A nurse is caring for a patient who is scheduled for a colonoscopy and
whose bowel preparation will include polyethylene glycol electrolyte
lavage prior to the procedure. The presence of what health problem
would contraindicate the use of this form of bowel preparation?
A) Inflammatory bowel disease
B) Intestinal polyps
C) Diverticulitis
D) Colon cancer
Ans: A
Feedback: The use of a lavage solution is contraindicated in patients
with intestinal obstruction or inflammatory bowel disease. It can safely
be used with patients who have polyps, colon cancer, or diverticulitis.
A nurse is promoting increased protein intake to enhance a patients
wound healing. The nurse knows that enzymes are essential in the
digestion of nutrients such as protein. What is the enzyme that initiates
the digestion of protein?
A) Pepsin
B) Intrinsic factor
C) Lipase
D) Amylase
Ans: A
Feedback:
The enzyme that initiates the digestion of protein is pepsin. Intrinsic
factor combines with vitamin B12 for absorption by the ileum. Lipase
aids in the digestion of fats and amylase aids in the digestion of starch.
A patient has been brought to the emergency department with
abdominal pain and is subsequently diagnosed with appendicitis. The
patient is scheduled for an appendectomy but questions the nurse about
how his health will be affected by the absence of an appendix. How
should the nurse best respond?
A) Your appendix doesn’t play a major role, so you won’t notice any
difference after your recovery from surgery.
B) The surgeon will encourage you to limit your fat intake for a few
weeks after the surgery, but your body will then begin to compensate.
C) Your body will absorb slightly fewer nutrients from the food you
eat, but you won’t be aware of this.
D) Your large intestine will adapt over time to the absence of your
appendix.
Ans: A
Feedback: The appendix is an appendage of the cecum (not the large
intestine) that has little or no physiologic function. Its absence does not
affect digestion or absorption.
Feedback:
Postprocedural patient education includes information about
increasing fluid intake; evaluating bowel movements for evacuation of
barium; and noting increased number of bowel movements, because
barium, due to its high osmolarity, may draw fluid into the bowel, thus
increasing the intraluminal contents and resulting in greater output.
Yellow stool, diarrhea, and anal bleeding are not expected.
A patient has come to the outpatient radiology department for
diagnostic testing. Which of the following diagnostic procedures will
allow the care team to evaluate and remove polyps?
A) Colonoscopy
B) Barium enema
C) ERCP
D) Upper gastrointestinal fibroscopy
Ans: A
Feedback: During colonoscopy, tissue biopsies can be obtained as
needed, and polyps can be removed and evaluated. This is not possible
during a barium enema, ERCP (Endoscopic retrograde
cholangiopancreatography) , or gastroscopy.
A nurse is caring for a patient with recurrent hematemesis who is
scheduled for upper gastrointestinal fibroscopy (UGF). How should
the nurse in the radiology department prepare this patient?
A) Insert a nasogastric tube.
B) Administer a micro-Fleet enema at least 3 hours before the
procedure.
C) Have the patient lie in a supine position for the procedure.
D) Apply local anesthetic to the back of the patient’s throat.
Ans: D
Feedback: Preparation for UGF includes spraying or gargling with a
local anesthetic. A nasogastric tube or a micro-Fleet enema is not
required for this procedure. The patient should be positioned in a sidelying position in case of emesis.
The nurse is providing health education to a patient scheduled for a
colonoscopy. The nurse should explain that she will be placed in what
position during this diagnostic test?
A) In a knee-chest position (lithotomy position)
B) Lying prone with legs drawn toward the chest
C) Lying on the left side with legs drawn toward the chest
D) In a prone position with two pillows elevating the buttocks
Ans: C
A patient asks the nursing assistant for a bedpan. When the patient is
finished, the nursing assistant notifies the nurse that the patient has
bright red streaking of blood in the stool. What is this most likely a
result of?
Feedback: For best visualization, colonoscopy is performed while the
patient is lying on the left side with the legs drawn up toward the chest.
A knee chest position, lying on the stomach with legs drawn to the
chest, and a prone position with two pillows elevating the legs do not
allow for the best visualization.
