Chapter 43: Assessment of Digestive and
Gastrointestinal Function
1. A nurse is caring for a patient who is
scheduled for a colonoscopy and whose bowel
preparation will include polyethylene glycol
electrolyte lavage prior to the procedure. The
presence of what health problem would
contraindicate the use of this form of bowel
preparation?
A) Inflammatory bowel disease
B) Intestinal polyps
C) Diverticulitis
D) Colon cancer
Feedback: The use of a lavage solution is
contraindicated in patients with intestinal
obstruction or inflammatory bowel disease. It
can safely be used with patients who have
polyps, colon cancer, or diverticulitis.
2. A nurse is promoting increased protein
intake to enhance a patients wound healing.
The nurse knows that enzymes are essential in
the digestion of nutrients such as protein. What
is the enzyme that initiates the digestion of
protein?
A) Pepsin
B) Intrinsic factor
C) Lipase
D) Amylase
Feedback: The enzyme that initiates the
digestion of protein is pepsin. Intrinsic factor
combines with vitamin B12 for absorption by
the ileum. Lipase aids in the digestion of fats
and amylase aids in the digestion of starch.
3. A patient has been brought to the
emergency department with abdominal pain
and is subsequently diagnosed with
appendicitis. The patient is scheduled for an
appendectomy but questions the nurse about
how his health will be affected by the absence
of an appendix. How should the nurse best
respond?
A) Your appendix doesnt play a major role, so
you wont notice any difference after you
recovery from surgery.
B) The surgeon will encourage you to limit your
fat intake for a few weeks after the surgery, but
your body will then begin to compensate.
C) Your body will absorb slightly fewer
nutrients from the food you eat, but you wont
be aware of this.
D) Your large intestine will adapt over time to
the absence of your appendix.
Feedback: The appendix is an appendage of
the cecum (not the large intestine) that has
little or no physiologic function. Its absence
does not affect digestion or absorption.
4. A patient asks the nursing assistant for a
bedpan. When the patient is finished, the
nursing assistant notifies the nurse that the
patient has bright red streaking of blood in the
stool. What is this most likely a result of?
A) Diet high in red meat
B) Upper GI bleed
C) Hemorrhoids
D) Use of iron supplements
Feedback: Lower rectal or anal bleeding is
suspected if there is streaking of blood on the
surface of the stool. Hemorrhoids are often a
cause of anal bleeding since they occur in the
rectum. Blood from an upper GI bleed would
be dark rather than frank. Iron supplements
make the stool dark, but not bloody and red
meat consumption would not cause frank
blood.
5. An adult patient is scheduled for an upper GI
series that will use a barium swallow. What
teaching should the nurse include when the
patient has completed the test?
A) Stool will be yellow for the first 24 hours
postprocedure.
B) The barium may cause diarrhea for the next
24 hours.
C) Fluids must be increased to facilitate the
evacuation of the stool.
D) Slight anal bleeding may be noted as the
barium is passed.
Feedback: Postprocedural patient education
includes information about increasing fluid
intake; evaluating bowel movements for
evacuation of barium; and noting increased
number of bowel movements, because barium,
due to its high osmolarity, may draw fluid into
the bowel, thus increasing the intraluminal
contents and resulting in greater output. Yellow
stool, diarrhea, and anal bleeding are not
expected.
6. A patient has come to the outpatient
radiology department for diagnostic testing.
Which of the following diagnostic procedures
will allow the care team to evaluate and
remove polyps?
A) Colonoscopy
B) Barium enema
C) ERCP
D) Upper gastrointestinal fibroscopy
Feedback: During colonoscopy, tissue biopsies
can be obtained as needed, and polyps can be
removed and evaluated. This is not possible
during a barium enema, ERCP, or
gastroscopy.
7. A nurse is caring for a patient with recurrent
hematemesis who is scheduled for upper
gastrointestinal fibroscopy (UGF). How should
the nurse in the radiology department prepare
this patient?
A) Insert a nasogastric tube.
B) Administer a micro Fleet enema at least 3
hours before the procedure.
C) Have the patient lie in a supine position for
the procedure.
D) Apply local anesthetic to the back of the
patients throat.
Feedback: Preparation for UGF includes
spraying or gargling with a local anesthetic. A
nasogastric tube or a micro Fleet enema is not
required for this procedure. The patient should
be positioned in a side-lying position in case of
emesis.
8. The nurse is providing health education to a
patient scheduled for a colonoscopy. The
nurse should explain that she will be placed in
what position during this diagnostic test?
A) In a knee-chest position (lithotomy position)
B) Lying prone with legs drawn toward the
chest
C) Lying on the left side with legs drawn toward
the chest
D) In a prone position with two pillows
elevating the buttocks
Feedback: For best visualization, colonoscopy
is performed while the patient is lying on the
left side with the legs drawn up toward the
chest. A kneechest position, lying on the
stomach with legs drawn to the chest, and a
prone position with two pillows elevating the
legs do not allow for the best visualization.
9. A patient has sought care because of recent
dark-colored stools. As a result, a fecal occult
blood test has been ordered. The nurse should
instruct the patient to avoid which of the
following prior to collecting a stool sample?
A) NSAIDs
B) Acetaminophen
C) OTC vitamin D supplements
D) Fiber supplements
Feedback: NSAIDs can cause a false-positive
fecal occult blood test. Acetaminophen, vitamin
D supplements, and fiber supplements do not
have this effect.
10. The nurse is preparing to perform a
patients abdominal assessment. What
examination sequence should the nurse
follow?
A) Inspection, auscultation, percussion, and
palpation
B) Inspection, palpation, auscultation, and
percussion
C) Inspection, percussion, palpation, and
auscultation
D) Inspection, palpation, percussion, and
auscultation
Feedback: When performing a focused
assessment of the patients abdomen,
auscultation should always precede percussion
and palpation because they may alter bowel
sounds. The traditional sequence for all other
focused assessments is inspection, palpation,
percussion, and auscultation.
11. A patient who has been experiencing
changes in his bowel function is scheduled for
a barium enema. What instruction should the
nurse provide for postprocedure recovery?
A) Remain NPO for 6 hours postprocedure.
B) Administer a Fleet enema to cleanse the
bowel of the barium.
C) Increase fluid intake to evacuate the barium.
D) Avoid dairy products for 24 hours
postprocedure.
Feedback: Adequate fluid intake is necessary
to rid the GI tract of barium. The patient must
not remain NPO after the test and enemas are
not used to cleanse the bowel of barium. There
is no need to avoid dairy products.
12. A nurse is caring for a newly admitted
patient with a suspected GI bleed. The nurse
assesses the patients stool after a bowel
movement and notes it to be a tarry-black
color. This finding is suggestive of bleeding
from what location?
A) Sigmoid colon
B) Upper GI tract
C) Large intestine
D) Anus or rectum
Feedback: Blood shed in sufficient quantities in
the upper GI tract will produce a tarry-black
color (melena). Blood entering the lower
portion of the GI tract or passing rapidly
through it will appear bright or dark red. Lower
rectal or anal bleeding is suspected if there is
streaking of blood on the surface of the stool or
if blood is noted on toilet tissue.
13. A nursing student has auscultated a
patients abdomen and noted one or two bowel
sounds in a 2-minute period of time. How
would you tell the student to document the
patients bowel sounds?
A) Normal
B) Hypoactive
C) Hyperactive
D) Paralytic ileus
Feedback: Documenting bowel sounds is
based on assessment findings. The terms
normal (sounds heard about every 5 to 20
seconds), hypoactive (one or two sounds in 2
minutes), hyperactive (5 to 6 sounds heard in
less than 30 seconds), or absent (no sounds in
3 to 5 minutes) are frequently used in
documentation. Paralytic ileus is a medical
diagnosis that may cause absent or hypoactive
bowel sounds, but the nurse would not
independently document this diagnosis.
14. An advanced practice nurse is assessing
the size and density of a patients abdominal
organs. If the results of palpation are unclear to
the nurse, what assessment technique should
be implemented?
A) Percussion
B) Auscultation
C) Inspection
D) Rectal examination
Feedback: Percussion is used to assess the
size and density of the abdominal organs and
to detect the presence of air-filled, fluid-filled,
or solid masses. Percussion is used either
independently or concurrently with palpation
because it can validate palpation findings.
15. A nurse is caring for a patient with biliary
colic and is aware that the patient may
experience referred abdominal pain. Where
would the nurse most likely expect this patient
to experience referred pain?
A) Midline near the umbilicus
B) Below the right nipple
C) Left groin area
D) Right lower abdominal quadrant
Feedback: Patients with referred abdominal
pain associated with biliary colic complain of
pain below the right nipple. Referred pain
above the left nipple may be associated with
the heart. Groin pain may be referred pain from
ureteral colic.
16. An inpatient has returned to the medical
unit after a barium enema. When assessing the
patients subsequent bowel patterns and stools,
what finding should the nurse report to the
physician?
A) Large, wide stools
B) Milky white stools
C) Three stools during an 8-hour period of time
D) Streaks of blood present in the stool
Feedback: Barium has a high osmolarity and
may draw fluid into the bowel, thus increasing
the intraluminal contents and resulting in
greater output (large stools). The barium will
give the stools a milky white appearance, and
it is not uncommon for the patient to
experience an increase in the number of bowel
movements. Blood in fecal matter is not an
expected finding and the nurse should notify
the physician.
17. A nurse in a stroke rehabilitation facility
recognizes that the brain regulates swallowing.
Damage to what area of the brain will most
affect the patients ability to swallow?
A) Temporal lobe
B) Medulla oblongata
C) Cerebellum
D) Pons
Ans: B
Feedback: Swallowing is a voluntary act that is
regulated by a swallowing center in the
medulla oblongata of the central nervous
system. Swallowing is not regulated by the
temporal lobe, cerebellum, or pons.
18. A patient is being assessed for a suspected
deficit in intrinsic factor synthesis. What
diagnostic or assessment finding is the most
likely rationale for this examination of intrinsic
factor production?
A) Muscle wasting
B) Chronic jaundice in the absence of liver
disease
C) The presence of fat in the patients stool
D) Persistently low hemoglobin and hematocrit
Feedback: In the absence of intrinsic factor,
vitamin B12 cannot be absorbed, and
pernicious anemia results. This would result in
a marked reduction in hemoglobin and
hematocrit.
19. A patient with a recent history of
intermittent bleeding is undergoing capsule
endoscopy to determine the source of the
bleeding. When explaining this diagnostic test
to the patient, what advantage should the
nurse describe?
A) The test allows visualization of the entire
peritoneal cavity.
B) The test allows for painless biopsy
collection.
C) The test does not require fasting.
D) The test is noninvasive.
Feedback: Capsule endoscopy allows the
noninvasive visualization of the mucosa
throughout the entire small intestine. Bowel
preparation is necessary and biopsies cannot
be collected. This procedure allows
visualization of the entire GI tract, but not the
peritoneal cavity.
20. A nurse is caring for a patient admitted with
a suspected malabsorption disorder. The nurse
knows that one of the accessory organs of the
digestive system is the pancreas. What
digestive enzymes does the pancreas secrete?
Select all that apply.
A) Pepsin
B) Lipase
C) Amylase
D) Trypsin
E) Ptyalin
Feedback: Digestive enzymes secreted by the
pancreas include trypsin, which aids in
digesting protein; amylase, which aids in
digesting starch; and lipase, which aids in
digesting fats. Pepsin is secreted by the
stomach and ptyalin is secreted in the saliva.
21. The nurse is caring for a patient with a
duodenal ulcer and is relating the patients
symptoms to the physiologic functions of the
small intestine. What do these functions
include? Select all that apply.
A) Secretion of hydrochloric acid (HCl)
B) Reabsorption of water
C) Secretion of mucus
D) Absorption of nutrients
E) Movement of nutrients into the bloodstream
Feedback: The small intestine folds back and
forth on itself, providing approximately 7000
cm2 (70 m2) of surface area for secretion and
absorption, the process by which nutrients
enter the bloodstream through the intestinal
walls. Water reabsorption primarily takes place
in the large bowel. HCl is secreted by the
stomach.
22. A nurse is performing an abdominal
assessment of an older adult patient. When
collecting and analyzing data, the nurse should
be cognizant of what age-related change in
gastrointestinal structure and function?
