Upper GI NCLEX Questions

What organs/glands are included in the GI system? a. Mouth, pharynx, esophagus, stomach, and small/large intestine. b. Pharynx, esophagus, stomach, liver, and small/large intestine c. Mouth, pharynx, esophagus, stomach, gallbladder, small/large intestine.

A

Which change occurs within the GI system as a person ages? A. peristalsis decreases B. HCl levels in the stomach increase, causing atrophy of gastric mucosa. C. increase in lipase production D. constriction of pancreatic ducts

A

A client had an endoscopic retrograde cholangiopancreatography (ERCP). The nurse teaches the client and family about the signs of potential complications which include what problems? (Select all that apply.) a. Cholangitis b. Pancreatitis c. Perforation d. Renal lithiasis e. Sepsis

ANS: A, B, C, E Possible complications after an ERCP include cholangitis, pancreatitis, perforation, sepsis, and bleeding. Kidney stones are not a complication of ERCP.

What are the actions of antacids, histamine blockers, and proton pump inhibitors? a. inhibited gastric secretions, accelerated gastric emptying, protection of gastric mucosa b. inhibited gastric secretions, decreased gastric emptying, protection of gastric mucosa c. inhibited gastric secretions, decreased gastric emptying, decreased nausea

a

Patients with PUD should avoid. Select all that apply. a. NSAIDs b. aspirin c. acetaminophen d. antacids e. situations that cause stress

a, b, e

The primary health care provider prescribes bismuth sub-salicylate for a client as part of treating H. pylori infection. What health teaching will the nurse include for the client about this drug.? a. do not crush this drug before taking b. the drug may cause you tongue and stool to turn black c. take the drug at night only d. the drug cause you to have diarrhea.

b

A bulging, pulsating mass is present when assessing the abdomen. What is this indicative of and what is the best course of action? Select all that apply. a. diaphragmatic hernia b. abdominal aortic aneurysm (life-threatening) c. do not touch d. palpate for tenderness and ask about level of pain e. notify the prover of this finding immediately

b, c, e

The nurse is caring for a client diagnosed with peptic ulcer disease (PUD). For which potential complications will the nurse monitor? Select all that apply. a. pneumonia b. peritonitis c. anemia d. stroke e. hypotension d. cirrhosis

b, c, e

Which client statement about GERD triggers requires further nursing teaching. Select all that apply. a. I will decrease my alcohol intake. b. Smoking one or two cigarettes a day won't hurt. c. My plan is to eat six small meals daily. d. tomato-based foods should be avoided e. I love soda but I'm going to stop drinking it f. Our family eats tacos and burritos several times weekly

b, f

A patient recovering from an acute duodenal ulcer is admitted to the floor. The nurse understands that the following drug protects ulcers from further injury by acid and pepsin by changing into a viscous substance that adheres to the ulcer. a. Prilosec b. Reglan c. Sucralfate

c

Instead of typical symptoms associated with GERD, older adults experience more severe complications such as. Select all that apply. a. a-typical chest pain; ear, nose, and throat infections b. aspiration pneumonia c. sleep apnea d. asthma e. all the above

e

Which of the following is (are) (a) risk factor(s) for gastric cancer? (Select all that apply.) a. Achlorhydria b. Chronic atrophic gastritis c. H. pylori infection d. Iron deficiency anemia e. Pernicious anemia

ANS: A, B, C, E Achlorhydria, chronic atrophic gastritis, H. pylori infection, and pernicious anemia are all risk factors for developing gastric cancer. Iron deficiency anemia is not a risk factor.

The nurse is caring for a client with sialadenitis. What comfort measures are appropriate for this client? (Select all that apply.) a. Applying warm compresses b. Applying ice to salivary glands c. Offering fluids every hour d. Providing lemon-glycerin swabs e. Reminding the patient to avoid speaking

ANS: A, C Warm compresses and fluids can help promote comfort for this client. Application of ice or lemon-glycerin swabs would not be used. Speaking has no effect on this condition.

A client who had a partial gastrectomy 3 days ago begins to experience vertigo, sweating, and tachycardia about 30 minutes after eating breakfast. What postoperative complication would the nurse suspect? a. Pyloric obstruction b. Dumping syndrome c. Delayed gastric emptying d. Pernicious anemia

ANS: B Dumping syndrome causes autonomic symptoms as food quickly leaves the stomach due to its decreased size after surgery.

