Gastrointestinal Nursing

Why C is correct

Protein digestion begins in the stomach. Glands in the stomach lining make stomach acid and enzymes, body chemicals that break food into smaller parts, and these start breaking down protein. The breakdown of protein is finished later in the small intestine.

Why the other options are wrong

• A — "Mouth": No enzyme in the mouth acts on protein. Chewing only breaks food into smaller pieces.
• B — "Small intestine": Protein digestion is finished here, not started. Juices in the small intestine play a role in breaking down protein, but the stomach acts on it first.
• D — "Pancreas": No digestion takes place inside the pancreas. Its juice works only after it reaches the small intestine.

Why D is correct

Severe stress diverts blood away from the stomach lining, and the unprotected lining erodes without pain.

This is why the drug is started before there is anything to treat. The lining loses its blood supply first, so the ulcer stays silent until it bleeds. These stress erosions after burns are known as Curling's ulcers.

Why the other options are wrong

• A — "Burn injury drives up stomach acid, and that is what opens the ulcer": The lining fails first because its blood supply falls. Stomach acid plays a role in deepening the injury, but it is not what opens the ulcer.
• B — "The antibiotics used on burn wounds commonly wear away the stomach lining": Wound antibiotics are not the reason acid suppression is started here.
• C — "The drug is given to settle the nausea that follows a large burn": These drugs lower acid; they do not treat nausea.

Why B is the answer

The client must hold his breath while the needle is in the liver. In a percutaneous liver biopsy, a needle through the skin takes a tiny piece of liver. The liver moves with each breath, so breathing while the needle is inside can tear it. He holds his breath on cue until the needle is out.

Why the other options are not the answer

• A — "Have your clotting time checked before the biopsy": This instruction is correct. Clotting tests come first because a biopsy is unsafe when the blood clots poorly.
• C — "Expect some mild pain after the biopsy": This instruction is correct. Mild pain is part of normal recovery, but severe or worsening pain is reported at once.
• D — "Stop taking your aspirin before the biopsy": This instruction is correct. Aspirin slows clotting, so it is stopped days before, as prescribed.

Why B is correct

Compare the nitrogen he takes in with the nitrogen he loses. This comparison is called nitrogen balance.

Protein is roughly one part nitrogen in six. So nitrogen intake minus nitrogen losses shows directly whether the feeding covers what his body is breaking down. Losing more than he takes in means he is still living off his own muscle. Taking in more than he loses means he is building tissue again.

Why the other options are wrong

• A — "His weight today set against his weight on admission": Weight after surgery moves with fluid, so it cannot separate lean tissue from water.
• C — "The trend in his serum albumin across the week": Albumin drops with inflammation and changes too slowly to show this week's protein. Albumin, a protein in the blood made by the liver, is a valid nutrition marker, but it cannot report on a single week of feeding.
• D — "The share of each ordered feeding that he actually receives": Delivered volume shows what went in, not what his body did with it.

Why A is correct

Two openings mean the bowel was brought up as a loop. The limb coming from above delivers what the bowel sends down it, which is stool. The limb heading onward receives nothing from above, but its lining goes on producing mucus, so mucus is what appears. That second opening is a mucous fistula.

Why the other options are wrong

• B — "Stool as well, since both limbs open into the same bowel": Stool arrives from above, and the stoma diverts it there, so none reaches the downstream limb.
• C — "Nothing, since that limb was closed off inside the abdomen": A limb sealed inside the abdomen does drain nothing, which is correct for an end stoma, but this one reaches the skin and keeps secreting.
• D — "Gas, since the bowel beyond the stoma is no longer used": Gas travels with the stool, which leaves at the stoma.