A) Diet high in red meat
B) Upper GI bleed
C) Hemorrhoids
D) Use of iron supplements
A patient has sought care because of recent dark-colored stools. As a
result, a fecal occult blood test has been ordered. The nurse should
instruct the patient to avoid which of the following prior to collecting
a stool sample?
Ans: C
A) NSAIDs
B) Acetaminophen
C) OTC vitamin D supplements
D) Fiber supplements
Feedback: Lower rectal or anal bleeding is suspected if there is
streaking of blood on the surface of the stool. Hemorrhoids are often a
cause of anal bleeding since they occur in the rectum. Blood from an
upper GI bleed would be dark rather than frank. Iron supplements make
the stool dark, but not bloody and red meat consumption would not
cause frank blood.
An adult patient is scheduled for an upper GI series that will use a
barium swallow. What teaching should the nurse include when the
patient has completed the test?
A) Stool will be yellow for the first 24 hours post procedure.
B) The barium may cause diarrhea for the next 24 hours.
C) Fluids must be increased to facilitate the evacuation of the stool.
D) Slight anal bleeding may be noted as the barium is passed.
Ans: C
Ans: A
Feedback: NSAIDs can cause a false-positive fecal occult blood test.
Acetaminophen, vitamin D supplements, and fiber supplements do not
have this effect.
The nurse is preparing to perform a patient’s abdominal assessment.
What examination sequence should the nurse follow?
A) Inspection, auscultation, percussion, and palpation
B) Inspection, palpation, auscultation, and percussion
C) Inspection, percussion, palpation, and auscultation
D) Inspection, palpation, percussion, and auscultation
Ans: A
Feedback: When performing a focused assessment of the patient’s
abdomen, auscultation should always precede percussion and
palpation because they may alter bowel sounds. The traditional
sequence for all other focused assessments is inspection, palpation,
percussion, and auscultation.
A patient who has been experiencing changes in his bowel function is
scheduled for a barium enema. What instruction should the nurse
provide for post procedure recovery?
A) Remain NPO for 6 hours post procedure.
B) Administer a Fleet enema to cleanse the bowel of the barium.
C) Increase fluid intake to evacuate the barium.
D) Avoid dairy products for 24 hours post procedure.
Ans: C
Feedback: Adequate fluid intake is necessary to rid the GI tract of
barium. The patient must not remain NPO after the test and enemas are
not used to cleanse the bowel of barium. There is no need to avoid
dairy products.
A nurse is caring for a newly admitted patient with a suspected GI
bleed. The nurse assesses the patients stool after a bowel movement
and notes it to be a tarry-black color. This finding is suggestive of
bleeding from what location?
A) Sigmoid colon
B) Upper GI tract
C) Large intestine
D) Anus or rectum
Ans: B
Feedback: Bloodshed in sufficient quantities in the upper GI tract will
produce a tarry-black color (melena). Blood entering the lower portion
of the GI tract or passing rapidly through it will appear bright or dark
red. Lower rectal or anal bleeding is suspected if there is streaking of
blood on the surface of the stool or if blood is noted on toilet tissue.
A nursing student has auscultated a patient’s abdomen and noted one
or two bowel sounds in a 2-minute period of time. How would you tell
the student to document the patient’s bowel sounds?
A) Normal
B) Hypoactive
C) Hyperactive
D) Paralytic ileus
Ans: B
Feedback: Documenting bowel sounds is based on assessment
findings. The terms normal (sounds heard about every 5 to 20 seconds),
hypoactive (one or two sounds in 2 minutes), hyperactive (5 to 6
sounds heard in less than 30 seconds), or absent (no sounds in 3 to 5
minutes) are frequently used in documentation. Paralytic ileus is a
medical diagnosis that may cause absent or hypoactive bowel sounds,
but the nurse would not independently document this diagnosis.
C) Left groin area
D) Right lower abdominal quadrant
Ans: B
Feedback: Patients with referred abdominal pain associated with
biliary colic complain of pain below the right nipple. Referred pain
above the left nipple may be associated with the heart. Groin pain may
be referred pain from ureteral colic.
An inpatient has returned to the medical unit after a barium enema.
When assessing the patient’s subsequent bowel patterns and stools,
what finding should the nurse report to the physician?