The nurse knows that a client with prolonged prothrombin time (PT) values (not related to medication) probably has dysfunction in which organ? a. Kidneys b. Liver c. Spleen d. Stomach

ANS: B Severe acute or chronic liver damage leads to a prolonged PT secondary to impaired synthesis of clotting proteins. The other organs are not related to this issue.

The priority care for a patient with upper GI bleeding is. Choose the best answer. a. maintain airway, breathing, circulation (ABCs) b. NPO until gag reflex returns c. monitor serum potassium d. administer opioid analgesics per order

a

A public health nurse is assessing community clients for oral health disorders. Which client is identified at highest risk? a. 23 yo with three dental fillings b. 34 yo with schizophrenia c. 55 yo with stable angina d. 62 yo with irritable bowel syndrome

b

Hiatal Hernias are also called... a. peptic ulcers b. diaphragmatic hernias c. esophageal hernias d. inguinal hernias

b

The barium swallow study with fluoroscopy is the most specific test for identifying... a. peptic ulcers b. gastritis c. hiatal hernias

c

The nurse is caring for a client with a long history of peptic ulcer disease. What assessment findings would the nurse anticipate if the client experiences upper gastrointestinal (GI) bleeding? (Select all that apply.) a. Decreased heart rate b. Decreased blood pressure c. Bounding radial pulse d. Dizziness e. Hematemesis f. Decreased urinary output

ANS: B, D, E, F The client who has upper GI bleeding would likely have vomiting that contains blood (hematemesis), and would have signs and symptoms of dehydration such as a decreased blood pressure, dizziness, and/or decreased urinary output. The heart rate increases rather than decreases and the pulse is weak rather than bounding in clients who are dehydrated.

What lifestyle changes can help a patient with GERD and PUD? A. Drink milk before bedtime. B. Avoid spicy foods. C. Drink water frequently throughout the night. D. Up your cardio to 4 times a week.

B

Which of the following drugs provide long-acting inhibition of gastric acid secretion, are the drug of choice for severe GERD? a. Prilosec b. Reglan c. Sucralfate d. Antacids

a

What are the symptoms of Gastritic ulcers. Select all that apply. a. Pain with eating. b. Pain after eating c. Pain to upper epigastric area to the left.

a, c

A community health nurse is screening clients for esophageal cancer. Which client is identified as being at highest risk? a. 22 yo who drinks a glass of beer weekly b. 44 yo who smokes a pack of cigarettes daily c. 50 yo who takes over the counter omeprazole d. 63 yo who uses protein supplements regularly

b

What are the symptoms of Duodenal ulcers. Select all that apply. a. Pain with eating b. Pain to the right or below the epigastric area c. Pain after eating

b, c

What are the symptoms of Chronic gastritis. Select all that apply. a. Rapid onset of epigastric pain and dyspepsia b. May have few symptoms unless ulceration occurs c. Nausea, vomiting, upper abdominal discomfort d. Vague abdominal pain relieved with food

b, c, d

Which 3 major types of medications are used to treat GERD and PUD? A. antacids, histamine blockers, NSAIDs B. antacids, calcium channel blockers, proton pump inhibitors C. antacids, histamine blockers, proton pump inhibitors

c

Immediately following a colonoscopy, which client behavior will the nurse report to the healthcare provider? Select all that apply. a. passing of flatus b. blood pressure 128/80 c. Abdominal guarding d. Change in mental status e. you will need to refrain from eating for at least 6 to 8 hours before the EGD.

c, d

Which of the following drugs neutralize HCl acid and elevate pH in stomach? a. Prilosec b. Reglan c. Sucralfate d. Antacids

d

The nurse notes that the primary health care provider documented the presence of mucosal erythroplasia in a client. What does the nurse understand that this most likely means for this client? a. Early sign of oral cancer b. Fungal mouth infection c. Inflammation of the gums d. Obvious oral tumor

ANS: A Mucosal erythroplasia is the earliest sign of oral cancer. It is not a fungal infection, inflammation of the gums, or an obvious tumor.

