Deck 44: Nursing Management: Upper Gastrointestinal Problems

Question 1

What is the location of the vomiting centre that coordinates the multiple components involved in vomiting?

A) Chemoreceptor zone
B) Brainstem
C) Vestibular area
D) Visceral receptors from afferent fibres in the gastrointestinal (GI)tract

Answer 1

Brainstem

Question 2

A patient who has recently been experiencing frequent heartburn is seen in the clinic.The nurse will anticipate teaching the patient about which of the following?

A) Endoscopy procedures
B) Barium swallow
C) Radionuclide tests
D) Proton pump inhibitors

Answer 2

Proton pump inhibitors

Question 3

The nurse teaches a patient who is trying to stop the use of smokeless tobacco to examine the mouth routinely for the danger signs of oral cancer,especially for the presence of which of the following signs?

A) Acutely sore ulcers
B) A red,velvety patch
C) White,curdlike plaques
D) Reddened and swollen tongue

Answer 3

A red,velvety patch

Question 4

Which information about a patient who has just been admitted to the hospital with nausea and vomiting will require the most rapid nursing intervention?

A) The patient has been vomiting several times a day for the last 4 days.
B) The patient is lethargic and difficult to arouse.
C) The patient's chart indicates a recent resection of the small intestine.
D) The patient has taken only sips of water.

Question 5

The nurse identifies the nursing diagnosis of deficient fluid volume for a patient with prolonged vomiting.Which of the following nursing assessments is most helpful in determining the source of the vomiting?

A) Ask the times when the vomiting occurs.
B) Determine the amount and character of the vomitus.
C) Measure the intake and output,and daily weight patterns.
D) Assess the serum sodium,potassium,and chloride levels.

Question 6

A patient tells the nurse that when he feels nauseous,he takes ginger.The nurse should instruct the patient that he should not take ginger if he is also taking which one of the following medications?

A) Digoxin
B) Penicillin
C) Tetracycline
D) Protein pump inhibitor

Question 7

Which information will the nurse include when teaching a patient with newly diagnosed GERD?

A) "Peppermint tea may be helpful in reducing your symptoms."
B) "You will need to keep the head of your bed elevated on blocks."
C) "You should avoid eating between meals to reduce acid secretion."
D) "Vigorous physical activities may increase the incidence of reflux."

Question 8

A patient who has been on nothing by mouth (NPO)status during treatment for nausea and vomiting related to gastric irritation is to start oral intake of clear liquids.To promote tolerance to oral fluids,what should the nurse first offer the patient?

A) Orange juice
B) Hot chicken broth
C) A dish of lemon gelatin
D) Coffee with cream and sugar

Question 9

A patient with recurring heartburn tells the nurse that he has used over-the-counter antacids and famotidine (Pepcid),but the physician has now prescribed esomeprazole (Nexium).In teaching the patient about this medication,what should the nurse explain about this drug?

A) It reduces the reflux of gastric acid into the esophagus by increasing the rate of gastric emptying.
B) It coats the stomach and protects the stomach lining and esophagus from the effects of increased gastric acid.
C) It is used to treat GERD by decreasing stomach acid production.
D) It provides a quick,but short-lived,relief of symptoms and is an inexpensive means of treating gastroesophageal reflux.

Question 10

Which of the following will the nurse plan to teach the patient with newly diagnosed achalasia?

A) Drinking fluids with meals should be avoided.
B) Lying down and resting after meals is recommended.
C) A liquid or blenderized diet will be necessary.
D) Endoscopic procedures may be used for treatment.

Question 11

A 62-year-old man with weight loss,difficulty chewing,and malaise has been diagnosed with squamous cell carcinoma of the oral cavity.Which of the following information obtained from the patient during the nursing history is the most significant risk factor for oral cancer?

A) Use of tobacco
B) Neglected oral hygiene
C) Chronic overexposure to the sun
D) Recurrent herpes simplex infections

Question 12

A patient with oral squamous cell carcinoma is transferred to the postoperative surgical unit after a hemiglossectomy and radical neck procedure.When planning care,the nurse will anticipate the need to do which of the following?

