Chapter 5 Challenge
Patti Hamilton
1.
Because the small intestine needs
bile only a few times a day, bile is
stored and concentrated in the:
1. Pancreas
2. Gallbladder
3. Liver
4. Small intestine
Answer - 2. gallbladder
Rationale – the gallbladder functions to
store and concentrate bile.
2. Although food is digested throughout
the alimentary canal, up to 90% of
digestion is accomplished in the:
1. gallbladder
2. mouth
3. small intestine
4. large intestine
answer – 3. small intestine
rationale – Most of the digestion and absorption
occurs within the duodenum which is the beginning
segment of the small intestine.
3. The exit from the stomach is
called the:
• 1. cardiac sphincter
• 2. pyloric sphincter
• 3. lesser curvature
• 4. greater curvature
• Answer – 2. pyloric sphincter
• Rationale – The pyloric sphincter is located at the
end of the stomach and regulates the rate at
which gastric content is delivered to the small
intestine.
4. The intrinsic factor is a gastric
secretion necessary for the
intestinal absorption of vitamin:
•
•
•
•
1. B1
2. B12
3. C
4.K
• Answer – 2. B12
• Rationale – Intrinsic factor of the stomach is
necessary for the absorption of B12 in the ileum
segment of the small intestine.
5. Which organ manufactures
heparin, prothrombin, and
fibrinogen?
•
•
•
•
1. gallbladder
2. liver
3. pancreas
4. salivary gland
• Answer – 2. liver
• Rationale – A function of the liver is the synthesis
of plasma proteins. Plasma proteins play an
important role in maintaining blood volume and
controlling blood coagulation.
6. The digestive enzyme present in
saliva is called:
•
•
•
•
1. ptyalin
2. sucrase
3. lipase
4. trypsin
• Answer – 1. ptyalin
• Rationale – Digestion of carbohydrates starts in
the mouth with the enzyme amylase which is
pytalin of the salivary glands.
7. In preparing the patient for endoscopic examination
of the upper GI tract, the patient pharynx is
anesthetized with lidocaine. Nursing interventions for
postendoscopic examination include:
•
•
•
•
1. allowing fluids to up to 4 hours before examination.
2. withholding anticholinergic medications.
3. prohibiting smoking before the test.
4. keeping patient NPO until gag reflex returns.
•
•
Answer – 4. keeping patient NPO until gag reflex returns.
Rationale – Nursing interventions for postendoscopic examination
are the nurse should not allow the patient to eat or drink anything
until the gag reflex returns. The nurse should also assess for any
signs and symptoms of perforation, including abdominal pain and
tenderness, guarding, oral bleeding, melena, and hypovolemic shock.
8. Mr. S., a 35 yr. old patient, has been admitted with a
diagnosis of peptic ulcers. The nurse recognizes which
drugs as those most commonly used in these patients to
decrease acid secretions?
1.
2.
3.
4.
Maalox and Kayexalate
Tagamet and Zantac
Erythromycin and Flagyl
Dyazide and Carafate
Answer – 2. Tagamet and Zantac
Rationale – Histamine H2 receptor blockers decrease acid
secretions by blocking the histamine H2 receptors, these
include cimetidine(tagamet), ranitidine(Zantac),
famotidine(Pepcid), and nizatidine(Axid).
9. Ms. P. is scheduled in the morning for a
hemicolectomy for removal of a cancerous tumor of the
ascending colon. The physician has ordered intestinal
antibiotics for her preoperatively to :
1.
2.
3.
4.
Decrease the bulk of colon contents.
Reduce the bacteria content of the colon.
Soften the stool.
Prevent pneumonia
Answer – 2. Reduce the bacteria content of the colon.
Rationale – The bowel has a high level of bacteria including
E.coli. By opening it up you have a high risk for
peritonitis.
10. Ms. B. is 78 years old and was admitted during the
evening shift with a tentative diagnosis of cancer of the
esophagus. The nurse in her initial assessment finds
the patients major complaint is:
1.
2.
3.
4.
Dysphagia
Malnutrition
Pain
Regurgitation of food.
Answer – 1. Dysphagia
Rationale – Collection of subjective data includes noting that
initially the patient may have difficulty swallowing
(dysphagia) when bulky foods are eaten.
11. Deficient knowledge is a commonly used nursing
diagnosis when patients need information regarding
their conditions and diagnostic tests. Before a
gastroscopy, the nurse should inform the patient that:
• 1. fasting for 6 to 8 hours is necessary before the
examination.
• 2. a general anesthetic will be used.
• 3. after gastroscopy, the patient may eat or drink
immediately.
• 4. it is necessary to an inpatient in the hospital.
• Answer – 1. fasting for 6 to 8 hours is necessary before the
examination.
• Rationale – NPO after midnight for better visualization of
gastric mucosa.
12. In evaluating the care of Ms. K., a young executive
admitted with bleeding peptic ulcer, the nurse focuses
on nursing interventions. A nursing intervention
associated with this type of patient is:
•
•
•
•
1. checking the blood pressure and pulse rates each shift.
