Upper GI NCLEX questions
Which of the following types of gastritis ic associated with Helicobacter pylori and duodenal ulcers? 1. Erosive (hemorrhagic) gastritis 2. Fundic gland gastritis (type A) 3. Antral gland gastritis (type B) 4. Aspiring-induced gastric ulcer
Correct answer: Antral gland gastritis ( type B). Rationale: Antral gland gastritis is the most common form of gastritis and is associated with Helicobacter pylori and duodenal ulcers
Which assessment data support to the the nurse the client's diagnosis of gastric ulcer? A. Presence of blood in the client's stool for the past month? B. Reports of a burning sensation moving like a wave. C. Sharp pain in the upper abdomen after eating a heavy meal. D. Complaints of epigastric pain 30-60 minutes after ingesting food
- Answer: D In a client diagnosed with a gastric ulcer, pain usually occurs 30-60 minutes after eating, but not at night. In contrast, a client with a duodenal ulcer has pain during the night often relieved by eating foods. Other answers: the presence of blood does not specifically indicate diagnose of an ulcer. The client could have hemorrhoids or cancer. A waveline burning sensation is a symptom of GERD. Sharp pain in the upper abdomen after eating a heavy meal is a symptom of gallbladder disease
"The nurse is teaching the patient a client with a peptic ulcer discharge instructions. The client asks the nurse which type of analgesic he may take. Which of the following responses by the nurse would be most accurate? "1. Aspirin 2. Acetaminophen 3. Naproxen 4. Ibuprofen
2.Acetaminophen is recommended for pain relief because it does no promote irritation of the mucosa. Aspirin, and nonsteroidal anti- inflammatory drugs suchs as naproxen and ibuprofen, may cause irritation of the mucosa and subsequent bleeding
The nurse is planning to teach the client with GERD about substance that will increase the lower esophageal sphincter pressure. Which item should the nurse include on this list? Saunders NCLEX Examination Review 1. Coffee 2. Chocolate 3. Fatty Foods 4.Nonfat milk
4. Nonfat milk Foods that increase LES pressure will decrease reflux and decrease symptoms. Milk will increase LES pressure
The nurse determines that a patient has experienced the beneficial effects of medication therapy with famotidine (Pepcid) when which of the following symptoms is relieved? 1. Ice tea 2. Dry toast 3. warm broth 4. plain hamburger
B) Dry toast (Dry toast or crackers may alleviate the feeling of nausea and prevent further vomiting. Extremely hot or cold liquids and fatty foods are generally not well tolerated
Which of the following statements are accurate as they relate to medications used to manage GERD? "A)Magnesium-containing antacids can cause diarrhea. B) Aluminum-containing antacids can cause constipation. C) Cimetidine (Tagamet HB) causes osteomalacia and hypophosphatemia. D)Misoprostol's (Cytotec) major side effect is G.I. bleeding
A&B. Rationale: Magnesium-containing antacids can cause diarrhea, and should be used with caution in older persons with renal dysfunction. Aluminum-containing antacids can cause constipation, osteomalacia, and hypophosphatemia. Cimetidine has the greatest chance for adverse reactions, including erectile dysfunction, Gynecomastia, and confusion. Misoprostol's major side effects are diarrhea and abdominal pain
A client with gastroesophageal reflux disease complains about having difficulty sleeping at night, what should the nurse instruct the client to do? A. sleep on several pillows B. eliminate carbohydrates from the diet C. suggest a glass of milk before retiring D. take antacids such as sodium bicarbonate
A. sleeping on pillows raises the upper torso and minimizes reflux of the gastic contents
A client receives a local anesthetic to suppress the gag reflex for a diagnostic procedure of the upper GI tract. Which of the following nursing interventions is advised for this patient? a The client should be monitored for any breathing related disorder or discomforts b) The client should not be given any food and fluids until the gag reflex returns, c. The client should be monitored for cramping or abdominal distention, d) The client's fluid output should be measured for at least 24 hours after the procedure
ANSWER: B 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 with gastroesophageal reflux disease (GERD) complains of a chronic cough. The nurse understands that in a client with GERD this symptom may be indicative of which of the following conditions? "1. Development of laryngeal cancer. 2. Irritation of the esophagus. 3. Esophageal scar tissue formation. 4. Aspiration of gastric contents
Answer 4, "Clients with GERD can develop pulmonary symptoms, such as coughing, wheezing, and dyspnea, that are caused by the aspiration of gastric contents. GERD does not predispose the client to the development of laryngeal cancer. Irritation of the esophagus and esophageal scar tissue formation can develop as a result of GERD. However, GERD is more likely to cause painful and difficult swallowing
The doctor has ordered Tagamet for a client admitted with gastroesophageal reflux disease (GERD). After looking up the drug in the Physician's Desk Reference, you understand it is being used to:1. Neutralize stomach acid. 2. Treat a hiatal hernia. 3. Aid in the digestion of food. Decrease stomach acid production
Answer 4, 4. Treatment for GERD includes medications such as Tagamet to decrease stomach acid production and promote healing of esophagus
"A patient with a history of peptic ulcer disease has presented to the ED with complaints of severe abdominal pain and a rigid, boardlike abdome, prompting the health care team to suspect a perforated ulcer. Which of the following actions should the nurse anticiptate? source: http://quizlet.com/20002414/nclex-review-lower-gi-problems-ibd-crohns-disease-ulcerative-colitis-flash-cards/ or Lewis chapt. 42 Upper GI NCLEX" "A: Providing IV fluids and inserting a nasogastric tube B:Administering oral bicarbonate and testing patient's gastric pH level C:Performing a fecal occult blood test and administering IV calcium gluconate D: Starting parenteral nutrition and placing the patient in high-fowler's position
Answer A, "A: providing IV fluids and inserting a nasogastric tube rationale: A perforated peptic ulcer requires IV replacement of fluid losses and continued gastric aspiration by NG tube. Nothing is given by mouth and gastric pH testing is not a priority. Calcium gluconate is not a medication directly relevent to the patient's suspected diagnosis and parenteral nutrition is not a priority in the short term
22. Nurse Hannah is teaching a group of middle-aged men about peptic ulcers. When discussing risk factors for peptic ulcers, the nurse should mention: A. a sedentary lifestyle and smoking. B. a history of hemorrhoids and smoking, C. alcohol abuse and a history of acute renal failure. D. alcohol abuse and smoking
Answer D, Answer D. 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
A patient with a history of peptic ulcer disease has presented to the emergency department with complaints of severe abdominal pain and a rigid, boardlike abdomen, prompting the health care team to suspect a perforated ulcer. Which of the following actions should the nurse anticipate? A. Providing IV fluids and inserting a nasogastric tube B. Administering oral bicarbonate and testing the patient's gastric pH level. C. Performing a fecal occult blood test and administering IV calcium gluconate. D. Starting parenteral nutrition and placing the patient in high-Fowler's position
Answer A, A perforated peptic ulcer requires IV replacement of fluid losses and continued gastric aspiration by NG tube. Nothing is given by mouth and gastric pH testing is not a priority. Calcium gluconate is not a medication directly relevant to the patient's suspected diagnosis and parenteral nutrition is not a priority in the short term
The nurse is reviewing the medication record of a female client with acute gastritis. Which medication, if noted on the client's record, would the nurse question? "a. Digoxin (Lanoxin) b. Furosemide (Lasix) c. Indomethacin (Indocin) d. Propranolol hydrochloride (Inderal)
Answer is C, Indomethacin (Indocin) is a nonsteroidal anti-inflammatory drug and can cause ulceration of the esophagus, stomach, or small intestine. Indomethacin is contraindicated in a client with gastrointestinal disorders. Furosemide (Lasix) is a loop diuretic. Digoxin is a cardiac medication. Propranolol (Inderal) is a β-adrenergic blocker. Furosemide, digoxin, and propranolol are not contraindicated in clients with gastric disorders
"Which of the following types of gastritis is associated with Helicobacter pylori and duodenal ulcers? 1. Erosive (hemorrhagic) gastritis 2. Fundic gland gastritis (type A) 3. Antral gland gastritis (type B) 4.Aspiring-induced gastric ulcer
Answer: 3 - Erosive (hemorrhagic) gastritis can be caused by ingestion of substances that irritate the gastric mucosa. Fundic gland gastritis (type A) is associated with diffuse severe mucosal atrophy and the presence of pernicious anemia. Antral gland gastritis (type B) is the most common form of gastritis, and is associated with Helicobacter pylori and duodenal ulcers
Caffeinated beverages and smoking are risk factors to assess for in the development of what condition? A. Duodenal ulcers B. Peptic ulcers C. Helicobacter pylori D. Esophageal reflux
Answer: B PUD risk factors include family history, blood group O, smoking tobacco, and beverages containing caffeine
"The nurse is teaching the patient and family about possible causative factors for peptic ulcers. The nurse explains that ulcer formation is a. caused by a stressful lifestyle and other acid-producing factors such as H. pylori. b. inherited within families and reinforced by bacterial spread of Staphylococcus aureus in childhood. c. promoted by factors that tend to cause oversecretion of acid, such as excess dietary fats, smoking, and H. pylori. d. promoted by a combination of possible factors that may result in erosion of the gastric mucosa, including certain drugs and alcohol
Answer D, Rationale: Peptic ulcers develop only in the presence of an acidic environment. However, an excess of hydrochloric acid (HCl) may not be necessary for ulcer development. The back-diffusion of HCl into the gastric mucosa results in cellular destruction and inflammation. Histamine is released from the damaged mucosa, resulting in vasodilation and increased capillary permeability and further secretion of acid and pepsin. A variety of agents (i.e., certain infections, medications, and lifestyle factors) can damage the mucosal barrier. Helicobacter pylori can alter gastric secretion and produce tissue damage leading to peptic ulcer disease. The response to H. pylori is likely influenced by a variety of factors, including genetics, environment, and diet. Ulcerogenic drugs, such as aspirin and NSAIDs, inhibit synthesis of prostaglandins, increase gastric acid secretion, and reduce the integrity of the mucosal barrier. Patients on corticosteroids, anticoagulants, and selective serotonin reuptake inhibitors (e.g., fluoxetine [Prozac]) are also at increased risk for ulcers. High-alcohol intake is associated with acute mucosal lesions. Alcohol stimulates acid secretion. Coffee (caffeinated and uncaffeinated) is a strong stimulant of gastric acid secretion. Psychologic distress, including stress and depression, can negatively influence the healing of ulcers after they have developed. Smoking also delays ulcer healing. Infection with herpes and cytomegalovirus (CMV) in immunocompromised patients may also lead to gastric ulcers
"The nurse explains to the patient with gastroesophageal reflux disease that this disorder: "A. results in acid erosion of the esophagus caused by frequent vomiting B. Will require surgical wrapping of the pyloric sphincter to control the symptoms C. Is the protrusion of a portion of the stomach into the esophagus through the opening in the diaphragm D. Often involves relaxation of the lower esophageal sphincter, allowing the stomach contents to back up into the esophagus
Answer: D. The acidic contents of the stomach touching the inside of the esophagus are responsible for the physical sensation known as "heart-burn" that is a cardinal symptom of GERD
A client with inflammatory bowel disease undergoes an ileostomy. On the first day after surgery, the nurse notes that the client's stoma appears dusky. How should the nurse interpret this finding?"a) The ostomy bag should be adjusted. b) Blood supply to the stoma has been interrupted. c) An intestinal obstruction has occurred. d) This is a normal finding 1 day after surgery
Correct Answer: (B), Blood supply to the stoma has been interrupted An ileostomy stoma forms as the ileum is brought through the abdominal wall to the surface skin, creating an artificial opening for waste elimination. The stoma should appear cherry red, indicating adequate arterial perfusion. A dusky stoma suggests decreased perfusion. The nurse should interpret this finding as an indication that the stoma's blood supply is interuppted, which may lead to tissue damage or necrosis. A dusky stoma isn't a normal finding 1 day after surgery. Adjusting the ostomy bag wouldn't affect stoma color, which depends on blood supply to the area. An intestinal obstruction also wouldn't change stoma color
"The nurse is caring for a 68 year old patient admitted with abdominal pain, nausea, and vomiting. The patient has an abdominal mass and a bowel obstruction is suspected. The nurse auscultating the abdomen listens for which of the following types of bowel sounds that is consistent with the patient's clinical picture? "A. low pitched and rumbling above the area of obstruction B. High pitched and hypoactive below the area of obstruction C. low pitched and hyperactive below the area of obstruction (D). high pitched and hyperactive above the area of obstruction
Early in intestinal obstruction, the patient's bowel sounds are hyperactive adn high pitched. This occurs because peristaltic action increases to "push past" the area of obstruction. As the obstruction becomes complete, bowel sounds decrease and finally become absent
The nurse is teaching the patient and family about possible causative factors for peptic ulcers. The nurse explains that ulcer formation is: (Source: Medical-Surgical Nursing, LDH p. 1004) a) caused by stressful lifestyle and other acid producing factors such as H. pylori. b) inherited within families and reinforced by bacterial spread of Staphylococcus aureus in childhood. c) promoted by factors that tend to cause oversecretion of acid, such as excess dietary fats, smoking, and H. pylor. d) promoted by a combination of possible factors that may result in erosion of the gastric mucosa, including certain drugs and alcohol
Peptic ulcers develop only in the presence of an acidic environment. However, an excess of hydrochloric acid (HCl) may not be necessary for ulcer development. The back-diffusion of HCl into the gastric mucosa results in cellular destruction and inflammation. Histamine is released from the damaged mucosa, resulting in vasodilation and increased capillary permeability and further secretion of acid and pepsin. A variety of agents (i.e., certain infections, medications, and lifestyle factors) can damage the mucosal barrier
The nurse teaches the client about an anti-ulcer diet. Which of the following statements by the client indicates to the nurse that dietary teaching was successful? 1. "I must eat bland foods to help my stomach heal." 2. "I can eat most foods, as long as they don't bother my stomach." 3. "I cannot eat fruits and vegetables because they cause too much gas." 4. "I should eat a low-fiber diet to delay gastric emptying -
The answer is 2.
"The nurse is planning the care of a client diagnosed with lower esophageal sphincter dysfunction. Which dietary modifications should be included in the plan of care? 1. Allow any of the client's favorite foods as long as the amount is limited. 2. Have the client perform eructation exercises several times a day. 3. Eat four (4) to six (6) small meals a day and limit fluids during mealtimes. 4. Encourage the client to consume a glass of red wine with one (1) meal a day
"1. The client is instructed to avoid spicy and acidic foods and any food producing symptoms. 2. Eructation means belching, which is a symptom of GERD. 3. Clients should eat small, frequent meals and limit fluids with the meals to prevent reflux into the esophagus from a distended stomach.CORRECT 4. Clients are encouraged to forgo all alcoholic beverages because alcohol relaxes the lower esophageal sphincter and increases the risk of reflux
Which assessment data support the client's diagnosis of gastric ulcer?"1. Presence of blood in the client's stool for the past month. 2.Complaints of a burning sensation that moves like a wave. 3.Sharp pain in the upper abdomen after eating a heavy meal. 4.Comparison of complaints of pain with ingestion of food and sleep
"1. The presence of blood does not specifically indicate diagnosis of an ulcer. The client could have hemorrhoids or cancer that would result in the presence of blood. 2. A wavelike burning sensation is a symptom of gastroesophageal reflus. 3. Sharp pain in the upper abdomen after eating a heavy meal is a symptom of gallbladder disease. 4. (CORRECT) In a client diagosed with a gastric ulcer, pain usually occurs 30-60 minutes after eating, but not at night. In contrast, a client with duodenal ulcer has pain durin ghte night that is often relieved by eating food. Pain occurs 1-3 hours after meals
