Upper GI problems-46

A patient in the emergency department has acute gastrointestinal bleeding. What interventions would the nurse perform? (Select all that apply.) a. establish 2 large bore IV lines. b. limit intravenous fluids c. monitor intake and output every shift d. initiate ECG monitoring e. obtain vital signs every 8 hours

A,D Emergency management of acute GI bleeding includes placing IV lines, preferably 2, with a 16- or 18-gauge needle for fluid and blood replacement: Giving fluid or blood replacement as ordered: an accurate intake and output record is essential so you can assess the patient's hydration status: measure urine output hourly: if a central venous pressure line or pulmonary artery catheter is in place, record these readings every 1 to 2 hours: apply ECG monitoring: monitor vital signs closely, especially in the patient with CVD, because dysrhythmias may occur: Obtain blood for CBC, clotting studies, and type and crossmatch as needed; insert NG tube as needed; insert indwelling urinary catheter; and give IV PPI therapy to decrease acid secretion.

The nurse is caring for a patient with abdominal pain and hematemesis. Which new assessment finding(s) would indicate the patient's condition is declining? Pallor and diaphoresis Reddened peripheral IV site Guaiac-positive diarrhea stools Heart rate 90, respiratory rate 20, BP 110/60

A. A patient with hematemesis has some degree of bleeding from an unknown source. Guaiac-positive diarrhea stools would be an expected finding. When monitoring the patient for stability, the nurse observes for signs of hypovolemic shock such as tachycardia, tachypnea, hypotension, altered level of consciousness, pallor, and cool and clammy skin. A reddened peripheral IV site will require assessment to determine the need for reinsertion. Access would be critical in the immediate treatment of shock, but the IV site does not represent a decline in condition.

The results of a patient's recent endoscopy indicate peptic ulcer disease (PUD). Which teaching would the nurse provide to the patient based on this diagnosis? a. it would be beneficial for you to stop drinking alcohol. b."You'll need to drink at least 2 to 3 glasses of milk daily." c. "Many people find that a minced or pureed diet eases their symptoms of PUD." d."You can keep your present diet and minimize symptoms by taking medication."

A. Alcohol increases the amount of stomach acid produced, so it should be avoided. Although there is no specific recommended dietary modification for PUD, most patients find it necessary to make some dietary modifications to minimize symptoms. Milk may worsen PUD.

The nurse teaches older adults at a community center how to prevent food poisoning at social events. Which statement reflects accurate understanding of the teaching provided? a. "Pasteurized juices and milk are safe to drink." b. "Raw cookie dough is safe to eat if it is cold." c."Fresh fruits do not need washed before eating." d."Ground beef is safe to eat if it is slightly pink."

A. Drink only pasteurized milk, juice, or cider. Ground beef should be cooked thoroughly. Browned meat can still harbor live bacteria. Cook ground beef until a thermometer reads at least 160° F. If a thermometer is unavailable, decrease the risk of illness by cooking the ground beef until there is no pink color in the middle. Fruits and vegetables should be washed thoroughly, especially those that will not be cooked. Do not eat raw food products, such as dough, that are supposed to be cooked.

36. Which patient would the nurse assess first after receiving change-of-shift report? a. A patient with esophageal varices who has a rapid heart rate b. A patient with a history of gastrointestinal bleeding who has melena c. A patient with nausea who has a dose of metoclopramide (Reglan) due d. A patient who is crying after receiving a diagnosis of esophageal cancer

ANS: A A patient with esophageal varices and a rapid heart rate indicate possible hemodynamic instability caused by GI bleeding. The other patients require interventions, but their findings do not indicate acutely life-threatening complications.

19. Which diagnostic test would the nurse anticipate for an older patient who is vomiting "coffee-ground" emesis? a. Endoscopy b. Angiography c. Barium studies d. Gastric analysis

ANS: A Endoscopy is the primary tool for visualization and diagnosis of upper gastrointestinal (GI) bleeding. Angiography is used only when endoscopy cannot be done because it is more invasive and has more possible complications. Barium studies are helpful in determining the presence of gastric lesions, but not whether the lesions are actively bleeding. Gastric analysis testing may help with determining the cause of gastric irritation, but it is not used for acute GI bleeding.

18. Which action would the nurse in the emergency department anticipate for a young adult patient who has had several acute episodes of bloody diarrhea? a. Obtain a stool specimen for culture. b. Administer antidiarrheal medication. c. Provide teaching about antibiotic therapy. d. Teach the adverse effects of acetaminophen (Tylenol).

ANS: A Patients with bloody diarrhea should have a stool culture for Escherichia coli O157:H7. Antidiarrheal medications are usually avoided for possible infectious diarrhea to avoid prolonging the infection. Antibiotic therapy in the treatment of infectious diarrhea is controversial because it may precipitate kidney complications. Acetaminophen does not cause bloody diarrhea.

