HESI Upper GI Practice Quiz

A client is admitted to the hospital with *Laënnec cirrhosis and chronic pancreatitis*. Bile salts (bile acid factor) are prescribed, and the client asks why they are needed. What is the nurse's best response?

"They aid absorption of fat-soluble vitamins. Bile salts are used to aid digestion of fats and absorption of the fat-soluble vitamins A, D, E, and K. Bile salts are not involved in stimulating prothrombin production, in promoting bilirubin secretion in the urine, or in stimulating contraction of the common bile duct.

A client is diagnosed with *chronic pancreatitis* Which dietary instruction is most important for the nurse to share with the client?

Avoid ingesting alcoholic bev Alcohol will cause the most damage. Alcohol increases pancreatic secretions, which cause autodigestion of the pancreas, leading to severe pain. Although the diet should be low in fat, it should be high in protein; also, it should be moderate in carbohydrates. The client should be consuming a sufficient amount of complex carbohydrates each day to maintain weight and promote tissue repair. A bland diet can be consumed, but snacks high in calories are also recommended.

*Duodenal ulcer* pain is relieved with

Food and antacids it often awakens the client at night when sleeping

Two thirds of individuals with gastric or duodenal ulcers are infected with this organism.

Helicobacter pylori.

A client is admitted with the diagnosis of *acute pancreatitis*. Which clinical manifestations should a nurse assess in the client? Select all that apply.

1. Jaundice 2. Acute pain 3. Increased amylase http://static.us.elsevierhealth.com/EAQ%20for%20NCLEX_RN_2_9780323429146/9780323429146_0008.mp4 Obstruction of the common bile duct by inflammation leads to jaundice. Autodigestion of the pancreas causes severe abdominal pain. Obstruction of the pancreatic duct leads to elevated levels of amylase and lipase. Hypotension, not hypertension, is caused by fluid shifting out of the intravascular space. Decreased pancreatic function causes hyperglycemia, not hypoglycemia.

Discharge planning for a client with *chronic pancreatitis* includes dietary teaching. Which statement indicates to the nurse that the client needs *more teaching*?

"I can eat foods high in fat now that the acute stage is over. The nurse needs to follow up on the client statement that indicates eating foods high in fat can be allowed. *A low-fat diet should be followed to avoid diarrhea*. All the rest of the client responses are correct and do not require additional teaching. The response to eating foods high in calories is appropriate because *additional calories are needed to maintain weight*. The response to *avoiding alcoholic beverages is appropriate to prevent overstimulation of the pancreas*. *Small, frequent meals limit stimulation of the pancreas and is appropriate*.

The nurse is caring for a client following a laparoscopic cholecystectomy. Which nursing action is priority?

Assess puncture sites for bleeding The one to four puncture sites used to perform the surgery laparoscopically should be monitored for any possible bleeding. There will not be an abdominal dressing unless a traditional cholecystectomy is performed. Patient-controlled analgesia is not necessary as there is no abdominal incision. Activity restriction is about one week with a laparoscopic cholecystectomy.

melena

Black tarry stool

An obese client with a hiatal hernia asks the nurse how to prevent esophageal reflux. Which is the nurse's best response?

Eat less food w/ each meal Eating less food not only relieves intraabdominal pressure, but it promotes weight loss, which helps to decrease the tendency of gastric contents to reflux into the esophagus. The response "Lie down after eating" increases pressure against the diaphragmatic hernia, thereby increasing symptoms. Fats decrease emptying of the stomach and promote gas, extending the period during which reflux can occur; fats should be decreased. The response "Drink more fluid with each meal" will increase intraabdominal pressure; fluid should be discouraged with meals.

A client is evaluated at a clinic, and the healthcare provider suspects that the client has *anemia and a peptic ulcer*. To determine if the client has a peptic ulcer, the nurse expects that what diagnostic test will be performed?

Gastric culture

A nurse is performing the initial history and physical examination of a client with a diagnosis of *duodenal ulcer*. Which type of pain does the nurse expect the client to describe? a. Pain that is relieved with eating b. Pain that is worse with antacids c. Pain that is relieved with sleep d. Pain that is worse one hour after eating

Pain that is relieved with eating Duodenal ulcer pain is relieved with food and antacids and often awakens the client at night when sleeping. Gastric ulcer pain is worse with eating or one hour after eating.

A client who is obese and has a history of alcohol abuse is admitted to the hospital with the diagnosis of acute pancreatitis. Which is the initial priority expected client outcome in response to therapy at this time? a. Report decreased pain b. Insert nasogastric (NG) tube quickly c. Join Alcoholics Anonymous d. Lose four pounds (1.8 kilograms) a week

*Report decreased pain* Pain relief is the priority. Severe pain is associated with acute pancreatitis caused by inflammation of the pancreas, peritoneal irritation, and biliary tract obstruction. Although inserting the NG tube quickly is appropriate, it is not priority, and some clients do not need an NG tube; the NG tube is inserted to allow the pancreas to rest, decreasing pain. Losing weight and joining Alcoholics Anonymous are later goals.

A client had a laparoscopic cholecystectomy. Postoperatively the client experiences nausea and vomiting and is admitted overnight for observation and hydration. What should the nurse include in the teaching plan when preparing this client for discharge? Select all that apply.

1. Call l the healthcare provider if you have a fever of 100o F (37.8oC) or more for two days. 2. Check the puncture sites daily for redness, tenderness, swelling, heat, or drainage A fever of 100o F (37.8o C) or more for two days is the sign of an infection that should be reported to the healthcare provider. Redness, tenderness, swelling, heat, and drainage are physical responses associated with an infection or a problem with healing. The puncture sites should be washed gently with mild soap and warm water. Tape-strips should be allowed to fall off; they should not be pulled off because they reinforce closure of the incision. A heating pad 20 minutes hourly is recommended to relieve discomfort in the right, not left, shoulder as a result of phrenic nerve irritation because of retention of carbon dioxide gas insufflated into the abdomen during surgery.

A nurse is caring for a client with cholelithiasis and obstructive jaundice. When assessing this client, the nurse should be alert for which findings that are consistent with these conditions? Select all that apply.

1. Ecchymosis 2. Yellow sclera 3. Pain in right upper quadrant Inadequate bile flow interferes with vitamin K absorption, contributing to ecchymosis, hematuria, and other bleeding. Yellow sclera results from failure of bile to enter the intestines, with subsequent backup into the biliary system and diffusion into the blood. The bilirubin is carried to all body regions, including the skin and mucous membranes. Pain in the right upper quadrant occurs especially after eating foods high in fat and is characteristic of acute cholecystitis and biliary colic. With obstructive jaundice the stool is clay colored, not dark brown; the presence of bile causes stool to be brown. When bile levels in the bloodstream are high, as in obstructive jaundice, there is bile in the urine, causing it to have a dark color.

A client is discharged the same day after ambulatory surgery for a laparoscopic cholecystectomy. The nurse is providing discharge teaching about how many days the client should wait to engage in certain activities. Place in order the activities from the first to the last in which the client may engage.

1. Getting out of bed is the activity that should be implemented first. It allows the client to adjust to the upright position before ambulating. 2. OOB to sitting in a chair. 3. Light exercise, such as walking, can begin after tolerating OOB to char 4. A client may shower or bathe one to two days after surgery. 5. A client may drive three to four days after surgery. 6. Objects exceeding 10 lb (4.5 kg) may be lifted one week after surgery.

The nurse is creating a discharge teaching plan for a client who had a subtotal gastrectomy. The nurse should include what instructions about minimizing dumping syndrome? Select all that apply.

