GASTROINTESTINAL SYSTEM
DISORDERS Challenge Exam #3
- QUESTIONS AND CORRECT
ANSWERS WITH RATIONALES
2023/2024
GRADED A+ NEW
1. Question
A patient with chronic alcohol abuse is admitted with liver failure. Do you closely
monitor the patient’s blood pressure because of which change is associated with
liver failure?
A. Hypoalbuminemia
B. Increased capillary permeability
C. Abnormal peripheral vasodilation
D. Excess renin release from the kidneys
Correct Answer: A. Hypoalbuminemia
Blood pressure decreases as the body is unable to maintain normal oncotic pressure
with liver failure, so patients with liver failure require close blood pressure monitoring.
Increased capillary permeability, abnormal peripheral vasodilation, and excess renin
released from the kidneys aren’t direct ramifications of liver failure.
Option B: Once ascites is present, most therapeutic modalities are directed on
maintaining negative sodium balance, including salt restriction, bed rest, and diuretics.
Paracentesis and albumin infusion is applied to tense ascites. Transjugular intrahepatic
portosystemic shunt is considered for refractory ascites. With worsening of liver
disease, fluid retention is associated with other complications; such as spontaneous
bacterial peritonitis.
,Option C: Hepatorenal syndrome is a state of functional renal failure in the setting of low
cardiac output and impaired renal perfusion. Its management is based on drugs that
restore normal renal blood flow through peripheral arterial and splanchnic
vasoconstriction, renal vasodilation, and/or plasma volume expansion. However, the
definitive treatment is liver transplantation.
Option D: The most acceptable theory for ascites formation is peripheral arterial
vasodilation leading to underfilling of circulatory volume. This triggers the
baroreceptor-mediated activation of the renin-angiotensin-aldosterone system,
sympathetic nervous system, and nonosmotic release of vasopressin to restore
circulatory integrity. The result is an avid sodium and water retention, identified as a pre
ascitic state. This condition will evolve in overt fluid retention and ascites, as the liver
disease progresses.
2. Question
You’re assessing the stoma of a patient with a healthy, well-healed colostomy.
You expect the stoma to appear:
A. Pale, pink and moist
B. Red and moist
C. Dark or purple-colored
D. Dry and black
Correct Answer: B. Red and moist
Good circulation causes tissues to be moist and red, so a healthy, well-healed stoma
appears red and moist. A stoma should be pink to red in color, preferably raised above
skin level, and moist. Stomas that are flat or convex can still be healthy but they can
present challenges in terms of ostomy management and directing waste into the pouch.
Option A: Major color changes in a stoma, with the stoma becoming pale or dark, are a
sign that the tissue is not receiving the blood supply that it should. This type of change
should be immediately reported to the surgeon, whether the surgery was recent or in
the past.
Option C: Necrosis occurs if the blood supply to the stoma is restricted. Initially, the
stoma will become a darker red/purple and may even turn black, which is an indication
that the blood supply is impaired. It may also feel cold and hard to touch.
Option D: Stoma necrosis usually occurs within the first 5 postoperative days. The
stoma appears discolored rather than red, moist, and shiny. Discoloration may be
cyanotic, black, dark red, dusky bluish-purple, or brown. The stoma mucosa may be
hard and dry or flaccid.
,3. Question
You’re caring for a patient with a sigmoid colostomy. The stool from this
colostomy is:
A. Formed
B. Semisolid
C. Semiliquid
D. Watery
Correct Answer: A. Formed
A colostomy in the sigmoid colon produces a solid, formed stool. This is the most
common type. It is located in the bottom part of the large intestine. The sigmoid colon
moves waste to the rectum. Sigmoid colostomies produce stool that is more solid and
regular than other colostomies.
Option B: The transverse colon crosses the top of the abdomen. Stool in this area is
usually soft. This is because only a small portion of the colon has absorbed water from
the indigestible material. This common type of colostomy has 3 versions.
Option C: A double-barrel colostomy divides the colon into 2 ends that form separate
stomas. Stool exits from 1 of the stomas. Mucus made by the colon exits from the other.
This type of transverse colostomy is the least common. A loop colostomy creates a
stoma through which stool exits. In this type, the colon stays connected to the rectum.
As a result, people will sometimes pass stool or gas through the rectum.
Option D: The ascending colon runs from the beginning of the large intestine to the right
side of the abdomen. In this procedure, only part of the colon still works. As a result,
little water is absorbed from the waste. This means the stool is usually liquid. This type
of colostomy is rare. An ileostomy is more appropriate for this portion of the colon.
