Functional Ability: Nutrition
A nurse is assessing an infant who has hypertrophic pyloric stenosis. Which of the following manifestations should the nurse expect? (Select all that apply.) A. Projectile vomiting B. Dry mucus membranes C. Currant jelly stools D. Sausage-shaped and mass E. Constant hunger
A. Projectile vomiting B. Dry mucus membranes E. Constant hunger Explanation: A client who has pyloric stricture has thickening of the pyloric sphincter, resulting in projectile vomiting. A client who has pyloric stricture is unable to consume adequate food & liquid, resulting in dehydration & hunger.
The client has been taking omeprazole for 4 weeks. The nurse evaluates that the client is receiving the optimal intended effect of the medication if the client reports the absence of which symptom? A. Diarrhea B. Heartburn C. Flatulence D. Constipation
B. Heartburn Explanation: Omeprazole is a proton pump inhibitor classified as an antiulcer agent. The intended effect of the medication is relief of pain from gastric irritation, often called "heartburn" by clients.
A nurse is completing discharge teaching for a patient who has an infection due to H. pylori. Which of the following statements by the patient indicates understanding of the teaching? A. "I will continue my prescription for corticosteroids." B. "I will schedule a CT scan to monitor improvement." C. "I will take a combination of medications for treatment." D. "I will have my throat swabbed to recheck for this bacteria."
C. "I will take a combination of medications for treatment." Explanation: A combination of antibiotics and a histamine2 receptor antagonist is used to treat an infection caused by H. pylori
The nurse is collecting data from a client who is taking pantoprazole. The nurse determines that the medication is most effective if the client states relief of which symptom? A. Heartburn B. Constipation C. A nighttime cough D. Migraine headaches
A. Heartburn Explanation: Pantoprazole is a gastric acid pump inhibitor that increases the gastric pH and reduces gastric acid production. It is used to treat gastric and duodenal ulcers and gastroesophageal reflux disease. It is not used to treat cough, constipation, or migraine headaches.
A nurse is providing discharge teaching for a client who has peptic ulcer disease and a new famotidine. Which of the following statements by the client indicates an understanding of the teaching? A. "I should take this medication at bedtime." B. "I should expect this medication to discolor my stools." C. "I will drink iced tea with my meals and snacks." D. "I will monitor my blood glucose level regularly while taking this medication."
A. "I should take this medication at bedtime." Explanation: The nurse should instruct the client to take the medication at bedtime to inhibit the action of histamine at the H2-receptor site in the stomach.
A nurse is caring for a client who has a new diagnosis of gastroesophageal reflux disease (GERD). The nurse should anticipate prescriptions for which of the following medications? (Select all that apply.) A. Antacids B. Histamine2 receptor antagonists C. Opioid analgesics D. Fiber laxatives E. Proton pump inhibitors
A. Antacids B. Histamine2 receptor antagonists E. Proton pump inhibitors Explanation: Antacids neutralize gastric acid which irritates the esophagus during reflux. Histamine2 receptor antagonists decrease acid secretion, which contributes to reflux. Proton pump inhibitors decrease gastric acid production, which contributes to reflux.
A nurse is caring for a client with gastroesophageal reflux disease (GERD). Which information should the nurse include in the client's discharge instructions? A. Eat small, frequent meals B. Take bulk-forming laxatives C. Consume a high-protein diet D. Avoid taking fluids at bedtime
A. Eat small, frequent meals Explanation: Eating small, frequent meals prevents the gastric secretions from going backward through the lower esophageal sphincter that occurs in GERD. Bulk-forming laxatives are not used in the treatment of GERD. A high-protein diet is recommended for clients with malnutrition, not GERD. Avoiding fluids at bedtime is an intervention for clients with dumping syndrome, not GERD.
A nurse is teaching a client who has a duodenal ulcer and a new prescription for esomeprazole. Which of the following information should the nurse include in the teaching? (Select all that apply.) A. Take the medication 1 hr before a meal B. Limit NSAIDS when taking this medication C. Expect skin flushing when taking this medication D. Increase fiber intake when taking this medication E. Chew the medication thoroughly before swallowing
A. Take the medication 1 hr before a meal B. Limit NSAIDS when taking this medication
A nurse is teaching a client who will begin taking aluminum hydroxide. Which of the following information should the nurse include in the teaching? A. "If constipation develops, switch to a calcium-based antacid." B. "Take this medication 2 hours before or after other medications." C. "This medication increases the risk for pneumonia." D. "Have your magnesium level monitored while taking this medication."