Eat small, frequent meals. Lie down for one hour after eating Small, frequent meals keep the volume within the stomach to a minimum at any one time, limiting dumping syndrome. Lying down delays emptying of the stomach contents, which will limit dumping syndrome. Fluids should be taken between meals to decrease the volume within the stomach at one time. Dumping syndrome occurs after eating because of the rapid movement of food into the jejunum without the usual digestive mixing in the stomach and processing in the duodenum. Chewing a set number of times before swallowing is not pertinent to solving this problem. High fiber, complex carbohydrates, moderate fats, and high protein in small, frequent meals are recommended to prevent dumping syndrome.

A primary healthcare provider diagnoses a client with *acute cholecystitis with biliary colic*. Which clinical findings should the nurse expect when performing a health history and physical assessment? Select all that apply.

Intolerance to foods high in fat Pain that radiates to the right shoulder Interference with bile flow into the intestine will lead to an increasing inability to tolerate fatty foods. Although the gallbladder is in the upper right quadrant of the abdomen, when inflamed it can radiate to the right shoulder or scapula. Diarrhea with melena (black feces) is not associated with cholecystitis. Melena is tarry stools associated with upper gastrointestinal bleeding; diarrhea is associated with increased intestinal motility. Coffee-ground emesis is indicative of gastric bleeding; it is not associated with cholecystitis. Gnawing pain when the stomach is empty is associated with duodenal ulcers, not with cholecystitis.

A client who is diagnosed with a *duodenal ulcer asks*, "Now that I have an ulcer, what comes next?" What is the nurse's best response? a. "Most peptic ulcers heal with medical treatment." b. "Clients with peptic ulcers have pain while eating." c. "Early surgery is advisable, especially after the first attack." d. "If ulcers are untreated, cancer of the stomach can develop."

Most peptic ulcers heal with medical treatment." Treatment with medications, rest, diet, and stress reduction relieves symptoms, heals the ulcer, and prevents complications and recurrence. Clients with duodenal ulcers have pain after eating and especially at night; gastric ulcers cause pain during or close to eating. Surgery may be done after multiple recurrences and for treating complications. Perforation, pyloric obstruction, and hemorrhage, not cancer, are major complications.

Which is the priority intervention for the *dependent* client with peptic ulcer disease (PUD) who is vomiting bright red blood? a. Apply oxygen b. Place the client in a side-lying position c. Prepare to administer packed red blood cells d. Assess the client's pulse and blood pressure

Place the client in a side-lying position Recall the airway, breathing, and circulation (ABCs) of priority care. The client who needs assistance to manage self-care (dependent) should be placed in the side-lying position when vomiting to prevent aspiration. The use of supplemental oxygen may support oxygen saturation in the client with decreased hemoglobin because of gastrointestinal bleeding. However, in the dependent client who is vomiting, applying oxygen is of lower priority than placing the client in a side-lying position. The nurse should anticipate a prescription for packed red blood cells in the client with a significant gastrointestinal bleed. Restoring circulation, however, is of lower priority than protecting the airway in a dependent client whose airway is at risk. The immediate physical examination of the client with active gastrointestinal bleeding includes evaluation of vital signs as a means of assessing for shock. Assessing for adequate circulation does not take priority over protecting the airway.

A nurse is teaching a newly admitted client who has acute pancreatitis about dietary restrictions. What should the education include?

Use of IV fluids Acute pancreatitis requires an NPO status to allow the pancreas to rest. IV fluids are administered. Spicy, seasoned foods stimulate the pancreas and should be avoided, not just sparingly used. Small, frequent feedings place less demand on the pancreas to release digestive enzymes and are instituted when the acute phase is resolved. Fats stimulate the release of lipase from the pancreas, whether they are saturated or unsaturated fats, and should be avoided. Coffee stimulates pancreatic secretions and should be avoided.

A client is admitted to the hospital with slight jaundice and reports of pain on the left side and back. A diagnosis of *acute pancreatitis* is made. Which common response to acute pancreatitis should the nurse monitor in the client?

