GI prepu quiz prep

To prevent gastroesophageal reflux in a client with hiatal hernia, the nurse should provide which discharge instruction? a) "Avoid coffee and alcoholic beverages." b) "Lie down after meals to promote digestion." c) "Limit fluid intake with meals." d) "Take antacids with meals."

"Avoid coffee and alcoholic beverages." To prevent reflux of stomach acid into the esophagus, the nurse should advise the client to avoid foods and beverages that increase stomach acid, such as coffee and alcohol. The nurse also should teach the client to avoid lying down after meals, which can aggravate reflux, and to take antacids after eating. The client need not limit fluid intake with meals as long as the fluids aren't gastric irritants. (less)

A client who underwent abdominal surgery and has a nasogastric (NG) tube in place begins to complain of abdominal pain that he describes as "feeling full and uncomfortable." Which assessment should the nurse perform first? a) Assess patency of the NG tube. b) Assess vital signs. c) Measure abdominal girth. d) Auscultate bowel sounds.

Assess patency of the NG tube. When an NG tube is no longer patent, stomach contents collect in the stomach, giving the client a sensation of fullness. The nurse should begin by assessing patency of the NG tube. The nurse can measure abdominal girth, auscultate bowels, and assess vital signs, but she should check NG tube patency first to help relieve the client's discomfort. (less)

A nurse is inserting a nasogastric tube in an alert client. During the procedure, the client begins to cough constantly and has difficulty breathing. The nurse suspects the nasogastric tube is a) Coiling in the client's mouth b) Irritating the epiglottis c) Inserted into the lungs d) Passing into the esophagus

Inserted into the lungs The alert client may cough constantly and have difficulty with respirations when the nasogastric tube enters the lungs. The client may cough but will not have difficulty with respirations with the nasogastric tube coiling in the mouth or irritating the epiglottis. Usually if the nastogastric tube is entering the esophagus, the client will not exhibit coughing or dyspnea. (less)

Which of the following would be an intervention for a patient with a chemical burn to the esophagus? a) Gastric lavage b) Soft diet c) Insertion of nasogastric (NG) tube d) Vomiting

Insertion of nasogastric (NG) tube An NG tube may be inserted by the medical team. Vomiting and gastric lavage are avoided to prevent further exposure of the esophagus to the caustic agent. The patient is given nothing by mouth, and IV fluids are administered. (less)

A client has a new order for metoclorpramide (Reglan). The nurse knows that this medication should not be used long term and only in cases where all other options have been exhausted. This is because this medication has the potential for extrapyramidal side effects. Extrapyramidal side effects include which of the following? a) Anxiety or irritability b) Dry mouth not relieved by sugar-free hard candy c) Excessive drowsiness d) Uncontrolled rhythmic movements of the face or limbs

Uncontrolled rhythmic movements of the face or limbs Metoclorpramide is a prokinetic agent that accelerates gastric emptying. Because metoclopramide can have extrapyramidal side effects that are increased in certain neuromuscular disorders, such as Parkinson's disease, it should be used only if no other option exists, and the client should be monitored closely. It is contraindicated with hemorrhage or perforation. It is not used to treat gastritis. (less)

Which of the following is the gold standard for assessing placement of a nasogastric (NG) tube for the patient receiving feedings? a) pH testing b) X-ray c) Visual assessment of aspiration d) Use of capnographic device

X-ray The gold standard for verifying placement of a blindly inserted tube is radiographic or X-ray confirmation. X-ray confirmation is necessary if the patient will be receiving feedings or medications through the tube. When the tube is used to remove air or fluid and not for instillation, the nurse can use a combination of visually assessing the aspirate, testing its pH, and using capnographic devices to initially determine placement. (less)

When caring for a client with the nursing diagnosis Impaired swallowing related to neuromuscular impairment, the nurse should: a) place the client in a supine position. b) encourage the client to remove dentures. c) elevate the head of the bed 90 degrees during meals. d) encourage thin liquids for dietary intake.

