Chapter 18: Gastrointestinal Alterations

Chapter 18: Gastrointestinal Alterations

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. The patient is admitted with constipation. In anticipation of treatment, the nurse prepares to:

a.	give medications that will suppress the autonomic nervous system.
b.	provide therapies that will innervate the autonomic nervous system.
c.	teach the patient that the submucosa is the innermost part of the gut wall.
d.	give medications intravenously because the submucosa has no blood vessels.

 

 

ANS:   B

The second layer of the gut wall, the submucosa, is composed of connective tissue, blood vessels, and nerve fibers. Beneath the mucosa, submucosa, and muscular layer are various nerve plexuses that are innervated by the autonomic nervous system. Disturbances in these neurons in a given segment of the GI tract cause a lack of motility. Therapies innervating the autonomic nervous system are thus appropriate. The muscular layer is the major layer of the wall. The serosa is the outermost layer.

 

DIF:    Cognitive Level: Remember/Knowledge                              REF:    p. 480

OBJ:    Review the anatomy and physiology of the gastrointestinal system.

TOP:    Nursing Process Step: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity

 

2. The nurse is assessing the patient and notices that the oral cavity is only slightly moist and contains a scant amount of thick saliva even though the patient’s fluid intake has been sufficient. The nurses realizes that the condition of the patient’s mouth is probably caused by

a.	thoughts of food.
b.	sympathetic nerve stimulation.
c.	overstimulation of the sublingual glands.
d.	parasympathetic nerve stimulation.

 

 

ANS:   B

Saliva is the major secretion of the oropharynx and is produced by three pairs of salivary glands: submaxillary, sublingual, and parotid. Stimuli such as sight, smell, thoughts, and taste of food stimulate salivary gland secretion. Parasympathetic stimulation promotes a copious secretion of watery saliva. Conversely, sympathetic stimulation produces a scant output of thick saliva. The normal daily secretion of saliva is 1200 mL.

 

DIF:    Cognitive Level: Understand/Comprehension                      REF:    p. 481

OBJ:    Review the anatomy and physiology of the gastrointestinal system.

TOP:    Nursing Process Step: Assessment

MSC:   NCLEX Client Needs Category: Physiological Integrity

 

3. The nurse is caring for a patient who has a peptic ulcer. To treat the ulcer and prevent more ulcers from forming, the nurse should be prepared to administer

a.	H2-histamine receptor blockers.
b.	gastrin.
c.	vagal stimulation.
d.	vitamin B12.

 

 

ANS:   A

Stimulants of hydrochloric acid secretion include vagal stimulation, gastrin, and the chemical properties of chyme. Histamine, which stimulates the release of gastrin, also stimulates the secretion of hydrochloric acid. Current drug therapies for ulcer disease use H₂-histamine receptor blockers that block the effects of histamine and therefore hydrochloric acid stimulation. Vitamin B₁₂ is critical for the formation of red blood cells (RBCs), and a deficiency in this vitamin causes anemia but has no effect on ulcer formation. Gastrin is a hormone that stimulates acid. The vagus nerve helps digestion; however, vagal stimulation is not a treatment for peptic ulcer disease.

 

DIF:    Cognitive Level: Apply/Application                                     REF:    p. 495

OBJ:    Review the anatomy and physiology of the gastrointestinal system.

TOP:    Nursing Process Step: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity

 

4. The nurse is caring for a patient who is receiving several cardiac medications designed to stimulate the sympathetic nervous system, vitamin B₁₂, and an H₂ blocker. The nurse should do which of the following?

a.	Assess for signs of peptic ulcer.
b.	Be watchful for increased saliva production.
c.	Evaluate for a decrease in potassium level.
d.	Give the patient medications to prevent anemia.

 

 

ANS:   A

Secretion of mucus by Brunner’s glands is inhibited by sympathetic stimulation, which leaves the duodenum unprotected from gastric juice. This inhibition is thought to be one of the reasons why this area of the GI tract is the site for more than 50% of peptic ulcers. Sympathetic stimulation produces a scant output of thick saliva. Vitamin B₁₂ is critical for the formation of red blood cells (RBCs), and a deficiency in this vitamin causes anemia. However, the patient is receiving vitamin B₁₂. The stomach also secretes fluid that is rich in sodium, potassium, and other electrolytes. Loss of these fluids via vomiting or gastric suction places the patient at risk for fluid and electrolyte imbalances and acid-base disturbances. However, nothing indicates that the patient is vomiting or has GI suction.

 

DIF:    Cognitive Level: Apply/Application                                     REF:    p. 482

OBJ:    Review the anatomy and physiology of the gastrointestinal system.

TOP:    Nursing Process Step: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity