Deck 42: Nursing Management: Upper Gastrointestinal Problems

Question 1

A patient who is nauseated and vomiting up blood streaked fluid is admitted to the hospital with acute gastritis. When obtaining the admission health history, it will be most important for the nurse to ask the patient about

A) frequency of nonsteroidal antiinflammatory drug (NSAID) use.
B) family history of gastric problems.
C) recent weight gain or loss.
D) the amount of fat in the diet.

Answer 1

frequency of nonsteroidal antiinflammatory drug (NSAID) use.

Question 2

A 62-year-old patient who has been diagnosed with esophageal cancer tells the nurse, "I know that my chances are not very good, but I do not feel ready to die yet." Which response by the nurse is most appropriate?

A) "You may have quite a few years to live still left."
B) "Having this new diagnosis must be very hard for you."
C) "Thinking about dying will only make you feel worse."
D) "It is important that you be realistic about your prognosis."

Answer 2

"Having this new diagnosis must be very hard for you."

Question 3

Which of these assessment findings in a patient with a hiatal hernia who returned from a laparoscopic Nissen fundoplication 4 hours ago is most important for the nurse to address immediately?

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

Answer 3

The patient has absent breath sounds throughout the left lung.

Question 4

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 5

The nurse is admitting a patient who has been diagnosed with squamous cell carcinoma of the buccal mucosa. When interviewing the patient for the health history, the nurse will ask about

A) any use of tobacco by the patient.
B) any history of streptococcal throat infection.
C) chronic overexposure to the sun.
D) recurrent herpes simplex (HSV) infections.

Question 6

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

A) endoscopy procedures.
B) barium swallow.
C) radionuclide tests.
D) proton pump inhibitors.

Question 7

A patient with recurring heartburn receives a new prescription for esomeprazole (Nexium). In teaching the patient about this medication, the nurse explains that this drug

A) reduces the reflux of gastric acid by increasing the rate of gastric emptying.
B) coats and protects the lining of the stomach and esophagus from gastric acid.
C) treats gastroesophageal reflux disease by decreasing stomach acid production.
D) neutralizes stomach acid and provides relief of symptoms in a few minutes.

Question 8

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

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 9

A patient who has been NPO during treatment for nausea and vomiting caused by gastric irritation is to start oral intake. Which of these should the nurse offer to the patient?

A) A glass of orange juice
B) A bowl of hot chicken broth
C) A dish of lemon gelatin
D) A cup of coffee with cream

Question 10

The nurse will plan to teach the patient with newly diagnosed achalasia that

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

When admitting a patient with a stroke who is unconscious and unresponsive to stimuli, the nurse learns from the patient's family that the patient has a history of GERD. The nurse will plan to do frequent assessment of the patient's

A) bowel sounds.
B) breath sounds.
C) apical pulse.
D) abdominal girth.

Question 12

When the nurse is assessing the mouth of a patient who uses smokeless tobacco for signs of oral cancer, which finding will be of most concern?

A) A 3-mm ulcer on the floor of the mouth
B) A red, velvety patch on the buccal mucosa
C) White, curdlike plaques on the back of the tongue
D) Painful blisters at the border of the lips

Question 13

Which of these nursing actions should the RN working in the emergency department delegate to a nursing assistant who is helping with the care of a patient who has been admitted with nausea and vomiting?

A) Assess for signs of dehydration.
B) Ask the patient what precipitated the nausea.
C) Auscultate the bowel sounds.
D) Assist the patient with oral care after vomiting.

Question 14

The nurse is assessing a patient with gastroesophageal reflux disease (GERD) who is experiencing increasing discomfort. Which patient statement indicates that additional patient education about GERD is needed?

A) "I take antacids between meals and at bedtime each night."
B) "I quit smoking several years ago, but I still chew a lot of gum."
C) "I sleep with the head of the bed elevated on 4-inch blocks."
D) "I eat small meals throughout the day and have a bedtime snack."

Question 15

A patient who is receiving chemotherapy develops a Candida albicans oral infection. The nurse will anticipate the need for

A) hydrogen peroxide rinses.
B) administration of nystatin (Mycostatin) oral tablets.
C) the use of antiviral agents.
D) referral to a dentist for professional tooth cleaning.

