Introduction to the Gastrointestinal System

1.

What is a unique characteristic of the gastrointestinal (GI) system?
A)
It contains multiple organs that work together.
B)
It is lined with epithelial tissue.
C)
It is the only system open to the external environment.
D)
The GI tract is sterile and contains no bacteria.
Ans:
C

Feedback:

The GI system is the only system that is open to the external environment. The definition of a system is multiple organs working together to perform a function or functions. Many systems are lined with epithelial tissue. The GI tract is not sterile and does contain bacteria.

2.

What is the purpose of the peritoneum?
A)
Help propel the GI contents down the tract
B)
Help keep the GI tract in place and prevent friction with movement
C)
Decrease the muscle tone to slow the GI tract from moving too fast
D)
Serve as a supportive layer and helps the tube maintain its shape
Ans:
B

Feedback:

The peritoneum lines the abdominal wall and viscera and helps keep the GI tract in place and prevents a buildup of friction with movement. The muscularis mucosa layer helps propel the GI contents downward. The nerve plexus helps to slow the GI tract when digestion is not a priority or stimulates it for digestion. The adventitia serves as a supportive layer and helps the tube maintain its shape.

3.

A patient complains of frequent acid indigestion. The nurse instructs the patient to increase intake of what to reduce stimulation of acid production?
A)
Protein
B)
Calcium
C)
Fiber
D)
Alcohol
Ans:
C

Feedback:

Fiber does not promote acid production so it would be a safe food for patients to eat to avoid stimulating more acid in the stomach. Acid production in the stomach is stimulated by gastrin which increases in the presence of protein, calcium, caffeine, or alcohol in the stomach.

4.

When the nurse administers a medication that stimulates the parasympathetic nervous system the drug will have what impact on the GI system?
A)
Decrease sphincter tone
B)
Decrease muscle tone
C)
Decrease contractions
D)
Decrease secretions
Ans:
A

Feedback:

The effect of the parasympathetic nervous system is that of “rest and digest.” It stimulates the GI tract causing increased muscle tone, secretions and contractions, and decreased sphincter tone allowing for easy movement.

5.

What reflex causes an increase in small intestine activity when the stomach is stimulated by stretching, the presence of food, or cephalic stimulation?
A)
Duodenal–colic
B)
Gastroenteric
C)
Gastrocolic
D)
Ileogastric
Ans:
B

Feedback:

The gastroenteric reflex is stimulation of the stomach, which causes an increase in activity in the small intestine. The duodenal–colic reflex stimulates colon activity and mass movement. The gastrocolic reflex is stimulation in the stomach, which increases activity in the colon. The ileogastric reflex is the introduction of chyme or stretch to the large intestine and slow stomach activity.

6.

The nurse expects to find that the major activities of the GI tract decrease in a patient experiencing what?
A)
A stress reaction
B)
A medication regimen including cholinergic drugs
C)
A local irritation of the small intestine
D)
Thoughts of food
Ans:
A

Feedback:

Stimulation of the sympathetic nervous system will decrease all activity in the GI tract, and stress is a trigger for stimulating the sympathetic nervous system. Parasympathetic stimulation caused by cholinergic drugs, local irritation of the intestine, and the thought of food will all increase GI activity.

7.

The nurse assesses the postoperative patient who had abdominal surgery and finds a complete absence of bowel sounds caused by what reflex?
A)
Gastrocolic reflex
B)
Renointestinal reflex
C)
Intestinal–intestinal reflex
D)
Somatointestinal reflex
Ans:
C

Feedback:

After the intestinal irritation that occurs with handling the bowel during abdominal surgery, the risk of paralytic ileus is high because of the intestinal–intestinal reflex. The gastrocolic reflex increases GI movement when food is in the stomach. The renointestinal reflex slows GI activity in response to renal capsule swelling. The somatointestinal reflex slows GI activity in response to tight stretching of skin across the abdominal wall.

