GASTROINTESTINAL SYSTEM
DISORDERS Challenge Exam #2
- QUESTIONS AND CORRECT
ANSWERS WITH RATIONALES
2023/2024
GRADED A+ NEW
1. Question
During preparation for bowel surgery, a male client receives an antibiotic to
reduce intestinal bacteria. Antibiotic therapy may interfere with the synthesis of
which vitamin and may lead to hypoprothrombinemia?
A. Vitamin A
B. Vitamin D
C. Vitamin E
D. Vitamin K
Correct Answer: D. Vitamin K
Intestinal bacteria synthesize such nutritional substances as vitamin K, thiamine,
riboflavin, vitamin B12, folic acid, biotin, and nicotinic acid. Therefore, antibiotic therapy
may interfere with the synthesis of these substances, including vitamin K. Antibiotics,
especially those known as cephalosporins, reduce the absorption of vitamin K in the
body. Using them for more than 10 days may lower levels of vitamin K because these
drugs kill not only harmful bacteria but also the bacteria that make vitamin K.
Option A: Vitamin A is a general term that encompasses various fat-soluble substances
such as retinol, retinyl palmitate, and beta-carotene. In the liver, retinol is esterified to
retinyl esters and stored in the stellate cells. In the tissues, both retinol and
beta-carotene are oxidized to retinal and retinoic acid, which are essential for vision and
,gene regulation, respectively. These active metabolites bind nuclear receptors of the
RAR family to control gene expression.
Option B: Vitamin D is labeled as the “sunshine vitamin,” as it is produced in the skin on
sun exposure. Vitamin D is a hormone obtained through dietary consumption and skin
production. Ultraviolet B (UVB) radiation, wavelength (290 to 315 nm) converts
7-dehydrocholesterol in the skin to previtamin D. This previtamin D undergoes heat
isomerization and is converted to vitamin D. Vitamin D from the skin and diet is
metabolized in the liver to 25-hydroxyvitamin D (25 OH D), and 25-hydroxyvitamin D is
useful in assessing vitamin D status.
Option C: Intestinal bacteria don’t synthesize vitamin E. Vitamin E or tocopherol is a
fat-soluble vitamin functioning as an antioxidant, protecting the cell membrane. As with
all fat-soluble vitamins, transport and absorption require intact fat digestion
mechanisms. Fat metabolism involves lipases, both lingual and gastric, bile salts,
pancreatic enzymes, and intestinal absorption.
2. Question
When evaluating a male client for complications of acute pancreatitis, the nurse
would observe for:
A. Increased intracranial pressure
B. Decreased urine output
C. Bradycardia
D. Hypertension
Correct Answer: B. Decreased urine output
Acute pancreatitis can cause decreased urine output, which results from the renal
failure that sometimes accompanies this condition. AKI develops late in the course of
acute pancreatitis, usually after failure of other organs. Remarkably, the kidney was the
first organ to fail in only 8.9% of patients with AKI, and only a minority of patients
develop isolated AKI
Option A: Intracranial pressure neither increases nor decreases in a client with
pancreatitis. The causes of increased intracranial pressure (ICP) can be divided based
on the intracerebral components causing elevated pressures. Generalized swelling of
the brain or cerebral edema from a variety of causes such as trauma, ischemia,
hyperammonemia, uremic encephalopathy, and hyponatremia.
Option C: Tachycardia, not bradycardia, usually is associated with pulmonary or
hypovolemic complications of pancreatitis. Tachycardia and mild hypotension may result
from hypovolemia from sequestration of fluid in the pancreatic bed. About 60% of
,patients develop low-grade pyrexia from peripancreatic inflammation without evident
infection.
Option D: Hypotension can be caused by a hypovolemic complication, but hypertension
usually isn’t related to acute pancreatitis. Release into the systemic circulation of
activated enzymes and proteases may cause endothelial damage leading to
extravasation of fluids from the vascular space, hypovolemia, hypotension, increased
abdominal pressure, intense kidney vasoconstriction, hypercoagulability, and fibrin
deposition in the glomeruli.