In planning care for the patient with Crohn's disease, the nurse recognizees that a mojor difference between ulcdrative colitis and Crohn's disease is that Crohn's disease "a. frequently results in toxic megacolon b. causes fewer nutritional deficiencies than does ulcerative colitis C. Often recurs after surgery whereas UC is curable with colectomy d. is manifested by rectal bleeding and anemia more frequently than is ulcerative colitis
"4. Correct answer: c Rationale: Because there is a high recurrence rate after surgical treatment of Crohn's disease, medications are the preferred treatment
The pernicious anemia that may accompany gastritis is due to which of the following? a. Chronic autoimmune destruction of cobalamin stores in the body b. Progressive gastric atrophy from chronic breakage in the mucosal barrier and blood loss c. A lack of intrinsic factor normally produced by acid-secreting cells of the gastric mucosa d. Hyperchlorhydria resulting from an inrease in acid-secreting parietal cells and degradation of RBC's
"Correct answer: c Rationale: Gastritis may cause a loss of parietal cells as a result of atrophy. The source of intrinsic factor is also lostthe loss of intrinsic factor, a substance essential for the absorption of cobalamin in the terminal ileum, ultimately results in cobalamin deficiency. With time, the body's storage of cobalamin is depleted, and a deficiency state exists. Because it is essential for the growth and maturation of red blood cells, the lack of cobalamin results in pernicious anemia and neurologic complications
"The nurse explains to the patient with gastroesophageal reflux disease that this disorder: "A. results in acid erosion of the esophagus caused by frequent vomiting B. Will require surgical wrapping of the pyloric sphincter to control the symptoms C. Is the protrusion of a portion of the stomach into the esophagus through the opening in the diaphragm D. Often involves relaxation of the lower esophageal sphincter, allowing the stomach contents to back up into the esophagus
"right answer: d Rationale: Gastroesophageal reflux disease (GERD) results when the defenses of the esophagus are overwhelmed by the reflux of acidic gastric contents into the lower esophagus. An incompetent lower esophageal sphincter (LES) is a common cause of gastric reflux
"Which assessment data support the client's diagnosis of gastric ulcer? 1.Presence of blood in the client's stool for the past month.2.Complaints of a burning sensation that moves like a wave.3.Sharp pain in the upper abdomen after eating a heavy meal.(4).Comparison of complaints of pain with ingestion of food and sleep
(4) In a client diagnosed with a gastric ulcer,pain usually occurs 30-60 minutes after eating, but not at night. In contrast, a client with a duodenal ulcer has pain during thenight that is often relieved by eating food.Pain occurs 1-3 hours after meals
The nurse is administering morning medications at 0730. Which medication should have priority? A. a proton pump inhibitor B. A nonnarcotic analgesicC. A histamine receptor antagonist D. A mucosal barrier agent
...CORRECT ANSWER: D.A. PPI's can be administered routinely. B. Pain medication is important but can be adminstered after a medication that is timed. C. A histamine receptor antagonist can be administered at routine dosing time. D. A mucosal barrier agent must be adminstered on an empty stomach for the medication to coat the stomach lining
The nurse is monitoring the client with a diagnosis of peptic ulcer. Which assessment finding would most likely indicate perforation of the ulcer? 1. Bradycardia 2. Numbness in Legs 3. Nausea and Vomiting 4. A rigid, board-like abdomen
4. Perforation of an ulcer is a surgical emergency and is a sudden, sharp, intolerable severe pain beginning in the midepigastric area and spreading over the abdomen, which becomes rigid and board-like. Nausea and vomiting may occur. Tachycardia may occur as hypovolemic shock develops. Numbness in the leg is not an associated finding
