Chapter 20 High Acuity Nursing 6th Edition by Kathleen Dorman Wagner

Chapter 20 High Acuity Nursing 6th Edition by Kathleen Dorman Wagner

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

Question 1

Type: MCSA

A patient is diagnosed with esophageal reflux. The nurse explains to the patient that there is an impairment in which structure?

1. Fundus
2. Duct of Wirsung
3. Cardiac sphincter
4. Antrum

Correct Answer: 3

Rationale 1: The fundus is part of the stomach and is not involved in esophageal reflux.

Rationale 2: The Duct of Wirsung is the main pancreatic duct and is not involved in esophageal reflux.

Rationale 3: The lower esophageal sphincter, also known as the cardiac sphincter, has high resting muscle tone at the distal end, which prevents gastroesophageal reflux. The patient diagnosed with esophageal reflux would have an impairment of this sphincter.

Rationale 4: The antrum is part of the stomach and is not involved in esophageal reflux.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 20-1

 

Question 2

Type: MCSA

A patient is diagnosed with a gastric ulcer located on the antrum. The nurse is aware that the ulcer may also affect the function of which adjacent structure?

1. Sphincter of Oddi
2. Acinus
3. Pyloric sphincter
4. Lower esophageal sphincter

Correct Answer: 3

Rationale 1: The Sphincter of Oddi is located in the pancreas and is not anatomically close to the antrum.

Rationale 2: The acinus is the functional unit of the pancreas and is not anatomically close to the antrum.

Rationale 3: The antrum is located at the base of the stomach, ending at the pyloric sphincter. Depending upon the extent of the ulcer, the function of the pyloric sphincter may be affected.

Rationale 4: The lower esophageal sphincter is located at the gastroesophageal juncture and is not the structure closest to the antrum.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 20-1

 

Question 3

Type: MCMA

A patient has been diagnosed with deficiency of the hormone cholecystokinin (CCK). The nurse would expect this patient to have difficulty digesting which nutrients?

 

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Fats
2. Proteins
3. Carbohydrates
4. Vitamins
5. Minerals

Correct Answer: 1,2

Rationale 1: CCK is secreted in response to the presence of fat in the duodenum.

Rationale 2: CCK is secreted in response to the presence of protein in the duodenum.

Rationale 3: Gastric inhibitory peptide (GIP) is secreted in response to the presence of carbohydrates.

Rationale 4: Vitamins are not digested, but are absorbed from or synthesized by the GI tract.

Rationale 5: Minerals are not digested, but are absorbed from the GI tract.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 20-4

 

Question 4

Type: MCSA

A patient is demonstrating hepatic encephalopathy due to buildup of ammonia. The nurse anticipates intervention to support which function of the liver?

1. Protein metabolism
2. Vitamin synthesis
3. Fat metabolism
4. Carbohydrate metabolism

Correct Answer: 1

Rationale 1: The liver is responsible for synthesis of the majority of the body’s proteins and for degrading amino acids for energy use through the process of deamination. The major by-product of deamination is ammonia, which is toxic to tissues. The liver is responsible for converting ammonia into urea, a nontoxic substance. Urea diffuses from the liver into the circulation for urinary excretion. When liver failure occurs, ammonia cannot be converted to urea and levels rapidly build in the blood.

Rationale 2: If the liver is not synthesizing vitamins, the patient would demonstrate findings related to vitamin A, D, E, and K deficiency.

Rationale 3: Fat metabolism is not related to the development of hepatic encephalopathy or a buildup of ammonia.

Rationale 4: Alterations in ability to metabolize carbohydrates would not result in hepatic encephalopathy, but rather in changes such as serum glucose levels.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 20-3