UGI 32,33

The nurse is collecting health information from a patient. Which patient statement is most concerning?

Lately, I've had two or three loose, black stools every day. 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 inspecting a patient's oral cavity prior to surgery and notices reddened areas on the gums that are bleeding, several teeth with cavities, and multiple loose teeth. Which finding is of greatest concern?

Loose teeth can lead to aspiration and airway blockage. Loose teeth can be aspirated into the airway and become a choking risk or cause airway blockage. This finding is the nurse's greatest concern because of safety. The finding needs to be reported to the surgical team.

The nurse is caring for a patient who has an NG tube that is not vented. Which suction setting should the nurse select?

Low intermittent suction If suction is ordered, low intermittent suction is used with nonvented NG tubes.

The nurse is performing an abdominal examination and performing auscultation before palpation and percussion. Why did the nurse make this decision?

Palpation will alter or stimulate bowel sounds. The nurse will need to listen to current bowel sounds. Palpation is a physical examination of the abdomen and will alter or stimulate bowel sounds.

The nurse is planning care for an older adult patient with disorders of the GI tract. What should the nurse consider?

Peristalsis diminishes and slows motility, causing constipation. Effective peristalsis diminishes because of loss of muscle elasticity and slowed motility, which leads to constipation.

The nurse is reinforcing teaching with a patient who had a large portion of the stomach surgically removed. Which nutritional problem is a lifelong concern and requires education?

Pernicious anemia because intrinsic factor secretion is reduced or gone. Normally, vitamin B12 12 Vitamin B12 deficiency can occur after some or all of the stomach is removed

The nurse is providing care for a patient who has just undergone a percutaneous needle biopsy to rule out liver disease. Which priority action should the nurse take after the procedure?

Position the patient on the right side for 2 hours. The most important nursing intervention following a percutaneous liver biopsy is to keep the patient positioned on the right side for 2 hours to apply pressure on the site and prevent bleeding. Risk for bleeding is associated with the vascularity of the liver, and because liver disease can cause reduced clotting ability.

The nurse is providing care for a patient who is diagnosed with a Mallory-Weiss tear (MWT). What findings are consistent with this diagnosis?

Pregnancy with hyperemesis An MWT is due to forceful coughing, vomiting, seizures, prolapse of the stomach into the esophagus, or cardiopulmonary resuscitation (CPR). Hyperemesis—severe or prolonged vomiting—during pregnancy is a finding consistent with this diagnosis,.

The nurse is providing care to a patient 3 days after a gastroduodenostomy procedure. Which observation is most concerning?

Reports of sweating shortly after eating Dumping syndrome is a complication of Billroth I (gastroduodenostomy) procedure and occurs 15 to 30 minutes after eating. Symptoms include dizziness, tachycardia, fainting, sweating, nausea, diarrhea, a feeling of fullness, and abdominal cramping.

The nurse is providing care for a client 1 day after major surgery. The client's abdomen is distended, bowel sounds are absent, and the patient is nauseated. What action should the nurse consider?

Request placement of an NG tube. The most common way to achieve abdominal decompression is by the placement of an NG tube. The NG tube will also remove any fluid accumulation related to poor or absent peristalsis.

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 priority concern?

Risk of choking With esophageal cancer, it is possible for the esophagus to become narrow; the condition is exacerbated by the radiation therapy. The risk for choking and/or aspiration is high and of greatest concern.

A clear liquid diet has been prescribed for a client with gastroenteritis. Which item is appropriate to offer to the client?

fat free broth

PUD complications

hemorrhage, perforation, gastric outlet obstruction

The nurse is assisting with the insertion of a nasogastric tube into a client. The nurse would place the client in which position for insertion?

high fowlers position

The nurse is preparing to perform an abdominal examination. Which step would be taken first?

inspection

Levels of Solid Textures (Dysphagia Diet)

level 1: purred: totally smooth level 2: mechanically altered soft textured moist semi solid level 3 advanced: near normal textured food

The nurse is administering a cleansing enema to a client with a fecal impaction. Before administering the enema, the nurse asks the client to assume a modified left lateral recumbent position. The nurse explains that this positioning is preferred because of which reason?

the enema will flow into the bowel easily

Duodenal ulcer

ulcer located in the duodenum can be from a h pylori infection

The nurse is caring for a client with a diagnosis of chronic gastritis. The nurse anticipates that the client is at risk for which vitamin deficiency?

vit b12

Restrictive bariatric surgery

laparoscopic adjustable gastric band or sleeve reduces stomach volume capacity patient need to adheres to weight loss protocols

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.)