A nurse is preparing to administer pantoprazole intravenously to prevent stress ulcers during surgery. What action(s) by the nurse is (are) most appropriate? (Select all that apply.) a. Administer the drug through a separate IV line. b. Infuse pantoprazole using an IV pump. c. Keep the drug in its original brown container. d. Take vital signs frequently during infusion. e. Use an in-line IV filter when infusing.

ANS: A, B, E When infusing pantoprazole, use a separate IV line, a pump, and an in-line filter. A brown wrapper and frequent vital signs are not needed.

During an interview, the client tells the nurse that the client has a duodenal ulcer. Which assessment finding would the nurse expect? a. Hematemesis b. Pain when eating c. Melena d. Weight loss

ANS: C All of the other assessment findings are more commonly seen in clients who have gastric ulcers rather than duodenal ulcers.

What is the action of Famotidine? A. Inhibits the action of histamine a, the H2 receptor site located primarily in the gastric parietal cells, resulting in inhibition of gastric secretion. B. Neutralize gastric acid following dissolution in gastric contents. C. Aluminum salt of sulfated sucrose reacts with gastric acid to form a thick paste, which selectively adheres to the ulcer surface. D. Binds to an enzyme on gastric parietal cells in the presence of acidic gastric pH, preventing the final transport of hydrogen ions into the gastric lumen.

A

A client has dumping syndrome after a partial gastrectomy. Which action by the nurse would be appropriate? a. Arrange a dietary consult. b. Increase fluid intake. c. Limit the client's foods. d. Make the client NPO.

ANS: A The client with dumping syndrome after a gastrectomy has multiple dietary needs. A referral to the registered dietitian nutritionist will be extremely helpful. Food and fluid intake is complicated and needs planning. The client should not be NPO.

A client is scheduled for a colonoscopy and the nurse has provided instructions on the bowel cleansing regimen. What statement by the client indicates a need for further teaching? a. "It's a good thing I love orange and cherry gelatin." b. "My spouse will be here to drive me home." c. "I'll avoid ibuprofen for several days before the test." d. "I'll buy a case of clear Gatorade before the prep."

ANS: A The client would be advised to avoid beverages and gelatin that are red, orange, or purple in color as their residue can appear to be blood. The other statements show an understanding of the preparation for the procedure.

The nurse is teaching a client about risk factors for esophageal cancer. Which risk factors would the nurse include? (Select all that apply.) a. Alcohol intake b. Obesity c. Smoking d. Lack of fresh fruits and vegetables e. Untreated GERD f. Use of NSAIDs

ANS: A, B, C, D, E All of these factors increase the risk of esophageal cancer except for the use of NSAIDs. Untreated GERD causes damage to esophageal tissue which may develop into Barrett esophagus, or precancerous cells.

The nurse is teaching a client about the risk of uncontrolled or untreated the client's gastroesophageal reflux disease (GERD). What complication(s) may occur if the GERD is not successfully managed? (Select all that apply.) a. Asthma b. Laryngitis c. Dental caries d. Cardiac disease e. Cancer

ANS: A, B, C, D, E Any of these complications may occur in clients who have uncontrolled or untreated GERD.

The nurse is caring for a client diagnosed with probable gastroesophageal reflux disease (GERD). What assessment finding(s) would the nurse expect? (Select all that apply.) a. Dyspepsia b. Regurgitation c. Belching d. Coughing e. Chest discomfort f. Dysphagia

ANS: A, B, C, D, E, F All of these signs and symptoms are commonly seen in clients who have GERD.

The nurse recalls that the risk factors for acute gastritis include which of the following? (Select all that apply.) a. Alcohol b. Caffeine c. Corticosteroids d. Fruit juice e. Nonsteroidal anti-inflammatory drugs (NSAIDs)

ANS: A, B, C, E Risk factors for acute gastritis include alcohol, caffeine, corticosteroids, and chronic NSAID use. Fruit juice is not a risk factor, although in some people it does cause distress.

The nurse working with older clients understands age-related changes in the gastrointestinal system. Which changes does this include? (Select all that apply.) a. Decreased hydrochloric acid production b. Diminished sensation that can lead to constipation c. Fat not digested as well in older adults d. Increased peristalsis in the large intestine e. Pancreatic vessels become calcified

ANS: A, B, C, E Several age-related changes occur in the gastrointestinal system. These include decreased hydrochloric acid production, diminished nerve function that leads to decreased sensation of the need to pass stool, decreased fat digestion, decreased peristalsis in the large intestine, and calcification of pancreatic vessels.

