Chapter 45: Care of the Patient with a Gastrointestinal Disorder

Cooper: Adult Health Nursing, 8th Edition

MULTIPLE CHOICE

1. The nurse clarifies that the end product of carbohydrate metabolism is absorbed and put into
the bloodstream by the:
a. gastric lining of the stomach.
b. villi of the small intestine.
c. bile of the liver in the large intestine.
d. excretion from the cecum.
ANS: B
The inner surface of the small intestine contains millions of tiny, fingerlike projections
called villi, which contain small blood vessels. They are responsible for absorbing the
products of digestion.

DIF: Cognitive Level: Comprehension REF: 1394 OBJ: 2

TOP: Digestive KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity

2. A 56 -year-old man is admitted to the emergency room with an acute attack of diverticulitis.
The patient has a temperature of 102°F, and has an elevated white count. Which assessment
would alert the nurse to impending septic shock?
a. Chest pain
b. Seizure
c. Tachycardia
d. Massive diarrhea
ANS: C
The patient with diverticulitis who has fever and an elevated white count has an infection
that could lead to septic shock, which will present as tachycardia and hypotension.

DIF: Cognitive Level: Comprehension REF: 1429 OBJ: 9

TOP: Diverticulitis KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity

3. Because bowel contents from an ileostomy are virtually liquid, what should the nurse
include in the plan of care?
a. Evaluation and assessment of dietary intake of fiber
b. Evaluation and assessment of patient cleanliness
c. Evaluation and assessment of peristomal skin integrity
d. Evaluation and assessment of the adequacy of the collection device
ANS: C
The nurse should assess the peristomal skin for impairment of integrity. The fecal material is
liquid and has a potential for severe skin excoriation from the digestive enzymes.

DIF: Cognitive Level: Application REF: 1424 OBJ: 8

 TOP: Ulcerative colitis KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity

4. The home health nurse caring for a patient who has dysarthria related to radiation therapy
for an oral cancer would recommend that the family provide:
a. a tablet and pencil as a communication aid.
b. a TV for diversion.
c. a bell to summon help.
d. a walkie-talkie.
ANS: A
The provision of an alternative method of communicating will lessen the frustration of the
patient who has trouble speaking understandably. The call bell would be helpful also, but
without a way to communicate, the bell is not as essential as a method of communication.

DIF: Cognitive Level: Application REF: 1402 OBJ: 5

TOP: Cancer of esophagus KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity

5. Which recommendation is most appropriate for a patient who has had an esophageal dilation
related to achalasia?
a. Consume only liquid.
b. Avoid fruit juices.
c. Drink 10 oz of fluid with each meal.
d. Lie down for 30 minutes after each meal.
ANS: C
The patient should drink fluid with each meal to increase lower esophageal pressure to push
food into the stomach.

DIF: Cognitive Level: Comprehension REF: 1406 OBJ: 5

TOP: Esophageal dilation KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

6. A patient who is being evaluated for episodes of hematemesis and dyspepsia tells the nurse
that pain occurs when he eats, but pain does not waken him. The nurse recognizes a
diagnostic sign of which condition?
a. Duodenal ulcer
b. Gastritis
c. Achalasia
d. Peptic ulcer
ANS: D
A significant subjective data assessment for a peptic ulcer is the patient report that pain is
associated with eating. With duodenal ulcers the patient often complains of pain 1 to 2 hours
after eating.

DIF: Cognitive Level: Knowledge REF: 1408 OBJ: 5

TOP: Peptic ulcer KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity
7. The nurse anticipates that the patient who has had a subtotal gastrectomy will need
supplemental:
a. protein due to the loss of some of the digestive processes.
b. vitamin B12 due to the loss of the intrinsic factor.
c. bulk to prevent constipation.
d. vitamin A due to the loss of the gastric lining.
ANS: B
It is recommended that all patients with a gastrectomy have a blood serum vitamin B12 level
measured every 1 to 2 years. Decreased absorption of vitamin B12 may cause pernicious
anemia.