B. "Take this medication 2 hours before or after other medications." Explanation: Cimetidine alters the absorption of many medications. The client should ensure no other medications are taken within 1 to 2 hours of taking cimetidine.
A nurse in a provider's office is assessing a client who has GERD. When documenting the client's history, the nurse should expect the client to report that symptoms worsen with which of the following actions? A. Stair-climbing B. Bending over C. Sitting D. Walking
B. Bending over Explanation: Gastroesophageal reflux symptoms are most evident with activities that increase intraabdominal pressure (e.g. bending over, straining, lifting, and lying down).
A nurse is providing discharge teaching for a client who has a new prescription for medications to treat peptic ulcer disease. The nurse should identify that which of the following medications inhibits gastric acid secretion? A. Calcium carbonate B. Famotidine C. Aluminum hydroxide D. Sucralfate
B. Famotidine Explanation: The nurse should inform the client that famotidine is an H2-receptor antagonist that is prescribed for the treatment of peptic ulcer disease to inhibit the secretion of gastric acid.
The nurse is caring for a client who is being evaluated for gastroesophageal reflux disease (GERD). Which client statement is consistent with the clinical manifestations of GERD? A. "I get headaches after I eat a large meal." B. "I feel sleepy right after eating my dinner." C. "I have a burning feeling in my chest after meals." D. "I wake up at night with excessive sweat."
C. "I have a burning feeling in my chest after meals." Explanation: Heartburn, which is often described as a burning sensation in the chest area, is the most common symptom of GERD. Headaches, postprandial sleepiness, and night sweats are not symptoms associated with GERD.
A nurse is teaching a client who takes phenytoin and has a new prescription for sucralfate tablets. Which of the following instructions should the nurse include? A. Take an antacid with the sucralfate B. Take sucralfate with a glass of milk C. Allow a 2-hr interval between this medication D. Chew the sucralfate thoroughly before swallowing
C. Allow a 2-hr interval between this medication Explanation: Sucralfate can interfere with the absorption of phenytoin, so the client should allow a 2-hr interval between the sucralfate and phenytoin
An older client has recently been taking cimetidine. The nurse should monitor the client for which most frequent central nervous system side effect of this medication? A. Tremors B. Dizziness C. Confusion D. Hallucinations
C. Confusion Explanation: Cimetidine is a histamine 2 (H2)-receptor antagonist. Older clients are especially susceptible to CNS side effects of cimetidine. The most frequent of these is confusion. Less common CNS side effects include headache, dizziness, drowsiness, and hallucinations.
A nurse is teaching a client about cimetidine. Which of the following are adverse effects of cimetidine? (Select all that apply.) A. Increased libido B. Insomnia C. Enlargement of breast tissue D. Confusion E. Decreased sperm count
C. Enlargement of breast tissue D. Confusion E. Decreased sperm count Explanation: Gynecomastia, confusion & impotence is an adverse effect of cimetidine
A nurse is providing teaching to a client who has a peptic ulcer disease and is to start a new prescription for sucralfate. Which of the following actions of sucralfate should the nurse include in the teaching? A. Decreases stomach acid secretion B. Neutralizes acids in the stomach C. Forms a protective barrier over ulcers D. Treats ulcers by eradicating H. pylori
C. Forms a protective barrier over ulcers Explanation: Secretions by the parietal and chief cells, hydrochloric acid and pepsin, can further irritate the ulcerated areas. Sucralfate, a mucosal protectant, forms a gel-like substance that coats the ulcer, creating a barrier to hydrochloric acid and pepsin
The nurse is caring for a client who was admitted to the hospital with peptic ulcer disease (PUD). Which finding, if noted by the nurse, is a manifestation of complications from PUD? A. Bradycardia B. Numbness in the legs C. Nausea and vomiting D. A rigid, board-like abdomen
D. A rigid, board-like abdomen Explanation: A risk of peptic ulcer disease is perforation, a surgical emergency. The nurse assesses the client with PUD for this possibility. The client will also have sudden sharp pain, possible nausea and vomiting, and tachycardia. Numbness in the legs is unrelated to perforation.
The nurse is caring for an infant being evaluated for gastroesophageal reflux disease (GERD). Which assessment finding should the nurse expect? A. Poor weight gain B. Forceful vomiting C. Respiratory issues D. Arching of the back
D. Arching of the back Explanation: The infant with GERD may have small amounts of spit-up or forceful vomiting. Poor weight gain, respiratory involvement, and arching of the back are clinical manifestations seen more often in children with GERD.
