PN4003- CHPT 45, 46, 47 (GI- MED-
SURG) EXAM QUESTIONS WITH
ANSWERS VERIFIED | GRADED A+ .
What is anorexia? - Correct Answer -or lack of appetite, is a common symptom of many
diseases. (See Chapter 70 for information on anorexia nervosa, a complex psychological
eating disorder.) Prolonged anorexia may lead to serious consequences such as malnutrition.
etiology of anorexia? - Correct Answer -The appetite center, which stimulates or suppresses
the appetite, is located in the hypothalamus. Pleasant or noxious food odors, effects of drugs,
emotional stress, fear, psychological problems, or illnesses may affect appetite.
Pathophysiology of anorexia? - Correct Answer -Brief periods of anorexia are not life-
threatening but can cause temporary malnutrition. During periods of reduced food
consumption, most people have a sufficient reserve of stored glycogen, which provides
energy through the process of glycogenolysis, the conversion of glycogen to glucose.
Hormones such as glucagon, glucocorticoid hormones from the adrenal cortex, and thyroid
hormones stimulate the liver to carry out gluconeogenesis, the synthesis of additional glucose
by the liver from protein breakdown or lactate production. Selective reabsorption by the
kidneys can temporarily maintain electrolyte balance.
SS of anorexia? - Correct Answer -Hunger usually is absent, and clients describe having no
desire for food. Some clients state that they feel nauseous when they smell food or even think
about eating. Some eat a small amount only because they feel they should or others coerce
them to do so. Amounts of weight loss vary depending on how long the anorexia and reduced
food intake have lasted. Eventually, the client may show signs of hypovitaminosis (vitamin
deficiency). The body does not store any water-soluble vitamins (B vitamins, including folic
acid and vitamin C) except for vitamin B12. Therefore, deficiencies in these vitamins may be
seen in more acute phases of illness. The body does store fat-soluble vitamins (A, D, E, and
K) but requires fat absorption to do so. Chronic illnesses and those that directly affect fat
absorption (e.g., cystic fibrosis, pancreatitis, liver disease) result in deficiency of the fat-
soluble vitamins.
Diagnostic findings for patients with anorexia? - Correct Answer -Depending on the
chronicity of the anorexia, hemoglobin level and blood cell counts may be reduced. Red
blood cells (RBCs) may become abnormally enlarged. Serum albumin, electrolyte, and
1
,protein levels may be low, with accompanying cardiac dysrhythmias. For example, an
elevated U wave on the electrocardiogram may indicate potassium deficiency.
Medical and surgical management for a patient with anorexia? - Correct Answer -
Management depends on the cause. Short-term anorexia (less than 1 week) usually requires
no medical intervention. Persistent anorexia may require various approaches, such as a high-
calorie diet, high-calorie supplemental feedings, tube feedings, and total parenteral nutrition
(TPN). Psychological support, psychiatric treatment, or both may be essential for the client
whose anorexia is linked to anorexia nervosa, a psychiatric disorder, instead of a defined
organic disease
Nursing management for a client with anorexia? - Correct Answer -To maintain sufficient
nutrition and sustain normal body weight, the client must eat an adequate quantity of food. In
assisting the client to meet this goal, the nurse monitors their weight daily. They also obtain a
complete medical and allergy (drugs and food) history from the client or a family member
and compiles a dietary history, including a description of the client's eating patterns and food
preferences.
Additional nursing measures depend on any consequences of anorexia. In the case of altered
bowel patterns (diarrhea or constipation) from reduced bulk secondary to liquid supplements,
potential interventions include the following:
-Keep a record of the client's bowel movements.
If the client experiences diarrhea, consult with the primary provider and dietitian about
changing the type of supplement.
-If the client is constipated, change the formula to one that contains fiber to add bulk to
stools.
-Dilute the formula temporarily until the client adjusts to the concentrated contents.
-Assist the client and dietitian to increase dietary fiber.
-Administer a prescribed stool softener to promote ease and frequency of bowel elimination.
How do nurses manage care of client with anorexia? - Correct Answer --Provide foods that
the client likes during meals.
-Offer nourishing beverages (eggnog, milk shakes, and commercial concentrates such as
Ensure or Instant Breakfast) as between-meal snacks.
