Chapter 22: Gastrointestinal Disorders and Therapeutic Management

Chapter 22: Gastrointestinal Disorders and Therapeutic Management

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

MULTIPLE CHOICE

1. Which of the following disorders is the leading cause of upper GI hemorrhage?

ANS:  B

Peptic ulcer disease (gastric and duodenal ulcers), resulting from the breakdown of the gastromucosal lining, is the leading cause of upper GI hemorrhage, accounting for approximately 21% of cases.

2. Esophagogastric varices are the result of

ANS:  A

Esophagogastric varices are engorged and distended blood vessels of the esophagus and proximal stomach that develop as a result of portal hypertension secondary to hepatic cirrhosis, a chronic disease of the liver that results in damage to the liver sinusoids. Without adequate sinusoid function, resistance to portal blood flow is increased, and pressures within the liver are elevated. This leads to a rise in portal venous pressure (portal hypertension), causing collateral circulation to divert portal blood from areas of high pressure within the liver to adjacent areas of low pressure outside the liver, such as into the veins of the esophagus, spleen, intestines, and stomach.

3. The patient at risk for GI hemorrhage should be monitored for which of the following signs and symptoms?

ANS:  D

The initial clinical presentation of the patient with acute gastrointestinal (GI) hemorrhage is that of a patient in hypovolemic shock; the clinical presentation depends on the amount of blood lost. Hematemesis (bright red or brown, coffee grounds emesis), hematochezia (bright red stools), and melena (black, tarry, or dark red stools) are the hallmarks of GI hemorrhage.

4. A nursing priority for a patient with GI hemorrhage is

ANS:  D

Priorities in the medical management of a patient with gastrointestinal hemorrhage include airway protection, fluid resuscitation to achieve hemodynamic stability, correction of co-morbid conditions (e.g., coagulopathy), therapeutic procedures to control or stop bleeding, and diagnostic procedures to determine the exact cause of the bleeding.

5. The physician orders gastric lavage to control GI bleeding. The nurse has inserted a large-bore NG tube. What temperature and irrigating fluid would be used to obtain the best results?

ANS:  C

Historically, iced saline was favored as a lavage irrigant. Research has shown, however, that low-temperature fluids shift the oxyhemoglobin dissociation curve to the left, decrease oxygen delivery to vital organs, and prolong bleeding time and prothrombin time. Iced saline also may further aggravate bleeding; therefore, room temperature water or saline is the preferred irrigant for use in gastric lavage