- I will take the capsule before eating a meal in the morning - I will report any abdominal pain, diarrhea or bleeding that occurs

21. Which patients does the nurse recommend as benefiting from PN? (Select all that apply.)

- a patient who has esophageal cancer = a patient who is NPO for esophageal varies -a patient with severe burns across the face and test

The nurse is reviewing the prescriptions of a client admitted to the hospital with a diagnosis of acute pancreatitis. Which interventions would the nurse expect to be prescribed? Select all that apply.

- administer antacids as prescribed - encourage coughing and deep breathing - administer anticholinergics as prescribed

When reinforcing dietary instructions to a client with irritable bowel syndrome whose primary symptom is alternating constipation and diarrhea, which foods would the nurse tell the client are best to include in the diet for this disorder? select all that apply

- apples - whole grain bread

The nurse is providing care for a client with gallbladder disease. The client states, "What good is a gallbladder anyway?" The nurse is aware that which digestive processes are a function of the gallbladder? (Select all that apply.)

- bile causes emulsification of large globules of fats into small globules - bile carries bilirubin and excess cholesterol through the intestine -bile secretion by the gallbladder is stimulated by the hormone secretion

The nurse is providing care for an older adult client. The client states, "I don't eat much anymore and I have terrible problems with my bowels." Which information does the nurse share with the patient to explain the changes as related to age? (Select all that apply.)

- decreased GI peristalsis contributes to constipation - constipation requires an increased intake of fluids and roughage -decreased sense of taste can cause a loss of desire to eat - periodontal disease can interfere with eating and healthy nutrition

A patient returns from an esophagogastroduodenoscopy (EGD) and reports a dry, scratchy throat. The unlicensed assistive personnel (UAP) fills the water pitcher and starts to give the patient a drink. What actions should the nurse take? (Select all that apply.)

- evaluate if a gag reflex is present - stop the patient from drinking - speak with a UAP in a private location

A licensed practical nurse (LPN) is preparing to assist a registered nurse (RN) with removing a nasogastric (NG) tube from the client. Which interventions would be included in the procedure? Select all that apply.

- explain the procedure to the client - ask the client to take a deep breath and how - pull the tube out in one continuous steady motion - remove the device or tape securing the tube from the nose

A patient is admitted to the skilled nursing unit and only has lower dentures and several broken teeth on the upper gums. What actions should the nurse take? (Select all that apply.)

- gather more data to determine if the dentures are loose - consult a dietitian - determine if the teeth are loose

The nurse is providing care for a patient with an NG tube for PN, an IV line for fluids and medications, and a nasal cannula for oxygen therapy. Which safety interventions does the nurse implement during care for this patient? (Select all that apply.)

- label or color code feeling tubes and connectors - write 'alert!' for enteral use only on all tube feedings - during the handoff process check tube orginins and connections

A histamine (H2)-receptor antagonist will be prescribed for a client. The nurse understands that which medications are H2-receptor antagonists? Select all that apply.

- nizatidine - ranitidine

The nurse is contributing to the care plan of a patient admitted after a massive gastric bleed. Which goals will the nurse consider during this process of planning care? (Select all that apply.)

- recognize and treat hypovolemic shock - reassess for indications of electrolyte imbalances - implement measures to prevent or treat hydration

Malabsorption Bariatric Surgery

-Reroute to small intestine - Risk of malnourishment -Weight stays off

The nurse reviews the laboratory results for a patient with malnutrition from a lack of intrinsic factor secretion. The results indicate a low hemoglobin level. What symptoms should the nurse inquire about?

1. Numbness and tingling Vitamin B12 deficiency may occur after some or all of the stomach is removed because intrinsic factor secretion is reduced or absent. Symptoms of pernicious anemia include anemia, weakness, sore tongue, numbness and tingling, and GI upset, which should be closely monitored because they may not be reversible.

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 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.

After a client undergoes a liver biopsy, the nurse places the client in the prescribed right-side lying position. The nurse understands that the purpose of this intervention is to accomplish which?

limit bleeding from the biopsy site

The nurse is reinforcing discharge instructions to a client after a gastrectomy. Which measure would the nurse include during client teaching to help prevent dumping syndrome?

limit the fluids taken with meals

A client with hiatal hernia chronically experiences heartburn after meals. Which would the nurse teach the client to avoid?

lying recumbent after meals

gastric cancer

malignant tumor of the stomach symptoms Indigestion, anorexia, pain relieved by antacids, weight loss, nausea, vomiting, anemia

The client has an as-needed prescription for ondansetron. For which condition would the nurse administer this medication?

nausea and vomiting

hiatal hernia

occurs when the stomach protrudes upward into the mediastinum through the esophageal opening in the diaphragm

The nurse has inserted a nasogastric (NG) tube in a client and is checking for the correct placement of an NG tube. Which is the most reliable data to ensure that the end of the tube is in the stomach?

placement is certified on x-ray

The nurse is monitoring for stoma prolapse in a client with a colostomy. Which stoma observation would indicate that a prolapse has occurred?

protruding and swollen

The client has begun medication therapy with pancrelipase. The nurse evaluates that the medication is having the optimal intended benefit if which effect is observed?

reduction of steatorrhea

The nurse is reviewing the primary health care provider's (PHCP'S) prescriptions written for a client admitted with acute pancreatitis. Which PHCP prescription would the nurse verify if noted in the client's chart?

supine and flat client positioning

The nurse is monitoring a client for the early signs and symptoms of dumping syndrome. Which indicates this occurrence?

sweating and pallor

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.)

