             Evaluation and assessment of patient cleanliness

c.             Evaluation and assessment of periostomal skin integrity

d.             Evaluation and assessment of the adequacy of the collection device

ANS: C

The nurse should assess the periostomal skin for impairment of integrity. The fecal material is liquid and has a potential for severe skin excoriation from the digestive enzymes.

PTS: 1 DIF: Cognitive Level: Application REF: Page 5-5-84 OBJ:8TOP:Ulcerative colitis

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

4. The home health nurse caring for a patient who has dysarthria related to radiation therapy for an oral cancer would recommend that the family provide:

a.                      a tablet and pencil as a communication aid.

b.                      a TV for diversion.

c.                      a bell to summon help.

d.                      a walkie-talkie.

ANS: A

The provision of an alternative method of communicating will lessen the frustration of the patient who has trouble speaking understandably. The call bell would be helpful also, but without a way to communicate, the bell is not as essential as a method of communication.

PTS: 1 DIF: Cognitive Level: Application REF: Page 5-28 OBJ:5TOP:Cancer of esophagus

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

5. Which recommendation is most appropriate for a patient who has had an esophageal dilation related to achalasia?

a.                       Consume only liquid

b.                       Avoid fruit juices

c.                       Drink 10 oz of fluid with each meal

d.                       Lie down for 30 minutes after each meal

ANS: C

The patient should drink fluid with each meal to increase lower esophageal pressure to push food into the stomach.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 5-41 OBJ:5TOP:Esophageal dilation

KEY:Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

6.A patient who is being evaluated for episodes of hematemesis and dyspepsia tells the nurse that pain occurs when he eats, but pain does not waken him. The nurse recognizes a diagnostic sign of which condition?

a.                                                         Duodenal ulcer

b.                                                         Gastritis

c.                                                         Achalasia

d.                                                         Peptic ulcer

ANS: D

A significant subjective data assessment for a peptic ulcer is the patient report that pain is associated with eating, but not with an empty stomach, because there would be pain with a duodenal ulcer.

PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 5-46

OBJ: 5 TOP: Peptic ulcer KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

7. The nurse anticipates that the patient who has had a subtotal gastrectomy will need supplemental:

a.               protein due to the loss of some of the digestive processes.

b.               vitamin B₁₂ due to the loss of the intrinsic factor.

c.               bulk to prevent constipation.

d.               vitamin A due to the loss of the gastric lining.

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.

PTS: 1 DIF: Cognitive Level: Application REF: Page 5-61

OBJ: 6 TOP: Gastrectomy KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity