NUS111: ELIMINATION/DIGESTION REVIEW

Which diagnostic test would be used first to evaluate a client with upper GI bleeding? Upper GI series Endoscopy Hemoglobin and hematocrit Arteriography

Hemoglobin and hematocrit Explanation: The nurse assesses for faintness or dizziness and nausea, which may precede or accompany bleeding. It is important to monitor vital signs frequently and to evaluate for tachycardia, hypotension, and tachypnea. Other nursing interventions include monitoring the hemoglobin and hematocrit, testing the stool for gross or occult blood, and recording hourly urinary output to detect anuria or oliguria (absence of or decreased urine production). If bleeding cannot be managed by the measures described, other treatment modalities such as endoscopy may be used to halt bleeding and avoid surgical intervention. There is debate regarding how soon endoscopy should be performed. Some clinicians believe endoscopy should be performed within the first 24 hours after hemorrhaging has ceased. Others believe endoscopy may be performed during acute bleeding, as long as the esophageal or gastric area can be visualized (blood may decrease visibility). An upper GI is less accurate than endoscopy and would not reveal a bleed. Arteriography is an invasive study associated with life-threatening complications and would not be used for an initial evaluation.

After relocating to new community, a 60-year-old man has presented for care to a nurse practitioner. During the nurse's initial health assessment, the man states that he has had a diagnosis of gastroesophageal reflux disease (GERD) for several years. The nurse should anticipate that a medication reconciliation is likely to reveal that the man has been prescribed: A calcium channel blocker A proton pump inhibitor (PPI) A bisphosphonate A nitrate

A proton pump inhibitor (PPI) Explanation: PPIs are frequently effective in the treatment of GERD. Nitrates, bisphosphonates, and calcium channel blockers are not relevant to the treatment of GERD.

The nurse is caring for a client recovering from an esophagogastroduodenoscopy (EGD). Which of the following client symptoms would require further nursing assessment? Drowsiness Abdominal distention Sore throat Thirst

Abdominal distention Explanation: The nurse is correct to fully assess the client experiencing abdominal distention following an esophagogastroduodenoscopy (EGD). Abdominal distention could indicate complications such as perforation and bleeding. The client experiences drowsiness from the sedative during the early recovery process and a sore throat from passage of the scope. The client may also experience thirst because the client has not had liquids for a period of time.

A client is admitted with a new onset of pyloric obstruction. What client symptoms should the nurse anticipate? Select all that apply. Anorexia Nausea and vomiting Diarrhea Weight loss Epigastric fullness

Anorexia Nausea and vomiting Epigastric fullness

Diagnostic testing has attributed a middle-aged man's peptic ulcer to Helicobacter pylori, and the man has been prescribed a therapeutic drug regimen. Which of the following drug families will form the basis of the man's drug therapy? Select all that apply. Antibiotics Prokinetics (GI stimulants) Antiemetics Antacids Proton pump inhibitors

Antibiotics Proton pump inhibitors Explanation: Currently, the most commonly used therapy for peptic ulcers is a combination of antibiotics, proton pump inhibitors, and bismuth salts that suppress or eradicate H. pylori. Prokinetics are not used. Antiemetics and antacids may provide some symptom relief, but neither will resolve the underlying health problem.

A patient diagnosed with esophageal reflux disorder has been admitted to the floor. When planning teaching for this patient what should the nurse advise the patient to do? Keep the head of the bed lowered. Drink a cup of hot tea before bedtime. Avoid carbonated drinks. Drink a carbonated drink after meals.

Avoid carbonated drinks. Explanation: For a patient diagnosed with esophageal reflux disorder, the nurse should instruct the patient to keep the head of the bed elevated. Carbonated drinks, caffeine, and tobacco should be avoided. A high-fiber, low-fat diet should be eaten daily.

The nurse is assessing a client who is stating gastrointestinal upset and a feeling of bloating. Which type of meal would the nurse anticipate causing these types of symptoms? Grilled chicken on a spinach salad Steamed rice with pork and broccoli Hamburger and French fries Salmon with cheddar mashed potatoes

Hamburger and French fries Explanation: Fatty foods delay stomach emptying (bloating) and can cause symptoms of gastrointestinal upset. Fried and deep fried foods contain elevated amounts of fat. The other options have a lower fat content.

Rebleeding may occur from a peptic ulcer and often warrants surgical interventions. Signs of bleeding include which of the following? Mental confusion Bradycardia Bradypnea Hypertension

Mental confusion Explanation: Signs of bleeding include tachycardia, tachypnea, hypotension, mental confusion, thirst, and oliguria.

The nurse is conducting a community education class on gastritis. The nurse includes that chronic gastritis caused by Helicobacter pylori is implicated in which disease/condition? Pernicious anemia Systemic infection Peptic ulcers Colostomy

Peptic ulcers Explanation: Chronic gastritis caused by Helicobacter pylori is implicated in the development of peptic ulcers. Chronic gastritis is sometimes associated with autoimmune disease, such as pernicious anemia, but not as a cause of the anemia. Chronic gastritis is not implicated in system infections and/or colostomies. Reference:

A nurse is caring for a client who is suspected to have developed a peptic ulcer hemorrhage. Which action would the nurse perform first? Place the client in a recumbent position with the legs elevated. Prepare a peripheral and central line for intravenous infusion. Assess vital signs. Notify the healthcare provider.

Place the client in a recumbent position with the legs elevated. Explanation: The treatment of hemorrhage includes complete rest for the GI tract, placing the client in a recumbent position with the legs elevated to increase blood flow to vital organs, blood transfusions, and gastric lavage with saline solution. Placing an IV, checking the client's vital signs, and notifying the healthcare provider are important, but not the priority action for the nurse when a client is actively bleeding.

A nurse is monitoring a client with peptic ulcer disease. Which assessment findings would most likely indicate perforation of the ulcer? Select all that apply. Tachycardia Hypotension Mild epigastric pain A rigid, board-like abdomen Diarrhea

Tachycardia Hypotension A rigid, board-like abdomen

A client has a new order for metoclopramide. What extrapyramidal side effect should the nurse assess for in the client? Anxiety or irritability Hyperactivity Uncontrolled rhythmic movements of the face or limbs Dry mouth not relieved by sugar-free hard candy

Uncontrolled rhythmic movements of the face or limbs Explanation: Metoclopramide 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 for uncontrolled rhythmic movements of the face or limbs. Metoclopramide side effects are headache, confusion, and drowsiness. Anxiety, hyperactivity, and a dry mouth are not common side effects.

Which statement correctly identifies a difference between duodenal and gastric ulcers? Malignancy is associated with duodenal ulcer. Weight gain may occur with a gastric ulcer. A gastric ulcer is caused by hypersecretion of stomach acid. Vomiting is uncommon in clients with duodenal ulcers.

Vomiting is uncommon in clients with duodenal ulcers. Explanation: Vomiting is uncommon in clients diagnosed with duodenal ulcer. Malignancy is associated with a gastric ulcer. Weight gain may occur with a duodenal ulcer. Duodenal ulcers cause hypersecretion of stomach acid.

A nurse is teaching a group of middle-aged men about peptic ulcers. When discussing risk factors for peptic ulcers, the nurse should mention: a sedentary lifestyle and smoking. a history of hemorrhoids and smoking. alcohol abuse and a history of acute renal failure. alcohol abuse and smoking.

alcohol abuse and smoking. Explanation: The nurse should mention that risk factors for peptic (gastric and duodenal) ulcers include alcohol abuse, smoking, and stress. A sedentary lifestyle and a history of hemorrhoids aren't risk factors for peptic ulcers. Chronic renal failure, not acute renal failure, is associated with duodenal ulcers.

