Ch 34 Caring for Clients with Upper Gastrointestinal Disorders

12. Which of these factors contributes to a client developing gastritis? a. exposure to irritating substances, i.e., ibuprofen b. impaired esophageal sphincter function c. high-fat diet d. viral infection

ANS: A Gastritis, inflammation of the stomach mucosa, can occur as the result of exposure to medications, smoking, food allergens, or toxic chemicals or from impaired mucosal defenses. Medical management of the client who has gastritis primarily involves prescription of antacids and histamine receptor antagonists. Nursing care focuses on relieving pain and teaching the client to avoid substances that aggravate gastric irritation and to minimize consumption of foods such as milk, coffee, and cola beverages that increase gastric acid secretions.

13. When teaching the client with gastritis, the nurse should include which of these instructions? a. "Avoid eating at bedtime." b. "Drink as much decaffeinated tea and coffee as you like." c. "Drink only milk products and antacids until the pain subsides." d. "Eat anything you want as long as you take your medications on time."

ANS: A Gastritis, inflammation of the stomach mucosa, can occur as the result of exposure to medications, smoking, food allergens, or toxic chemicals or from impaired mucosal defenses. Medical management of the client who has gastritis primarily involves prescription of antacids and histamine receptor antagonists. Nursing care focuses on relieving pain and teaching the client to avoid substances that aggravate gastric irritation and to minimize consumption of foods such as milk, coffee, and cola beverages that increase gastric acid secretions and to avoid eating before lying down or at bedtime.

9. Hematemesis is best described as: a. vomiting blood b. bleeding gastric ulcer c. bloody diarrhea d. black, sticky, tar-like stools

ANS: A Hematemesis is known as vomiting blood.

15. The nursing student is aware that the cause of peptic ulcers is related to: a. acid/pepsin imbalance b. erosive gastritis that starts to bleed c. impaired mucosal defenses d. high secretion of HCl (hydrochloric acid)

ANS: A Peptic ulcers are mucosal erosions that occur in the esophagus, stomach, or duodenum as the result of acid/pepsin imbalance.

2. A nurse has been asked to speak with a high school baseball team about the use of chewing tobacco and the risk of oral cancers. Which of the signs and symptoms below will the nurse teach to the team? a. mouth sore that bleeds easily b. bad breath c. difficulty chewing d. difficulty swallowing e. trouble moving jaw f. sore that won't heal g. a lump or swollen lymph node

ANS: A, C, D, E, F, G Oral cancer refers to cancers of the lips, tongue, oral cavity, and pharynx. Symptoms include a mouth sore that bleeds easily and does not heal, a lump, swollen lymph nodes or difficulty chewing, swallowing, or moving tongue or jaw. The cancerous lesions are often painless. Lip cancer may appear as a sore or lesion that grows gradually and does not heal.

17. A client who has been treated for gastric ulcers will have which of these dietary prescriptions? a. fat controlled diet b. liberal bland diet c. low residue diet d. regular diet

ANS: B A liberal bland diet eliminates gastrointestinal irritants and is prescribed for clients with gastritis and ulcers.

3. Aging of the body makes the client susceptible to which change in the oral cavity? a. excessive salivation b. gingivitis c. vitamin deposits on teeth d. changes in tongue shape

ANS: B As clients age, they are susceptible to dry mouth, gingivitis (inflammation and bleeding of gums) and candida albicans (yeast infection). Good oral hygiene is very important to prevent gum disease and dryness.

8. What clinical symptom distinguishes esophageal varices from bleeding gastric ulcers? a. diarrhea b. constipation c. anorexia d. abdominal pain

ANS: D With esophageal varices, there is no abdominal pain. The symptom of abdominal pain helps distinguish esophageal varices from bleeding gastric ulcers, which generally do cause pain that worsens after eating.

4. A client has undergone a radical neck dissection for cancer of the pharynx and required a tracheostomy postoperatively. A tracheostomy was performed to: a. protect the pharynx b. protect the airway c. prevent aspiration d. protect the larynx

ANS: B Clients undergoing radical neck dissection frequently have a tracheostomy. The tracheostomy is used to protect the airway and prevent obstruction.