2. frequently monitoring arterial blood levels.
3. observing vomitus for color, consistency, and volume.
4. checking the patients low-residue diet.
• Answer – 3. observing vomitus for color, consistency, and
volume.
• Rationale – when GI bleeding occurs, one sign is vomiting
blood (hematemesis) that has a “coffee grounds”
appearance as a result of action of the gastric acid on the
hemoglobin molecule.
13. Mr. L., the staff nurse on the surgical floor, is aware
of pulmonary complications that frequently follow upper
abdominal incisions. These are most frequently related
to :
•
•
•
•
1. aspiration
2. pneumothorax if the chest cavity has been entered.
3. shallow respirations to minimize pain.
4. not forcing fluids.
• Answer – 3. shallow respirations to minimize pain.
• Rationale – Encourage patient to turn, breath deep, and
cough ( if physician ordered) to prevent pneumonia and
atelectasis.
14. Which of the following tests can distinguish
between peptic ulcer and gastric malignancy?
•
•
•
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1. radiographic GI series
2. Breath test for H. pylori
3. Serum test for H. pylori antibodies
4. Endoscopy with biopsy
• Answer – 4. endoscopy with biopsy
• Rationale – the endoscope can be used in obtaining tissue
specimens for biopsy or culture to determine presence of
H. pylori.
15. A recently approved medication for the treatment
of Crohn’s disease, infliximab (remicade), is classified
as which type of drug?
•
•
•
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1. enzyme
2. antimetabolite
3. alkylating agent
4. monoclonal antibody
• Answer – 4. monoclonal antibody
• Rationale- Infliximab is the only medication specifically
indicated for the treatmen;t of Crohn’s disease. It works
by neutralizing tumor necrosis factor, a protein that causes
much of the intestinal inflammation.
16. During assessment of the patient with esophageal
achalasia, the nurse would expect the patient to report:
1.
2.
3.
4.
A history of alcohol abuse.
A sore throat and hoarseness.
Dysphagia, especially with liquids.
Relief of pyrosis with the use of antacids.
answer – 3. Dysphagia, especially with liquids.
rationale – The primary symptom of achalasia is dysphagia.
The patient has a sensation of food or liquid sticking in
the lower portion of the esophagus.
17. A nursing intervention that is most appropriate to
decrease postoperative edema and pain in the male
patient following inguinal herniorrhaphy is:
•
•
•
•
1. applying a truss to the hernial site.
2. allowing the patient to stand to void.
3. elevation of the scrotum with a support or small pillow.
4. supporting the incision during routine coughing and deep
breathing.
•
•
Answer – 3. elevation of the scrotum with a support or small pillow.
Rationale – if scrotal edema is present, it may be decreased by
elevating the scrotum on a rolled pad, applying an ice pack, and
providing a supportive garment (jockstrap or brief). This support
along with analgesics will help relieve pain and edema.
18. The use of nonabsorbable antibiotics as preparation
for bowel surgery is done primarily to:
•
•
•
•
1. reduce the bacterial flora in the colon.
2. prevent additional formation of ammonia.\
3. prevent postoperative formation of intestinal gas.
4. stimulate bowel bacteria to increase production of
vitamin K.
• Answer – 1. reduce the bacterial flora in the colon.
• Rationale – The bowel has a E. coli as part of its normal
flora. The antibiotic is given prophyllactically to reduce the
level of E. coli to prevent the spread of infection.
19. In planning care for the patient with ulcerative
colitis, the nurse recognizes that a major difference
between ulcerative colitits and Crohn’s disease is that
ulcerative colitis:
•
•
•
•
•
•
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1. causes more nutritional deficiencies than does
Crohn’s disease.
2. causes more abdominal pain and cramping than does Crohn’s
disease.
3. is curable with a colectomy, whereas Crohn’s disease often
recurs after surgery.
4. is more highly associated with a familial relationship than is
Crohn’s disease.
Answer – 3. is curable with a colectomy, whereas Crohn’s disease
often recurs after surgery.
Rationale- Statistics show that the rate of recurrence for Chron’s
disease after surgery is 50% for the 1st 5 yrs, and 75% in 10 yrs.
20. Which group of medications should be avoided in
patients with E. coli 0157:H7?
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•
•
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1. antiemetics
2. antimotility drugs
3. antilipidemic agents
4. beta blockers
• Answer – 2. antimotility drugs
• Rationale – Antidiarrheals and antimotility drugs should not
be given because these medications prevent the intestines
from getting rid of the E.coli pathogen.
21. Which of the following should a patient be taught
after a hemmorrhoidectomy?
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1. do not use the Valsalva maneuver.
2. eat a low-fiber diet to rest the colon.
3. administer oil-retention enema to empty the colon.
4. use prescribed analgesic before a bowel movement.
• Answer- 4. use prescribed analgesic before a bowel
movement.
• Rationale – An analgesic may be taken before bowel
movement to reduce discomfort.