MED/SURG2: Chapter 41

Which condition can be diagnosed by measuring fasting serum gastrin levels?

Zollinger-Ellison syndrome. Zollinger-Ellison syndrome can be diagnosed by measuring fasting serum gastrin levels, which will determine the amount of gastrin secreted by G cells of the stomach. Acute gastritis is diagnosed by endoscopic examination with biopsy. Pyloric obstruction is diagnosed by performing an endoscopy with dilated balloons. Gastric outlet obstruction is diagnosed by performing a barium contrast study. pp. 912-913

The nurse is caring for a patient who is on misoprostol medication for peptic ulcer disease. Which side effects does the nurse anticipate in this patient?

-Diarrhea -Uterine cramping -Abdominal cramping Misoprostol is a synthetic prostaglandin analog that can cause diarrhea, uterine cramping, and abdominal cramping. Tachycardia and blurred vision are the side effects of anticholinergics. p. 914

A patient with a peptic ulcer begins vomiting. The nurse would expect and be concerned with which type of vomitus?

"Coffee ground". The appearance of blood exposed to hydrochloric acid and other digestive enzymes in the stomach is dark brown with a coffee-ground consistency. This should be reported by the nurse. Fecal vomitus would be experienced with a total bowel obstruction. Bilious vomitus or undigested food may be seen with various gastrointestinal disturbances, such as gallbladder disease, gastroenteritis, or gastritis. p. 922

The nurse is giving a patient instructions regarding the management of gastroesophageal reflux disease (GERD). Which statement indicates that further teaching is required?

"I can have warm milk at bedtime, just not chocolate milk." Patients with GERD should be instructed to avoid milk, especially at bedtime, because it increases gastric acid secretion. There is not a specific diet for GERD, but rather the recommendation to avoid particular foods. Small frequent meals are recommended to prevent gastric distention. Chewing gum increases salivation and helps reduce a mild presentation of symptoms. p. 902

A patient presents to the outpatient clinic with concerns over persistent signs and symptoms of heartburn (pyrosis) . What is the most appropriate response for the nurse?

"I know it is uncomfortable for you. Have you been taking your medications as prescribed and making the necessary dietary adjustments?" It is important to ascertain the patient's adherence to prescribed medication and dietary parameters first. Instructing the patient to allow time for the medication to take affect is not addressing the dietary aspect of care. Although a sore throat and nocturnal episodes of coughing and choking are symptoms associated with pyrosis, they are not the initial questions the nurse should ask about. pp. 900-902

The nurse is teaching about home care to a patient with gastrointestinal reflux disease (GERD). Which statement made by the patient indicates the need for further teaching?

"I should lie down for two to three hours after eating." After eating, the patient should wait for three hours to lie down. This will help maintain gravity, which in turn prevents the development of acid reflux. The patient should not bend over after eating. The patient should not eat food within three hours of bedtime. The head of the bed should be elevated during sleep. p. 902

The nurse is teaching an older patient about treatment and management of peptic ulcer disease. Which statement made by the patient indicates the need for further teaching?

"I should report abdominal pain and discomfort to the nurse." The patient should report abdominal pain or discomfort to the primary health care provider, not to the nurse. For the treatment and management of peptic ulcer disease the nurse should instruct the patient to avoid irritating substances that cause peptic ulcer; take nonsteroidal antiinflammatory drugs (NSAIDs) and other gastric irritating substances along with food, milk, or antacids; and adhere to the proton pump inhibitor (PPI) and histamine-receptor blocker therapy as prescribed. p. 919

The results of a patient's recent endoscopy indicate the presence of peptic ulcer disease (PUD). Which teaching point should the nurse provide to the patient based on this new diagnosis?

"It would likely be beneficial for you to eliminate drinking alcohol." Alcohol increases the amount of stomach acid produced, so it should be avoided. Milk may exacerbate PUD, so two to three glasses would not be recommended. There is no reason to puree or mince food, and a current diet is likely to be altered to minimize symptoms. p. 912

Where does Zenker's diverticulum occur?

Above the upper esophageal sphincter. Diverticula are the saclike outpouchings of one or more layers of the esophagus. Zenker's diverticulum occurs above the upper esophageal sphincter. Esophageal cancers occur at the wall of the esophagus. Traction diverticulum occurs near the esophageal midpoint. Esophageal varices occur at the lower portion of the esophagus. pp. 907-908

The nurse is teaching a patient about measures to prevent Salmonella poisoning. Which action indicates effective learning?

The patient avoids eating half-boiled eggs. Improperly cooked eggs are a source of . Avoiding improperly cooked eggs prevents Salmonella poisoning. Contaminated cheese contains Escherichia coli (E. coli) and therefore causes E. coli poisoning. Canned food poses a risk of botulism. Rewarmed meat contains Clostridium perfringens and may cause clostridial poisoning. Text Reference - p. 925

Why does a primary health care provider place stents endoscopically while preparing a patient with esophageal cancer for surgery?

To improve nutrition status. Endoscopic stents are placed to improve nutrition and hydration. Placing the patient in an upright position will help prevent regurgitation and improve gastric emptying. Using an incentive spirometer will help prevent respiratory complications. pp. 905-906

The nurse finds fever, bleeding ulcers in the mouth, and bad oral odor in a patient with bleeding and painful gums. Which intervention is most beneficial to the patient?

Topical application of antibiotics. Painful bleeding gums, anorexia, fever, and bleeding ulcers in the mouth with bad odor indicates Vincent's infection. It is caused by fusiform bacteria, called Vincent spirochetes. Topical application of antibiotics is used to treat Vincent's infection. Acyclovir is used in patients with herpes simplex infection. Oral suspension of amphotericin B is used to treat oral candidiasis. In aphthous stomatitis, topical application of corticosteroids is recommended. Text Reference -p. 897

Which is a common antireflux surgery for repair of a hiatal hernia?

Toupet fundoplication. Toupet fundoplication is a common antireflux surgery for repair of a hiatal hernia. Cryotherapy, photodynamic therapy, and endoscopic mucosal resection are endoscopic therapies, not surgeries. pp. 902-903

A patient complains of nausea. When administering a dose of metoclopramide, the nurse should teach the patient to report which potential adverse effect?

Tremors. Extrapyramidal side effects, including tremors and tardive dyskinesia, may occur as a result of metoclopramide administration. Constipation, double vision, and numbness in fingers and toes are not adverse effects of metoclopramide. Text Reference - p. 895

The postoperative patient states that he or she has never taken pantoprazole in the past. The patient asks why he or she is getting this medication if the patient has never had heartburn. What is the best response by the nurse?

"This will reduce the amount of acid in your stomach until you can eat a regular diet again." Pantoprazole is a proton pump inhibitor that decreases acid production in the stomach. It minimizes damage to the gastric mucosa while the patient is on bed rest and hospitalized after surgery. Pantoprazole will not prevent gas pains and will not prevent stomach bleeding from surgery. Heartburn is not a side effect of diabetes. Text Reference - p. 903

The nurse is teaching a group of high school students about the prevention of food poisoning. Which comment by the student shows understanding of foodborne illness protection?

"When they gave me a pink hamburger I sent it back and asked for a new bun and clean plate." The student who did not accept the pink hamburger and asked for a new bun and clean plate understood that the pink meat may not have reached 160°F and could be contaminated with bacteria. Mixing ingredients and leaving them long enough for the flavors to melt, eating raw cookie dough from a refrigerated package, and only using one cutting board without washing it with hot soapy water between the chicken and salad vegetables could all lead to food poisoning from contamination. pp. 925-926

Which statement made by the nurse to an achalasia patient about how to manage symptoms needs correction?

"You should only eat soft food." Achalasia is a condition in which peristalsis of the lower two-thirds of the esophagus is absent. Patients with achalasia can also eat semisoft foods. The patient should eat food slowly. The patient should drink fluids with meals and should keep the head elevated while sleeping. p. 908

Which teaching should the nurse include in the discharge instructions for a postgastrectomy patient?

"You should report it to the primary health care provider if regurgitation occurs." Regurgitation should resolve after the surgery. If regurgitation persists after the surgery, the patient should report it the primary health care provider. Solid foods should be gradually given to the patient to resume a normal diet. Heartburn should be resolved after the surgery. Dysphagia may be reported one month after the surgery. p. 904

Which instruction should the nurse provide to the patient with inflammation of the parotid glands?

"You should try chewing gum." Inflammation of parotid glands is known as parotitis. Parotitis is characterized by pain in the ear, exudate from the glands, erythema, and absence of saliva. Chewing gum helps stimulate salivary glands, resulting in the secretion of saliva. Therefore, the patient should chew gum. Intake of fibrous foods is beneficial for patients with gingivitis. Warm compresses are encouraged in patients with parotitis. The patient should use warm compresses and suck on hard candy. Text Reference - p. 897

The nurse is preparing to administer a dose of octreotide to a patient who is experiencing an acute episode of upper gastrointestinal (GI) bleeding and is waiting for an endoscopy procedure. The nurse knows that the octreotide will have which mechanism of action?

-Decreases blood flow to the GI tract -Decreases hydrochloric acid secretion by decreasing the release of gastrin. Octreotide is a somatostatin analog that works by reducing blood flow to the GI tract and reduces hydrochloric acid secretion by reducing the release of gastrin. Octreotide does not increase production of mucus in the stomach. Epinephrine, when injected during an endoscopy procedure, produces hemostasis by causing tissue edema and pressure on the source of bleeding. Vasopressin works by causing vasoconstriction, reducing pressure in the portal circulation and stopping the bleeding. p. 923

What are the characteristics of gastric ulcers?

-Gastric ulcer lesions are superficial. -Gastric ulcers predominantly occur in antrum. -Gastric ulcers cause pain one to two hours after meals. Gastric ulcer lesions are superficial, round, oval, or cone shaped. They predominantly occur in antrum and cause pain one to two hours after meals. Gastric ulcers decrease gastric secretion, whereas duodenal ulcers increase gastric secretion. In gastric ulcers, there is a burning, cramping pain in the high left epigastrium. pp. 910-911

Which laboratory results determine the type and amount of intravenous fluids administered?