45. A patient is admitted with possible botulism poisoning after eating home-canned green beans. Which intervention ordered by the health care provider would the nurse question? a. Encourage oral fluids to 3 L/day. b. Document neurologic symptoms. c. Position patient lying on the side. d. Observe respiratory status closely.

ANS: A The patient should not have oral fluids because neuromuscular weakness increases risk for aspiration. Side-lying position and assessment of neurologic and respiratory status are expected interventions.

3. A woman receiving chemotherapy for breast cancer develops a Candida albicans oral infection. Which intervention would the nurse anticipate? a. Nystatin tablets b. Antiviral agents c. Referral to a dentist d. Hydrogen peroxide rinses

ANS: A C. albicans infections are treated with an antifungal such as nystatin. Peroxide rinses would be painful. Oral saltwater rinses may be used but will not cure the infection. Antiviral agents are used for viral infections such as herpes simplex. Referral to a dentist is indicated for gingivitis but not for Candida infection.

32. The nurse is assessing a patient who had a total gastrectomy 8 hours ago. Which information is most important to report to the health care provider? a. Hemoglobin (Hgb) 10.8 g/dL b. Temperature 102.1F (38.9C) c. Absent bowel sounds in all quadrants d. Scant nasogastric (NG) tube drainage

ANS: B An elevation in temperature may indicate leakage at the anastomosis, which may require return to surgery or keeping the patient NPO. The other findings are expected in the immediate postoperative period for patients who have this surgery and do not require any urgent action

35. A patient has been admitted with hypotension and dehydration after 3 days of nausea and vomiting. Which prescribed action will the nurse implement first? a. Insert a nasogastric (NG) tube. b. Infuse normal saline at 250 mL/hr. c. Administer IV ondansetron (Zofran). d. Provide oral care with moistened swabs.

ANS: B Because the patient has severe dehydration, rehydration with IV fluids is the priority. The other orders would be accomplished after the IV fluids are initiated.

16. Which statement by a patient with chronic atrophic gastritis indicates that the nurse's teaching regarding cobalamin injections has been effective? a. "The cobalamin injections will prevent gastric inflammation." b. "The cobalamin injections will prevent me from becoming anemic." c. "These injections will increase the hydrochloric acid in my stomach." d. "These injections will decrease my risk for developing stomach cancer."

ANS: B Cobalamin supplementation prevents the development of pernicious anemia. Chronic gastritis may cause achlorhydria, but cobalamin does not correct this. The loss of intrinsic factor secretion with chronic gastritis is permanent, and the patient will need lifelong supplementation with cobalamin. The incidence of stomach cancer is higher in patients with chronic gastritis, but cobalamin does not reduce the risk for stomach cancer.

13. Which nursing action would be included in the postoperative plan of care for a patient after a laparoscopic esophagectomy? a. Reposition the NG tube if drainage stops. b. Elevate the head of the bed to at least 30 degrees. c. Start oral fluids when the patient has active bowel sounds. d. Notify the doctor for any bloody nasogastric (NG) drainage.

ANS: B Elevation of the head of the bed decreases the risk for reflux and aspiration of gastric secretions. The NG tube would not be repositioned without consulting with the health care provider. Bloody NG drainage is expected for the first 8 to 12 hours. A swallowing study is needed before oral fluids are started.

21. Which information will the nurse include when teaching a patient with peptic ulcer disease about the effect of famotidine (Pepcid)? a. "Famotidine absorbsthe excess gastric acid." b. "Famotidine decreases gastric acid secretion." c. "Famotidine constricts the blood vessels near the ulcer." d. "Famotidine covers the ulcer with a protective material."

ANS: B Famotidine is a histamine-2 (H2) receptor blocker that decreases the secretion of gastric acid. Famotidine does not constrict the blood vessels, absorb the gastric acid, or cover the ulcer.

22. A young adult patient is hospitalized with massive abdominal trauma from a motor vehicle crash. The patient asks about the purpose of receiving famotidine (Pepcid). Which information would the nurse explain about the action of the medication? a. "It decreases nausea and vomiting." b. "It inhibits development of stress ulcers." c. "It lowersthe risk for H. pylori infection." d. "It prevents aspiration of gastric contents."

ANS: B Famotidine is administered to prevent the development of physiologic stress ulcers, which are associated with a major physiologic insult such as massive trauma. Famotidine does not decrease nausea or vomiting, prevent aspiration, or prevent H. pylori infection.

6. A patient who has gastroesophageal reflux disease (GERD) is experiencing increasing discomfort. Which patient statement to the nurse indicates a need for additional teaching about GERD? a. "I quit smoking years ago, but I chew gum." b. "I eat small meals and have a bedtime snack." c. "I take antacids between meals and at bedtime each night." d. "Isleep with the head of the bed elevated on 4-inch blocks."

ANS: B GERD is exacerbated by eating late at night, and the nurse would plan to teach the patient to avoid eating within 3 hours of bedtime. Smoking cessation, taking antacids, and elevating the head of the bed are appropriate actions to control symptoms of GERD.

24. A patient who underwent a gastroduodenostomy (Billroth I) 12 hours ago reports increasing abdominal pain. The patient has no bowel sounds and 200 mL of bright red nasogastric (NG) drainage in the past hour. Which nursing action is the highest priority? a. Monitor drainage. b. Contact the surgeon. c. Irrigate the NG tube. d. Give prescribed morphine.

ANS: B Increased pain and 200 mL of bright red NG drainage 12 hours after surgery indicate possible postoperative hemorrhage, and immediate actions such as blood transfusion or return to surgery are needed (or both). Because the NG is draining, there is no indication that irrigation is needed. Continuing to monitor the NG drainage is needed but not an adequate response to the findings. The patient may need morphine, but this is not the highest priority action.

43. The nurse and a licensed practical/vocational nurse (LPN/VN) are working together to care for a patient who had an esophagectomy 2 days ago. Which action by the LPN/VN requires that the nurse intervene? a. The LPN/VN uses soft swabs to provide oral care. b. The LPN/VN positions the head of the bed in a flat position. c. The LPN/VN includes the enteral feeding volume when calculating intake. d. The LPN/VN encourages the patient to use pain medications before coughing.

ANS: B The patient's bed would be in Fowler's position to prevent reflux and aspiration of gastric contents. The other actions by the LPN/LVN are appropriate

40. The nurse is administering IV fluid boluses and nasogastric irrigation to a patient with acute gastrointestinal (GI) bleeding. Which assessment finding is most important for the nurse to communicate to the health care provider? a. The bowel sounds are hyperactive in all four quadrants. b. The patient's lungs have crackles audible to the mid-chest. c. The nasogastric (NG) suction is returning coffee-ground material. d. The patient's blood pressure (BP) has increased to 142/84 mm Hg.

ANS: B The patient's lung sounds indicate that pulmonary edema may be developing because of the rapid infusion of IV fluid and that the fluid infusion rate would be slowed. The return of coffee-ground material in an NG tube is expected for a patient with upper GI bleeding. The BP is slightly elevated but would not be an indication to contact the health care provider immediately. Hyperactive bowel sounds are common when a patient has GI bleeding.

23. A patient admitted with a peptic ulcer has a nasogastric (NG) tube in place. When the patient develops sudden, severe upper abdominal pain, diaphoresis, and a firm abdomen, which action would the nurse take? a. Irrigate the NG tube. b. Check the vital signs. c. Give the ordered antacid. d. Elevate the foot of the bed.

ANS: B The patient's symptoms suggest acute perforation, and the nurse should assess for signs of hypovolemic shock. Irrigation of the NG tube, administration of antacids, or both would be contraindicated because any material in the stomach will increase the spillage into the peritoneal cavity. Elevating the foot of the bed may increase abdominal pressure and discomfort, as well as making it more difficult for the patient to breathe

2. Which item would the nurse offer to the patient restarting oral intake after being NPO due to nausea and vomiting? a. Glass of orange juice b. Dish of lemon gelatin c. Cup of coffee with cream d. Bowl of hot chicken broth

ANS: B Clear cool liquids are usually the first foods started after a patient has been nauseated. Acidic foods such as orange juice, very hot foods, and coffee are poorly tolerated when patients have been nauseated.

12. Which information will the nurse provide for a patient with newly diagnosed gastroesophageal reflux disease (GERD)? a. "Peppermint tea may reduce yoursymptoms." b. "Keep the head of your bed elevated on blocks." c. "Avoid eating between meals to reduce acid secretion." d. "Vigorous exercise may increase the incidence of reflux."

ANS: B Elevating the head of the bed will reduce the incidence of reflux while the patient is sleeping. Peppermint will decrease lower esophageal sphincter (LES) pressure and increase the chance for reflux. Small, frequent meals are recommended to avoid abdominal distention. There is no need to make changes in physical activities because of GERD.

31. A patient with a family history of stomach cancer asks the nurse about ways to decrease the risk for developing stomach cancer. What would the nurse teach the patient to avoid? a. Emotionally stressful situations b. Smoked foods such as ham and bacon c. Foods that cause distention or bloating d. Chronic use of H2 blocking medications

ANS: B Smoked foods such as bacon, ham, and smoked sausage increase the risk for stomach cancer. Stressful situations, abdominal distention, and use of H2 blockers are not associated with an increased incidence of stomach cancer.

29. Which information about dietary management would the nurse include when teaching a patient with peptic ulcer disease (PUD)? a. "You will need to remain on a bland diet." b. "Avoid foods that cause pain after you eat them." c. "High-protein foods are least likely to cause pain." d. "You should avoid eating raw fruits and vegetables."

ANS: B The best information is that each person should choose foods that are not associated with postprandial discomfort. Raw fruits and vegetables may irritate the gastric mucosa but chewing well seems to decrease this problem and some patients tolerate these healthy foods well. High-protein foods help neutralize acid, but they also stimulate hydrochloric (HCl) acid secretion and may increase discomfort for some patients. Bland diets may be recommended during an acute exacerbation of PUD, but there is little evidence to support their ongoing use.

5. Which information will the nurse include when teaching adults to decrease the risk for cancers of the tongue and buccal mucosa? a. Use sunscreen even on cloudy days. b. Avoid cigarettes and smokeless tobacco. c. Complete antibiotic courses used to treat throat infections. d. Use antivirals to treat herpes simplex virus (HSV) infections

ANS: B Tobacco use greatly increases the risk for oral cancer. Acute throat infections do not increase the risk for oral cancer, although chronic irritation of the oral mucosa does increase risk. Sun exposure does not increase the risk for cancers of the buccal mucosa, although it increases risk for cancer of the lip. Human papillomavirus (HPV) infection is associated with an increased risk, but HSV infection is not a risk factor for oral cancer.

44. After change-of-shift report, which patient would the nurse assess first? a. A 42-yr-old patient who has acute gastritis and ongoing epigastric pain b. A 70-yr-old patient with a hiatal hernia who experiences frequent heartburn c. A 60-yr-old patient with nausea and vomiting who is lethargic with dry mucosa d. A 53-yr-old patient who has dumping syndrome after a recent partial gastrectomy

ANS: C A patient with nausea and vomiting who is lethargic with dry mucosa is at high risk for problems such as aspiration, dehydration, and fluid and electrolyte disturbances. The other patients will also need to be assessed, but the information about them indicates symptoms that are typical for their diagnoses and are not life threatening.

39. Which prescribed action will the nurse implement first for a patient who has vomited 1100 mL of blood? a. Give an IV H2 receptor antagonist. b. Draw blood for type and crossmatch. c. Administer 1 L of lactated Ringer's solution. d. Insert a nasogastric (NG) tube and connect to suction

ANS: C Because the patient has vomited a large amount of blood, correction of hypovolemia and prevention of hypovolemic shock are the priorities. The other actions also are important to implement quickly but are not the highest priorities.

25. Which patient statement indicates that the nurse's postoperative teaching after a gastroduodenostomy has been effective? a. "I will drink more liquids with my meals." b. "I should choose high carbohydrate foods." c. "Vitamin supplements may prevent anemia." d. "Persistent heartburn is expected after surgery."

ANS: C Cobalamin deficiency may occur after partial gastrectomy, and the patient may need to receive cobalamin via injections or nasal spray. Although peptic ulcer disease may recur, persistent heartburn is not expected after surgery, and the patient should call the health care provider if this occurs. Ingestion of liquids with meals is avoided to prevent dumping syndrome. Foods that have moderate fat and low carbohydrate should be chosen to prevent dumping syndrome.

37. A patient returned from a laparoscopic Nissen fundoplication for hiatal hernia 4 hours ago. Which assessment finding is most important for the nurse to address immediately? a. The patient reports 7/10 (0 to 10 scale) abdominal pain. b. The patient is experiencing intermittent waves of nausea. c. The patient has no breath sounds in the left anterior chest. d. The patient has hypoactive bowel sounds in all four quadrants.

ANS: C Decreased breath sounds on one side may indicate a pneumothorax, which requires rapid diagnosis and treatment. The nausea and abdominal pain would be addressed, but they are not as high priority as the patient's respiratory status. Decreased bowel sounds are expected after surgery and require ongoing monitoring but no other action.

41. The nurse has completed teaching a patient with newly diagnosed eosinophilic esophagitis about the management of the disease. Which patient action indicates that the teaching has been effective? a. Patient orders nonfat milk for each meal. b. Patient uses the prescribed corticosteroid inhaler. c. Patient schedules an appointment for allergy testing. d. Patient takes ibuprofen (Advil) to control throat pain.

ANS: C Eosinophilic esophagitis is frequently associated with environmental allergens, so allergy testing is used to determine possible triggers. Corticosteroid therapy may be prescribed, but the medication will be swallowed, not inhaled. Milk is a frequent trigger for attacks. NSAIDs are not used for eosinophilic esophagitis.

34. A young adult has been admitted to the emergency department with nausea and vomiting. Which action could the RN delegate to assistive personnel (AP)? a. Auscultate the bowel sounds. b. Assess for signs of dehydration. c. Assist the patient with oral care. d. Ask more questions about the nausea.

ANS: C Oral care is included in AP education and scope of practice. The other actions are all assessments that require more education and a higher scope of nursing practice

26. At his first postoperative checkup appointment after a gastrojejunostomy (Billroth II), a patient reports that dizziness, weakness, and palpitations occur about 20 minutes after each meal. Which action would the nurse teach the patient to take? a. Increase the amount of fluid with meals. b. Eat foods that are higher in carbohydrates. c. Lie down for about 30 minutes after eating. d. Drink sugared fluids or eat candy after meals.

ANS: C The patient is experiencing symptoms of dumping syndrome, which may be reduced by lying down for a short rest after eating. Increasing fluid intake and choosing high carbohydrate foods will increase the risk for dumping syndrome. Having a sweet drink or hard candy will correct the hypoglycemia that is associated with dumping syndrome but will not prevent dumping syndrome.

15. A patient vomiting blood-streaked fluid is admitted to the hospital with acute gastritis. What would the nurse ask the patient about to determine possible risk factors for gastritis? a. The amount of saturated fat in the diet b. A family history of gastric or colon cancer c. Use of nonsteroidal antiinflammatory drugs d. A history of a large recent weight gain or loss

ANS: C Use of an NSAID is associated with damage to the gastric mucosa, which can result in acute gastritis. Family history, recent weight gain or loss, and fatty foods are not risk factors for acute gastritis.

20. An adult with E. coli O157:H7 food poisoning is admitted to the hospital with bloody diarrhea and dehydration. Which prescribed action will the nurse question? a. Infuse lactated Ringer's solution at 250 mL/hr. b. Monitor blood urea nitrogen and creatinine daily. c. Administer loperamide (Imodium) after each stool. d. Provide a clear liquid diet and progress diet as tolerated.

ANS: C Use of antidiarrheal agents is avoided with this type of food poisoning because the drugs slow GI motility and can prolong infection. IV fluids, clear oral fluids, and monitoring renal function are appropriate for dehydration.

33. A patient has just been admitted to the emergency department with nausea and vomiting. Which information requires the most rapid intervention by the nurse? a. The patient has been vomiting for 4 days. b. The patient takes antacids 8 to 10 times a day. c. The patient is lethargic and difficult to arouse. d. The patient had a small intestinal resection 2 years ago.

ANS: C A lethargic patient is at risk for aspiration, and the nurse will need to position the patient to decrease aspiration risk. The other information is also important to collect, but it does not require as quick action as the risk for aspiration.

1. After change-of-shift report, which patient would the nurse assess first? a. A 42-yr-old patient who has acute gastritis and ongoing epigastric pain b. A 70-yr-old patient with a hiatal hernia who experiences frequent heartburn c. A 60-yr-old patient with nausea and vomiting who is lethargic with dry mucosa d. A 53-yr-old patient who has dumping syndrome after a recent partial gastrectomy

ANS: C A patient with nausea and vomiting who is lethargic with dry mucosa is at high risk for problems such as aspiration, dehydration, and fluid and electrolyte disturbances. The other patients will also need to be assessed, but the information about them indicates symptoms that are typical for their diagnoses and are not life threatening.

4. Which finding in the mouth of a patient who uses smokeless tobacco is suggestive of oral cancer? a. Bleeding during tooth brushing b. Painful blisters at the lip border c. Red patches on the buccal mucosa d. Curdlike plaques on the posterior tongue

ANS: C A red, velvety patch suggests erythroplasia, which has a high incidence (>50%) of progression to squamous cell carcinoma. The other lesions are suggestive of acute processes (e.g., gingivitis, oral candidiasis, herpes simplex).

7. A patient with a stroke is unconscious and unresponsive to stimuli. After learning that the patient has a history of gastroesophageal reflux disease (GERD), which assessment would the nurse plan to make more frequently than is routine? a. Apical pulse b. Bowel sounds c. Breath sounds d. Abdominal girth

ANS: C Because GERD may cause aspiration, the unconscious patient is at risk for developing aspiration pneumonia. Bowel sounds, abdominal girth, and apical pulse will not be affected by the patient's stroke or GERD and do not require more frequent monitoring than the routine.

9. Which patient choice for a snack 3 hours before bedtime indicates that the nurse's teaching about gastroesophageal reflux disease (GERD) has been effective? a. Chocolate pudding b. Glass of low-fat milk c. Cherry gelatin with fruit d. Peanut butter and jelly sandwich

ANS: C Gelatin and fruit are low fat and will not decrease lower esophageal sphincter (LES) pressure. Foods such as chocolate are avoided because they lower LES pressure. Milk products increase gastric acid secretion. High-fat foods such as peanut butter decrease both gastric emptying and LES pressure.

17. A patient has peptic ulcer disease associated with Helicobacter pylori. Which medications will the nurse plan to teach the patient? a. Sucralfate (Carafate), nystatin, and bismuth (Pepto-Bismol) b. Metoclopramide (Reglan), bethanechol, and promethazine c. Amoxicillin (Amoxil), clarithromycin, and omeprazole (Prilosec) d. Famotidine (Pepcid), magnesium hydroxide (Mylanta), and pantoprazole

ANS: C The drugs used in triple drug therapy include a proton pump inhibitor such as omeprazole and the antibiotics amoxicillin and clarithromycin. The other combinations listed are not included in the protocol for H. pylori infection.

11. A woman who was recently diagnosed with esophageal cancer tells the nurse, "I do not feel ready to die yet." Which response would the nurse provide? a. "You may have quite a few years still left to live." b. "Thinking about dying will only make you feel worse." c. "Having this new diagnosis must be very hard for you." d. "It is important that you be realistic about your prognosis."

ANS: C This response is open ended and will encourage the patient to further discuss feelings of anxiety or sadness about the diagnosis. Patients with esophageal cancer have a low survival rate, so the response "You may have quite a few years still left to live" is misleading. The response beginning, "Thinking about dying" indicates that the nurse is not open to discussing the patient's fears of dying. The response beginning, "It is important that you be realistic" discourages the patient from feeling hopeful, which is important to patients with any life-threatening diagnosis.

10. Which topic would the nurse anticipate teaching to a patient who has a new report of heartburn? a. Radionuclide tests b. Barium swallow exam c. Endoscopy procedures d. Proton pump inhibitors

ANS: D Because diagnostic testing for heartburn that is probably caused by gastroesophageal reflux disease (GERD) is expensive and uncomfortable, proton pump inhibitors are frequently used for a short period as the first step in the diagnosis of GERD. The other tests may be used but are not usually the first step in diagnosis.

14. Which information will the nurse provide for a patient with achalasia? a. A liquid diet will be necessary. b. Avoid drinking fluids with meals. c. Lying down after meals is recommended. d. Treatment may include endoscopic procedures

ANS: D Endoscopic and laparoscopic procedures are the most effective therapy for improving symptoms caused by achalasia. Keeping the head elevated after eating will improve esophageal emptying. A semisoft diet is recommended to improve esophageal emptying. Patients are advised to drink fluids with meals.

42. An 80-year-old patient who is hospitalized with peptic ulcer disease develops new-onset auditory hallucinations. Which prescribed medication will the nurse discuss with the health care provider before administration? a. Sucralfate (Carafate) b. Aluminum hydroxide c. Omeprazole (Prilosec) d. Metoclopramide (Reglan)

ANS: D Metoclopramide can cause central nervous system side effects ranging from anxiety to hallucinations. Hallucinations are not a side effect of proton pump inhibitors, mucosal protectants, or antacids.

27. A patient who takes a nonsteroidal antiinflammatory drug (NSAID) daily for the management of severe rheumatoid arthritis has recently developed melena. What would the nurse anticipate teaching the patient? a. Substitution of acetaminophen (Tylenol) for the NSAID b. Use of enteric-coated NSAIDs to reduce gastric irritation c. Reasons for using corticosteroids to treat the rheumatoid arthritis d. Misoprostol (Cytotec) to protect the gastrointestinal (GI) mucosa

ANS: D Misoprostol, a prostaglandin analog, reduces acid secretion and the incidence of upper GI bleeding associated with NSAID use. Enteric coating of NSAIDs does not reduce the risk for GI bleeding. Corticosteroids increase the risk for ulcer development and will not be substituted for NSAIDs for this patient. Acetaminophen will not be effective in treating rheumatoid arthritis.

28. The health care provider prescribes antacids and sucralfate (Carafate) for treatment of a patient's peptic ulcer. Which medication schedule would the nurse teach the patient? a. Sucralfate at bedtime and antacids before each meal b. Sucralfate and antacids together 0 minutes before meals c. Antacids 30 minutes before each dose of sucralfate is taken d. Antacids after meals and sucralfate 30 minutes before meals

ANS: D Sucralfate is most effective when the pH is low and should not be given with or soon after antacids. Antacids are most effective when taken after eating. Administration of sucralfate 30 minutes before eating and antacids just after eating will ensure that both drugs can be most effective. The other regimens will decrease the effectiveness of the medications.

38. Which assessment would the nurse perform first for a patient who just vomited bright red blood? a. Measuring the quantity of emesis b. Palpating the abdomen for distention c. Auscultating the chest for breath sounds d. Taking the blood pressure (BP) and pulse

ANS: D The nurse is concerned about blood loss and possible hypovolemic shock in a patient with acute gastrointestinal bleeding. BP and pulse are the best indicators of these complications. The other information is important to obtain, but BP and pulse rate are the best indicators for assessing intravascular volume.

30. A patient is diagnosed with stomach cancer after an unintended 20-lb weight loss. Which action would the nurse include in the plan of care? a. Refer the patient for hospice services. b. Infuse IV fluids through a central line. c. Teach the patient about antiemetic therapy. d. Offersupplemental feedings between meals

ANS: D The patient data indicate a poor nutritional state and improvement in nutrition will be helpful in improving the response to therapies such as surgery, chemotherapy, or radiation. Nausea and vomiting are not common clinical manifestations of stomach cancer. There is no indication that the patient requires hospice or IV fluid infusions.

8. How would the nurse explain esomeprazole (Nexium) to a patient who has recurring heartburn? a. "It reduces gastroesophageal reflux by increasing the rate of gastric emptying." b. "It neutralizes stomach acid and provides relief of symptoms in a few minutes." c. "It coats and protects the lining of the stomach and esophagus from gastric acid." d. "It treats gastroesophageal reflux disease by decreasing stomach acid production."

ANS: D The proton pump inhibitors decrease the rate of gastric acid secretion. Promotility drugs such as metoclopramide (Reglan) increase the rate of gastric emptying. Cryoprotective medications such as sucralfate (Carafate) protect the stomach. Antacids neutralize stomach acid and work rapidly

After administering a dose of promethazine to a patient with nausea and vomiting, what would the nurse teach the patient is a common and expected side effect? Tinnitus Drowsiness Reduced hearing Sensation of falling

B 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.

A patient is seeking emergency care after choking on a piece of steak. The nursing assessment reveals a history of alcohol use, cigarette smoking, and hemoptysis. Which diagnostic study is most likely to be performed on this patient? a. barium swallow b. endoscopic biopsy c. capsule endoscopy d. endoscopic ultrasonography

B Because of this patient's history of alcohol use, smoking, and hemoptysis and the current choking episode, cancer may be present. A biopsy is necessary to make a definitive diagnosis of cancer, 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. An endoscopic ultrasonography may be used to stage esophageal cancer. Capsule endoscopy can show esophageal problems but is more often used for small intestine problems. A barium swallow, capsule endoscopy, and endoscopic ultrasonography cannot provide a definitive diagnosis for cancer.

The patient receiving chemotherapy rings the call bell and reports the onset of nausea. The nurse would prepare an as-needed dose of which medication? Zolpidem Ondansetron Dexamethasone Morphine sulfate

B Ondansetron is a 5-HT3 receptor antagonist antiemetic that is especially effective in reducing cancer chemotherapy-induced nausea and vomiting. Morphine sulfate may cause nausea and vomiting. Zolpidem does not relieve nausea and vomiting. Dexamethasone is usually used in combination with ondansetron for acute and chemotherapy-induced emesis.

The nurse is caring for a patient being treated with IV fluid therapy for severe vomiting. As the patient recovers and begins to tolerate oral intake, which initial food choice would be appropriate? Iced tea Dry toast Hot coffee Plain yogurt

B. Dry toast or crackers may alleviate the feeling of nausea and prevent further vomiting. Water is the initial fluid of choice. Extremely hot or cold liquids and fatty foods are generally not well tolerated.

A patient who had a gastroduodenostomy (Billroth I operation) for stomach cancer reports generalized weakness, sweating, palpitations, and dizziness 15 to 30 minutes after eating. What long-term complication does the nurse suspect? Malnutrition Bile reflux gastritis Dumping syndrome Postprandial hypoglycemia

C 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 2 hours after eating.

A patient has a sliding hiatal hernia. What priority nursing intervention will reduce the symptoms of heartburn and dyspepsia? Keeping the patient NPO Putting the bed in the Trendelenburg position Having the patient eat 4 to 6 smaller meals each day Giving various antacids to determine which one works for the patient

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

The nurse determines a patient has experienced the beneficial effects of famotidine when which symptom is relieved? a. nausea b. belching c. epigastric pain d. difficulty swallowing

C Famotidine is an H2-receptor antagonist that inhibits parietal cell output of HCl acid and minimizes damage to gastric mucosa related to hyperacidity, thus relieving epigastric pain. It is not indicated for nausea, belching, and dysphagia.

The patient with chronic gastritis is being put on medication therapy to eradicate Helicobacter pylori. Which drugs does the nurse anticipate being ordered? a. antibiotics, antacid, and corticosteroid b. antibiotics, aspirin, and antiulcer/protectant c. antibiotics, proton pump inhibitor, and bismuth d. antibiotics and nonsteroidal antinflammatory drugs NSAIDs

C 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.

The nurse is caring for a postoperative patient who has just vomited yellow-green liquid. Which action would be appropriate? a.Offer the patient an herbal supplement such as ginseng. b.Discontinue medications that may cause nausea or vomiting. c.Apply a cool washcloth to the forehead and provide mouth care. d.Take the patient for a walk in the hallway to promote peristalsis.

C. Cleansing the face and hands with a cool washcloth and providing mouth care are appropriate comfort interventions for nausea and vomiting. Ginseng is not used to treat postoperative nausea and vomiting. Unnecessary activity should be avoided. The patient should rest in a quiet environment. Medications may be temporarily held until the acute phase is over, but the medications should not be discontinued without consultation with the health care provider.

After receiving a dose of metoclopramide, which assessment finding would indicate the medication was effective? a. decreased blood pressure b. absence of muscle tremors c. relief of nausea and vomiting d. no further episodes of diarrhea

C. Metoclopramide is classified as a prokinetic and antiemetic medication. If it is effective, the patient's nausea and vomiting should resolve. Metoclopramide does not affect blood pressure, muscle tremors, or diarrhea.

The patient is having an esophagoenterostomy with anastomosis of a segment of the colon to replace the resected portion. What initial postoperative care would the nurse expect when the patient returns to the unit? a. Deep breathe, cough, and use spirometer every 4 hours. b. Maintain an upright position for at least 2 hours after eating. c. NG will have bloody drainage and it should not be repositioned. d. Keep in a supine position to prevent movement of the anastomosis.

C. The patient will have bloody drainage from the nasogastric (NG) tube for 8 to 12 hours, and it should not be repositioned or reinserted without contacting the surgeon. Deep breathing and spirometry will be done every 2 hours. Coughing would put too much pressure in the area and should not be done. Because the patient will have the NG tube, the patient will not be eating yet. The patient should be kept in a semi-Fowler's or Fowler's position, not supine, to prevent reflux and aspiration of secretions.

A patient with osteoporosis is diagnosed with gastroesophageal reflux disease (GERD). Which over-the-counter medication to treat GERD would be used with caution? a. sucralfate b. cimetidine c. omeprazole d. metoclopramide

C. There is a potential link between proton pump inhibitors (PPIs) (e.g., omeprazole) use and bone metabolism. Long-term use or high doses of PPIs may increase the risk of fractures of the hip, wrist, and spine.

The nurse is teaching a group of college students how to prevent food poisoning. Which statement shows an understanding of food borne illness protection? a."To save refrigerator space, leftover food can be kept on the counter if it is in a sealed container." b."Eating raw cookie dough from the package is a great snack when you do not have time to bake." c."Since we only have one cutting board, we can cut up chicken and salad vegetables at the same time." d."When the cafeteria gave me a pink hamburger, I sent it back and asked for a new bun and clean plate."

D 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. Improperly storing cooked foods, 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.

A patient was admitted with epigastric pain from a gastric ulcer. Which assessment finding warrants an urgent change in the plan of care? Back pain 3 or 4 hours after eating a meal Chest pain relieved with eating or drinking water Burning epigastric pain 90 minutes after breakfast Rigid abdomen and vomiting following indigestion

D. 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 3 to 4 hours after a meal is more likely to occur with a duodenal ulcer. Burning epigastric pain 1 to 2 hours after a meal is an expected manifestation of a gastric ulcer related to increased gastric secretions and does not cause an urgent change in the nursing plan of care.

Which patient is at highest risk for developing oral candidiasis? a.A 74-yr-old patient who has vitamin B and C deficiencies b.A 22-yr-old patient who smokes 2 packs of cigarettes per day c.A 58-yr-old patient who is receiving amphotericin B for 2 days d.A 32-yr-old patient who is receiving ciprofloxacin for 3 weeks

D. Oral candidiasis is caused by prolonged antibiotic treatment (e.g., ciprofloxacin) or high doses of corticosteroids. Amphotericin B is used to treat candidiasis. Vitamin B and C deficiencies may lead to Vincent's infection. Use of tobacco products leads to stomatitis, not candidiasis.

A patient reporting nausea receives a dose of metoclopramide. Which potential adverse effect would the nurse tell the patient to report? a. tremors b. constipation c. Double vision d. numbness in fingers and toes

a. tremors Extrapyramidal side effects, including tremors and tardive dyskinesias, may occur with metoclopramide administration. Constipation, double vision, and numbness in fingers and toes are not adverse effects of metoclopramide.

The patient with a history of irritable bowel disease and gastroesophageal reflux disease (GERD) is admitted with diverticulitis and has received a dose of Mylanta 30 mL PO. The nurse would determine the medication was effective when which symptom has resolved? a. diarrhea b. heartburn c. constipation d. lower abdominal pain

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

A patient with a history of peptic ulcer disease presents to the emergency department with severe abdominal pain and a rigid, board-like abdomen. The health care provider suspects a perforated ulcer. Which interventions would the nurse anticipate? a.Providing IV fluids and inserting a nasogastric (NG) tube b.Administering oral bicarbonate and testing the patient's gastric pH level c.Performing a fecal occult blood test and administering IV calcium gluconate d.Starting parenteral nutrition and placing the patient in a high Fowler's position

A A perforated peptic ulcer requires IV replacement of fluid losses and continued gastric aspiration by NG tube. Nothing is given 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.

A patient with oral cancer is not eating. A small-bore feeding tube was inserted, and the patient started on enteral feedings. Which patient goal would best indicate improvement? a. weight gain of 1 kg in 1 week b. tolerated the tube feeding without nausea c. consumed 50% of clear liquid tray this shift d. the feeding tube remained in proper placement

A The best goal for a patient with oral cancer that is not eating would be to note weight gain rather than loss. Consuming 50% of the clear liquid tray is not a realistic goal. The absence of nausea and proper tube placement, while desired, do not indicate nutritional improvement.