DIF: Cognitive Level: Application REF: 1416 OBJ: 6

TOP: Gastrectomy KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity

8. The home health nurse is caring for a patient who has frequent bouts of diverticulitis
accompanied by increased flatulence, diarrhea, and nausea. Which of the following is the
most appropriate suggestion to lessen these symptoms?
a. Eat a diet high in fiber content.
b. Increase dietary fat intake.
c. Exercise to increase intraabdominal pressure.
d. Take daily laxatives.
ANS: A
The symptoms of diverticulitis can be reduced or prevented by eating a high-fiber diet,
reduction of meat and fats in the diet, and avoiding activities that increase intraabdominal
pressure. Although laxatives might be prescribed sparingly, daily laxatives are not
recommended.

DIF: Cognitive Level: Analysis REF: 1439 OBJ: 9

TOP: Diverticulitis KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance

9. The nurse caring for a patient with a peptic ulcer who has had a nasogastric tube inserted
notes bright blood in the tube; the patient complains of pain and has become hypotensive.
Which condition should the nurse recognize these as signs of?
a. Hiatal hernia
b. Gastritis
c. Perforation
d. Bowel obstruction
ANS: C
Perforation of the gastric wall causes pain, hypotension, and hematemesis. Immediate
reporting to the charge nurse/physician is essential as peritonitis, potentially lethal, is the
result of a perforation.

DIF: Cognitive Level: Analysis REF: 1408 OBJ: 5

TOP: Ulcer perforation KEY: Nursing Process Step: Assessment
 MSC: NCLEX: Psychosocial Integrity

10. Dumping syndrome after a Billroth II procedure occurs when high-carbohydrate foods are
ingested over a period of less than 20 minutes. What would the nurse suggest to reduce the
risk of dumping syndrome?
a. Eating a high-carbohydrate diet
b. Drinking 10 oz of fluids with meals
c. Remaining upright for 2 hours after meals
d. Eating six small daily meals high in protein and fat
ANS: D
Treatment for dumping syndrome includes eating six small meals daily that are high in
protein and fat, and low in carbohydrates. Fluids should be avoided during meals. If
possible, the patient should lie down for 1 hour after meals.

DIF: Cognitive Level: Analysis REF: 1416 OBJ: 4

TOP: Dumping syndrome KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity

11. The patient has come to the PACU following an ileostomy for the treatment of ulcerative
colitis. The patient is conscious and has a nasogastric tube in place and a pouch over the
stoma. What should be the nurse’s initial action?
a. Turn patient to right side.
b. Give patient ice chips to moisten mouth.
c. Attach NG tube to suction.
d. Irrigate NG tube.
ANS: C
Initially, the NG tube should be attached to suction to decompress the stomach and prevent
nausea. Assessing the tube for the need of future irrigation will be part of the postoperative
care.

DIF: Cognitive Level: Application REF: 1425 OBJ: 4

TOP: Appendicitis KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity

12. The home health nurse evaluates a patient being treated for a peptic ulcer with Riopan
(antacid) and famotidine (histamine receptor blocker). Which statement made by the patient
indicates a need for further instruction?
a. “I know famotidine will not interfere with my Coumadin.”
b. “I take the Riopan at least 2 hours after any of my other drugs.”
c. “Boy! That Riopan keeps my stomach happy!”
d. “I take both those meds at the same time every morning.”
ANS: D
Antacids should not be taken with other drugs, because the absorption of the other drugs
may be affected.

DIF: Cognitive Level: Analysis REF: 1410 TOP: Pharmacology

KEY: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity
13. What should a nurse do when obtaining a stool specimen to be examined for ova and
parasites?
a. Use an oil retention enema to facilitate collection.
b. Refrigerate the specimen immediately.
c. Obtain three different stool specimens on subsequent days.
d. Check the specimen for the presence of occult blood.
ANS: C
Diagnosing a parasitic infection requires three different stool specimens on subsequent days.
Use only normal saline or tap water enemas to prevent alteration of results.