-Hematocrit -Electrolytes -Hemoglobin Hematocrit, electrolytes, and hemoglobin are laboratory test results that determine the type and amount of intravenous fluids administered based on the degree of dehydration, vomiting, and electrolyte imbalance. Liver enzymes are used to detect any liver problems that may complicate ulcer healing. Serum amylase helps in determining pancreatic function. p. 915

The nurse is completing a health history on a patient diagnosed with peptic ulcer disease. Which questions are appropriate while assessing the patient's cognitive-perceptual pattern? Multiple selection question

-"Do you experience any nocturnal pain?" -"Do you experience high epigastric pain one to two hours after eating?" While assessing the effect of peptic ulcer disease on a patient's cognitive-perceptual pattern, the appropriate questions to ask are whether the patient has experienced any nocturnal pain and high epigastric pain one to two hours after eating. Asking the patient about hematemesis will determine the nutritional-metabolic pattern in the patient. Asking the patient about black, tarry stools will help in assessing the elimination pattern in the patient. Asking the patient if there is a family history of peptic ulcer disease will help assess the patient's health history. p. 915

Which dietary instructions should the nurse provide the caregiver of a postoperative patient with dumping syndrome?

-"Give the patient eggs and meat." -"Avoid giving jelly and jam." -"Avoid giving fluids with meals." Eggs and meat contain proteins and fat, which help to rebuild body tissues and meet energy demands. Distention and fullness of the stomach can occur if fluids are consumed along with meals. Jelly and jam cause diarrhea and dizziness; these foods should be avoided. Cheese contains proteins and fats and should be provided to the patient. The meals of the patient should be divided into six small feedings to avoid overloading the stomach and intestine during meal times. pp. 917-918

A patient is being discharged after receiving a diagnosis of a duodenal ulcer. Which patient statements would indicate that the patient understands the nurse's discharge teaching regarding the management of his or her condition?

-"I should really drink less coffee." -"This is the excuse I need to quit smoking. Then my ulcer will heal faster." -"I won't change brands of OTC antacids without first talking to my doctor." Coffee is known to be acidic and further increases hydrochloric acid production in the stomach, irritating the mucosal layer. Antacids, even if they are over-the-counter (OTC), can have serious interactions with other drugs that may decrease absorption of the medications, making it essential that the health care provider be aware of and approve any changes to regimen. Continued smoking increases healing times in duodenal ulcers. Medication should always be taken as prescribed by the provider, as taking them intermittently increase incidence of relapse. Black, tarry stools are not a normal finding and should therefore be reported to the health care provider. A common home remedy for relief of ulcer pain is to drink milk, which actually increases acid production in the stomach. p. 916

The nurse is caring for a patient with a hiatal hernia. Which instructions should the nurse include teaching?

-"You should avoid caffeine" -"You should avoid chocolate" Caffeine and chocolate are reflux-inducing foods that irritate the esophagus or weaken the lower esophageal sphincter, causing backward flow of stomach contents. Therefore caffeine and chocolate should be avoided in patients with a hiatal hernia. Soda is acidic and should be avoided in patients with a hiatal hernia. Peppermint is a reflux-inducing food and should be avoided. Acidic pH beverages such as orange juice should also be avoided by patients with a hiatal hernia. pp. 904-905

The nurse is caring for a patient diagnosed with Helicobacter pylori (H. pylori) infection. Which medications should the nurse expect to be included in the triple-drug therapy?

-Amoxicillin -Omeprazole -Clarithromycin Amoxicillin, omeprazole, and clarithromycin are the medications included in triple-drug therapy to treat Helicobacter pylori (H. pylori) infection. Cimetidine is an H 2 receptor blocker that is used to reduce gastric hydrochloric acid secretion. Tetracycline is an antibiotic that is included in quadruple therapy for the treatment of H. pylori infection. p. 910

Which symptoms noted by the patient would indicate a severe adverse reaction to metoclopramide?

-Anxiety -Tremor -Hallucinations Anxiety, tremor, and hallucinations are adverse reactions. Uncontrolled movement of the mouth is a sign of tardive dyskinesia, which is a possibly irreversible extrapyramidal adverse effect of metoclopramide. The nurse should withhold the dose and notify the health care provider of this development to maintain patient safety. Altered sense of smell and bradycardia are not known adverse reactions to metoclopramide. Text Reference - p. 895

Which factors increase intraabdominal pressure and lead to the development of a hiatal hernia?

-Ascites -Obesity -Pregnancy Factors increasing intraabdominal pressure include ascites, obesity, and pregnancy. They may lead to the development of a hiatal hernia. Fatty foods and peppermint are factors that decrease lower esophageal sphincter pressure. p. 904

Which medications increase the risk of ulcer development?

-Aspirin -Fluoxetine Aspirin and fluoxetine are ulcerogenic drugs that inhibit the synthesis of prostaglandins, increase gastric acid secretion, and reduce the integrity of the mucosal barrier. These medications increase the risk of ulcer development. Misoprostol, bethanechol, and metoclopramide are used in gastroesophageal reflux disease and peptic ulcer drug therapy. pp. 911-912

Which findings indicate that a patient with gastroesophageal reflux disease has aspirated gastric contents into the respiratory system?

-Asthma -Pneumonia -Chronic bronchitis Asthma, pneumonia, and chronic bronchitis may develop as a result of aspiration into the respiratory system. Cough and bronchospasm cause irritation of the upper airway by gastric secretions. p. 901

The nurse explains to the patient with gastroesophageal reflux disease (GERD) that this is a disorder that can be aggravated by which of the following?

-Caffeine -Chocolate -Orange juice -Cigarette smoking GERD results when the defenses of the esophagus are overwhelmed by the reflux of acidic gastric contents into the lower esophagus. An incompetent lower esophageal sphincter (LES) is a common cause of gastric reflux. Decreased LES pressure can be caused by certain foods (e.g., caffeine, chocolate, orange juice, and peppermint) and drugs (e.g., anticholinergics). Cigarette and cigar smoking also can contribute to GERD. GERD is not exacerbated by intake of dietary fiber or a high-protein diet. Text Reference - pp. 900-902

Which otolaryngologic symptoms occur in gastroesophageal reflux disease (GERD)?

-Choking -Hoarseness -Sore throat Otolaryngologic symptoms in GERD include choking, hoarseness, and sore throat. Wheezing and dyspnea are the respiratory symptoms that occur in GERD. pp. 900-901

The nurse provides information to a student nurse about appropriate goals for patients with upper gastrointestinal bleeding. The identification of which goals by the student nurse indicates the need for further teaching?

-Decreased hemoglobin level -Optimal nutritional status The initial hemoglobin in patients with acute upper GI bleeding will often be at the patient's baseline because the patient is losing whole blood. With time (typically after 24 hours or more) the hemoglobin will decline as the blood is diluted by the influx of extravascular fluid into the vascular space and by fluid administered during resuscitation. Decreased hemoglobin is not an appropriate goal. Optimal nutritional status is a goal for patients with stomach cancer. The goals for patients with upper gastrointestinal bleeding include no gastrointestinal bleeding, a return to a normal hemodynamic state, and minimization of pain or anxiety. p. 924

The nurse is caring for a patient with anorexia, nausea, vomiting, epigastric pain, and feeling of fullness. Which interventions are beneficial to the patient?

-Inserting a nasogastric tube -Administering intravenous fluids -Maintaining the patient on nothing-by-mouth (NPO) status Anorexia, nausea, vomiting, epigastric pain, and a feeling of fullness are the symptoms of acute gastritis. Therefore a nasogastric tube should be inserted to irrigate the precipitating agent from the stomach, to monitor bleeding, and to keep the stomach free from noxious smell. Administration of intravenous fluids may compensate for fluid loss in patients due to vomiting. The patient with acute gastritis should be kept on nothing-by-mouth (NPO) status to prevent vomiting. Drug therapy for gastritis includes H 2 receptor blockers (ranitidine, cimetidine) and proton pump inhibitors (lansoprazole, omeprazole). The nurse should inform the patient about the therapeutic effects of the medications. Cimetidine is an H 2 receptor blocker that causes headache, abdominal pain, constipation, and diarrhea; it is not associated with fainting. Providing a nonirritating diet consisting of six small feedings per day is helpful for patients with chronic gastritis. pp. 909-910

A nurse is teaching an obese patient with gastroesophageal reflux disease (GERD) measures that should be taken to prevent complications. What instructions should the nurse give?

-Maintain a low-fat diet -Avoid smoking cigarettes -Avoid tea and coffee In an obese person, the intraabdominal pressure is increased, which can exacerbate GERD. Maintaining a low-fat diet could help in losing weight and therefore relieve the condition. Tea, coffee, and nicotine (a component of cigarettes) are known to decrease the lower esophageal sphincter pressure, aggravating GERD. Patients with GERD are prescribed cholinergic drugs to relieve their condition. Anticholinergic drugs, on the other hand, affect the lower esophageal sphincter pressure and may therefore cause GERD. Lying down immediately after eating food may promote the movement of food toward the esophageal sphincter and increase the pressure on it, therefore exacerbating the condition. pp. 901-902

Several patients are seen at an urgent care center with symptoms of nausea, vomiting, and diarrhea that began two hours ago while attending an office picnic. The nurse will question the patients about foods they ate that included which of these?

-Milk products -Salad dressings -Cream-filled pastries Toxins provoke the onset of symptoms (e.g., vomiting, nausea, abdominal cramping, and diarrhea) within 30 minutes and up to seven hours. Meat, bakery products, cream fillings, salad dressings, and milk are the usual sources from the skin and respiratory tract of food handlers. Fried chicken and home-preserved vegetables are not correct answers; other foodborne illnesses become evident after eight hours. p. 925

A patient has had persistent nausea and vomiting for the last five days. Which immediate nursing interventions available are appropriate for this patient?

-Monitor the vital signs continuously. -Administer intravenous fluids and electrolytes. -Insert a nasogastric tube connected to suction. The vital signs should be monitored continuously to determine the physiologic state of the patient. Patients with persistent vomiting should immediately be put on NPO status (no food or liquid by mouth) and should be given intravenous fluids to prevent dehydration. A nasogastric tube should be placed for aspiration of stomach contents. Opioids induce vomiting and hence should not be administered. Persistent vomiting would induce fatigue, and physical activity would worsen the condition of the patient. Text Reference - pp. 894-895

The nurse is preparing a care plan for a patient who underwent an open high abdominal incision. Which necessary interventions should the nurse include in the care plan?

-Monitoring pulse rate -Monitoring respiratory rate After an open high abdominal incision, respiratory complications can occur. Therefore the nurse should monitor pulse rate and respiratory rate. Bowel sounds and blood glucose level are not altered after an open high abdominal incision. Serum creatinine levels are altered in kidney and liver diseases but not after an open high abdominal incision. Text Reference - p. 904

Which medications decrease lower esophageal sphincter pressure in elderly patients with a hiatal hernia and gastroesophageal reflux disease (GERD)?

