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 autonomi
...
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. - ANSWER 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
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. - ANSWER 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
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. - ANSWER 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
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. - ANSWER 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
After gastric bypass surgery, the patient is getting vitamin B12 injections. The patient asks
about the purpose of this vitamin. The nurse explains that
a. vitamin B12 is needed for the formation of red blood cells.
b. vitamin B12 is needed to prevent a type of anemia.
c. vitamin B12 is essential for surgical wound healing.
d. vitamin B12 is always deficient in obese people. - ANSWER ANS: A
Vitamin B12 is absorbed in the terminal ileum in the presence of intrinsic factor produced in
the stomach. Vitamin B12 is essential in the formation of red blood cells. A deficiency of B12
does lead to anemia, but this answer is not as specific as stating the relationship of B12 to red
blood cells, so it is not as informative. Vitamins A and C are more essential for wound
healing. Obese people may or may not be deficient in this vitamin.
DIF: Cognitive Level: Understand/Comprehension REF: p. 482
OBJ: Review the anatomy and physiology of the gastrointestinal system.
TOP: Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
The nurse is assessing a patient admitted with pancreatitis. In doing so, the nurse
a. palpates the pancreas for size and shape.
b. emphasizes to the patient that pancreatic inflammation does not spread.
c. assesses symptoms that could indicate involvement of the stomach.
d. explains to the patient that back pain is not a sign of pancreatitis. - ANSWER ANS: C
Because the pancreas lies retroperitoneally, it cannot be palpated; this characteristic explains
why diseases of the pancreas can cause pain that radiates to the back. In addition, a
well-developed pancreatic capsule does not exist, and this may explain why inflammatory
processes of the pancreas can spread freely and affect the surrounding organs (stomach and
duodenum).
DIF: Cognitive Level: Apply/Application REF: p. 483
OBJ: Review the anatomy and physiology of the gastrointestinal system.
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity
The nurse is caring for a patient with liver disease. When assessing the patient's laboratory
values, the nurse should
a. disregard the level of conjugated bilirubin.
b. assess the total bilirubin
c. call the provider immediately if the direct bilirubin is elevated.
d. be aware that unconjugated bilirubin is harmless. - ANSWER ANS: B
Bilirubin enters the circulation bound to albumin and is unconjugated. This portion of the
bilirubin is reflected in the indirect serum bilirubin level. In the liver, bilirubin is conjugated
with glucuronic acid. Conjugated bilirubin is soluble and excreted in bile. Cirrhosis and
liver cancer decrease the liver's ability to conjugate bilirubin. Some conjugated bilirubin
returns to the blood and is reflected in the direct serum bilirubin level. The direct or
conjugated bilirubin is increased in liver failure. Total bilirubin is also measured and will
also be increased in liver failure. There is no need to call the provider for values only
slightly elevated. Unconjugated bilirubin is toxic to cells.
DIF: Cognitive Level: Understand/Comprehension REF: p. 484
OBJ: Review the anatomy and physiology of the gastrointestinal system.
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity
The liver plays a major role in homeostasis by
a. synthesizing factor I but not factor II.
b. synthesizing clotting factors without the need for vitamin K.
c. removing active clotting factors from the circulation.
d. synthesizing factor II but not factor I. - ANSWER ANS: C
The liver synthesizes fibrinogen (factor I); prothrombin (factor II); and factors VII, IX, and
X. Vitamin K is essential for the synthesis of other clotting factors. The liver also removes
active clotting factors from the circulation and therefore prevents clotting in the
macrovascular and microvascular.
DIF: Cognitive Level: Understand/Comprehension REF: p. 485
OBJ: Review the anatomy and physiology of the gastrointestinal system.
TOP: Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
The liver detoxifies the blood by
a. converting fat-soluble compounds to water-soluble compounds.
b. converting water-soluble compounds to fat-soluble compounds.
c. excreting fat-soluble compounds in feces.
d. metabolizing inactive toxic substances to active forms. - ANSWER ANS: A
Drugs, hormones, and other toxic substances are metabolized by the liver into inactive
forms for excretion. This process is usually accomplished by conversion of the fat-soluble
compounds to water-soluble compounds. They can then be excreted via the bile or the urine.
DIF: Cognitive Level: Understand/Comprehension REF: p. 485
OBJ: Review the anatomy and physiology of the gastrointestinal system.
TOP: Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
The patient is being admitted to the hospital. At home, the patient takes an over-the-counter
supplement of vitamin D and is concerned because the doctor did not order that vitamin D to
be given in the hospital. The nurse explains that
a. the body does not store vitamins so the doctor will have to be called.
b. the kidneys will produce enough vitamin D and that supplements are not needed.
c. over-the-counter supplements are never given in the hospital.
d. vitamin D is stored in the liver with a 10-month supply to prevent deficiency. - ANSWER ANS: D
The liver plays a central role in the storage, synthesis, and transport of various vitamins and
minerals. It functions as a storage depot principally for vitamins A, D, and B12, where up to
3-, 10-, and 12-month supplies, respectively, of these nutrients are stored to prevent
deficiency states. The kidneys do not produce vitamin D. Over-the-counter supplements are
ordered, depending on the patient's status.
DIF: Cognitive Level: Understand/Comprehension
OBJ: Review the anatomy and physiology of the gastrointestinal system.
TOP: Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
The nurse is caring for a patient with a heart rate of 140 beats/min. The provider orders
parasympathetic medications to slow down the heart rate. With this type of medication, the
nurse should
a. evaluate the patient for symptoms of constipation.
b. observe for diarrhea.
c. assess mucous membranes for signs of dryness.
d. expect decreased bowel sounds. - ANSWER ANS: B
Functions of the GI system are influenced by neural and hormonal factors. Parasympathetic
cholinergic fibers, or drugs that mimic parasympathetic effects, stimulate GI secretion and
motility.
DIF: Cognitive Level: Remember/Knowledge REF: p. 485
OBJ: Review the anatomy and physiology of the gastrointestinal system.
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity
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