-If the client is hospitalized or in another health care facility, encourage family members to
bring favorite foods that can be refrigerated or reheated.
-Conduct a daily caloric count if necessary to determine total proteins and carbohydrates in
the client's diet.
2
,-Keep serving sizes and containers small to avoid overwhelming the client.
-Serve and keep hot foods hot and cold foods cold.
-Encourage eating in the company of others.
-Formulate a nutritional plan with the client and dietitian that promotes weight gain
(approximately 600 calories per meal).
-If necessary, arrange for supplementation based on documented deficiencies in the client's
intake.
-Consult the primary provider and dietitian in cases of prolonged anorexia.
What is nausea and vomiting? - Correct Answer -Nausea and vomiting are common and often
coexisting problems. If these symptoms are prolonged, weakness, weight loss, nutritional
deficiency, dehydration, and electrolyte and acid-base imbalances may result.
Etiology of nausea and vomiting? - Correct Answer -Some of the more common causes of
nausea and vomiting include drugs, infections and inflammatory conditions of the GI tract,
intestinal obstruction, systemic infections, lesions of the central nervous system, food
poisoning, emotional stress, early pregnancy, and uremia.
Pathophysiology of nausea and vomiting? - Correct Answer -Nausea generally precedes
vomiting and usually results from distention of the duodenum. Increased salivation and
peripheral vasoconstriction, which causes cold, clammy skin, and tachycardia, accompany
nausea. The vomiting center, located in the medulla, is particularly sensitive to
parasympathetic neurotransmitters released in response to gastric irritation. The Valsalva
maneuver, which accompanies the forceful expulsion of stomach contents, causes dizziness,
hypotension, and bradycardia.
SS of nausea and vomiting? - Correct Answer -The client describes an unpleasant feeling,
identified as nausea, which usually is associated with loss of appetite and refusal to eat. When
a client vomits, others may observe them retching while they evacuate the stomach contents.
The process occurs once or several times in succession.
The client who experiences excessive fluid loss (dehydration) with vomiting may complain of
excessive thirst and report decreased or no urine production. Eyes and oral mucosa appear
dry or dull, and poor skin turgor reflects fluid loss (see Chapter 16).
The client's history may include ingestion of noxious substances, such as excessive amounts
of alcohol, presumably contaminated food, or drugs that commonly cause GI side effects.
Exposure to other people with similar symptoms suggests a bacterial or viral cause. When
vomiting is secondary to intestinal obstruction, the abdomen is distended, tender, and firm to
the touch. Bowel sounds may be absent or hypoactive.
3
, Diagnostic findings for a patient with nausea and vomiting? - Correct Answer -Prolonged
vomiting may lead to low levels of serum sodium and chloride. Bicarbonate levels may rise
to compensate for the loss of chloride and accumulation of metabolic acids. The hematocrit
value, if high, is secondary to the hemoconcentration that accompanies dehydration.
Medical and surgical management for a patient with nausea and vomiting? - Correct Answer -
Sometimes, nausea and vomiting are short-lived and do not require medical intervention. In
some instances, intravenous (IV) fluids, electrolyte replacement, and drug therapy are
necessary. Elimination of the cause necessitates various interventions, ranging from stopping
a drug to surgical intervention for intestinal obstruction. Symptomatic relief may be achieved
by administering an antiemetic agent, providing IV fluid and electrolyte replacement, and
temporarily restricting food intake until the cause of vomiting is eliminated
Drugs used for nausea and vomiting? - Correct Answer -Serotonin (5-HT3) Receptor
antagonist:
-Ondansetron (Zofran)
-Palonosetron (Aloxi) -granisetron
Action: Chemotherapy-induced nausea, post-op vomiting, hyperemesis in pregnancy; works
by blocking neural receptors for 5HT3
Antidopaminergic:
-Prochlorperazine
Action: Control of nausea and vomiting, intractable hiccoughs by inhibiting the CTZ
Cholinergic blocking drug:
-Trimethobenzamide (Tigan)
Action: Control of nausea and vomiting at CTZ
Antivertigo:
Dimenhydrinate (Dramamine)
Action: Inhibits vestibular stimulation in the ear, thereby relieving motion sickness
Nutrition notes for the client with nausea and vomiting? - Correct Answer --The client should
eat small meals and eat and drink slowly.