8.

The nurse is caring for a patient who is having difficulty swallowing tablets. What action will the nurse implement to help the patient swallow their medication?
A)
Turn the patient’s head to one side
B)
Place a warm cloth on the back of the patient’s neck
C)
Have the patient suck on a Popsicle
D)
Give the patient a copious amount of water to drink with the tablet
Ans:
C

Feedback:

Have the patient suck on a Popsicle, which will block external nerve impulses and allow the basic reflex to respond. The patient’s head should be straight to allow the muscle pairs to work together. A cold cloth can be placed on the back of the neck or the sternum to stimulate the reflex, but a warm cloth is not indicated. Textured food, not liquids, can also help with swallowing a tablet.

9.

What does the nurse anticipate will happen first when the chemoreceptor trigger zone (CTZ) is stimulated?
A)
Salivation increases
B)
Gastric acid production decreases
C)
Sweating increases
D)
Heart rate increases
Ans:
A

Feedback:

When the CTZ is stimulated, salivation is stimulated first, which leads to a decrease in gastric acid production and then an increase in sweating and heart rate.

10.

What is the most basic type of movement that occurs in the esophagus?
A)
Peristalsis
B)
Mass movement
C)
Churning
D)
Segmentation
Ans:
A

Feedback:

Peristalsis is the basic movement of the esophagus. The large intestine uses mass movement, the stomach uses churning, and the small intestine uses segmentation.

11.

Which substance is required for digestion and absorption of fats and fat-soluble vitamins?
A)
Hydrochloric acid
B)
Bile
C)
Pancreatic enzymes
D)
Gastric juice
Ans:
B

Feedback:

Bile is an alkaline secretion that is formed continuously in the liver, carried to the gallbladder by the bile ducts, and stored there. Bile salts are required for digestion and absorption of fats, including fat-soluble vitamins. Hydrochloric acid is produced in the stomach and begins the process of digestion. Pancreatic enzymes include chymotrypsin and trypsin that break down proteins, lipases to break down fat, and amylases to break down sugars. Gastric juice includes hydrochloric acid.

12.

The nurse, caring for a patient about to undergo gastric bypass surgery, explains that the majority of nutrients are absorbed where?
A)
Sigmoid colon
B)
Stomach
C)
Small intestine
D)
Ascending colon
Ans:
C

Feedback:

The stomach empties into the small intestine where absorption of nutrients occurs. Therefore, very little absorption occurs in the stomach, mostly limited to alcohol and water. The colon allows for water to be absorbed from the feces but does not absorb nutrients.

13.

Water is absorbed in which portion of the intestine?
A)
Duodenum
B)
Jejunum
C)
Ileum
D)
Colon
Ans:
D

Feedback:

The colon absorbs water and sodium. The duodenum, ileum, and jejunum are parts of the small intestine where nutrients are absorbed.

14.

The nurse is caring for a patient who does not produce adequate mucus in the stomach resulting in what problem?
A)
Diarrhea
B)
Ulceration
C)
Constipation
D)
Distention
Ans:
B

Feedback:

Mucus functions to protect the lining of the digestive tract from digestive juices and protects the gastrointestinal mucosa from injury. Lack of mucous does not cause diarrhea, constipation, or distention.

15.

What is the stimulus for the Duodenal–colic reflex?
A)
Cephalic stimulation
B)
Presence of food
C)
Over extension of stomach
D)
Swallowing
Ans:
B

Feedback:

Duodenal–colic reflex is stimulated by the presence of food or stretching in the duodenum that stimulates colon activity and mass movement, again to empty the colon for the new chyme.

16.