A) Large, wide stools
B) Milky white stools
C) Three stools during an 8-hour period of time
D) Streaks of blood present in the stool
Ans: D
Feedback: Barium has a high osmolarity and may draw fluid into the
bowel, thus increasing the intraluminal contents and resulting in
greater output (large stools). The barium will give the stools a milky
white appearance, and it is not uncommon for the patient to experience
an increase in the number of bowel movements. Blood in fecal matter
is not an expected finding and the nurse should notify the physician.
A nurse in a stroke rehabilitation facility recognizes that the brain
regulates swallowing. Damage to what area of the brain will most
affect the patient’s ability to swallow?
A) Temporal lobe
B) Medulla oblongata
C) Cerebellum
D) Pons
Ans: B
Feedback: Swallowing is a voluntary act that is regulated by a
swallowing center in the medulla oblongata of the central nervous
system. Swallowing is not regulated by the temporal lobe, cerebellum,
or pons.
A patient is being assessed for a suspected deficit in intrinsic factor
synthesis. What diagnostic or assessment finding is the most likely
rationale for this examination of intrinsic factor production?
A) Muscle wasting
B) Chronic jaundice in the absence of liver disease
C) The presence of fat in the patients stool
D) Persistently low hemoglobin and hematocrit
Ans: D
Feedback:
In the absence of intrinsic factor, vitamin B12 cannot be absorbed, and
pernicious anemia results. This would result in a marked reduction in
hemoglobin and hematocrit.
An advanced practice nurse is assessing the size and density of a
patient’s abdominal organs. If the results of palpation are unclear to the
nurse, what assessment technique should be implemented?
A patient with a recent history of intermittent bleeding is undergoing
capsule endoscopy to determine the source of the bleeding. When
explaining this diagnostic test to the patient, what advantage should the
nurse describe?
A) Percussion
B) Auscultation
C) Inspection
D) Rectal examination
A) The test allows visualization of the entire peritoneal cavity.
B) The test allows for painless biopsy collection.
C) The test does not require fasting.
D) The test is noninvasive.
Ans: A
Ans: D
Feedback: Percussion is used to assess the size and density of the
abdominal organs and to detect the presence of air-filled, fluid-filled,
or solid masses. Percussion is used either independently or
concurrently with palpation because it can validate palpation findings.
Feedback: Capsule endoscopy allows the noninvasive visualization of
the mucosa throughout the entire small intestine. Bowel preparation is
necessary, and biopsies cannot be collected. This procedure allows
visualization of the entire GI tract, but not the peritoneal cavity.
A nurse is caring for a patient with biliary colic and is aware that the
patient may experience referred abdominal pain. Where would the
nurse most likely expect this patient to experience referred pain?
A nurse is caring for a patient admitted with a suspected malabsorption
disorder. The nurse knows that one of the accessory organs of the
digestive system is the pancreas. What digestive enzymes does the
pancreas secrete? Select all that apply.
A) Midline near the umbilicus
B) Below the right nipple
A) Pepsin
B) Lipase
C) Amylase
D) Trypsin
E) Ptyalin
Ans: B, C, D
Feedback: Digestive enzymes secreted by the pancreas include
trypsin, which aids in digesting protein; amylase, which aids in
digesting starch; and lipase, which aids in digesting fats. Pepsin is
secreted by the stomach and ptyalin is secreted in the saliva.
The nurse is caring for a patient with a duodenal ulcer and is relating
the patients’ symptoms to the physiologic functions of the small
intestine. What do these functions include? Select all that apply.
A) Secretion of hydrochloric acid (HCl)
B) Reabsorption of water
C) Secretion of mucus
D) Absorption of nutrients
E) Movement of nutrients into the bloodstream
The physiology instructor is discussing the GI system with the prenursing class. What should the instructor describe as a major function
of the GI tract?
A) The breakdown of food particles into cell form for digestion
B) The maintenance of fluid and acid-base balance
C) The absorption into the bloodstream of nutrient molecules produced
by digestion
D) The control of absorption and elimination of electrolytes
Ans: C
Feedback: Primary functions of the GI tract include the breakdown of
food particles into molecular form for digestion; the absorption into the
bloodstream of small nutrient molecules produced by digestion; and
the elimination of undigested unabsorbed food stuffs and other waste
products. Nutrients must be broken down into molecular form, not cell
form. Fluid, electrolyte, and acid-base balance are primarily under the
control of the kidneys.
Ans: C, D, E
A nurse is providing preprocedure education for a patient who will
undergo a lower GI tract study the following week. What should the
nurse teach the patient about bowel preparation?
Feedback: The small intestine folds back and forth on itself, providing
approximately 7000 cm2 (70 m2) of surface area for secretion and
absorption, the process by which nutrients enter the bloodstream
through the intestinal walls. Water reabsorption primarily takes place
in the large bowel. HCl is secreted by the stomach.
A) You’ll need to fast for at least 18 hours prior to your test.
B) Starting today, take over-the-counter stool softeners twice daily.
C) You’ll need to have enemas the day before the test.
D) For 24 hours before the test, insert a glycerin suppository every 4
hours.
A nurse is performing an abdominal assessment of an older adult
patient. When collecting and analyzing data, the nurse should be
cognizant of what age-related change in gastrointestinal structure and
function?
Ans: C
A) Increased gastric motility
B) Decreased gastric pH
C) Increased gag reflex
D) Decreased mucus secretion
Ans: D
Feedback: Older adults tend to secrete less mucus than younger adults.
Gastric motility slows with age and gastric pH rises due to decreased
secretion of gastric acids. Older adults tend to have a blunted gag reflex
compared to younger adults.
The nurse educator is reviewing the blood supply of the GI tract with
a group of medical nurses. The nurse is explaining the fact that the
veins that return blood from the digestive organs and the spleen form
the portal venous system. What large veins will the nurse list when
describing this system? Select all that apply.
Feedback: Preparation of the patient includes emptying and cleansing
the lower bowel. This often necessitates a low-residue diet 1 to 2 days
before the test; a clear liquid diet and a laxative the evening before;
NPO after midnight; and cleansing enemas until returns are clear the
following morning.
A patient presents at the walk-in clinic complaining of recurrent sharp
stomach pain that is relieved by eating. The nurse suspects that the
patient may have an ulcer. How would the nurse explain the formation
and role of acid in the stomach to the patient?
A) Hydrochloric acid is secreted by glands in the stomach in response
to the actual or anticipated presence of food.
B) As digestion occurs in the stomach, the stomach combines free
hydrogen ions from the food to form acid.
C) The body requires an acidic environment in order to synthesize
pancreatic digestive enzymes; the stomach provides this environment.
D) The acidic environment in the stomach exists to buffer the highly
alkaline environment in the esophagus.
Ans: A
A) Splenic vein
B) Inferior mesenteric vein
C) Gastric vein
D) Inferior vena cava
E) Saphenous vein
Feedback: The stomach, which stores and mixes food with secretions,
secretes a highly acidic fluid in response to the presence or anticipated
ingestion of food. The stomach does not turn food directly into acid
and the esophagus is not highly alkaline. Pancreatic enzymes are not
synthesized in a highly acidic environment.
Ans: A, B, C
Feedback: This portal venous system is composed of five large veins:
the superior mesenteric, inferior mesenteric, gastric, splenic, and cystic
veins, which eventually form the vena portae that enters the liver. The
inferior vena cava is not part of the portal system. The saphenous vein
is located in the leg.
Results of a patient’s preliminary assessment prompted an examination
of the patient’s carcinoembryonic antigen (CEA) levels, which have
come back positive. What is the nurse’s most appropriate response to
this finding?
A) Perform a focused abdominal assessment.
B) Prepare to meet the patients’ psychosocial needs.
C) Liaise with the nurse practitioner to perform an anorectal
examination.
D) Encourage the patient to adhere to recommended screening
protocols.
Ans: B
Feedback: CEA is a protein that is normally not detected in the blood
of a healthy person; therefore, when detected it indicates that cancer is
present, but not what type of cancer is present. The patient would likely
be learning that he or she has cancer, so the nurse must prioritize the
patients’ immediate psychosocial needs, not abdominal assessment.
Future screening is not a high priority in the short term.
A clinic patient has described recent dark-colored stools; the nurse
recognizes the need for fecal occult blood testing (FOBT). What aspect
of the patient’s current health status would contraindicate FOBT?
