Chapter 30 Nutrition and Digestive System

Black & Hawks: Medical-Surgical Nursing: Clinical Management for Positive
Outcomes, 7th Edition
Chapter 30: Assessment of Nutrition and the Digestive System
MULTIPLE CHOICE
1. The nurse is assessing a client who describes “stomach discomfort.” The most appropriate
sequence for conducting the physical examination of the abdomen is
a. inspection, palpation, percussion, auscultation.
b. auscultation, percussion, palpation, inspection.
c. inspection, auscultation, percussion, palpation.
d. palpation, percussion, auscultation, inspection.
ANS: c
Assess the abdomen in the following sequence: inspection, auscultation, percussion, and
palpation.
DIF: Cognitive Level: Comprehension REF: Text Reference: 678, 679, 680, 681;
TOP: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance
2. The nurse is assessing the abdomen of a 67-year-old woman who is admitted to the
emergency department for treatment of multiple problems. The finding noted during the
abdominal examination that requires further assessment is
a. rounded abdominal contour.
b. umbilicus that is concave.
c. flat appearance below the umbilicus.
d. visible peristalsis.
ANS: d
Normally, peristaltic movements are not visible, although abdominal pulsations may be observed
in a very thin client.
DIF: Cognitive Level: Comprehension REF: Text Reference: 680

3. Before determining the absence of bowel sounds, the nurse must auscultate the abdomen for
a. 1 minute.
b. 5 minutes.
c. 30 minutes.
d. 1 hour.
ANS: b
To determine the absence of bowel sounds, the nurse must listen a total of 5 minutes, or at least 1
minute per abdominal quadrant.
Chapter 30: Assessment of Nutrition and the Digestive System 2
DIF: Cognitive Level: Knowledge REF: Text Reference: 680

4. When the nurse measures triceps skinfold thickness (TSF) and calculates the midarm muscle
circumference (MAMC), the nurse is assessing
a. overall muscle strength.
b. the size of the body frame.
c. reserves of protein and calories.
d. the need to gain or lose weight.
ANS: c
The TSF and midarm circumference are used to calculate the MAMC, which is an indication of
protein and calorie reserves.
DIF: Cognitive Level: Application REF: Text Reference: 679, Figure 30-1;
5. For a client with malabsorption syndrome who is to undergo a D-xylose absorption test, the
nurse would provide the special instruction to
a. drink large amounts of fluid the day before the test.
b. remain in bed during the test.
c. avoid exposure to sunlight for at least 1 week after the test.
d. adhere to the special diet prescribed during the test.
ANS: b
The client is instructed to remain in bed during the test because activity alters the test results.
DIF: Cognitive Level: Application REF: Text Reference: 683

TOP: Nursing Process Step: Intervention
6. A client has returned to the nursing unit after an upper gastrointestinal (GI) series and
anxiously informs the nurse that her bowel movement was white. The nurse’s best response
would be
a. “The white color is expected after this examination. Your stool should return to the
normal color in 72 hours.”
b. “The color indicates that you are developing a barium obstruction. I will call the
physician right away.”
c. “The color means you are not getting rid of that contrast medium as quickly as we
would like. I will bring you a saline enema.”
d. “That is unusual. Very few people absorb the contrast medium in their stool.”
ANS: a
Initially, the client’s stool is white in color, but it should return to its normal brown color within
72 hours. Constipation with a distended abdomen may indicate a barium impaction.
Elsevier items and derived items  2005 by Elsevier Inc.


MSC: NCLEX: Physiological Integrity
7. For a client having all the following GI tests, the nurse schedules as the last test the
a. flat plate of abdomen.
b. barium swallow.
c. computed tomography scan.
d. ultrasound.
ANS: b
Ultrasound, abdominal scan, and colonoscopy, if indicated, should be performed first, because
the barium interferes with these tests.

