Chapter 9: GI

Question 1

1. If a patient with multiple sclerosis starts coughing frequently during meals and starts to eat significantly less food than normal, the patient may have
   a. pneumonia.
   b. gastroesophageal reflux disease.
   c. peptic ulcer.
   d. dysphagia.

Answer 1

ANS: D
Patients with multiple sclerosis may develop dysphagia; coughing during meals and eating less than usual are common symptoms. Dysphagia may cause pneumonia if food enters the lungs and causes infection. Gastroesophageal reflux disease causes burning and pain but typically not coughing. Peptic ulcer causes intestinal pain but not coughing.

Question 2

4. The most acute risk for patients with dysphagia is
   a. constipation.
   b. dehydration.
   c. dry mouth.
   d. panic attacks.

Answer 2

ANS: B
An acute daily concern for patients with dysphagia is dehydration. Patients are not usually allowed to drink fluids without supervision, and so fluid intake must be monitored throughout the day. Constipation and dry mouth may occur with poor fluid and food intake but are less acute. Patients with dysphagia may experience feelings of panic, but this is not the most acute concern.

Question 3

5. The most helpful recommendation for a client who often experiences heartburn at night would be to
   a. avoid eating within 4 hours of going to bed.
   b. increase the fiber content of the diet.
   c. decrease the fiber content of the diet.
   d. take antacid medications before going to bed.

Answer 3

ANS: A
Gastroesophageal reflux disease (GERD) usually occurs 1 to 4 hours after eating; therefore, waiting at least 4 hours after eating before going to bed would help prevent heartburn at night. Antacid medications may be helpful but should not be used on a regular basis before other strategies have been tried. Fiber content of the diet does not affect heartburn

Question 4

6. An example of a meal that is likely to relax the lower esophageal sphincter and allow gastroesophageal reflux is
   a. pasta with marinara sauce and sourdough bread.
   b. ham with rice pilaf.
   c. fried chicken and pasta salad.
   d. chicken and spinach tortilla wrap and salsa.

Answer 4

ANS: C
High-fat foods and beverages relax the lower esophageal sphincter (allowing stomach contents to back up). Both fried chicken and pasta salad are high in fat and would exacerbate gastroesophageal reflux. The other meals are relatively low in fat and would be much less likely to cause reflux.

Question 5

10. An appropriate meal for someone with dumping syndrome would be
    a. a small vanilla milkshake.
    b. cream of mushroom soup.
    c. half a turkey sandwich.
    d. popcorn and sugar-free soda.

Answer 5

ANS: C
Individual tolerances vary, but the turkey half-sandwich would probably be tolerated best. Half a sandwich is probably small enough not to cause symptoms. A milkshake is high in sugar and probably too cold. Cream of mushroom soup is probably too hot, and liquids should be taken between rather than with meals. The carbonation in the soda may increase gastrointestinal distention because of gas.
11. If a patient has

Question 6

11. If a patient has esophagitis and also has worn tooth enamel, he or she may have
    a. a hiatal hernia.
    b. fluoride deficiency.
    c. an eating disorder.
    d. gastroesophageal reflux disease.

Answer 6

ANS: C
The eating disorder bulimia nervosa causes esophagitis and eroded tooth enamel because of the effects of stomach acid being vomited back into the esophagus and mouth. A hiatal hernia and GERD may cause esophagitis, but stomach contents would enter only the esophagus, not the mouth, and so the teeth would not be worn. Fluoride deficiency may cause loss of tooth enamel but would not cause esophagitis.

Question 7

15. For patients with inflammatory bowel disease, nutrition therapy is
    a. the primary mode of treatment.
    b. rarely necessary.
    c. an important adjunct to drugs and surgery.
    d. highly specialized.

Answer 7

ANS: C
Nutrition therapy is important to help maintain nutritional status of patients with inflammatory bowel disease, but is used in conjunction with drug and surgical treatments; it is not the primary mode of treatment. Nutrition therapy is often needed to maintain weight and micronutrient status

Question 8

16. Because patients with active Crohns disease have intestinal inflammation, they benefit from high intake of
    a. fat.
    b. dietary fiber.
    c. simple sugars.
    d. protein.

Answer 8

ANS: D
Patients with inflammatory bowel disease benefit from a diet high in protein to compensate for malabsorption. Fat intake should be moderate to provide adequate kilocalories within a healthful diet; high fat intake may cause steatorrhea. Dietary fiber may irritate the inflamed gut. Simple sugars provide a readily digested and absorbed source of energy but no other nutrients.