-Nifedipine -Imipramine -Isosorbide dinitrate Calcium channel blockers (nifedipine), antidepressants (imipramine), and nitrates (isosorbide dinitrate) are the medications commonly prescribed for elderly patients with a hiatal hernia and GERD. These medications result in decreased lower esophageal sphincter pressure. Nonsteroidal antiinflammatory drugs (aspirin) and potassium irritate the esophageal mucosa. pp. 908, 914

A patient has had esophageal surgery, and a jejunostomy feeding tube is inserted to administer oral fluids. The nurse has been told to check for signs of intolerance and leakage of feeding into the mediastinum. Which signs should the nurse be observant for?

-Pain -Dyspnea -Increased temperature With tube feedings, the patient should be observed for signs of intolerance of feeding or leakage of the feeding into the mediastinum. Symptoms that indicate leakage are pain, dyspnea, and increased temperature. Feeding is done through the tube in an upright position; therefore, the chance of acid reflux is unlikely. Tachycardia doesn't occur immediately as a sign of leakage into the mediastinum. p. 906

Which complications can occur due to long-term use of proton pump inhibitors in patients with gastroesophageal reflux disease (GERD)?

-Pneumonia -Decreased bone density -Chronic hypochlorhydria Long-term use of proton pump inhibitors is associated with pneumonia, decreased bone density, and chronic hypochlorhydria. Renal calculi are associated with antacids. Prostaglandins can cause uterine rupture. p. 902

A patient who is admitted with an upper gastrointestinal bleed has a history of two previous heart attacks and is presently being given large doses of intravenous fluids. For which possible complication(s) should the nurse monitor the patient?

-Pulmonary edema -Cardiac failure First, the patient is being given large doses of fluids in a short period of time, which can result in volume overload. This may eventually cause cardiac failure and subsequent pulmonary edema. Also, the patient has had two previous heart attacks, which means heart function is compromised. Intravenous fluids are unlikely to cause conduction abnormalities, infection, or vomiting. Text Reference - p. 924

The nurse is teaching care management to a patient with gastroesophageal reflux disease (GERD). In the follow-up visit, the patient complains of severe heartburn. Which actions indicate the need for further teaching?

-The patient eats oranges daily -The patient eats ice cream often -The patient drinks a cup of milk at bedtime Oranges are a source of citric acid. Eating acidic foods aggravates the symptoms of gastroesophageal reflux disease ( GERD). Ice cream is rich in fatty acids. Fats tend to decrease lower esophageal sphincter (LES) pressure, resulting in regurgitation of stomach acid. Drinking a cup of milk at bedtime increases gastric acid secretion. Therefore the nurse recommends that the patient avoid oranges, ice cream, and milk. Drinking 2 L of water neutralizes the pH of stomach acid and reduces the symptoms of GERD. Chewing gum increases the production of saliva, thereby helping neutralize the pH of gastric acid. Ginger is known for its antiinflammatory and antacid activities.

Which medications are beneficial in relieving the pain through their effects on afferent pain fiber transmission?

-Tofranil -Imipramine Tofranil and imipramine are tricyclic antidepressants that provide overall pain relief through their effects on afferent pain fiber transmission. Bismuth is included in quadruple-drug therapy for the treatment of Helicobacter pylori (H. pylori) infection. Misoprostol is prescribed to prevent gastric ulcers caused by nonsteroidal antiinflammatory drugs (NSAIDs) and aspirin. Pantoprazole reduces hydrochloric acid secretion. pp. 914-915

What are the late symptoms of cancer of the tongue?

-Toothache -Slurred speech -Increased salivation Toothache, slurred speech, and increased salivation are the later symptoms of cancer of the tongue. Cancerous lesions on the tongue and limited movement of the tongue are the early symptoms of tongue cancer.

A patient presents to the ambulatory clinic complaining of "stomach upset" that has occurred intermittently for the past several months. The patient does not want an invasive workup and would prefer to avoid medication therapy. Working with the patient, which goals would the nurse discuss and document in the care plan?

-Weight reduction by 15 lb -Smoking cessation within the next 60 days -Avoiding caffeinated and alcoholic beverages Weight reduction in an overweight patient may help mitigate symptoms of many stomach disorders. If the patient smokes, he or she should quit because nicotine is a trigger for many individuals with acid reflex since it lowers the lower esophageal sphincter (LES) pressure and put patients at risk for gastritis and PUD. Caffeine and alcohol both can trigger acid reflux by lowering LES pressure as well as causing adverse effects in patients with peptic ulcer disease (PUD) and gastritis. Exercise is an excellent recommendation for overall health and cardiovascular fitness which may help weight loss; however, it will not directly mitigate stomach symptoms. While the patient may need dietary changes, increasing consumption of acidic foods may aggravate symptoms; lifestyle management for many stomach disorders includes limiting foods with high acid content like orange juice and tomato-based foods. pp. 912-913

A patient requires a dose of promethazine for nausea. The prescription states to give 25 mg intravenous (IV) push q8hr as needed. On hand is a vial labeled "100 mg/mL." How many milliliters should the nurse administer?

0.25 mL. Using ratio and proportion, multiply 100 by x and multiply 25 × 1 to yield 100x = 25. Divide 25 by 100 to yield 0.25 mL. Text Reference - p. 895

The patient undergoing chemotherapy is nauseated and can have promethazine 12.5-25 mg intravenous (IV) push q4-6hr as needed (PRN) for nausea. On hand is a vial labeled "25 mg/mL." How many milliliters should the nurse administer to give a 12.5-mg dose?

0.5 mL. Using ratio and proportion, multiply 25 by x and multiply 12.5 × 1 to yield 25x = 25. Divide 25 by 12.5 to yield 0.5 mL. Text Reference - p. 895

The patient has a new prescription to receive omeprazole 20 mg daily. Available are 40 mg tablets. How many tablets should the nurse administer?

0.5 tablets. Using ratio and proportion, multiply 40 by x and 20 by 1 to yield 40x = 20. Divide 20 by 40 to yield 0.5 tablets. Text Reference - p. 903

The patient has a prescription for metoclopramide 10 mg intravenously (IV). Available is a premixed IV bag containing 40 mg/50 mL. How many mL of this solution should be infused?

12.5 mL. Using ratio and proportion, multiply 40 by x and multiply 10 × 50 to yield 40x = 500. Divide 500 by 40 to yield 12.5 mL. Text Reference - p. 926

The nurse has a prescription to give famotidine 20 mg by the intravenous (IV) push route. To administer this drug safely, the nurse should give this medication over a minimum of how many minutes?

2 minutes. The nurse should give the IV push medication over a minimum of two minutes to administer it safely. It is not necessary to administer the drug over 5, 10, or 15 minutes.

A patient has a prescription to receive famotidine (Pepcid) 30 mg intravenous piggyback (IVPB) or intravenous push (IVP) q12hr. Available is a vial containing 10 mg/mL. How many milliliters should the nurse draw up to administer this dose?

3 mL. Multiply 10 by x and multiply 30 × 1 to yield 10x = 30. Divide 30 by 10 to yield 3 mL. Text Reference - p. 903

Which antacid used in the treatment of gastrointestinal reflux disease (GERD) causes phosphorus depletion with chronic use?

Aluminum hydroxide. Aluminum hydroxide is an antacid used for treating GERD that causes phosphorus depletion with chronic use. Magnesium oxide causes diarrhea and hypermagnesemia. Calcium carbonate causes renal calculi, diarrhea, milk-alkali syndrome, and constipation. Sodium bicarbonate causes milk-alkali syndrome when used with large amounts of calcium. p. 903

A patient diagnosed with Eosinophilic esophagitis (EE) may require a referral to which kind of specialist because of the underlying pathology and etiology of the condition?

Allergist. People with EE frequently have a personal or family history of other allergic diseases. The most common food triggers are milk, egg, wheat, rye, and beef. Environmental allergens, such as pollens, molds, cat, dog, and dust mite allergens, may be involved in the development of EE. Consults with a pulmonologist, cardiologist, and rheumatologist would not address the body system affected by this disorder, the immune system. p. 907

A patient is diagnosed with gastrointestinal bleeding after a surgical operation for peptic ulcer disease. On a follow-up visit, the nurse identifies a block in the nasogastric (NG) tube. Which complication is likely to occur?

Abdominal distention. Abdominal distention occurs due to accumulation of fluid or air in the abdomen causing outward expansion beyond the normal girth of the stomach as a result of the blockage of the NG tube. Perforation is a complication of peptic ulcer disease involving the complete penetration of the wall of the gastrointestinal tract resulting in intestinal contents flowing into the abdomen. Dumping syndrome occurs as a complication of surgical operation of a large portion of stomach and pylorus. Gastric outlet obstruction is a complication of peptic ulcer disease in which there is an obstruction at the pylorus. p. 916

Which condition is associated with symptoms of weight loss, halitosis, nocturnal regurgitation, and an inability to belch?

Achalasia. Nocturnal regurgitation, an inability to belch, weight loss, and halitosis may indicate achalasia. Achalasia is the absence of peristalsis in the lower two-thirds of the esophagus. Esophageal varices are dilated, tortuous veins that occur in the lower portion of the esophagus. Esophageal stricture is the narrowing of the esophagus. EE is the inflammation of the esophagus due to an infiltration of eosinophils. Text Reference - p. 908

Which medication does the nurse expect to be beneficial to the patient who works outdoors, has high levels of emotional stress, and complains of lip lesions and painful ulcers?

Acyclovir. Lip lesions and painful ulcers caused by herpes simplex infection and triggered by excessive exposure to sunlight and emotional stress can be treated by antiviral drugs such as acyclovir. Ampicillin is an antibiotic used in the treatment of parotitis and Vincent's infection. Prednisone is a corticosteroid used in the treatment of aphthous stomatitis. Amphotericin B is an antifungal agent used in the treatment of oral candidiasis. Text Reference - p. 897

The nurse reviews a patient's medication profile and identifies that which medication has a direct, irritating effect on the gastrointestinal (GI) tract?

Alendronate. Alendronate has a direct, irritating effect that damages the mucosal barrier of the gastrointestinal (GI) tract. Sucralfate provides cryoprotection for the GI tract by forming a protective layer that serves as a barrier against acids, bile salts, and enzymes in the stomach. Bethanechol increases gastric emptying. Metoclopramide increases gastric motility and emptying. p. 909

The nurse is caring for a patient with suspected stress-related mucosal disease (SRMD). Which medication can be co-administered with antisecretory agent for the patient's condition?

Aluminum hydroxide. Antacids such as aluminum hydroxide are co-administered with antisecretory agents to treat SRMD. Aluminum hydroxide helps by decreasing basal acid secretions and secretions stimulated by histamine. Ranitidine is a histamine-receptor blocker, which can be concurrently used with antacids to treat duodenal ulcers. Amoxicillin is included in triple-drug therapy to treat Helicobacter pylori ( H. pylori) infection. Pantoprazole is a proton pump inhibitor used concurrently with antibiotics to treat H. pylori infection. pp. 922-923

Which medication causes gastritis?

