GASTROINTESTINAL , HEPATOBILIARY & PANCREATIC SYSTEMS FUNCTION, ASSESSMENT & THERAPEUTIC MEASURES EXAM

Chapter 32. Gastrointestinal, Hepatobiliary, and Pancreatic Systems Function, Assessment, and Therapeutic Measures Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. The nurse is inspecting a patient’s oral cavity and notices reddened areas on the gums, several teeth with cavities, and multiple loose teeth. Which finding is of greatest safety concern to the nurse? 1. Reddened area on the gums can be a source of infection. 2. Dental cavities can be painful and a possible source of infection. 3. Loose teeth concern due to possible aspiration and airway blockage. 4. Abnormal findings in the oral cavity can lead to poor nutrition status. ____ 2. The nurse is providing care for a patient whose nasogastric (NG) tube is attached to low intermittent suction for decompression of a bowel obstruction. The nurse notes the NG tube is not draining. After checking placement, which action should the nurse take? 1. Advance the NG tube 2 inches. 2. Change the suction setting to high. 3. Reinsert the NG tube into the other nares. 4. Irrigate the NG tube with 30 milliliters of normal saline. ____ 3. During the inspection of a patient’s abdomen, which data finding is most unlikely indicative of a serious disorder? 1. Jaundice 2. Caput medusae 3. Visible mound 4. Silver-colored lines ____ 4. The nurse is auscultating the bowel sounds of a patient who is severely constipated and exhibits a swollen abdomen and pain. Which bowel sounds cause the nurse to suspect a bowel obstruction? 1. A series of soft clicks and gurgles 2. A complete absence of sounds 3. A high-pitched tinkling sound 4. A variety of nearly constant sounds ____ 5. The nurse is providing care for a patient who has just undergone a needle biopsy to rule out liver disease. Which nursing intervention is most critical following the procedure? 1. Monitor vital signs every 4 hours. 2. Instruct to avoid coughing or straining. 3. Remain positioned on right side for 2 hours. 4. Medicate as needed for pain. ____ 6. A patient is being prepared for an upper gastrointestinal (GI) series involving a barium swallow. Which statement indicates that the patient understands the preparation for this test? 1. “I should eat a soft diet the night before the procedure.” 2. “I must not eat or drink for 4 hours after the procedure.” 3. “I’ll be given a clear liquid diet the night after the procedure.” 4. “I can’t have anything to eat or drink for 6 hours before the procedure.” ____ 7. The nurse is ready to begin a tube feeding via an NG feeding tube for a patient who is comatose. What action should the nurse take before starting the feeding? 1. Listen to bowel sounds. 2. Check the pH of gastric aspirate. 3. Secure the NG tube with additional tape. 4. Irrigate the tube with 10 mL of sterile water. ____ 8. The nurse reviews the results of a patient’s stool occult blood test, which tests positive. Which additional data is unlikely to cause a false positive for the testing? 1. If the patient has bleeding gums following a recent dental procedure 2. If the patient ingested red meat within 3 days of testing 3. If the patient took oral laxatives in preparation for the test 4. If the patient ate turnips, fish, or horseradish prior to testing ____ 9. The nurse is caring for a patient who has a nonvented NG tube. Which suction setting should the nurse select? 1. Low continuous suction 2. High continuous suction 3. Low intermittent suction 4. High intermittent suction ____ 10. The nurse is planning to reinforce teaching to a patient regarding the function of the organs in the GI tract. Which information is correct? 1. The presence of food is necessary to trigger the release of gastric juices. 2. The colon is the last 3 feet of GI tract where digestion is completed. 3. The duodenum is where the common bile and pancreatic duct enters the small intestine. 4. The singular function of the liver is to remove potentially toxic substances from the blood. ____ 11. The nurse is performing research to obtain best practice information on the topic of enteral feedings. Which information is least likely to be included in best practice recommendations? 1. Residual checks can cause clogged tubes and the stoppage of feeding. 2. Measurement of residual volumes reflect gastric emptying and aspiration risk. 3. Stopping tube feedings based solely on residual findings can result in malnutrition. 4. Eliminating residual volume checks does not decrease patient safety with enteral feedings. ____ 12. The nurse is providing care for a client who requires gastric irrigation for a medication overdose. The nurse understands the use of an orogastric tube requires which intervention? 1. The abdominal incision requires regular wound care. 2. The patient needs careful observation for a sinus infection. 3. Suction equipment is needed at the bedside for nasal drainage. 