CHAPTER 20 The Gastrointestinal System

CHAPTER 20 The Gastrointestinal System

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

Chapter 20

The Gastrointestinal System

20.1•A client tells the nurse he is constipated. The initial action by the nurse in this situation is to

1. determine what the client means by constipation.
2. obtain an order for a laxative and an enema if needed.
3. encourage the client to increase fluid intake and activity.
4. assess the diet for adequacy of fiber and fluids.

Answer: 1

Rationale: The nurse should first carefully evaluate the client’s concern and question the person as to what he considers to be constipation. Determining the client’s normal frequency of bowel movement, consistency of stool, and effort in passing stool is important before deciding to act. The other suggestions—achieving adequate fluid intake, exercising, including fiber in the diet, and using a laxative (and possibly an enema)—may be appropriate once the nurse has adequately assessed the client’s concern of constipation.

Assessment

Physiological Integrity

Application

20.2•Risk factors for the development of primary liver cancer include which of the following?

1. positive history for hepatic cysts
2. history of colon polyps
3. presence of diverticula
4. history of previous infection with hepatitis B or C

Answer: 4

Rationale: A positive history of hepatitis type B or C puts the client at increased risk for primary liver cancer or hepatocellular cancer. The tumor usually develops in an area of cirrhosis secondary to the hepatitis infection. Hepatic cysts commonly occur in older clients, are usually benign, and are not a risk factor for cancer of the liver. The presence of colon polyps and diverticula is not associated with the development of liver cancer.

Assessment

Physiological Integrity

Analysis

20.3•Which of the following statements describing diarrhea associated with Cl. difficile is correct?

1. difficile is not usually found in the normal bacteria flora of the bowel.
2. The diagnosis of infection with difficile is usually made by flexible sigmoidoscopy, which confirms the pseudomembranous colitis diagnosis.
3. The recommended treatment for diarrhea from difficile includes oral metronidazole for 7 to 10 days.
4. The diarrhea from a difficile infection is usually bloody, in large amounts, and puts the client at risk for dehydration.

Answer: 3

Rationale: Diarrhea from Cl. difficile is treated with metronidazole for 7 to 10 days. Cl. difficile is found in the normal flora but occurs as an overgrowth in the flora with the infection, frequently after treatment with antibiotics for some other reason. The diarrhea is very watery with little stool, copious, and puts the client at risk for dehydration. A pseudomembrane is usually present but sigmoidoscopy is avoided because of risk of perforation. Diagnosis is made by a stool sample analysis, which is positive for the toxin of Cl. difficile.

Diagnosis

Physiological Integrity

Analysis

20.4•Changes in the gastrointestinal system normally associated with aging include

1. increase in hydrochloric acid in the stomach.
2. increased absorption of nutrients in the intestines.
3. decreased incidence of cholelithiasis.
4. decreased esophageal motility.

Answer: 4

Rationale: Changes in the gastrointestinal system that occur with the aging process include a decrease in esophageal motility, which leads to increased problems of gastroesophageal reflux disease (GERD). There is a decrease in the amount of hydrochloric acid in the stomach. A lessening of nutrient absorption occurs in the intestines. Older clients experience an increase in the occurrence of cholelithiasis (gallstones).

Diagnosis

Physiological Integrity

Analysis