Aspirin. Aspirin is a nonsteroidal antiinflammatory drug (NSAID) that causes gastritis by decreasing prostaglandin in the lining of the stomach. Amoxicillin is used in the treatment of H. pylori infections. Lansoprazole and metronidazole are used in the treatment of gastritis. pp. 909-910

The nurse is caring for a patient with variceal bleeding. Which procedure should be used for this patient?

Balloon tamponade. A balloon tamponade involves the insertion of balloons into the esophagus or stomach by endoscopy to alleviate refractory bleeding; this method should be used to treat a patient with variceal bleeding. Gastrectomy is a procedure involving the removal of the stomach, which is done in patients with stomach cancer if the lesion is located in the fundus. The Billroth I and II procedure is used for patients with stomach cancer to treat lesions located in the antrum or the pyloric region. Radiation therapy is a treatment option for patient with stomach cancer. p. 923

Which medication increases lower esophageal sphincter pressure?

Bethanechol. Bethanechol increases the pressure in the lower esophagus. Diazepam, theophylline, and morphine sulfate are medications that decrease lower esophageal pressure. Text Reference - p. 902

What surgical procedure involves the removal of two-thirds of the stomach and anastomosis of the gastric stump to the duodenum?

Billroth I operation. A Billroth I operation, also known as a gastroduodenostomy, is a partial gastrectomy in which the distal two thirds of the stomach is removed and there is an anastomosis of the gastric stump to the duodenum. A vagotomy is the severing of the vagus nerve totally or selectively. A pyloroplasty is the surgical enlargement of the pyloric sphincter in order to facilitate easy passage of contents from the stomach. A Billroth II operation is called a gastrojejunostomy; it is the removal of the distal two thirds of the stomach and anastomosis of the gastric stump to the jejunum. p. 917

Which complication does the nurse expect in a patient with gastroesophageal reflux disease (GERD) who has been taking dexlansoprazole for one year?

Bone fracture. Dexlansoprazole is a proton pump inhibitor (PPI). PPIs inhibit the proton pump responsible for the secretion of hydrochloric acid, which is an important mediator of calcium absorption. Long-term use of this medication will increase the risk of a bone fracture. Syncope is the temporary loss of consciousness leading to fainting. It occurs as a side effect of cholinergic drugs. Dyskinesia is a side effect of prokinetic medications. Renal calculi are a side effect of antacids. Text Reference - p. 903

The nurse is caring for a patient with upper gastrointestinal (GI) bleeding caused by acute hemostasis. Which medication is beneficial to this patient?

Epinephrine. Injection therapy with epinephrine is used to treat gastrointestinal (GI) bleeding caused by acute hemostasis. Epinephrine causes tissue edema and pressure on the source of the bleeding. Etoposide is used in the chemotherapy of stomach cancer. Octreotide and vasopressin are used to treat upper GI bleeding caused by esophageal varices. p. 923

A patient with gastroesophageal reflux disease (GERD) is on cimetidine therapy. Which parameter does the nurse monitor to provide effective care?

Bowel sounds. Cimetidine is a histamine receptor used in the treatment of peptic ulcer and GERD. Cimetidine decreases gastric motility and causes constipation. Therefore the nurse monitors the patient for any changes in bowel sounds. This may help with early detection of constipation. Cimetidine does not have extrapyramidal side effects and does not cause motor incoordination. Cimetidine does not alter serum calcium or magnesium levels. p. 903

Which medication has a side effect of milk-alkali syndrome?

Calcium carbonate. Calcium carbonate is an antacid used to treat gastroesophageal reflux disease (GERD). Ingestion of calcium carbonate may result in milk-alkali syndrome. Misoprostol causes abdominal pain, diarrhea, and gastrointestinal bleeding. Central nervous system side effects such as anxiety, hallucinations, and tremors are caused by metoclopramide. Aluminum hydroxide causes constipation. p. 903

Which of the conditions is not a common cause of an upper gastrointestinal (GI) bleed?

Cholecystitis. Cholecystitis affects the gastrointestinal system but is not associated with an upper GI bleed. Esophageal varices, stomach cancer, and NSAIDS are common causes of an upper GI bleed. Text Reference - p. 922

The nurse is caring for a patient who is experiencing continuous epigastric distress and vomiting after undergoing a peptic ulcer surgery. Which medication does the nurse expect to be beneficial for the patient?

Cholestyramine Continuous epigastric distress and vomiting are symptoms associated with bile reflux gastritis, a disease that occurs as a complication of peptic ulcer disease surgery. Cholestyramine is administered before or with meals to treat reflux gastritis by binding with bile salts to prevent their reabsorption, which is the source of gastric irritation. Omeprazole is a proton pump inhibitor that reduces gastric acid secretion. Metronidazole is included in quadruple-drug therapy to treat Helicobacter pylori infection. Aluminum hydroxide gel is an antacid that is used as adjunct therapy for peptic ulcer disease. p. 918

A patient reports pain in the upper abdomen after eating. Upon reviewing the medical reports, the nurse finds that the patient underwent pylorus surgery. Which medication does the nurse expect the primary health care provider to prescribe?

Cholestyramine. Pain in the upper abdomen after eating is known as epigastric distress. It occurs due to reflux of bile into the stomach in patients who underwent gastric surgery involving the reconstruction or removal of the pylorus. Cholestyramine is a bile acid sequestrant that binds bile in the gastrointestinal tract to prevent its reabsorption. Fluticasone is a corticosteroid used to treat eosinophilic esophagitis. Misoprostol is used to treat gastric ulcers caused by NSAIDs and aspirin. Isosorbide dinitrate is used to treat dysphagia. p. 918

A patient experiences chronic gastritis with a loss of parietal cells due to atrophy. The nurse determines that the patient is at risk for a complication associated with the loss of the parietal cells. Which diagnostic test will assist in making this determination?

Complete blood count. When parietal cells are lost because of atrophy, there is a loss of the source of intrinsic factor. This results in cobalamin deficiency, which leads to pernicious anemia. A complete blood count can indicate anemia from blood loss or loss of intrinsic factor. Liver enzyme studies are used to determine liver problems such as cirrhosis. A secretin stimulation test is used to differentiate patients with gastrinoma from those with hypergastrinemia. Serum amylase determination identifies pancreatic function. p. 909

Which medication is responsible for causing flatulence in a patient on medication therapy for gastroesophageal reflux disease (GERD)?

Dexlansoprazole. Proton pump inhibitors such as dexlansoprazole are used to treat GERD and are associated with flatulence as a side effect. Sucralfate is an antiulcer agent that is associated with constipation. Famotidine is a histamine (H 2) receptor blocker that causes headaches, constipation, abdominal pain, and diarrhea as side effects. Abdominal pain, diarrhea, uterine rupture in pregnancy, and gastrointestinal bleeding are side effects associated with misoprostol. p. 903

Which condition results from sympathetic activation?

Diaphoresis. Excessive sweating indicates diaphoresis. Sympathetic activation causes diaphoresis. Parasympathetic stimulation increases salivation, gastric motility, and relaxes the lower esophageal sphincter. Text Reference - pp. 893-894

A patient undergoes gastrectomy. What should the nurse recommend to decrease the symptoms of dumping syndrome?

Drinking no fluids with meals. Avoiding fluids with meals prevents dilution and liquefaction of food and thus slows the movement of food into the jejunum. Postgastrectomy patients are often instructed to eat "dry" meals. Remaining in a high Fowler's position after meals may increase the risk for dumping syndrome. A diet high in carbohydrates, especially simple carbohydrates, increases the risk of dumping syndrome. Taking fluids with meals causes stomach contents to empty more rapidly into the jejunum, resulting in dumping syndrome. pp. 917-918

After administering a dose of promethazine to a patient with nausea and vomiting, the nurse explains that what may be experienced as a common temporary adverse effect of the medication?

Drowsiness. Although being given to this patient as an antiemetic, promethazine also has sedative and amnesic properties. For this reason, the patient is likely to experience drowsiness as an adverse effect of the medication. Tinnitus, reduced hearing, and loss of balance are not side effects of promethazine. Text Reference - p. 895

After administering a dose of promethazine, the nurse explains that which common temporary adverse effect may occur?

Drowsiness. Although being given to this patient as an antiemetic, promethazine also has sedative and amnesic properties. For this reason, the patient is likely to experience drowsiness as an adverse effect of the medication. Urinary retention, tinnitus, and a sensation of falling are not considered common adverse effects of promethazine. Text Reference - p. 895

The nurse is caring for a patient treated with intravenous (IV) fluid therapy for severe vomiting. As the patient recovers and begins to tolerate oral intake, the nurse understands that which food choice would be most appropriate?

Dry toast. Dry toast or crackers may alleviate the feeling of nausea and prevent further vomiting. Water is the initial fluid of choice. Extremely hot (hot coffee) or cold liquids (iced tea) and fatty foods (hamburgers) generally are not well tolerated. Text Reference - p. 928

A patient who underwent abdominal surgery complains of sweating, weakness, palpitations, and dizziness 20 minutes after a meal. Upon auscultation, the nurse finds the patient to have borborygmi. The laboratory test reports reveal decrease in the plasma volume. Which complication does the nurse suspect in the patient?

Dumping syndrome. A patient experiencing sweating, weakness, palpitations, and dizziness 20 minutes after eating is suffering from dumping syndrome. The dizziness soon after eating is cause by a sudden decrease in the plasma volume, which is confirmed by the laboratory test. Audible abdominal sounds produced by hyperactive intestinal peristalsis are called borborygmi, which are observed in the patient. Achalasia is the absence of lower esophageal peristalsis characterized by dysphagia. Bile reflux gastritis is a complication of abdominal surgery and is characterized by epigastric distress. Postprandial hypoglycemia shares symptoms with dumping syndrome; however, the symptoms of postprandial hypoglycemia occur two hours after eating. pp. 917-918

The patient is having a gastroduodenostomy (Billroth I operation) for stomach cancer. What long-term complication is occurring when the patient reports generalized weakness, sweating, palpitations, and dizziness 15 to 30 minutes after eating?

Dumping syndrome. After a Billroth I operation, dumping syndrome may occur 15 to 30 minutes after eating because of the hypertonic fluid going to the intestine and additional fluid being drawn into the bowel. Malnutrition may occur but does not cause these symptoms. Bile reflux gastritis cannot happen when the stomach has been removed. Postprandial hypoglycemia occurs with similar symptoms, but two hours after eating. pp. 917-918

A postmenopausal patient complains of back pain and burning pain in midepigastric region three hours after a meal. The medical history of the patient reveals hyperparathyroidism. Which condition does the nurse suspect in the patient?