5. A nurse is caring for a client who has esophageal varices. A difference of how many mmHg in orthostatic blood pressure could indicate a change in fluid volume and possible recurrence of varix bleeding? a. 10 b. 20 c. 30 d. 40

ANS: B Esophageal varices are enlarged, twisted esophageal veins that are usually associated with chronic liver obstruction such as occurs in cirrhosis; they are asymptomatic until they rupture and hemorrhage. Medical management includes sclerotherapy or ligation; balloon tamponade is used during active bleeding. Medications may also be prescribed to prevent esophageal irritation, to control bleeding, and to control pain following sclerotherapy. Surgical treatment includes creation of a portosystemic shunt or a transjugular intrahepatic portosystemic shunt. Nursing care focuses on monitoring the client's vital signs and overall condition for evidence of bleeding, orthostatic blood pressure (20 mmHg drop) could indicate a change in fluid volume and possible recurrence of varix bleeding and alleviating client anxiety.

19. A client has a gastrectomy and vagotomy for treatment of peptic ulcer disease. Why was the vagotomy performed? a. to anastomose the remaining portion of the stomach to the bowel b. to remove the vagal innervation to the fundus of the stomach c. to remove the perforated section of the stomach or bowel d. to prevent further hemorrhage from the site

ANS: B Gastrectomy, with or without vagotomy (removal of the vagal innervation to the fundus of the stomach), is the surgical treatment used for clients who have perforated ulcers or for ulcers that are resistant to medical treatment.

16. When do clients who have gastric ulcers MOST often complain of pain? a. 2 hours before meals b. 1 to 2 hours after eating c. 3 to 4 hours after eating d. whenever the stomach is empty

ANS: B Gastric ulcers are limited to the stomach and are associated with Helicobacter pylori (H. pylori) infections; exposure to irritants such as smoking, alcohol, and nonsteroidal anti-inflammatory (NSAIDs) medications; or impaired mucosal defenses. Client complains of abdominal pain 1 to 2 hours after eating.

20. A client experiences postprandial rapid gastric dumping after a gastrectomy. Which of these approaches should the nurse include in the client's teaching plan? a. Avoid complex carbohydrates. b. Eat small meals frequently. c. Reduce fiber and protein intake. d. Drink carbonated beverages with meals.

ANS: B Nursing care focuses on monitoring the client for evidence of bleeding, managing pain, and teaching the client how to manage the condition (e.g., avoiding factors that aggravate symptoms such as taking NSAIDs or consuming alcohol), and following the prescribed medication regimen. If the client has a gastrectomy, the nurse should teach the client to observe for development of dumping syndrome as a postoperative complication and encourage clients to eat small, frequent meals.

14. An example of a proton pump inhibitor is: a. calcium carbonate b. ranitidine c. aluminum hydroxide d. omeprazole

ANS: B Omeprazole (Prilosec) reduces gastric secretions and should be given before meals.

18. Stress ulcers are the result of which of these factors? a. acid/pepsin imbalance b. erosive gastritis that starts to bleed c. exposure to irritants d. high secretion of HCl

ANS: B Stress ulcers, one type of gastric ulcer, form when gastritis becomes erosive and occur in clients experiencing stress (e.g., from trauma, burns, or radiation therapy).

1. The nurse is caring for a client diagnosed with gastroesophageal reflux disease (GERD). Which of the following would the nurse expect the health care provider to use to treat this client? (Select all that apply.) a. NPO diet b. fundoplication c. antacids d. low-fat, low-protein diet e. proton pump inhibitors f. increase use of milk products

ANS: B, C, E Medical treatment for gastroesophageal reflux disease (GERD) includes fundoplication, antacids, H2 receptor antagonists, proton pump inhibitors, cytoprotective agents and GI motility agents, and a low-fat and high-protein diet with the reduction of caffeine, milk products, alcohol, peppermint, licorice, and spicy foods.

