Chapter 39 Upper Digestive Tract Disorders

You are reviewing the admission papers for a new resident of a long-term care facility. You note a medical diagnosis of achalasia. Which of the following should be included in the nursing care plan? Select all that apply 1. Determine the best position for the patient during meals 2. Be sure clothing is not restrictive 3. Place the patient on NPO status 4. Auscultate bowel sounds in all four quadrants 5. Maintain strict intake and output records

1. Determine the best position for the patient during meals 2. Be sure clothing is not restrictive

As the nurse, you are providing instructions to a patient who recently had a gastrectomy. You focus your teaching on prevention of dumping syndrome. Which instruction do you include in your teaching? 1. Increase ambulation after each meal 2. Eat high-carbohydrate meals 3. Limit fluids taken with meals 4. Remain in a high Fowler position while eating

1. Increase ambulation after each meal

You have been assigned to care for a patient who was recently diagnosed with a hiatal hernia. The patient is experiencing chronic heartburn when eating a meal. You will teach the patient to avoid which of the following situations? 1. Lying flat after eating a meal 2. Ingesting small, frequent meals 3. Raising the HOB on 6 to 8 inch blocks 4. Taking the prescribed histamine receptor antagonist medications

1. Lying flat after eating a meal

Inspection of the mouth of an older adult reveals of of the data listed below. Which findings should the nurse recognize as normal? Select all that apply 1. Worn chewing surfaces on the teeth 2. Recession of the gingiva (gums) 3. Loss of most of the natural teeth 4. Teeth appear dark and transparent 5. Whitish patches on the border of the tongue

1. Worn chewing surfaces on the teeth 2. Recession of the gingiva (gums) 4. Teeth appear dark and transparent

You are reading a drug label and note the safe dose is listed as 0.25 mg/kg/day. What is the safe dose for a patient that weighs 6 kg? (Round to the nearest tenth).

1.5 mg/day

Other than a radiograph, the most reliable way to assess placement of a nasogastric tube is to do which of the following? 1. Auscultate the epigastrium while injecting air into the tube 2. Examine and check pH of aspirated stomach contents 3. Place the end of the tube in water and observe for bubbling 4. Listen for air movement at the end of tube

2. Examine and check pH of aspirated stomach contents

Which of the following types of antiulcer drugs work by inhibiting the secretion of gastric acid? Select all that apply 1. Antacids 2. H2 receptor blockers 3. Mucosal barriers 4. Proton pump inhibitors 5. Synthetic prostaglandins

2. H2 receptor blockers 4. Proton pump inhibitors 5. Synthetic prostaglandins

A patient with a diagnosis of chronic gastritis is at risk for which vitamin deficiency? 1. Vitamin A 2. Vitamin B12 3. Vitamin C 4. Vitamin E

2. Vitamin B12

A patient who has had oral surgery complains of dry mouth. Your most appropriate action is to do which of the following? 1. Tell the patient this normal after oral surgery 2. Provide a commercial mouthwash for rinsing the mouth 3. Check the health care provider's orders for mouth care 4. Suction the mouth after giving the patient sips of water

3. Check the health care provider's orders for mouth care

Enzyme that intiates the breakdown of carbohydrates.

Amylase

Indigestion

Dyspepsia

Difficulty swallowing

Dysphagia

The nurse is caring for patients with diseases that affect the stomach, small intestine, large intestine, and rectum. Which of these patients is at greater risk for problems with absorption of nutrients?

Small intestine

True or false: Among the outcomes of nursing care for patients with oral cancer are pain relief, effective, communication, and adaption to change in body image.

True

You have been assigned to care for a patient who was recently diagnosed with a hiatal hernia. The patient is experiencing chronic heartburn when eating a meal. You will teach the patient to avoid which of the following situations? Select one: a. lying flat after eating a meal b. taking the prescribed histamine receptor antagonist medications c. raising the head of the bed on 6 - 8 inch blocks d. ingesting small, frequent meals

a. lying flat after eating a meal

It is important for the nurse to instruct the patient with gastritis to avoid which of the following medications? Select one: a. non-steroidal anti-inflammatory medications (NSAIDS) b. aminoglycoside antibiotics c. opioid analgesics d. beta-adrenergic blockers

a. non-steroidal anti-inflammatory medications (NSAIDS)

lack of appetite

anorexia

Omeprazole (Prilosec), esomeprazole (Nexium), and pantoprazole (Protonix) are classified as: Select one: a. antacids b. Proton pump inhibitors (PPIs) c. anticholinergics d. stimulant laxatives

b. Proton pump inhibitors (PPIs)