A nurse cares for a client who is recovering from a colonoscopy. Which actions would the nurse take? (Select all that apply.) a. Obtain vital signs every 15 to 30 minutes until alert. b. Assess the client for rectal bleeding and severe pain. c. Administer prescribed pain medications as needed. d. Monitor the client's serum and urine glucose levels. e. Confirm the client has a ride home and plans to rest.

ANS: A, B, E During the recovery phase after a colonoscopy, the nurse would obtain vital signs every 15 to 30 minutes until the client is alert, assess for rectal bleeding or severe pain, and confirm the client has arranged for another person to drive home to get rest. Pain medications are not necessary after the procedure, and neither is glucose monitoring.

A nurse knows that job-related risks for developing oral cancer include which occupations? (Select all that apply.) a. Coal miner b. Electrician c. Metal worker d. Plumber e. Textile worker

ANS: A, C, D, E The occupations of coal mining, metal working, plumbing, and textile work produce exposure to polycyclic aromatic hydrocarbons (PAHs), which are known carcinogens. Electricians do not have this risk

The nurse is aware of the most recent American Cancer Society Screening Guidelines for colon cancer, which include which accepted testing modalities for people over the age of 50? (Select all that apply.) a. Colonoscopy every 10 years b. Endoscopy every 5 years c. Computed tomography (CT) colonography every 5 years d. Double-contrast barium enema every 10 years e. Flexible sigmoidoscopy every 5 years

ANS: A, C, E The options for colon cancer screening for people over the age of 50 include colonoscopy every 10 years and CT colonography, double-contrast barium enema, or flexible sigmoidoscopy every 5 years.

A client has dumping syndrome. What menu selections indicate the client understands the correct diet to manage this condition? (Select all that apply.) a. Apricots b. Coffee cake c. Milk shake d. Potato soup e. Steamed broccoli

ANS: A, D Canned apricots and potato soup are appropriate selections as they are part of a high-protein, high-fat, and low- to moderate-carbohydrate diet. Coffee cake and other sweets must be avoided. Milk products and sweet drinks such as shakes must be avoided. Gas-forming foods such as broccoli must also be avoided.

The nurse working with clients who have gastrointestinal problems knows that which laboratory values are related to which organ functions or dysfunctions? (Select all that apply.) a. Alanine aminotransferase: biliary system b. Ammonia: liver c. Amylase: liver d. Lipase: pancreas e. Urine urobilinogen: stomach

ANS: B, D Alanine aminotransferase and ammonia are related to the liver. Amylase and lipase are related to the pancreas. Urobilinogen evaluates both hepatic and biliary function.

A client is having an esophagogastroduodenoscopy (EGD) and has been given midazolam hydrochloride. The client's respiratory rate is 8 breaths/min. What action by the nurse is appropriate? a. Administer naloxone. b. Call the Rapid Response Team. c. Provide physical stimulation. d. Ventilate with a bag-valve-mask.

ANS: C For an EGD, clients are given mild sedation but would still be able to follow commands. For shallow or slow respirations after the sedation is given, the nurse's most appropriate action is to provide a physical stimulation such as a sternal rub and directions to breathe deeply. Naloxone is not the antidote for midazolam HCl. The Rapid Response Team is not needed at this point. The client does not need manual ventilation.

A client had a colonoscopy and biopsy yesterday and calls the gastrointestinal clinic to report a spot of bright red blood on the toilet paper today. What response by the nurse is appropriate? a. Ask the client to call back if this happens again today. b. Instruct the client to go to the emergency department. c. Remind the client that a small amount of bleeding is possible. d. Tell the client to come to the clinic this afternoon.

ANS: C After a colonoscopy with biopsy, a small amount of bleeding is normal. The nurse would remind the client of this and instruct him or her to go to the emergency department for large amounts of bleeding, severe pain, or dizziness.

