ch. 42 upper GI problems
Which information about dietary management should the nurse include when teaching a patient with peptic ulcer disease (PUD)?
b."Avoid foods that cause pain after you eat them."
Which information will the nurse include for a patient with newly diagnosed gastroesophageal reflux disease (GERD)?
b."Keep the head of your bed elevated on blocks." Elevating the head of the bed will reduce the incidence of reflux while the patient is sleeping.
The nurse is administering IV fluid boluses and nasogastric irrigation to a patient with acute gastrointestinal (GI) bleeding. Which assessment finding is most important for the nurse to communicate to the health care provider?
b.The patient's lungs have crackles audible to the midchest.
Which finding in the mouth of a patient who uses smokeless tobacco is suggestive of oral cancer?
c. Red, velvety patches on the buccal mucosa A red, velvety patch suggests erythroplasia, which has a high incidence (greater than 50%) of progression to squamous cell carcinoma.
A 38-year old woman receiving chemotherapy for breast cancer develops a Candida albicans oral infection. The nurse will anticipate the need for
c. administration of nystatin (Mycostatin) tablets. Candida albicans is treated with an antifungal such as nystatin.
Which order from the health care provider will the nurse implement first for a patient who has vomited 1200 mL of blood?
c.Administer 1000 mL of lactated Ringer's solution. Because the patient has vomited a large amount of blood, correction of hypovolemia and prevention of hypovolemic shock are the priorities.
A 57-year-old man with Escherichia coli O157:H7 food poisoning is admitted to the hospital with bloody diarrhea and dehydration. Which order will the nurse question?
c.Administer loperamide (Imodium) after each stool. Use of antidiarrheal agents is avoided with this type of food poisoning.
A 53-year-old male patient with deep partial-thickness burns from a chemical spill in the workplace experiences severe pain followed by nausea during dressing changes. Which action will be most useful in decreasing the patient's nausea?
c.Administer the prescribed morphine sulfate before dressing changes. Because the patient's nausea is associated with severe pain, it is likely that it is precipitated by stress and pain.
After change-of-shift report, which patient should the nurse assess first?
d.60-year-old with nausea and vomiting who has dry oral mucosa and lethargy
A 62-year-old man patient who requires daily use of a nonsteroidal antiinflammatory drug (NSAID) for the management of severe rheumatoid arthritis has recently developed melena. The nurse will anticipate teaching the patient about
d.misoprostol (Cytotec) to protect the gastrointestinal (GI) mucosa.
The nurse will anticipate teaching a patient experiencing frequent heartburn about
d.proton pump inhibitors.
When a 72-year-old patient is diagnosed with achalasia, the nurse will teach the patient that
d.treatment may include endoscopic procedures. Endoscopic and laparoscopic procedures are the most effective therapy for improving symptoms caused by achalasia.
The nurse explaining esomeprazole (Nexium) to a patient with recurring heartburn describes that the medication
d.treats gastroesophageal reflux disease by decreasing stomach acid production. The proton pump inhibitors decrease the rate of gastric acid secretion. Promotility drugs such as metoclopramide (Reglan) increase the rate of gastric emptying.
Vasopressin (Pitressin) 0.2 units/min infusion is prescribed for a patient with acute arterial gastrointestinal (GI) bleeding. The vasopressin label states vasopressin 100 units/250 mL normal saline. How many mL/hr will the nurse infuse?
30
In which order will the nurse take the following actions when caring for a patient who develops watery diarrhea and a fever after prolonged omeprazole (Prilosec) therapy?
a. Contact the health care provider. b. Assess blood pressure and heart rate. c. Give the PRN acetaminophen (Tylenol). d. Place the patient on contact precautions. ANS: D, B, A, C
Which patient statement indicates that the nurse's teaching following a gastroduodenostomy has been effective?
a."Vitamin supplements may prevent anemia." Cobalamin deficiency may occur after partial gastrectomy, and the patient may need to receive cobalamin via injections or nasal spray
Which information will the nurse include when teaching adults to decrease the risk for cancers of the tongue and buccal mucosa?
a.Avoid use of cigarettes and smokeless tobacco. Tobacco use greatly increases the risk for oral cancer.
Which action should the nurse in the emergency department anticipate for a 23-year-old patient who has had several episodes of bloody diarrhea?
a.Obtain a stool specimen for culture. Patients with bloody diarrhea should have a stool culture for E. coli.
A 50-year-old patient who underwent a gastroduodenostomy (Billroth I) earlier today complains of increasing abdominal pain. The patient has no bowel sounds and 200 mL of bright red nasogastric (NG) drainage in the last hour. The highest priority action by the nurse is to
a.contact the surgeon. Increased pain and 200 mL of bright red NG drainage 12 hours after surgery indicate possible postoperative hemorrhage,
The nurse will anticipate preparing a 71-year-old female patient who is vomiting "coffee-ground" emesis for
a.endoscopy. Endoscopy is the primary tool for visualization and diagnosis of upper gastrointestinal (GI) bleeding
Which medications will the nurse teach the patient about whose peptic ulcer disease is associated with Helicobacter pylori?
b. Amoxicillin (Amoxil), clarithromycin (Biaxin), and omeprazole (Prilosec)
Which information will the nurse include when teaching a patient with peptic ulcer disease about the effect of ranitidine (Zantac)?
b."Ranitidine decreases gastric acid secretion." Ranitidine is a histamine-2 (H2) receptor blocker, which decreases the secretion of gastric acid.
The nurse determines that teaching regarding cobalamin injections has been effective when the patient with chronic atrophic gastritis states which of the following?
b."The cobalamin injections will prevent me from becoming anemic." Cobalamin supplementation prevents the development of pernicious anemia.
A 44-year-old man admitted with a peptic ulcer has a nasogastric (NG) tube in place. When the patient develops sudden, severe upper abdominal pain, diaphoresis, and a firm abdomen, which action should the nurse take?
b.Check the vital signs. The patient's symptoms suggest acute perforation, and the nurse should assess for signs of hypovolemic shock.
Which item should the nurse offer to the patient who is to restart oral intake after being NPO due to nausea and vomiting?
b.Dish of lemon gelatin. Clear cool liquids are usually the first foods started after a patient has been nauseated.
Which nursing action should be included in the postoperative plan of care for a patient after a laparoscopic esophagectomy?
b.Elevate the head of the bed to at least 30 degrees. Elevation of the head of the bed decreases the risk for reflux and aspiration of gastric secretions.
A 49-year-old man has been admitted with hypotension and dehydration after 3 days of nausea and vomiting. Which order from the health care provider will the nurse implement first?
b.Infuse normal saline at 250 mL/hr. Because the patient has severe dehydration, rehydration with IV fluids is the priority.
The nurse and a licensed practical/vocational nurse (LPN/LVN) are working together to care for a patient who had an esophagectomy 2 days ago. Which action by the LPN/LVN requires that the nurse intervene?
b.The LPN/LVN positions the head of the bed in the flat position.
A family member of a 28-year-old patient who has suffered massive abdominal trauma in an automobile accident asks the nurse why the patient is receiving famotidine (Pepcid). The nurse will explain that the medication will
b.inhibit development of stress ulcers. Famotidine is administered to prevent the development of physiologic stress ulcers, which are associated with a major physiologic insult such as massive trauma.
A 68-year-old patient with a bleeding duodenal ulcer has a nasogastric (NG) tube in place, and the health care provider orders 30 mL of aluminum hydroxide/magnesium hydroxide (Maalox) to be instilled through the tube every hour. To evaluate the effectiveness of this treatment, the nurse
b.periodically aspirates and tests gastric pH. Checking gastric pH is the most direct way of evaluating the effectiveness of the medication.
A 26-year-old patient with a family history of stomach cancer asks the nurse about ways to decrease the risk for developing stomach cancer. The nurse will teach the patient to avoid
b.smoked foods such as ham and bacon. Smoked foods such as bacon, ham, and smoked sausage increase the risk for stomach cancer.
A 58-year-old woman who recently has been diagnosed with esophageal cancer tells the nurse, "I do not feel ready to die yet." Which response by the nurse is most appropriate?
c."Having this new diagnosis must be very hard for you." This response is open-ended and will encourage the patient to further discuss feelings of anxiety or sadness about the diagnosis.
A 46-year-old female with gastroesophageal reflux disease (GERD) is experiencing increasing discomfort. Which patient statement indicates that additional teaching about GERD is needed?
c."I eat small meals during the day and have a bedtime snack." GERD is exacerbated by eating late at night, and the nurse should plan to teach the patient to avoid eating at bedtime.
Which patient should the nurse assess first after receiving change-of-shift report?
c.A patient with esophageal varices who has a blood pressure of 92/58 mm Hg. The patient's history and blood pressure indicate possible hemodynamic instability caused by GI bleeding.
A 26-year-old woman has been admitted to the emergency department with nausea and vomiting. Which action could the RN delegate to unlicensed assistive personnel (UAP)?
c.Assist the patient with oral care.
Which patient choice for a snack 2 hours before bedtime indicates that the nurse's teaching about gastroesophageal reflux disease (GERD) has been effective?
c.Cherry gelatin with fruit Gelatin and fruit are low fat and will not decrease lower esophageal sphincter (LES) pressure.
An 80-year-old who is hospitalized with peptic ulcer disease develops new-onset auditory hallucinations. Which prescribed medication will the nurse discuss with the health care provider before administration?
c.Metoclopramide (Reglan) Metoclopramide can cause central nervous system (CNS) side effects ranging from anxiety to hallucinations.
After the nurse has completed teaching a patient with newly diagnosed eosinophilic esophagitis about the management of the disease, which patient action indicates that the teaching has been effective?
c.Patient schedules an appointment for allergy testing.
The nurse is assessing a patient who had a total gastrectomy 8 hours ago. What information is most important to report to the health care provider?
c.Temperature 102.1° F (38.9° C)
A patient returned from a laparoscopic Nissen fundoplication for hiatal hernia 4 hours ago. Which assessment finding is most important for the nurse to address immediately?
c.The patient has absent breath sounds in the left anterior chest. Decreased breath sounds on one side may indicate a pneumothorax
A 58-year-old patient has just been admitted to the emergency department with nausea and vomiting. Which information requires the most rapid intervention by the nurse?
c.The patient is lethargic and difficult to arouse. A lethargic patient is at risk for aspiration, and the nurse will need to position the patient to decrease aspiration risk
A 68-year-old male patient with a stroke is unconscious and unresponsive to stimuli. After learning that the patient has a history of gastroesophageal reflux disease (GERD), the nurse will plan to do frequent assessments of the patient's
c.breath sounds. Because GERD may cause aspiration, the unconscious patient is at risk for developing aspiration pneumonia.
At his first postoperative checkup appointment after a gastrojejunostomy (Billroth II), a patient reports that dizziness, weakness, and palpitations occur about 20 minutes after each meal. The nurse will teach the patient to
c.lie down for about 30 minutes after eating. The patient is experiencing symptoms of dumping syndrome, which may be reduced by lying down after eating.
A 73-year-old patient is diagnosed with stomach cancer after an unintended 20-pound weight loss. Which nursing action will be included in the plan of care?
d.Offer supplemental feedings between meals.
Which assessment should the nurse perform first for a patient who just vomited bright red blood?
d.Taking the blood pressure (BP) and pulse
The health care provider prescribes antacids and sucralfate (Carafate) for treatment of a patient's peptic ulcer. The nurse will teach the patient to take
d.antacids after meals and sucralfate 30 minutes before meals.
A 50-year-old man vomiting blood-streaked fluid is admitted to the hospital with acute gastritis. To determine possible risk factors for gastritis, the nurse will ask the patient about
d.use of nonsteroidal antiinflammatory drugs (NSAIDs). Use of an NSAID is associated with damage to the gastric mucosa, which can result in acute gastritis.