A) Insert a long-term central venous catheter for parenteral nutrition.
B) Use an alphabet board to assist the patient with communication.
C) Administer chemotherapy starting the first postoperative day.
D) Reinforce pressure dressings at the surgical incision.

Question 13

A patient returns to the surgical unit following an abdominal Nissen fundoplication for treatment of GERD.Four hours postoperatively,which one of the following is it most important for the nurse to address?

A) The patient has dyspnea and absent breath sounds throughout the left lung.
B) The patient complains of level 6 (of a 0 to 10 scale)abdominal pain.
C) The patient has decreased bowel sounds in all four quadrants.
D) The patient is experiencing intermittent waves of nausea.

Question 14

A patient with chronic gastroesophageal reflux disease (GERD)is experiencing increasing discomfort.During assessment of the patient's current management of the problem,the nurse determines that further teaching is needed when the patient makes which following statement?

A) "I use antacids between meals and at bedtime."
B) "I quit smoking several years ago,but I still chew a lot of gum."
C) "I've learned to sleep with the head of the bed elevated on 10-cm blocks."
D) "I eat small meals throughout the day and have a bedtime snack."

Question 15

A patient who is on NPO status and has been receiving parenteral nutrition for 2 weeks develops bilateral pain in the area of the ears.The nurse recognizes that the patient is at risk for development of which of the following conditions?

A) Parotitis
B) Stomatitis
C) Oral candidiasis
D) Vincent's infection (trench mouth)

Question 16

A patient undergoes an esophagectomy with a synthetic graft replacement for treatment of esophageal cancer.Following his return to the surgical unit,why should the nurse place the patient in a semi-Fowler's position?

A) To facilitate respiratory function
B) To prevent reflux of gastric secretions
C) To promote drainage from the NG tube
D) To promote movement of fluids through the GI tract

Question 17

When teaching a patient with GERD about recommended dietary modifications,the nurse explains that which of the following foods decreases lower esophageal sphincter (LES)pressure and should be avoided?

A) Acidic and pickled foods
B) Coffee,tea,and chocolate
C) Milk and other dairy products
D) Spicy and highly seasoned foods

Question 18

A 62-year-old patient develops an acute gastritis caused by the nonsteroidal anti-inflammatory drug (NSAID)she uses to treat her arthritis.In teaching the patient about the effects of these drugs on the stomach's mucosal barrier,what should the nurse explain?

A) "NSAIDs stimulate histamine receptors,which increase the release of hydrochloric acid."
B) "NSAIDs inhibit the synthesis of prostaglandins that normally decrease acid secretion in the stomach."
C) "NSAIDs stimulate the parietal cells of the stomach to release pepsin,which is capable of digesting stomach tissue."
D) "The inflammatory response stimulated by prostaglandin release in the stomach is increased with the use of NSAIDs."

Question 19

When admitting a patient with a stroke who is unconscious and unresponsive to stimuli,the nurse learns from the patient's wife that the patient has a history of GERD.About which of the following will the nurse complete frequent assessments?

A) Bowel sounds
B) Breath sounds
C) Apical pulse
D) Abdominal girth

Question 20

When a patient with persistent nausea and severe vomiting is admitted to the hospital for control of the symptoms,what is the first order that the nurse should act on?

A) Provide oral care with moistened swabs.
B) Infuse normal saline at 250 mL/hour.
C) Insert a 16-gauge nasogastric (NG)tube.
D) Administer intravenous (IV)ondansetron (Zofran).

Question 21

The family member of a patient who has suffered massive abdominal trauma in an automobile accident asks the nurse why the patient is receiving famotidine.The nurse will explain that the medication will do which of the following?

A) Decrease the risk for nausea and vomiting.
B) Prevent aspiration of gastric contents.
C) Inhibit the development of stress ulcers.
D) Lower the chance for H.pylori infection.

Question 22

Which of the following foods are associated with an increased incidence of gastric cancer that the nurse should specifically question the patient about when obtaining a nursing history?

A) Milk and milk products
B) Raw fruits and vegetables
C) Smoked,highly salted,or spiced foods
D) Beans and other gas-forming foods

Question 23

The physician orders IV ranitidine (Zantac)every 6 hours for a patient with an acute exacerbation of his chronic peptic ulcer disease.As the nurse administers the drug,the patient asks about it,saying that the only ulcer drug he had been given IV before was cimetidine (Tagamet).In responding to the patient,what should the nurse explain?