DIF: Cognitive Level: Knowledge REF: 1417 OBJ: 3

TOP: Diagnostic studies KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

14. The nurse explains to the patient with Crohn disease that the tube feedings allow for:
a. rapid absorption in the upper GI tract.
b. decompression of the stomach.
c. reduction of diarrheic episodes.
d. a permanent nutritional support.
ANS: A
The tube feedings allow for rapid absorption of the nutrients in the upper GI tract. The tube
feedings are not permanent and will be followed by oral intake of a low-residue, high-
protein, high-calorie diet.

DIF: Cognitive Level: Comprehension REF: 1427 OBJ: 7

TOP: Crohn disease KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

15. A patient with a large inguinal hernia has abdominal distention and inguinal pain. The nurse
recognizes these as indicators of which type of hernia?
a. Strangulated
b. Hiatal
c. Ventral
d. Umbilical
ANS: A
The hernia is strangulated when the blood supply and intestinal flow are occluded, which
results in pain and distention.

DIF: Cognitive Level: Knowledge REF: 1432 OBJ: 10

TOP: Inguinal hernia KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity

16. A patient with a ruptured diverticulum in the descending colon has undergone a transverse
loop colostomy. The patient is upset and says, “I didn’t know it was going to be this awful. I
hate this!” Which response made by the nurse would be most helpful?
a. “This is a temporary solution. It will be closed in 6 weeks.”
 b. “This seems awful now, but you won’t have the problems you had before.”
c. “If everything goes well the surgeon can close this colostomy in about a year.”
d. “With the appropriate pouch and loose clothing, no one will notice a thing.”
ANS: A
The loop colostomy is a temporary colostomy that allows for complete bowel rest. It can be
closed in as short a time as 6 weeks.

DIF: Cognitive Level: Analysis REF: 1430 | 1437 OBJ: 8

TOP: Diverticulum KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity

17. A male patient complains that he will never adjust to his colostomy. Which is the best action
for the nurse in this situation?
a. Encourage him to express his concern.
b. Suggest that he discuss his concerns with his physician.
c. Counsel him that everything will be all right.
d. Assure him that his concerns will diminish when he is able to care for his
colostomy.
ANS: A
When a colostomy is performed, the patient or significant other should be able to verbalize
and demonstrate understanding of ostomy care to the nurse.

DIF: Cognitive Level: Analysis REF: 1430 OBJ: 8

TOP: Colostomy KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity

18. In caring for a patient with gastric bleeding who has a nasogastric tube in place, the nurse
should include in the plan of care to ensure that the NG tube is:
a. clamped for 10 minutes every hour.
b. kept patent with irrigation.
c. frequently repositioned to the opposite nostril.
d. changed every 72 hours.
ANS: B
Irrigating the NG tube PRN will keep the tube patent and ensure effective decompression.

DIF: Cognitive Level: Application REF: 1435 OBJ: 4

TOP: NG tube KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

19. What should the nurse include in a teaching plan for a patient with a hiatal hernia to reduce
the frequency of heartburn?
a. Drinking 10 oz of milk with every meal
b. Lie down after eating
c. Panting through mouth when symptoms begin
d. Eating small meals
ANS: D
 Taking care not to overeat is the best defense again pyrosis (heartburn) for the person with a
hiatal hernia.

DIF: Cognitive Level: Knowledge REF: 1433 OBJ: 10

TOP: Hiatal hernia KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

20. The nurse points out which of the following as an example of a nonmechanical bowel
obstruction?
a. A paralytic ileus
b. Narrowed bowel lumen from an inflammatory process
c. Tumor of the bowel
d. Fecal impaction
ANS: A
A nonmechanical bowel obstruction can be caused by a paralytic ileus.

DIF: Cognitive Level: Comprehension REF: 1433 OBJ: 4

TOP: Cancer KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity

21. Bowel sound assessment on a patient with an obstruction who has distention, nausea, and
visible peristaltic waves would be:
a. loud and clearly audible.
b. high pitched.
c. hyperactive.
d. absent.
ANS: B
Because there are visible peristaltic waves, there will be bowel sounds that will be faint and
high pitched.

