Ch 33 NC of Pts with Upper GI Disorders

The nurse is providing care for a patient who is experiencing nausea and vomiting. Which pathological manifestation is unlikely to occur with prolonged vomiting? 1. Anemia 2. Dehydration 3. Metabolic alkalosis 4. Electrolyte imbalance

1. Anemia Rational: The patient is unlikely to experience anemia with prolonged vomiting. However, vomiting of blood in any form can be a cause of anemia.

A pt is admitted with chronic gastritis type B. Which of the following signs and symptoms would the nurse anticipate finding? 1. Anorexia 2. Dysphagia 3. Diarrhea 4. Feeling of fullness

1. Anorexia

A pt had a gastrectomy 2 months ago and is being seen in the clinic for greasy stools and frequent bowel movements. After the pts surgical recovery and current eating habits are identified, which type of diet would be most appropriate for the nurse to teach the pt to use? 1. Soft diet 2. High-Carb diet 3. Low-fat diet 4. Pureed diet

3. Low-fat diet

A pt who has just returned from surgery after a total gastrectomy begins to vomit bright red blood. What is the priority acting for the nurse to take? 1. Increase IV rate 2. Take BP 3. Place pt on side 4. Administer O2

3. Place pt on side

The nurse is caring for a pt who has developed esophagitis from gastroesophageal reflux disease (GERD). For which additional complications should the nurse anticipate providing care to this patient? 1. Laryngospasm 2. Bronchospasm 3. Barrett's esophagus 4. Aspiration pneumonia

3. Barrett's esophagus Rational: Complications of GERD can result in esophagitis. Over time, this can lead to changes in the epithelium of the esophagus and lead to Barrett's esophagus, a precancerous lesion.

The nurse is providing care for a patient who reports nausea following chemotherapy. Which nursing intervention is unlikely to effectively manage the patient's nausea? 1. Provide a quiet, odor-free, visually clean environment 2. Give an antiemetic as needed and prescribed by the HCO 3. Bring the patient a small, bland meal to ease any hunger 4. Provide frequent mouth care to remove noxious tastes

3. Bring the patient a small, bland meal to ease any hunger Rationale: Even a small, bland meal can trigger nausea and vomiting. The patient may be able to tolerate clear liquids, preferably water or ice chips. If liquids are tolerated, crackers or dry toast may also be tolerated.

The nurse is collecting data on a pt who recently returned from surgery after fundoplication. Which symptom is essential to report to the HCP? 1. Nausea 2. Pain rated as 4 out of 10 3. Dysphagia 4. Thirst

3. Dysphagia

The nurse works with cancer patients. Which factor does the nurse identify as a cause of gastric cancer? 1 The female gender 2. Oxidants in fruit and vegatables 3. High intake of smoked fish and meats 4. Medical history of iron deficiency anemia

3. High intake of smoked fish and meats Rationale: Patients with a diet high in smoked fish and meats have an increased risk for gastric cancer.

A pt is having an acute episode of gastric bleeding. The HCP orders 1.000 mL of 0.9% NS via IV, a CBC, a NG tube to low-wall suction, and O2 via NC. Which order should the nurse perform first? 1. Administer 1,000 mL of 0.9% NS 2. Draw blood for a CBC 3. Insert NG tube 4. Apply O2 via NC

4. Apply O2 via NC

The nurse is providing care for a client with multiple injuries from a serious car accident. The HCP prescribes a diet as tolerated and administration of sucralfate orally. Which condition and goal does the nurse associate with the HCP's prescriptions? 1. Prevention of peptic ulcer disease 2. Decreased healing from malnutrition 3. Management of causes of shock 4. Formation of stress ulcers

4. Formation of stress ulcers Rationale: The stress response to illness causes decreased blood flow to the stomach and small intestine, which can result in damage to the gastric mucosa. The goal of the HCP's prescription is to reduce stress ulcers. Feeding the patient within 24 hours and giving prophylactic sucralfate (to form a gel that binds to the base of the ulcer) are appropriate treatments. Antacids and histamine can also be prescribed.

