Chapter 45 - Prep U (Upper GI disorders)

A client comes to the clinic reporting pain in the epigastric region. What assessment question during the health interview would most help the nurse determine if the client has a peptic ulcer?

Does your pain resolve when you have something to eat?

Which clinical manifestation is not associated with hemorrhage?

bradycardia

grafted skin

highly vulnerable to inadequate perfusion and subsequent ischemia and necrosis.

A nurse is caring for a client who is acutely ill and has included vigilant oral care in the client's plan of care. What factor increases this client's risk for dental caries?

inadequate nutrition & decreased saliva production can cause cavities

When a client's nasogastric tube (NG) tube becomes clogged the nurse attempted to aspirate with a large-bore syringe, but with no success. What should the nurse do next?

- attach a syringe filled w/ warm water - attempt an in & out motion of instilling & aspirating

A client diagnosed with a peptic ulcer says, "Now I have something else I have to worry about." Which actions will the nurse take to help reduce the client's anxiety?

- interact w/ the client in a relaxed manner - help identify the client's current stressors - discuss potential coping techniques w/ the client - offer information about relaxation methods

A patient has been diagnosed with acute gastritis and asks the nurse what could have caused it. What is the best response by the nurse?

- it can be caused by ingestion of strong acids - you may have ingested some irritating foods - is it possible that you are overusing aspirin

A client with peptic ulcer disease wants to know nonpharmacologic ways to prevent recurrence. Which of the following measures would the nurse recommend?

- smoking cessation - substituting decaffeinated products for all forms of coffee - avoidance of alcohol - following a regular schedule for rest, relaxation, & meals

The nurse inserts a nasogastric tube into the right nares of a patient. When testing the tube aspirate for pH to confirm placement, what does the nurse anticipate the pH will be if placement is in the lungs?

6

A nurse is providing care for a client whose neck dissection surgery involved the use of a graft. When assessing the graft, the nurse should prioritize data related to what nursing diagnosis?

ineffective tissue perfusion

A patient is scheduled for a Billroth I procedure for ulcer management. What does the nurse understand will occur when this procedure is performed?

A partial gastrectomy is performed w/ anastomosis of the stomach segment to the duodenum

A patient has been diagnosed with a hiatal hernia. The nurse explains the diagnosis to the patient and his family by telling them that a hernia is a (an):

protrusion of the upper stomach into the lower portion of the thorax

The nurse is obtaining a history on a patient who comes to the clinic. What symptom described by the patient is one of the first symptoms associated with esophageal disease?

Dysphagia

Which of the following is the most successful treatment for gastric cancer?

removal of the tumor

A patient describes a burning sensation in the esophagus, pain when swallowing, and frequent indigestion. What does the nurse suspect that these clinical manifestations indicate?

GERD

A nurse is performing health education with a client who has a history of frequent, serious dental caries. When planning educational interventions, the nurse should identify a risk for what nursing diagnosis?

Imbalanced Nutrition: Less than Body requirements

A nurse is preparing to place a client's prescribed nasogastric tube. What anticipatory guidance should the nurse provide to the client?

Insertion is likely to cause some gagging

A client with an H. pylori infection asks why bismuth subsalicylate is prescribed. Which response will the nurse make?

It aids in the healing of the stomach lining

A client recovering from the removal of a gastric tumor asks why radiation therapy is needed. Which response will the nurse provide?

It is to kill any remaining cancer cells

A client with Crohn's disease is losing weight. For which reason will the nurse anticipate the client being prescribed parenteral nutrition?

impaired ability to absorb food

A healthcare provider prescribes a combination of drugs to treat reoccurring peptic ulcer disease, and the client asks the nurse the reason for all the medications. What teaching should the nurse review with the client?

The bismuth salts, antibiotics, and proton pump inhibitors will work together to suppress or eradicate H. pylori.

A patient is scheduled for a Billroth I procedure for ulcer management. What does the nurse understand will occur when this procedure is performed?

a partial gastrectomy is performed w/ anastomosis of the stomach segment to the duodenum

A nurse is performing an assessment for a client who presents to the clinic with an erythemic, fissuring lip lesion with white hyperkeratosis. What does the nurse suspect that these findings are characteristic of?

actinic cheilitis

A client comes to the clinic after developing a headache, abdominal pain, nausea, hiccupping, and fatigue about 2 hours ago. The client tells the nurse that the last food was buffalo chicken wings and beer. Which medical condition does the nurse find to be most consistent with the client's presenting problems?

