Upper GI Disorders—exam 5

Which of the following client comments obtained during a client history would lead the nurse to believe a client's vomiting and abdominal pain are caused by acute gastritis? A. "I had bands placed in my esophagus 6-years ago." B. "I had my gallbladder removed last month." C. "My last bowel movement was 3 days ago." D. "I have been taking naproxen 220mg twice a day for the last 2 weeks." E. "I ate sushi last night for dinner."

D. I have been taking naproxen 220mg twice a day for the last 2 weeks Consistent use of NSAIDs can erode the mucosa of the stomach and lead to symptoms of acute gastritis E. I ate sushi last night for dinner Recently consuming raw seafood is a known risk factor for food poisoning which can lead to gastritis

The nurse suspects that a client has a duodenal ulcer. Which of the following signs indicate this condition? A. Gnawing, sharp pain 30-60 minutes after eating B. Pain immediately after eating C. Hematemesis D. Pain 1.5-3 hours after eating, relieved by eating

D. Pain 1.5-3 hours after eating, relieved by eating Pain 1.5-3 hours after eating that is relieved by eating is indicative of a duodenal ulcer

A nurse is educating a client about their new diagnosis of pyloric stenosis. The client indicates understanding of this diagnosis when they point to which location as the site of pyloric stenosis? A. Fundus B. Esophagogasrtic junction C. Body of the stomach D. Pyloric valve

D. Pyloric valve The pyloric valve is the muscle surrounding the opening between the stomach and the duodenum. Pyloric stenosis is narrowing of the opening from the stomach to the first part of the small intestine (duodenum), due to enlargement (hypertrophy) of the muscle surrounding this opening which spasms when the stomach empties.

A nurse knows that which of the following layers of the stomach lining are most often inflamed in a client with acute gastritis? (Select all that apply) A. Subdural B. Serosa C. Muscle layers D. Submucosa E. Mucosa

D. Submucosa Submucosa, in more serious cases of acute gastritis, will also be irritated. This irritation contributes to the client's symptoms and can worsen if the client is not treated. E. Mucosa The mucosa is always inflamed in a client with acute gastritis. The inflammation of the stomach's mucosal lining is the trigger for the common symptoms of nausea, vomiting, and abdominal pain

A new nurse in the ED received a client in the trauma bay. The client was playing football and tackled from behind and now is complaining of severe pain in the abdomen. Another nurse is performing an initial assessment and tells the client that the Grey-Turner sign is positive. The new nurse knows that this indicated the client has bruising to which of the following? A. Flank B. Umbilicus C. Rectum D. Chest

A. Flank The Grey-Turner sign is ecchymosis over the flank, usually at the level of the 11th and 12th ribs.

The nurse is reviewing orders for a client with PUD. Which of the following would the nurse question? A. 325mg aspirin PO daily B. 20mg famotidine PO BID C. 40mg pantoprazole PO daily D. 500mg calcium carbonate PO QID

A. 325mg aspirin PO daily Aspirin and NSAIDs are avoided with PUD because they exacerbate symptoms

The nurse has received report on 4 clients. All clients have pantoprazole ordered. Which client will need this medication first? A. A client with a GI bleed B. A client with a DVT C. A client with a gallstone D. A client with hypovolemia

A. A client with a GI bleed Pantoprazole is a proton pump inhibitor that decreases the amount of acid in the GI tract and is used for GERD, GI bleeding, and esophageal varicies. The client with a GI bleed will need the medication first, as active bleeding is the priority out of the clients listed.