The nurse provides teaching for a pt with a peptic ulcer. Which pt statement would the nurse evaluate as indication understanding of the purpose of histamine 2 (H@)-receptor antagonists? 1. H2-receptor antagonists neutralize gastric acid 2. H2-receptor antagonists form a protective paste 3. H2-receptor antagonists determine gastric pH levels 4. H2-receptor antagonists inhibit secretion of gastric acid

4. H2-receptor antagonists inhibit secretion of gastric acid

A pt is taught preventive measures for GERD. Which statement by the pt indicates that te3aching has been effective? 1. I need to eat large meals 2. I will sleep without pillows 3. I need to lie down for 2 hours after each meal 4. I will identify foods that cause discomfort

4. I will identify foods that cause discomfort

The nurse is reinforcing teaching provided to a pt with peptic ulcer. Which pt statement indicates understanding of the medication ranitidine? 1. It clings to the ulcer 2. It coats your stomach 3. It neutralizes stomach acid 4. It reduces production of gastric acid

4. It reduces production of gastric acid Rational: Ranitidine reduces production of gastric acid, which aids in healing the ulcer.

The nurse is caring for a pt with gastritis. Which interventions should the nurse implement for a pt with acute gastritis? 1. Monitor pt for bloody diarrhea 2. Explain that aspirin rarely causes gastritis 3. Administer phenothiazine to control vomiting 4. Encourage a regular diet during the acute phase of gastritis

1. Monitor pt for bloody diarrhea

Which of the following does the nurse understand is a sign or symptom of oral cancer? 1. Painless ulcer 2. White painful ulcers 3. Feeling of fullness 4. Heartburn

1. Painless ulcer

The nurse is providing care for a patient who is receiving chemotherapy and radiation as treatment for esophageal cancer. Which factor in the care of this patient is the nurse's least concern? 1. Risk for choking 2. The ability to speak 3. Meeting nutritional needs 4. Effective pain management

2. The ability to speak Rationale: The patient may or may not be able to speak. Alternate methods of communication make this the least concern for the nurse.

A pt has been diagnosed with a hiatal hernia. The pt has heartburn and occasional regurgitation. Which interventions should the nurse teach the pt to reduce the symptoms? 1. Eat small, frequent meals 2. Recline for 1 hour after meals 3. Sleep flat without a pillow 4. Eat a bedtime snack

1. Eat small, frequent meals

Which of the following surgical procedures is the most likely treatment for a pt with gastric cancer? 1. Gastrectomy 2. Gastric stapling 3. Gastroplasty 4. Gastrorrhaphy

1. Gastrectomy

The nurse is teaching a pt with gastroesophageal reflux related to a hiatal hernia about body position for management of the disease process. Which pt statement indicates that teaching has been effective? 1. I elevate the head of the bed 4-6 inches on blocks 2. I elevate the foot of the bed 12-16 inches on blocks 3. I sleep on my back with several pillows under my head 4. I sleep in a recliner to elevate the

1. I elevate the head of the bed 4-6 inches on blocks Rationale: The patient with gastroesophageal reflux needs to keep the head elevated during sleep or when prone to rest. The head of the bed needs to be solidly elevated with blocks to a height of 4 to 6 inches.

The nurse is providing care for a patient who underwent a Billroth I surgery for stomach cancer. Which nursing care is most important during the postoperative period for this patient? 1. Medicating for pain to promote coughing and deep breathing 2. Assisting the patient out of bed to prevent clot formation 3. Observing the surgical dressing to recognize excessive bleeding 4. Monitoring the amount and type of drainage from the NG tube

1. Medicating for pain to promote coughing and deep breathing Rationale: After any surgery with general anesthesia, the most important issue is the establishment and maintenance of a patent airway. The location of this patient's surgery will make it difficult to cough and deep breathe; adequate pain management is essential.

The nurse is contributing to the care plan of a patient admitted a massive gastric bleed. Which goals will the nurse consider during this process of planning care? (Select all that apply) 1. Recognize and treat hypovolemic shock 2. Reassess for pain and medicate as needed 3. Monitor and report signs of stress-induced ulcers 4. Reassess for indications of electrolyte imbalances 5. Implement measure to prevent or treat dehydration

1. Recognize and treat hypovolemic shock 4. Reassess for indications of electrolyte imbalances 5. Implement measure to prevent or treat dehydration Rationale: The patient who experiences a massive gastric bleed is susceptible to hypovolemic shock, which can be fatal. Because the patient is likely to be hypovolemic due to a massive gastric bleed, the nurse should be alert to signs of electrolyte imbalances. After a massive gastric bleed, the patient is likely to be dehydrated due to the loss of blood. The option includes measures to correct the condition.

An asymptomatic pt is admitted with gastric bleeding. For which of the following signs or symptoms of severe gastric bleeding should the nurse monitor? (Select all that apply) 1. Restlessness 2. Diaphoresis 3. Bounding pulse 4. Hypotension 5. Confusion

1. Restlessness 2. Diaphoresis 4. Hypotension 5. Confusion

The nurse reviews the lab results for a pt during a routine office visit. The results indicate a low hemoglobin level. The client denies any obvious signs of illness. For which primary reason does the nurse suspect the HCP will order gastric studies? 1. The condition can be related to low intrinsic factor 2. Gastric bleeding is the likely cause of the anemia 3. Type A chronic gastritis is asymptomatic 4. The lab results have been noted previously

1. The condition can be related to low intrinsic factor Rationale: Chronic type A gastritis is often symptomatic except for anemia. In this condition there is usually a deficiency of intrinsic factor secreted from the stomach cells, which results in difficulty absorbing vitamin B12, resulting in pernicious anemia.

A patient who had extensive gastric surgery for stomach cancer reports feeling sick and diaphoretic with abdominal cramping about 20 minutes after eating. The nurse is providing information about dumping syndrome. Which information is correct? (Select all that apply) 1. The patient is experiencing one of the most common complications 2. Food enters the jejunum without adequate amounts of digestive juices 3. The condition is lifelong and may require treatment with insulin 4. High concentrations of electrolytes and sugar draws fluid into the bowel 5. The patient will need to eat some candy or drink juice containing sugar

1. The patient is experiencing one of the most common complications 2. Food enters the jejunum without adequate amounts of digestive juices 4. High concentrations of electrolytes and sugar draws fluid into the bowel 5. The patient will need to eat some candy or drink juice containing sugar Rationales: Dumping syndrome is one of the most common complications following extensive gastric surgery. Dumping syndrome occurs when food rapidly enters the jejunum without being thoroughly mixed with digestive juices. The concentration of electrolytes and sugar is diluted when the body draws fluid into the bowel and from the circulating blood volume. The rapid drop in circulating fluid volume causes many of the symptoms of dumping syndrome. In addition, high sugar concentrations trigger the release of insulin, which results in hypoglycemia about 2 hours after eating. The patient needs a rapid source of oral sugar to alleviate the symptoms.

A patient who had bariatric surgery presents at the HCP's office and is diagnosed with aphthous stomatitis. Given the patient's medical history, the nurse recognizes which cause of the condition is most likely? 1. Vitamin B12 deficiency 2. Emotional stress 3. Recent dental work 4. Menstruation

1. Vitamin B12 deficiency Rationale: The patient has oral inflammation. Given the medical history of bariatric surgery, the most likely cause of the condition is the lack of vitamin B12.

The nurse is planning care for a patient admitted for gastric bleeding, which is presently controlled. If the patient experiences a recurrence of bleeding, which manifestation will indicate to the nurse that the patient is experiencing hypovolemic shock? 1. tachycardia and tachypnea 2. Dry mucous membranes 3. Change in LOC 4. Reports of fatigue and thirst

1. tachycardia and tachypnea Rationale: Tachycardia and tachypnea, along with hypotension, chills, palpations, and diaphoresis, are all signs of hypovolemic shock.