A nurse us caring for a client who has GERD and a new prescription for metoclopramide. The nurse should plan to monitor for which of the following adverse effects? A. Thrombocytopenia B. Hearing loss C. Hypersalivation D. Ataxia
D. Ataxia Explanation: The nurse should plan to monitor the client for extrapyramidal symptoms, such as ataxia, and should report any of these findings to the provider.
The primary health care provider has written a prescription for ranitidine, for a client with gastrointestinal reflux disease. The nurse is explaining how this medication works to treat this disease. Which explanation should the nurse give? A. The medication neutralizes stomach acid. B. The medication hastens gastric emptying time. C. The medication suppresses secretion of gastric acid. D. The medication suppresses acid secretion by blocking H2 receptors.
D. The medication suppresses acid secretion by blocking H2 receptors. Explanation: RANITIDINE suppresses acid secretion by blocking H2 receptors on parietal cells. ANTACIDS neutralize stomach acid. METOCLOPRAMIDE hastens gastric emptying time PROTON PUMP INHIBITORS suppress secretion of gastric acid
A nurse is admitting a client who has bleeding esophageal varices. The nurse should anticipate a prescription for which of the following medications? A. Propranolol B. Metoclopramide C. Ranitidine D. Vasopressin
D. Vasopressin Explanation: Vasopressin constricts blood vessels and is used to treat bleeding esophageal varices.
A 74-yr-old female patient with osteoporosis is diagnosed with gastroesophageal reflux disease (GERD). Which over-the-counter medication to treat GERD should be used with caution? A. Sucralfate B. Cimetidine C. Omeprazole D. Metoclopramide
c. Omeprazole Explanation: Long-term use or high doses of PPIs may increase the risk of fractures of the hip, wrist, and spine
A nurse is providing discharge teaching for a client who has GERD. Which of the following statements by the client indicates an understanding of the teaching? A. "I will decrease the amount of carbonated beverages I drink." B. "I will avoid drinking liquids for 30 minutes after taking a chewable antacid tablet." C. "I will eat a snack before going to bed." D. "I will lie down for at least 30 minutes after eating each meal."
A. "I will decrease the amount of carbonated beverages I drink." Explanation: The nurse should instruct the client to limit or eliminate fatty foods, coffee, cola, tea, carbonated beverages, and chocolate from his diet because they irritate the lining of the stomach.
A nurse is assessing a client who has a bleeding duodenal ulcer. Which of the following findings should the nurse expect? A. Emesis with a coffee-ground appearance B. Increased blood pressure C. Decreased heart rate D. Bright green stools
A. Emesis with a coffee-ground appearance Explanation: The nurse should expect a client who has a bleeding duodenal ulcer to have emesis that resembles coffee-grounds or is bright red in color. Hematemesis indicates upper gastrointestinal bleeding, occurring at or above the duodenojejunal junction.
A nurse is assessing a client who is experiencing perforation of a peptic ulcer. Which of the following manifestations should the nurse expect? A. Increased blood pressure B. Decreased heart rate C. Yellowing of the skin D. Board-like abdomen
D. Board-like abdomen Explanation: The nurse should expect this client who is experiencing perforation of a peptic ulcer to exhibit manifestations of a board-like abdomen and severe pain in the abdomen or back that radiates to the right shoulder. Vomiting of blood and shock can occur if the perforation causes hemorrhaging.
A nurse is teaching a client who has a new diagnosis of dumping syndrome following gastric surgery. Which of the following should be included in the teaching? A. Eat 3 moderate-sized meals a day. B. Drink at least 1 glass of water with each meal. C. Eat a bedtime snack that contains a milk product. D. Increase protein in the diet.
D. Increase protein in the diet. Explanation: Eat a high protein, high fat, low fiber, and moderate to low carb diet
A nurse is assessing a client who has a duodenal ulcer. Which of the following findings should the nurse expect? A. The client states that the pain is in the upper epigastrium. B. The client is malnourished. C. The client states that ingesting food intensifies the pain. D. The client reports that pain occurs during the night.
D. The client reports that pain occurs during the night Explanation: Pain associated with a duodenal ulcer occurs when the stomach is empty, which is typically 1.5 to 3 hr after meals and during the night
A nurse is teaching a parent of an infant about GERD. Which of the following should the nurse include in the teaching? (Select all that apply.) A. Offer frequent feedings B. Thicken formula with rice cereal C. Use a bottle with a one-way valve D. Position the baby upright after feedings E. Use a wide-base nipple for feedings
A. Offer frequent feedings B. Thicken formula with rice cereal D. Position the baby upright after feedings Explanation: Frequent feeding, thickened formula & positioning the infant in an upright position following feedings will assist in decreasing the amount of vomiting episodes.