3. Question
A male client with a recent history of rectal bleeding is being prepared for a
colonoscopy. How should the nurse position the client for this test initially?
A. Lying on the right side with legs straight
B. Lying on the left side with knees bent
C. Prone with the torso elevated
D. Bent over with hands touching the floor
Correct Answer: B. Lying on the left side with knees bent
For a colonoscopy, the nurse initially should position the client on the left side with
knees bent. Preparation for a colonoscopy is the biggest complaint that most patients
have about receiving the procedure, and is a primary reason for non-compliance to
screening colonoscopies. The technician or nurse is there to assist with preserving
stability and preventing the patient from rolling forward or backward. Also, they are there
to help provide counter pressure to the abdomen to assist the endoscopist in navigating
corners and turns.
Option A: Placing the client on the right side with legs straight wouldn’t allow proper
visualization of the large intestine. Performing a colonoscopy requires practice and is a
skill that is difficult to master. While watching an experienced clinician perform a
colonoscopy may appear simple, the technique is something that requires time,
patience, and a lot of practice. Navigating through a cylindrical tube that can flex, dilate,
contract, and move is not an easy task.
Option B: Placing the client prone with the torso elevated wouldn’t allow proper
visualization of the large intestine. The patient should be positioned in the left lateral
decubitus position. Although, some clinicians may prefer the patient on their back or
right side if circumstances require. The legs being flexed toward the chest help to relax
the puborectalis and pubococcygeus muscles. This allows for easier entry and
traversing past the angle at the sacral prominence.
, Option D: Placing the client bent over with hands touching the floor wouldn’t allow
proper visualization of the large intestine. On the left-sided position, the patient’s legs
should be flexed, and pillows should be placed around their back, head, and between
their knees to help prevent injury to the bony prominence and to help maintain position.
4. Question
A male client with extreme weakness, pallor, weak peripheral pulses, and
disorientation is admitted to the emergency department. His wife reports that he
has been “spitting up blood.” A Mallory-Weiss tear is suspected, and the nurse
begins taking the client’s history from the client’s wife. The question by the nurse
that demonstrates her understanding of Mallory-Weiss tearing is:
A. “Tell me about your husband’s alcohol usage.”
B. “Is your husband being treated for tuberculosis?”
C. “Has your husband recently fallen or injured his chest?”
D. “Describe spices and condiments your husband uses on food.”
Correct Answer: A. “Tell me about your husband’s alcohol usage.”
A Mallory-Weiss tear is associated with massive bleeding after a tear occurs in the
mucous membrane at the junction of the esophagus and stomach. There is a strong
relationship between ethanol usage, resultant vomiting, and a Mallory-Weiss tear.
Mallory-Weiss tears account for an estimated 1-15% of cases of upper gastrointestinal
bleeding. Although the age range varies widely, affected individuals are generally in
middle age (40s-50s), and men reportedly have a higher incidence than women by a
ratio of 2-4:1.
Option B: The bleeding is coming from the stomach, not from the lungs as would be true
in some cases of tuberculosis. The presence of a hiatal hernia is a predisposing factor
and is found in 35-100% of patients with Mallory-Weiss tears. During retching or
vomiting, the transmural pressure gradient is greater within the hernia than the rest of
the stomach, and it is the location most likely to sustain a tear
Option C: A Mallory-Weiss tear doesn’t occur from chest injuries or falls. Precipitating
factors include retching, vomiting, straining, hiccupping, coughing, primal scream
therapy, blunt abdominal trauma, and cardiopulmonary resuscitation. In a few cases, no
apparent precipitating factor can be identified. One study reported that 25% of patients
had no identifiable risk factor.
