Chapter 5 ChallengeChapter 5 ChallengeChapter 5 ChallengeChapter 5 Challenge

Patti HamiltonPatti Hamilton

1. Because the small intestine needs bile only a few times a

day, bile is stored and concentrated in the:

1. Pancreas2. Gallbladder3. Liver4. Small intestine

Answer - 2. gallbladderRationale – 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. Maalox and Kayexalate2. Tagamet and Zantac3. Erythromycin and Flagyl4. Dyazide and Carafate

Answer – 2. Tagamet and ZantacRationale – 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. Decrease the bulk of colon contents.2. Reduce the bacteria content of the colon.3. Soften the stool.4. 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. Dysphagia2. Malnutrition3. Pain4. Regurgitation of food.

Answer – 1. DysphagiaRationale – 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?

• 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?

• 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. A history of alcohol abuse.2. A sore throat and hoarseness.3. Dysphagia, especially with liquids.4. 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:

• 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?

• 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?

• 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.