The nurse is caring for a client with a hiatal hernia. Which of the following is an appropriate treatment? (Select all that apply) A. Administer antacids B. Teach the client to avoid anticholinergics C. Teach the client to avoid straining D. Recommend eating large meals E. Recommend a high fat diet

A. Administer antacids A hiatal hernia occurs when the stomach protrudes through the diaphragm. The client will experience heartburn, and therefore antacids are appropriate to administer B. Teach the client to avoid anticholinergics The nurse should educate the client to avoid anticholinergics, as these slow gastric motility C. Teach the client to avoid straining The client should be taught to avoid straining, as this can worsen the hernia

The nurse is caring for a client who is recovering from a gastric resection. The nurse provides teaching about how to prevent dumping syndrome. Which of the following statements are correct? (Select all that apply) A. Avoid consuming sugar, salt, and milk B. Do not consume fluids with meals C. Lie down after each meal D. Eat two large meals each day E. Increase carbohydrate intake

A. Avoid consuming sugar, salt, and milk One measure to prevent dumping syndrome is to avoid sugar, salt, and milk. When these elements move too quickly into the small intestine, dumping occurs. B. Do not consume fluids with meals Fluids can cause the intestines to rapidly push food through, causing an episode fo dumping C. Lie down after each meal Dumping syndrome can occur after gastric resections when the contents of the stomach are rapidly moved into the small intestine. Symptoms of dumping syndrome include nausea, vomiting, cramping, sweating, and diarrhea. Measures to prevent dumping syndrome include a low carb, high fat, high protein diet, avoiding fluid consumption with meals, avoiding sugar, salt, and milk, and lying down after each meal. The patient may also take antispasmodic drugs to delay gastric emptying, if prescribed.

A client has a serious complication of chronic acid entering the esophagus over many years. The client's esophageal lining has pathologically changes to resemble tissue in the intestine. What is this called? A. Barrett's esophagus B. Esophagitis C. Heartburn D. GERD

A. Barrett's esophagus Barrett's esophagus is a serious condition that can lead to esophageal cancer due to acid chronically entering the esophagus over many years, which changes the lining to resemble intestinal lining from irritation.

The nurse is teaching a client who has been diagnosed with peptic ulcer disease about what foods to eat. Which of the following is a food that the client is allowed to eat with this diagnosis? (Select all that apply) A. Citrus B. Tea C. Purine containing foods D. Chocolate E. Coffee

A. Citrus Citrus fruits are not contraindicated for a client with PUD C. Purine containing foods Purines are avoided for gout, but not PUD

A nurse is caring for a client with chronic alcohol abuse and is concerned the client may have developed pancreatitis. Which of the following signs are indicative of this? (Select all the apply) A. Cullen's sign B. McBurney's sign C. Goodell's sign D. Chadwick's sign E. Turner's sign

A. Cullen's sign Bruising around the umbilicus that is indicative of pancreatitis or inflammation of the pancreas E. Turner's sign Bruising along the flank that is indicative of pancreatitis

The nurse knows that which of the following most accurately describes the rationale for administering famotidine to a client with gastritis? A. Decrease inflammation in the stomach B. Alleviate chest pain C. Decrease acid reflux D. Reduce nausea and vomiting

A. Decrease inflammation in the stomach Famotidine is an H2 receptor blocker that decreases inflammation caused by gastritis by halting the histamine response to the inflamed area

A nurse is caring for a client with pancreatitis. Which of the following labs would the nurse NOT expect to see? (Select all the apply) A. Decreased liver enzymes B. Hypermagnesemia C. Elevated bilirubin D. Hypercalcemia E. Elevated WBC

A. Decreased liver enzymes In pancreatitis, clients are more likely to have increased liver enzymes, not decreased B. Hypermagnesemia The nurse would expect to see hyPOmagnesemia, not hyPERmagnesemia D. Hypercalcemia Pancreatitis created hyPOcalcemia, not hyPERcalcemia

A nurse is caring for a client who is suffering from a gastric ulcer. Which of the following is an appropriate nursing intervention? (Select all that apply) A. Eat small, frequent meals B. Drink caffeinated beverages C. Drink plenty of milk D. Take a histamine blocker E. Take a proton pump inhibitor

A. Eat small, frequent meals Small, frequent meals are less likely to cause irritation to an ulcer than large meals D. Take a histamine blocker Histamine blockers or PPIs should be given to reduce stomach acid E. Take a proton pump inhibitor Histamine blockers or PPIs should be given to reduce stomach acid

A client with a peptic ulcer has been brought in to the healthcare clinic and is being assessed by the nurse for an upper GI bleed. Which of the following signs or symptoms would the nurse expect to see with this condition? (Select all that apply) A. Epigastric pain B. Swelling in the lower legs C. Melena D. Abdominal fullness E. Hematemesis

A. Epigastric pain C. Melena E. Hematemesis Epigastric pain, melena, and hematemesis are correct. An upper GI bleed occurs in the upper portion of the GI tract, including the area within the esophagus. Signs or symptoms associated with bleeding from this area include epigastric pain, vomiting blood, and dark blood in stool (melena).

The nurse is reviewing a medication list for a client who reports they take medication for gastroesophageal reflux. The client asks the nurse to confirm which mediation is used for this condition. Which of the following medications is taken for reflux? A. Famotidine B. Fentanyl C. Fluoxetine D. Furosemide

A. Famotidine This is an anti-ulcer H2 histamine blocker, used to treat ulcers, gastroesophageal reflux (GERD), and over-production of acid in the GI system.

A nurse is planning medication administration for a client who has all of the following medications due at 0900: calcium carbonate, codeine, levetiracetam, metoclopramide. What is the most appropriate action by the nurse? A. Give calcium carbonate 1 hour after the others B. Give codeine 30 minutes before the others C. Give levetiracetam 30 minutes after the others D. Give metoclopramide 1 hour before the others

A. Give calcium carbonate 1 hours after the others Calcium carbonate is an antacid, which should always be given 1 hour after other oral medications, otherwise it may impair absorption of those medications. In this case, it would be appropriate to give the other medications at 0830 and the calcium carbonate at 0930.

The nurse is working with a client who has PUD. Which of the following labs is important to monitor with this condition? A. H/H B. Procalcitonin C. Lactic acid D. Magnesium

A. H/H In PUD, bleeding is a concern, so monitoring the hematocrit and hemoglobin levels will alert the clinician of developing or worsening bleeding.

The nurse is caring for a client with an intestinal ulcer who takes lansoprazole. The nurse knows to monitor the client for which of the following adverse reactions? (Select all that apply) A. Headache B. Oliguria C. Anxiety D. Nausea E. Diarrhea

A. Headache D. Nausea E. Diarrhea Lansoprazole is a PPI that carries the risk of adverse reactions. These include abdominal pain, headache, nausea, and diarrhea.

A client presents with complaints of nausea, vomiting, and abdominal pain for the last 12 hours. The client states to the nurse, "I have had gastritis before and think I might have it again." Which of the following statements from the client would lead the nurse to believe it is something other than gastritis? A. The pain is a 7/10 in the lower right area of my abdomen B. My HCP told me I have had H. Pylori before C. I hurt my knee at work last week and have been taking 400mg of ibuprofen every 6 hours ever since D. I drink a 6 pack of beer every night

A. The pain is a 7/10 in the lower right area of my abdomen This is correct. RLQ pain does not suggest gastritis. Pain associated with gastritis is most often in the mid-upper and LUQ of the abdomen. RLQ pain is more likely associated with acute appendicitis.

The nurse is caring for a client who is being treated for pancreatitis. The provider orders a metabolic panel as part of routine testing and the nurse notes that the client's calcium level is 5.2mg/dL. The client asks the nurse what this means. Which of the following responses from the nurse is correct? A. Your calcium levels are low, most likely from your condition. I will need to administer a supplement of calcium through your IV B. Your calcium levels are normal, which is a sign that you are healing C. Your calcium levels are elevated. I will have to give you a diuretic to help your body get rid of some of the excess. D. As long as you are feeling all right, I wouldn't worry about this level

A. Your calcium levels are low, most likely from your condition. I will need to administer a supplement of calcium through your IV. Calcium may be measured as part of a metabolic panel performed with lab testing of the blood. The normal calcium level is between 8.4 and 10.2mg/dL for an adult. In this case, the client has a level of 5.2mg/dL and the nurse would need to provide calcium replacement.