DIF: Cognitive Level: Comprehension REF: 1434 OBJ: 11

TOP: Bowel obstruction KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity

22. The patient with a peptic ulcer has been placed on regular doses of bismuth salicylate
(Pepto-Bismol) to combat Helicobacter pylori. What color will this drug turn the stool?
a. Gray-black
b. Dark green
c. Red-orange
d. Yellow
ANS: A
Bismuth products turn the stool gray-black.

DIF: Cognitive Level: Knowledge REF: 1410 OBJ: 4

TOP: Shock KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity
23. Which of the following should be included in the patient teaching of a patient with a peptic
ulcer?
a. Introducing irritating foods in minute amounts to desensitize the stomach
b. Restricting fluid to 1000 mL per day
c. Eating 6 small meals a day
d. Drinking alcohol and caffeine in moderation
ANS: C
The patient with a peptic ulcer should eat frequently to keep food in the stomach. Eating 6
small meals daily is helpful. Restriction of fluid is not necessary and irritating foods,
alcohol, and caffeine should be discouraged.

DIF: Cognitive Level: Analysis REF: 1409 OBJ: 4

TOP: Peptic ulcer KEY: Nursing Process Step: Planning
MSC: NCLEX: Health Promotion and Maintenance

24. Which of the following would be the most helpful nursing intervention to increase the
comfort of a patient with appendicitis?
a. Application of ice bag
b. Administration of small tap water enema
c. Warm compress over entire abdomen
d. Ambulate for short periods in the room
ANS: A
Application of an ice bag will decrease the flow of blood to the area and impede the
inflammatory process.

DIF: Cognitive Level: Application REF: 1428 OBJ: 9

TOP: Appendicitis KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

25. To assist a family with a bowel-training program to reduce fecal incontinence, the nurse
would suggest the use of a ___________ at an optimal time to stimulate defecation.
a. warm bath
b. a tap water enema
c. glycerin suppository
d. large glass of warm lemonade
ANS: C
The use of a glycerin suppository for fecal stimulation is a helpful aid in a bowel-training
program. The suppository is administered at what the family and patient have determined is
the optimal time for a bowel movement.

DIF: Cognitive Level: Comprehension REF: 1441 OBJ: 13

TOP: Bowel training KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

26. What is the most lethal complication of a peptic ulcer?

a. Bleeding
b. Perforation
 c. Severe pain
d. Gastric outlet obstruction
ANS: B
Perforation is considered the most lethal complication of peptic ulcer. Bleeding may occur
when the ulcer erodes into a blood vessel; however, perforation occurs when the ulcer crater
penetrates the entire thickness of the wall of the stomach or duodenum. Gastric outlet
obstruction can occur at any time and can be relieved by NG aspiration of stomach contents.

DIF: Cognitive Level: Comprehension REF: 1408 OBJ: 4

TOP: Disorders of the stomach KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity

27. The nurse takes into consideration that a proton pump inhibitor drug, such as
______________, will completely eradicate gastric acid production.
a. omeprazole (Prilosec)
b. ranitidine (Zantac)
c. sucralfate (Carafate)
d. olsalazine (Dipentum)
ANS: A
Omeprazole (Prilosec) is a proton pump inhibitor that interferes with the production of
gastric acid.

DIF: Cognitive Level: Comprehension REF: 1409 OBJ: 4

TOP: Disorders of the stomach KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity

28. Which of the following is the purpose of antibiotic therapy in treating peptic ulcers?
a. It eradicates H. pylori.
b. It inhibits gastric acid secretion.
c. It protects the gastric mucosa.
d. It neutralizes or reduces the acidity of stomach contents.
ANS: A
Antibiotic therapy eradicates H. pylori.

DIF: Cognitive Level: Knowledge REF: 1409 OBJ: 4

TOP: Peptic ulcer KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity

29. Why are peptic ulcers a common problem of aging?

a. Because of overuse of antibiotics
b. Because of overuse of antacids
c. Because of overuse of NSAIDs
d. Because of overuse of laxatives
ANS: C
Medications such as aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) taken for
arthritis or degenerative joint conditions may contribute to ulcer formation.
 DIF: Cognitive Level: Comprehension REF: 1433 OBJ: 4
TOP: Disorders of the stomach KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity

30. The patient with irritable bowel syndrome tells the home health nurse she is going to an
acupuncturist for therapy for her condition. Which of the following would be the best
nursing response?
a. “Go for it. Alternative medicine does great things.”
b. “YIKES! An acupuncturist?”
c. “It may help, but there has been no clinical proof of its effectiveness.”
d. “You should confirm that the acupuncturist is licensed.”
ANS: C
While it is true that some have found relief, there is no evidence that these therapies relieve
the symptoms of IBS.