Question 9

17. Patients with inflammatory bowel disease may benefit from a high-fiber diet during
    a. acute episodes.
    b. times of remission.
    c. recovery from surgery.
    d. preparation for surgery.

Answer 9

ANS: B
A high-fiber diet may help stimulate peristalsis during times of remission in patients with inflammatory bowel disease. During acute episodes, the diet should be low in fiber and should promote bowel rest. In general, the diet should be high calorie, high protein, and nutrient dense to compensate for malabsorption.

Question 10

21. If a patient has had a large portion of their small intestine removed because of cancer and is unable to maintain a stable weight, a feeding regimen that would be most appropriate is
    a. enteral feedings into the stomach.
    b. enteral feedings into the jejunum.
    c. parenteral nutrition only.
    d. supplemental parenteral nutrition.

Answer 10

ANS: D
Patients who have undergone removal of large portions of the small intestine and are unable to maintain their weight should receive supplemental parenteral nutrition. Enteral feedings would not be more effective than oral feedings because these patients have a limited amount of gut to absorb the nutrients. Parenteral nutrition should not be used alone because some oral feeding helps stimulate recovery of gut function and maintain gut integrity.

Question 11

23. The best way to prevent formation of diverticula in the colon is to
    a. eat plenty of fruits, vegetables, and whole grains.
    b. avoid foods with rough hulls, such as nuts and seeds.
    c. use stool softeners to promote daily bowel movements.
    d. avoid foods that cause gas and increase pressure in the colon.

Answer 11

ANS: A
Diverticula are caused by high pressure in the colon, often in association with straining to have a bowel movement; they can be prevented by intake of high-fiber foods, such as fruits, vegetables, and whole grains. There is no evidence that nuts, seeds, or other foods with hulls increase risk of diverticula. Using stool softeners to promote daily bowel movements may help prevent diverticula, but eating a high-fiber diet is preferable because of other nutritional benefits. Foods that cause gas are not associated with formation of diverticula.

Question 12

1. Where in the brain is the vomiting center located?
   a. Hypothalamus c. Pons
   b. Medulla oblongata d. Midbrain

Answer 12

ANS: B
The vomiting center of the brain lies in the medulla oblongata. The other locations listed are not related to vomiting.

Question 13

2. Antiemetic agents, such as domperidone and haloperidol, are antagonists for which receptors?
   a. 5-Hydroxytryptamine (5-HT) serotonin
   b. Histamine-2
   c. Acetylcholine
   d. Dopamine

Answer 13

ANS: D
Metoclopramide, domperidone, and haloperidol are dopamine antagonists, making them effective antiemetic agents. This selection is the only option that identifies a receptor that is involved in the process of vomiting.

Question 14

9. Which statement is false concerning how abdominal pain is produced?
   a. Chemical mediators, such as histamine, bradykinin, and serotonin, produce abdominal pain.
   b. Edema and vascular congestion produce abdominal pain by stretching.
   c. Ischemia, caused by distention of bowel obstruction or mesenteric vessel thrombosis, produces abdominal pain.
   d. Low concentrations of anaerobes, such as Streptococci, Lactobacilli, Staphylococci, Enterobacteria, and Bacteroides, produce abdominal pain.

Answer 14

ANS: D
Low concentrations of anaerobes are not typically a cause of abdominal pain.

Question 15

13. What is the cause of functional dysphagia?
    a. Intrinsic mechanical obstruction c. Tumor
    b. Extrinsic mechanical obstruction d. Neural or muscular disorders

Answer 15

ANS: D
Neural or muscular disorders that interfere with voluntary swallowing or peristalsis cause functional dysphagia. This selection is the only option that accurately identifies a cause of functional dysphagia.

Question 16

18. What are the cardinal symptoms of small intestinal obstruction?
    a. Constant, dull pain in the lower abdomen relieved by defecation
    b. Acute, intermittent pain 30 minutes to 2 hours after eating
    c. Colicky pain caused by distention, followed by vomiting
    d. Excruciating pain in the hypogastric area caused by ischemia

Answer 16

ANS: C
Of the options available, only colicky pain caused by distention followed by vomiting are considered the cardinal symptoms of a small intestinal obstruction.