The physician has ordered omeprazole 20 mg twice daily, clarithromycin 500 mg twice daily, and amoxicillin 1 g daily for a client with peptic ulcer disease (PUD). It is most important for the nurse to instruct the client to do which measure when taking these medications? A. Stop the drugs and notify the physician if a rash, hives, or itching develops. B. Consume 8 oz of yogurt or buttermilk daily while on the medication. C. Take the drugs on an empty stomach, 1 hour before breakfast and at least 2 hours after dinner. D. Take the drugs with a full glass of water.
A. Stop the drugs and notify the physician if a rash, hives, or itching develops. Explanation: Rash, hives, and itching indicate a hypersensitivity reaction and need to be reported immediately. Consuming yogurt and taking the drugs on an empty stomach with a full glass of water are also taught to the client but are not as important as a hypersensitive reaction, which can lead to anaphylaxis and death.
The client who is being evaluated for peptic ulcer disease (PUD) asks the nurse what test would provide the most definitive diagnosis of PUD. Which response by the nurse is most accurate? A. Urea breath test B. Gastroscopy with biopsy C. Barium contrast studies D. Gastric acid analysis
B. Gastroscopy with biopsy Explanation: Gastroscopy allows for visualization of the gastric mucosa for presence of ulcers. The biopsy can differentiate PUD from gastric cancer and can be used to test for presence of H. pylori. The urea breath test can only confirm presence of H. pylori, but not ulcers. Barium studies can only detect 80% to 90% of ulcers, and can miss the small, superficial ulcers. Gastric acid analysis is used for testing of Zollinger-Ellison syndrome, not PUD.
A client is being evaluated for a possible duodenal ulcer. The nurse monitors the client for which manifestation that would indicate this diagnosis? A. Epigastric pain relieved by food B. History of chronic NSAID use C. Distended abdomen D. Positive fluid wave
B. History of chronic NSAID use Explanation: The pain of a duodenal ulcer is relieved by eating because the pancreatic juices stimulated by eating are high in bicarbonate. NSAID use is irritating to the stomach. Distended abdomen and positive fluid wave are unrelated to ulcers.
Sucralfate 1 g four times daily has been prescribed for a client with a diagnosis of gastric ulcer. The nurse reinforces instructions to the client regarding administration of the medication. Which statement by the client indicates an understanding of the use of the medication? A. "I need to take the medication every 6 hours around the clock." B. "I need to take the medication with my meals and again at bedtime." C. "I need to take the medication 1 hour before my meals and at bedtime." D. "I need to take the medication 1 hour after meals and again at bedtime."
C. "I need to take the medication 1 hour before my meals and at bedtime." Explanation: This medication is timed to allow it to form a protective coating over the gastric ulcer before food intake stimulates gastric acid production and mechanical irritation. Therefore, the medication should be scheduled for administration 1 hour before meals and at bedtime.
The client with diagnosed peptic ulcer disease has been prescribed misoprostol and sucralfate. The nurse reinforces teaching the client that these two medications will work primarily for which reason? A. The medications kill intestinal bacteria. B. The medications inhibit histamine action. C. The medications decrease stomach acid. D. The medications protect the gastric mucosa.
D. The medications protect the gastric mucosa Explanation: Both of these medications protect the stomach lining. Misoprostol increases mucous production and bicarbonate levels, although sucralfate coats the ulcer surface. Options A and B reflect histamine antagonists and antibiotics, respectively. Option C describes antacids.
A nurse is caring for four clients who have peptic ulcer disease. The nurse should identify misoprostol is contraindicated for which of the following clients? A. A client who is pregnant B. A client who has osteoarthritis C. A client who has kidney stone D. A client who has urinary tract infection
A. A client who is pregnant Explanation: Misoprostol can induce labor and is contraindicated in pregnancy
A nurse in a provider's office is assessing a client who has GERD. The nurse should expect the client to report which of the following manifestations? (Select all that apply.) A. Regurgitation B. Nausea C. Belching D. Heartburn E. Weight loss
A. Regurgitation B. Nausea C. Belching D. Heartburn Explanation: Regurgitation and heartburn are primary manifestations of GERD. Nausea and belching are also common manifestations.