A) Increased gastric motility
B) Decreased gastric pH
C) Increased gag reflex
D) Decreased mucus secretion
Feedback: Older adults tend to secrete less
mucus than younger adults. Gastric motility
slows with age and gastric pH rises due to
decreased secretion of gastric acids. Older
adults tend to have a blunted gag reflex
compared to younger adults.
23. nurse is explaining the fact that the veins
that return blood from the digestive organs and
the spleen form The nurse educator is
reviewing the blood supply of the GI tract with
a group of medical nurses. The the portal
venous system. What large veins will the nurse
list when describing this system? Select all that
apply.
A) Splenic vein
B) Inferior mesenteric vein
C) Gastric vein
D) Inferior vena cava
E) Saphenous vein
Feedback: This portal venous system is
composed of five large veins: the superior
mesenteric, inferior mesenteric, gastric,
splenic, and cystic veins, which eventually form
the vena portae that enters the liver. The
inferior vena cava is not part of the portal
system. The saphenous vein is located in the
leg.
24. The physiology instructor is discussing the
GI system with the pre-nursing class. What
should the instructor describe as a major
function of the GI tract?
A) The breakdown of food particles into cell
form for digestion
B) The maintenance of fluid and acid-base
balance
C) The absorption into the bloodstream of
nutrient molecules produced by digestion
D) The control of absorption and elimination of
electrolytes
Feedback: Primary functions of the GI tract
include the breakdown of food particles into
molecular form for digestion; the absorption
into the bloodstream of small nutrient
molecules produced by digestion; and the
elimination of undigested unabsorbed food
stuffs and other waste products. Nutrients must
be broken down into molecular form, not cell
form. Fluid, electrolyte, and acid-base balance
are primarily under the control of the kidneys.
25. A nurse is providing preprocedure
education for a patient who will undergo a
lower GI tract study the following week. What
should the nurse teach the patient about bowel
preparation?
A) Youll need to fast for at least 18 hours prior
to your test.
B) Starting today, take over-the-counter stool
softeners twice daily.
C) Youll need to have enemas the day before
the test.
D) For 24 hours before the test, insert a
glycerin suppository every 4 hours.
Feedback: Preparation of the patient includes
emptying and cleansing the lower bowel. This
often necessitates a low-residue diet 1 to 2
days before the test; a clear liquid diet and a
laxative the evening before; NPO after
midnight; and cleansing enemas until returns
are clear the following morning.
26. A patient presents at the walk-in clinic
complaining of recurrent sharp stomach pain
that is relieved by eating. The nurse suspects
that the patient may have an ulcer. How would
the nurse explain the formation and role of acid
in the stomach to the patient?
A) Hydrochloric acid is secreted by glands in
the stomach in response to the actual or
anticipated presence of food.
B) As digestion occurs in the stomach, the
stomach combines free hydrogen ions from the
food to form acid.
C) The body requires an acidic environment in
order to synthesize pancreatic digestive
enzymes; the stomach provides this
environment.
D) The acidic environment in the stomach
exists to buffer the highly alkaline environment
in the esophagus.
Feedback: The stomach, which stores and
mixes food with secretions, secretes a highly
acidic fluid in response to the presence or
anticipated ingestion of food. The stomach
does not turn food directly into acid and the
esophagus is not highly alkaline. Pancreatic
enzymes are not synthesized in a highly acidic
environment.
27. Results of a patients preliminary
assessment prompted an examination of the
patients carcinoembryonic antigen (CEA)
levels, which have come back positive. What is
the nurses most appropriate response to this
finding?
A) Perform a focused abdominal assessment.
B) Prepare to meet the patients psychosocial
needs.
C) Liaise with the nurse practitioner to perform
an anorectal examination.
D) Encourage the patient to adhere to
recommended screening protocols.
Feedback: CEA is a protein that is normally not
detected in the blood of a healthy person;
therefore, when detected it indicates that
cancer is present, but not what type of cancer
is present. The patient would likely be learning
that he or she has cancer, so the nurse must
prioritize the patients immediate psychosocial
needs, not abdominal assessment. Future
screening is not a high priority in the short
term.
28. A clinic patient has described recent dark-
colored stools;the nurse recognizes the need
for fecal occult blood testing (FOBT). What
aspect of the patients current health status
would contraindicate FOBT?