- the patient is experiencing one of the most common complications - food enters the jejunum without adequate amounts of digestive juices - high concentrations of electrolytes and sugar draw fluid into the bowel - the patient will need to eat some candy or drink juice containing sugar

The nurse is palpating the abdomen of a patient reporting mild abdominal pain in the lower region. How deep should the nurse depress this patient's abdomen?

1 inch When palpating the abdomen of a patient reporting mild abdominal pain in the upper right quadrant, the nurse should depress the abdomen no more than 1 inch.

Peptic Ulcer Disease

An abrasion of the stomach or small intestine.

The nurse is preparing to provide care for a client diagnosed with peptic ulcer disease. Which considerations should the nurse make?

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

The nurse is auscultating the bowel sounds of a patient who is severely constipated and exhibits a swollen abdomen and pain. Which bowel sounds are consistent with a bowel obstruction?

A high-pitched tinkling sound A high-pitched tinkling sound is commonly associated with a bowel obstruction, especially if bowel sounds are absent distal to the area of auscultation.

The nurse is caring for a patient who has GERD. Which complication should the nurse monitor for?

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

The nurse is providing care for a patient whose nasogastric (NG) tube is attached to low intermittent suction for decompression of a bowel obstruction. The nurse notes the NG tube is not draining. What action should the nurse take?

Confirm placement with x-ray imaging. The nurse should confirm placement with an x-ray per agency policy.

The nurse is reviewing the record of a client with Crohn's disease. Which stool characteristic would the nurse expect to see documented in the record?

Diarrhea

esophageal varies

Dilated and tortuous veins in the submucosa of the esophagus

A patient is being scheduled for a barium swallow test to rule out esophageal strictures and gastric ulcer. Which pretesting information will the nurse provide for the patient?

Do not smoke on the morning of the testing. The patient is encouraged not to smoke the morning of the barium swallow because smoking can stimulate gastric motility.

The nurse is providing care for a patient who is experiencing nausea and vomiting. Which complication should the nurse monitor for?

Electrolyte imbalance When there is a loss of fluid, there is also the risk for electrolyte imbalance with prolonged vomiting.

The nurse reviews the results of a patient's stool occult blood test, which tests positive. What question should the nurse ask the patient?

Have you eaten turnips, fish, or horseradish prior to testing? Ingestion of fish, turnips, or horseradish, and use of medications, including anticoagulants, aspirin, colchicine, NSAIDs, steroids, and iron preparations in large doses can lead to a false-positive test.

The nurse works with cancer patients. Which factor does the nurse identify as an increased risk of gastric cancer?

High intake of smoked fish and meats Patients with diets high in smoked fish and meats have an increased risk for gastric cancer.

A patient is being prepared for an upper gastrointestinal (GI) series involving a barium swallow. Which statement by the patient indicates an understanding of the instructions?

I can't have anything to eat or drink for 8 hours before the procedure. An appropriate patient diet preparation for an upper GI series is placing the patient on NPO restriction 8 hours before the procedure for best visualization.

The nurse is teaching a patient with gastroesophageal reflux disease (GERD) about minimizing symptoms. Which patient statement indicates that teaching has been effective?

I elevate the head of the bed 4 to 6 inches on blocks. The patient with GERD 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 caring for a patient admitted with malnutrition and placed on parenteral nutrition (PN). Which information should the nurse consider regarding insulin therapy for this patient?

Insulin coverage may be added to the PN solution. Regular insulin is ordered to control hyperglycemia during PN therapy. It can be given as an additive to the PN solution or subcutaneously per a sliding scale based on specified blood glucose monitoring results, such as every 6 hours, or both.

The nurse is asking about the type of bariatric surgery the patient had during the admission data collection. The patient states, "They put something in my stomach to fill it up so I don't get hungry." How should the nurse document this surgery?

Intragastric balloon With this type of bariatric surgery, a balloon is inserted endoscopically into the stomach, filled with saline, and left in place for 6 months.

The nurse is caring for a client after a Billroth II (gastrojejunostomy) procedure. During review of the postoperative prescriptions, which would the nurse clarify?

Irrigating the nasogastric NG tube

The nurse is reinforcing teaching provided to a patient with a peptic ulcer. Which patient statement indicates understanding of the medication famotidine?