Question 17

39. Which hormones are natural appetite suppressants? (Select all that apply.)
    a. Insulin
    b. Cortisol
    c. Galanin
    d. Calcitonin
    e. Serotonin

Answer 17

ANS: A, D, E
Insulin, calcitonin, and serotonin are natural appetite suppressants, whereas cortisol and galanin are natural appetite stimulants.

Question 18

5. Food enters the stomach via which sphincter?
   a. Cardiac c. Gastric
   b. Upper esophageal d. Fundal

Answer 18

ANS: A
Each end of the esophagus is opened and closed by a sphincter. The upper esophageal sphincter (cricopharyngeal muscle) prevents entry of air into the esophagus during respiration. The lower esophageal sphincter (cardiac sphincter) prevents regurgitation from the stomach. The lower esophageal sphincter is located near the esophageal hiatus—the opening in the diaphragm where the esophagus ends at the stomach. The cardiac sphincter is the only option that fulfills the function described in the question

Question 19

6. Which gastric cells secrete hydrochloric acid and intrinsic factor?
   a. Parietal c. G
   b. Chief d. H

Answer 19

ANS: A
Of the available options, only the parietal cells (oxyntic cells) secrete hydrochloric acid and intrinsic factor.

Question 20

7. Which cells in the stomach secrete histamine?
   a. Oxyntic c. D
   b. Chief d. Enterochromaffin-like

Answer 20

ANS: D
Of the available options, only enterochromaffin-like cells secrete histamine.

Question 21

11. Exposure to which substance protects the mucosal barrier of the stomach?
    a. Prostaglandins c. Helicobacter pylori
    b. Aspirin d. Regurgitated bile

Answer 21

ANS: A
Prostaglandins and enterogastrones, such as gastric inhibitory peptide, somatostatin, and secretin, inhibit acid secretion. This selection is the only option that accurately identifies a substance that protects the mucosal barrier of the stomach.

Question 22

S&S of diverticulitis

Answer 22

fever, nausea, achy pain, occult blood, tender abdominal mass, pericolonic fat stranding (abnormal increase in fat attenuation)

Question 22

Why does diverticulitis occur?

Answer 22

weak muscularis layer/abnormal connective tissue, high pressure gradient between colon/peritoneal space d/t increased pressure needed to propel stool (low fiber)

Question 23

layers of the GI tract.

Answer 23

mucosa - innermost, produces mucus, high cell turnover rate

submucosa - connective tissue (blood vessels, nerves, lymph, secretory glands)

muscular - circular, then longitudinal (allows for peristalsis)

serosa - outer layer that connects to other structures

Question 24

Cranial nerves involved in swallowing

Answer 24

trigeminal (V), glossopharyngeal (IX), vagus (X)

Question 25

parts of the stomach

Answer 25

top to bottom = lower esophageal sphincter --> fundus --> body --> pyloris --> pyloric sphincter

Question 26

S&S of ulcerative colitis

Answer 26

n/v/diarrhea (bloody), tenesmus (defecation urgency), proctitis (inflammation of rectum), cramping, weight loss, diffuse colon inflammation

Question 27

S&S of cholecystitis

Answer 27

RUQ pain (especially after fatty foods) and tenderness, nausea, fever,

Question 28

factors that increase likelihood of cholelithiasis or cholecystitis

Answer 28

obesity, high fat diet, high levels of estrogen (cholesterol concentration of bile and decrease gallbladder motility) -- premenopausal women Fat Female Forty Fertile

Question 29

Risk factors for peptic ulcer disease (PUD)

Answer 29

NSAID ingestion, smoking, psychologic stress, H pylori infection = diminish mucosal protection

Question 30

cause/patho of a gastric ulcer

Answer 30

excess acid or decreased mucosal defense = stomach lining erosion

Question 31

1. A major complication of persistent gastroesophageal reflux is: A) strictures. B) heartburn. C) chest pain. D) hoarseness.

Answer 31

A) strictures.

Question 32

2. Acute gastritis refers to a transient inflammation of the gastric mucosa that is most commonly associated with: A) diarrhea. B) food allergies. C) gastric reflux. D) alcohol intake.

Answer 32

D) alcohol intake.

Question 33

3. The Helicobacter pylori protobacteria cause peptic ulceration by producing: A) acids B) toxins C) ischemia D) bleeding

Answer 33

B) toxins

Question 34

4. A hallmark of irritable bowel syndrome is abdominal pain: A) relieved by defecation. B) most severe at night. C) with blood in the stool. D) after and between meals.