elevate the head of the bed 90 degrees during meals. The head of the bed must be elevated while the client is eating. The client should be placed in a recumbent position — not a supine position — when lying down to reduce the risk of aspiration. The nurse should encourage the client to wear properly fitted dentures to enhance his chewing ability. Thick liquids — not thin — decrease the risk of aspiration. (less)

A client has a nasogastric tube for continuous tube feeding. The nurse does all the following every shift to verify placement (select all options that apply): a) Confirms the tip of the tube with radiology b) Checks the pH of the gastric contents c) Inserts 30 mL of tap water through the nasogastric tube d) Visually assesses the color of the aspirate e) Compares exposed tube length with original measurement

• Compares exposed tube length with original measurement • Visually assesses the color of the aspirate • Checks the pH of the gastric contents The nasogastric tube must be checked every shift for placement when a client is receiving continuous feedings. Recommended methods are comparing the exposed nasogastric tube length to the original measurement, visually assessing the color of the aspirate, and checking the pH of the gastric contents with a pH sensor. Confirming tube placement with radiology is costly and may be performed at the time of initial insertion. Inserting tap water through the nasogastric tube does not verify placement. (less)

A nurse is teaching a client what to expect following a barium enema. Which client statement indicates a need for further teaching? a) "I won't need a laxative after the procedure." b) "I should report when I have a bowel movement." c) "I should increase my fluid intake to 2,000 to 3,000 ml/day." d) "I should limit my fiber intake for 1 to 2 weeks following the procedure."

"I should limit my fiber intake for 1 to 2 weeks following the procedure." There's no need to limit fiber intake after a barium enema. The client may resume his normal diet. Barium may increase stool elimination, so there's no need for a laxative after the procedure. The client should increase fluid intake to facilitate barium elimination. The client should report bowel movements so the nurse can ensure that barium elimination occurs. (less)

A client is diagnosed with a hiatal hernia. Which statement indicates effective client teaching about hiatal hernia and its treatment? a) "I'll lie down immediately after a meal." b) "I'll eat three large meals every day without any food restrictions." c) "I'll gradually increase the amount of heavy lifting I do." d) "I'll eat frequent, small, bland meals that are high in fiber."

"I'll eat frequent, small, bland meals that are high in fiber." The head of the bed must be elevated while the client is eating. The client should be placed in a recumbent position — not a supine position — when lying down to reduce the risk of aspiration. The nurse should encourage the client to wear properly fitted dentures to enhance his chewing ability. Thick liquids — not thin — decrease the risk of aspiration. (less)

A nurse is caring for a patient with a Salem sump gastric tube attached to low intermittent suction for decompression. The patient asks, "What's this blue part of the tube for?" Which response by the nurse would be most appropriate? a) "It is a vent that prevents backflow of the secretions." b) "It acts as a siphon, pulling secretions into the clear tubing." c) "It helps regulate the pressure on the suction machine." d) "It works as a marker to make sure that the tube stays in place."

"It is a vent that prevents backflow of the secretions." The blue part of the Salem sump tube vents the larger suction-drainage tube to the atmosphere and, when kept above the patient's waist, prevents reflux of gastric contents through it. Otherwise it acts as a siphon. A gauge on the suction device regulates the pressure of the device. The tube has markings on it to aid in measurement. (less)

The nurse teaches the patient with gastroesophageal reflux disease (GERD) which of the following measures to manage his disease? a) Elevate the foot of the bed on 6- to 8-inch blocks b) Avoid eating or drinking 2 hours before bedtime c) Minimize intake of caffeine, beer, milk, and foods containing peppermint and spearmint d) Eat a low carbohydrate diet

Avoid eating or drinking 2 hours before bedtime The patient should not recline with a full stomach. The patient should be instructed to avoid the listed foods and food components. The patient should be instructed to elevate the head of the bed on 6- to 8-inch blocks. The patient is instructed to eat a low-fat diet. (less)

The nurse instructs the client with gastroesophageal reflux disease (GERD) regarding dietary measures. The client has understood the recommended dietary changes by: a) Avoiding steamed foods. b) Avoiding chocolate and coffee. c) Eliminating spicy foods. d) Eliminating cucumbers and other foods with seeds.

Avoiding chocolate and coffee. Chocolate, tea, cola, and caffeine lower esophageal sphincter pressure, thereby increasing reflux. Clients do not need to eliminate spicy foods unless such foods bother them. Foods with seeds are restricted in diverticulosis. Steamed foods are encouraged to retain vitamins and decrease fat intake. (less)

The hydrogen breath test was developed to evaluate which type of absorption? a) Fat b) Protein c) Carbohydrate d) Vitamin B12

Carbohydrate

A client with a feeding tube is to receive medication. The medication supplied is an enteric-coated tablet. Which of the following would be most appropriate? a) Sprinkle the contents of the opened tablet into the tube. b) Check with the pharmacist to see of a liquid form is available. c) Dissolve the tablet in water after crushing it. d) Give the tablet as is in its original state.

Check with the pharmacist to see of a liquid form is available. Enteric-coated tablets due to their formulation cannot be crushed. Rather the nurse would need to contact the pharmacist to see if there is a liquid form available. Some time-released tablet forms can be opened but cannot be crushed because doing so may release too much of the drug too quickly Giving the tablet as is in its original form would be inappropriate because it would not pass through the tube, thus not reaching its intended site for absorption. (less)

If a client's central venous catheter accidentally becomes disconnected, what should a nurse do first? a) Call the physician. b) Clamp the catheter. c) Apply a dry sterile dressing to the site. d) Tell the client to take and hold a deep breath.

Clamp the catheter. If a central venous catheter becomes disconnected, the nurse should immediately apply a catheter clamp. If a clamp isn't available, the nurse may place a sterile syringe or catheter plug in the catheter hub. After cleaning the hub with alcohol or povidone-iodine solution, the nurse must replace the I.V. extension set and restart the infusion. Calling the physician, applying a dry sterile dressing to the site, and telling the client to take a deep breath aren't appropriate interventions at this time. (less)

Nursing students are reviewing information about various gastrointestinal tubes. They demonstrate a need for additional study when they identify which of the following as a nasogastric tube? a) Salem b) Sengstaken-Blakemore c) Dobbhoff d) Levin

Dobbhoff The Dobbhoff tube is a nasoenteric feeding tube. Levin, Salem, and Sengstaken-Blakemore tubes are nasogastric. (less)

Rebound hypoglycemia is a complication of parental nutrition caused by which of the following? a) Fluid infusing rapidly b) Cap missing from the port c) Glucose intolerance d) Feedings stopped too abruptly

Feedings stopped too abruptly Rebound hypoglycemia occurs when the feedings are stopped too abruptly. Hyperglycemia is caused by glucose intolerance. Fluid overload is caused by fluids infusing too rapidly. Air embolism can occur from a missing cap on a port. (less)

A client has a gastrointestinal tube that enters the stomach through a surgically created opening in the abdominal wall. The nurse documents this as which of the following? a) Orogastric tube b) Nasogastric tube c) Gastrostomy tube d) Jejunostomy tube

Gastrostomy tube A gastrostomy tube enters the stomach through a surgically created opening into the abdominal wall. A jejunostomy tube enters jejunum or small intestine through a surgically created opening into the abdominal wall. A nasogastric tube passes through the nose into the stomach via the esophagus. An orogastric tube passes through the mouth into the stomach. (less)

A patient is receiving parenteral nutrition. The current solution is nearing completion, and a new solution is to be hung, but it has not arrived from the pharmacy. Which action by the nurse would be most appropriate? a) Have someone go to the pharmacy to obtain the new solution. b) Hang a solution of dextrose 10% and water until the new solution is available. c) Begin an infusion of normal saline in another site to maintain hydration. d) Slow the current infusion rate so that it will last until the new solution arrives.

Hang a solution of dextrose 10% and water until the new solution is available. The infusion rate of the solution should not be increased or decreased; if the solution is to run out, a solution of 10% dextrose and water is used until the next solution is available. Having someone go to the pharmacy would be appropriate, but there is no way to determine if the person will arrive back before the solution runs out. Starting another infusion would be inappropriate. Additionally, the infusion needs to be maintained through the central venous access device to maintain patency. (less)

A client presents to the emergency department, reporting that he has been vomiting every 30 to 40 minutes for the past 8 hours. Frequent vomiting puts this client at risk for which imbalances? a) Metabolic acidosis and hypokalemia b) Metabolic alkalosis and hypokalemia c) Metabolic alkalosis and hyperkalemia d) Metabolic acidosis and hyperkalemia

Metabolic alkalosis and hypokalemia Gastric acid contains large amounts of potassium, chloride, and hydrogen ions. Excessive vomiting causes loss of these substances, which can lead to metabolic alkalosis and hypokalemia. Excessive vomiting doesn't cause metabolic acidosis or hyperkalemia. (less)

Which of the following is the most common symptom of gastrointestinal (GI) problems in general? a) Nausea b) Vomiting c) Dysphagia d) Odynophagia

Nausea Nausea is the most common symptoms of GI problems in general. Vomiting is a nonspecific symptom that may have a variety of causes. Dysphagia may vary from an uncomfortable feeling that a bolus of food is caught in the upper esophagus to acute pain on swallowing. Odynophagia refers to acute pain on swallowing. (less)

A group of students is reviewing the medications that may be used to treat esophageal reflux. The students demonstrate understanding of the information when they identify which of the following as an example of a proton-pump inhibitor? a) Cisapride (Propulsid) b) Sucralfate (Carafate) c) Ranitidine (Zantac) d) Omeprazole (Prilosec)

Omeprazole (Prilosec) Proton-pump inhibitors include omeprazole (Prilosec) and lansoprazole (Prevacid). Ranitidine (Zantac) is a histamine-2 antagonist; sucralfate (Carafate) is a cytoprotective agent; cisapride (Propulsid) is a gastrointestinal motility agent. (less)

Tube feedings are given to a patient after an oral surgery. The nurse manages tube feedings to minimize the risk of aspiration. Which of the following measures should the nurse include in the care plan to reduce the risk of aspiration? a) Change tube feeding container and tubing b) Administer 15 to 30 mL of water before and after medications and feedings c) Place patient in semi-Fowler's position during and 60 minutes after an intermittent feeding d) Avoid cessation of feedings

Place patient in semi-Fowler's position during and 60 minutes after an intermittent feeding To minimize the risk of aspiration, it is important to place the patient in a semi-Fowler's position during and 60 minutes after an intermittent feeding because proper positioning prevents regurgitation. Checking tube placement and gastric residual prior to feedings is another important measure because it prevents improper infusion and vomiting. If aspiration is suspected, feeding should be stopped as cessation prevents further problems and allows for treatment of the immediate problem. Changing tube feeding container and tubing, monitoring weight daily, and administering 15 to 30 mL of water before and after medications and feedings are measures to maintain tube function. (less)

Which of the following terms refers to the symptom of gastroesophageal reflux disease (GERD) which is characterized by a burning sensation in the esophagus? a) Dysphagia b) Dyspepsia c) Pyrosis d) Odynophagia

Pyrosis Pyrosis refers to a burning sensation in the esophagus and indicates GERD. Indigestion is termed dyspepsia. Difficulty swallowing is termed dysphagia. Pain on swallowing is termed odynophagia. (less)

A patient is receiving continuous tube feedings. The nurse would maintain the patient in which position at all times? a) Side-lying with the head slightly lower than the chest b) High Fowler's with the patient sitting erect c) Supine with a small pillow under the patient's head d) Semi-Fowler's with the head of the bed elevated 30 to 45 degrees

Semi-Fowler's with the head of the bed elevated 30 to 45 degrees For the patient receiving continuous enteral feedings, the nurse would position the patient in the semi-Fowler's position with the head of the bed elevated 30 to 45 degrees at all times to reduce the risk of reflux and aspiration. This is the only appropriate patient position. (less)

Which patient teaching component is important for the nurse to communicate regarding pain management prior to or during diagnostic testing for a disorder of the GI system? a) The patient should lie down in a supine position for at least 3 hours before the test to reduce any discomfort during the test. b) The patient should inform the test personnel if he or she experiences pressure or cramping during the instillation of test fluids. c) The patient should not expel gas and test fluids from the bowel when he or she experiences the urge during the procedure. d) The patient should take a sedative before the procedure to avoid the possibility of experiencing any discomfort.

The patient should inform the test personnel if he or she experiences pressure or cramping during the instillation of test fluids.

The client is experiencing swallowing difficulties and is now scheduled to receive a gastric feeding. She has the following oral medications prescribed: furosemide (Lasix), digoxin, enteric coated aspirin (Ecotrin), and vitamin E. The nurse withholds a) enteric coated aspirin b) digoxin c) vitamin E d) furosemide

enteric coated aspirin Simple compressed tablets (furosemide, digoxin) may be crushed and dissolved in water. Soft gelatin capsules filled with liquid (vitamin E) may be opened, and the contents squeezed out. Enteric coated tablets (enteric coated aspirin) are not to be crushed and a change in the form of the medications is required. (less)

A client who reports increasing difficulty swallowing, weight loss, and fatigue is diagnosed with esophageal cancer. Because this client has difficulty swallowing, the nurse should assign highest priority to: a) helping the client cope with body image changes. b) ensuring adequate nutrition. c) preventing injury. d) maintaining a patent airway.

maintaining a patent airway. Rapid growth of cancer cells in the esophagus may put pressure on the adjacent trachea, jeopardizing the airway. Therefore, maintaining a patent airway is the highest care priority for a client with esophageal cancer. Helping the client cope with body image changes, ensuring adequate nutrition, and preventing injury are appropriate for a client with this disease, but are less crucial than maintaining airway patency. (less)

The patient is on a continuous tube feeding. The tube placement should be checked every a) 24 hours. b) 12 hours. c) shift. d) hour.

shift Each nurse caring for the patient is responsible for verifying that the tube is located in the proper area for continuous feeding. Checking for placement each hour is unnecessary unless the patient is extremely restless or there is basis for rechecking the tube based on other patient activities. Checking for placement every 12 or 24 hours does not meet the standard of care due the patient receiving continuous tube feedings. (less)

The most significant complication related to continuous tube feedings is a) the interruption of GI integrity, b) an interruption in fat metabolism and lipoprotein synthesis. c) the potential for aspiration, d) a disturbance in the sequence of intestinal and hepatic metabolism.

the potential for aspiration, Because the normal swallowing mechanism is bypassed, consideration of the danger of aspiration must be foremost in the mind of the nurse caring for the patient receiving continuous tube feedings. Tube feedings preserve GI integrity by intraluminal delivery of nutrients. Tube feedings preserve the normal sequence of intestinal and hepatic metabolism. Tube feedings maintain fat metabolism and lipoprotein synthesis. (less)

A nurse is assessing a patient receiving tube feedings and suspects dumping syndrome. Which of the following would lead the nurse to suspect this? Select all that apply. a) Diarrhea b) Decreased bowel sounds c) Hypertension d) Diaphoresis e) Tachycardia

• Diarrhea • Tachycardia • Diaphoresis Dumping syndrome is manifested by hypotension, diarrhea, tachycardia, and diaphoresis. The patient often reports a feeling of fullness, nausea, and vomiting. Because of the rapid movement of water to the stomach and intestines, bowel sounds would most likely be increased. (less)

Which of the following is a proton pump inhibitor used in the treatment of gastroesophageal reflux disease (GERD)? Select all that apply. a) Rabeprazole (AcipHex) b) Lansoprazole (Prevacid) c) Famotidine (Pepcid) d) Esomeprazole (Nexium) e) Nizatidine (Axid)

• Lansoprazole (Prevacid) • Rabeprazole (AcipHex) • Esomeprazole (Nexium)

Which of the following are clinical manifestations of gastroesophageal reflux disease (GERD)? Select all that apply. a) Regurgitation b) Pyrosis c) Hypersalivation d) Esophagitis e) Dyspepsia

• Regurgitation • Dyspepsia • Pyrosis • Hypersalivation • Esophagitis Symptoms of GERD may include pyrosis, dyspepsia, regurgitation, dysphagia or odynophagia, hypersalivation, and esophagitis. (less)