The most common symptom of esophageal disease is nausea. vomiting. dysphagia. odynophagia.

dysphagia. Explanation: Dysphagia may vary from an uncomfortable feeling that a bolus of food is caught in the upper esophagus to acute pain upon swallowing. Nausea is the most common symptom of gastrointestinal problems in general. Vomiting is a nonspecific symptom that may have a variety of causes. Odynophagia refers specifically to acute pain upon swallowing. Reference:

A nurse is providing education to a client with GERD. The client asks what measures can be taken independently to help reduce the symptoms. Which interventions would the nurse recommend? Select all that apply. maintaining an upright position following meals avoiding foods that intensify symptoms sleeping in a supine position ensuring intake of food and fluids 2 to 3 hours before bedtime

maintaining an upright position following meals avoiding foods that intensify symptoms

The nurse is evaluating a client's ulcer symptoms to differentiate ulcer as duodenal or gastric. Which symptom should the nurse at attribute to a duodenal ulcer? Vomiting Hemorrhage Awakening in pain Weight loss

Awakening in pain Explanation: The client with a gastric ulcer often awakens between 1 to 2 AM with pain, and ingestion of food brings relief. Vomiting is uncommon in clients with duodenal ulcer. Hemorrhage is less likely in clients with duodenal ulcer than those with gastric ulcer. The client with a duodenal ulcer may experience weight gain.

The nurse instructs the client with gastroesophageal reflux disease (GERD) regarding dietary measures. Which action by the client demonstrates that the client has understood the recommended dietary changes? Eliminating spicy foods. Avoiding chocolate and coffee. Eliminating cucumbers and other foods with seeds. Avoiding steamed foods.

Avoiding chocolate and coffee. Explanation: 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.

The nurse is working in a diagnostic testing unit focusing on gastrointestinal studies. For which testing procedure is the nurse correct to assess the gag reflex before offering fluids? Esophagogastroduodenoscopy Sigmoidoscopy Peritoneoscopy Colonoscopy

Esophagogastroduodenoscopy Explanation: The nurse is correct to assess the gag reflex prior to offering fluids for a client having an esophagogastroduodenoscopy (EGD). The other options are lower gastrointestinal studies typically requiring a bowel preparation.

A patient describes a burning sensation in the esophagus, pain when swallowing, and frequent indigestion. What does the nurse suspect that these clinical manifestations indicate? Peptic ulcer disease Esophageal cancer Gastroesophageal reflux disease Diverticulitis

Gastroesophageal reflux disease Explanation: Symptoms may include pyrosis (burning sensation in the esophagus), dyspepsia (indigestion), regurgitation, dysphagia or odynophagia (pain on swallowing), hypersalivation, and esophagitis

The nurse teaches the client with gastroesophageal reflux disease (GERD) which measure to manage the disease? Consume foods containing peppermint or spearmint. Avoid eating or drinking 2 hours before bedtime. Elevate the foot of the bed on 6- to 8-inch blocks. Eat a low-carbohydrate diet.

Avoid eating or drinking 2 hours before bedtime. Explanation: The client should not recline with a full stomach. The client should be instructed to avoid caffeine, beer, milk, and foods containing peppermint or spearmint, and to eat a low-fat diet. The client should be instructed to elevate the head of the bed on 6- to 8-inch blocks.

A nurse is assessing a client who reports abdominal pain, nausea, and diarrhea. When examining the client's abdomen, which sequence should the nurse use? Inspection, palpation, percussion, and auscultation Inspection, auscultation, percussion, and palpation Auscultation, inspection, percussion, and palpation Palpation, auscultation, percussion, and inspection

Inspection, auscultation, percussion, and palpation Explanation: The correct sequence for abdominal examination is inspection, auscultation, percussion, and palpation. This sequence differs from that used for other body regions (inspection, palpation, percussion, and auscultation) because palpation and percussion increase intestinal activity, altering bowel sounds. Therefore, the nurse shouldn't palpate or percuss the abdomen before auscultating. Assessment of any body system or region starts with inspection; therefore, auscultating or palpating the abdomen first would be incorrect.

A patient comes to the clinic with the complaint, "I think I have an ulcer." What is a characteristic associated with peptic ulcer pain that the nurse should inquire about? Select all that apply. Burning sensation localized in the back or mid-epigastrium Feeling of emptiness that precedes meals from 1 to 3 hours Severe gnawing pain that increases in severity as the day progresses Pain that radiates to the shoulder or jaw Vomiting without associated nausea

Burning sensation localized in the back or mid-epigastrium Feeling of emptiness that precedes meals from 1 to 3 hours Severe gnawing pain that increases in severity as the day progresses

A client with peptic ulcer disease wants to know nonpharmacologic ways to prevent recurrence. Which of the following measures would the nurse recommend? Select all that apply. Smoking cessation Substitution of coffee with decaffeinated products Avoidance of alcohol Eating whenever hungry Following a regular schedule for rest, relaxation, and meals

Smoking cessation Avoidance of alcohol Following a regular schedule for rest, relaxation, and meals

Which of the following interventions are appropriate for clients with gastritis? Select all that apply. Use a calm approach to reduce anxiety. Give the client food and fluids every 4 hours. Discourage cigarette smoking. Notify the physician of inidicators of hemorrhagic gastritis. Provide general education about how to prevent recurrences.

Use a calm approach to reduce anxiety. Discourage cigarette smoking. Notify the physician of inidicators of hemorrhagic gastritis.

A client with a peptic ulcer is about to begin a therapeutic regimen that includes a bland diet, antacids, and famotidine. Before the client is discharged, the nurse should provide which instruction? "Eat three balanced meals every day." "Stop taking the drugs when your symptoms subside." "Avoid aspirin and products that contain aspirin." "Increase your intake of fluids containing caffeine."

"Avoid aspirin and products that contain aspirin." Explanation: The nurse should instruct the client to avoid aspirin because it's a gastric irritant and should not be taken by clients with peptic ulcer to prevent further erosion of the stomach lining. The client should eat small, frequent meals rather than three large ones. Antacids and ranitidine prevent acid accumulation in the stomach; they should be taken even after symptoms subside. Caffeine should be avoided because it increases acid production in the stomach.

A nurse is preparing to discharge a client newly diagnosed with peptic ulcer disease. The client's diagnostic test results were positive for H. pylori bacteria. The health care provider has ordered the "triple therapy" regimen. Which medications will the nurse educate the client on? H2-receptor antagonist and two antibiotics H2-receptor antagonist, proton-pump inhibitor, and an antibiotic Proton-pump inhibitor, an antibiotic, and bismuth salts Proton-pump inhibitor and two antibiotics

Proton-pump inhibitor and two antibiotics Explanation: Currently, the most commonly used therapy for peptic ulcers is a combination of antibiotics, proton-pump inhibitors, and bismuth salts that suppress or eradicate H. pylori bacteria. Recommended therapy for 10 to 14 days includes triple therapy with two antibiotics (e.g., metronidazole [Flagyl] or amoxicillin [Amoxil] and clarithromycin [Biaxin]) plus a proton-pump inhibitor (e.g., lansoprazole [Prevacid], omeprazole [Prilosec], or rabeprazole [Aciphex]), or quadruple therapy with two antibiotics (metronidazole and tetracycline) plus a proton-pump inhibitor and bismuth salts (Pepto-Bismol). Research is being conducted to develop a vaccine against H. pylori.

A client admitted for treatment of a gastric ulcer is being prepared for discharge. The client will follow a regimen of antacid therapy. Discharge teaching should include which instructions? Choose all that apply. "Continue to take antacids even if your symptoms subside." "You may take antacids with other medications." "You may be prescribed H2-receptor antagonists for up to 1 year." "Be sure to take antacids with meals." "The antacids will make you sleepy, so do not operate machinery while taking them."

"Continue to take antacids even if your symptoms subside." "You may be prescribed H2-receptor antagonists for up to 1 year."

A client is admitted with a gastrointestinal bleed. What client symptom may indicate a peptic ulcer perforation to the nurse? Sudden, severe upper abdominal pain Hypertension Bradycardia Soft abdomen

Sudden, severe upper abdominal pain Explanation: The client with a peptic ulcer perforation may have symptoms such as sudden, sever upper abdominal pain, vomiting, fainting, an extremely tender and rigid (board-like) abdomen, and hypotension and tachycardia, indicating shock. The client with a bleeding peptic ulcer will not experience hypertension or bradycardia. The client's abdomen with a peptic ulcer bleed will not be soft, but rigid.

A client receives a local anesthetic to suppress the gag reflex for a diagnostic procedure of the upper GI tract. The nurse determines which nursing intervention is advised for this client? monitor for any breathing-related disorder or discomforts measure fluid output for at least 24 hours after the procedure monitor for cramping or abdominal distention do not give any food and fluids until the gag reflex returns

do not give any food and fluids until the gag reflex returns Explanation: For a client receiving a local anesthetic that suppresses the gag reflex, the nurse is advised to withhold food and fluids until the reflex returns. The client is monitored for other symptoms specifically related to the procedure but may not be monitored for cramping or abdominal distention or breathing related discomforts unless reporting these symptoms. It is also not essential to monitor the client's fluid output for 24 hours, since the client is advised to avoid fluid or food intake until the reflex returns. However, the client may be monitored for any dehydration related to not consuming any fluids or food before the procedure.

A nurse is caring for a client who is undergoing a diagnostic workup for a suspected gastrointestinal problem. The client reports gnawing epigastric pain following meals and heartburn. What would the nurse suspect this client has? peptic ulcer disease ulcerative colitis appendicitis diverticulitis

peptic ulcer disease Explanation: Peptic ulcer disease is characterized by dull, gnawing pain in the midepigastrium or the back that worsens with eating. Ulcerative colitis is characterized by exacerbations and remissions of severe bloody diarrhea. Appendicitis is characterized by epigastric or umbilical pain along with nausea, vomiting, and low-grade fever. Pain caused by diverticulitis is in the left lower quadrant and has a moderate onset. It's accompanied by nausea, vomiting, fever, and chills. Reference:

A nurse is teaching a client with gastritis about the need to avoid the intake of caffeinated beverages. The client asks why this is so important. Which explanation from the nurse would be most accurate? "Caffeine stimulates the central nervous system and thus gastric activity and secretions, which need to be minimized to promote recovery." "Caffeine increases the fluid volume in your system, which irritates your digestive organs." "Caffeine intake can cause tears in your esophagus and intestines, which can lead to hemorrhage." "Caffeine can interfere with absorption of vitamin B12, which leads to anemia and further digestive problems."

"Caffeine stimulates the central nervous system and thus gastric activity and secretions, which need to be minimized to promote recovery." Explanation: Caffeine is a central nervous system stimulant that increases gastric activity and pepsin secretion. Caffeine is a diuretic that causes decreased fluid volume and potential dehydration. It does not lead to hemorrhage and does not interfere with absorption of vitamin B12.

A nurse is preparing a presentation for a local community group about peptic ulcer disease and the two major types. When comparing the potential risk factors associated with duodenal and gastric ulcers, which factor would the nurse include as being associated with both types? Select all that apply. Helicobacter pylori (H. pylori) infection alcohol use cigarette smoking NSAID use cirrhosis

Helicobacter pylori (H. pylori) infection alcohol use cigarette smoking

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

"I'll eat frequent, small, bland meals that are high in fiber." Explanation: In hiatal hernia, the upper portion of the stomach protrudes into the chest when intra-abdominal pressure increases. To minimize intra-abdominal pressure and decrease gastric reflux, the client should eat frequent, small, bland meals that can pass easily through the esophagus. Meals should be high in fiber to prevent constipation and minimize straining on defecation (which may increase intra-abdominal pressure from the Valsalva maneuver). Eating three large meals daily would increase intra-abdominal pressure, possibly worsening the hiatal hernia. The client should avoid spicy foods, alcohol, and tobacco because they increase gastric acidity and promote gastric reflux. To minimize intra-abdominal pressure, the client shouldn't recline after meals, lift heavy objects, or bend.