4
SURG) EXAM QUESTIONS WITH
ANSWERS VERIFIED | GRADED A+ .
What is anorexia? - Correct Answer -or lack of appetite, is a common symptom of many
diseases. (See Chapter 70 for information on anorexia nervosa, a complex psychological
eating disorder.) Prolonged anorexia may lead to serious consequences such as malnutrition.
etiology of anorexia? - Correct Answer -The appetite center, which stimulates or suppresses
the appetite, is located in the hypothalamus. Pleasant or noxious food odors, effects of drugs,
emotional stress, fear, psychological problems, or illnesses may affect appetite.
Pathophysiology of anorexia? - Correct Answer -Brief periods of anorexia are not life-
threatening but can cause temporary malnutrition. During periods of reduced food
consumption, most people have a sufficient reserve of stored glycogen, which provides
energy through the process of glycogenolysis, the conversion of glycogen to glucose.
Hormones such as glucagon, glucocorticoid hormones from the adrenal cortex, and thyroid
hormones stimulate the liver to carry out gluconeogenesis, the synthesis of additional glucose
by the liver from protein breakdown or lactate production. Selective reabsorption by the
kidneys can temporarily maintain electrolyte balance.
SS of anorexia? - Correct Answer -Hunger usually is absent, and clients describe having no
desire for food. Some clients state that they feel nauseous when they smell food or even think
about eating. Some eat a small amount only because they feel they should or others coerce
them to do so. Amounts of weight loss vary depending on how long the anorexia and reduced
food intake have lasted. Eventually, the client may show signs of hypovitaminosis (vitamin
deficiency). The body does not store any water-soluble vitamins (B vitamins, including folic
acid and vitamin C) except for vitamin B12. Therefore, deficiencies in these vitamins may be
seen in more acute phases of illness. The body does store fat-soluble vitamins (A, D, E, and
K) but requires fat absorption to do so. Chronic illnesses and those that directly affect fat
absorption (e.g., cystic fibrosis, pancreatitis, liver disease) result in deficiency of the fat-
soluble vitamins.
Diagnostic findings for patients with anorexia? - Correct Answer -Depending on the
chronicity of the anorexia, hemoglobin level and blood cell counts may be reduced. Red
blood cells (RBCs) may become abnormally enlarged. Serum albumin, electrolyte, and
1
,protein levels may be low, with accompanying cardiac dysrhythmias. For example, an
elevated U wave on the electrocardiogram may indicate potassium deficiency.
Medical and surgical management for a patient with anorexia? - Correct Answer -
Management depends on the cause. Short-term anorexia (less than 1 week) usually requires
no medical intervention. Persistent anorexia may require various approaches, such as a high-
calorie diet, high-calorie supplemental feedings, tube feedings, and total parenteral nutrition
(TPN). Psychological support, psychiatric treatment, or both may be essential for the client
whose anorexia is linked to anorexia nervosa, a psychiatric disorder, instead of a defined
organic disease
Nursing management for a client with anorexia? - Correct Answer -To maintain sufficient
nutrition and sustain normal body weight, the client must eat an adequate quantity of food. In
assisting the client to meet this goal, the nurse monitors their weight daily. They also obtain a
complete medical and allergy (drugs and food) history from the client or a family member
and compiles a dietary history, including a description of the client's eating patterns and food
preferences.
Additional nursing measures depend on any consequences of anorexia. In the case of altered
bowel patterns (diarrhea or constipation) from reduced bulk secondary to liquid supplements,
potential interventions include the following:
-Keep a record of the client's bowel movements.
If the client experiences diarrhea, consult with the primary provider and dietitian about
changing the type of supplement.
-If the client is constipated, change the formula to one that contains fiber to add bulk to
stools.
-Dilute the formula temporarily until the client adjusts to the concentrated contents.
-Assist the client and dietitian to increase dietary fiber.
-Administer a prescribed stool softener to promote ease and frequency of bowel elimination.
How do nurses manage care of client with anorexia? - Correct Answer --Provide foods that
the client likes during meals.
-Offer nourishing beverages (eggnog, milk shakes, and commercial concentrates such as
Ensure or Instant Breakfast) as between-meal snacks.