Duodenal ulcer. Back pain and burning pain in the midepigastric region two to five hours after eating indicate a duodenal ulcer. These ulcers are more common in men but increasingly occur in postmenopausal women. They are associated with disease conditions such as renal failure, pancreatitis, hyperparathyroidism, and chronic obstructive pulmonary disease. Gastric ulcers are characterized by burning pain in the left epigastrium and upper abdomen. Zollinger-Ellison syndrome is a condition that involves severe peptic ulceration and hydrochloric acid secretion. Postprandial hypoglycemia is a postoperative complication of gastrectomy that occurs two hours after eating. Symptoms include sweating, weakness, confusion, palpitations, anxiety, and tachycardia. pp. 910-911

The nurse is caring for a patient who presents with burning pain in the midepigastric region five hours after eating. The patient's medical history reveals pancreatic disease. Which condition does the nurse suspect?

Duodenal ulcer. Duodenal ulcers are characterized by burning pain in the midepigastric region that occurs two to five hours after eating. Gastric ulcers are characterized by burning or gaseous pressure in the high left epigastrium and upper abdomen. Symptoms of acute gastritis include anorexia, nausea, vomiting, and feeling of fullness. Signs of stomach cancer include anemia, indigestion, weight loss, abdominal pain, and satiety. pp. 910-911

Which condition is indicated by endoscopic findings of saclike pouches on the esophagus?

Esophageal diverticula. Esophageal diverticula are saclike outpouchings formed on one or more layers of the esophagus. Esophageal varices are dilated and tortuous veins observed in the lower portion of the esophagus due to portal hypertension. Narrowing of the esophagus is called esophageal stricture. Eosinophilic esophagitis is characterized by swelling of the esophagus. pp. 907-908

The nurse is obtaining a health history from a patient who comes to the office for evaluation of gastric distress. The patient indicates that the symptoms occur two to five hours after meals, and the pain is "burning" and sometimes like a cramp in the midepigastric region, just below the xiphoid process. Based on these descriptions, the nurse suspects that the patient has which disorder?

Duodenal ulcer. The symptoms of duodenal ulcers occur when gastric acid comes in contact with the ulcers. With meal ingestion, food is present to help buffer the acid. Symptoms of duodenal ulcers occur generally two to five hours after a meal. The pain is described as "burning" or "cramplike." It most often is located in the midepigastric region beneath the xiphoid process. Duodenal ulcers also can produce back pain. The discomfort generally associated with gastric ulcers is located high in the epigastrium and occurs about one to two hours after meals. The pain is described as "burning" or "gaseous." If the ulcer has eroded through the gastric mucosa, food tends to aggravate rather than alleviate the pain. For some patients, the earliest symptoms are caused by a serious complication, such as perforation. Pain and burning two to five hours after meals are not symptoms of esophagitis or chronic gastritis. A patient with a gastric ulcer will experience pain one to two hours after meals. p. 911

Which condition does the nurse suspect in a patient who reports pain and discomfort in the upper abdomen?

Dyspepsia. Dyspepsia is discomfort or pain in the upper abdomen. Pyrosis or heartburn is a burning, tight sensation that is felt intermittently beneath the lower sternum and spreads toward the throat or jaw. Halitosis is foul-smelling breath in patient with achalasia. Water brash or hypersalivation is the regurgitation of an excessive accumulation of saliva from the lower part of the esophagus. Text Reference - pp. 900-901

A patient presents with complaints of abdominal cramping and diarrhea, which initially was watery but is now bloody. Symptoms began three days ago after eating out with friends. You suspect the patient is experiencing which infection?

E. Coli O157:H7 infection The clinical manifestations of O157:H7 include diarrhea (often bloody) and abdominal cramping pain for two to eight days (average three to four days) after swallowing the organism. The diarrhea may start out as watery but may progress to bloody. Staphylococcal toxin has a 30 minute to seven-hour onset with nausea, abdominal cramping, and diarrhea as its clinical manifestations. Botulism has an onset of 12 to 36 hours with clinical manifestations of nausea, vomiting, abdominal pain, constipation, distention, and central nervous system alterations. Clostridial has an 8 to 24-hour onset with diarrhea, nausea, abdominal cramping, vomiting (rare), and midepigastric pain as clinical manifestations. pp. 924-925

A female patient has a sliding hiatal hernia. What nursing interventions will prevent the symptoms of heartburn and dyspepsia that she is experiencing?

Eating smaller meals during the day will decrease the gastric pressure and the symptoms of hiatal hernia. Keeping the patient NPO or in a Trendelenburg position are not safe or realistic for a long period of time for any patient. Varying antacids will be administered only with the health care provider's prescription, so this is not a nursing intervention. Text Reference - pp. 901, 904-905

Which diagnostic study is used to stage esophageal cancer?

Endoscopic Ultrasonography (EUS). EUS is used to stage esophageal cancer. Radionuclide tests help detect reflux of gastric contents. Manometric studies help measure pressure in the esophagus, lower esophageal sphincter, and esophageal motility function. Esophagram (barium swallow) shows the narrowing of the esophagus at the tumor site. p. 905

A patient is seeking emergency care after choking on a piece of steak. The nursing assessment reveals a history of alcoholism, cigarette smoking, and hemoptysis. Which diagnostic study is most likely to be performed on this patient?

Endoscopic biopsy. Because of this patient's history of excessive alcohol intake, smoking, hemoptysis, and the current choking episode, cancer may be present. A biopsy is necessary to make a definitive diagnosis of carcinoma, so an endoscope will be used to obtain a biopsy and observe other abnormalities as well. A barium swallow may show narrowing of the esophagus, but it is more diagnostic for achalasia. Capsule endoscopy can show alterations in the esophagus, but more often is used for small intestine problems. An endoscopic ultrasonography may be used to stage esophageal cancer. A barium swallow, capsule endoscopy, and endoscopic ultrasonography cannot provide a definitive diagnosis for cancer when it is suspected. p. 905

Which procedure involves the disruption of the lower esophageal sphincter using balloons?

Endoscopic pneumatic dilation. Endoscopic pneumatic dilation is the procedure in which the lower esophageal sphincter is disrupted using balloons of increasing diameter. A Heller myotomy is a surgical procedure in which the lower esophageal sphincter is disrupted laparoscopically. Esophagectomy is the removal of part or the entire esophagus. Esophagoenterostomy is the resection of a portion of the esophagus and anastomosis of a segment of the colon to the remaining portion. p. 908

Which surgical therapy is used to treat pyloric obstruction?

Endoscopy. An endoscopy with balloon dilations is used in the treatment of pyloric obstruction. A vagotomy is the severing of the vagus nerve either totally or selectively to decrease gastric acid secretion. A gastrojejunostomy involves a partial gastrectomy with removal of two-thirds of the stomach and an anastomosis of the gastric stump to the jejunum. Gastroduodenostomy is a partial gastrectomy with removal of two-thirds of the stomach and an anastomosis of the gastric stump to the duodenum. p. 915

A nurse assesses a patient with suspected peptic ulcer disease. Which symptom will the patient most likely report?

Epigastric discomfort relieved by eating. Symptoms of peptic ulcer disease (PUD) are variable and often absent. However, discomfort, if present, may occur before meals or two to three hours after meals and at bedtime. The discomfort may be relieved by eating because the food will dilute and buffer gastric acid. Although vomiting or abdominal distention after meals may occur and there may be an intolerance of fatty and spicy foods, they are less likely to be associated with PUD than is the relief caused by eating. pp. 910-911

The nurse determines that a patient has experienced the beneficial effects of therapy with famotidine when which symptom is relieved?

Epigastric pain Famotidine is an H 2 receptor antagonist that inhibits parietal cell output of HCl acid and minimizes damage to gastric mucosa related to hyperacidity, thus relieving epigastric pain. Famotidine is not indicated for nausea, belching, and dysphagia. Text Reference - p. 903

Which medication used in gastroesophageal reflux disease decreases the conversion of pepsinogen to pepsin?

Famotidine. Famotidine is a histamine (H 2) receptor blocker that reduces the conversion of pepsinogen into pepsin. Misoprostol is a prostaglandin that increases the production of gastric mucosa. Rabeprazole is a proton pump inhibitor that results in a decrease of hydrochloric acid secretion. Metoclopramide increases gastric motility and emptying. p. 903

Which microorganism causes Vincent's infection?

Fusiform bacteria. Fusiform bacteria cause Vincent's infection. Staphylococcus species cause parotitis. Oral candidiasis is caused by Candida albicans. Herpes simplex virus causes herpes. Text Reference - p. 897

Assessment findings of a patient include a reflux of bile and pancreatic secretions and clinical manifestations of shock. The nurse suspects which diagnosis?

Gastritis. Burns, reflux of bile and pancreatic secretions, and shock are the clinical manifestations of gastritis. Achalasia is characterized by substernal chest pain, dysphasia, and nocturnal regurgitation. Early satiety, abdominal pain, and weight loss are the clinical manifestations of stomach cancer. Bloody vomitus and black, tarry stools are manifestations of upper gastrointestinal bleeding. p. 909

A patient presents with burning pain in the epigastrium accompanied by nausea. On interviewing the patient, the nurse finds that the patient has been taking nonsteroidal antiinflammatory drugs (NSAIDs) on a regular basis to relieve headaches. Which condition should the nurse suspect?

Gastritis. Gastritis occurs as the result of a breakdown in the normal gastric mucosal barrier. NSAIDs inhibit the synthesis of prostaglandins that are protective to the gastric mucosa and thus cause gastritis. Symptoms of gastritis include anorexia, nausea and vomiting, epigastric tenderness, and a feeling of fullness. Esophagitis is usually a complication of GERD. GERD is caused by alterations in pressure in the lower esophageal sphincter, and NSAIDs do not cause these pressure changes. Achalasia is a rare disease with unknown etiology and involves absence of peristalsis of the lower two thirds of the esophagus. p. 909

A 65-year-old female patient who has been on warfarin for five years reports nausea, episodes of vomiting, and pain in the abdomen upon palpation. What could be the reason for the patient's condition?

Gastritis. Nausea, vomiting, and abdominal pain are the characteristics of gastritis. Warfarin is an anticoagulant, which causes gastritis by increasing the risk of bleeding. Oral cancer is characterized by sore throat, sore mouth, and voice changes. Stomach cancer involves weight loss, anemia, weakness, dizziness, and supraclavicular lymph nodes. Peptic ulcer disease includes ulcers; this is characterized by experiencing burning pains in the abdomen after eating. p. 909

Which surgery is used to attach the stomach subdiaphragmatically to prevent reherniation?