MSC: NCLEX: Safe, Effective Care Environment;
8. A 65-year-old client who had a barium study of the bowel 4 days earlier calls the nurse in the
GI clinic to ask, “Is there anything I can do about my constipation? I have not had a bowel
movement since the x-ray, and my stomach is so big that I look pregnant.” The most
appropriate response for the nurse to make is
a. “Increase fluids in your diet to 10 glasses of water a day.”
b. “Take a strong laxative immediately.”
c. “You need to be examined in the clinic today.”
d. “Do you normally have more frequent bowel movements?”
ANS: c
The nurse should instruct the client to contact the physician immediately if constipation and
abdominal distention occur, because these may be manifestations of a barium impaction.
DIF: Cognitive Level: Analysis REF: Text Reference: 684

9. Preparing a client for an upper GI series, the nurse includes the information that
a. enemas will be given to empty the bowel after the procedure.
b. a nasogastric tube will be passed to instill the barium.
c. the procedure will take about 3 hours.
d. nothing by mouth is allowed for 6 to 8 hours before the study.
ANS: d
The client is not allowed to have food or fluids for at least 6 hours before the upper GI series. A
laxative is given afterward to help expel the barium. The client must drink the medium, and the
procedure lasts about 45 minutes.


10. The nurse administers an anticholinergic drug to a client scheduled for an endoscopy in order
to provide
a. sedation.
b. increased peristalsis.
c. muscle relaxation.
d. decreased secretions.
ANS: d
Anticholinergic medications may be given to decrease oropharyngeal secretions.

11. The nurse caring for a client immediately after endoscopy places the client in the
a. side-lying postion.
b. high-Fowler’s postion.
c. low-Fowler’s position.
d. prone position.
ANS: a
The client is placed in the side-lying (Sims) position until the sedation and local anesthesia wear
off.

12. When preparing a client for gastric analysis, the nurse should plan for
a. nasogastric tube insertion.
b. antacid administration.
c. frequent expectoration for samples.
d. fluoroscopic examination.
ANS: a
The client receives nothing by mouth for 12 hours before the test. A nasogastric tube is inserted,
and any contents left in the stomach are removed.

13. A nurse explains to a client with a temperature elevation that for each degree of temperature,
the client’s caloric requirements will increase by
a. 3%.

b. 5%.
c. 7%.
d. 10%.
ANS: c
Fever increases caloric requirements 7% for each degree Fahrenheit of temperature increase.
DIF: Cognitive Level: Comprehension REF: Text Reference: 669

TOP: Nursing Process Step: Intervention MSC: NCLEX: Physiological Integrity
14. The nurse conducting a physical assessment on a client with ascorbic acid (vitamin C)
deficiency would note that the clinical manifestation associated with this problem is
a. ecchymotic lesions on the skin.
b. bumpy or scaly skin.
c. edema.
d. muscle tetany.
ANS: a
Evidence of vitamin C (ascorbic acid) deficit includes gingivitis, dry mouth, alopecia, pruritus,
and ecchymotic lesions on the skin.
DIF: Cognitive Level: Application REF: Text Reference: 670, Table 30-1;
15. The amount of calories and protein that a female client weighing 185 pounds would require
is at least
a. 1575 calories and 53 g of protein.
b. 2394 calories and 62 g of protein.
c. 2520 calories and 67 g of protein.
d. 2743 calories and 73 g of protein.
ANS: c
The client weighs 84 kg (185  2.2 = 84); calories: 84  30 = 2520; protein: 84  0.8 = 67.2.

16. In a client admitted with possible small bowel obstruction, the nurse would assess for
a. flattened abdomen.
b. pain increasing with motion.
c. shock.
d. pain that is intermittent or colicky.
ANS: d

Characteristics of intestinal obstruction include distended abdomen, no bowel movements or

flatus, intermittent or colicky pain, right upper quadrant pain radiating to shoulder associated
with gallbladder, pain near umbilicus associated with small bowel, and lumbar pain associated
with colon.
DIF: Cognitive Level: Comprehension REF: Text Reference: 673, Table 30-4;
17. For a client taking a histamine H2 blocker to reduce clinical manifestations of gastritis, the
nurse would clarify that the client is at risk for a possible deficiency of
a. vitamin A.
b. vitamin B12.
c. vitamin D.
d. vitamin C.
ANS: b
In a possible nutrient interaction, histamine H2 blockers may cause decreased vitamin B12
absorption.
DIF: Cognitive Level: Application REF: Text Reference: 674, Table 30-6;
TOP: Nursing Process Step: Intervention MSC: NCLEX: Physiological Integrity
18. An ambulatory care client currently weighs 141 pounds and says that her usual weight is 125.
The nurse calculates the weight increase as
a. 10.2% of usual weight.
b. 12.8% of usual weight.
c. 14.7% of usual weight.
d. 15.5% of usual weight.
ANS: b
141 (present weight) – 125 (usual weight) = 16 lb; 16/125 = 12.8 % increase.

19. The location where the nurse palpates the abdomen to assess for pain or tenderness at
McBurney’s point is
a. left lower quadrant midway between umbilicus and greater trochanter.
b. right lower quadrant midway between umbilicus and anterior iliac crest
c. left lower quadrant midway between umbilicus and femoral artery.
d. right lower quadrant midway between umbilicus and symphysis pubis.
ANS: b
McBurney’s point is located in the right lower quadrant midway between the umbilicus and the
anterior iliac crest. Localization of pain in this area suggests appendicitis.


TOP: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity
20. In collecting a 24-hour urine specimen to determine nitrogen balance for a client, the nurse
would
a. use a preservative in the container.
b. avoid using ice while collecting the specimen.
c. throw away the voided specimen at the start time.
d. throw away the voided specimen at the end time.
ANS: c
The 24-hour urine collection begins with discarding the first voided specimen, then collecting all
urine for the next 24 hours in an iced, preservative-free container.

21. The nurse preparing a nutritional teaching plan for a client with pancreatitis would include
information to increase intake of
a. vitamin A.
b. vitamin B12.
c. vitamin D.
d. vitamin K.
ANS: 2
Persons with pancreatitis have difficulty with metabolizing fats and fat-soluble vitamins.
Vitamins A, D, E, and K are fat soluble. The client would have to increase water-soluble
vitamins, such as vitamin B12, to support nutritional intake.

22. When a client has arrived to have an upper GI endoscopy, the nurse should assist the client
into the
a. left lateral decubitus position.
b. supine position with head flat.
c. supine position with head elevated.
d. seated-upright position.
ANS: a
To reduce the risk of aspiration, the client is placed in the left lateral decubitus (Sims) position to
allow saliva to drain from the side of the mouth.

MSC: NCLEX: Safe, Effective Care Environment


Chapter 30 Nutrition and Digestive System

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Chapter 30 Nutrition and Digestive System

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Black & Hawks: Medical-Surgical Nursing: Clinical Management for Positive

Outcomes, 7th Edition

Chapter 30: Assessment of Nutrition and the Digestive System

DIF: Cognitive Level: Comprehension REF: Text Reference: 680

DIF: Cognitive Level: Knowledge REF: Text Reference: 680

DIF: Cognitive Level: Application REF: Text Reference: 683

Elsevier items and derived items  2005 by Elsevier Inc.

DIF: Cognitive Level: Application REF: Text Reference: 684

DIF: Cognitive Level: Application REF: Text Reference: 684

DIF: Cognitive Level: Analysis REF: Text Reference: 684

DIF: Cognitive Level: Application REF: Text Reference: 684

Elsevier items and derived items  2005 by Elsevier Inc.

TOP: Nursing Process Step: Intervention

DIF: Cognitive Level: Application REF: Text Reference: 685

DIF: Cognitive Level: Application REF: Text Reference: 685

DIF: Cognitive Level: Application REF: Text Reference: 686

Elsevier items and derived items  2005 by Elsevier Inc.

DIF: Cognitive Level: Comprehension REF: Text Reference: 669

DIF: Cognitive Level: Analysis REF: Text Reference: 669

Elsevier items and derived items  2005 by Elsevier Inc.

Characteristics of intestinal obstruction include distended abdomen, no bowel movements or

DIF: Cognitive Level: Analysis REF: Text Reference: 676

Elsevier items and derived items  2005 by Elsevier Inc.

DIF: Cognitive Level: Knowledge REF: Text Reference: 682

DIF: Cognitive Level: Application REF: Text Reference: 683

DIF: Cognitive Level: Analysis REF: Text Reference: 671

DIF: Cognitive Level: Knowledge REF: Text Reference: 685

Elsevier items and derived items  2005 by Elsevier Inc.

Elsevier items and derived items  2005 by Elsevier Inc.

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