Chapter 20 A Person-centred Approach to Assessing the Gastrointestinal System

55 year old Phyllis Green visits the general practitioners surgery with concerns about weight gain during menopause. Mrs Green asks the nurse for information concerning high-carbohydrate foods she should monitor in her diet. Which of the following recommendations by the nurse is most appropriate?
You just need to limit your sugar intake
After menopause there is little you can do to lose weight
Limiting fats, processed foods and sugars will assist you in your weight control efforts
Totally cut all carbohydrates from your diet
Mr Frankston attends the outpatient clinic every month for routine blood pressure and cholesterol testing. During the latest visit, Mr Frankston asks the nurse to describe the role of adipose tissue. The nurse explains that adipose tissue acts as an insulating layer to help reduce heat loss through the skin and it acts as a protective agent around the organs. From the following, which is the third primary function of adipose tissue in the human body the nurse should describe to Mr Frankston?
A source of thiamine
A concentrated source of fuel for cellular energy
A foundation for the construction of elastin in connective tissue
An inhibitor of clot formation
A principal function of the liver is bile production and the live cells make approximately 700-1200mL per day. During periods when bile is not required for digestion, where is it stored?
Stomach
Exocrine pancreas
Gallbladder
Liver
Mr Barry Gee, aged 45 years, visits the practice nurse complaining of recent bouts of constipation. During the discussion Mr Gee reports that he often suppresses the feeling of defecation. The nurse understands that the suppression of the defecation reflex may be voluntarily controlled by:
The internal sphincter
The spinal cord reflex
The rectum
The external sphincter
What will stimulation by sympathetic nervous system cause in the stomach and small intestine?
Decreased secretion activity
Increased bile production
Increased secretion activity
Increased peristalsis
The fundus, body, cardiac region and pylorus are all regions of which part of the gastrointestinal system?
Liver
Small intestine
Stomach
Gall bladder
Miss Penny Lowe, 22 years, has been having recent episodes of abdominal cramping and loose watery stools. What is the most appropriate question the nurse should ask this person regarding her recent changes in bowel elimination?
Do you wake up hungry during the night?
Have you noticed an increase in urination?
Do you have any difficulties understanding health information?
Have you travelled overseas recently?
When conducting a health assessment interview for Mr Gary Black's gastrointestinal system, what questions should the nurse ask to determine Mr Black's nutritional -metabolic pattern?
What exercise do you do and how often?
How does this problem make you feel about yourself?
How often do you have a bowel movement?
Have you noticed any change in your appetite recently?
In a busy emergency department Alex Thompson has presented with abdominal pain. During the assessment the triage nurse asks Alex to specify the location of his pain. He directs his hand to the right upper quadrant of his abdomen. Which gastrointestinal disorder does the triage nurse infer?
Cholecystitis
Obstruction of the colon
Diverticulitis
Constipation
Ms. Sally Lake attends her local general practice with complaints of recent weight gain. Which inquiry by the nurse will provide the most useful information to assist in the development of the plan of care?
Describe your normal diet, including alcohol intake during a 24 hour period
Is there a family history of obesity?
Have you always had a problem with your weight?
You do not appear to be maintaining a healthy weight
Mrs Abby Evans is scheduled for a Bernstein test. The nurse caring for Mrs Evans should instruct her that this test assists in distinguishing between:
Acute myocardial infarction and iron deficiency
Gastric acid reflux and cardiac disease
Asthma and gastric ulcers
Chronic obstructive pulmonary disease and Celiac disease
Mr Richard Brown is scheduled to undergo a liver biopsy. During the pre-procedural education, the nurse caring for Mr. Brown demonstrates exhaling and then holding the breath, as this action will need to be performed during the procedure. Mr Brown asks the nurse why this is being recommended. What explanation should the nurse provide?
The deep breath will increase the body's oxygen concentration during the testing process
This breathing techniques will lower the liver and facilitate the testing
Breathing in this manner will assist in relaxing during the procedure
The breathing technique will raise the liver and diaphragm
The nurse caring for Mrs Deana Watts, aged 78 years, suspects that she is experiencing stomach mucosa atrophy when Mrs Watts complains of:
Cramping
Angina
Vomiting
Stomach burning
Mr Jack Black, aged 71 years, visits the practice nurse after his wife notices that he is over seasoning his meals. What should the nurse explain to Mr Black?