The nurse is reinforcing teaching with a pt who had a large portion of the stomach surgically removed. For which condition related to the surgery will the pt need to receive vitamin B12 for life? 1. Sickle cell anemia 2. Pernicious anemia 3. Iron-deficiency anemia 4. Acquired hemolytic anemia

2. Pernicious anemia Rationale: Vitamin B12 deficiency can occur after some or all of the stomach is removed because intrinsic factor secretion is reduced or gone. Normally, vitamin B12 combines with intrinsic factor to prevent its digestion in the stomach and promote its absorption in the intestines. Lifelong administration of vitamin B12 is required to prevent the development of pernicious anemia.

The nurse is preparing to provide care for a client diagnosed with peptic ulcer disease. Which pathophysiological characteristics will the nurse correctly associate with the patient's diagnosis? 1. Erosion is confined to the stomach and esophagus 2. A common cause is an infection from Helicobacter pylori 3. Surgery to increase mucus will heal the ulcerations 4. Gastric ulcers occur more frequently than do peptic ulcers

2. A common cause is an infection from Helicobacter pylori Rationale: The most common cause of peptic ulcer disease is infection from H pylori.

The nurse is planning care to a team of pts. To provide pt-centered care safetly, for which pts should the nurse use specialized mobility equipment designed for the pt who is obese? (Select all that apply) 1. A woman with body weight 22% above ideal body weight 2. A man with body weight 30% above ideal body weight 3. A man with BMI of 31 4. A woman with a BMI of 24 5. A woman with waist measurement of 36 inches 6. A man with waist measurement of 44 inches

2. A man with body weight 30% above ideal body weight 3. A man with BMI of 31 5. A woman with waist measurement of 36 inches 6. A man with waist measurement of 44 inches

During a visit with the HCP, the pt asks for guidance in losing some weight. The pt is currently 310 pounds with a height of 5 foot 7 inches. When contributing to the plan of care, the nurse would recognize that the initial treatment for obesity would include which of these? (Select all that apply) 1. Biofeedback 2. Calorie restriction 3. Counseling 4. Healthy diet 5. Exercise 6. Fasting

2. Calorie restriction 4. Healthy diet 5. Exercise

The nurse is teaching a pt with dumping syndrome about food choices. Which of these foods would the nurse instruct the pt to avoid? 1. Spinach with avocado salad 2. Coffee and glazed donut 3. Sausage and liver 4. Creamed chipped beef

2. Coffee and glazed donut

Which of the following procedures does the nurse understand is done palliatively for the dysphagia that occurs in inoperable esophageal cancer? 1. Gastrectomy 2. Esophageal dilation 3. Radical neck dissection 4. Modified neck dissection

2. Esophageal dilation

The nurse is asking about the type of bariatric surgery the pt had. The pt states, "They folded my stomach inward and sutured the folds in place." Which surgery description does the nurse recognize? 1. Sleeve gastrectomy 2. Gastric plication 3. Roux-en Y bypass 4. Gastric banding

2. Gastric plication Rationale: The gastric plication is a bariatric surgery that folds the stomach inward and sutures the folds together.

The nurse is collecting health information from a pt. Which pt statement will cause the nurse the most concern? 1. My stool has been dark green and hard to pass lately 2. Lately, I've had 2-3 loose, sticky, black tarry stools every day 3. Usually I move my bowels every day and the stool is light brown 4. My stool is soft and dark brown, I usually move my bowels twice a day

2. Lately, I've had 2-3 loose, sticky, black tarry stools every day Rationale. The nurse is most concerned from the patient's description, which is indicative of blood loss causing black tarry stools (melena) caused by slow bleeding from the upper gastrointestinal (GI) area.