Hypovolemia Hypovolemia that results from a fluid shift from the intravascular compartment to the peritoneal cavity can cause circulatory collapse; this is a life-threatening event that requires immediate intervention. Crackles indicate an accumulation of fluid in the alveoli associated with hypervolemia, not hypovolemia. Gastric reflux occurs with gastroesophageal reflux disease (GERD), not with pancreatitis. Jugular vein distention indicates hypervolemia, not hypovolemia.

A nurse teaches a client about limiting the discomfort associated with a hiatal hernia. Which statement from the client indicates teaching by the nurse is effective?

"After meals I will rest in a sitting position for one hour. Gravity (sitting up after meals) facilitates digestion and prevents reflux of stomach contents into the esophagus. Exercise immediately after eating may prolong the digestive process. Water should not be taken with or immediately after meals because it overdistends the stomach. Lying down in bed for at least 20 minutes is not an appropriate action because it promotes the reflux of gastric contents into the esophagus.

A stool examination may identify

melena or parasites not definitive for peptic ulcers.

A nurse is obtaining a health history from a client with the diagnosis of *peptic ulcer disease*. Which client statement provides evidence to support the identification of a possible contributory factor? a. My blood type is A positive." b. "I smoke one pack of cigarettes a day." c. "I have been overweight most of my life." d. "My blood pressure has been high lately."

"I smoke one pack of cigarettes a day." Smoking cigarettes increases the acidity of gastrointestinal secretions, which damages the mucosal lining. While *blood type O is more frequently associated with duodenal ulcer*, type A has no significance. Being overweight is unrelated to peptic ulcer disease. High blood pressure is not directly related to peptic ulcer disease.

A nurse reviews the laboratory results of a client with acute pancreatitis. Which test is most significant in determining the client's response to treatment? a. Platelet count b. Amylase level c. Red blood cell count d. Erythrocyte sedimentation rate

*Amylase level* In 90% of clients with acute pancreatitis, the amylase level is elevated up to three times over baseline; serum amylase usually returns to expected adult levels within three days after treatment begins. The platelet count is not an indicator of the response to treatment for pancreatitis; platelets are important in the control of bleeding. The red blood cell count is unchanged in acute pancreatitis, unless hemorrhage is present. The erythrocyte sedimentation rate is not an indicator of a response to treatment for pancreatitis.

A client is admitted with a diagnosis of *acute pancreatitis*. The medical and nursing measures for this client are aimed toward maintaining nutrition, promoting rest, maintaining fluid and electrolytes, and decreasing anxiety. Which interventions should the nurse implement? Select all that apply.

1. Administer analgesics 2. Teach relaxation exercises 3. Monitor cardiac rate and rhythm *Analgesics, histamine-receptor antagonists, and proton pump inhibitors* may be administered to decrease gastrointestinal activity and the secretion of pancreatic enzymes. Relaxation will decrease the metabolic rate, which will decrease gastrointestinal activity, including the secretion of pancreatic enzymes. Monitoring cardiac rate and rhythm is necessary to assess for hypokalemia and fluid volume changes. The client would be kept nothing by mouth to decrease gastrointestinal activity and the secretion of pancreatic enzymes. Walking increases the metabolic rate, which will increase gastrointestinal activity, including the secretion of pancreatic enzymes. Hypocalcemia, not hypercalcemia, occurs because of calcium and fatty acids combining during fat necrosis.

outlines structural changes in the lower gastrointestinal tract; it will not outline the stomach or duodenum.

A barium enema

enables the healthcare provider to identify the presence of Helicobacter pylori.

A gastric culture

Optimal discharge teaching with regard to dumping syndrome following gastroduodenostomy should include what information?

Assuring the client that symptoms generally resolve within a year of surgery The symptoms of dumping syndrome generally resolve within several months to a year after surgery. Including this information in the client's instructions offers reassurance and may increase cooperation with the therapeutic treatment plan. The client should rest for 30 minutes after each meal to decrease the sweating, palpitations, and dizziness that result from the stimulation of the sympathetic nervous system that accompanies dumping syndrome. To decrease the volume of chyme entering the small intestine after eating, meals should be small and dry. Fluids should be consumed between rather than with meals. To decrease the hyperosmolar composition of chyme, the client should follow a low carbohydrate, low refined sugar, moderate protein, and moderate fat diet.

A client returns from surgery after an *abdominal cholecystectomy for a gangrenous gallbladder*. For which postoperative complication, associated with the location of the surgical site, should the nurse assess the client?

Atelectasis Subcostal incisional pain causes the client to splint and avoid deep breathing, which impedes air exchange in the alveoli. The location of the incision does not increase the risk of hemorrhage. Paralytic ileus can be a postoperative problem, but it is unrelated to the site of the incision. The subcostal incision site is not specifically vulnerable to infection.

A client is admitted to the hospital for surgery for a laparoscopic cholecystectomy. To monitor the flow of bile to the gastrointestinal tract, what symptom should the nurse assess?

Color of the stool As edema of the common bile duct subsides, bile flows to the duodenum and gives stool its characteristic brown color. Peristalsis may affect the consistency of the stool but not the color. Blood from the operative site does not enter the gastrointestinal tract and therefore does not alter the color of the stool. Absence of color suggests absence of bile and corresponding fat intolerance, not cholesterol intolerance.

The nurse is creating a dietary plan for a client with cholecystitis who has been placed on a modified diet. Which will be most appropriate to include in the client's dietary plan?

Decrease fat intake to avoid stimulation of the cholecystokinin mechanism for bile release Fat intake stimulates cholecystokinin release that signals the gallbladder to contract, causing pain. Soft-textured foods are unnecessary. Eating low-cholesterol foods to avoid further formation of gallstones is not true for all clients with cholecystitis; low-cholesterol foods are necessary if the cholecystitis is precipitated by cholelithiasis and the stones are composed of cholesterol. An increase in protein intake is necessary to promote tissue healing and improve energy reserves after a cholecystectomy, but is not as important as fat intake for cholecystitis.

A nurse is caring for a client who just had a gastrectomy. What should the nurse emphasize when teaching the client how to avoid dumping syndrome?

Eat small meals with low carbohydrate and moderate fat content Small meals with low carbohydrate, moderate fat, and high protein are recommended; these are digested more readily and prevent rapid stomach emptying. Rest, not activity, after meals assists in limiting dumping syndrome. Fluid intake with meals should be in moderation. Fluids with meals cause rapid emptying of the food from the stomach into the jejunum before it is adequately subjected to the digestive process; the hyperosmolar mixture causes a fluid shift to the jejunum. A high-Fowler position will not reduce the risk of dumping syndrome.

A client undergoes an abdominal cholecystectomy with common duct exploration. In the immediate postoperative period, what is the priority nursing action?

Encouraging coughing and deep breathing In an abdominal cholecystectomy, the incision is high, causing pain when the client is deep breathing. Self-splinting results in shallow breathing, which does not aerate or expand the lungs adequately, particularly the lower right lobe, leading to pneumonia. The client should be encouraged to deep breathe and cough, while splinting the incision with a pillow to help decrease the pain, yet expanding the lungs to decrease atelectasis or pneumonia. The T-tube is never irrigated; it drains by gravity until the edema in the operative area subsides; the primary healthcare provider then removes the tube. The nurse does not change the dressing in the immediate postoperative period; the client's respiratory status takes priority. The client will ingest nothing by mouth immediately after surgery.

A client experiences occasional right upper quadrant pain attributed to cholecystitis. The nurse is providing discharge instructions, including a list of foods that cause dyspepsia. Which foods should be on the list the nurse provided the client?