A) Gastroesophageal reflux disease (GERD)
B) Peptic ulcers
C) Hemorrhoids
D) Recurrent nausea and vomiting
Feedback: FOBT should not be performed
when there is hemorrhoidal bleeding. GERD,
peptic ulcers and nausea and vomiting do not
contraindicate the use of FOBT as a diagnostic
tool.
29. A patient will be undergoing abdominal
computed tomography (CT) with contrast. The
nurse has administered IV sodium bicarbonate
and oral acetylcysteine (Mucomyst) before the
study as ordered. What would indicate that
these medications have had the desired
therapeutic effect?
A) The patients BUN and creatinine levels are
within reference range following the CT.
B) The CT yields high-quality images.
C) The patients electrolytes are stable in the 48
hours following the CT.
D) The patients intake and output are in
balance on the day after the CT.
Feedback: Both sodium bicarbonate and
Mucomyst are free radical scavengers that
sequester the contrast byproducts that are
destructive to renal cells. Kidney damage
would be evident by increased BUN and
creatinine levels. These medications are
unrelated to electrolyte or fluid balance and
they play no role in the results of the CT.
30. A medical patients CA 19-9 levels have
become available and they are significantly
elevated. How should the nurse best interpret
this diagnostic finding?
A) The patient may have cancer, but other GI
disease must be ruled out.
B) The patient most likely has early-stage
colorectal cancer.
C) The patient has a genetic predisposition to
gastric cancer.
D) The patient has cancer, but the site is
unknown.
Feedback: CA 19-9 levels are elevated in most
patients with advanced pancreatic cancer, but
they may also be elevated in other conditions
such as colorectal, lung, and gallbladder
cancers; gallstones; pancreatitis; cystic
fibrosis; and liver disease. A cancer diagnosis
cannot be made solely on CA 19-9 results.
31. A patient has come to the clinic
complaining of blood in his stool. A FOBT test
is performed but is negative. Based on the
patients history, the physician suggests a
colonoscopy, but the patient refuses, citing a
strong aversion to the invasive nature of the
test. What other test might the physician order
to check for blood in the stool?
A) A laparoscopic intestinal mucosa biopsy
B) A quantitative fecal immunochemical test
C) Computed tomography (CT)
D) Magnetic resonance imagery (MRI)
Feedback: Quantitative fecal immunochemical
tests may be more accurate than guaiac
testing and useful for patients who refuse
invasive testing. CT or MRI cannot detect
blood in stool. Laparoscopic intestinal mucosa
biopsy is not performed.
32. A nurse is assessing the abdomen of a
patient just admitted to the unit with a
suspected GI disease. Inspection reveals
several diverse lesions on the patients
abdomen. How should the nurse best interpret
this assessment finding?
A) Abdominal lesions are usually due to age-
related skin changes.
B) Integumentary diseases often cause GI
disorders.
C) GI diseases often produce skin changes.
D) The patient needs to be assessed for self-
harm.
Feedback: Abdominal lesions are of particular
importance, because GI diseases often
produce skin changes. Skin problems do not
normally cause GI disorders. Age-related skin
changes do not have a pronounced effect on
the skin of the abdomen when compared to
other skin surfaces. Self-harm is a less likely
explanation for skin lesions on the abdomen.
33. Probably the most widely used in-office or
at-home occult blood test is the Hemoccult II.
The patient has come to the clinic because he
thinks there is blood in his stool. When you
reviewed his medications, you noted he is on
antihypertensive drugs and NSAIDs for early
arthritic pain. You are sending the patient
home with the supplies necessary to perform 2
hemoccult tests on his stool and mail the
samples back to the clinic. What instruction
would you give this patient?
A) Take all your medications as usual.
B) Take all your medications except the
antihypertensive medications.
C) Dont eat highly acidic foods 72 hours before
you start the test.
D) Avoid vitamin C for 72 hours before you
start the test.
Feedback: Red meats, aspirin, nonsteroidal
anti-inflammatory drugs, turnips, and
horseradish should be avoided for 72 hours
prior to the study, because they may cause a
false-positive result. Also, ingestion of vitamin
C from supplements or foods can cause a
false-negative result. Acidic foods do not need
to be avoided.
