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Flashcards in Ch 29 Quiz Deck (13)
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1

Hiatal hernias can cause severe pain if the hernia is large. Gastroesophogeal reflux is a common comorbitity of hiatal hernia, and when this occurs, what might the hernia do?

a - increase esophageal acid clearance
b- retard esophageal acid clearance
c - decrease esophageal acid clearance
d- accelerate esophageal acid clearance

b. retard esophageal acid clearance

Esophageal acid clearance can be retarded in cases of severe erosive esophagitis where gastroesophageal reflux and a large hiatal hernia coexist. The other answers are incorrect.

2

Infants and children commonly have gastroesophageal reflux. Many times it is asymptomatic and resolves on its own. What are the signs and symptoms of gastroesophogeal reflux in infants with severe disease?

a- consolable crying and early satiety
b- delayed satiety and sleeping after feeding
c- tilting of the head to one side and arching the back
d- inconsolable crying and delayed satiety

c. tilting of the head to one side and arching the back

Tilting of the head to one side and arching of the back may be noted in children with severe reflux. Early satiety is another indication of gastroesophageal reflux, but not coupled with with consolable crying. The other answers are not correct.

3

The stomach secretes acid to begin the digestive process on the food that we eat. The gastric mucosal barrier works to prevent acids secreted by the stomach from actually damaging the wall of the stomach. What are the factors that make up the gastric mucosal barrier? (Mark all that apply)

a. An impermeable epithelial cell surface covering.
b. Mechanisms for selective transport of bicarbonate and potassium ions.
c. Characteristics of gastric mucus
d. Cell coverings that act as antacids
e. Mechanisms for selective transport of hydrogen and bicarbonate atoms.

a. An impermeable epithelial cell surface covering.
c. Characteristics of gastric mucus
e. Mechanisms for selective transport of hydrogen and bicarbonate atoms.

The stomach lining usually is impermeable to the acid it secretes, a property that allows the stomach to conatin acid and pepsin without its wall digested. Several factors contribute to the protection of the gastric mucosa, including an impermeable epithelial cell surface covering, mechanisms for the selective transport of hydrogen and bicarbonate ions, and the characteristics of gastric mucus. These mechanisms are collectively referred to as the gastric mucosal barrier. the other answers are incorrect.

4

Helicobacter pylori gastritis has a prevalence of over 50% of American adults over the age of 50, which is thought to be caused by a previous infection when the client was younger. What can chronic gastritis caused by H. pylori cause?

a-decreased risk of gastric adenocarcinoma
b- decreased risk of low-grade B-cell gastric lymphoma
c- duodenal cancer
d. Gastric atrophy

d. Gastric atrophy

Helicobacter pylori gastritis can be a chronic infection that can lead to gastric atrophy, peptic ulcer, and is associated with increased risk of gastric adenocarcinoma and low-grade B-cell gastric lymphoma (mucosa-associated lymphoid tissue (MALToma)). The other answers are incorrect.

5

A 39 yr old white woman presetns at the clinic with complaints of epigastric pain that is cramplike, rhythmic, and just below the xiphoid. She states that it wakes her up around 1am, and she is not sleeping well because of it. She further states that this is the third episode of having this pain in the past year. The nurse suspects the client has a peptic ulcer and expects to receive what orders from the physician?

a- Schedule client for a complete metabolic panel and a complete blood count.
b. Schedule client for laparoscopic examination.
c- Schedule client for a swallow study.
d- Schedule client for a lower gastrointestinal study.

a. Schedule client for a complete metabolic panel and a complete blood count.

Diagnostic procedures for peptic ulcer include history taking, laboratory tests, radiologic imaging, and endoscopic examination. The other answers are not expected orders for a suspected peptic ulcer.

6

A client in a nursing home complains to her nurse that she is not feeling well. When asked to describe how she feels, the client states that she really is not hungry anymore and seems to have indigestion a lot. The nurse checks the client's chart and finds that her vital signs are normal, but that she has lost weight over the past two months. She also notes that there is a history of gastric cancer in the client's family. The nurse notifies the physician and expects to receive what orders?

a. Schedule a barium radiograph and an endoscopy
b. Perform a Papanicolaou smear on the client's gastric secretions.
c. Order cytological studies to be done during the endoscopy.
d. Schedule a lower gastrointestinal study
e. Have the technician do an endoscopic ultrasound.

a. Schedule a barium radiograph and an endoscopy c. Order cytological studies to be done during the endoscopy.

Diagnosis of gastric cancer is accomplished by means of a variety of techniques, including barium radiographic studies, endoscopic studies with biopsy, and cytogenic studies (Papanicolaou smear) of gastric secretions. Cytologic studies can prove nparticularly useful as routine screening tests for persons with atrophic gastritis or gastric polyps. Computed tomography and endoscopic ultrasonography often are used to dilineate the spread of a diagnosed stomach cancer. Papanicolaou smears are done on gastric secretions, but not by the nurse. A lower gastrointestinal study would be of no value in diagnosing this client. A technician does not do an endoscopic ultrasound.