The patient learns there are healthy bacteria in the bowel that aids in digestion and asks the nurse why bacterium doesn’t get into the bloodstream. The nurse described what barrier to answer the patient’s question?
A)
The mononuclear phagocyte system
B)
The portal system
C)
The omenta
D)
The vomiting reflex
Ans:
C

Feedback:

The greater and lesser omenta hang from the stomach over the lower GI tract and are full of lymph nodes, lymphocytes, monocytes, and other components of the mononuclear phagocyte system. This barrier provides rapid protection for the rest of the body if any of the bacteria or other foreign agents in the GI tract should be absorbed into the body. Other options do not serve as barriers.

17.

The nurse is caring for a child diagnosed with cystic fibrosis whose body does not produce pancreatic enzymes appropriately which results in what?
A)
Secretion of insulin
B)
Maintenance of serum glucose levels
C)
Digestion of carbohydrates
D)
Regulation of glucose metabolism
Ans:
C

Feedback:

The absence of the pancreatic enzymes results in inadequate digestion and absorption of carbohydrates, fats, and proteins. The pancreas also secretes insulin and glucagon, hormones that regulate glucose metabolism and regulate blood sugar levels but this is not related to enzymes but rather to hormone secretion.

18.

What does the liver produce that is important in the digestive process?
A)
Bile
B)
Glucagon
C)
Ammonia
D)
Bilirubin
Ans:
A

Feedback:

The liver produces bile, which is stored in the gallbladder. The bile is very important in the digestion of fats and is deposited into the small intestine when the gallbladder is stimulated to contract by the presence of fats. Glucagon is a hormone secreted in response to the presence of food in the bowel. Ammonia is a byproduct of the breakdown of protein and bilirubin is metabolized by the liver and stored to produce more red blood cells.

19.

What is a layer of the nerve plexus?
A)
Mesenteric
B)
Mucosal
C)
Sympathetic
D)
Myenteric
Ans:
D

Feedback:

The nerve plexus has two layers of nerves, one submucosal layer and one myenteric layer. The other options are not part of the nerve plexus.

20.

A nurse in a rehab facility recognizes the patient with damage to what area of the brain will affect the patient’s 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. Therefore, other options are incorrect.

21.

The nurse is caring for a patient admitted with a suspected malabsorption disorder as the result of pancreatic damage. What digestive enzymes does the pancreas secrete? (Select all that apply.)
A)
Pepsin
B)
Lipase
C)
Amylase
D)
Trypsin
E)
Ptyalin
Ans:
B, C, D

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.

22.

The nurse collects a nursing history from a patient who says she keeps so busy she often ignores the need to defecate. The nurse explains the danger of this behavior is what?
A)
External sphincter will require more distention to stimulate reflex
B)
Incontinence of stool due to loss of sphincter control
C)
Diarrhea
D)
Malabsorption of nutrients from the colon
Ans:
A

Feedback:

The receptors in the external sphincter adapt relatively quickly and will stretch and require more and more distention to stimulate the reflex if the reflex is ignored. This will not lead to bowel incontinence and is more likely to result in constipation from prolonged water absorption than diarrhea. Nutrients are not absorbed from the colon.

23.

Nutrients absorbed from the small intestine travel directly to the liver via what system?
A)
Mesenteric system
B)
Splenic system
C)
Arterial system
D)
Portal system
Ans:
D

Feedback:

The portal system drains the entire lower GI tract, where absorption occurs, and delivers what is absorbed into the venous system directly to the liver. The other options are distractors for this question.

24.

The nurse is caring for a patient who has developed severe constipation. What rationale does the nurse have for why the patient has also lost his or her appetite?
A)
Ileogastric reflex
B)
Intestinal–intestinal reflex
C)
Peritoneointestinal reflex
D)
Renointestinal reflex
Ans:
A

Feedback:

The introduction of chyme or stretch to the large intestine slows stomach activity, known as the ileogastric reflex which explains why patients who are constipated have no appetite. The intestinal–intestinal reflex is triggered by irritation of a section of the small intestine causing cessation of activity above that section. Peritoneointestinal reflex results from irritation of the peritoneum while renointestinal reflex results from irritation or swelling of the renal capsule.