The nurse is caring for a client who has pancreatitis and an order to insert an NG tube. Which response by the nurse is accurate? A. "The NG tube is used to administer enteral nutrition." B. "This is used for removing gastric contents to suppress pancreatic secretions." C. "We use the NG tube to administer your medications." D. "This is used to decompress the stomach which stimulated the pancreas, increasing blood flow."

B. "This is used for removing gastric contents to suppress pancreatic secretions." The purpose of an NG tube is to remove gastric secretions, which in turn suppresses pancreas secretions. This allows the pancreas to rest which is essential. The client with pancreatitis will be NPO.

A 36-year old client presents complaining of nausea and vomiting for the last 24 hours. The client has not been able to keep food or medications down and complains of LUQ abdominal pain rated a 4/10. The nurse knows that which of the following orders should be questioned? A. 20mg famotidine B. 400mg ibuprofen C. 4mg ondansetron D. 1000mL normal saline

B. 400mg ibuprofen Uncontrolled nausea and vomiting coupled with LUQ abdominal pain are trademark symptoms of acute gastritis. Ibuprofen and other NSAIDs are known to irritate the stomach lining and may worsen the inflammation associated with gastritis

The nurse is caring for a client with peptic ulcer disease due to H. Pylori. Which drug combinations should be given along with macrolide antibiotic? A. Tetracycline and sodium bicarbonate B. Amoxicillin and Prilosec C. Flagyl and amphogel D. Penicillin and axid

B. Amoxicillin and Prilosec H. Pylori can be complicated to treat, because the bacteria quickly becomes resistant to antibiotics. Therefore, "triple therapy" is used. (When triple therapy fails, "quadruple therapy" is recommended.) Triple therapy consists of a macrolide antibiotic, a PPI, and a penicillin-related antibiotic.

The client has a chronic peptic ulcer and wants to know the difference between an acute and chronic peptic ulcer. How does the nurse educate the client? A. An acute ulcer lasts only a month and a chronic ulcer lasts greater than one month B. An acute ulcer is a superficial erosion, while a chronic ulcer extends through the muscular wall of the stomach C. An acute ulcer is treated with H2 blockers while a chronic ulcer is treated with PPIs D. H. Pylori is present with a chronic ulcer but not with an acute ulcer

B. An acute ulcer is a superficial erosion, while a chronic ulcer extends through the muscular wall of the stomach When the erosion in the lining of the GI tract extends through the mucosal wall and muscle in a portion of the GI tract accessible to gastric secretions, it is called a chronic ulcer. Locations include the stomach, pylorus, duodenum, and esophagus. An acute ulcer is in the same locations, but is a superficial erosion through the mucosal wall only

A 57-year-old client with peptic ulcer disease is being seen for abdominal pain. Which of the following assessments for hemorrhage in this client? (Select all that apply) A. Speaking calmly to the client to reduce anxiety B. Assessing for symptoms of dizziness or nausea C. Monitoring the client's hemoglobin and hematocrit levels D. Recording hourly urinary output E. Administering stool softeners

B. Assessing for symptoms of dizziness or nausea A client with peptic ulcer disease is at higher risk of bleeding because of the disease process. The nurse can assess for bleeding by monitoring hemoglobin and hematocrit levels and assessing for signs of low BP such dizziness and nausea C. Monitoring the client's hemoglobin and hematocrit levels A client with peptic ulcer disease is at higher risk of bleeding because of the disease process. The nurse can assess for bleeding by monitoring hemoglobin and hematocrit levels and assessing for signs of low BP such as dizziness and nausea

The nurse is caring for a client with poorly controlled GERD. The nurse is providing education regarding foods that can exacerbate the condition. Which of the following would be an appropriate food for this client to eliminate? A. Gluten-containing foods B. Chocolate C. Citrus fruits D. Purine-containing foods like organ meats (liver, kidneys)

B. Chocolate Chocolate contributes to GERD symptoms, becuase it decreases the tone of the esophageal sphincter which worsens the reflux. Other foods that have this effect include coffee, soda, tea, peppermint, and fried or fatty foods.