A) Gastroesophageal reflux disease (GERD)
B) Peptic ulcers
C) Hemorrhoids
D) Recurrent nausea and vomiting
Ans: C
Feedback: FOBT should not be performed when there is hemorrhoidal
bleeding. GERD, peptic ulcers and nausea and vomiting do not
contraindicate the use of FOBT as a diagnostic tool.
A patient will be undergoing abdominal computed tomography (CT)
with contrast. The nurse has administered IV sodium bicarbonate and
oral acetylcysteine (Mucomyst) before the study as ordered. What
would indicate that these medications have had the desired therapeutic
effect?
A) The patients BUN and creatinine levels are within reference range
following the CT.
B) The CT yields high-quality images.
C) The patient’s electrolytes are stable in the 48 hours following the
CT.
D) The patient’s intake and output are in balance on the day after the
CT.
Ans: A
Feedback: Both sodium bicarbonate and Mucomyst are free radical
scavengers that sequester the contrast byproducts that are destructive
to renal cells. Kidney damage would be evident by increased BUN and
creatinine levels. These medications are unrelated to electrolyte or
fluid balance, and they play no role in the results of the CT.
A medical patients CA 19-9 levels have become available, and they are
significantly elevated. How should the nurse best interpret this
diagnostic finding?
Ans: C
Feedback: Abdominal lesions are of particular importance because GI
diseases often produce skin changes. Skin problems do not normally
cause GI disorders. Age-related skin changes do not have a pronounced
effect on the skin of the abdomen when compared to other skin
surfaces. Self-harm is a less likely explanation or skin lesions on the
abdomen.
Probably the most widely used in-office or at-home occult blood test
is the Hemoccult II. The patient has come to the clinic because he
thinks there is blood in his stool. When you reviewed his medications,
you noted he is on antihypertensive drugs and NSAIDs for early
arthritic pain. You are sending the patient home with the supplies
necessary to perform 2 hemoccult tests on his stool and mail the
samples back to the clinic. What instruction would you give this
patient?
A) Take all your medications as usual.
B) Take all your medications except the antihypertensive medications.
C) Don’t eat highly acidic foods 72 hours before you start the test.
D) Avoid vitamin C for 72 hours before you start the test.
Ans: D
Feedback: Red meats, aspirin, nonsteroidal anti-inflammatory drugs,
turnips, and horseradish should be avoided for 72 hours prior to the
study, because they may cause a false-positive result. Also, ingestion
of vitamin C from supplements or foods can cause a false-negative
result. Acidic foods do not need to be avoided.
A patient’s sigmoidoscopy has been successfully completed and the
patient is preparing to return home. Which of the following teaching
points should the nurse include in the patients discharge education?
A) The patient should drink at least 2 liters of fluid in the next 12 hours.
B) The patient can resume a normal routine immediately.
C) The patient should expect fecal urgency for several hours.
D) The patient can expect some scant rectal bleeding.
Ans: B
A) The patient may have cancer, but other GI disease must be ruled
out.
B) The patient most likely has early-stage colorectal cancer.
C) The patient has a genetic predisposition to gastric cancer.
D) The patient has cancer, but the site is unknown.
Feedback: Following sigmoidoscopy, patients can resume their
regular activities and diet. There is no need to push fluids and neither
fecal urgency nor rectal bleeding is expected.
Ans: A
A nurse is caring for an 83-year-old patient who is being assessed for
recurrent and intractable nausea. What age-related change to the GI
system may be a contributor to the patients’ health complaint?
Feedback: CA 19-9 levels are elevated in most patients with advanced
pancreatic cancer, but they may also be elevated in other conditions
such as colorectal, lung, and gallbladder cancers; gallstones;
pancreatitis; cystic fibrosis; and liver disease. A cancer diagnosis
cannot be made solely on CA 19-9 results.
A patient has come to the clinic complaining of blood in his stool. A
FOBT test is performed but is negative. Based on the patient’s history,
the physician suggests a colonoscopy, but the patient refuses, citing a
strong aversion to the invasive nature of the test. What other test might
the physician order to check for blood in the stool?