7. Clients who have a history of esophageal varices should avoid which of the following? a. antibiotics b. antihistamines c. NSAIDs (nonsteroidal anti-inflammatory drugs) d. laxatives

ANS: C Esophageal varices are enlarged, twisted esophageal veins that are usually associated with chronic liver obstruction such as occurs in cirrhosis; they are asymptomatic until they rupture and hemorrhage. Medical management includes medications prescribed to prevent esophageal irritation, to control bleeding, and to control pain following sclerotherapy. Nursing care focuses on monitoring the client's vital signs and overall condition for evidence of bleeding and alleviating client anxiety. Teaching should include avoiding medications, which will promote bleeding such as NSAIDs, aspirin, and anticoagulants.

6. A client is being treated for bleeding esophageal varices with a Sengstaken-Blakemore tube. Nursing care will include which of these approaches? a. allowing the client to assume a position of choice b. emptying the drainage bottle and recording output c. periodically deflating the balloon d. providing sips of ice water every 30 to 45 minutes

ANS: C Esophageal varices are enlarged, twisted esophageal veins that are usually associated with chronic liver obstruction such as occurs in cirrhosis; they are asymptomatic until they rupture and hemorrhage. Medical management includes sclerotherapy or ligation; balloon tamponade is used during active bleeding. Medications may also be prescribed to prevent esophageal irritation, to control bleeding, and to control pain following sclerotherapy. Surgical treatment includes creation of a portosystemic shunt or a transjugular intrahepatic portosystemic shunt. Nursing care focuses on monitoring the client's vital signs and overall condition for evidence of bleeding, periodically deflating the balloon if a Sengstaken-Blakemore tube is used, and alleviating client anxiety.

10. Jaundice is a result of the liver's inability to fully remove which of the below from blood? a. globulin b. albumin c. bilirubin d. glucose

ANS: C If cirrhosis of the liver is present, jaundice, a yellowing of the skin, mucous membranes, and sclera of the eyes, is present. Jaundice results when the liver is unable to fully remove bilirubin from the blood.

2. Oral care for a client with stomatitis should include which of the following? a. alcohol based mouthwash b. firm toothbrush c. saline rinse every 4 hours d. rinse mouth with warm to hot water

ANS: C Nursing management of stomatitis includes monitoring caloric and fluid intake for adequacy, encouraging the client to eat soft, bland foods and cool or room temperature liquids, assessing for mouth discomfort and checking the mouth for inflammation and ulcerations. The nurse should also provide oral care and administer medications as ordered. Instruct client to rinse mouth after eating and to use a soft toothbrush. Clients may use a saline solution to rinse the mouth, however, strong mouth washes containing alcohol should be avoided. Notify physician if pain medications are not effective in relieving discomfort.

1. A client develops stomatitis as a complication of cancer chemotherapy. Which of these approaches should be included in the client's nursing care? a. oral care q.d. b. high-calorie liquid diet c. diet as tolerated d. intravenous (IV) morphine

ANS: C Stomatitis is a disorder of the mouth that is characterized by inflammation and ulcerations resulting from infection, substances that irritate the mucous membranes, or chemotherapy. Medical management includes prescription of topical anesthetics, analgesics, and anti-infectives as necessary. Nursing care focuses on monitoring the client's oral mucous membranes, relieving the client's pain, and maintaining adequate nutrition.

11. In GERD, gastric secretions flow upward into the esophagus, damaging the tissues. This is caused by the inability of which of the below to fully close? a. epiglottis b. upper esophageal sphincter (UES) c. pylorus d. lower esophageal sphincter (LES)

ANS: D In gastroesophageal reflux disease (GERD), gastric secretions flow upward into the esophagus, damaging the tissues. An inability of the lower esophageal sphincter (LES) to fully close contributes to this condition. Environmental and physical factors contribute to decreased pressure in the LES. Fatty foods, caffeine, nicotine, calcium channel blockers, hiatal hernia, and NSAIDs decrease the tightness of the sphincter.