A) Both drugs neutralize stomach acid,but ranitidine has fewer side effects than does cimetidine.
B) Ranitidine and cimetidine work the same way to decrease the effect of histamine and decrease acidity.
C) Ranitidine blocks histamine receptors to decrease acid production,but cimetidine acts on the nervous system to decrease gastric motility and secretions.
D) Cimetidine creates a protective pastelike complex covering the ulcer during healing,whereas ranitidine coats the entire stomach and duodenum.

Question 24

In teaching a patient with peptic ulcer disease about nutritional management of the disorder,what should the nurse stress that the patient should do?

A) Avoid raw fruits and vegetables.
B) Avoid foods that cause discomfort.
C) Eat six small meals a day with bland foods.
D) Eliminate milk and milk products from the diet.

Question 25

A patient with acute GI bleeding is receiving normal saline IV at a rate of 500 mL/hour.Which of the following assessment data obtained by the nurse are most important to communicate immediately to the physician?

A) The NG suction is returning "coffee grounds" material.
B) The patient's lungs have crackles audible to the midline.
C) The patient's blood pressure has increased to 142/94 mm Hg.
D) The bowel sounds are very hyperactive in all four quadrants.

Question 26

The following orders are received for a patient who has vomited 1500 mL of bright-red blood.Which order will the nurse act on first?

A) Infuse 1000 mL of lactated Ringer's solution.
B) Administer IV famotidine 40 mg.
C) Insert an NG tube,and connect it to suction.
D) Type and crossmatch for 4 units of packed red blood cells.

Question 27

Which one of the following drug classifications increases lower esophageal sphincter pressure and is used in the treatment of GERD?

A) Prokinetic
B) Antacids
C) Cholinergic
D) H₂-receptor blockers

Question 28

A patient is hospitalized with vomiting of "coffee grounds" emesis of unknown cause.The patient is very anxious about the source of the bleeding and asks the nurse whether it is possible to find the cause.Which of the following diagnostic tests should the nurse explain can most accurately identify the source of the bleeding?

A) An endoscopy
B) An angiography
C) A gastric analysis
D) Barium contrast studies

Question 29

The nurse implements discharge teaching for a patient following a gastroduodenostomy for treatment of a peptic ulcer.Which patient statement indicates that the teaching has been effective?

A) "I will need to choose foods that are low in fat and high in carbohydrate."
B) "I will try to drink liquids along with my meals."
C) "Vitamin injections may be needed to prevent problems with anemia."
D) "The surgery has cured my peptic ulcer disease."

Question 30

A patient with chronic gastritis associated with the presence of Helicobacter pylori is treated with triple-drug therapy.Which of the following medications should the nurse explain to the patient are commonly included in this regimen?

A) Tetracycline,bismuth subsalicylate (Pepto-Bismol),and amoxicillin
B) Tetracycline,metronidazole (Flagyl),and bismuth subsalicylate (Pepto-Bismol)
C) Amoxicillin,clarithromycin (Biaxin),and omeprazole (Losec)
D) Metronidazole (Flagyl),clarithromycin (Biaxin),and omeprazole (Losec)

Question 31

A patient undergoes a gastroduodenostomy (Billroth I)for treatment of a perforated ulcer.Postoperative orders include morphine with a patient-controlled analgesia (PCA)device and NPO status with low,intermittent NG suction in addition to IV fluids and antibiotics.Twenty four hours after the patient returns to the surgical unit,she complains of increasing abdominal pain.The nursing assessment reveals absence of bowel sounds and 200 mL of bright-red NG drainage in the last hour.What is the most appropriate nursing action?

A) Notify the physician.
B) Irrigate the NG tube per orders.
C) Assess the patient's use of the PCA.
D) Splint the abdomen to relieve pressure on the incision.

Question 32

The physician orders IV vasopressin (Pitressin)to be administered to a patient with esophageal bleeding.The nurse monitors for which of the following during administration of this medication?

A) Polyuria
B) Metabolic alkalosis
C) Intention tremors
D) Chest pain

Question 33

Cobalamin injections have been prescribed for a patient with chronic atrophic gastritis.The nurse determines that teaching regarding the injections has been effective when the patient makes which following statement?