Answer 34

A) relieved by defecation.

Question 35

5. Inflammatory bowel diseases are accompanied by systemic manifestations that include: A) autoimmune anemia. B) rheumatoid arthritis. C) thrombocytopenia. D) lactose intolerance.

Answer 35

A) autoimmune anemia.

Question 36

6. Crohns type of inflammatory bowel disease is characterized by: A) granulomatous lesions. B) ulcerative erosions. C) fibrotic smooth muscle. D) necrotic crypt abscesses.

Answer 36

A) granulomatous lesions.

Question 37

7. Unlike the Crohn type of inflammatory bowel disease, the ulcerative colitis type is characterized by: A) skip lesions. B) steatorrhea. C) gastric ulcers. D) pseudopolyps.

Answer 37

D) pseudopolyps.

Question 38

8. Diverticulitis, a complication of diverticulosis, is manifested by acute: A) rectal bleeding. B) abdominal distention. C) large-volume diarrhea. D) lower left quadrant pain.

Answer 38

D) lower left quadrant pain.

Question 39

9. Major causes of mechanical bowel obstruction include: A) chemical irritation. B) ruptured appendix. C) abdominal distention. D) postoperative adhesions.

Answer 39

D) postoperative adhesions

Question 40

10 As a protective measure to keep abdominal inflammation and infection . localized, the peritoneum: A) constricts bowel contents. B) secretes fibrous exudate. C) increases intestinal motility. D) abdominal vasoconstriction.

Answer 40

B) secretes fibrous exudate.

Question 41

11 Which of the following signs and symptoms most clearly suggests the need . for endoscopy to rule out esophageal cancer? A) Heartburn after an individual consumes high-fat meals B) Dysphagia in an individual with no history of neurologic disease C) A new onset of gastroesophageal reflux in a previously healthy individual D) Recurrent episodes of gastritis that do not respond to changes in diet

Answer 41

B) Dysphagia in an individual with no history of neurologic disease

Question 42

12 A 60-year-old male patient has presented to his primary care provider to . follow up with his ongoing treatment for peptic ulcer disease. What is the most likely goal of this patients pharmacologic treatment? A) Inhibiting gastric acid production B) Promoting hypertrophy of the gastric mucosa C) Increasing the rate of gastric emptying D) Increasing muscle tone of the cardiac sphincter

Answer 42

A) Inhibiting gastric acid production

Question 43

13 Which of the following individuals most likely faces the greatest risk of . developing Clostridium difficile colitis? A) A 55-year-old man who takes proton pump inhibitors for the treatment of peptic ulcers B) A 79-year-old hospital patient who is being treated with broad-spectrum antibiotics C) A premature neonate who has developed hyperbilirubinemia and is receiving phototherapy D) A 30-year-old patient who has a history of Crohn disease and has been admitted to a hospital to treat a recent flare-up

Answer 43

B) A 79-year-old hospital patient who is being treated with broad-spectrum antibiotics

Question 44

14 A 66-year-old woman has been diagnosed with diverticular disease based on . her recent complaints and the results of a computed tomography (CT) scan. Which of the patients following statements demonstrates an accurate understanding of this diagnosis? A) From now on, Im going to stick to an organic diet and start taking more supplements. B) I think this might have happened because Ive used enemas and laxatives too much. C) Ive always struggled with heartburn and indigestion, and I guess I shouldnt have ignored those warning signs. D) I suppose I should try to eat more fiber and become a bit more active.

Answer 44

D) I suppose I should try to eat more fiber and become a bit more active.

Question 45

15 An ultrasound has confirmed appendicitis as the cause of a 20-year-old mans . sudden abdominal pain. Which of the following etiologic processes is implicated in the development of appendicitis? A) Obstruction of the intestinal lumen B) Elimination of normal intestinal flora C) Sloughing of the intestinal mucosa D) Increased osmolality of intestinal contents

Answer 45

A) Obstruction of the intestinal lumen

Question 46

16 Which of the following characteristics differentiates inflammatory diarrhea . from the noninflammatory type? A) Larger volume of diarrhea B) Electrolyte imbalances C) Absence of blood in the stool D) Infection of intestinal cells

Answer 46

D) Infection of intestinal cells

Question 47

17 Which of the following patients should the nurse observe most closely for . the signs and symptoms of paralytic ileus? A) A patient who is postoperative day 1 following gall bladder surgery B) A patient whose acute diarrhea has necessitated the use of antidiarrheal medications C) An obese patient who refuses to ambulate because he complains of shortness of breath D) A patient with a longstanding diagnosis of irritable bowel syndrome

