Chapter 41-Upper GI Problems Practice Questions

After change-of-shift report, which patient should the nurse assess first?

A 60-yr-old patient with nausea and vomiting who is lethargic with dry mucosa (This patient is at high risk for problems such as aspiration, dehydration, and fluid and electrolyte disturbances.)

Which patient should the nurse assess first after receiving change-of-shift report?

A patient with esophageal varices who has a rapid heart rate (A patient with esophageal varices and a rapid heart rate indicate possible hemodynamic instability caused by GI bleeding.)

Which nursing action should be included in the postoperative plan of care for a patient after a laparoscopic esophagectomy?

Elevate the head of the bed to at least 30 degrees.

What diagnostic test should the nurse anticipate for an older patient who is vomiting "coffee-ground" emesis?

Endoscopy (Endoscopy is the primary tool for visualization and diagnosis of upper gastrointestinal (GI) bleeding.)

A woman receiving chemotherapy for breast cancer develops a Candida albicans oral infection. Which intervention should the nurse anticipate?

Nystatin tablets (C. albicans infections are treated with an antifungal such as nystatin.)

Which action should the nurse in the emergency department anticipate for a young adult patient who has had several acute episodes of bloody diarrhea?

Obtain a stool specimen for culture. (Patients with bloody diarrhea should have a stool culture for Escherichia coli)

A 73-yr-old patient is diagnosed with stomach cancer after an unintended 20-lb weight loss. Which nursing action will be included in the plan of care?

Offer supplemental feedings between meals.

The nurse is assessing a patient who had a total gastrectomy 8 hours ago. What information is most important to report to the health care provider?

Temperature 102.1° F (38.9° C) (An elevation in temperature may indicate leakage at the anastomosis, which may require return to surgery or keeping the patient NPO.)

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?

The patient has no breath sounds in the left anterior chest. (Decreased breath sounds on one side may indicate a pneumothorax, which requires rapid diagnosis and treatment.)

A patient has just been admitted to the emergency department with nausea and vomiting. Which information requires the most rapid intervention by the nurse?

The patient is lethargic and difficult to arouse. (A lethargic patient is at risk for aspiration, and the nurse will need to position the patient to decrease aspiration risk.)

Which information about dietary management should the nurse include when teaching a patient with peptic ulcer disease (PUD)?

"Avoid foods that cause pain after you eat them."

A 58-yr-old woman who was recently diagnosed with esophageal cancer tells the nurse, "I do not feel ready to die yet." Which response by the nurse is most appropriate?

"Having this new diagnosis must be very hard for you."

Which prescribed action will the nurse implement first for a patient who has vomited 1100 mL of blood?

Administer 1 L of lactated Ringer's solution. (Because the patient has vomited a large amount of blood, correction of hypovolemia and prevention of hypovolemic shock are the priorities.)

A patient has peptic ulcer disease that has been associated with Helicobacter pylori. About which medications will the nurse plan to teach the patient?

Amoxicillin (Amoxil), clarithromycin (Biaxin), and omeprazole (Prilosec) (The drugs used in triple drug therapy include a proton pump inhibitor such as omeprazole and the antibiotics amoxicillin and clarithromycin.)

Which information will the nurse include when teaching adults to decrease the risk for cancers of the tongue and buccal mucosa?

Avoid cigarettes and smokeless tobacco.

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 should the nurse take?

Check the vital signs. (The patient's symptoms suggest acute perforation, and the nurse should assess for signs of hypovolemic shock.)

Which item should the nurse offer to the patient restarting oral intake after being NPO due to nausea and vomiting?

Dish of lemon gelatin (Clear cool liquids are usually the first foods started after a patient has been nauseated.)

Which finding in the mouth of a patient who uses smokeless tobacco is suggestive of oral cancer?

Red patches on the buccal mucosa (A red, velvety patch suggests erythroplasia, which has a high incidence (>50%) of progression to squamous cell carcinoma)

A patient who has gastroesophageal reflux disease (GERD) is experiencing increasing discomfort. Which patient statement to the nurse indicates that additional teaching about GERD is needed?

"I eat small meals and have a bedtime snack." (GERD is exacerbated by eating late at night, and the nurse should plan to teach the patient to avoid eating at bedtime.)

A young adult patient is hospitalized with massive abdominal trauma from a motor vehicle crash. The patient asks the nurse about the purpose of receiving famotidine (Pepcid). What should the nurse explain about the action of the medication?

"It inhibits development of stress ulcers."

How should the nurse explain esomeprazole (Nexium) to a patient with recurring heartburn?

"It treats gastroesophageal reflux disease by decreasing stomach acid production."

Which information will the nurse provide for a patient with newly diagnosed gastroesophageal reflux disease (GERD)?

"Keep the head of your bed elevated on blocks."