25.

A patient presents at the walk-in clinic complaining of stomach pain that is relieved by eating which the nurse suspects is caused by a peptic ulcer. How would the nurse explain the ulceration in the stomach to the patient?
A)
A mucosal lining protects the stomach from hydrochloric acid and a reduction in the mucosal lining or increase in acid production allows peptic ulcers to develop.
B)
After digesting food, the stomach secretes a neutralizing solution to make the pH of the stomach neutral and if this doesn’t occur peptic ulcers can develop.
C)
Our body makes hydrochloric acid for the digestion of the food we eat and that can eat right through the stomach causing ulceration when you eat a diet high in spicy food.
D)
Acid is secreted by cells in the first part of the small intestine and when we eat the acid flows into the stomach so people who eat often have more exposure to acid.
Ans:
A

Feedback:

Gastrin and the parasympathetic system stimulate histamine-2 receptors near the parietal cells, causing the cells to release hydrochloric acid into the lumen of the stomach. Other digestive enzymes are released appropriately, in response to proteins and carbohydrates, to begin digestion. Peptic ulcers can develop when there is a decrease in the protective mucosal layer or an increase in acid production. Research indicates that people who eat a spicy diet everyday are less prone to stomach ulceration; the stomach does not neutralize the hydrochloric acid but the highly alkaline duodenum neutralizes the pH when chyme arrives from the stomach. Acid does not flow from the small intestine to the stomach.

26.

What organs are considered accessory digestive organs because they add in the digestive process? (Select all that apply.)
A)
The liver
B)
The pancreas
C)
The spleen
D)
The gallbladder
E)
The appendix
Ans:
A, B, D

Feedback:

The pancreas, liver, and gallbladder are accessory organs that support the functions of the GI system. The spleen is not involved in digestion and the appendix is a part of the bowel, not an accessory organ.

27.

What process is used by the large intestine to evacuate waste products from the body?
A)
Rectal stimulation
B)
Basic electrical rhythm
C)
Segmentation
D)
Mass movement
Ans:
D

Feedback:

The large intestine uses a process of mass movement with an occasional peristaltic wave. When the beginning segment of the large intestine is stimulated, it contracts and sends a massive peristaltic movement throughout the entire large intestine. The end result of the mass movement is usually excretion of waste products. Segmentation occurs in the small intestine. The nerve plexus maintains a basic electrical rhythm (BER), much like the pacemaker rhythm in the heart. Rectal stimulation is not normally required for a bowel movement.

28.

The steps of the swallowing reflex are
1. Soft palate elevates.
2. Respirations cease.
3. Larynx rises and the glottis closes.
4. Pharyngeal constrictor muscles contract.
In what order do these actions occur in order to allow a person to swallow?
A)
2, 4, 1, 3
B)
4, 3, 2, 1
C)
1, 2, 3, 4
D)
3, 1, 4, 2
Ans:
C

Feedback:

Receptors send impulses to the medulla, which stimulates a series of nerves that cause the following actions, which are the soft palate elevates and seals off the nasal cavity, respirations cease in order to protect the lungs, the larynx rises and the glottis closes to seal off the airway, and the pharyngeal constrictor muscles contract and force the food bolus into the top of the esophagus, where pairs of muscles contract in turn to move the bolus down the esophagus into the stomach.

29.

What occurs when the emetic zone is stimulated?
A)
Regurgitation
B)
Nothing due to overriding by mature centers
C)
Projectile vomiting
D)
Gagging
Ans:
C

Feedback:

The more primitive center is called the emetic zone. When stimulated, it initiates projectile vomiting. This type of intense reaction is seen in young children and whenever increased pressure in the brain or brain damage allows the more primitive center to override the more mature chemoreceptor trigger zone (CTZ). Regurgitation is vomiting. In adults the CTZ does not always override the emetic zone (patient with a severe head injury), and gagging is an adult precursor to vomiting.