Gastropexy. Gastropexy is the attachment of the stomach subdiaphragmatically to prevent reherniation. Herniotomy is the excision of the hernia sac. Herniorrhaphy is the closure of the hiatal defect. Heller myotomy is the surgical alteration of the lower esophageal sphincter. pp. 904-905

Which infection does the nurse suspect in a patient with periodontitis who complains of bleeding during brushing and reveals the he or she has a high intake of soft foods?

Gingivitis. Bleeding during brushing and formations of abscess with loosening of teeth (periodontitis) are symptoms of gingivitis. It occurs in patients who eat soft foods instead of fibrous foods. Parotitis is the inflammation of the parotid gland in which there is pain in the parotid gland and ear. Inflammation of the mouth with excess salivation, sore mouth, and halitosis are symptoms of stomatitis. Oral candidiasis causes the formation of membranous lesions of mucosa of the mouth and larynx. Text Reference - p. 897

Which laboratory test is beneficial for diagnosing the presence of a small amount of blood in gastric secretions and stools?

Guaiac test. Small amounts of blood in gastric secretions and stools indicate occult blood, and the guaiac test is used to detect traces of blood in the feces. Liver enzyme studies are performed to detect any liver problems. A complete blood count (CBC) test is used to detect anemia, which is secondary to ulcer bleeding. Serum amylase determination helps to determine pancreatic function. p. 922

When administering a dose of ondansetron, the nurse would teach the patient to report which common adverse effect?

Headache. Headache that is severe enough to require an analgesic medication is a common adverse effect of ondansetron. The patient should be taught to report this symptom to the nurse. Double vision and paresthesias are not adverse reactions associated with ondansetron. Nausea would indicate the ondansetron was not effective. Text Reference - p. 895

The nurse is aware that the primary symptoms of a sliding hiatal hernia are associated with reflux and should assess the patient for which symptoms?

Heartburn, regurgitation, and dysphagia. The most common symptom of a hiatal hernia is heartburn, also known as pyrosis. It results from reflux of gastric secretions into the esophagus. Regurgitation of gastric contents and dysphagia are other common symptoms. Jaundice, ascites, and edema are associated with liver disorders. Abdominal cramps, diarrhea, and anorexia are associated with gastroenteritis. Low abdominal pain, fever, and board-like abdominal rigidity are symptoms of appendicitis, ruptured ovarian cyst, and peritonitis. pp. 904-905

The patient who is admitted with a diagnosis of diverticulitis and a history of irritable bowel disease and gastroesophageal reflux disease (GERD) has received a dose of Mylanta 30 mL orally. The nurse should evaluate its effectiveness by questioning the patient as to whether which symptom has resolved?

Heartburn. Mylanta is an antacid that contains both aluminum and magnesium. It is indicated for the relief of gastrointestinal discomfort, such as with heartburn associated with GERD. Mylanta can cause both diarrhea and constipation as a side effect. Mylanta does not affect lower abdominal pain. p. 903

The patient has a prescription for rabeprazole. The nurse would assess the effectiveness of the medication by noting whether the patient obtained relief from which symptom?

Heartburn. Rabeprazole is a proton pump inhibitor that provides relief of gastric discomfort and heartburn by neutralizing gastric acid. This medication would not be effective in the treatment of abdominal pain, flatulence, or constipation. p. 903

Which complication occurs when cancer erodes through the esophagus and into the aorta?

Hemorrhage. Hemorrhage occurs when esophageal cancer erodes through the esophagus and into the aorta. Choking and hoarseness occur when the tumor is in the upper third of the esophagus. Blood-flecked regurgitation occurs with severe esophageal stenosis. p. 905

Which condition does the nurse expect in a patient with gastroesophageal reflux disease (GERD) who has esophagitis and stenosis?

Hiatal hernia. GERD associated with esophagitis and stenosis leads to a hiatal hernia. A hiatal hernia is a herniation of a portion of the stomach into the esophagus through a hiatus in the diaphragm. Achalasia is the absence of peristalsis in the lower two-thirds of the esophagus, characterized by nocturnal regurgitation, dysphagia, and foul-smelling breath. Esophageal stricture is the narrowing of the esophagus, which involves dysphagia, regurgitation, and weight loss. Eosinophilic esophagitis is the inflammation of the esophagus due to an infiltration of eosinophils. Text Reference - p. 904

A patient has received a dose of aluminum hydroxide with magnesium and simethicone 30 mL by mouth (PO). The nurse would evaluate its effectiveness by questioning the patient as to whether which symptom resolved?

Indigestion. Mylanta is an antacid that contains both aluminum and magnesium. It is indicated for the relief of gastrointestinal (GI) distress, such as heartburn and gastroesophageal reflux. Mylanta will not have an effect on diarrhea, constipation, or flatus.

Which treatment will the nurse expect will provide short-term relief to an elderly patient who has difficulty swallowing food and has chest pain immediately after meals?

Injection of botulinum toxin endoscopically. Achalasia is a chronic disorder in which peristalsis of the lower two-thirds of the esophagus is absent. The pressure on the lower esophageal sphincter (LES) is increased, which causes difficulty swallowing and chest pain after meals. Injection of botulinum toxin endoscopically into the LES is beneficial in elderly patients with achalasia. It causes relaxation of smooth muscles and provides short-term relief to the patient. A Heller myotomy is a surgical procedure and is inappropriate for elderly patients. In endoscopic pneumatic dilation, the LES muscle is disrupted from within using balloons of progressively larger diameter, which is contraindicated in elderly patients. Endoscopic stapling diverticulotomy is a treatment for esophageal diverticula, not achalasia. p. 908

A patient underwent abdominal surgery four days ago and has sutures in the upper epigastric region. Which is the most appropriate initial nursing intervention to prevent pulmonary complications?

Instruct the patient to splint the incision site with a pillow while coughing. Splinting the incision site with a pillow reduces the pain during coughing and deep breathing and should be taught first. Steam inhalation and bronchodilator drugs also prevent pulmonary complications but are more useful if the patient is not able to remove pulmonary secretions by himself. Early ambulation is also a measure to prevent pulmonary complications but is not applicable in the early phase of care. p. 918

The patient has a prescription for promethazine 25 mg. To prevent harm to the patient, the dose should be administered through which site?

Intramuscular. Doses of promethazine should be administered intramuscularly to decrease the risk of severe tissue injury, including gangrene. Subcutaneous, intradermal, and intravenous administration are contraindicated related to the possible tissue injury and gangrene. Text Reference - p. 925

The nurse is connecting a nasogastric tube (NG) to suction for a patient who underwent abdominal surgery. Which therapy should be maintained in this condition?

Intravenous therapy. Intravenous (IV) therapy includes adding potassium and vitamin supplements to the infusion until oral feedings are resumed. Adjuvant therapy includes surgical resection and chemotherapy for stomach cancer. Triple-drug therapy that includes proton pump inhibitor, amoxicillin, and clarithromycin is prescribed for Helicobacter pylori infection. Cobalamin replacement therapy is prescribed for pernicious anemia. p. 918

Which treatment strategy does the nurse expect to be beneficial for an elderly patient with a hiatal hernia who has a cardiovascular complication?

Laparoscopic surgery. Laparoscopic surgery is minimally invasive and when performed in elderly patients reduces the risk of complications and time for recovery and is beneficial. Antireflux surgery is a surgical intervention and is not recommended in elderly patients with cardiovascular and pulmonary complications. Calcium channel blocker therapy decreases lower esophageal pressure in elderly patients. Nonsteroidal antiinflammatory drugs (NSAIDs) may irritate the esophageal mucosa, which may aggravate the symptoms more. Text Reference - p. 905

Which diagnostic or surgical procedure can best determine the spread of stomach cancer to the peritoneum?

Laparoscopy. A laparoscopy can determine the spread of cancer to the peritoneum. A biopsy of the tissue and subsequent histologic examination are important for the diagnosis of stomach cancer. Ultrasound and CT studies are used to stage the disease. p. 919

The nurse is caring for a patient who presents with abdominal pain, rigid board-like abdomen and shallow grunting respirations after undergoing a surgery. Which surgery does the nurse expect to be beneficial for the patient?

Laparoscopy. Abdominal pain, rigid board-like abdomen, and shallow grunt respirations are the clinical manifestations of perforation. Laparoscopic suture closure is performed, either with or without an omental patch, to cover the repaired ulcer and decrease the probability of leakage. A vagotomy is the severing of the vagus nerve, either totally or selectively, in order to decrease gastric acid secretion. An endoscopy is performed for gastric outlet obstruction to determine active ulcers. Pyloroplasty consists of the surgical enlargement of the pyloric sphincter to facilitate the easy passage of contents from the stomach. p. 915

The nurse is caring for a patient who presents with tachycardia, lower abdominal pain, and nausea and vomiting. Upon clinical examination, the primary health care provider identifies a rigid and board-like abdomen. Which surgical therapy is beneficial for the patient?

Laparoscopy. Tachycardia, lower abdomen pain, nausea, and vomiting are the clinical manifestations of perforation, a complication of peptic ulcer disease. A laparoscopy involves a simple closure with an omentum graft, which will repair the perforation with appropriate source control and limit the parietal cell acid secretion. Billroth I involves a partial gastrectomy where two-thirds of the stomach is removed and there is an anastomosis of the gastric stump to the duodenum. A vagotomy involves severing the vagus nerve either totally or selectively. Pyloroplasty consists of surgical enlargement of the pyloric sphincter. p. 916

Which respiratory complication occurs due to irritation of the upper airway by gastric secretions?

Laryngospasm. Laryngospasm occurs due to irritation of the upper airway by gastric secretions. Asthma, pneumonia, and chronic bronchitis are respiratory complications that occur due to aspiration. p. 901

Which condition does the nurse suspect in a patient with oral cancer who has "smoker's patch" on the mucosa of the mouth?

Leukoplakia. Leukoplakia is a precancerous lesion called "smoker's patch," characterized by a white patch on the mucosa of the mouth or tongue of patients with oral cancer. Pyrosis is heartburn, which is a burning, tight sensation felt intermittently beneath the lower sternum and spreading upward to the throat or jaw. Erythroplasia, or erythroplakia, is a red, velvety patch on the tongue or mouth of oral cancer patients. Keratinization of "smoker's patch" indicates hyperkeratosis. Text Reference - p. 898

After reviewing the medical reports of a patient with portal hypertension, the nurse concludes that the patient has esophageal varices. Which other finding supports the nurse's conclusion?