The nurse assesses a client who has possible gastritis. Which assessment finding(s) indicate(s) that the client has chronic gastritis? (Select all that apply.) a. Anorexia b. Dyspepsia c. Intolerance of fatty foods d. Pernicious anemia e. Nausea and vomiting

ANS: C, D Intolerance of fatty or spicy foods and pernicious anemia are signs of chronic gastritis. Anorexia and nausea/vomiting can be seen in both conditions. Dyspepsia is seen in acute gastritis.

A nurse is assessing a client reporting right upper quadrant (RUQ) abdominal pain. What technique would the nurse use to assess this client's abdomen? a. Auscultate after palpating. b. Avoid any type of palpation. c. Lightly palpate the RUQ first. d. Lightly palpate the RUQ last.

ANS: D If pain is present in a certain area of the abdomen, that area would be palpated last to keep the client from tensing which could possibly affect the rest of the examination. Auscultation of the abdomen occurs prior to palpation.

What are the layers of the GI tract lumen (inner wall)? A. pleura, mucosa, muscularis, and serosa. B. periserosa, submucosa, muscularis, and mucosa. C. mucosa, submucosa, muscularis, and serosa.

C

Which priority assessments are necessary post-EGD procedure? A. Check vital signs one hour after procedure. B. Test for a gag reflex post-op. C. Check vital signs q15-30min until sedation wears off. D. Keep the patient NPO 2 hours after the procedure.

C

What is a sign and symtom of peptic ulcer perforation? A. Burning pain in the abdomen B. Sharp pain in the umbilical region C. Sudden sharp pain in the left lower quadrant that spreads to the right lower quadrant. D. Sudden sharp pain in the mid-epigastric region that spreads over the entire abdomen

D

What are the 4 functions of the GI system?

Secretion, digestion, absorption, motility, and elimination.

Proton pump inhibitors (PPIs)... a. may increase risk for hip fracture (interfere with calcium absorption and protein digestion). b. are contraindicated for use in patients with hx of dyspepsia and wheezing/coughing at night. c. should only be used for 1 week to manage S/S of GERD and PUD.

a

The nurse in the outpatient clinic instructs a client taking lansoprazole for the first time. The nurse determines further teaching is required if the client makes which statement. a. I should take the medication on a full stomach b. the capsules are not to be crushed or chewed c. I can take this medication with antacids. d. i can open the capsule and sprinkle the contents on soft food, such as apple sauce, and swallow immediately.

a

The nurse provides care for a client diagnosed with a peptic ulcer. Which nursing action is most appropriate? a. identify stress factors in the client's environment. b. Avoid giving the client choices to make. c. Encourage the client to become angry d. avoid discussing the client's symptoms.

a

Which client statement regarding diet and nutrition after total gastrectomy requires further teaching by the nurse. a. I should stay sitting up for an hour after I eat. b. I will avoid liquids with my meals c. I need to eat small frequent meals d. I need to stay away from concentrated sweets.

a

While performing an abdominal assessment on a client, the nurse notes a bruit over the aorta. What is the appropriate nursing action? a. Notify the health care provider of the findings b. Consult another nurse to verify the bruit c. Auscultate each quadrant for 5 minutes each d. perform light palpation to further assess the pulsation.

a

Priority care for a patient post EGD include. Select all that apply. a. prevent aspiration b. do not offer fluids or food until gag reflex is intact c. monitor for signs of perforation (pain, bleeding, fever) d. monitor for signs of respiratory depression e. recite Metallica's "nothing else matters." So close, no matter how far. Couldn't be much more from the heart. Forever trusting who we are. No, nothing else matters. f. look at yourself in the mirror and say, Nurse, followed by your name. That feels good, doesn't it!

a, b, c

A client who had the Stretta procedure to treat severe GERD is being discharged. Which client statement requires further nursing teaching? Select all that apply. a. dysphagia after this procedure is normal. b. It's important to stop proton pump inhibitors. c. I will not take NSAIDs and aspirin for at least 10 days. d. I might cough up some blood following this procedure e. today I will drink clear liquids and tomorrow I can eat soft food.