4. The tube is temporary and is removed following treatment. ____ 13. The nurse is palpating the abdomen of a patient reporting mild abdominal pain in the upper right quadrant. How deep should the nurse depress this patient’s abdomen? 1. 1 inch 2. 2 inches 3. 3 inches 4. 4 inches ____ 14. The nurse is gathering data from a client in a physician’s office. The client reports severe diarrhea, nausea, and abdominal pain. Which additional data information will cause the nurse to report possible Clostridium difficile to the HCP? 1. Osteoarthritis treated with anti-inflammatories 2. Currently in outpatient treatment for alcohol abuse 3. Recent hospitalization for treatment of pneumonia 4. History of poorly controlled type 2 diabetes mellitus ____ 15. The nurse is preparing to perform an abdominal examination. For which reason will the nurse perform auscultation before palpation and percussion? 1. Palpation will alter or stimulate bowel sounds. 2. Percussion is painful and makes auscultation difficult. 3. Auscultation is expected and will relax the patient. 4. Inspection is normally followed by auscultation. ____ 16. The nurse is providing care for a client 1 day after major abdominal surgery. The client’s abdomen is distended and bowel sounds are absent. Which treatment does the nurse expect the HCP to prescribe? 1. Insertion of a nasointestinal tube to stimulate peristalsis 2. Administration of medication to dissipate abdominal gas 3. Placement of a NG tube for decompression 4. Use of a rectal tube to clear flatus from the distal colon ____ 17. The nurse is caring for a patient admitted with malnutrition related to gastric disease. The HCP orders parenteral nutrition (PN). Which information does the nurse consider regarding insulin therapy for this patient? 1. The PN will likely cause diabetes mellitus. 2. A combination of insulins is used for control. 3. The patient was identified as a prediabetic. 4. Temporary insulin coverage uses regular insulin. ____ 18. A patient is being scheduled for a barium swallow test to rule out esophageal strictures and gastric ulcer. Which pretesting information will the nurse provide for the patient? 1. Remain NPO for 12 hours prior to the procedure. 2. Increased fluid intake afterward should be water. 3. Do not smoke on the morning of the testing. 4. Notify the HCP if stools are abnormal in color. ____ 19. The nurse is providing care for a client prescribed to undergo a basal cell secretion test. Which nursing action is incorrect? 1. An NG tube is inserted. 2. A syringe is used to suction specimens. 3. The NG tube is left unconnected between specimens. 4. Specimens are labeled in order of obtainment. Multiple Response Identify one or more choices that best complete the statement or answer the question. ____ 20. The nurse is providing care for a client with gallbladder disease. The client states, “What good is a gallbladder anyway?” The nurse is aware that which digestive processes are a function of the gallbladder? (Select all that apply.) 1. Bile causes emulsification of large globules of fats into small globules. 2. Bile carries bilirubin and excess cholesterol through the intestines. 3. Bile secretion by the gallbladder is stimulated by the hormone secretin. 4. The solitary function of the gallbladder is to produce bile. 5. The liver ceases to produce bile if the gallbladder is diseased. ____ 21. The nurse is contributing to a patient’s plan of care. Which patients does the nurse recommend as benefiting from PN? (Select all that apply.) 1. A patient who has esophageal cancer 2. A patient scheduled for leg amputation 3. A patient who is NPO for esophageal varices 4. A patient who is postoperative for an appendectomy 5. A patient with severe burns across the face and chest ____ 22. The nurse is providing care for an older adult client. The client states, “I don’t eat much anymore and I have terrible problems with my bowels.” Which information does the nurse share with the patient to explain the changes as related to age? (Select all that apply.) 1. Decreased GI peristalsis contributes to constipation. 2. Constipation requires an increased intake of fluids and roughage. 3. Decreased sense of taste can cause a loss of desire to eat. 4. Periodontal disease can interfere with eating and healthy nutrition. 5. Decline of eating habits and nutrition is an expected part of aging. ____ 23. The nurse is providing care for a patient with an NG tube for PN, an IV line for fluids and medications, and a nasal cannula for oxygen therapy. Which safety interventions does the nurse implement during care for this patient? (Select all that apply.) 1. Label or colorcode feeding tubes and connectors. 2. Physically arrange the tubes for quick identification. 3. Write “Alert! For enteral use only” on all tube feeding bags. 4. Mark enteral tubes with a black marker for quick recognition. 5. During the handoff process, check tube origins and connections