Option D: A Mallory-Weiss tear isn’t associated with eating spicy foods. Mallory-Weiss
tears are usually associated with other mucosal lesions. In one study, 83% of patients
DISORDERS Challenge Exam #2
- QUESTIONS AND CORRECT
ANSWERS WITH RATIONALES
2023/2024
GRADED A+ NEW
1. Question
During preparation for bowel surgery, a male client receives an antibiotic to
reduce intestinal bacteria. Antibiotic therapy may interfere with the synthesis of
which vitamin and may lead to hypoprothrombinemia?
A. Vitamin A
B. Vitamin D
C. Vitamin E
D. Vitamin K
Correct Answer: D. Vitamin K
Intestinal bacteria synthesize such nutritional substances as vitamin K, thiamine,
riboflavin, vitamin B12, folic acid, biotin, and nicotinic acid. Therefore, antibiotic therapy
may interfere with the synthesis of these substances, including vitamin K. Antibiotics,
especially those known as cephalosporins, reduce the absorption of vitamin K in the
body. Using them for more than 10 days may lower levels of vitamin K because these
drugs kill not only harmful bacteria but also the bacteria that make vitamin K.
Option A: Vitamin A is a general term that encompasses various fat-soluble substances
such as retinol, retinyl palmitate, and beta-carotene. In the liver, retinol is esterified to
retinyl esters and stored in the stellate cells. In the tissues, both retinol and
beta-carotene are oxidized to retinal and retinoic acid, which are essential for vision and
,gene regulation, respectively. These active metabolites bind nuclear receptors of the
RAR family to control gene expression.
Option B: Vitamin D is labeled as the “sunshine vitamin,” as it is produced in the skin on
sun exposure. Vitamin D is a hormone obtained through dietary consumption and skin
production. Ultraviolet B (UVB) radiation, wavelength (290 to 315 nm) converts
7-dehydrocholesterol in the skin to previtamin D. This previtamin D undergoes heat
isomerization and is converted to vitamin D. Vitamin D from the skin and diet is
metabolized in the liver to 25-hydroxyvitamin D (25 OH D), and 25-hydroxyvitamin D is
useful in assessing vitamin D status.
Option C: Intestinal bacteria don’t synthesize vitamin E. Vitamin E or tocopherol is a
fat-soluble vitamin functioning as an antioxidant, protecting the cell membrane. As with
all fat-soluble vitamins, transport and absorption require intact fat digestion
mechanisms. Fat metabolism involves lipases, both lingual and gastric, bile salts,
pancreatic enzymes, and intestinal absorption.
2. Question
When evaluating a male client for complications of acute pancreatitis, the nurse
would observe for:
A. Increased intracranial pressure
B. Decreased urine output
C. Bradycardia
D. Hypertension
Correct Answer: B. Decreased urine output
Acute pancreatitis can cause decreased urine output, which results from the renal
failure that sometimes accompanies this condition. AKI develops late in the course of
acute pancreatitis, usually after failure of other organs. Remarkably, the kidney was the
first organ to fail in only 8.9% of patients with AKI, and only a minority of patients
develop isolated AKI
Option A: Intracranial pressure neither increases nor decreases in a client with
pancreatitis. The causes of increased intracranial pressure (ICP) can be divided based
on the intracerebral components causing elevated pressures. Generalized swelling of
the brain or cerebral edema from a variety of causes such as trauma, ischemia,
hyperammonemia, uremic encephalopathy, and hyponatremia.
Option C: Tachycardia, not bradycardia, usually is associated with pulmonary or
hypovolemic complications of pancreatitis. Tachycardia and mild hypotension may result
from hypovolemia from sequestration of fluid in the pancreatic bed. About 60% of
,patients develop low-grade pyrexia from peripancreatic inflammation without evident
infection.
Option D: Hypotension can be caused by a hypovolemic complication, but hypertension
usually isn’t related to acute pancreatitis. Release into the systemic circulation of
activated enzymes and proteases may cause endothelial damage leading to
extravasation of fluids from the vascular space, hypovolemia, hypotension, increased
abdominal pressure, intense kidney vasoconstriction, hypercoagulability, and fibrin
deposition in the glomeruli.
