Unit2: Ch 37- Disorders of Gastrointestinal Function (Porth's 5th Ed) Flashcards
The nurse walks into a room and finds the patient forcefully expelling stomach contents
into a wash basin. When documenting this occurrence, the nurse will use the term
A) nauseous.
B) retching.
C) vomiting.
D) expatriate.
Ans: C
Feedback:
Vomiting or emesis is the sudden and forceful oral expulsion of the contents of the
stomach. It is usually preceded by nausea. Nausea is a subjective and unpleasant
sensation. Retching consists of rhythmic spasmodic movements of the diaphragm, chest
wall, and abdominal muscles. It usually precedes or alternates with periods of vomiting.
Expatriate means to banish or withdraw.
A middle-aged male walks into the emergency department complaining of chest pain
radiating to the neck, shortness of breath, and nausea. His heart rate is 120 and BP is
94/60. The ED physician recognizes the patient is having an acute MI with decreased
cardiac output. The nurse identifies the nausea to be in response to
A) the patient not having a very high pain tolerance.
B) hypoxia exerting a direct effect on the chemoreceptor trigger zone.
C) the patient not having digested his meal completely.
D) fear of having to make major lifestyle changes.
Ans: B
Feedback:
Hypoxia exerts a direct effect on the vomiting center (chemoreceptor trigger zone),
producing nausea and vomiting. This direct effect probably accounts for the vomiting
that occurs during periods of decreased cardiac output, shock, and environmental
hypoxia. We are given no information about the patient’s pain tolerance, when he last
had a meal, or his routine lifestyle. This patient is going into shock (rapid pulse, low
BP) that can result in shunting of blood away from the gut and other organs. During
shock, the priority organs for oxygenation include the heart, brain, lungs, and kidneys.
A female neonate has been in respiratory distress since delivery and is unresponsive to
oxygen therapy. Endoscopy has confirmed a diagnosis of esophageal atresia and
tracheoesophageal fistulae (EA/TEF). Which of the following explanations should the
care team provide to the infant’s parents?
A) “We will have to perform surgery to correct the hole in her throat to make sure
that she is able to swallow and breathe normally.”
B) “This problem will require respiratory therapy and supplementary feeding, but it
will likely resolve itself over time.”
C) “The biggest risk that your daughter will face until this is fixed is the danger of
malnutrition and dehydration.”
D) “The priority in our immediate treatment prior to her surgery will be pain
management, as the contents of her stomach can burn her lungs.”
Ans: A
Feedback:
EA/TFE necessitate surgery and preclude both normal respiration and swallowing.
Aspiration is the primary immediate risk and the priority for treatment. Although the
infant will require respiratory therapy to assist with proper tube placement and ventilator
maintenance, the only effective treatment is surgery. Aspiration of feeding (aspiration
pneumonia) is a major complication that can occur immediately and can be life
threatening. Maintaining an open airway and adequate gas exchange are the priority
nursing diagnoses for this infant.
A stroke patient is having difficulty swallowing food and beverages. The patient
complains that he feels like “the food is sticking to the back of his throat.” Given this
information, the priority nursing interventions would be to
A) make the patient “nothing per os” (NPO) and call the physician.
B) feed the patient while he is sitting in an upright position.
C) add a thickening agent to all of the patient’s beverages.
D) warrant no action since this is a normal occurrence after a stroke.
Ans: A
Feedback:
People with dysphagia usually complain of choking, coughing, or an abnormal sensation
of food sticking in the back of the throat or upper chest when they swallow. A
neuromuscular cause involves lesions of the CNS, such as a stroke, which often involve
the cranial nerves that control swallowing. Feeding in upright position is good once it is
determined by swallowing evaluation that the patient can swallow food without it going
into the lungs. Likewise, thickening agents help dysphagia patients after a swallow
evaluation has been performed. No action could put the patient at risk for aspiration
pneumonia.
A nurse practitioner is providing care for a male client with a long-standing hiatal
hernia. Which of the following statements most accurately captures an aspect of the
pathophysiology of hiatal hernias?
A) Paraesophageal hiatal hernias are common and are normally not treated if the
client is asymptomatic.
B) The root causes of hiatal hernias are normally treatable with medication.
C) If esophageal acid clearance is impaired, esophagitis can result.
D) An incompetent pyloric sphincter and high-fat diet are commonly implicated in
the development of hiatal hernias.
Ans: C
Feedback:
Erosive esophagitis can be a complication of hiatal hernias if esophageal acid clearance
is significantly impaired. Paraesophageal hiatal hernias are more serious than the sliding
variety and require treatment. The root cause of hiatal hernias, herniation of the stomach
through the diaphragm, is not normally amenable to treatment with medication. The
pyloric sphincter is not associated with hiatal hernias.