4. Question
You’re advising a 21 y.o. with a colostomy who reports problems with flatus. What
food should you recommend?
A. Peas
B. Cabbage
C. Broccoli
D. Yogurt
Correct Answer: D. Yogurt
, High-fiber foods stimulate peristalsis, and as a result, flatus. Yogurt reduces gas
formation. Eating bland foods will help avoid uncomfortable symptoms such as diarrhea
(loose or watery bowel movements), bloating, and gas. Bland foods are cooked,
easy-to-digest foods that aren’t spicy, heavy, or fried.
Option A: Excessive gas, or flatulence, can be caused by foods, such as beans and
cabbage, that have high amounts of fiber and carbohydrates which tend to ferment a lot
during digestion and in turn have a greater tendency to cause bad-smelling flatulence.
Option B: Well-cooked vegetables without skins or seeds, such as peeled potatoes,
peeled zucchini with the seeds removed, and peeled tomatoes with the seeds removed
should be included in the diet. Some vegetables, like cabbage, may cause gas or odor
for some people.
Option C: Include lettuce instead of broccoli in the diet. For the first few weeks after
surgery, it’s normal to have gas in the pouch and odor when the pouch is opened.
Buttermilk, cranberry juice, parsley, and kefir help prevent gas, odor, or both.
5. Question
You have to teach ostomy self-care to a patient with a colostomy. You tell the
patient to measure and cut the wafer:
A. To the exact size of the stoma.
B. About 1/16” larger than the stoma.
C. About 1/8” larger than the stoma.
Correct Answer: B. About 1/16” larger than the stoma.
A proper fit protects the skin but doesn’t impair circulation. A 1/16” should be cut. After
the stoma has been measured, the patient will need to cut an opening that matches the
measurement on the back of the barrier. If a one-piece pouch is being used, be sure to
pull the pouch away to prevent cutting into the plastic. The opening should match the
size of the stoma leaving no exposed skin.
Option A: Not all wafers will act the same when they are worn. While all wafers tend to
swell a bit as they come in contact with fluids or output, the degree in which they swell
can differ from brand to brand. Because of this, the patient may need to cut the wafer
slightly larger to accommodate the expansion. Doing this also helps to prevent the wafer
from “strangulating” the stoma by putting too much pressure around it.
DISORDERS Challenge Exam #3
- QUESTIONS AND CORRECT
ANSWERS WITH RATIONALES
2023/2024
GRADED A+ NEW
1. Question
A patient with chronic alcohol abuse is admitted with liver failure. Do you closely
monitor the patient’s blood pressure because of which change is associated with
liver failure?
A. Hypoalbuminemia
B. Increased capillary permeability
C. Abnormal peripheral vasodilation
D. Excess renin release from the kidneys
Correct Answer: A. Hypoalbuminemia
Blood pressure decreases as the body is unable to maintain normal oncotic pressure
with liver failure, so patients with liver failure require close blood pressure monitoring.
Increased capillary permeability, abnormal peripheral vasodilation, and excess renin
released from the kidneys aren’t direct ramifications of liver failure.
Option B: Once ascites is present, most therapeutic modalities are directed on
maintaining negative sodium balance, including salt restriction, bed rest, and diuretics.
Paracentesis and albumin infusion is applied to tense ascites. Transjugular intrahepatic
portosystemic shunt is considered for refractory ascites. With worsening of liver
disease, fluid retention is associated with other complications; such as spontaneous
bacterial peritonitis.
,Option C: Hepatorenal syndrome is a state of functional renal failure in the setting of low
cardiac output and impaired renal perfusion. Its management is based on drugs that
restore normal renal blood flow through peripheral arterial and splanchnic
vasoconstriction, renal vasodilation, and/or plasma volume expansion. However, the
definitive treatment is liver transplantation.
Option D: The most acceptable theory for ascites formation is peripheral arterial
vasodilation leading to underfilling of circulatory volume. This triggers the
baroreceptor-mediated activation of the renin-angiotensin-aldosterone system,
sympathetic nervous system, and nonosmotic release of vasopressin to restore
circulatory integrity. The result is an avid sodium and water retention, identified as a pre
ascitic state. This condition will evolve in overt fluid retention and ascites, as the liver
disease progresses.
2. Question
You’re assessing the stoma of a patient with a healthy, well-healed colostomy.