Question 16

After the nurse teaches a patient with GERD about recommended dietary modifications, which diet choice for a snack 2 hours before bedtime indicates that the teaching has been effective?

A) Chocolate pudding
B) Glass of low-fat milk
C) Peanut butter sandwich
D) Cherry gelatin and fruit

Question 17

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

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 18

All the following orders are received for a patient who has been admitted with dehydration after 3 days of nausea and vomiting. Which order will the nurse act on first?

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

Question 19

A patient has just arrived on the postoperative unit after having a laparoscopic esophagectomy for treatment of esophageal cancer. Which nursing actions should be included in the postoperative plan of care?

A) Elevate the head of the bed to at least 30 degrees.
B) Reposition NG tube if drainage stops or decreases.
C) Notify doctor immediately about bloody NG drainage.
D) Start oral fluids when patient has active bowel sounds.

Question 20

A patient with deep partial-thickness (second-degree) burns over 70% of the body experiences severe pain associated with nausea and occasional vomiting during dressing changes. To promote relief of the patient's nausea and vomiting, the nurse should

A) administer the prescribed morphine sulfate before dressing changes.
B) avoid performing dressing changes close to the patient's mealtimes.
C) keep the patient NPO for 2 hours before and after dressing changes.
D) give the ordered prochlorperazine (Compazine) before dressing changes.

Question 21

A patient who requires daily use of a nonsteroidal antiinflammatory drug (NSAID) for management of severe rheumatoid arthritis has recently developed melena. The nurse will anticipate teaching the patient about

A) the use of ranitidine (Zantac) to decrease the risk for peptic ulcers.
B) reasons for using corticosteroids to treat the arthritis.
C) substitution of acetaminophen (Tylenol) for the NSAID.
D) the benefits of misoprostol (Cytotec) in protecting the GI mucosa.

Question 22

The health care provider orders IV ranitidine (Zantac) for a patient with an acute exacerbation of chronic peptic ulcer disease. When teaching the patient about the effect of the medication, which information will the nurse include?

A) "Ranitidine constricts the blood vessels in the stomach and decreases bleeding."
B) "Ranitidine decreases secretion of gastric acid."
C) "Ranitidine neutralizes the acid in the stomach."
D) "Ranitidine covers the ulcer with a protective material which promotes healing."

Question 23

Twelve hours after undergoing a gastroduodenostomy (Billroth I) for treatment of a perforated ulcer, a patient complains of increasing abdominal pain. The nursing assessment reveals an absence of bowel sounds and 200 ml of bright red NG drainage in the last hour. The most appropriate action by the nurse at this time is to

A) notify the health care provider.
B) irrigate the NG tube.
C) administer the ordered morphine sulfate.
D) continue to monitor the NG drainage.

Question 24

A patient is hospitalized with vomiting of "coffee-ground" emesis. The nurse will anticipate preparing the patient for

A) endoscopy.
B) angiography.
C) gastric analysis testing.
D) barium contrast studies.

Question 25

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 states,

A) "These injections will decrease my risk for developing 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) "The cobalamin injections will prevent me from becoming anemic."

Question 26

The health care provider orders insertion of a 20-gauge orogastric tube for a patient experiencing massive hematemesis. As the nurse inserts the tube, resistance is met in advancing the tube. The appropriate action by the nurse is to

A) ask the patient to hyperextend the neck.
B) stop and notify the health care provider of the resistance.
C) inject additional lubricant through the tube.
D) withdraw the tube a few inches and then reinsert.

Question 27

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 28

A patient with acute GI bleeding is receiving normal saline IV at a rate of 500 ml/hr. Which assessment data obtained by the nurse are most important to communicate immediately to the health care provider?

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

Question 29

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, the nurse teaches the patient to

A) increase the amount of fluid intake with meals.
B) lie down for about 30 minutes after eating.
C) drink sugared fluids or eat candy after each meal.
D) choose foods that are high in carbohydrates.

Question 30

A patient with a bleeding duodenal ulcer has an NG tube in place, and the health care provider orders 30 ml of aluminum hydroxide/magnesium hydroxide (Maalox) to be instilled through the tube every hour. To evaluate the effectiveness of this treatment, the nurse

A) periodically aspirates and tests gastric pH.
B) measures the amount of residual stomach contents hourly.
C) monitors arterial blood gas values on a daily basis.
D) checks each stool for the presence of occult blood.