After several months of persistent heartburn, a 57-year-old female client has been
diagnosed with gastroesophageal reflux disease (GERD). Which of the following
treatment regimens is likely to best address the woman’s health problem?
A) Surgical correction of the incompetent pylorus
B) Antacids; avoiding positions that exacerbate reflux; a soft-textured diet
C) Weight loss and administration of calcium channel blocking medications
D) Proton pump inhibitors; avoiding large meals; remaining upright after meals
Ans: D
Feedback:
Proton pump inhibitors block the final stage of gastric acid production, effectively
controlling the root cause of the esophageal damage associated with GERD. The pylorus
is not involved, and a soft diet is not indicated. Calcium channel–blocking drugs would
not address the problem. Calcium channel blockers are primarily heart disease drugs
that relax blood vessels and increase the supply of blood and oxygen to the heart
while also reducing the heart’s workload.
Parents of a 20-month-old infant report that he refuses food or eats poorly and that he
grimaces when he swallows. He also is irritable and cries a lot. The mother is worried
that he ate something inappropriate this morning, because he vomited something that
looked like coffee grounds. Which of the following health problems would the care
team first suspect?
A) Rotavirus infection
B) Appendicitis
C) Esophagitis from gastrointestinal reflux
D) Hirschsprung disease
Ans: C
Feedback:
Esophagitis secondary to reflux can cause feeding problems, early satiety, and
hematemesis. Infants may demonstrate signs of pain when swallowing and may be
irritable and cry frequently. Rotavirus causes diarrhea and vomiting, but not the other
symptoms. Appendicitis is inflammation of the appendix. Appendicitis usually starts
with the main symptom of pain around the navel that moves to the lower right abdomen.
Hirschsprung disease is a blockage of the large intestine due to improper muscle
movement in the bowel. It is a congenital condition, which means it is present from
birth. In Hirschsprung disease, the nerves are missing from a part of the bowel. One
primary s/s is a failure to pass meconium shortly after birth.
68-year-old African American man who has smoked for at least 50 years reports that
lately he feels as though food is getting stuck in his throat. At first, this was a problem
just with dry food, but now his morning oatmeal is getting “stuck.” On questioning, he
reports drinking at least three alcoholic beverages nearly every day. His problem is most
likely
A) achalasia.
B) squamous cell carcinoma of the esophagus.
C) dysphagia secondary to scleroderma.
D) gastrointestinal reflux disease.
Ans: B
Feedback:
Squamous cell carcinoma of the esophagus is the seventh leading cause of cancer death
among men, particularly black men; mean age at diagnosis is 67 years. Alcohol and
tobacco use are the main risk factors for this cancer, and dysphagia is a common
presenting complaint. An esophageal motility disorder involves the smooth muscle layer
of the esophagus and the lower esophageal splincter (LES). Achalasia is characterized
by difficulty swallowing and regurgitation. GERD (gastroesophageal reflux disease) is
a condition that causes the esophagus to become irritated and inflamed. Clients with
GERD usually feel a burning in the chest or throat called heartburn. Sometimes, they
taste stomach fluid in the back of the mouth.
A male patient has just been diagnosed with esophageal cancer. He knew that he was
losing weight and fatigued most days, but he just attributed it to aging and working. The
physician recommends chemotherapy and irradiation. However, the cancer has already
metastasized. The patient asks the nurse what he can expect if he agrees to the
treatments. The nurse responds,
A) “The therapies may shrink the cancer.”
B) “The doctor is prescribing treatment measures to help you swallow better.”
C) “These therapies will most likely cure your cancer.”
D) “You need to talk with your physician some more. I will page him for you.”
Ans: A
Feedback:
The prognosis for people with cancer of the esophagus, although poor, has improved.
Even with modern forms of therapy, the long-term survival is limited because, in many
cases, the disease has already metastasized by the time the diagnosis is made. These
therapies may help with food consumption, but that is not their primary purpose. Nor,
will these therapies cure the cancer.
43-year-old male client has presented to the emergency department with vomiting that
he claims is of a sudden onset. The client also states that the emesis has often contained
frank blood in the hours prior to admission. His vital signs are stable with temperature
98.3°F, pulse 88, BP 140/87, and respiratory rate 18. Which of the following potential
contributing factors would the health care team suspect first?
A) Overuse of antacids
B) Alcohol consumption
C) Staphylococcal enterotoxins
D) Effects of Helicobacter pylori
Ans: B
Feedback:
Acute gastritis associated with alcohol use is characterized by intermittent vomiting and
the possibility of hematemesis. Aspirin and H. pylori do not normally cause such an
acute symptom onset, and infectious organisms do not normally cause bleeding of the
stomach lining. A combination of calcium carbonate and magnesium is commonly
found in antacids. Overdose of antacids can result in irregular heartbeat, poor balance,
shallow, rapid breathing and stupor (lack of alertness).