acute gastritis

A nurse is teaching a group of middle-aged men about peptic ulcers. When discussing risk factors for peptic ulcers, the nurse should mention:

alcohol abuse & smoking

The nurse is inserting a nasogastric tube for a patient with pancreatitis. What intervention can the nurse provide to allow facilitation of the tube insertion?

allow the patient to sip water as the tube is being inserted

While caring for a patient who has had radical neck surgery, the nurse notices an abnormal amount of serosanguineous secretions in the wound suction unit during the first postoperative day. What does the nurse know is an expected amount of drainage in the wound unit?

approximately 80 to 120 mL

Which term describes a reddened, circumscribed lesion that ulcerates and becomes crusted and is a primary lesion of syphilis?

chancre

A client sustained second- and third-degree burns over 30% of the body surface area approximately 72 hours ago. What type of ulcer should the nurse be alert for while caring for this client?

curling's ulcer

The nurse is caring for a client who has developed dumping syndrome while recovering from a gastrectomy. What recommendation should the nurse make to the client?

eat several small meals daily spaced at equal intervals

A client comes to the clinic after developing a headache, abdominal pain, nausea, hiccupping, and fatigue about 2 hours ago. The client tells the nurse that the last food was buffalo chicken wings and beer. Which medical condition does the nurse find to be most consistent with the client's presenting problems?

erosion of the lining of the stomach or intestine

A nurse has obtained an order to remove a client's NG tube that was placed for feeding. What is the nurse's best initial action?

explain the process clearly to the client

Rebound hypoglycemia is a complication of parenteral nutrition caused by

feedings stopped too abruptly

The nurse assesses a patient who recently had a nasoenteric intubation. Symptoms of oliguria, lethargy, and tachycardia in the patient would indicate to the nurse what common complication?

fluid volume deficit

A client is preparing for discharge to home following a partial gastrectomy and vagotomy. Which is the best rationale for the client being taught to lie down for 30 minutes after each meal?

it slows gastric emptying

A client who reports increasing difficulty swallowing, weight loss, and fatigue is diagnosed with esophageal cancer. Because this client has difficulty swallowing, what should the nurse assign highest priority to?

maintaining a patent airway

dysphagia

most common symptom of esophageal disease,

A client has received a diagnosis of oral cancer. During client education, the client expresses dismay at not having recognized any early signs or symptoms of the disease. The nurse tells the client that in early stages of this disease, it is usual to have:

no symptoms

The nurse working in the recovery room is caring for a client who had a radical neck dissection. The nurse notices that the client makes a coarse, high-pitched sound upon inspiration. Which intervention by the nurse is appropriate?

notify the physician

The school nurse is planning a health fair for a group elementary school students and dental health is one topic that the nurse plans to address. When teaching the children about the risk of tooth decay, the nurse should caution them against consuming large quantities of

organic fruit juice

An elderly client comes into the emergency department reporting an earache. The client and has an oral temperature of 37.9° (100.2ºF) and otoscopic assessment of the ear reveals a pearly gray tympanic membrane with no evidence of discharge or inflammation. Which action should the triage nurse take next?

palpate the client's parotid glands to detect swelling & tenderness

A nurse is caring for a client with a nasogastric tube for feeding. During shift assessment, the nurse auscultates a new onset of bilateral lung crackles and notes a respiratory rate of 30 breaths per minute. The client's oxygen saturation is 89% by pulse oximetry. After ensuring the client's immediate safety, what is the nurse's most appropriate action?

report possible signs of aspiration pneumonia to the primary provider

A client with peptic ulcer disease has been prescribed sucralfate. What health education should the nurse provide to this client?

take the medication 2 hrs before or after other medications

The nurse is inserting a Levin tube for a patient for gastric decompression. The tube should be inserted to 6 to 10 cm beyond what length?

the distance measured from the tip of the nose to the earlobe from the earlobe to the diploid process

The most significant complication related to continuous tube feedings is

the increased potential for aspiration

The nurse is inserting a nasogastric tube and the patient begins coughing and is unable to speak. What does the nurse suspect has occurred?

the nurse has inadvertently inserted the tube into the trachea

The nurse is caring for a client receiving enteral nutrition with a standard polymeric formula. For which reason will the nurse question using this formula for the client?

their diagnosed w/ malabsorption syndrome

A client receives tube feedings after an oral surgery. The nurse manages tube feedings to minimize the risk of aspiration. Which measure should the nurse include in the care plan to reduce the risk of aspiration?

use semi fowlers position during, 60 minutes after, & an intermittent feeding