7

Irritable bowel syndrome is thought to be present in 10%-15% of the population in the United States. what is it's hallmark symptom?

a. Nausea and abdominal pain unrelieved by defecation.
b. Abdominal pain relieved be defecation with a change in consistency or frequency of stools
c. Diarrhea and abdominal pain unrelieved by defecation
d. Abdominal pain relieved by defecation and bowel impaction

b. Abdominal pain relieved be defecation with a change in consistency or frequency of stools

A hallmark of irritable bowel syndrome is abdominal pain that is relieved by defecation and associated with a change in consistency or frequency of stools. Nausea, altered bowel function, and diarrhea are also symptoms of irritable bowel syndrome but not combined with with abdominal pain that is unrelieved by defecation. A bowel impaction is not a sign of irritable bowel syndrome.

8

Rotavirus is a common infection in children younger than 5 years of age. Like other diseases, rotavirus i most severe in children under 24 months of age. what is a symptom of rotavirus infection?

a. Mild to moderate fever that gets higher after the second day.
b. Vomiting that lasts for the course of the disease.
c. Fever that disappears after 7 days
d. Vomiting that disappears around the second day.

d. Vomiting that disappears around the second day.

Rotavirus infection typically begins after an incubation period of less than 24 hours, with mild to moderate fever, and vomiting, followed by onset of frequent watery stools. The fever and vomiting usually disappear on the second day, but the diarrhea continues for 5-7 days. Dehydration may develop rapidly, particularly in infants. The other answers are incorrect.

9

Diverticulitis is the herniation of tissue of the large intestine through the muscularis layer of the colon. It is often asyptomatic and is found in approximately 80% of people over the age of 85. Diverticulitis is often asymptomatic, but when symptoms do occur what is the most common complaint of the client?

a. Lower left quadrant pain with nausea and vomiting
b. Right lower quadrant pain with nausea and vomiting.
c. Mid epigastric pain with nausea and vomiting.
d. Right lower quadrant pain with rebound tenderness on the left.

a. Lower left quadrant pain with nausea and vomiting

One of the most common complaints of diverticulitis is pain in the lower left quadrant, accompanied by nausea and vomiting, tenderness in the lower left quadrant, a slight fever, and an elevated white blood cell count. Both b and d describe a suspected appendicitis, and c describes symptoms of a peptic ulcer.

10

Diarrhea is described as a change int he frequency of stool passage to a point where it is excessively frequent. Diarrhea can be acute or chronic, inflammatory or noninflammatory. What are the symptoms of noninflammatory diarrhea?

a. Small volume watery stools
b. nonbloody stools
c. periumbilical crampsd.
d. nausea and/or vomiting
e. large-volume blood stools

b. nonbloody stools
c. periumbilical crampsd.
d. nausea and/or vomiting

Non inflammatory dierrhea is associated with large volume watery and nonbloody stools, periumbilical cramps, bloating and nausea and/or vomiting. The other answers are incorrect.

11

Peritonitis is an inflammatory condition of the lining of the adbominal cavity. what is one of the most important signs of peritonitis?

a. Vomitting of coffee ground-appearing emesis
b. The translocation of extracellular fluid into the peritoneal cavity
c. The translocation of intracellular fluid into the peritoneal cavity
d. Vomitting of bloody emesis

b. The translocation of extracellular fluid into the peritoneal cavity

One of the most important manifestations of peritonitis is the translocation of extracellular fluid into the peritoneal cavity

12

Celiac disease commonly presents in infancy as failure to thrive. It is an inappropriate t-cell mediated response and there is no cure for it. What is the treatment of choice for celiac disease?

a. Removal of protein from the diet
b. Removal of fat from the diet
c. Removal of gluten from the diet
d. Removal of sugar fromt he diet

c. Removal of gluten from the diet

The primary treatment of celiec disease consists of removal of gluten and related proteins from the diet. No other answer is correct.

13

One of the accepted methods of screening for colorectol cancer is testing for occult blood in the stool. Because it is possible to get a false positive result on these tests, you would instruct the client to do what?

a. Eat lots of red meat for three or four days before the test is done
b. Take 1000 mg of Vitamin C in supplement form for 1 week prior to testing.
c. Eat citrus fruits at least 5 times a day for 2 days prior to testing
d. Avoid nonsteroidal anti-inflammatory drugs for one week prior to testing

d. Avoid nonsteroidal anti-inflammatory drugs for one week prior to testing

To reduce the likelyhood of false positive tests, persons are instructed to avoid nonsteroidal anti-inflammatory drugs such as ibuprophen and aspirin for 7 days prior to testing, to avoid vitamin C in excess of 250 mg from either supplements or citrus fruits for 3 days before testing, and to avoid red meats for three days before testing. The other answers are incorrect.