DIF: Cognitive Level: Comprehension REF: 1420

TOP: Alternative therapy KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

31. The nurse uses a poster to show the process of bowel obstruction from diverticulitis. What is
the third sequential pathophysiologic event?
a. Increase in intraabdominal pressure
b. Weakened wall of sigmoid
c. Pouch fills with fecal matter
d. Pouch protrudes through smooth muscle
e. Narrowing of bowel lumen
f. Inflammation of diverticula
ANS: D
Bowel obstruction from diverticulitis follows a sequential path: The wall of the bowel is
weakened (usually the sigmoid), increase in abdominal pressure from such activities as
bending and carrying heavy loads causes a pouch to protrude through the smooth muscle of
the colon, the pouch fills with fecal matter, becomes inflamed, and narrows the lumen of the
bowel causing obstruction.

DIF: Cognitive Level: Analysis REF: 1428-1429 OBJ: 9

TOP: Bowel obstruction KEY: Nursing Process Step: Planning
MSC: NCLEX: Health Promotion and Maintenance

32. Celiac sprue in the adult can lead to systemic problems. What is the last pathophysical event
of this in order of appearance?
a. Malabsorption
b. Weight loss/vitamin deficiency
c. Systemic involvement
d. Diarrhea
e. Ingestion of gluten
f. Destruction of villi in the small intestine
ANS: C
 The ingestion of gluten in the small intestine damages the villi, which leads to
malabsorption and diarrhea. Weight loss and vitamin deficiency, which occur from altered
nutrition, can expand into systemic involvement.

DIF: Cognitive Level: Analysis REF: 1419 OBJ: 4

TOP: Celiac sprue KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity

MULTIPLE RESPONSE

1. Which of the following are indicators of colorectal cancer? (Select all that apply.)
a. Constant diarrhea
b. Excessive flatulence
c. Cachexia
d. Cramps
e. Rectal bleeding
f. Anemia
ANS: B, C, D, E, F
The indicators for colorectal cancer are changing bowel habits between diarrhea and
constipation, flatulence, cachexia, cramps, rectal bleeding, and anemia.

DIF: Cognitive Level: Analysis REF: 1432 OBJ: 12

TOP: Colorectal cancer KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

2. How should the nurse counsel the 34-year-old woman who has been prescribed
sulfasalazine (Azulfidine) for Crohn disease? (Select all that apply.)
a. Expose her to sunlight at least 30 minutes a day for vitamin D synthesis.
b. Tell her to drink at least 1500 mL of fluid a day.
c. Advise assessing self for rash.
d. Use alternate birth control methods to oral contraception.
e. Take drug on an empty stomach.
ANS: B, C, D
Cautionary information about sulfasalazine (Azulfidine) would include having adequate
fluid intake to prevent crystallization in the kidneys, avoiding exposure to the sun, and using
alternate birth control methods as oral contraception is made unreliable by this drug. The
drug should be taken with meals and the patient should be assessing for rash.

DIF: Cognitive Level: Analysis REF: 1411 OBJ: 7

TOP: Crohn disease KEY: Nursing Process Step: Planning
MSC: NCLEX: Safe, Effective Care Environment

3. In designing a teaching plan to present to a group of older adults regarding the prevention of
esophageal cancer, the nurse would include information about the significance of: (Select all
that apply.)
a. cessation of smoking.
b. good oral care.
 c. regular checkups if dysphagia is present.
d. reducing excessive weight.
e. limiting alcohol consumption.
f. reduction of consumption of citrus fruits.
ANS: A, B, C, E
Preventive measures include cessation of smoking and alcohol consumption, good oral care,
and medical evaluation of dysphagia. Weight and reduction of citrus fruits are
noncontributory to prevention of esophageal cancer.