It inhibits gastric acid secretion. Histamine 2 (H2)-receptor antagonists like famotidine inhibit gastric acid secretion by blocking H2-receptors on gastric parietal cells.

The nurse is inspecting the skin of a patient's abdomen. Which finding is consistent with gallbladder disease?

Jaundice Jaundice (icterus) is a yellowing of the skin and is usually associated with liver or gallbladder dysfunction or disease.

The nurse is evaluating the understanding of a new graduate licensed practical nurse/licensed vocational nurse (LPN/LVN) about the topic of enteral feedings. What information by the new nurse requires correction?

Measurement of residual volumes reflect gastric emptying and aspiration risk. Research does not support the belief that measurement of residual volumes reflects gastric emptying and aspiration risk. This requires correction.

The nurse is providing care for a patient who recently underwent a Billroth II surgery for stomach cancer. What nursing care is the priority?

Medicating for pain to promote coughing and deep breathing 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 collecting data for a patient who is taking pantoprazole for peptic ulcer disease. Which finding requires nursing action?

Melena With pantoprazole administration, the nurse should assess for diarrhea, headache, abdominal pain, or blood in stool (tarry stools or melena). Notify the physician if any evidence of bleeding has occurred.

The nurse is gathering data from a client in a clinic after hospitalization for an infection. The client reports having diarrhea, nausea, and abdominal pain since discharge. What action should the nurse take?

Notify the HCP promptly. if risk factors are present, monitor patients closely for indicators of C. difficile infection (e.g., diarrhea, fever, abdominal tenderness, or pain). Report these signs and symptoms to the HCP promptly. C. difficile infection can be fatal.

The nurse is providing care for a patient who reports nausea following chemotherapy. Which action should the nurse consider?

Offer a ginger soft drink. Ginger and ginger drinks can ease nausea.

The nurse is ready to begin a tube feeding via an NG feeding tube for a patient who is comatose. What action should the nurse take before starting the feeding?

Raise the head of the bed 30 degrees. When feedings are administered, patients must be positioned with the head of the bed at 30 to 45 degrees to reduce the risk of aspiration.

dumping syndrome

Rapid emptying of gastric contents into small intestines. Client experience ab pain, nausea, vomiting, explosive diarrhea, weakness, dizziness, palpitations & tachycardia. encourage client to eat meals in low fowlers and remain for 30 minutes after eating thicken food

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?

Reduced formation of stress ulcers 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 is providing care for a client who had surgical repair of a paraesophageal hernia. The nurse observes that the patient is having difficulty swallowing during the first postoperative meal. Which action should the nurse take?

Report the observation to the health-care provider (HCP). After the repair of a paraoesophageal hernia, dysphagia should be reported to the HCP. The corrective fundoplication surgery may have the stomach fundus wrapped too tightly around the esophagus, causing food obstruction.

The nurse is providing care for a client who requires gastric irrigation for a medication overdose. The nurse understands the use of an orogastric tube requires which intervention?

The tube is temporary and is removed following treatment. The orogastric tube is placed through the client's mouth and is primarily used

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 finding indicates that they are experiencing hypovolemic shock?

Thready pulse Hypotension; a weak, thready pulse; chills; palpitations; dizziness; confusion; and cold/clammy extremities are all signs of hypovolemic shock.

The nurse is providing care for a client with a body mass index (BMI) of 44, type 2 diabetes mellitus, sleep apnea, and recent hospitalization for congestive heart failure. The patient tells the nurse, "I know my weight is causing a lot of my health issues, I just don't know what to do." How should the nurse reply?

You are eligible for weight-loss surgery. Have you ever discussed this with your health-care provider? The patient is exhibiting medical and physical indications that bariatric surgery is essential. The nurse should offer this as an option to consider.

The nurse is providing care for a client with gallstones who is preparing for an endoscopic retrograde cholangiopancreatography (ERCP). What should the nurse include with teaching?

Your throat will be sore with hoarseness.

The client has an as-needed prescription for loperamide hydrochloride. For which condition would the nurse administer this medication?

an episode of diarrhea

gastroesophageal reflux disease (GERD)

backflow of contents of the stomach into the esophagus, often resulting from abnormal function of the lower esophageal sphincter, causing burning pain in the esophagus

A client with Crohn's disease is scheduled to receive an infusion of infliximab. The nurse assisting with caring for the client would take which action to monitor the effectiveness of treatment?

checking the frequency and consistency of bowel movements

An older client has recently been taking cimetidine. The nurse would monitor the client for which most frequent central nervous system side effect of this medication?

confusion

esophageal varices

enlarged and swollen veins at the lower end of the esophagus

gastric ulcer

erosion of gastrointestinal lining in the stomach - common from H pylori infection

anorexia

lack of appetite common effect of some medications