Module 8: Upper GI EAQs (MEDSURG)

Which medication increases lower esophageal sphincter pressure? 1 Diazepam 2 Bethanechol 3 Theophylline 4 Morphine sulfate

ANS 2 Rationale Bethanechol increases the pressure in the lower esophagus. Diazepam, theophylline, and morphine sulfate are medications that decrease lower esophageal pressure. p. 902

Which of the conditions is not a common cause of an upper gastrointestinal (GI) bleed? 1 Cholecystitis 2 Stomach cancer 3 Esophageal varices 4 Nonsteroidal antiinflammatory drugs (NSAIDS)

ANS 1 Rationale 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.

A patient with a history of peptic ulcer disease has presented to the emergency department reporting severe abdominal pain and has a rigid, board-like abdomen that prompts the health care team to suspect a perforated ulcer. What intervention should the nurse anticipate? 1 Providing intravenous (IV) fluids and inserting a nasogastric (NG) tube 2 Administering oral bicarbonate and testing the patient's gastric pH level 3 Performing a fecal occult blood test and administering IV calcium gluconate 4 Starting parenteral nutrition and placing the patient in a high Fowler's position

ANS 1 Rationale A perforated peptic ulcer requires IV replacement of fluid losses and continued gastric aspiration by NG tube. Oral bicarbonate would not be given because the client would be nothing by mouth, and gastric pH testing is not a priority. Calcium gluconate is not a medication directly relevant to the patient's suspected diagnosis, and parenteral nutrition is not a priority in the short term. pp. 912, 915

Which medication causes gastritis? 1 Aspirin 2 Amoxicillin 3 Lansoprazole 4 Metronidazole

ANS 1 Rationale 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

A patient undergoes gastrectomy. What should the nurse recommend to decrease the symptoms of dumping syndrome? 1 Drinking no fluids with meals 2 Remaining in a high Fowler's position after meals 3 Increasing the carbohydrate intake with each meal 4 Consuming a large amount of water with each meal

ANS 1 Rationale 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

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? 1 Heartburn 2 Flatulence 3 Constipation 4 Abdominal pain

ANS 1 Rationale 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

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? 1 Ranitidine 2 Sucralfate 3 Tetracycline 4 Aluminum hydroxide gel

ANS 1 Rationale 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

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? 1 2 minutes 2 5 minutes 3 10 minutes 4 15 minutes

ANS 1 Rationale 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.

The nurse is interviewing a patient with a duodenal ulcer. Which characteristic of pain is the nurse likely to find? 1 The pain is cramplike. 2 The pain is aggravated by food intake. 3 The pain occurs one to two hours after a meal. 4 The pain is located high up in the epigastrium.

ANS 1 Rationale 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

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? 1 The caregiver gave aspirin to the patient on an empty stomach. 2 The caregiver allowed the patient to drink 10 mL of alcohol once a month. 3 The caregiver encouraged the patient to practice deep breathing exercises. 4 The caregiver gave the patient an analgesic along with a proton pump inhibitor.

ANS 1 Rationale 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.

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? 1 Severe esophageal stenosis 2 Tumor in the upper third of the esophagus 3 Obstruction of the esophagus at the diaphragm 4 Cancer eroding through the esophagus and into the aorta

ANS 1 Rationale 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

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? 1 Gastritis 2 Achalasia 3 Esophagitis 4 Gastroesophageal reflux disease (GERD)

ANS 1 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 patient with gastroesophageal reflux disease (GERD) is on cimetidine therapy. Which parameter does the nurse monitor to provide effective care? 1 Bowel sounds 2 Motor movements 3 Serum calcium levels 4 Serum magnesium levels

ANS 1 Rationale 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.

Which laboratory test is beneficial for diagnosing the presence of a small amount of blood in gastric secretions and stools? 1 Guaiac test 2 Liver enzyme studies 3 Complete blood count (CBC) 4 Serum amylase determination

ANS 1 Rationale 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

A patient presents with uterine cramping, abdominal cramping, and diarrhea. The patient takes a medication for treatment of peptic ulcer disease. The nurse identifies that which medication is the likely cause of the patient's symptoms? 1 Misoprostol 2 Bethanechol 3 Esomeprazole 4 Metoclopramide

ANS 1 Rationale Uterine cramping, abdominal cramping, and diarrhea are side effects of misoprostol. Bethanechol's side effects include lightheadedness, syncope, and diarrhea. Side effects of esomeprazole are headaches, abdominal pain, and flatulence. Metoclopramide has central nervous system side effects such as anxiety and hallucinations.

A nurse is caring for a patient diagnosed with peptic ulcer disease. On assessment, the nurse identifies spillage of gastric contents into the duodenal cavity. Which complication supports the finding? 1 Perforation 2 Hemorrhage 3 Dumping syndrome 4 Gastric outlet obstruction

ANS 1 Rationale With perforation, the ulcer penetrates the stomach's serosal surface and spillage of either gastric or duodenal contents into the peritoneal or duodenal cavity will occur. A hemorrhage is a complication that occurs due to the changes in the vital signs and an increase in the amount and redness of the aspirate, often signaling massive upper GI bleeding. Dumping syndrome is the direct result of surgical removal of a large portion of a stomach and the pyloric sphincter. Gastric outlet obstruction is a peptic ulcer complication that occurs in a patient whose ulcer is close to the pylorus. p. 915

The nurse is caring for a patient with anorexia, nausea, vomiting, epigastric pain, and feeling of fullness. Which interventions are beneficial to the patient? Select all that apply. 1 Inserting a nasogastric tube 2 Administering intravenous fluids 3 Maintaining the patient on nothing-by-mouth (NPO) status 4 Educating the patient that fainting may occur due to cimetidine 5 Providing the patient with nonirritating diet consisting of six small feedings a day

ANS 1,2,3 Rationale 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.

Which factors increase intraabdominal pressure and lead to the development of a hiatal hernia? Select all that apply. 1 Ascites 2 Obesity 3 Pregnancy 4 Fatty foods 5 Peppermint

ANS 1,2,3 Rationale 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

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? Select all that apply. 1 Avoid tea and coffee. 2 Maintain a low-fat diet. 3 Avoid smoking cigarettes. 4 Lie down immediately after having food. 5 Use anticholinergic drugs, as prescribed.