3. Question
A male client with a recent history of rectal bleeding is being prepared for a
colonoscopy. How should the nurse position the client for this test initially?
A. Lying on the right side with legs straight
B. Lying on the left side with knees bent
C. Prone with the torso elevated
D. Bent over with hands touching the floor
Correct Answer: B. Lying on the left side with knees bent
For a colonoscopy, the nurse initially should position the client on the left side with
knees bent. Preparation for a colonoscopy is the biggest complaint that most patients
have about receiving the procedure, and is a primary reason for non-compliance to
screening colonoscopies. The technician or nurse is there to assist with preserving
stability and preventing the patient from rolling forward or backward. Also, they are there
to help provide counter pressure to the abdomen to assist the endoscopist in navigating
corners and turns.
Option A: Placing the client on the right side with legs straight wouldn’t allow proper
visualization of the large intestine. Performing a colonoscopy requires practice and is a
skill that is difficult to master. While watching an experienced clinician perform a
colonoscopy may appear simple, the technique is something that requires time,
patience, and a lot of practice. Navigating through a cylindrical tube that can flex, dilate,
contract, and move is not an easy task.
Option B: Placing the client prone with the torso elevated wouldn’t allow proper
visualization of the large intestine. The patient should be positioned in the left lateral
decubitus position. Although, some clinicians may prefer the patient on their back or
right side if circumstances require. The legs being flexed toward the chest help to relax
the puborectalis and pubococcygeus muscles. This allows for easier entry and
traversing past the angle at the sacral prominence.
, Option D: Placing the client bent over with hands touching the floor wouldn’t allow
proper visualization of the large intestine. On the left-sided position, the patient’s legs
should be flexed, and pillows should be placed around their back, head, and between
their knees to help prevent injury to the bony prominence and to help maintain position.
4. Question
A male client with extreme weakness, pallor, weak peripheral pulses, and
disorientation is admitted to the emergency department. His wife reports that he
has been “spitting up blood.” A Mallory-Weiss tear is suspected, and the nurse
begins taking the client’s history from the client’s wife. The question by the nurse
that demonstrates her understanding of Mallory-Weiss tearing is:
A. “Tell me about your husband’s alcohol usage.”
B. “Is your husband being treated for tuberculosis?”
C. “Has your husband recently fallen or injured his chest?”
D. “Describe spices and condiments your husband uses on food.”
Correct Answer: A. “Tell me about your husband’s alcohol usage.”
A Mallory-Weiss tear is associated with massive bleeding after a tear occurs in the
mucous membrane at the junction of the esophagus and stomach. There is a strong
relationship between ethanol usage, resultant vomiting, and a Mallory-Weiss tear.
Mallory-Weiss tears account for an estimated 1-15% of cases of upper gastrointestinal
bleeding. Although the age range varies widely, affected individuals are generally in
middle age (40s-50s), and men reportedly have a higher incidence than women by a
ratio of 2-4:1.
Option B: The bleeding is coming from the stomach, not from the lungs as would be true
in some cases of tuberculosis. The presence of a hiatal hernia is a predisposing factor
and is found in 35-100% of patients with Mallory-Weiss tears. During retching or
vomiting, the transmural pressure gradient is greater within the hernia than the rest of
the stomach, and it is the location most likely to sustain a tear
Option C: A Mallory-Weiss tear doesn’t occur from chest injuries or falls. Precipitating
factors include retching, vomiting, straining, hiccupping, coughing, primal scream
therapy, blunt abdominal trauma, and cardiopulmonary resuscitation. In a few cases, no
apparent precipitating factor can be identified. One study reported that 25% of patients
had no identifiable risk factor.
Option D: A Mallory-Weiss tear isn’t associated with eating spicy foods. Mallory-Weiss
tears are usually associated with other mucosal lesions. In one study, 83% of patients