Question 31

The health care provider orders IV vasopressin (Pitressin) to be administered to a patient with esophageal bleeding. During administration of the drug, the nurse will monitor the patient for

A) polyuria.
B) metabolic alkalosis.
C) intention tremors.
D) chest pain.

Question 32

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 33

A patient with chronic gastritis associated with the presence of Helicobacter pylori is treated with triple-drug therapy. The nurse explains to the patient that the drugs commonly included in this regimen include

A) famotidine (Pepcid), magnesium hydroxide (Mylanta), and pantoprazole (Protonix).
B) amoxicillin (Amoxil ), clarithromycin (Biaxin), and omeprazole (Prilosec).
C) sucralfate (Carafate), nystatin (Mycostatin), and bismuth subsalicylate (Pepto-Bismol).
D) metoclopramide (Reglan), bethanechol (Urecholine), and promethazine (Phenergan).

Question 34

A patient who has intermittent epigastric distress, weight loss, and ascites is diagnosed with stomach cancer. The nurse plans care for the patient with the knowledge that these findings indicate that

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 will need a referral to hospice services.

Question 35

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 (Pepcid). The nurse will explain that the medication will

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 36

Which information will be best for the nurse to include when teaching a patient with PUD about dietary management of the disease?

A) "You should avoid eating many raw fruits and vegetables."
B) "High-protein foods are least likely to cause pain."
C) "Avoid foods that cause pain after you eat them."
D) "You will need to remain on a bland diet indefinitely."

Question 37

When counseling a patient with a family history of stomach cancer about ways to decrease risk for developing stomach cancer, the nurse will teach the patient to avoid

A) chronic use of H₂-blocking medications.
B) emotionally or physically stressful situations.
C) smoked foods such as bacon and ham.
D) foods that cause abdominal distension.

Question 38

The health care provider prescribes antacids and sucralfate (Carafate) for treatment of a patient's peptic ulcer. The nurse will teach the patient to take

A) sucralfate and antacids together 30 minutes before each meal.
B) antacids 30 minutes before the sucralfate.
C) sucralfate at bedtime and antacids before meals.
D) antacids after eating and sucralfate 30 minutes before eating.

Question 39

A patient who is vomiting bright red blood is admitted to the emergency department. Which assessment should the nurse accomplish first?

A) Measuring the quantity of any emesis
B) Checking the level of consciousness
C) Auscultating the chest for breath sounds
D) Taking the blood pressure (BP) and pulse

Question 40

All of these 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 (Pepcid) 40 mg.
C) Insert NG tube and connect to suction.
D) Type and cross match for 4 units of packed red blood cells.

Question 41

A 22-year-old patient with Escherichia coli O157:H7 food poisoning is admitted to the hospital with bloody diarrhea and dehydration. All of the following orders are received. Which order will the nurse question?

A) Infuse lactated Ringer's solution at 250 ml/hr.
B) Monitor blood urea nitrogen and creatinine daily.
C) Administer loperamide (Imodium) after each stool.
D) Provide a clear liquid diet and progress diet as tolerated.

Question 42

The nurse will instruct the patient with GERD who is being discharged after a Stretta procedure that

A) acetaminophen (Tylenol) tablets can be used for pain.
B) postoperative nausea is an expected symptom.
C) gelatin, clear broth, and tea are appropriate foods for the next 24 hours.
D) intake and output should be measured and reported to the health care provider.

Question 43

The nurse suspects the possibility of Escherichia coli O157:H7 food poisoning when several individuals who have eaten in the same restaurant develop

A) fever and chills.
B) hemorrhagic diarrhea.
C) muscular incoordination.
D) nausea and vomiting.

Question 44

Which nursing diagnosis is appropriate for the home health nurse to use when planning care for a patient who has had a total gastrectomy with an anastomosis of the esophagus to the jejunum for treatment of stomach cancer?

A) Chronic pain related to altered GI tract function secondary to the surgery
B) Risk for infection related to ongoing need for parenteral nutrition
C) Risk for impaired skin integrity related to leakage from jejunostomy tube
D) Imbalanced nutrition: less than body requirements related to inability to absorb nutrients