34. A patients sigmoidoscopy has been
successfully completed and the patient is
preparing to return home. Which of the
following teaching points should the nurse
include in the patients discharge education?
A) The patient should drink at least 2 liters of
fluid in the next 12 hours.
B) The patient can resume a normal routine
immediately.
C) The patient should expect fecal urgency for
several hours.
D) The patient can expect some scant rectal
bleeding.
Feedback: Following sigmoidoscopy, patients
can resume their regular activities and diet.
There is no need to push fluids and neither
fecal urgency nor rectal bleeding is expected.
35. A nurse is caring for an 83-year-old patient
who is being assessed for recurrent and
intractable nausea. What age-related change
to the GI system may be a contributor to the
patients health complaint?
A) Stomach emptying takes place more slowly.
B) The villi and epithelium of the small intestine
become thinner.
C) The esophageal sphincter becomes
incompetent.
D) Saliva production decreases.
Feedback: Delayed gastric emptying occurs in
older adults and may contribute to nausea.
Changes to the small intestine and decreased
saliva production would be less likely to
contribute to nausea. Loss of esophageal
sphincter function is pathologic and is not
considered an age-related change.
36. A patient has been experiencing significant
psychosocial stress in recent weeks. The nurse
is aware of the hormonal effects of stress,
including norepinephrine release. Release of
this substance would have what effect on the
patients gastrointestinal function? Select all
that apply.
A) Decreased motility
B) Increased sphincter tone
C) Increased enzyme release
D) Inhibition of secretions
E) Increased peristalsis
Feedback: Norepinephrine generally
decreases GI motility and secretions, but
increases muscle tone of sphincters.
Norepinephrine does not increase the release
of enzymes.
37. A patient with cystic fibrosis takes
pancreatic enzyme replacements on a regular
basis. The patients intake of trypsin facilitates
what aspect of GI function?
A) Vitamin D synthesis
B) Digestion of fats
C) Maintenance of peristalsis
D) Digestion of proteins
Feedback: Trypsin facilitates the digestion of
proteins. It does not influence vitamin D
synthesis, the digestion of fats, or peristalsis.
38. The nurse is caring for a patient who has a
diagnosis of AIDS. Inspection of the patients
mouth reveals the new presence of white
lesions on the patients oral mucosa. What is
the nurses most appropriate response?
A) Encourage the patient to gargle with salt Feedback: An ultrasound produces no ill
water twice daily. effects and there are not specific limits on its
use, even during pregnancy.
B) Attempt to remove the lesions with a tongue
depressor.
C) Make a referral to the units dietitian.
D) Inform the primary care provider of this
finding.
Feedback: The nurse should inform the
primary care provider of this abnormal finding
in the patients oral cavity, since it necessitates
medical treatment. It would be inappropriate to
try to remove skin lesions from a patients
mouth and salt water will not resolve this
problem, which is likely due to candidiasis. A
dietitian referral is unnecessary.
39. A patient has been scheduled for a urea
breath test in one months time. What nursing
diagnosis most likely prompted this diagnostic
test?
A) Impaired Dentition Related to Gingivitis
B) Risk For Impaired Skin Integrity Related to
Peptic Ulcers
C) Imbalanced Nutrition: Less Than Body
Requirements Related to Enzyme Deficiency
D) Diarrhea Related to Clostridium Difficile
Infection
Feedback: Urea breath tests detect the
presence of Helicobacter pylori, the bacteria
that can live in the mucosal lining of the
stomach and cause peptic ulcer disease. This
test does not address fluid volume, nutritional
status, or dentition.
40. A female patient has presented to the
emergency department with right upper
quadrant pain; the physician has ordered
abdominal ultrasound to rule out cholecystitis
(gallbladder infection). The patient expresses
concern to the nurse about the safety of this
diagnostic procedure. How should the nurse
best respond?
A) Abdominal ultrasound is very safe, but it
cant be performed if youre pregnant.
B) Abdominal ultrasound poses no known
safety risks of any kind.
C) Current guidelines state that a person can
have up to 3 ultrasounds per year.
D) Current guidelines state that a person can
have up to 6 ultrasounds per year.