Liver cirrhosis. Esophageal varices are the dilated, tortuous veins that occur in the lower portion of the esophagus. They occur as a result of portal hypertension. Esophageal varices are common complications of liver cirrhosis. Therefore liver cirrhosis is a finding that supports the nurse's conclusion. Kyphosis is associated with a hiatal hernia. Throat lacerations may cause esophageal strictures, and squamous cell carcinoma is associated with achalasia. Text Reference - p. 908

Which antacid does the nurse expect the primary health care provider to prescribe to a patient who reports mild, intermittent chest pain after meals?

Magnesium trisilicate. Magnesium trisilicate helps relieve heartburn after meals by creating a foam barrier on the stomach acid. It is prescribed for mild and intermittent chest pain after meals. Sodium citrate, calcium carbonate, and aluminum carbonate are also antacids used in the treatment of gastroesophageal reflux disease causing heartburn; however, they are not used for mild and intermittent heartburn. p. 903

Which medication for peptic ulcer disease causes hallucinations?

Metoclopramide. Metoclopramide is a prokinetic agent that causes central nervous system side effects such as hallucinations and anxiety. Nizatidine is a histamine (H 2) receptor blocker that causes abdominal pain, headache, diarrhea, and constipation. Sucralfate is an antiulcer medication that causes constipation. Omeprazole is a proton pump inhibitor that causes nausea, abdominal pain, headache, diarrhea, and flatulence. p. 895

Which medication used to treat nausea and vomiting may cause dyskinesia?

Metoclopramide. Metoclopramide is a prokinetic medication that causes extrapyramidal side effects such as tremor and dyskinesia. Nizatidine is a histamine (H 2) receptor blocker that causes abdominal pain, diarrhea, constipation, and headache as side effects. Sucralfate is an antiulcer medication that causes constipation. Omeprazole is a proton pump inhibitor that causes headache, nausea, vomiting, abdominal pain, and flatulence. p. 903

On reviewing the previous medical history of a patient with a sore mouth who has been on a high-dose of antibiotics for a year, the nurse finds bluish-white "milk-curd" lesions in the mouth. Which medication will the nurse expect to be beneficial?

Miconazole. Sore mouth and bluish-white "milk-curd" lesions on the mucosa of mouth indicate oral candidiasis caused by infection with yeast-like fungus. Oral candidiasis is caused by prolonged use of high-dose antibiotics. Miconazole is an antifungal medication used in the treatment of oral candidiasis. Acyclovir is used in the treatment of herpes simplex. Fluticasone and tetracycline are used in the treatment of aphthous stomatitis. Text Reference - p. 928

Which medication is prescribed for the prevention of peptic ulcer caused by nonsteroidal antiinflammatory drugs (NSAIDs) and aspirin?

Misoprostol Because of its protective and antisecretory effects on gastric mucosa, misoprostol (a synthetic prostaglandin analog) is prescribed to prevent peptic ulcers caused by NSAIDS and aspirin. Famotidine is a histamine-receptor blocker used to heal ulcers. Imipramine is a tricyclic antidepressant prescribed for patients with peptic ulcer disease. Clarithromycin is a medication included in triple-drug therapy for treating Helicobacter pylori (H. pylori) infection. p. 913

Which medication does the nurse expect to be beneficial to the patient who reports difficulty swallowing and is diagnosed with achalasia?

Nifedipine. Difficulty in swallowing is known as dysphagia. It is the most common symptom of achalasia. Calcium channel blockers such as nifedipine, when administered sublingually 30 to 45 minutes before meals, may help reduce dysphagia in patients with achalasia. Cisplatin is an antineoplastic agent used in the treatment of esophageal cancer. Prednisone is used in the treatment of eosinophilic esophagitis. Porfimer sodium is a photosensitizer that is injected intravenously during photodynamic therapy of esophageal cancer. p. 908

Which action of the nurse is appropriate if, while administering fluids through a jejunostomy feeding tube to a patient who underwent an esophageal surgery, the nurse suspects that the tube is misplaced?

Notify the primary health care provider immediately. The nurse should notify the primary health care provider immediately if the tube is misplaced. The nurse should not reinsert or reposition the tube without an order from the primary health care provider. Documenting the findings and continuing to administer will put the patient's safety at risk. p. 906

While caring for a postoperative patient with a nasogastric tube, the nurse suspects that the tube is repositioned. What is the priority nursing intervention to prevent complications in the patient?

Notifying the primary health care provider immediately. When the nurse suspects repositioning of the nasogastric tube, the primary health care provider should be called as soon as possible because there is a danger of either perforation of the gastric mucosa or a disruption of the suture line. The nurse should not insert a new tube without the order of the primary health care provider. Irrigating the tube with normal saline solution is helpful in preventing tube clogging. Monitoring for the symptoms of edema and inflammation will put the safety of the patient at risk. p. 918

A nurse on an inpatient medical-surgical unit is taking care of a patient with acute gastritis. The patient has a nasogastric tube (NGT) to low-intermittent suction with bilious aspirate. Upon reassessment, the nurse finds the aspirate to have become blood-tinged. What should the nurse do next?

Obtain a set of vital signs. Vital sign changes coupled with sudden changes of nasogastric aspirate from bilious to bloody can signal a life-threatening situation; hemorrhage is a common adverse event that can occur with acute gastritis. Both hypotension and tachycardia are signs and symptoms of shock and should be assessed quickly in this instance. The physician should be called but only once the vital signs have been assessed. A patient may have alterations in his or her pain with acute hemorrhage, but assessing for life-threatening changes must take priority. This information should be recorded in the patient's chart once the patient's safety is ensured. pp. 909-910

The nurse is caring for a patient who is diagnosed with gastrointestinal (GI) bleeding. Diagnostic test results indicate a Mallory-Weiss tear. The nurse anticipates that which medication will be prescribed?

Octreotide. A Mallory-Weiss tear indicates a tear in the mucous membrane where the esophagus meets the stomach; this results in upper gastrointestinal (GI) bleeding. Octreotide is used to treat this bleeding by decreasing blood flow to the GI tract. Cisplatin is used to treat stomach cancer. Injection therapy with epinephrine is used to treat GI bleeding caused by ulceration. Oxaliplatin is used to treat stomach cancer. p. 923

A registered nurse is evaluating the medication charts of four patients that have been prepared by a student nurse. Which patient's medication chart needs correction?

Patient 1. Gastritis is an inflammation of the gastric mucosa due to breakdown of the gastric mucosal barrier. It may be caused by Helicobacter pylori infection. The drug therapy for this includes H 2 receptor blockers such as omeprazole, lansoprazole, and esomeprazole and proton pump inhibitors (PPIs) such as cimetidine, famotidine, and ranitidine. Therefore the medication chart for patient 1 needs correction. Isosorbide dinitrate is a nitrate derivative used in the treatment of achalasia, a condition seen in patient 2. Achalasia is the loss of peristalsis in the lower esophagus. Calcium channel blockers such as nifedipine are also used to treat achalasia. A corticosteroid, such as prednisone, is effectively used in the treatment of eosinophilic esophagitis, which is used to treat patient 3. Omeprazole is used in the treatment of gastric esophageal reflux disease; this is seen in patient 4. pp. 909-910

The nurse is caring for a patient who underwent surgical therapy for peptic ulcer disease. Upon clinical examination, the primary health care provider suspected that a complication occurred due to loss of intrinsic factor. Which complication does the nurse suspect?

Pernicious anemia. Pernicious anemia is a complication that occurs in a patient after undergoing a partial gastrectomy. It occurs due to loss of intrinsic factor, which is required for the production of vitamin B 12. Bile reflux gastritis occurs as a complication of gastric surgery of the pylorus. Dumping syndrome occurs as a complication after surgical removal of the stomach and pylorus. Postprandial hypoglycemia is a variant of dumping syndrome that occurs due to uncontrolled gastric emptying of a bolus of fluid high in carbohydrate into the small intestine. pp. 918-919

The nurse finds that a patient with weight loss reports nausea, vomiting, difficulty swallowing, and a burning sensation in the chest. The biopsy and endoscopy reports reveal infiltration of eosinophils. Which medication does the nurse expect to be beneficial to the patient?

Prednisone. A burning sensation in the chest, nausea, vomiting, weight loss, and difficulty swallowing indicate eosinophilic esophagitis (EE). Corticosteroids such as prednisone are used to treat EE. Sucralfate and misoprostol are used in the treatment of gastroesophageal reflux disease (GERD). Methotrexate is used in the treatment of esophageal cancer. p. 907

The nurse is assessing a patient who has suspected esophageal cancer. Which of these is the most common symptom of esophageal cancer?

Progressive dysphagia. Progressive dysphagia is the most common symptom of esophageal cancer and may be described as a substernal feeling, as if food were not passing. Initially, the dysphagia occurs only with meat, then with soft foods, and eventually with liquids. Weight loss, regurgitation, and epigastric pain during swallowing are also symptoms of esophageal cancer, but they occur later and are not the most common symptoms. p. 905

A patient reports having a dry mouth and asks for something to drink. The nurse recognizes that this symptom most likely can be attributed to a common adverse effect of which medication that the patient is taking?

Promethazine. A common adverse effect of promethazine, an antihistamine/antiemetic agent, is dry mouth; another is blurred vision. Common side effects of digoxin are yellow halos and bradycardia. Common side effects of cefotetan are nausea, vomiting, stomach pain, and diarrhea. Common side effects of famotidine are headache, abdominal pain, constipation, or diarrhea. Text Reference - p. 926

Deep muscle injection is the preferred route of administration of this drug used to treat nausea and vomiting because of its necrotizing effect on tissue when infiltration occurs.

Promethazine. When promethazine is administered intravenously (IV), it can leak out from the vein and cause serious damage to surrounding tissue. Deep muscle injection is the preferred route of injection administration. Methergine is used to control postpartum hemorrhage. Prochlorperazine and metoclopramide are not reported to have as damaging an effect on tissue when administered IV. Text Reference - p. 894

The nurse finds that a patient taking a prescribed medication for gastroesophageal reflux disease (GERD) had a miscarriage. Which medication does the nurse expect to be responsible for the miscarriage?

Prostaglandins. Prostaglandins are a class of medications that cause uterine rupture in pregnancy. Uterine rupture in pregnancy leads to miscarriage. Therefore the nurse suspects prostaglandins to be the cause of miscarriage. Cholinergics cause syncope, diarrhea, stomach cramps, and dizziness. Antiulcer agents such as sucralfate cause constipation. Headache, abdominal pain, constipation, and diarrhea are the side effects of histamine (H 2) receptor blockers. Text Reference - pp. 903, 914

The patient with peptic ulcer disease is on sucralfate medication. Which outcome does the nurse anticipate?