A) A laparoscopic intestinal mucosa biopsy
B) A quantitative fecal immunochemical test
C) Computed tomography (CT)
D) Magnetic resonance imagery (MRI)
Ans: B
Feedback: Quantitative fecal immunochemical tests may be more
accurate than guaiac testing and useful for patients who refuse invasive
testing. CT or MRI cannot detect blood in stool. Laparoscopic
intestinal mucosa biopsy is not performed.
A nurse is assessing the abdomen of a patient just admitted to the unit
with a suspected GI disease. Inspection reveals several diverse lesions
on the patient’s abdomen. How should the nurse best interpret this
assessment finding?
A) Abdominal lesions are usually due to age-related skin changes.
B) Integumentary diseases often cause GI disorders.
C) GI diseases often produce skin changes.
D) The patient needs to be assessed for self-harm.
A) Stomach emptying takes place more slowly.
B) The villi and epithelium of the small intestine become thinner.
C) The esophageal sphincter becomes incompetent.
D) Saliva production decreases.
Ans: A
Feedback: Delayed gastric emptying occurs in older adults and may
contribute to nausea. Changes to the small intestine and decreased
saliva production would be less likely to contribute to nausea. Loss of
esophageal sphincter function is pathologic and is not considered an
age-related change.
A patient has been experiencing significant psychosocial stress in
recent weeks. The nurse is aware of the hormonal effects of stress,
including norepinephrine release. Release of this substance would have
what effect on the patient’s gastrointestinal function? Select all that
apply.
A) Decreased motility
B) Increased sphincter tone
C) Increased enzyme release
D) Inhibition of secretions
E) Increased peristalsis
Ans: A
Feedback: Norepinephrine generally decreases GI motility and
secretions but increases muscle tone of sphincters. Norepinephrine
does not increase the release of enzymes.
A patient with cystic fibrosis takes pancreatic enzyme replacements on
a regular basis. The patient’s intake of trypsin facilitates what aspect
of GI function?
A) Vitamin D synthesis
B) Digestion of fats
C) Maintenance of peristalsis
D) Digestion of proteins
Ans: D
Feedback: Trypsin facilitates the digestion of proteins. It does not
influence vitamin D synthesis, the digestion of fats, or peristalsis.
The nurse is caring for a patient who has a diagnosis of AIDS.
Inspection of the patient’s mouth reveals the new presence of white
lesions on the patient’s oral mucosa. What is the nurses most
appropriate response?
A) Encourage the patient to gargle with salt water twice daily.
B) Attempt to remove the lesions with a tongue depressor.
C) Make a referral to the unit’s dietitian.
D) Inform the primary care provider of this finding.
Ans: D
Feedback: The nurse should inform the primary care provider of this
abnormal finding in the patient’s oral cavity since it necessitates
medical treatment. It would be inappropriate to try to remove skin
lesions from a patient’s mouth, and salt water will not resolve this
problem, which is likely due to candidiasis. A dietitian referral is
unnecessary.
A patient has been scheduled for a urea breath test in one months’ time.
What nursing diagnosis most likely prompted this diagnostic test?
A) Impaired Dentition Related to Gingivitis
B) Risk For Impaired Skin Integrity Related to Peptic Ulcers
C) Imbalanced Nutrition: Less Than Body Requirements Related to
Enzyme Deficiency
D) Diarrhea Related to Clostridium Difficile Infection
Ans: B
Feedback: Urea breath tests detect the presence of Helicobacter
pylori, the bacteria that can live in the mucosal lining of the stomach
and cause peptic ulcer disease. This test does not address fluid volume,
nutritional status, or dentition.
A female patient has presented to the emergency department with right
upper quadrant pain; the physician has ordered abdominal ultrasound
to rule out cholecystitis (gallbladder infection). The patient expresses
concern to the nurse about the safety of this diagnostic procedure. How
should the nurse best respond?
A) Abdominal ultrasound is very safe, but it can’t be performed if
you’re pregnant.
B) Abdominal ultrasound poses no known safety risks of any kind.
C) Current guidelines state that a person can have up to 3 ultrasounds
per year.
D) Current guidelines state that a person can have up to 6 ultrasounds
per year.
Ans: B
Feedback: An ultrasound produces no ill effects and there are not
specific limits on its use, even during pregnancy.