You expect the stoma to appear:
A. Pale, pink and moist
B. Red and moist
C. Dark or purple-colored
D. Dry and black
Correct Answer: B. Red and moist
Good circulation causes tissues to be moist and red, so a healthy, well-healed stoma
appears red and moist. A stoma should be pink to red in color, preferably raised above
skin level, and moist. Stomas that are flat or convex can still be healthy but they can
present challenges in terms of ostomy management and directing waste into the pouch.
Option A: Major color changes in a stoma, with the stoma becoming pale or dark, are a
sign that the tissue is not receiving the blood supply that it should. This type of change
should be immediately reported to the surgeon, whether the surgery was recent or in
the past.
Option C: Necrosis occurs if the blood supply to the stoma is restricted. Initially, the
stoma will become a darker red/purple and may even turn black, which is an indication
that the blood supply is impaired. It may also feel cold and hard to touch.
Option D: Stoma necrosis usually occurs within the first 5 postoperative days. The
stoma appears discolored rather than red, moist, and shiny. Discoloration may be
cyanotic, black, dark red, dusky bluish-purple, or brown. The stoma mucosa may be
hard and dry or flaccid.
,3. Question
You’re caring for a patient with a sigmoid colostomy. The stool from this
colostomy is:
A. Formed
B. Semisolid
C. Semiliquid
D. Watery
Correct Answer: A. Formed
A colostomy in the sigmoid colon produces a solid, formed stool. This is the most
common type. It is located in the bottom part of the large intestine. The sigmoid colon
moves waste to the rectum. Sigmoid colostomies produce stool that is more solid and
regular than other colostomies.
Option B: The transverse colon crosses the top of the abdomen. Stool in this area is
usually soft. This is because only a small portion of the colon has absorbed water from
the indigestible material. This common type of colostomy has 3 versions.
Option C: A double-barrel colostomy divides the colon into 2 ends that form separate
stomas. Stool exits from 1 of the stomas. Mucus made by the colon exits from the other.
This type of transverse colostomy is the least common. A loop colostomy creates a
stoma through which stool exits. In this type, the colon stays connected to the rectum.
As a result, people will sometimes pass stool or gas through the rectum.
Option D: The ascending colon runs from the beginning of the large intestine to the right
side of the abdomen. In this procedure, only part of the colon still works. As a result,
little water is absorbed from the waste. This means the stool is usually liquid. This type
of colostomy is rare. An ileostomy is more appropriate for this portion of the colon.
4. Question
You’re advising a 21 y.o. with a colostomy who reports problems with flatus. What
food should you recommend?
A. Peas
B. Cabbage
C. Broccoli
D. Yogurt
Correct Answer: D. Yogurt
, High-fiber foods stimulate peristalsis, and as a result, flatus. Yogurt reduces gas
formation. Eating bland foods will help avoid uncomfortable symptoms such as diarrhea
(loose or watery bowel movements), bloating, and gas. Bland foods are cooked,
easy-to-digest foods that aren’t spicy, heavy, or fried.
Option A: Excessive gas, or flatulence, can be caused by foods, such as beans and
cabbage, that have high amounts of fiber and carbohydrates which tend to ferment a lot
during digestion and in turn have a greater tendency to cause bad-smelling flatulence.
Option B: Well-cooked vegetables without skins or seeds, such as peeled potatoes,
peeled zucchini with the seeds removed, and peeled tomatoes with the seeds removed
should be included in the diet. Some vegetables, like cabbage, may cause gas or odor
for some people.
Option C: Include lettuce instead of broccoli in the diet. For the first few weeks after
surgery, it’s normal to have gas in the pouch and odor when the pouch is opened.
Buttermilk, cranberry juice, parsley, and kefir help prevent gas, odor, or both.
5. Question
You have to teach ostomy self-care to a patient with a colostomy. You tell the
patient to measure and cut the wafer:
A. To the exact size of the stoma.
B. About 1/16” larger than the stoma.
C. About 1/8” larger than the stoma.
Correct Answer: B. About 1/16” larger than the stoma.
A proper fit protects the skin but doesn’t impair circulation. A 1/16” should be cut. After
the stoma has been measured, the patient will need to cut an opening that matches the
measurement on the back of the barrier. If a one-piece pouch is being used, be sure to
pull the pouch away to prevent cutting into the plastic. The opening should match the
size of the stoma leaving no exposed skin.
Option A: Not all wafers will act the same when they are worn. While all wafers tend to
swell a bit as they come in contact with fluids or output, the degree in which they swell
can differ from brand to brand. Because of this, the patient may need to cut the wafer
slightly larger to accommodate the expansion. Doing this also helps to prevent the wafer
from “strangulating” the stoma by putting too much pressure around it.