-If the client is hospitalized or in another health care facility, encourage family members to
bring favorite foods that can be refrigerated or reheated.
-Conduct a daily caloric count if necessary to determine total proteins and carbohydrates in
the client's diet.
2
,-Keep serving sizes and containers small to avoid overwhelming the client.
-Serve and keep hot foods hot and cold foods cold.
-Encourage eating in the company of others.
-Formulate a nutritional plan with the client and dietitian that promotes weight gain
(approximately 600 calories per meal).
-If necessary, arrange for supplementation based on documented deficiencies in the client's
intake.
-Consult the primary provider and dietitian in cases of prolonged anorexia.
What is nausea and vomiting? - Correct Answer -Nausea and vomiting are common and often
coexisting problems. If these symptoms are prolonged, weakness, weight loss, nutritional
deficiency, dehydration, and electrolyte and acid-base imbalances may result.
Etiology of nausea and vomiting? - Correct Answer -Some of the more common causes of
nausea and vomiting include drugs, infections and inflammatory conditions of the GI tract,
intestinal obstruction, systemic infections, lesions of the central nervous system, food
poisoning, emotional stress, early pregnancy, and uremia.
Pathophysiology of nausea and vomiting? - Correct Answer -Nausea generally precedes
vomiting and usually results from distention of the duodenum. Increased salivation and
peripheral vasoconstriction, which causes cold, clammy skin, and tachycardia, accompany
nausea. The vomiting center, located in the medulla, is particularly sensitive to
parasympathetic neurotransmitters released in response to gastric irritation. The Valsalva
maneuver, which accompanies the forceful expulsion of stomach contents, causes dizziness,
hypotension, and bradycardia.
SS of nausea and vomiting? - Correct Answer -The client describes an unpleasant feeling,
identified as nausea, which usually is associated with loss of appetite and refusal to eat. When
a client vomits, others may observe them retching while they evacuate the stomach contents.
The process occurs once or several times in succession.
The client who experiences excessive fluid loss (dehydration) with vomiting may complain of
excessive thirst and report decreased or no urine production. Eyes and oral mucosa appear
dry or dull, and poor skin turgor reflects fluid loss (see Chapter 16).
The client's history may include ingestion of noxious substances, such as excessive amounts
of alcohol, presumably contaminated food, or drugs that commonly cause GI side effects.
Exposure to other people with similar symptoms suggests a bacterial or viral cause. When
vomiting is secondary to intestinal obstruction, the abdomen is distended, tender, and firm to
the touch. Bowel sounds may be absent or hypoactive.
3
, Diagnostic findings for a patient with nausea and vomiting? - Correct Answer -Prolonged
vomiting may lead to low levels of serum sodium and chloride. Bicarbonate levels may rise
to compensate for the loss of chloride and accumulation of metabolic acids. The hematocrit
value, if high, is secondary to the hemoconcentration that accompanies dehydration.
Medical and surgical management for a patient with nausea and vomiting? - Correct Answer -
Sometimes, nausea and vomiting are short-lived and do not require medical intervention. In
some instances, intravenous (IV) fluids, electrolyte replacement, and drug therapy are
necessary. Elimination of the cause necessitates various interventions, ranging from stopping
a drug to surgical intervention for intestinal obstruction. Symptomatic relief may be achieved
by administering an antiemetic agent, providing IV fluid and electrolyte replacement, and
temporarily restricting food intake until the cause of vomiting is eliminated
Drugs used for nausea and vomiting? - Correct Answer -Serotonin (5-HT3) Receptor
antagonist:
-Ondansetron (Zofran)
-Palonosetron (Aloxi) -granisetron
Action: Chemotherapy-induced nausea, post-op vomiting, hyperemesis in pregnancy; works
by blocking neural receptors for 5HT3
Antidopaminergic:
-Prochlorperazine
Action: Control of nausea and vomiting, intractable hiccoughs by inhibiting the CTZ
Cholinergic blocking drug:
-Trimethobenzamide (Tigan)
Action: Control of nausea and vomiting at CTZ
Antivertigo:
Dimenhydrinate (Dramamine)
Action: Inhibits vestibular stimulation in the ear, thereby relieving motion sickness
Nutrition notes for the client with nausea and vomiting? - Correct Answer --The client should
eat small meals and eat and drink slowly.
4