As our body ages, our taste perception decreases
As our body ages, our taste perception increases
As our body ages our saliva production increases
As our body ages, we require a greater salt intake
88 year old Debra Davis is attending the outpatient clinic at the local acute care facility to discuss with the nurse that her ability to swallow is increasingly taking longer. As all other assessment results are unremarkable, the nurse identifies that the increase in swallow time is an age-related change due to which of the following:
A increase in production of hydrochloric acid
Less efficient use of cholesterol
A decrease in the pH of the stomach
A reduction in peristalsis
Mr. Simon Marshall a well and active 71year old, visits the practice nurse to have a laceration redressed on his forearm. During the visit he discusses concerns that his mouth always seems to be dry and as a result he finds eating unpleasant. What is the first action the nurse should take?
No action is indicated
Collect a saliva specimen for pathology testing for the presence of bacteria
Encourage Mr. Marshall to increase his fluid intake
Explain to Mr. Marshall this is an abnormal occurrence
When obtaining a health assessment the nurse discovers that Terry Ford has had a large proportion of his small bowel including the duodenum removed as a result of serious trauma. What concerns might the nurse have for his nutritional status?
Poor production of Vitamin D
Inadequate bile production
Malabsorption
Loose stools
During an abdominal assessment, the nurse palpates for rebound tenderness and identifies peritoneal inflammation. What assisted the nurse to make this diagnosis?
Pain when fingers are withdrawn and pressure released
Right upper quadrant pain
Left lower quadrant pain
No pain during examination
Mrs Bates has been admitted to hospital for rehydration therapy due to nausea and vomiting. During the abdominal assessment the nurse documents that bowel sounds are absent with a sudden increase in abdominal pain. What would be the immediate action of the nurse caring for Mrs Bates?
Administer anti-emetic medication as charted
Administer pain relief medication as charted
Document assessment findings and re-assess in 12 hours
Contact the medical officer as these findings may indicate a bowel obstruction
During an admission to the gastrointestinal ward the nurse performs an assessment of Mrs Lewis's oral cavity. The nurse detects the presence of white-coated tongue. What action should the nurse perform next?
Provide education on correct oral hygiene
Ask Mrs Lewis for information regarding her recent use of medications
Initiate a referral for a dietitian consultation
Review the medical record for any history of malignancy
Mr Blake Owen, aged 32 years, has attended an appointment with the practice nurse. During the oral assessment the nurse notices lesions on the corners of his mouth and Mr Owen reports that they're a very painful. Mr Owen asks the nurse what may be causing these lesions. How should the nurse respond?
The lesions may be caused by gingivitis
The lesions may be caused by a folic acid deficiency
The lesions may be caused by a riboflavin and or niacin deficiency
The lesions may be caused by an iron deficiency
Mr Stan Bates presents to the emergency department complaining of lethargy and during an inspection of Mr Stan Bates abdomen, the emergency nurse observes spider angiomas. What should the emergency nurse identify as the most likely cause of this finding?
Malnutrition
Liver disease
Obesity
An aortic aneurysm
Melaena is black, tarry stools characterised by an offensive smell due to the presence of blood as a result of an upper gastrointestinal bleed. This breakdown of the blood also accounts for the dark colouration. Which mineral may turn stools black and mask melaena?
Iron
Zinc
Phosphorus
Magnesium
Hayley Sherwood presents to her local general practice with a history of coeliac disease. This disorder results in the malabsorption of nutrients triggered by an autoimmune response. Which gastrointestinal organ does this auto immune response cause damage to?
The stomach
The liver
The large intestine
The small intestine
Mrs Stacey Green, aged 67 years is currently being treated with chemotherapy for cancer. Mrs is also receiving TPN and has developed stomatitis. The most appropriate nursing intervention for Mrs Green is to:
Assess and document condition of oral mucosa every 4-8 hours
Consult with oral health to determine optimal agent for treatment
Brush teeth with a soft toothbrush only once per day
Rinse her mouth with a gentle mouthwash four times a day
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