A) "These injections will decrease my risk of stomach cancer."
B) "These injections will increase the hydrochloric acid in my stomach."
C) "The cobalamin injections need to be taken until my inflamed stomach heals."
D) "I must take these injections to prevent me from becoming anemic."

Question 34

A 68-year-old patient has had intermittent epigastric distress,anorexia,and weight loss over a period of 6 months.She is hospitalized with anemia and ascites,and an endoscopic examination reveals cancer located in the fundus of the stomach.The nurse plans care for the patient with the knowledge that these findings indicate which of the following?

A) The patient has a poor prognosis with any therapy.
B) Surgical intervention is not indicated for the patient.
C) Radiation therapy is the treatment of choice for the patient.
D) The patient has a good prognosis with the use of combination chemotherapy.

Question 35

A patient with a bleeding duodenal ulcer has an NG tube in place,and the physician orders 30 mL of aluminum hydroxide-magnesium hydroxide (Maalox)to be instilled through the tube every hour.How can the nurse evaluate the effectiveness of this treatment?

A) Monitor arterial blood gas values.
B) Check each stool for the presence of occult blood.
C) Periodically aspirate and test stomach contents for pH.
D) Measure the amount of residual stomach contents hourly.

Question 36

What information is most important for the nurse to obtain during the initial assessment of a patient admitted to the emergency department with vomiting of bright-red blood?

A) Current medical problems
B) Medications the patient is taking
C) History of prior bleeding episodes
D) Vital signs and symptoms of hypovolemia

Question 37

A patient recovering from a gastrojejunostomy (Billroth II)for treatment of a duodenal ulcer develops dizziness,weakness,and palpitations,with an urge to defecate about 20 minutes after eating.To avoid recurrence of these symptoms,what should the nurse teach the patient to do?

A) Increase fluid intake with meals.
B) Lie down for about 30 minutes after each meal.
C) Drink sugared fluids or eat candy after each meal.
D) Eat a high-carbohydrate,low-fat diet in six small feedings a day.

Question 38

A patient with a peptic ulcer who has an NG tube develops sudden,severe upper abdominal pain,diaphoresis,and a very firm abdomen.Which action should the nurse take next?

A) Irrigate the NG tube.
B) Obtain the vital signs.
C) Give the ordered antacid.
D) Listen for bowel sounds.

Question 39

The physician prescribes antacids and sucralfate (Carafate)for treatment of a patient's peptic ulcer.To promote the effects of these drugs,what should the nurse teach the patient to take?

A) Sucralfate and antacids together 30 minutes before each meal
B) Antacids every 2 hours while awake and sucralfate at bedtime
C) Antacids 1 hour before each meal and sucralfate between meals
D) Sucralfate 30 minutes before each meal and antacids 1 and 3 hours after meals and at bedtime

Question 40

A patient who uses an NSAID for management of severe osteoarthritis has recently developed melena.Which of the following changes in the treatment plan would the nurse expect to be made by the physician?

A) Administration of ranitidine
B) Substitution of corticosteroids for the NSAID
C) Substitution of acetaminophen for the NSAID
D) Administration of misoprostol (Cytotec)with the NSAID

Question 41

The nurse suspects the possibility of E.coli food poisoning when several individuals eating at the same establishment develop the onset of which of the following symptoms?

A) Fever and chills
B) Nausea and vomiting
C) Hemorrhagic diarrhea
D) Headache,dizziness,and muscular incoordination

Question 42

A patient tells the nurse that she frequently buys canned foods at a discount price because they are dented.She asks if there is a way to prevent food poisoning from using improperly canned products.Which of the following would be the nurse's best response?

A) Discard the canned food if the smell is abnormal.
B) Boil the canned food for 15 minutes before serving.
C) There is no known way to prevent food poisoning from improperly canned foods.
D) Open the cans immediately after purchase,and place the contents in plastic containers in the freezer for 48 hours.

Question 43

Which agent that causes bacterial food poisoning is known to have the quickest onset of symptoms?

A) Listeria
B) Escherichia coli
C) Clostridium botulinum
D) Staphylococcus aureus