30.

The nurse recognizes the potential for stimulation of the patient’s CTZ in what circumstances? (Select all that apply.)
A)
Stimulation of the back of the throat when examining the oral cavity
B)
Excessive stomach distention
C)
Increased intracranial pressure
D)
Stimulation of stretch receptors in the large bowel
E)
When the patient sits up abruptly
Ans:
A, B, C

Feedback:

Tactile stimulation of the back of the throat, excessive stomach distention, increased intracranial pressure, stimulation of vestibular receptors in the inner ear, and stimulation of stretch receptors in the uterus and bladder are types of stimuli that can activate the CTZ. Stimulating stretch receptors in the large bowel and sitting up abruptly are not activators of the CTZ.

31.

The patient who experiences nausea produces less stomach acid. The nurse recognizes this as having what effect?
A)
Increases the feeling of nausea
B)
Protects the lining of the upper GI tract
C)
Stimulates the parasympathetic nervous system
D)
Directs fluid to mucus production in the small bowel
Ans:
B

Feedback:

There is a large increase in the production of mucus in the upper GI tract, which is accompanied by a decrease in gastric acid production. This action protects the lining of the GI tract from potential damage by the acidic stomach contents when vomiting occurs. It does not increase the feeling of nausea, stimulate the parasympathetic nervous system, nor does it direct fluid to mucus production.

32.

The nurse is caring for a young child who fell and hit his or her head and is brought to the emergency room with projectile vomiting. How does the nurse interpret this behavior?
A)
The child is in intense pain
B)
The child probably ate too much for dinner
C)
The child likely has a full bladder
D)
The child has increased intracranial pressure
Ans:
D

Feedback:

Increased intracranial pressure applies direct pressure to the CTZ resulting in projectile vomiting. This child requires a thorough neurological assessment. Intense pain would be indicated by crying. A full bladder or eating too much for dinner would not cause projectile vomiting in a healthy child.

33.

What actions are required by the patient to protect the lungs when vomiting?
A)
Closing of the glottis
B)
Deep respirations
C)
Production of extra saliva in the mouth
D)
Reduction in acid production in the stomach
Ans:
A

Feedback:

The glottis must close and seal off the trachea in order to prevent entry of stomach contents into the lungs. The patient normally takes a deep breath just before the glottis closes but should not breath during emesis. Production of extra saliva and reduction in stomach acid do not protect the lungs.

34.

While bathing the noncommunicative patient, the nurse notices the patient is swallowing repeatedly. What should the nurse do in response?
A)
Offer the patient a drink
B)
Put the patient in a supine position
C)
Ready the emesis basin
D)
Continue the bath
Ans:
C

Feedback:

Nauseated patients who start swallowing repeatedly or complain about secretions in their throat are in the process of preparing for vomiting. The nurse should reach for the emesis basin. Offering water will increase vomiting. Placing the patient in a supine position risks the danger of aspiration of stomach contents into the lungs. Continuing the bath does not prepare the nurse if the patient begins to vomit.

35.

The nurse admits a woman to the clinic for an annual exam. The patient denies any health issues but reports frequent constipation despite increasing fiber and water intake in her diet. What assessment questions will the nurse ask?
A)
“How many calories do you eat per day?”
B)
“Do you often wear Spanx or other tight constraining clothing?”
C)
“Do you often ignore the need to urinate and allow your bladder to fill?”
D)
“Have you been taking narcotics every day?
Ans:
B

Feedback:

The nurse would assess the women to determine if tight constraining clothing such as Spanx are worn because taut stretching of skin and muscles over the abdomen irritates the nerve plexus and causes a slowing or cessation of GI activity to prevent further irritation. Calories per day would not contribute to constipation. It is unlikely the urge to void could be ignored long enough to cause constipation. Asking about the use of narcotics would only be appropriate if there are other manifestations that indicate the likelihood of this problem as constipation can be caused by many other things.