Decompression is a term used to describe: Select one: a. irrigation of the stomach b. emptying of the stomach c. administering feeding through an NG via pump or bolus d. checking placement of an NG tube

b. emptying of the stomach

The nurse is caring for a patient who is 12 hours post gastric ulcer repair with a nasogastric tube to low intermittent suction. All of the following are expected nursing interventions EXCEPT: Select one: a. providing good oral care b. reinserting the NG tube immediately if the patient pulls it out c. ensuring that the NG tube is taped securely & isn't pulling on the patient d. monitoring and recording NG output

b. reinserting the NG tube immediately if the patient pulls it out

When caring for the patient receiving TPN (total parenteral nutrition) on your nursing unit, it is important that the nurse have which of the following conversations with the patient? Select one: a. "Infection of the central line is common, so you will need to be sterile when you change your dressing." b. "This type of nutrition isn't ideal. The doctor doesn't know what he is doing." c. "We will be checking your blood sugar at regular intervals and you may need insulin short term." d. "We need to calculate and discuss your calorie and nutrient requirements."

c. "We will be checking your blood sugar at regular intervals and you may need insulin short term."

You are the nurse caring for a patient who is scheduled for an Upper GI series (UGI). Which of the following should be discussed with the patient? Select one: a. they will be required to stay until they are awake enough to drink and void b. they will be unable to drive themselves home due to administration of c. laxatives may be ordered after the procedure to facilitate the elimination of barium d. they will be NPO for up to 12 hours after the procedure

c. laxatives may be ordered after the procedure to facilitate the elimination of barium

tooth decay

caries

the stomach churns and mixes food with gastric secretions into a semiliquid mass called

chyme

Which of the following indicates that the patient is physically ready to have the NG tube, used for gastric decompression, removed? Select one: a. complaints of nausea b. NG output of 900 ml in 6 hours c. the patient says, " You had better get this thing out or I will!" d. presence of bowel sounds

d. presence of bowel sounds

burping

eructation

inflammation of the gums

gingivitis

inflammation of the parotid glands

parotitis

movement of food through the digestive tract (contraction)

peristalsis

lines the abdominal cavity and covers the surface of the abdominal organs

peritoneum

inflammation of the peritoneum

peritonitis

the gentle ejection of food or fluid without nausea or retching

regurgitation

Inflammation of the oral mucosa

stomatitis

inflammation of the mouth

stomatitis

Match the following complications of peptic ulcer disease with the appropriate symptoms. Hemorrhage, Obstruction, Perforation thread pulse, restlessness, diaphoresis, chills, oliguria, hematemesis, tarry stools, hypotension sudden, sharp midepigastric pain that spreads over the entire abdomen: rigid abdomen: absence of bowel sounds: shock feeling of fullness, nausea after eating, persistent vomiting

thread pulse, restlessness, diaphoresis, chills, oliguria, hematemesis, tarry stools, hypotension Hemorrhage sudden, sharp midepigastric pain that spreads over the entire abdomen: rigid abdomen: absence of bowel sounds: shock Perforation feeling of fullness, nausea after eating, persistent vomiting Obstruction

Match the following drugs and drug classes used in the treatment of upper digestive tract disorders with the appropriate use and action. (As stated in your Med-Surg Text). used to prevent and treat nausea and motion sickness. decreases the sensitivity of the vestibular apparatus of the inner ear. suppresses the vomiting center used to prevent nausea and vomiting caused by chemotherapy. used to draw water into bowel to distend and stimulate evacuation. it is intended for short-term use only. used to lubricate feces for easier passage used to speed up gastric emptying into the small intestine used to suppress the vomiting center. also often used for motion sickness. applied topically behind the ear.

used to prevent and treat nausea and motion sickness. decreases the sensitivity of the vestibular apparatus of the inner ear. suppresses the vomiting center - antihistamines: promethazine HCl (Phenergan), dimenhydrinate HCl (Dramamine), used to prevent nausea and vomiting caused by chemotherapy. - antiemetics, 5-HT3 receptor antagonists: ondansetron (Zofran) used to draw water into bowel to distend and stimulate evacuation. it is intended for short-term use only. - saline (osmotic) laxative: magnesium hydroxide (Milk of Magnesia), polyethylene glycol (MiraLAX) used to lubricate feces for easier passage - lubricant: mineral oil used to speed up gastric emptying into the small intestine - prokinetic agent: metoclopramide (Reglan) used to suppress the vomiting center. also often used for motion sickness. applied topically behind the ear. - anticholinergic scopolamine (Transderm Scop)

dry mouth

xerostomia