a, b, d

A nurse is caring for a 34 yo client newly diagnosed with GERD. Which lifestyle change will the nurse suggest? a. lose weight if needed b. do not eat before bed c. elevate the foot of your bed by 6 to 12 inches d. avoid pants with a tight waistband or belt e. eat fatty foods to minimize ongoing hunger

a, b, d

What are the symptoms of Acute gastritis. Select all that apply. a. Rapid onset of epigastric pain and dyspepsia b. Sometimes accompanied by gastric bleeding, hematemesis or melena c.. Nausea, vomiting, upper abdominal discomfort d. Resolves in days

a, b, d

Which nursing interventions should be implemented to prevent respiratory complications in patients post hiatal hernia repair. Select all that apply. a. elevate bed at least 30 degrees to lower diaphragm and promote lung expansion. b. help the patient get out of bed and ambulate ASAP c. turn, cough, deep breath d. splint the incision during coughing e. ask the patient to lift their legs and place their heels on the bed while simultaneously blowing on the incentive spirometer as hard as they can

a, b, d

What health teaching will the nurse include to promote gastric health for an adult client.. Select all that apply. a. stop smoking or using tobacco of any form b. do not drink excessive amounts of alcohol c. consume high-fat foods and decrease carbohydrates d. avoid excessive amounts of pickled or smoked food. e. avoid taking large amounts of NSAIDs

a, b, d, e

Which teaching will the nurse include when education a client who is scheduled to have an esophagogastroduodenoscopy (EGD)? Select all that apply. a. anesthesia will be used for sedation b. the procedure takes about 20 to 30 minutes to complete. c. informed consent will be needed prior to the procedure d. a separate test will be required to obtain any needed biopsies. e. you will need to refrain from eating for at least 6 to 8 hours before the EGD. f. you will need to refrain from anal intercourse for at least 72 hours prior to the procedure to reduce risk of bleeding.

a, b, d, e

Which daily behavior of a client with GI problems requires further nursing assessment? Select all that apply. A. Smokes a pack of cigarettes B. Uses Fleet enemas frequently to assist with bowel movements C. Practices intentional relaxation D. Eats multiple servings of fruits E. Takes 325 mg of aspirin at night for arthritic pain F. Exercises for 30 minutes three times weekly G. Travels extensively across the world

a, b, e, g

What are the signs of an intestinal obstruction and what should you do next? Select all that apply. a. peristalsis movements b. rigid, hard bulge in 1 or more abdominal quadrants c. note the quadrant and report findings to the provider d. all the above

a, c (peristalsis movements are rarely seen unless the patient is very thin)

Which teaching will the nurse provide to a community group about early detection of colorectal cancer? Select all that apply. A. Home testing kits are available with a prescription B. Sigmoidoscopy should be performed every 10 years. C. People over 40 years old should be tested for colon cancer. d. Bowel preparation is necessary prior to performance of a colonoscopy. e. Virtual colonoscopies (CT colonography) can be performed every 5 years.

a, d, e

A patient who has a hx of morning hoarseness and coughing/wheezing at night is admitted to the floor. While performing a physical assessment, the pt. complains of dyspepsia, and auscultation of the lungs reveals crackles. The nurse understands that the hx and S/S are consistent with which condition? a. Gastritis b. GERD c. PUD d. Hiatal Hernia

b

The nurse cares for a client receiving famotidine. The client reports resuming smoking and experiencing gastric pain about one after melas. Which response by the nurse is best? a. Smoking decreases stomach acid production, so you will not digest foods easily, b. smoking interferes with the medication's effectiveness, and you are no longer receiving the full anti-ulcer effect. c. Nicotine can increase feelings of anxiety and restlessness, which the medication lowers. d. if you smoke too much, you will become dizzy.

b

Which of the following drugs block dopamine & serotonin receptors to suppress emesis, and are used for GERD & diabetic gastroparesis? a. Prilosec b. Reglan c. Sucralfate d. Antacids

b

Which of the following drugs are H2 blockers that act on parietal cells in the stomach to decrease the production of acid? Select all that apply? a. Prilosec b. Reglan c. Pepsid e. Zantac

c, e

An older client states, "I have indigestion and have been taking lots of OTC cimetidine for 3 weeks for indigestion." Which client statement requires immediate follow up by the nurse? a. I should have consulted my healthcare provider before taking this medication, b. I don't have heartburn since I started taking this medication. c. I take cimetidine at the same time I take antacids d. My child tells me that I seem to be confused at times.

d