DIF: Cognitive Level: Application REF: 1404-1405 OBJ: 6

TOP: Esophageal cancer KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance

4. Which activities should the home health nurse suggest to an elderly patient to avoid
constipation? (Select all that apply.)
a. Schedule toileting after meals
b. Taking bulk-forming laxatives
c. Increasing fiber intake
d. Drinking at least 1000 mL fluid
e. Taking a daily stool softener
f. Using tap water enemas for persons with altered mobility
ANS: A, B, C, D
Inactivity and changes in diet and fluid intake can contribute to constipation. A nutritional
diet high in fiber and bulk-forming foods can promote normal elimination. Increasing fluids
to 8 to 10 glasses per day will be beneficial in preventing constipation. A daily bowel
routine will also benefit elimination. Use of daily stool softeners is no longer recommended
for the older adult. Tap water enemas for persons with altered mobility are helpful.

DIF: Cognitive Level: Analysis REF: 1425 OBJ: 4

TOP: Disorders of intestine KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

5. The home health nurse is caring for a patient who has frequent abdominal pain and diarrhea.
The nurse uses the Rome Criteria to direct assessment for irritable bowel syndrome. What is
included in the Rome Criteria? (Select all that apply.)
a. Discomfort at least 3 days a month
b. Blood in stool
c. Pain relieved by defecation
d. Excessive flatulence
e. Nausea and vomiting associated with onset
f. Onset associated with change in stool consistency or frequency
ANS: A, C, F
The Rome Criteria include that the patient experience discomfort at least 3 days a month
within the last 3 months, pain relieved by defecation, onset associated with change in stool
frequency, and onset in association with a change in stool appearance. Although increased
flatus is associated with diverticulitis, it is not part of the Rome Criteria.
 DIF: Cognitive Level: Application REF: 1420 OBJ: 5
TOP: Rome Criteria KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity

COMPLETION

1. Flexible sigmoidoscopy should be performed every ________ years.

ANS:
5
five

Flexible sigmoidoscopy should be performed every 5 years. Endoscopy of the lower GI tract
allows visualization and, if indicated, access to obtain biopsy specimens of tumors, polyps,
or ulcerations of the anus, rectum, and sigmoid colon. The lower GI tract is difficult to
visualize radiographically, but sigmoidoscopy allows direct visualization.

DIF: Cognitive Level: Knowledge REF: 1436 OBJ: 3

TOP: Screening for colorectal cancer KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity

2. The nurse explains that ___________, the chief enzyme of gastric juice, is activated by
hydrochloric acid to begin digestion of protein.

ANS:
pepsin

Pepsin is activated by the hydrochloric acid to break down protein for digestion.

DIF: Cognitive Level: Knowledge REF: 1393 OBJ: 2

TOP: Pepsin KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

3. The nurse caring for a patient with Crohn disease will closely monitor the urinary output to
ensure that the patient is excreting at least _______ mL/day.

ANS:
1500

The output of 1500 mL a day indicates good kidney perfusion. The disease allows such
dramatic fluid loss that a constant watch on I&O is a major nursing intervention.

DIF: Cognitive Level: Comprehension REF: 1443 OBJ: 7

TOP: Crohn disease KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity

4. The nurse takes into consideration that long-term use of antibiotics can cause an antibiotic-
associated pseudomembranous colitis from the organism ________.
 ANS:
Clostridium difficile

C. difficile causes a type of colitis from long-term antibiotic use to which older adults are
extremely susceptible.

DIF: Cognitive Level: Knowledge REF: 1417 OBJ: 4

TOP: C. difficile KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity

5. Due to frequent bouts of constipation, the nurse examines the bedfast nursing home resident
for ulceration of the anus, called anal __________________.

ANS:
fissure

Ulceration and laceration of the anal skin can occur because of overstretching with the
passing of constipated stool.

DIF: Cognitive Level: Knowledge REF: 1440 OBJ: N/A

TOP: Anal fissure KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity