Med-Surg Ch 28: Care of Patients With Disorders of the Upper Gastrointestinal System
The nurse calculates the body mass index (BMI) of a man who is 6 feet tall and weighs 150 pounds. Which value is correct? A. 21.0 B. 25.0 C. 43.1 D. 66.3
21.0 *weight in kg divided by height in squared meters (68.1 kg divided by 3.24 meters = 21.0)
A nurse is reviewing signs and symptoms of esophageal cancer with people who are at risk. Which statement indicates that the participants have understood the information? A. "A feeling of fullness in the throat is an early sign." B. "Belching and indigestion are caused by cancerous lesions." C. "Common symptoms are halitosis and dryness of the mouth." D. "Choking or coughing while swallowing liquids is an early sign."
"A feeling of fullness in the throat is an early sign." *Sensation of fullness in the throat is considered an early sign of esophageal cancer. (2) Belching and indigestion are more closely associated with a hiatal hernia or gastroesophageal reflux disease (GERD). (3) Dry mouth and halitosis are more closely associated with stomatitis. (4) Dysphagia with liquids is a late sign.
When working with an obese patient who wants to lose weight, which statement would indicate that the teaching has been understood? A. "Starting to exercise 2 hours a day is a good beginning for me." B. "Eating everything I want except for anything sweet will help me lose weight." C. "A program such as Weight Watchers will help me cut calories and keep on track." D. "Over-the-counter diet pills are a good way to jump start my weight loss."
"A program such as Weight Watchers will help me cut calories and keep on track." *Programs such as Weight Watchers, TOPS, and Overeaters Anonymous have shown the greatest success in promoting weight loss that then is maintained. (1) Beginning an exercise program is essential, but starting with 2 hours a day is unrealistic. The patient should consult their health care provider before starting any exercise program. (2) Cutting total calories is the goal of any weight loss program. Cutting out sweets helps but only if total calories are cut rather than replacing calories from sweets with other foods. (4) Over-the-counter diet pills have not been shown to promote significant weight loss, and they often have many undesirable side effects.
A patient who had gastric bypass surgery 5 weeks ago calls the office to report feelings of nausea, sweating, and diarrhea shortly after eating meals. What response by the nurse is most appropriate? A. "This is common after the type of surgery you had." B. "How much, if any, alcohol do you consume each day?" C. "Avoid large meals, limit sweets, and drink small amounts of liquids between meals." D. "You may be experiencing a postoperative infection."
"Avoid large meals, limit sweets, and drink small amounts of liquids between meals." *Some patients who have a gastrectomy experience a complication known as the "dumping syndrome." The patient has nausea, weakness, abdominal pain, and diarrhea and may feel faint and perspire profusely or experience palpitations after eating. These sensations are caused by the rapid passage of large amounts of food and liquid into the jejunum. When a patient experiences dumping syndrome, instruction is given to avoid eating large meals and to drink a minimum of fluids during the meal. Fluids may be taken in small amounts later, between meals. If sweet foods seem to aggravate the condition--and they sometimes do--the patient should try to avoid them. Although this is not uncommon manifestation after this type of surgery, informing the patient that this is common provides limited information to the patient and is not the best response. This problem is not connected to alcohol consumption and is not a symptom of a post-operative infection
The nurse is preparing a teaching plan for a patient with gastroesophageal reflux disease (GERD) who has been prescribed multi-drug therapy for treatment. Which information is most important for the nurse to obtain? A. "Can you identify triggers for your reflux?" B. "Can you commit to changing your diet?" C. "Do you understand how each type of medication works?" D. "Do you think you can afford those prescriptions?"
"Do you think you can afford those prescriptions?" *Drug therapy may include antacids, H2-receptor antagonists, proton pump inhibitors, and prokinetic drugs. Priorities related to education about medication include checking for possible drug interactions with other drugs the patient is taking and verifying that the patient can afford the drugs prescribed. (If the patient cannot afford the medications, compliance is an unrealistic expectation.) While it is important for the patient to attempt to identify triggers, commit to dietary and lifestyle modifications, and understand each medication, those are questions that can be answered over time
The nurse is discussing bariatric surgery complications with a patient. Which statement indicates that the patient accurately understands the nurse's teaching about common procedural side effects? A. "I understand that gastric ulcers frequently occur in patients who have bariatric surgery." B. "Gallstones are a common occurrence in patients who have bariatric surgery." C. "I know an umbilical occurrence in patients who have bariatric surgery." D. "I know an umbilical hernia might happen after I have bariatric surgery." D. "Unfortunately, I may experience gastritis after having bariatric surgery."
"Gallstones are a common occurrence in patients who have bariatric surgery." *Nutritional deficiencies caused by the banding result in the formation of gallstones in a large percentage of bariatric surgery patients. About a third of patients who undergo bariatric surgery develop gallstones
You reinforce diet recommendations to a patient with GERD. Which patient statement indicates a need for further teaching? A. "I should avoid spicy Italian sauces." B. "Clothes should be loose around the waist and abdomen." C. "I need to wait 30 minutes after eating before lying down." D. "I need to consider removing caffeine from my diet."
"I need to wait 30 minutes after eating before lying down." *The patient should know to wait 3 hours after eating before lying down. The other responses indicate that the patient has understood that (1) spicy tomato sauces should be avoided, (2) clothes should be loose around the waist and abdomen, and (4) caffeine should not be consumed.
The nurse is educating a patient with hiatal hernia. Which statement indicates that the patient understands the nurse's teaching? A. "I should avoid tea and chocolate." B. "I should wear an abdominal binder for added support." C. "I should sleep flat on a single pillow." D. I should not eat within an hour of going to bed."
"I should avoid tea and chocolate." *Hiatal hernia is diagnosed by an upper GI series. Nutritional modification indicated in patients with hiatal hernia includes limiting intake of alcohol, chocolate, caffeine, and fatty food. Other treatment includes weight reduction, avoidance of tight-fitting clothes around the abdomen, administration of antacids, histamine (H2) receptor antagonists, or proton pump inhibitors, and elevation of the head of the bed on 6 to 8 inch blocks. The patient is instructed not to eat within 3 h of going to bed
The nurse is educating a patient with Barrett esophagus. Which statement indicates that the patient requires a need for further instruction? A. "I should eat smaller meals and avoid foods that cause reflux." B. "I can still have a small glass of wine with dinner." C. "I should consider switching to smokeless tobacco." D. "I should stay upright after eating."
"I should consider switching to smokeless tobacco." *Care of the patient with Barrett esophagus is focused on encouraging measures to prevent GERD and on regular checkups. Patients should be encouraged not to use tobacco products and not to indulge in heavy alcohol use
Which statement made by a patient might indicate a precipitating factor of acute gastritis? A. "I never touch alcohol." B. "I take ibuprofen several times a day." C. "I try to jog at least 2 miles every day." D. "I just started a new diet."
"I take ibuprofen several times a day." *Drinking excessive amounts of alcohol, infection from eating contaminated food, Helicobacter pylori bacteria, and ingestions of aspirin, ibuprofen, corticosteroids, or nonsteroidal antiinflammatory drugs (NSAIDS) are gastrointestinal (GI) irritants. Exercise and a healthy diet help prevent gastritis.
The nurse is caring for a patient who is being treated for a gunshot wound to the abdomen. The patient is receiving total parenteral nutrition (TPN), and the physician has prescribed insulin coverage on a sliding scale. The patient reports he has never had diabetes before. What response is best for the nurse to make? A. "It is likely you have developed diabetes as a result of your illness." B. "Do you have a family history for diabetes?" C. "The TPN you are receiving has high amounts of glucose." D. "Insulin is needed to manage your stomach's inability to adequately metabolize food at this time."
"The TPN you are receiving has high amounts of glucose." *People on TPN are prone to hyperglycemia from the high glucose content of the solution
A nurse is taking care of a patient who had a modified radical neck dissection surgery. The patient's spouse asks, "Why do you have to apply cold packs and elevate my husband's head?" Which response is the most appropriate? A. "These intervention decrease the need for opiates." B. "These interventions reduce neck swelling." C. "These interventions promote faster healing." D. "These interventions reduce the incidence of postoperative fever.'
"These interventions reduce neck swelling." *Application of cold packs is to prevent excessive swelling in the neck that might compress the airway, circulation, and nerves. (1) Cold packs can reduce the need for opiates for some, but this is not the reason for the cold packs. (3) The interventions may or may not promote quicker healing. (4) These interventions do not reduce the incidence of postoperative fever.
The nurse is presenting a program about bulimia nervosa to a group of student nurses. After the program, the participants correctly identify which method(s) of treatment? (select all that apply) A. Appetite suppressants B. Antidepressant medications C. Psychotherapy D. Behavior modification E. Increased exercise
1. Antidepressant medications 2. Psychotherapy 3. Behavior modification *Bulimia nervosa is a psychological disorder. The bulimic patient consumes large quantities of food and then induces vomiting to get rid of it so that weight is not gained. Laxatives may be taken to purge the system after an eating binge. Treatment of bulimia includes psychotherapy, antidepressant medication, and behavior modification. Appetite suppressants and exercise are not part of treatment for bulimia nervosa
The nurse instructs the patient on the weight reduction drug Orlistat (Xenical, Alli) that he may experience which side effect(s)? (select all that apply) A. Diarrhea B. Hypoglycemia C. Abdominal cramping D. Constipation D. Nausea
1. Diarrhea 2. Abdominal cramping 3. Nausea *Medications that suppress appetite or block fat absorption may be used on a short-term basis. Orlistat (Xenical, Alli) inhibits lipase, causing fats to remain partially undigested and unabsorbed. Gastrointestinal side effects of orlistat include diarrhea (sometimes uncontrolled), abdominal cramping, and nausea
To best assist a patient with dysphagia, the nurse should implement which action(s)? (select all that apply) A. Encourage "practice swallowing" before the meal B. Coach the patient to chew thoroughly C. Assist the patient to sit upright with the head forward and chin tucked D. Offer fluid during the meal E. Give the patient thin liquids, such as water
1. Encourage "practice swallowing" before the meal 2. Coach the patient to chew thoroughly 3. Assist the patient to sit upright with the head forward and chin tucked 4. Offer fluid during the meal *To assist a patient with dysphagia (trouble swallowing), the nurse should encourage practice swallows and visualize the larynx rising. Coaching the patient to chew thoroughly while sitting upright, and offering appropriate liquids are actions that decrease likelihood of aspiration. The nurse should administer thickened liquids
The nurse explains to an obese patient that initial medically supervised weight reduction includes which component(s) (select all that apply) A. General health assessment B. Specialized exercise program C. Participation in a support group D. Stress reduction E. Surgery
1. General health assessment 2. Specialized exercise program 3. Participation in a support group 4. Stress reduction *Dietary control and exercise are the main treatments for obesity. A general health assessment should be conducted before a patient is placed on a weight reduction diet. A provider will usually prescribe a lower calorie diet and exercise. The patient is taught ways to change thinking about food and weight. Those with BMI over 40 may have surgery to achieve weight reduction if they meet established criteria. Participation in a support group and behavior modification with some sort of reward for weight loss are part of the total treatment plan. Teaching stress reduction and alternate ways of coping are essential to success. Medications that suppress appetite or block fat absorption may be used on a short-term basis. Surgery would be a last resort
When screening for the presence of risk factors for oral and pharyngeal cancers, which questions would you ask? (select all that apply) A. How much alcohol do you consume? B. Have you had any oral lesions? C. Do you have family members who have cancer? D. Do you smoke? E. Have you been exposed to the hepatitis virus? F. Have you vomited blood?
1. How much alcohol do you consume? 2. Have you had any oral lesions? 3. Do you have family members who have cancer? 4. Do you smoke? *Use of alcohol, use of tobacco and a personal history of oral lesions, or a family history of cancer are increased risk factors for oral and pharyngeal cancers. (5) History of hepatitis increases the risk for liver cancer. (6) Hematemesis is an indication of problems within the stomach or esophageal blood vessels but is not a symptom of cancer.
The nurse is providing education to a patient with a body mass index (BMI) of 42. The nurse should educate the patient about which conditions for which he is at risk? (Select all that apply.) A. Type 1 diabetes mellitus B. Insomnia C. Hyperthyroidism D. Hypertension E. Hyperlipidemia F. Obstructive sleep apnea
1. Hypertension 2. Hyperlipidemia 3. Obstructive sleep apnea *This patient has a BMI of 42, which is morbidly obese. This patient is at risk for hypertension, hyperlipidemia, type 2 diabetes mellitus (not type 1), and obstructive sleep apnea. Hypothyroidism can contribute to obesity, but obesity does not lead to hyperthyroidism. Insomnia is not directly related to morbid obesity.
While a nurse is obtaining a clinical history, a patient with a know history of peptic ulcers suddenly complains of severe upper abdominal pain of increasing intensity that spreads to the shoulders. The abdomen has borderline rigidity. Which sign(s) and/or symptom(s) signal worsening condition related to the peptic ulcer? (select all that apply) A. Slow, deep respirations B. Decreased oxygen saturation C. Increased pulse D. Hot, dry skin E. Belching and flatulence F. Confusion and restlessness
1. Increased pulse 2. Confusion and restlessness *An increased pulse is a compensatory measure and the first vital sign change that is expected with pain or bleeding. Restlessness and confusion are early signs of decreased perfusion, in this case related to hemorrhage. (1) Respirations are more likely to increase. (2) Oxygen saturation should not be affected at this point. (4) Hot, dry skin is more closely associated with infection. (5) Belching and flatulence are more closely associated with GERD.
The nurse is caring for a 70-year-old patient who was diagnosed with gastroenteritis after returning from a camping trip to Mexico. Which manifestation(s) is/are consistent with this diagnosis? (select all that apply) A. Positive stool culture for Giardia or Shigella B. Abdominal cramping C. Fat in the stool D. Mucus in stool E. Blood in stool
1. Positive stool culture for Giardia or Shigella 2. Abdominal cramping 3. Mucus in stool 4. Blood in stool *Manifestations associated with gastroenteritis include a positive stool culture for Giardia or Shigella, abdominal cramping, and presence of mucus or blood in the stool. Fat in the stool is not symptomatic of gastroenteritis
The nurse is providing discharge education to a patient after a roux-en-Y gastric bypass procedure. Which nutritional supplements must this patient take for the rest of his life? (Select all that apply.) A. Vitamin B12 B. Folic acid C. Vitamin D D. Vitamin C E. Calcium F. Iron
1. Vitamin B12 2. Folic acid 3. Calcium 4. Iron *After a roux-en-Y gastric bypass procedure, the patient is at risk for iron, calcium, folic acid, and vitamin B12 deficiencies and must take these supplements for life. The patient is not at risk for a vitamin C or D deficiency.
The nurse correctly recognizes that esophageal cancer is associated with which risk factor(s)? (select all that apply) A. Cigarette smoking B. Diabetes C. Hypertension D. Heavy alcohol use E. Smokeless tobacco
1. cigarette smoking 2. heavy alcohol use 3. smokeless tobacco *Cigarette smoking is a major cause of esophageal cancer in the United States. When combined with heavy alcohol consumption, the risk for esophageal cancer increases. Both substances are irritants to the mucosa of the esophagus. Smokeless tobacco is also associated with esophageal cancer. Diabetes and hypertension do not increase the risk of developing esophageal cancer
The nurse explains that the diagnosis of morbidly obese is reserved for people who exceed which percentage of their recommended weight? A. 50% B. 70% C. 90% D. 100%
100%
You are caring for a patient who is vomiting blood. The health care provider orders a normal saline IV fluid bolus of 500 mL to infuse over 30 minutes. The correct pump setting in mL/h is ___________.
1000 or 999 *999 mL as infusion pumps only allow programming of 999 as maximum due to distal display
For which patient should the nurse question an order for esomeprazole (Nexium)? A. A 55-year-old female who takes digoxin. B. A 52-year-old male who is noncompliant C. A 38-year-old female who has asthma D. A 56-year-old male who has epistaxsis
A 55-year-old female who takes digoxin. *Esomeprazole (Nexium) interferes with the absorption of digoxin, rabeprazole, and iron salts. In addition, the FDA has issued a warning that long-term use of the proton pump inhibitors esomeprazole (Nexium) or omeprazole (Prilosec) may increase the risk of heart problems
The nurse is reviewing the chart of a patient who recently underwent a total gastrectomy and notes the patient is receiving total parenteral nutrition (TPN). The nurse understands which information about TPN? A. A method of feeding a patient through a tube inserted through an incision in the stomach B. A new method of tube-feeding a patient with dysphagia C. A form of intravenous (IV) feeding D. A type of intestinal decompression
A form of intravenous (IV) feeding *TPN is indicated when the patient cannot ingest or digest food normally or has a problem with malabsorption. If a patient has continued weight loss and a negative nitrogen balance, TPN is indicated. TPN is essentially a form of IV feeding. However, because the amounts and kinds of nutrients needed for long-term nutritional maintenance usually cannot be handled as well by peripheral veins, the nutrient mix is given into a larger central vein such as the superior vena cava. A Replogle or Salem sump tube is used for GI decompression. Gastrostomy tubes are inserted through an incision in the stomach; enteral feeding is instilled through this tube.
The nurse is caring for a patient who is being treated for extensive burns. The nurse notes the presence of coffee-ground material in the Salem sump catheter. The nurse correctly recognizes which factor as the likely cause? A. Esophagitis B. Perforated gastric ulcer C. Gastric irritation from the Salem sump tube D. A physiologic stress ulcer
A physiologic stress ulcer *Prolonged physiologic stress produces what is known as a physiologic stress ulcer, which is believed to be the result of unrelieved stimulation of the vagus nerves and decreased perfusion to the stomach. A stress ulcer is pathologically and clinically different from a chronic peptic ulcer. It is more acute and more likely to produce hemorrhage. Perforation occurs occasionally, and pain is rare. Stress ulcers are a hazard for patients who are severely ill and in intensive care units for prolonged periods. Patients with multiple trauma, burns, or multisystem disorders are subject to physiologic stress ulcers, which may produce blood that has been in contact with gastric juices
The nurse documenting the presence of pain in a patient with possible gastric ulcer would anticipate that the pain would occur at which time? A. In the morning B. Erratically, without pattern C. At bedtime D. With meals
At bedtime *Pain occurs at bedtime because the stomach is empty, but the gastric juices are still high. Pain is absent in the morning when the digestive juices are low and when the stomach is filled with food
The nurse is educating a patient who has gastroesophageal reflux disease (GERD) about dietary modification. Which information is most important for the nurse to include in the teaching plan? A. Avoid highly seasoned or spiced foods B. Drink ginger ale or lemon lime soda rather than cola C. Use a straw to drink all fluids D. Eating three meals spaced evenly apart
Avoid highly seasoned or spiced foods *Avoiding highly seasoned or spicy food should be incorporated into diet changes for the patient with GERD. The avoidance of carbonated beverages with meals and the use of a straw do not reduce the impact of GERD. The frequency of dietary intake does not influence GERD
You are supervising a nursing student during the care of a patient with a gastrostomy tube. You should intervene if the student A. aspirates for residual contents before feeding B. Flushes the tube after each feeding C. Changes the tubing and bag every 4 hours D. Cleans and dries the skin around the table
Changes the tubing and bag every 4 hours *The tubing and bag are changed every 24 hours unless there is a special need based on assessment of the patient's circumstances. (1) Residual is aspirated before the subsequent feeding. (2) The tube is flushed after each feeding. (4) The skin should be kept clean and dry.
A patient with a gastrostomy tube gets a bolus feeding of 200 mL every 4 h. Before giving the bolus, the nurse aspirates a residual of 100 mL. Which action is most appropriate? A. Give the 200 mL feeding B. Record the residual and give 100 mL of the feeding C. Document the residual and hold the feeding D. Position the patient in high Fowler position and give the feeding
Document the residual and hold the feeding *On finding a large residual, the nurse should return the residual to the patient, document the amount of the residual, and hold the feeding to avoid possible aspiration
Which causative agent is the primary cause of Barrett esophagus? A. Gastroesophageal reflux disease (GERD) B. Eating hot, spicy foods C. Anorexia nervosa D. Esophageal polyps
Gastroesophageal reflux disease (GERD) *A major cause of Barrett esophagus is esophageal reflux
A 56-year-old man is admitted with a diagnosis of gastroesophageal reflux disease (GERD). The nurse anticipates the patient to report gastroesophageal discomfort after which meal? A. Poached salmon, mashed potatoes, and milk B. Turkey, salad, and a glass of red wine C. Chicken in lemon sauce, rice, and fruit juice D. Hamburger, peas, and cola
Hamburger, peas, and cola *Foods with significant fat content (hamburger) and carbonated beverages decrease the tone and contractility of the esophageal sphincter, allowing gastric contents to flow back up into the esophagus. Turkey, salad, red wine, chicken, rice, fruit juice, poached salmon, potatoes, and milk are less likely to cause discomfort.
The nurse is caring for a patient with suspected dysphagia. Which action is most appropriate for the nurse to take? A. Encourage incentive spirometry use B. Instruct the patient to take practice swallows before the meal C. Encourage patient attempts to communicate, and pay attention to nonverbal cues D. Encourage the patient to keep a food diary
Instruct the patient to take practice swallows before the meal *Dysphagia means difficult in swallowing. The nurse should have the patient take some "practice swallows: before beginning the meal, and watch to see that the larynx rises with each swallow. Incentive spirometry usage is important for patients with dyspnea, or shortness of breath. Encouraging communication and paying attention to nonverbal cues is an effective intervention for aphasia (inability to use or understand words), but it does not evaluate whether or not the patient can swallow effectively
The nurse is caring for a patient with a Salem sump tube for decompression. The patient displays dyspnea and reports feeling full and nauseated. What action should the nurse take first? A. Increase suction from low to high B. Notify the charge nurse C. Irrigate the tube with normal saline D. Withdraw the tube about three inches
Irrigate the tube with normal saline *Irrigation of the tube to restore patency is the first intervention when assessment indicates inadequate decompression. The suction should remain on low. Withdrawing the tube may cause inappropriate placement. Notifying the charge nurse is not necessary at this time. Irrigating an obstructed sump tube is a standard of care
A patient has been diagnosed with gastric cancer. What is associated with increased incidence of this disease? A. Luncheon meats ("cold cuts") B. Refined sugars C. Carbonated beverages D. Dairy products
Luncheon meats ("cold cuts") *Nitrites, found in processed foods such as luncheon meats, have been strongly linked to gastric cancer. Refined sugars, dairy products, and carbonated beverages have not been associated with development of gastric cancer.
The nurse is caring for a patient experiencing stomatitis. Which factor is most likely to have contributed to development of stomatitis? A. Morbid obesity B. Nutritional deficiencies C. Good oral hygiene D. Vegetarian diet
Nutritional deficiencies *Factors likely to have contributed to the development of stomatitis is nutritional deficiencies, trauma from ill-fitting dentures, malocclusions of the teeth, poor oral hygiene, excessive smoking, excessive drinking of alcohol, pathogenic microorganisms, radiation therapy, and drugs used in chemotherapy for malignancies and anticonvulsants. Morbid obesity and intake of a vegetarian diet do not contribute to the development of stomatitis.
A family member tells you, "Dad seems to be having some trouble swallowing lately." What is your priority action? A. Notify the health care provider B. Consult the speech therapist for advice C. Initiate aspiration precautions D. Observe during "practice swallows."
Observe during "practice swallows." *First, observe and assess the rise of the larynx during a practice swallow. (1) The health care provider would be notified if constant choking occurs. (2) Consulting a speech therapist may be appropriate, but it is not the priority action. (3) Aspiration precautions should always be in place for a patient who has trouble swallowing. However, it is essential to assess the patient's swallowing ability in order to determine if they really are having difficulty.
The specific cause of dysphagia can be determined more easily when the LPN/LVN obtains which information about the patient? A. Observing conditions under which the patient experiences difficulty swallowing. B. Patient's bowel habits and whether laxatives are taken habitually. C. Patient's vital signs, especially rate and depth. D. Level of physical activity tolerated by the patient.
Observing conditions under which the patient experiences difficulty swallowing. *When assessing the patient with dysphagia, the nurse should observe carefully the kinds of food the patient can tolerate and the conditions under which difficulties are experienced. Knowing the consistency and temperature of the foods most easily ingested by the patient is helpful. The patient's vital signs, level of tolerated physical activity, and bowel habits are important assessment data but are not related to the patient's dysphagia.
A patient has been admitted to the hospital with GI bleeding. Which is a priority nursing action for this patient? A. Obtain complete vital signs. B. Administer prescribed antacids every 2 h. C. Administer prescribed medication for nausea and vomiting. D. Administer prescribed medication for pain
Obtain complete vital signs. *The patient experiencing GI bleeding is at risk for hypovolemic shock. Assessment of vital signs will provide indicators of the patient's condition. The nurse should also plan to administer pain medication, antacids, and antiemetic medications.
The nurse is caring for a patient who is suspected of having oral cancer. When reviewing the patient's health history, which finding provides supportive data for the diagnosis? A. Presence of leukoplakia B. History of oral herpes simplex C. History of an oral yeast infection D. Reports of a dry oral cavity
Presence of leukoplakia *Leukoplakia, a precancerous lesion, may occur on the tongue or mucosa
A patient is receiving continuous enteral feedings. Which intervention will address the most serious problem associated with the feeding therapy? A. Assist the patient to ambulate several times a day B. Raise the head of the bed C. Place an emesis basin and tissues within close proximity D. Offer water, other fluids, or ice chips frequently
Raise the head of the bed *The most serious problem is aspiration from reflux; therefore maintaining elevation of the head of the bed is essential. (1) Ambulation is an intervention for constipation, which may occur but is less likely. (3) Vomiting is not expected as long as the patient is tolerating the amount of the feeding. Bolus feedings can cause vomiting, but if vomiting occurs, the health care provider should be notified so that the amount can be adjusted. (4) Subjective thirst and dryness in the mouth area may occur, but patients who are receiving enteral feedings may also be NPO; therefore encouraging fluids may not be appropriate. Good oral care should be provided and can help relieve subjective oral dryness.
A patient has been diagnosed with gastritis. Which medication can the nurse anticipate will be prescribed? A. Ranitidine B. Ampicillin C. Carafate D. Aspirin
Ranitidine *Ranitidine functions as a gastric-acid inhibitor. Carafate may be used in conjunction with cimetidine, but its action is to create a barrier protecting the gastric mucosa from exposure to excess stomach acid. Aspirin and NSAIDs are known gastric irritants and can result in GI bleeding without an already existing gastritis. Ampicillin is an antibiotic; it is not relevant to the treatment of gastritis.
The nurse explains that the laparoscopic adjustable gastric banding surgery is best described as which type of bariatric surgery? A. Restrictive B. Malabsorptive C. Restrictive/malabsorptive D. Obstructive
Restrictive *The three types of bariatric surgery are restrictive, malabsorptive, and restrictive/malabsortive. Laparoscopic adjustable gastric banding is performed by placing an inflatable band around the fundus of the stomach and is considered restrictive. This procedure may be performed laparoscopically. The band in inflated and deflated via a subcutaneous port to change the size of the stomach as the patient loses weight
The nurse is caring for a patient who is postoperative after esophageal resection. Shortly after the nurse starts a feeding, the patient suddenly becomes dyspneic and complains of substernal pain. What should the nurse do first? A. Stop the feeding B. Ambulate the patient C. Notify the charge nurse D. reassure the patient
Stop the feeding *After esophageal resection, pain, increased temperature, and dyspnea may indicate leakage of the feeding into the mediastinum. The nurse should immediately discontinue the feeding, then notify the charge nurse and address any patient concerns. Ambulation is not indicated at this time; ambulation is an intervention to address gas pains
The nurse is aware that patients who have chronic gastritis from renal failure may present with which first sign of this disorder? A. An increase in the the white blood cell count B. Sudden massive hemorrhage C. Asthma-like symptoms D. Extreme dyspnea
Sudden massive hemorrhage *Sudden massive GI hemorrhage may be the first indication of chronic gastritis. Many of these patients do not have any symptoms at all until the hemorrhage
The nurse is caring for a patient with a peptic ulcer. The patient also has a history of chronic bronchitis, diabetes, and arthritis. Which component of the patient's history is the most likely contributing factor to the patient's ulcer? A. The patient requires insulin to manage his diabetes B. The patient uses a daily inhaler to decrease incidence of asthma attacks C. The patient takes ibuprofen daily for arthritis D. The patient takes a multivitamin daily
The patient takes ibuprofen daily for arthritis *About 4.5 million people in the United States have experienced a peptic ulcer. Helicobacter pylori infection is the major cause. Smoking and the continued use of nonsteroidal antinflammatory drugs (NSAIDs) are other causes
A patient reports a history of gastric ulcer. Which sign or symptom indicates the need for a priority action of health care provider notification? A. Epigastric pain that is described as a burning sensation B. Pain that is most severe at bedtime C. Vomit that "looks like coffee grounds." D. Discomfort that comes for several days and then subsides.
Vomit that "looks like coffee grounds." *health care provider. (1) Epigastric pain is a common symptom and is not the priority in this situation. (2) Pain that is more severe at bedtime is treated with antacids. (4) Waxing and waning discomfort is not the priority symptom.
A patient who has GERD for many years is diagnosed with Barrett esophagus. Etiologic factors for Barrett esophagus include A. eating spicy foods and hot peppers on a regular basis B. long-term, gastroesophageal reflux causing mucosal irritation C. previous history of oral cancer D. moderate alcohol consumption during adult years
long-term, gastroesophageal reflux causing mucosal irritation *The irritation of gastric secretions via reflux into the esophagus causes chronic irritation, which eventually may cause the cellular changes of Barrett esophagus. (1) Spicy food and hot peppers have not been shown to be a factor in reflux or gastritis unless a person is individually susceptible to that problem. (3) Previous history of cancer is not an etiologic factor for Barrett esophagus. (4) Excessive alcohol consumption over a long period of time is a risk factor for Barrett esophagus. Moderate alcohol use is not considered a risk factor in itself. Smoking combined with alcohol does seem to increase the risk of esophageal cancer.