A nurse in the emergency department is completing an assessment of a client who has suspected stomach perforation due to peptic ulcer. Which of the following are expected findings? (Select all that apply.) A. Rigid abdomen B. Tachycardia C. Elevated blood pressure D. Circumoral cyanosis E. Rebound tenderness
A. Rigid abdomen B. Tachycardia E. Rebound tenderness Explanation: Manifestation of perforation include a rigid, board-like abdomen. Tachycardia occurs due to GI bleeding that accompanies a perforation. Rebound tenderness is an expected finding in a client who has perforation
A nurse is caring for a client who has ulcerative colitis. The client has had several exacerbations over the past 3 yr. Which of the following instructions should the nurse include in the plan of care tom minimize risk of further exacerbations? (Select all that apply) A. Use progressive relaxation techniques B. Increase dietary fiber intake C. Drink two 240 mL (8 oz) glasses of milk per day D. Arrange activities to allow for daily rest periods E. Restrict intake of carbonated beverages
A. Use progressive relaxation techniques D. Arrange activities to allow for daily rest periods E. Restrict intake of carbonated beverages Explanation: Progressive relaxation techniques, a form of biofeedback, are recommended to help the client minimize stress, which can precipitate an exacerbation. Daily rest periods decrease stress and reduce intestinal motility. The client should avoid gastrointestinal stimulants, such as carbonated beverages, nuts, peppers, and smoking.
A nurse is reviewing the laboratory results of a client who has acute pancreatitis. Which of the following findings should the nurse expect? A. Blood glucose 110 mg/dL B. Increased serum amylase C. WBC 9,000/mm3 D. Decreased bilirubin
B. Increased serum amylase Explanation: Serum amylase levels are increased in a client who has acute pancreatitis due to pancreatic cell injury.
A nurse is completing an assessment of a client who has GERD. Which of the following is an expected finding? A. Absence of saliva B. Painful swallowing C. Sweet taste in mouth D. Absence of eructation
B. Painful swallowing Explanation: Painful swallowing is a manifestation of GERD due to esophageal stricture or inflammation; Hypersalivation, bitter taste in the mouth, and increased burping are also an expected finding in a client who has GERD.
A nurse is caring for an infant who has just returned from the PACU following cleft lip and palate repair. Which of the following actions should the nurse take? A. Remove the packing in the mouth B. Place the infant in an upright position C. Offer a pacifier with sucrose D. Assess the mouth with a tongue blade
B. Place the infant in an upright position Explanation: Placing the infant in an upright position will facilitate drainage & prevent aspiration
A nurse is assessing a client who has upper GI bleeding. Which of the following findings should the nurse expect? A. Bradycardia B. Bounding peripheral pulses C. Hypotension D. Increased hematocrit levels
C. Hypotension Explanation: A client who has upper gastrointestinal bleeding is at risk for hemorrhagic shock. Hypotension is a manifestation of hemorrhagic shock
A nurse is caring for a child who has Hirschsprung's disease. Which of the following actions should the nurse take? A. Encourage a high-fiber, low-protein, low-calorie diet B. Prepare the family for surgery C. Place an NG tube for decompression D. Initiate bedrest
B. Prepare the family for surgery Explanation: A client who has Hirschsprung's disease requires surgery to remove the affected segment of the intestine. Prepare the family for surgery is an appropriate action for the nurse to take.
A nurse is teaching a client who has a new prescription for omeprazole. Which of the following information should the nurse include in the teaching? A. Take this medication at bedtime B. This medication decreases the production of gastric acid C. Take this medication 2 hr after eating D. This medication can cause hyperkalemia
B. This medication decreases the production of gastric acid Explanation: Omeprazole reduces gastric acid secretion by inhibiting the enzyme that produces gastric acid; This medication is administered in the morning, before meals with a glass of water for treatment of heartburn; Omeprazole can cause hypomagnesemia
A nurse is completing an assessment of a patient who has a gastric ulcer. Which of the following are expected findings? ( Select all that apply.) A. Patient reports pain relieved by eating B. Patient states that pain often occurs at night C. Patient reports a sensation of bloating D. Patient states that pain occurs 30 min to 1 hr after a meal E. Patient experiences pain upon palpation of the epigastric region
C. Patient reports a sensation of bloating D. Patient states that pain occurs 30 min to 1 hr after a meal E. Patient experiences pain upon palpation of the epigastric region Explanation: A client report of bloating sensation is an expected finding. A client who has gastric ulcer will often report pain 30 to 60 min after a meal. Pain in the epigastric region upon palpation is an expected finding
A nurse is providing teaching to a client who has a gastric ulcer and a new prescription for ranitidine. Which of the following instructions should the nurse include? A. Take the medication on an empty stomach for full effectiveness B. You may discontinue this medication when stomach discomfort subsides C. Report yellowing of the skin D. Store the medication in the refrigerator
C. Report yellowing of the skin Explanation: Ranitidine can be hepatotoxic and cause jaundice. The nurse should instruct the client to monitor for and report yellowing of the skin or eyes to the provider.