A patient has recently been diagnosed with H. pylori gastritis. The nurse knows that this
form of gastritis is usually treated with a combination of an antibiotic and
A) antianxiety medications.
B) proton pump inhibitors.
C) lactulose, to reduce the blood ammonia levels.
D) calcium carbonate, an antacid.
Ans: B
Feedback:
H. pylori is associated with an increased risk of gastric adenocarcinoma, gastric atrophy,
and peptic ulcer. It is less likely to contribute to IBD, esophagitis, or diverticular
disease. Eradication of H. pylori is difficult. Treatment requires a combination therapy
that includes the use of antibiotics and a proton pump inhibitor. The proton pump
inhibitors have direct antimicrobial properties against H. pylori. Antianxiety
medications will not kill the bacteria. H. pylori is not associated with elevated blood
ammonia levels. Calcium carbonate is usually given to relieve heartburn caused by
GERD.
Following a history of gastric pain and an endoscopy, a client has been diagnosed with a
duodenal peptic ulcer. Which of the following teaching points should his caregiver
provide?
A) “While your diet most certainly contributed to this problem, the good news is that
changing your diet can help solve it.”
B) “Ulcers like yours do not penetrate all layers of the stomach or duodenum, so you
don’t have to worry about losing too much blood.”
C) “Your family history, your smoking history, and NSAID use may all have
contributed to this problem.”
D) “While there aren’t really any effective medications for these ulcers, changes in
lifestyle can keep them well controlled.”
Ans: C
Feedback:
Family history, NSAID use, and smoking have all been identified as contributing factors
in the development of peptic ulcers. Diet therapy has not been shown to be effective,
and duodenal peptic ulcers are more common than the gastric variant. Perforation occurs
when an ulcer erodes through all layers of the stomach or duodenum wall. When
perforation occurs in older adults, their mortality is significantly increased. Effective
medication regimens are available with antacids, H2-receptor antagonists or proton
pump inhibitors being the most common medications used.
Which of the following clients is most clearly displaying the signs and symptoms of
irritable bowel disease (IBD)?
A) A 32-year-old mother who complains of intermittent abdominal pain that is worse
during her menstrual period
B) A 51-year-old male who states that his stomach pain is in his lower abdomen,
“comes and goes,” and “feels more like a cramp than a dull ache”
C) A 44-year-old man who works the evening shift at a factory and who states that
his lower abdominal pain is much worse at night than during the day
D) A 24-year-old man who has a stressful job but whose diarrhea and cramping do
not worsen during periods of high stress
Ans: B
Feedback:
IBD is commonly manifested as intermittent lower abdominal pain that feels like
cramping. Defecation normally relieves the pain, and symptoms are normally not
present at night or during sleep. Stress commonly exacerbates symptoms.
A 28-year-old man presents with complaints of diarrhea, fecal urgency, and weight loss.
His stool is light colored and malodorous, and it tends to float and be difficult to flush.
He has also noted tender, red bumps on his shins and complains of pain and stiffness in
his elbows and knees. Sigmoidoscopy reveals discontinuous, granulomatous lesions; no
blood is detected in his stool. Which of the following diagnoses would his care team
first suspect?
A) Crohn disease
B) Ulcerative colitis
C) Diverticulitis
D) Colon cancer
Ans: A
Feedback:
Crohn disease, like ulcerative colitis, causes diarrhea, fecal urgency, weight loss, and
systemic symptoms such as erythema nodosum and arthritis. Unlike ulcerative colitis, it
also causes steatorrhea but is not as likely to cause blood in the stool. The
granulomatous “skip” lesions confirm the diagnosis of Crohn disease. Neither
diverticulitis nor colon cancer would cause this combination of symptoms and signs.
A 20-year-old woman has visited her family physician due to occasional bouts of
bloody diarrhea over the past several weeks, a phenomenon that she experienced 2 years
prior as well. Her physician has diagnosed her with ulcerative colitis based on her
history and visualization of the affected region by colonoscopy and sigmoidoscopy.
Which of the following pathophysiological phenomena is most likely to underlie the
client’s health problem?
A) Fissures and crevices developing in the mucosa that are seen as a characteristic
“cobblestone” appearance
B) Erosion of the endothelial lining of the distal small intestine by a combination of
genetic, autoimmune, and environmental factors
C) Compromise of the mucosal layer of the large intestinal surface by the effects of
H. pylori
D) Mucosal hemorrhages that have developed into crypt abscesses, which have in
turn necrotized and ulcerated
Ans: D
Feedback:
The etiology and course of ulcerative colitis involves mucosal hemorrhages developing
into crypt abscesses, with consequent necrosis and ulceration. “Cobblestone”
appearance of intestinal mucosa is associated with Crohn disease. Ulcerative colitis is
confined to the colon and rectum, and H. pylori is not commonly implicated in the
etiology.