Protection of ulcer from acids. Sucralfate acts by forming a protective layer around an ulcer that serves as a barrier against acid, bile salts, and enzymes in the stomach. Histamine blockers are used to promote ulcer healing. Proton pump inhibitors such as omeprazole reduce gastric acid secretion. Antacids increase gastric pH and neutralize gastric acid secretion. pp. 903, 914

A patient who underwent a surgery for peptic ulcer disease (PUD) complains of continuous upper abdominal pain and vomiting. Upon assessment, the nurse identifies that the patient is on cholestyramine medication. Which surgery did the patient undergo?

Pyloroplasty. Continuous upper abdominal pain and vomiting are symptoms observed in patients with bile reflux gastritis, a disease caused by complications from pyloroplasty. Vagotomy involves severing the vagus nerve, either totally or selectively, to decrease gastric acid secretion. Gastrojejunostomy is a partial gastrectomy where two-thirds of the stomach is removed and there is an anastomosis of the gastric stump to the jejunum. Gastroduodenostomy is a partial gastrectomy involving removal of two-thirds of the stomach and anastomosis of the gastric stump to the duodenum. p. 917

Which diagnostic test detects reflux of gastric contents?

Radionuclide test A radionuclide test detects reflux of gastric contents. A biopsy helps differentiate stomach or esophageal cancer from Barrett's esophagus. An endoscopy helps assess the lower esophageal competence, degree of inflammation, scarring, and potential strictures. Manometric studies help measure esophageal pressure and lower esophageal sphincter and esophageal motility function. Text Reference - p. 901

A patient is on drug therapy for a peptic ulcer. Which medication does the nurse anticipate to be prescribed to help reduce hydrochloric acid secretion?

Ranitidine. Ranitidine, which is a histamine-receptor blocker, reduces hydrochloric acid (HCl) secretions by blocking histamine, a hormone responsible for HCl secretion. Sucralfate acts by forming a protective layer around the ulcer and serves as a barrier against acid, bile salts, and enzymes in the stomach. Tetracycline is an antibiotic prescribed concurrently with proton pump inhibitors. Aluminum hydroxide gel is an antacid that neutralizes gastric HCl secretion. pp. 903, 914

A patient with gastroesophageal reflux disease reports to the nurse, "I feel like there is a hot, bitter liquid in my mouth." What does the nurse document in the patient's medical record?

Regurgitation. Regurgitation is described as a hot, bitter, or sour liquid coming into the throat or mouth. Dysphagia is difficulty swallowing food. Hypersalivation or water brash is the regurgitation of an excessive accumulation of saliva from the lower part of the esophagus. Hyperchlorhydria is the excessive secretion of acid in the stomach. p. 901

The nurse identifies that a patient is at risk for upper gastrointestinal bleeding based on the patient's history of what?

Renal failure. Renal failure causes disturbances in the serum gastrin levels, resulting in abnormal mucosal barriers in the gastrointestinal tract and gastric acid secretion. These symptoms cause upper gastrointestinal bleeding. Hiatal hernia causes gastritis. Pernicious anemia causes stomach cancer. Pancreatic disease is the predisposing factor of duodenal ulcers. p. 922

A 72-year-old patient was admitted with epigastric pain caused by a gastric ulcer. Which patient assessment warrants an urgent change in the nursing plan of care?

Rigid abdomen and vomiting following indigestion. A rigid abdomen with vomiting in a patient who has a gastric ulcer indicates a perforation of the ulcer, especially if the manifestations of perforation appear suddenly. Midepigastric pain is relieved by eating, drinking water, or antacids with duodenal ulcers, not gastric ulcers. Back pain three to four hours after a meal is more likely to occur with a duodenal ulcer. Burning epigastric pain one to two hours after a meal is from an expected manifestation with a gastric ulcer related to increased gastric secretions and does not cause an urgent change in the nursing plan of care. p. 912

While caring for a patient with esophageal cancer, the nurse finds regurgitation of blood-flecked esophageal contents. What does the nurse expect to be the reason behind the patient's condition?

Severe esophageal stenosis. When there is severe narrowing of the esophagus, or stenosis, regurgitation of blood-flecked esophageal contents occurs. A tumor in the upper third of the esophagus causes sore throat, choking, and hoarseness. Achalasia occurs due to obstruction of the esophagus at the diaphragm. Cancer eroding through the esophagus and into the aorta leads to hemorrhage. p. 905

The nurse is caring for a patient with liver cirrhosis. Which medication should be used with caution in this patient?

Sodium citrate. Antacids high in sodium citrate need to be used with caution in a patient with liver cirrhosis because they interact with and reduce the absorption of the medications prescribed for liver cirrhosis. Magnesium oxide should be used with caution on patients with renal failure. Calcium carbonate should be cautiously prescribed to patients with hypercalcemia. Aluminum hydroxide should be used with caution on patients with hemorrhoids. p. 914

The nurse is caring for a patient with atrophic gastritis who has a cyanocobalamin deficiency. The nurse suspects what diagnosis?

Stomach cancer. Patients with atrophic gastritis will lose parietal cells because of atrophy, which causes pernicious anemia and stomach cancer. Gastric ulcers are caused by risk factors such as bile reflux, smoking, and alcohol abuse. Patients with a history of ulcer disease who use ulcerogenic drugs and anticoagulants tend to develop nonsteroidal-induced gastritis. Upper gastrointestinal bleeding is caused by drug-induced bleeding, esophageal bleeding, and systemic diseases. p. 909

Which disorder does the nurse suspect to be present in an alcoholic patient who complains of excessive salivation?

Stomatitis. Excessive salivation in a patient abusing alcohol indicates stomatitis, which is inflammation of the mouth. Parotitis is the inflammation of parotid glands involving the absence of saliva. Gingivitis involves inflamed gingivae and interdental papillae due to neglected oral hygiene. Aphthous stomatitis is characterized by ulcers of mouth and lips due to recurrent infection, trauma, and stress. Text Reference - p. 897

The nurse reviews a patient's medical record and notes a history of traumatic injuries as a result of a car fire that occurred one month prior to the current admission. The nurse recognizes that the patient is at risk for which condition?

Stress-related mucosal disease. Severe trauma and burns can lead to stress-related mucosal disease (SRMD). Burns cause hypersecretion of gastric acid and mucosal damage, resulting in SRMD. Shock, renal failure, and hiatal hernia are the risk factors for gastritis. Duodenal ulcers are caused by chronic obstructive pulmonary disease, pancreatic disease, and chronic renal failure. Atrophic gastritis, pernicious anemia, and adenomatous polyps cause stomach cancer. p. 922

A patient with severe burns is admitted in an emergency department. The medical reports of the patient reveal coagulopathy. Which condition does the nurse suspect in the patient?

Stress-related mucosal disease. Stress-related mucosal disease, or physiologic stress ulcers, is a condition observed in patients with severe burns or trauma or major surgery. Patients with coagulopathy are at a high risk for stress-related mucosal disease. Bile reflux gastritis is a complication associated with gastric surgery in which bile is refluxed into the stomach. Dumping syndrome is a postoperative complication of gastrectomy that involves weakness, sweating, dizziness, and palpitations 15 to 30 minutes after eating. Zollinger-Ellison syndrome involves severe peptic ulceration and hydrochloric acid secretion. p. 922

Which medication for treating gastroesophageal reflux disease (GERD) may cause constipation?

Sucralfate. Sucralfate is an antiulcer medication that forms a protective layer and serves as a barrier against acids, bile salts, and stomach enzymes. It causes constipation as a side effect. Misoprostol is a prostaglandin that causes diarrhea. Bethanechol is a cholinergic that causes diarrhea. Esomeprazole is proton pump inhibitor that causes diarrhea. p. 903

Which medication is prescribed for cytoprotective drug therapy?

Sucralfate. Sucralfate provides cytoprotective for the esophagus, stomach, and duodenum by forming a protective layer and serves as a barrier against acids, bile salts, and enzymes. Tofranil is a tricyclic antidepressant that provides pain relief in peptic ulcer disease. Cimetidine is a histamine blocker that provides ulcer healing. Misoprostol is prescribed to prevent gastric ulcers caused by nonsteroidal antiinflammatory drugs. p. 914

Which side effect occurs in a patient with gastroesophageal reflux disease who is on bethanechol therapy?

Syncope. Bethanechol is a cholinergic medication used to treat gastroesophageal reflux disease. Cholinergics cause syncope, which is the partial or complete loss of consciousness. Proton pump inhibitors cause flatulence. Renal calculi can occur with antacid use. Prokinetic medications cause hallucinations. Text Reference - p. 903

On a follow-up visit, the nurse finds that a patient prescribed prokinetic medication to treat nausea and vomiting has discontinued the medication. Which complication does the nurse expect to be present?

Tardive Dyskinesia Metoclopramide and domperidone are the prokinetic agents used to treat vomiting and nausea. When metoclopramide is discontinued, tardive dyskinesia occurs. It is characterized by involuntary movements of the patient's tongue, lips, face, trunk, and extremities. Xerostomia and somnolence are side effects of anticholinergic medications. Serotonin (5-HT 3) antagonists produce elevated liver function tests as a side effect. Text Reference - p. 895

The nurse is teaching care guidelines to the caregiver of a patient with upper gastrointestinal (GI) bleeding. In the follow-up visit, the patient complains of traces of blood in the vomit. Which action of the patient's caregiver is responsible for the patient's condition?

The caregiver gave an aspirin to the patient on an empty stomach. Traces of blood in the vomit indicate gastrointestinal bleeding. When given on an empty stomach, aspirin irritates the gastrointestinal mucosa and causes gastrointestinal (GI) bleeding. Therefore it should be taken along with meals or snacks. Alcohol consumption aggravates the symptoms of hyperacidity. However, drinking 10 mL of alcohol once a month will not cause GI bleeding. Co-administration of nonsteroidal antiinflammatory drugs (NSAIDs) and proton pump inhibitors reduces the risk of bleeding. Deep breathing provides relaxation and does not cause GI bleeding. Text Reference - pp. 922, 924

The nurse is interviewing a patient with a duodenal ulcer. Which characteristic of pain is the nurse likely to find?

The pain is cramplike. The pain related to a duodenal ulcer is cramplike and appears five to six hours after a meal. The pain is located in the midepigastric region beneath the xiphoid process. The pain is relieved by food intake. pp. 910-911

Which enzyme activates the immune response with antibody production and the release of inflammatory cytokines?

Urease. Urease activates the immune response with body antibody production and the release of inflammatory cytokines, resulting in mucosal edema. Pepsin is an enzyme released in the stomach that degrades food particles into peptides. Bile salts are released by liver cells, which bind with cholestyramine and cause gastric irritation. Serum amylase levels determine pancreatic function. p. 911