Answer 47

A) A patient who is postoperative day 1 following gall bladder surgery

Question 48

18 Which of the following meals is most likely to exacerbate an individuals . celiac disease? A) Spaghetti with meatballs and garlic bread B) Stir-fried chicken and vegetables with rice C) Oatmeal with milk, brown sugar, and walnuts D) Barbecued steak and a baked potato with sour cream

Answer 48

A) Spaghetti with meatballs and garlic bread

Question 49

19 Which of the following statements is true of colorectal cancer? . A) Aspirin and NSAIDs are implicated in the etiology. B) It is one of the few cancers that is known to sometimes have an infectious etiology. C) Most cases are quite advanced before symptoms become apparent. D) Survival rates for colorectal cancer are less than 20%, but are increasing.

Answer 49

C) Most cases are quite advanced before symptoms become apparent.

Question 50

20 Following the analysis of a recent barium enema and colonoscopy with . biopsy, a patient has been diagnosed with colorectal cancer. Which of the following treatment modalities will be the mainstay of this patients treatment? A) Chemotherapy B) Radiation therapy C) Pharmacologic therapies D) Surgery

Answer 50

D) Surgery

Question 51

A 15 year old male presents to the clinic with complaints of abdominal cramping, watery diarrhea, weight loss, and decreased appetite. He states this has been going on for a few months but has recently worsened. Upon further questioning he tells you that his eyes have been bothering him and he’s noticed his joints have been achy. What is the most likely diagnosis? Gastritis Crohn’s Ulcerative Colitis IBS

Answer 51

Crohn’s

Question 52

. The presence of which two conditions help to diagnose NASH from NAFL Metabolic syndrome and decreased ferritin Metabolic syndrome and increased ferritin Pulmonary HTN and increased TIBC Ascites and decreased TIBC

Answer 52

Metabolic syndrome and increased ferritin

Question 53

1. Which of the following statements about Inflammatory Bowel Disease (IBD) is true? A. IBD is a non-inflammatory condition that does not cause permanent intestinal damage. B. IBD includes conditions such as Crohn's disease and ulcerative colitis, which are characterized by chronic inflammation in the GI tract. C. IBD primarily affects the stomach and esophagus rather than the intestines. D. IBD is commonly caused by bacterial infections in the intestines.

Answer 53

B. IBD includes conditions such as Crohn's disease and ulcerative colitis, which are characterized by chronic inflammation in the GI tract.

Question 54

2. Which of the following GI cancers has the highest 5-year survival rate when detected early? A. Pancreatic cancer B. Gastric cancer C. Colorectal cancer D. Liver cancer

Answer 54

C. Colorectal cancer

Question 55

High cell turnover rate due to an acid environment is found in which layer of gastrointestinal tract? A: Submucosa B: Mucosa C: Serosa D: Muscular

Answer 55

B: Mucosa

Question 56

In the stomach, Gastrin stimulates gastric acid secretion whereas in the small intestine, ________ inhibits gastric acid secretion. A: Ghrelin B: Secretin C: Somatostatin D: Motilin

Answer 56

C. Somatostatin

Question 57

Chronic gastritis is associated with the presence of? A. Lymphocytes B. Plasma Cells C. Macrophages D. All of the above

Answer 57

D. All of the above

Question 58

What are the two main causes of peptic ulcers? a. Spicy foods and eating right before bedtime b. NSAID use and H. pylori infection c. Overeating and citrus fruits d. Gastroenteritis and streptococcal pneumoniae

Answer 58

b. NSAID use and H. pylori infection

Question 59

The most common cause of pancreatitis is? a. Alcohol use b. Fatty diet c. Obesity d. Cholelithiasis

Answer 59

d. Cholelithiasis

Question 60

secretin vs somatostatin

Answer 60

Secretin Stimulates the pancreas to secrete a fluid rich in bicarbonate, which neutralizes the pH of gastric chyme in the small intestine. Somatostatin Inhibits the pancreas from releasing hormones and enzymes, including insulin, glucagon, gastrin, and pancreatic enzymes. In the gastrointestinal tract, somatostatin reduces gastric secretion

Question 61

s & s of crohns

Answer 61

palpable abdominal mass skip lesions