ANS 1,2,3 Rationale 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

What are the late symptoms of cancer of the tongue? Select all that apply. 1 Toothache 2 Slurred speech 3 Increased salivation 4 Cancerous lesions on the tongue 5 Limited movement of the tongue

ANS 1,2,3 Rationale 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. p. 898

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? Select all that apply. 1 Weight reduction by 15 lb 2 Smoking cessation within the next 60 days 3 Avoiding caffeinated and alcoholic beverages 4 Exercise three times a week for 30 minutes or more 5 Increase of fruit consumption with citrus and tomato-based products daily

ANS 1,2,3 Rationale 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

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? Select all that apply. 1 Caffeine 2 Chocolate 3 Dietary fiber 4 Orange juice 5 Cigarette smoking 6 High-protein foods

ANS 1,2,4,5 Rationale 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. pp. 900-902

While providing fluids to a postgastrectomy patient, which symptoms support the nurse's suspicion that there is leakage from a jejunostomy feeding tube? Select all that apply. 1 Pain 2 Fever 3 Cough 4 Regurgitation 5 Difficulty breathing

ANS 1,2,5 Rationale When there is a leakage from the feeding tube, the patient experiences pain, high temperature, and dyspnea (difficulty breathing). Therefore these symptoms support the nurse's suspicion. Cough and regurgitation are manifestations of esophageal cancer. p. 906

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? Select all that apply. 1 "I should really drink less coffee." 2 "I will only take my medications when I'm having stomach pain." 3 "This is the excuse I needed to quit smoking. Then my ulcer will heal faster." 4 "I won't change brands of OTC antacids without first talking to my doctor." 5 "Black, tarry stools are to be expected and are not a cause for concern." 6 "Drinking milk will decrease the amount of acid my stomach produces."

ANS 1,3,4 Rationale 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

What are the characteristics of gastric ulcers? Select all that apply. 1 Gastric ulcer lesions are superficial. 2 Gastric ulcers increase the gastric secretion. 3 Gastric ulcers predominantly occur in antrum. 4 Gastric ulcers cause pain one to two hours after meals. 5 Gastric ulcers manifest as burning, cramping pain in the midepigastrium.

ANS 1,3,4 Rationale 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.

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? Select all that apply. 1 Milk products 2 Fried chicken 3 Salad dressings 4 Cream-filled pastries 5 Home-preserved vegetables.

ANS 1,3,4 Rationale Staphylococcus aureus 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

The nurse is conducting a health interview for a patient with suspected stomach cancer. Which questions are relevant in determining the diagnosis? Select all that apply. 1 "Do you experience unexplained weight loss?" 2 "Have you received blood transfusions in the past?" 3"Do you have other illnesses, such as liver cirrhosis?" 4"Do you have dyspepsia or intestinal gas discomfort?" 5"Do you have a religious preference that prohibits the use of blood?"

ANS 1,4 Patients with stomach cancer experience weight loss, dyspepsia, and intestinal gas discomfort. Asking the patient about blood transfusions in the past, whether the patient has illnesses like liver cirrhosis, and if the patient has a religious preference that prohibits the use of blood will help in the assessment of upper gastrointestinal bleeding and other conditions, but they are not specific to stomach cancer. 920

Which complications can occur due to long-term use of proton pump inhibitors in patients with gastroesophageal reflux disease (GERD)? Select all that apply. 1 Pneumonia 2 Renal calculi 3 Uterine rupture 4 Decreased bone density 5 Chronic hypochlorhydria

ANS 1,4,5 Rationale 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

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? Select all that apply. 1 Diarrhea 2 Tachycardia 3 Blurred vision 4 Uterine cramping 5 Abdominal cramp

ANS 1,4,5 Rationale 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 nurse is teaching a patient about prevention of peptic ulcers. What instructions should the nurse give the patient? Select all that apply. 1 Avoid smoking. 2 Consume raw uncooked food. 3 Use nonsteroidal antiinflammatory drugs (NSAIDs) for treatment of pain. 4 Wash hands thoroughly with soap after using the restroom and before eating. 5 Report symptoms of gastric irritation, such as nausea and epigastric pain, to the health care provider.

ANS 1,4,5 Rationale Nicotine, a component of cigarettes, causes gastric irritation, and therefore smoking should be avoided by those with peptic ulcers. Washing hands thoroughly with soap after using the restroom and before eating would help prevent the Helicobacter pylori infection that causes peptic ulcers. Any symptom of gastric irritation such as nausea and epigastric pain must be reported to the health care provider to prevent lethal consequences of peptic ulcer disease. Consumption of raw uncooked food increases the chance of H. pylori infection; therefore, it should be avoided. NSAIDs should not be taken over a long period of time because they are a potent gastric irritant. pp. 910-912

Which otolaryngologic symptoms occur in gastroesophageal reflux disease (GERD)? Select all that apply. 1 Choking 2 Dyspnea 3 Wheezing 4 Hoarseness 5 Sore throat

ANS 1,4,5 Rationale Otolaryngologic symptoms in GERD include choking, hoarseness, and sore throat. Wheezing and dyspnea are the respiratory symptoms that occur in GERD. pp. 900-901

A patient has had persistent nausea and vomiting for the last five days. Which immediate nursing interventions available are appropriate for this patient? Select all that apply. 1 Monitor the vital signs continuously. 2 Encourage patient to do physical activity. 3 Administer opioid drugs to sedate the patient. 4 Administer intravenous fluids and electrolytes. 5 Insert a nasogastric tube connected to suction.

ANS 1,4,5 Rationale 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. pp. 894-895

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? 1 "You'll need to drink at least two to three glasses of milk daily." 2 "It would likely be beneficial for you to eliminate drinking alcohol." 3 "Many people find that a minced or pureed diet eases their symptoms of PUD." 4 "Your medications should allow you to maintain your present diet while minimizing symptoms."

ANS 2 Rationale 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

The nurse is providing instructions to a patient who has been treated for gastrointestinal bleeding and is planned for discharge. Which statement made by the patient indicates effective learning? 1 "I should take low doses of aspirin." 2 "I should take aspirin with omeprazole." 3 "I should read the labels of over-the-counter drugs." 4 "I should take the lansoprazole one hour after meals."

ANS 2 Rationale Aspirin is a nonsteroidal antiinflammatory drug (NSAID) that reduces the prostaglandin lining of the stomach, leading to inflammation of gastric mucosa and bleeding. Therefore aspirin, taken along with proton pump inhibitors such as omeprazole and H 2 receptor blockers, can reduce the bleeding risk. Aspirin, even in the lowest dose, can cause gastrointestinal bleeding. Over-the-counter drugs contain aspirin and should not be taken because they increase the risk of bleeding. Lansoprazole is a proton pump inhibitor, which is taken before the meals to reduce the acid secretion in the stomach.

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? 1 Gastric ulcer 2 Duodenal ulcer 3 Zollinger-Ellison syndrome 4 Postprandial hypoglycemia

ANS 2 Rationale 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 teaching a patient preventive strategies to avoid staphylococcal poisoning. Which action indicates effective learning? 1 The patient avoids cooking meat at a high temperature. 2 The patient refrigerates leftover food to eat the next day. 3 The patient avoids eating food immediately after cooking it. 4 The patient boils canned food for five minutes before eating it.

ANS 2 Rationale Immediate refrigeration of foods helps prevent staphylococcal poisoning. The nurse should instruct the patient to eat food immediately after cooking it because it prevents the growth of microorganisms. Boiling canned food for 15 minutes before eating prevents botulism. Cooking meat at a high temperature prevents food poisoning.

The nurse is teaching a patient about measures to prevent Salmonella poisoning. Which action indicates effective learning? 1 The patient avoids eating cheese. 2 The patient avoids eating half-boiled eggs. 3 The patient avoids purchasing canned items. 4 The patient avoids eating rewarmed meat dishes.

ANS 2 Rationale Improperly cooked eggs are a source of Salmonella typhimurium. Avoiding improperly cooked eggs prevents Salmonellapoisoning. 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.

Which treatment strategy does the nurse expect to be beneficial for an elderly patient with a hiatal hernia who has a cardiovascular complication? 1 Antireflux surgery 2 Laparoscopic surgery 3 Calcium channel blocker therapy 4 Nonsteroidal antiinflammatory drugs (NSAIDs)

ANS 2 Rationale 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.

Which condition does the nurse suspect in a patient with oral cancer who has "smoker's patch" on the mucosa of the mouth? 1 Pyrosis 2 Leukoplakia 3 Erythroplasia 4 Hyperkeratosis

ANS 2 Rationale 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. p. 898

To prevent the recurrence of gastritis, what instruction should the nurse provide to the patient? 1 Take acetaminophen and ibuprofen for pain. 2 Stop smoking and do not consume alcoholic beverages. 3 Consume a soft diet with moderate spices and seasonings. 4 Stop smoking and consume alcoholic beverages in moderation.

ANS 2 Rationale Lifestyle modifications to prevent the recurrence of gastritis include refraining from consuming alcohol and cigarette smoking. Alcohol directly irritates the gastric mucosa, and nicotine from cigarette smoke inhibits neutralization of gastric acid. A bland diet (reduced spices and seasonings) is recommended to prevent the recurrence of gastritis. Alcohol should be eliminated from the diet, not merely reduced. Advising the patient to take acetaminophen and ibuprofen (Motrin) is incorrect because ibuprofen should not be taken by the gastritis patient. pp. 909-910

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? 1 Diarrhea 2 Heartburn 3 Constipation 4 Lower abdominal pain

ANS 2 Rationale 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 history indicates the patient was taking ondansetron at home before admission. The nurse inquires as to the effectiveness of this medication in treating which symptom? 1 Pain 2 Nausea 3 Headache 4 Leg cramps

ANS 2 Rationale Ondansetron is an antiemetic. The nurse would inquire as to its effectiveness in reducing the patient's nausea. Ondansetron will not treat headaches, pain, or leg cramps.

A patient has what is suspected to be a gastric ulcer perforation. Which symptom does the nurse expect will be present? 1 Pyrosis 2 Rigid abdomen 3 Bright-red emesis 4 Clay-colored stools

ANS 2 Rationale Perforation results in spillage of gastric or duodenal contents into the upper peritoneal cavity. The patient experiences sudden upper abdominal pain because the spillage causes irritation of pain receptors in the visceral and parietal layers of the peritoneum. The body then attempts to protect the area by contracting the abdominal muscles, resulting in a rigid, board-like abdomen. Pyrosis, a painful and burning sensation in the esophagus, just below the breastbone, is usually associated with regurgitation of gastric acid, also known as heartburn. Bright-red emesis may be present as a result of hemorrhage from the gastric ulcer but is not as common as the rigid, board-like abdomen. Clay-colored stools are associated with hepatic disease, such as hepatitis, not gastric ulcer perforation. p. 912

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? 1 Bile reflux gastritis 2 Pernicious anemia 3 Dumping syndrome 4 Postprandial hypoglycemia

ANS 2 Rationale 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 taking a prescribed medication for gastroesophageal reflux disease (GERD) had a miscarriage. Which medication does the nurse expect to be responsible for the miscarriage? 1 Cholinergics 2 Prostaglandins 3 Antiulcer agents 4 Histamine (H 2) receptor blockers

ANS 2 Rationale 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.

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? 1 Jaundice, ascites, and edema 2 Heartburn, regurgitation, and dysphagia 3 Abdominal cramps, diarrhea, and anorexia 4 Pelvic pain, fever, and board-like abdominal rigidity

ANS 2 Rationale 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

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? 1 0.15 mL 2 0.25 mL 3 0.5 mL 4 1 mL

ANS 2 Rationale 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. 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? 1 0.25 tablet 2 0.5 tablet 3 1.5 tablets 4 2 tablets

ANS 2 Rationale 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. p. 903

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? 1 Inserting a new nasogastric tube 2 Notifying the primary health care provider immediately 3 Irrigating the nasogastric tube with normal saline solution 4 Monitoring for the symptoms of edema and inflammation

ANS 2 Rationale 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.

The nurse finds that the patient has a hard, painless ulcer on the upper lip. What treatment does the nurse expect the primary health care provider to prescribe? 1 Glossectomy 2 Surgical excision 3 Mandibulectomy 4 Hemiglossectomy

ANS 2 Rationale A hard, painless ulcer is a sign of oral cancer affecting the lip. Surgical excision of the ulcer is the treatment option for cancer of the lip. Glossectomy is the complete removal of the tongue. It is performed when the tongue becomes cancerous. Mandibulectomy is the removal of the mandible (lower jaw). It is done when the mandibular region is affected by oral cancer. Hemiglossectomy is the surgical removal of part of the tongue. Hemiglossectomy is prescribed if the patient has tumors on part of the tongue.

A patient presents with suspected gastric carcinoma. The nurse anticipates that which diagnostic test will be prescribed? 1 Radiology 2 Tissue biopsy 3 Rapid urease testing 4 Endoscopic ultrasound

ANS 2 Rationale A tissue biopsy involves examining tissue removed from the stomach to detect gastric carcinoma. Radiology is not the best method because superficial mucosa is generally involved and changes will not show up clearly on x-ray examination. Rapid urease testing is used to detect the presence of urease in Helicobacter pylori infections. An endoscopic ultrasound is used to stage the disease of stomach cancer. p. 909

Which intervention should the nurse perform when finding that a postgastrectomy patient has greenish yellow discharge eight hours after insertion of a nasogastric tube? 1 Remove the nasogastric tube. 2 Document it as a normal finding. 3 Notify the primary health care provider. 4 Place the patient in a semi-Fowler's position.

ANS 2 Rationale Discharge of bloody, greenish to yellow drainage from the nasogastric tube for 8 to 12 hours after insertion is a common observation. Therefore the nurse should document it as a normal finding. The nurse should not remove the nasogastric tube without consulting the primary health care provider. Notifying the primary health care provider is not necessary because discharge of bloody drainage is a normal finding. Placing the patient in a semi-Fowler's position will help prevent the risk of aspiration; however, it will not reduce the drainage from the nasogastric tube. p. 907

Which condition does the nurse expect in a patient with gastroesophageal reflux disease (GERD) who has esophagitis and stenosis? 1 Achalasia 2 Hiatal hernia 3 Esophageal strictures 4 Eosinophilic esophagitis

ANS 2 Rationale 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. p. 904

When administering a dose of ondansetron, the nurse would teach the patient to report which common adverse effect? 1 Nausea 2 Headache 3 Paresthesias 4 Double vision

ANS 2 Rationale 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. p. 895

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? 1 Dysphagia 2 Regurgitation 3 Hypersalivation 4 Hyperchlorhydria

ANS 2 Rationale 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

Which is a common antireflux surgery for repair of a hiatal hernia? 1 Cryotherapy 2 Toupet fundoplication 3 Photodynamic therapy 4 Endoscopic mucosal resection

ANS 2 Rationale 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.

A patient with stomach cancer presents with weight loss, dumping syndrome, and impaired wound healing. The nurse suspects that which surgical treatment may have caused the patient's symptoms? 1 Pyloroplasty 2 Total gastrectomy 3 Partial gastrectomy 4 Esophagojejunostomy

ANS 2 Rationale Weight loss, dumping syndrome, and impaired wound healing are all consequences of a total gastrectomy. Total gastrectomy involves the resection of the lower esophagus, removal of the entire stomach, and anastomosis of the esophagus to the jejunum. Pyloroplasty consists of surgical enlargement of the pyloric sphincter to facilitate the easy passage of contents from the stomach. Partial gastrectomy involves the removal of two-thirds of the stomach and anastomosis of the gastric stump to the duodenum or jejunum. Esophagojejunostomy is the anastomosis of the esophagus with the jejunum. p. 921

Which antiemetic medication causes xerostomia as a side effect? 1 Granisetron 2 Scopolamine 3 Perphenazine 4 Domperidone

ANS 2 Rationale Xerostomia is dryness of the mouth. Scopolamine is an anticholinergic (antimuscarinic) medication that causes xerostomia. Granisetron is a serotonin (5-HT 3) antagonist that causes diarrhea. Perphenazine causes constipation, dry mouth, rashes, and sedative effects. Domperidone causes anxiety, hallucinations, tremors, and dyskinesias.

The nurse is caring for a patient with a hiatal hernia. Which instructions should the nurse include teaching? Select all that apply. 1 "You may drink soda." 2 "You should avoid caffeine." 3 "You should avoid chocolate." 4 "You should suck peppermint." 5 "You should drink orange juice."

ANS 2,3 Rationale 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 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? Select all that apply. 1 Hemodynamic stability 2 Optimal nutritional status 3 Decreased hemoglobin level 4 Minimal symptoms of pain or anxiety 5 Absence of gastrointestinal bleeding

ANS 2,3 Rationale 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.

Which dietary instructions should the nurse provide the caregiver of a postoperative patient with dumping syndrome? Select all that apply. 1 "Avoid giving cheese." 2 "Avoid giving jelly and jam." 3 "Avoid giving fluids with meals." 4 "Give the patient eggs and meat." 5 "Divide the meals into three feedings."

ANS 2,3,4 Rationale 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

The primary health care provider orders endoscopic nutrition via a nasogastric tube for a postsurgical patient whose nutrition is disrupted. Which interventions should the nurse perform for this patient? Select all that apply. 1 Irrigating the tube 2 Providing oral care 3 Providing nasal care 4 Assessing the drainage 5 Repositioning the tube

ANS 2,3,4 Rationale While providing care for a postsurgical patient with a nasogastric tube, the nurse should provide oral and nasal care to the patient. The nursing responsibilities also include assessing the drainage from the nasogastric tube. Irrigating and repositioning the tube should be performed only after consulting the primary health care provider. p. 907

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? Select all that apply. 1 Cimetidine 2 Amoxicillin 3 Omeprazole 4 Tetracycline 5 Clarithromycin

ANS 2,3,5 Rationale 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 findings indicate that a patient with gastroesophageal reflux disease has aspirated gastric contents into the respiratory system? Select all that apply. 1 Cough 2 Asthma 3 Pneumonia 4 Bronchospasm 5 Chronic bronchitis

ANS 2,3,5 Rationale 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 is involved in a health promotion program for teenagers related to the potential development of oral cancer. Which behaviors can put a person at risk for oral cancer? Select all that apply. 1 Chewing gum 2 Overexposure to the sun 3 Using smokeless tobacco 4 Drinking carbonated beverages 5 Excessive drinking of alcoholic beverages

ANS 2,3,5 Rationale Risk factors for oral cancer include use of smokeless tobacco, overexposure to the sun, and excessive intake of alcohol. Chewing gum and drinking carbonated beverages do not cause or place a patient at risk for oral cancer.

Which medications decrease lower esophageal sphincter pressure in elderly patients with a hiatal hernia and gastroesophageal reflux disease (GERD)? Select all that apply. 1 Aspirin 2 Nifedipine 3 Potassium 4 Imipramine 5 Isosorbide dinitrate

ANS 2,4,5 Rationale 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

Which diagnostic or surgical procedure can best determine the spread of stomach cancer to the peritoneum? 1 Biopsy 2 Ultrasound 3 Laparoscopy 4 Computed tomography (CT)

ANS 3 Rationale 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 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? 1 Malnutrition 2 Bile reflux gastritis 3 Dumping syndrome 4 Postprandial hypoglycemia

ANS 3 Rationale 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

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? 1 "I should not bend over after eating." 2 "I should sleep with the head of the bed elevated." 3 "I should lie down for two to three hours after eating." 4 "I should avoid eating within three hours of bedtime."

ANS 3 Rationale 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.

Regurgitation is defined as what? 1 A forceful expulsion of stomach contents without nausea 2 A feeling of discomfort in the epigastrium with a conscious desire to vomit 3 An effortless process in which partially digested food slowly comes up from the stomach 4 Involuntary wavelike movements occurring within the alimentary canal that force contents onward

ANS 3 Rationale An effortless process in which partially digested food slowly comes up from the stomach is the definition of regurgitation. A forceful expulsion of stomach contents without nausea is the definition of projectile vomiting. The feeling of discomfort in the epigastrium with a conscious desire to vomit is the definition of nausea. Involuntary wavelike movements occurring within the alimentary canal that force contents onward are defined as peristalsis.

Which condition does the nurse suspect in a patient who reports pain and discomfort in the upper abdomen? 1 Pyrosis 2 Halitosis 3 Dyspepsia 4 Water brash

ANS 3 Rationale 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.

A female patient has a sliding hiatal hernia. What nursing interventions will prevent the symptoms of heartburn and dyspepsia that she is experiencing? 1 Keep the patient nothing by mouth (NPO). 2 Put the bed in the Trendelenburg position. 3 Have the patient eat four to six smaller meals each day. 4 Give various antacids to determine which one works for the patient.

ANS 3 Rationale 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. pp. 901, 904-905

The nurse determines that a patient has experienced the beneficial effects of therapy with famotidine when which symptom is relieved? 1 Nausea 2 Belching 3 Epigastric pain 4 Difficulty swallowing

ANS 3 Rationale 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. p. 903

Which complication occurs when cancer erodes through the esophagus and into the aorta? 1 Choking 2 Hoarseness 3 Hemorrhage 4 Blood-flecked regurgitation

ANS 3 Rationale 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.

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? 1 Adjuvant therapy 2 Triple-drug therapy 3 Intravenous therapy 4 Cobalamin replacement therapy

ANS 3 Rationale 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

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? 1 0.2 mL 2 0.75 mL 3 3 mL 4 5 mL

ANS 3 Rationale Multiply 10 by x and multiply 30 × 1 to yield 10x = 30. Divide 30 by 10 to yield 3 mL.

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? 1 Flatus 2 Diarrhea 3 Indigestion 4 Constipation

ANS 3 Rationale 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. p. 903

The nurse explains to the patient with oral candidiasis that treatment will include which of these? 1 Oral acyclovir 2 Viscous lidocaine rinses 3 Nystatin oral suspension 4 Topical application of antibiotics

ANS 3 Rationale Oral candidiasis (moniliasis or thrush) is a fungal infection of the oral cavity caused by the Candida albicans microorganism; it can be present because of debilitation of the patient, or as a result of prolonged high-dose antibiotic therapy or inhaled corticosteroid therapy. Treatment includes good oral hygiene along with antifungal drugs such as nystatin oral suspension, and others. Viscous lidocaine, oral acyclovir, and topical antibiotics are not used to treat oral candidiasis. p. 897

The nurse is giving a patient instructions regarding the management of gastroesophageal reflux disease (GERD). Which statement indicates that further teaching is required? 1 "So I don't have to follow a specific diet?" 2 "Chewing gum may help relieve my symptoms." 3 "I can have warm milk at bedtime, just not chocolate milk." 4 "Instead of eating three large meals a day, I should eat small frequent meals throughout the day."

ANS 3 Rationale 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

The nurse is assessing a patient who has suspected esophageal cancer. Which of these is the most common symptom of esophageal cancer? 1 Weight loss 2 Regurgitation 3 Progressive dysphagia 4 Epigastric pain during swallowing

ANS 3 Rationale 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

The nurse identifies that radiation therapy is used concurrently with chemotherapy for cancer treatment for what reason? 1 To stage the disease 2 To examine histology 3 To reduce tumor mass 4 To determine peritoneal spread

ANS 3 Rationale Radiation therapy is concurrently used with chemotherapy to reduce recurrence and as a palliative measure to decrease tumor mass. This combination therapy provides temporary relief of obstruction. Endoscopic ultrasounds and computed tomography are used to stage the disease. Biopsies are used to perform a histologic examination. Peritoneal spread of cancer is determined by laparoscopy. p. 920

The patient with peptic ulcer disease is on sucralfate medication. Which outcome does the nurse anticipate? 1 Healing of ulcer 2 Reduction in acid secretion 3 Protection of ulcer from acids 4 Neutralization of gastric acid secretion

ANS 3 Rationale 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

The registered nurse explains a dietary plan to a postoperative patient of gastric surgery who is preparing for discharge. Which statement made by the patient indicates the need for further teaching? 1 "I should reduce my meal size." 2 "I should reduce my intake of liquids with meals." 3 "I should consume more sugar with every meal." 4 "I should consume dry foods with low carbohydrate content."

ANS 3 Rationale Taking large amounts of sugars after gastric surgery will raise the blood sugar levels because sugar is readily absorbed into the bloodstream. As a result, the body produces more insulin leading to a drop in blood sugar levels, which causes dizziness, sweating, tachycardia, and diarrhea. Therefore the patient should avoid consuming more sugar with every meal. The meal size should be reduced because the stomach's reservoir is diminished after surgery. Taking more amounts of liquids with meals may cause nausea and vomiting in the patient. The patient is best able to tolerate dry foods with low carbohydrate content. p. 918

A patient with a peptic ulcer begins vomiting. The nurse would expect and be concerned with which type of vomitus? 1 Fecal 2 Bilious 3 "Coffee ground" 4 Undigested food

ANS 3 Rationale 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 teaching a group of high school students about the prevention of food poisoning. Which comment by the student shows understanding of foodborne illness protection? 1 "We like to mix up the ingredients so the flavors will meld before we cook our beef stew." 2 "For a snack, I like to eat raw cookie dough from the package instead of baking the cookies." 3 "When they gave me a pink hamburger, I sent it back and also asked for a new bun and clean plate." 4 "We only have one cutting board, so we cut up our chicken and salad vegetables at the same time."

ANS 3 Rationale 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 meld, 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

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? 1 Esophagitis 2 Gastric ulcer 3 Duodenal ulcer 4 Chronic gastritis

ANS 3 Rationale 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

The patient with chronic gastritis is being put on a combination of medications to eradicate Helicobacter pylori. The nurse should know that which drugs probably will be used for this patient? 1 Antibiotic(s), antacid, and corticosteroid 2 Antibiotic(s), aspirin, and antiulcer/protectant 3 Antibiotic(s), proton pump inhibitor, and bismuth 4 Antibiotic(s) and nonsteroidal antiinflammatory drugs (NSAIDs)

ANS 3 Rationale To eradicate H. pylori, a combination of antibiotics, a proton pump inhibitor, and possibly bismuth (for quadruple therapy) will be used. Corticosteroids, aspirin, and NSAIDs are drugs that can cause gastritis and do not affect H. pylori. An antiulcer medication would not be effective in eradicating H. pylori. pp. 909-910

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? 1 Page the physician. 2 Assess the patient's pain. 3 Obtain a set of vital signs. 4 Record the information in the patient's record.

ANS 3 Rationale 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

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? 1 Achalasia 2 Bile reflux gastritis 3 Dumping syndrome 4 Postprandial hypoglycemia

ANS 3 Rationale 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.

Linked to stomach cancer and non-Hodgkin's lymphoma, what is a common cause of gastritis? 1 Syphilis 2 Cytomegalovirus 3 Helicobacter pylori 4 Mycobacterium species

ANS 3 Rationale H. pylori infection is highest in underdeveloped countries and in people of low socioeconomic status. Infection likely occurs during childhood with transmission from family members to the child, possibly through a fecal-oral or oral-oral route. Syphilis, cytomegalovirus, and Mycobacterium species also are causes of chronic gastritis, but they are not as common as H. pylori.

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? 1 "I should report abdominal pain or discomfort to the health care provider." 2 "I should avoid irritating substances that worsen my ulcer." 3 "I should take nonsteroidal antiinflammatory drugs (NSAIDs) with food, milk, or antacids." 4 "I should adhere to proton pump inhibitor (PPI) and histamine-receptor blocker therapy as prescribed."

ANS 3 Rationale The patient with peptic ulcer disease should not take NSADs for painful episodes. NSAIDs decrease the production of prostaglandins, which are necessary for secretion of protective gastric mucous. Abdominal pain or discomfort should be reported to the primary health care provider, since it can be an indication of a complication. For patients with peptic ulcer disease the nurse would instruct the patient to avoid irritating substances that exacerbate the ulcer and adhere to the proton pump inhibitor (PPI) and histamine-receptor blocker therapy as prescribed. p. 919

Following a gastrectomy performed for peptic ulcer disease, the patient has recovered and is ready for discharge. What instructions should the nurse include in discharge teaching to prevent dumping syndrome? 1 Take fluids along with meals. 2 Reduce protein and fats in the diet. 3 Divide meals into six small feedings. 4 Use concentrated sweets like honey, jam, and jelly.

ANS 3 Rationale To prevent dumping syndrome after gastrectomy, the patient should avoid large meals, instead dividing meals into six small meals to avoid overloading the intestines at mealtimes. Fluids should not be taken with meals. Fluids can be taken at least 30 to 45 minutes before or after meals. This helps prevent distention or a feeling of fullness. Concentrated sweets should be avoided because they sometimes cause dizziness, diarrhea, and a sense of fullness. Protein and fats should be increased in the diet to help rebuild body tissue and to meet energy needs.

A 54-year-old patient admitted with cancer has not been able to eat because of nausea. Which strategies should the nurse use to increase the patient's intake? Select all that apply. 1 Serve foods that are warm to hot in temperature. 2 Offer the patient meats and foods with mild spices. 3 Offer a diet that appeals to the patient's preferences. 4 Administer antiemetics one hour before meals to prevent nausea. 5 Offer the patient foods, such as cooked cereal and soft or canned fruits.

ANS 3,4,5 Rationale Foods such as cooked cereals, soft or canned fruits, crackers, toast, and sherbet are high-carbohydrate, low-fat foods that are helpful in managing nausea. An antiemetic before meals also would decrease nausea. Planning the diet around the patient's preferences also will help stimulate the appetite. Hot foods and foods with spices may worsen nausea. pp. 894-896

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? Select all that apply. 1 The patient chews gum daily. 2 The patient eats ginger daily. 3 The patient eats oranges daily. 4 The patient eats ice cream often. 5 The patient drinks 2 L of water daily. 6 The patient drinks a cup of milk at bedtime.

ANS 3,4,6 Rationale 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.

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? Select all that apply. 1 "Do you experience hematemesis?" 2 "Do you have any black, tarry stools?" 3 "Do you experience any nocturnal pain?" 4 "Do you have a family history of peptic ulcer disease?" 5 "Do you experience high epigastric pain one to two hours after eating?"

ANS 3,5 Rationale 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.

The nurse is evaluating a patient after teaching about management of peptic ulcer disease. Which statement by the patient indicates the need for further teaching? Select all that apply. 1 "I should report increased vomiting or epigastric pain." 2 "I should avoid smoking because it may delay healing of the ulcer." 3 "I should take over-the-counter drugs that have ingredients like aspirin." 4 "I should avoid spicy and acidic food that may cause epigastric distress." 5 "I should take medications that include only antisecretory class of drugs."

ANS 3,5 Rationale While teaching a patient about management of peptic ulcer disease, the nurse should instruct the patient to take medications that include both antisecretory drugs and antibiotics because of the development of antibiotic resistance organisms; this can be reduced by using antisecretory drugs concurrently with antibiotics. Over-the-counter (OTC) drugs that contain ingredients like aspirin should be avoided because they destroy mucosal cells and increase the risk of ulcer development. The patient should report increased vomiting or epigastric pain. The patient should avoid smoking because it may delay ulcer healing. The patient should follow dietary modifications by avoiding spicy and acidic food that may cause epigastric distress. pp. 913-914

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? 1 Chest pain relieved with eating or drinking water 2 Back pain three or four hours after eating a meal 3 Burning epigastric pain 90 minutes after breakfast 4 Rigid abdomen and vomiting following indigestion

ANS 4 Rationale 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

n assessing the vital signs of a patient with an upper gastrointestinal (GI) bleed, it is important to determine whether the patient is in which kind of shock? 1 Septic 2 Neurogenic 3 Cardiogenic 4 Hypovolemic

ANS 4 Rationale Although fluctuations in vital signs occur in neurogenic, cardiogenic, and septic shock states, these fluctuations are not associated with blood loss. However, signs and symptoms of hypovolemic shock caused by GI blood loss, such as elevated heart rate, respiratory rate, and decreased blood pressure, would be evident. Assessment of the patient's vital signs assist the nurse in determining whether patient is in hypovolemic shock. p. 924

The nurse is caring for a patient with chronic gastritis. Which of these symptoms is associated specifically with this condition? 1 Severe diarrhea 2 Gastric hemorrhage 3 Nausea and vomiting 4 Cobalamin deficiency

ANS 4 Rationale In chronic gastritis the manifestations are similar to those described for acute gastritis. Patients with acute gastritis and chronic gastritis may experience nausea and vomiting or hemorrhage. However, with chronic gastritis, when the parietal cells are lost as a result of atrophy, the source of intrinsic factor is also lost. The loss of intrinsic factor, a substance essential for the absorption of cobalamin in the terminal ileum, ultimately results in cobalamin deficiency. With time, the body's storage of cobalamin in the liver becomes depleted, and a state of deficiency exists. Diarrhea is not associated with gastritis. p. 909

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? 1 "Is your throat sore?" 2 "Are you waking up during the night coughing and choking?" 3 "Give the medication time to take effect. You will be feeling better really soon." 4 "I know it is uncomfortable for you. Have you been taking your medication as prescribed and making the necessary dietary adjustments?"

ANS 4 Rationale 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.

Which medication used to treat nausea and vomiting may cause dyskinesia? 1 Nizatidine 2 Sucralfate 3 Omeprazole 4 Metoclopramide

ANS 4 Rationale 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

The nurse identifies that a patient is at risk for upper gastrointestinal bleeding based on the patient's history of taking medications in what drug class? 1 Antacids 2 Anticholinergics 3 Tricyclic antidepressants 4 Nonsteroidal antiinflammatory drugs (NSAIDs)

ANS 4 Rationale Nonsteroidal antiinflammatory drugs (NSAIDs) may disrupt the production of prostaglandins, which are required for the protection of the stomach's mucosal lining, and result in upper gastrointestinal bleeding. Antacids are used as an adjunct therapy for the treatment of peptic ulcers. Anticholinergic drugs are used occasionally to treat peptic ulcer disease. Tricyclic antidepressants are used to reduce gastric acid secretions associated with peptic ulcer disease. p. 922

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? 1 "This will prevent gas pains from the excess air in your small intestine." 2 "This will prevent the heartburn that occurs as a side effect of your diabetes." 3 "The stress of surgery is likely to cause stomach bleeding if you do not receive it." 4 "This will reduce the amount of acid in your stomach until you can eat a regular diet again."

ANS 4 Rationale 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. p. 903

Which medication is beneficial to a patient reporting coughing, dyspnea, and radiating pain to the back, neck, and jaw? 1 Nifedipine 2 Prednisone 3 Isosorbide dinitrate 4 Aluminum hydroxide

ANS 4 Rationale Respiratory symptoms such as coughing and dyspnea accompanied with radiating pain to the back, neck, and jaw indicate gastroesophageal reflux disease (GERD). GERD-related chest pain is similar to angina. Antacids such as aluminum hydroxide are used in the treatment of GERD-related chest pain. Nifedipine and isosorbide dinitrate are used in the treatment of achalasia. Prednisone is used in the treatment of eosinophilic esophagitis.

A nurse assesses a patient with suspected peptic ulcer disease. Which symptom will the patient mostlikely report? 1 Vomiting after meals 2 Abdominal distention after eating 3 Intolerance of fatty and spicy foods 4 Epigastric discomfort relieved by eating

ANS 4 Rationale 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

A patient is admitted to the hospital with a severe duodenal ulcer. The patient suddenly complains of severe pain spreading over the entire abdomen, likely due to a perforation. What should be the mostimmediate intervention by the nurse, if prescribed? 1 Administer nitrates. 2 Administer pain medication. 3 Prepare for laparoscopic surgery. 4 Insert a nasogastric (NG) tube into the stomach.

ANS 4 Rationale The immediate focus of management for a patient with a perforation is to stop the spillage of gastric or duodenal contents into the peritoneal cavity and restore blood volume. An NG tube is inserted into the stomach to provide continuous aspiration and gastric decompression to stop spillage through the perforation and thereby prevent peritonitis. Administering nitrates to such a patient will not be helpful in relieving the condition. Administration of pain medications and preparations for laparoscopic surgery are done later. pp. 912, 915

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? 1 Reinsert the tube. 2 Reposition the tube. 3 Document the findings and continue to administer. 4 Notify the primary health care provider immediately.

ANS 4 Rationale 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.

Which patient statement indicates a need for further teaching regarding appropriate dietary choices for illness with vomiting? 1 "I should eat hard candy." 2 "I should eat plain baked potatoes." 3 "I should drink warm tea with crackers." 4 "I should drink carbonated beverages on ice."

ANS 4 Rationale The patient should avoid carbonated beverages on ice. Carbonated beverages at room temperature are easier to tolerate and can be consumed by the patient who is vomiting. Warm tea is easy to tolerate. Crackers have a mild flavor; are easy to digest and nutritious; and provide energy. The patient should consume a diet rich in carbohydrates and low in fat, such as hard candy and baked potatoes. pp. 894-895

The nurse is assisting a patient who has been admitted with severe abdominal pain. Suddenly, the patient vomits a large amount of emesis that looks similar to coffee grounds. Which action by the nurse is a priority? 1 Ask the patient about the timing of the last meal. 2 Offer the patient sips of water to prevent dehydration. 3 Monitor the patient for any further episodes of nausea and vomiting. 4 Notify the primary health care provider about the patient's condition.

ANS 4 Rationale Vomitus with a "coffee ground" appearance is related to gastric bleeding, in which blood changes to dark brown as a result of its interaction with hydrochloric acid. The primary health care provider needs to be notified immediately about this change in the patient's condition. Asking the patient about the timing of the last meal and monitoring the patient are appropriate, but not the priority. The nurse should not offer water just in case the patient may have to have a diagnostic study that requires nothing by mouth (NPO) status. p. 922

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? 1 Botulism 2 Clostridial 3 Staphylococcal toxin 4 Escherichia coli O157:H7 infection

ANS 4 The clinical manifestations of E. coli 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

During rounds, the nurse notes that a patient who had a total gastrectomy the day before has a very small amount of fluid draining from the nasogastric (NG) tube. What is the nurse's priority action? 1 Increase the power on the suction device. 2 Irrigate the NG tube with 50 mL of sterile saline. 3 Notify the primary health care provider immediately. 4 Continue to monitor the patient and NG tube drainage.

ANS 4 Rationale After total gastrectomy, the NG tube does not drain a large quantity of secretions because removal of the stomach has eliminated the reservoir capacity. The nurse will only need to continue to monitor the patient and the NG tube drainage. Increasing the level of suction places the patient at higher risk for acid-base imbalance. Irrigating the NG tube is not necessary. The health care provider does not need to be notified, because this is a normal finding.

Which antacid used in the treatment of gastrointestinal reflux disease (GERD) causes phosphorus depletion with chronic use? 1 Magnesium oxide 2 Calcium carbonate 3 Sodium bicarbonate 4 Aluminum hydroxide

ANS 4 Rationale 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.

Which microorganism causes gastritis? 1 Streptococcus 2 Fusiform bacteria 3 Candida albicans 4 Helicobacter pylori

ANS 4 Rationale H. pylori is a leading bacterial cause of gastritis. Streptococcus causes pharyngitis, cellulitis, and Scarlet fever. Candida albicans causes oral candidiasis. Fusiform bacteria cause Vincent's infection.

Which antacid does the nurse expect the primary health care provider to prescribe to a patient who reports mild, intermittent chest pain after meals? 1 Sodium citrate 2 Calcium carbonate 3 Aluminum carbonate 4 Magnesium trisilicate

ANS 4 Rationale 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

A patient is on nonsteroidal antiinflammatory drugs (NSAIDs). Which complication does the nurse anticipate? 1 Achalasia 2 Duodenal ulcer 3 Stomach cancer 4 Silent peptic ulcer

ANS 4 Rationale Silent peptic ulcers show no symptoms of ulcer disease until the presentation of their final, fatal illness. The ulcers occur in older patients or patients who take NSAIDs. Achalasia is a primary motility disorder characterized by the absence of peristalsis and impaired relaxation of the lower esophageal sphincter (LES) in response to swallowing. Duodenal ulcers occur due to excessive alcohol ingestion and smoking that result in increased hydrochloric acid secretion. Stomach cancer begins with a nonspecific mucosal injury as a result of infection, autoimmune-related inflammation, and tobacco use. p. 912

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? Select all that apply. 1 Infection 2 Vomiting 3 Arrhythmias 4 Cardiac failure 5 Pulmonary edema

ANS 4,5 Rationale 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. p. 924

The nurse is caring for a patient diagnosed with gastric outlet obstruction. Which assessment findings support the diagnosis? Select all that apply. 1 Rigid board-like abdomen 2 Audible abdominal sounds 3 Continuous epigastric distress 4 Overtime dilation of the stomach 5 Visible swelling in the upper abdomen

ANS 4,5 Rationale Overtime dilation of the stomach and visible swelling in the upper abdomen occur as a result of gastric outlet obstruction due to edema, inflammation, and fibrous scar tissue formation. A rigid board-like abdomen is indicative of perforated ulcer. Audible abdominal sounds are clinical manifestations of dumping syndrome. Continuous epigastric distress occurs after meals in patients with bile reflex gastritis. pp. 915-916