The nurse is collecting data for a pt who is taking lansoprazole for peptic ulcer disease. Which data collection finding requires immediate intervention? 1. A rash 2. Tarry stools 3. Constipation 4. Changes in mental status

2. Tarry stools Rational: With lansoprazole administration, the nurse should assess for epigastric or abdominal pain and for blood in stool (tarry stools), emesis, or gastric aspirate. Notify the physician if any evidence of bleeding has occurred.

The nurse is planning a teaching session for a pt with peptic ulcer. Which of these would the nurse include in the teaching plan as the primary cause of peptic ulcer? 1. Eating spicy foods 2. A stressful life 3. A bacterial infection 4. Excessive caffeine intake

3. A bacterial infection

The nurse instructs a patient prescribed omeprazole for peptic ulcer disease about the use of the medication. Which patient statements indicate understanding of the instructions? (Select all that apply) 1. I should not take antacids while I'm on this medication 2. If I wish, I can open the capsule and sprinkle it on food 3. I will take the capsule before eating a meal in the morning 4. I will need to take this drug for 3 weeks for my ulcer to heal 5. I will report any abdominal pain, diarrhea, or bleeding that occurs

3. I will take the capsule before eating a meal in the morning 5. I will report any abdominal pain, diarrhea, or bleeding that occurs Rationale: The patient is instructed to take omeprazole in the morning before a meal; instructions are understood. The patient needs to report abdominal pain, diarrhea, or bleeding to the HCP during the medication therapy; instructions are understood.

The nurse is providing care for a client who has surgical repair of a paraoesophageal hernia. The nurse observes that the pt exhibits signs of dysphagia during the first postoperative meal. Which action does the nurse take? 1. Offer the pt fluids 2. Cut the food into small pieces 3. Report observation to the HCP 4. Assure pt the problem is temporary

3. Report observation to the HCP Rationale: After the repair of a paraesophageal hernia, dysphagia should be reported to the HCP. The corrective fundoplication surgery may have the stomach fundus wrapped too tight around the esophagus, causing food obstruction.

The nurse is providing care for a patient who is diagnosed with a Mallory-Weiss tear (MWT). Which treatment for the condition is the nurse expecting? 1. Immediate emergency surgery 2. Ice lavage to the damaged esophagus 3. Positioning in reverse Trendelenburg's 4. An injection of epinephrine

4. An injection of epinephrine Rationale: The patient with MWT may receive an injection of epinephrine, which is a vasoconstrictor, to control bleeding.

The nurse is providing care for a client with a BMI of 44, type 2 DM, sleep apnea, and was recently hospitalized for CHF. The pt is SOB and ambulates with difficulty. Which therapeutic management does the nurse suspect the HCP will initially recommend? 1. Psychiatric treatment for poor seld-esteem 2. Enrollment in an exercise program for the obese 3. Attendance at a weight-loss support group 4. Initiation of the process for bariatric surgery

4. Initiation of the process for bariatric surgery Rationale: The patient is exhibiting medical and physical indications that bariatric surgery is essential. The nurse should suspect this as the HCP's initial recommendation.

The nurse is providing care to a pt 3 days after a Billroth I procedure. About which observation should the nurse be most concerned? 1. Pulse 58 bpm 2. incisional pain score 4/10 3. Pt tearful while viewing the incision 4. Reports of abdominal cramping shortly after eating

4. Reports of abdominal cramping shortly after eating Rationale: Dumping syndrome is a complication of Billroth I procedure and occurs 5 to 30 minutes after eating. Symptoms include dizziness, tachycardia, fainting, sweating, nausea, diarrhea, a feeling of fullness, and abdominal cramping.

A pt is diagnosed with aphthous stomatitis (canker sore). Which nursing action should the nurse implement? 1. Explain to not brush teeth until the sore is healed 2. Encourage pt to use a mouthwash four times a day 3. Apply acyclovir ointment to sore for pain relief 4. Teach pt to apply topical tetracycline several times a day to the sore

4. Teach pt to apply topical tetracycline several times a day to the sore