A nurse is caring for a client who is complaining of abdominal pain. Upon inspection of the abdomen, what sign should the nurse be looking for to alert you to potential pancreatitis? A. Murphy's sign B. Cullen's sign C. Battle's sign D. McBurnery's sign

B. Cullen's sign Cullen's sign is bruising located in the umbilicus area and indicates potential pancreatitis

The nurse is caring for a client who is scheduled to be evaluated for possible GERD. The nurse is aware that diagnostic tests for GERD include which of the following? (select all that apply) A. Sigmoid colonoscopy B. Esophagram C. Esophageal manometry D. Esophageal impedance pH study E. Upper endoscopy

B. Esophagram—tests to evaluate a client with GERD involve the esophagus. An esophagram evaluates the esophagus. C. Esophageal manometry—evaluates the esophagus D. Esophageal impedance pH study—evaluates the esophagus E. Upper endoscopy—evaluates the esophagus

A client has GERD. What changes should the nurse recommend to improve symptoms? A. Raise the foot of the bed 4-6 inches (select all that apply) B. Quit smoking C. Eat large meals D. Lose weight E. Quit drinking alcohol

B. Quit smoking—smoking can cause irritation and worsen GERD D. Lose Weight—excess weight increases abdominal pressure, making stomach acid leakage or backflow more likely to occur E. Quit drinking alcohol—alcohol can cause irritation and increase acid reflux For the management of GERD, the head of the bed should be raised 4-6 inches, the client should eat small meals, quit smoking, quit drinking, lose weight, and should not eat within four hours of bedtime.

A nurse is caring for a client that has been diagnosed with pancreatitis. Which of the following is not a complication commonly associated with this disease process? A. Disseminated intravascular coagulopathy B. Right lung effusion C. Hypocalcemia D. Hypovolemia

B. Right lung effusion In pancreatitis, effusions are usually seen in the LEFT lung, not right, because of its proximity to the pancreas.

The client has a hiatal hernia. How does the nurse describe this to the client? A. A part of the abdominal contents has exited through the abdominal wall B. A part of the abdominal contents has exited the femoral canal C. A part of the stomach has exited through the diaphragm D. A part of the abdominal contents has exited through the inguinal canal

C. A part of the stomach has exited through the diaphragm In a hiatal hernia, a part of the stomach has pushed up through a hole in the diaphragm

A client presents to the ER with chest pain. The EKG and troponin labs are all WNL. Upon reviewing the client's medication list, the nurse notes a medication for acid reflux. Which of the following medications is indicated for this condition? A. Cephalexin B. Captopril C. Cimetidine D. Clopidogrel

C. Cimetidine Cimetidine is an anti-ulcer H2 antagonist that treats GERD, ulcers and is used to prevent GI bleeding. When a client with chest pain has negative troponins and a normal EKG, acid reflux is sometimes the cause of their chest pain.

The nurse is assigned to a client complaining of left flank pain. Which sign would be concerning for internal bleeding and should be checked immediately? A. Murphy's sign B. Battle's sign C. Grey-Turner's sign D. Cullen's sign

C. Grey-Turner's sign Grey-Turner's sign is located on the flank and is an indicator of retoperitoneal hemorrhage

A client has a lipase of 405 U/L. The nurse recognizes this to be an issue with which of the following organs? A. Spleen B. Gallbladder C. Pancreas D. Liver

C. Pancreas The pancreas produces lipase which is an enzyme used to breakdown fats. The normal range is 23-300 U/L

The nurse is assessing a client and observes Cullen's sign and Grey-Turner's sign. The nurse knows that these are signs of which of the following conditions? A. Nephritis B. Diverticulitis C. Pancreatitis D. Cholecystitis

C. Pancreatitis Cullen's sign is ecchymosis around the umbilicus, and Grey-Turner's sign is bruising on the flank. These signs are usually present with pancreatitis.