Fried chicken and buttered corn Cholecystitis is often accompanied by intolerance to fatty foods, including fried foods and butter. Nuts and popcorn have a high fiber content but have less fat than fried foods; nuts and popcorn cause flatulence and pain for clients with lower intestinal problems, such as diverticulosis. Meatloaf and baked potato contain less fat than do fried foods or butter. Neither chocolate nor boiled seafood contains as much fat as fried chicken or butter.

A nurse has provided dietary instructions for a client who is being discharged following a gastroduodenostomy (Billroth I). Which client statement indicates correct understanding of the teaching?

I need to eat six small meals every day, limiting bulk Eating six small meals a day allows smaller boluses of undigested food to enter the duodenum, helping to prevent dumping syndrome. Pureed food usually is not necessary. Resuming a regular eating routine and diet is not realistic. The diet should be high in protein, low in carbohydrates, and moderate in fats.

After an acute episode of upper gastrointestinal (GI) bleeding, a client vomits undigested medications and reports severe epigastric and abdominal pain. The client has absent bowel sounds, rigid abdomen, a pulse rate of 134, and shallow respirations of 32 per minute. The primary healthcare provider has been contacted. What should be the nurse's next priority?

Keep the client nothing by mouth (NPO The assessment findings are classic indicators of a perforated ulcer, for which immediate surgery is indicated; this should be anticipated. Keeping the client NPO is priority. Teaching coughing and deep breathing is not appropriate at this time, even though the client will have surgery. Keeping the client NPO in preparation for surgery is more important than asking about the presence of black, tarry stools or red stools. Although this question should be asked, knowing whether any red or black stools have been noted will not change the medical or nursing care of the client at this time. Drawing up the knees is more comfortable for the client.

A nurse is caring for a client with a T-tube after an open cholecystectomy. What specific action should the nurse include in the plan of care?

Monitor the color of the stool A T-tube maintains patency of the common bile duct until inflammation subsides; when the duct is patent and bile enters the gastrointestinal tract, the color of stool is brown. Ankle pumping prevents venous stasis if a client is not able to ambulate. Absence of bile affects the ability to digest fats, not carbohydrates. A T-tube drains by gravity; it is not a self-contained suction device like a Hemovac, so compression is not necessary.

A client with an acute attack of cholecystitis has a cholecystectomy with a choledochostomy. The client returns from surgery with a T-tube connected to a drainage bag. What does the nurse conclude is the purpose of the T-tube?

Permit drainiage of bile The T-tube provides a passageway for bile to move through the common bile duct in the presence of edema; it does not reduce edema. When the common bile duct is explored, the T-tube maintains patency until edema subsides. The T-tube will not reduce edema. Antibiotics usually are not necessary postoperatively unless infected bile or pus is in the ducts (cholangitis). The gallbladder has been excised and therefore cannot be irrigated.

A nurse is caring for a client who recently is diagnosed with a *gastric ulcer*. The nurse expects that the plan of care will include a prescription for which type of diet?

Regular diet with foods that are tolerated No specific diet is recommended; the client is encouraged to avoid meals that overdistend the stomach and foods that cause gastrointestinal (GI) distress. There is no need for a soft diet; a soft diet is appropriate for those who have difficulty with chewing and swallowing. The client does not require a liquid diet. High-fat dairy products increase GI secretions and may not be tolerated by some clients.

*Gastric ulcer* pain is worse with

eating or one hour after eating.

Cholecystitis is often accompanied by intolerance to

fatty foods, including fried foods and butter.

Nuts and popcorn have a high fiber content but have less fat than fried foods; nuts and popcorn cause

flatulence and pain for clients with lower intestinal problems, such as diverticulosis.

A gastric biopsy is done to

identify the presence of malignant cells

A client with a rigid and painful abdomen is diagnosed with a perforated peptic ulcer. A nasogastric tube is inserted, and surgery is scheduled. Before surgery, the nurse should place the client in what position?

semi-Fowler position The semi-Fowler position will localize the spilled stomach contents in the lower part of the abdominal cavity.