Which information will the nurse include when teaching a patient with peptic ulcer disease about the effect of ranitidine (Zantac)?

"Ranitidine decreases gastric acid secretion." (Ranitidine is a histamine-2 (H2) receptor blocker that decreases the secretion of gastric acid.)

Which statement by a patient with chronic atrophic gastritis indicates that the nurse's teaching regarding cobalamin injections has been effective?

"The cobalamin injections will prevent me from becoming anemic."

Which patient statement indicates that the nurse's postoperative teaching after a gastroduodenostomy has been effective?

"Vitamin supplements may prevent anemia."

An adult with E. coli food poisoning is admitted to the hospital with bloody diarrhea and dehydration. Which prescribed action will the nurse question?

Administer loperamide (Imodium) after each stool.

The nurse is caring for a patient who develops watery diarrhea and a fever after prolonged omeprazole (Prilosec) therapy. In which order will the nurse take actions?

d. Place the patient on contact precautions. b. Assess blood pressure and heart rate. a. Contact the health care provider. c. Give the PRN acetaminophen (Tylenol). Rationale Proton pump inhibitors including omeprazole (Prilosec) may increase the risk of Clostridium difficile-associated colitis. Because the patient's history and symptoms are consistent with C. difficile infection, the initial action should be initiation of infection control measures to protect other patients. Assessment of blood pressure and pulse is needed to determine whether the patient has symptoms of hypovolemia or shock. The health care provider should be notified so that actions such as obtaining stool specimens and antibiotic therapy can be started. Tylenol may be administered but is the lowest priority of the actions.

A 53-yr-old male patient with deep partial-thickness burns from a chemical spill in the workplace has severe pain followed by nausea during dressing changes. Which action will be most useful in decreasing the patient's nausea?

Administer prescribed morphine sulfate before dressing changes. (Because the patient's nausea is associated with severe pain, it is likely that it is precipitated by stress and pain.)

The health care provider prescribes antacids and sucralfate (Carafate) for treatment of a patient's peptic ulcer. What should the nurse teach the patient to take?

Antacids after meals and sucralfate 30 minutes before meals (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.)

A young adult has been admitted to the emergency department with nausea and vomiting. Which action could the RN delegate to unlicensed assistive personnel (UAP)?

Assist the patient with oral care.

A 68-yr-old male patient with a stroke is unconscious and unresponsive to stimuli. After learning that the patient has a history of gastroesophageal reflux disease (GERD), what should the nurse plan to assess more frequently than is routine?

Breath sounds (Because GERD may cause aspiration, the unconscious patient is at risk for developing aspiration pneumonia.)

Which patient choice for a snack 3 hours before bedtime indicates that the nurse's teaching about gastroesophageal reflux disease (GERD) has been effective?

Cherry gelatin with fruit (Gelatin and fruit are low fat and will not decrease lower esophageal sphincter (LES) pressure.)

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. What is the highest priority action by the nurse?

Contact the surgeon. (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).)

A 49-yr-old man has been admitted with hypotension and dehydration after 3 days of nausea and vomiting. Which prescribed action will the nurse implement first?

Infuse normal saline at 250 mL/hr.

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. What should the nurse teach the patient to do?

Lie down for about 30 minutes after eating. (The patient is experiencing symptoms of dumping syndrome, which may be reduced by lying down after eating.)

An 80-yr-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?

Metoclopramide (Reglan) (Metoclopramide can cause central nervous system side effects ranging from anxiety to hallucinations.)

A patient who takes a nonsteroidal antiinflammatory drug (NSAID) daily for the management of severe rheumatoid arthritis has recently developed melena. What should the nurse anticipate teaching the patient?

Misoprostol (Cytotec) to protect the gastrointestinal (GI) mucosa (Misoprostol, a prostaglandin analog, reduces acid secretion and the incidence of upper GI bleeding associated with NSAID use.)

After 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?

Patient schedules an appointment for allergy testing.

What should the nurse anticipate teaching a patient with a new report of heartburn?

Proton pump inhibitor (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.)

A patient with a family history of stomach cancer asks the nurse about ways to decrease the risk for developing stomach cancer. What should the nurse teach the patient to avoid?

Smoked foods such as ham and bacon (increase the risk for stomach cancer.)

Which assessment should the nurse perform first for a patient who just vomited bright red blood?

Taking the blood pressure (BP) and pulse (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 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?

The LPN/VN positions the head of the bed in the flat position. (to prevent reflux and aspiration of gastric contents.)

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?

The patient's lungs have crackles audible to the midchest. (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 should be slowed.)

Which information will the nurse provide for a patient with achalasia?

Treatment may include endoscopic procedures.

A patient vomiting blood-streaked fluid is admitted to the hospital with acute gastritis. What should the nurse ask the patient about to determine possible risk factors for gastritis?

Use of nonsteroidal antiinflammatory drugs