"The results of a patient's recent endoscopy indicate the presence of peptic ulcer disease (PUD). Which of the following teaching points should the nurse provide to the patient in light of his new diagnosis? "A) "You'll need to drink at least two to three glasses of milk daily." B) "It would likely be beneficial for you to eliminate drinking alcohol." C) "Many people find that a minced or pureed diet eases their symptoms of PUD." D) "Your medications should allow you to maintain your present diet while minimizing symptoms
Although there is no specific recommended dietary modification for PUD, most patients find it necessary to make some sort of dietary modifications to minimize symptoms. Milk may exacerbate PUD and alcohol is best avoided because it can delay healing
The nurse caring for a client diagnosed with GERD writes the client problem of "behavior modification." which intervention should be included for this problem? d. 2. encourage the client to decrease the amount of smoking. 3. instruct the client to take over the counter medication for relief of pain. 4. discuss the need to attend alcoholics anonymous to quit drinking
Answer 1 (correct): the client should elevate the hdad of the bed on blocks or use afoam wedge to use gravity to help keep the grastric acid in the stomach and prevent reflux into the esophagus. behavior modification is changing one's behavior. 2. client should not reduce but quite smoking altogether. 3. nurse should be careful when suggesting OTC meds. 4. should stem alcohol but no indication client is an alcoholic
"The nurse is caring for an adult client diagnosed with gastroesophageal reflux disease(GERD). Which condition is the most common comorbid disease associated with GERD? 1.Adult-onset asthma. 2.Pancreatitis. 3.Peptic ulcer disease. 4.Increased gastric emptying
Answer 1, "1. CORRECT - Of adult-onset asthma cases, 80%-90% are caused by gastroesophageal reflux disease(GERD) 2. Pancreatitis is not related to GERD 3. Peptic ulcer disease is related to H. pylori bacterial infections and can lead to increased levelsof gastric acid, but it is not related to reflux. 4.GERD is not related to increased gastricemptying. Increased gastric emptying would bea benefit to a client with decreased functioningof the lower esophageal sphincter
The client with hiatal hernia chronically experiences heartburn following meals. The nurses plans to teach the client to avoid which action because it is contraindicated with a hiatal hernia? 1. Lying recumbent following meals 2. Taking in small, frequent, bland meals 3. Raising the head of bed on 6-inch blocks 4. Taking H2-receptor antagonist medication
Answer 1, Hiatal hernia is caused by a protrusion of a portion of the stomach above the diaphragm where the esophagus usually is positioned. The client usually experiences pain from reflux caused by ingestion of irritating foods, lying flat following meals or at night, and eating large or fatty meals. Relief is obtained with the intake of small, frequent meals, use of H2-receptor antagonists and antacids, and elevation of the thorax following meals and during sleep
A patient has a vagotomy with antrectomy to treat a duodenal ulcer. Postoperatively, the patient develops dumping syndrome. Which of the following statements, if made by the patient, should indicate to the nurse that further dietary teaching is needed? 1. I should eat bread with each meal 2. I should eat smaller meals more frequently. 3. I should lie down after eating. 4. I should avoid drinking fluids with my meals
Answer 1, Patient should decrease intake of carbohydrates
The client with hiatal hernia chronically experiences heartburn following meals. The nurse plans to teach the client to avoid which action because it is contraindicated with a hiatal hernia? 1. Lying recumbent following meals. 2. Taking in small, frequent bland meals. 3. Raising the head of the bed on 6-inch block. 4. Taking H2-receptor antagonist medication
Answer 1,Hiatal hernia is caused by a protrusion of a portion of the stomach above the diaphragm where the esophagus is normally positioned. he client usually experiences pain from reflux caused by ingestion of irritating foods, lying flat following meals or at night, and eating large or fatty meals. Option 2-4, and actually elevating the thorax after a meal, provide relief
The male client tells the nurse he has been experiencing "heartburn" at night that awakens him. Which assessment question should the nurse ask? "1. "How much weight have you gained recently?" 2. "What have you done to alleviate the heartburn?" 3. "Do you consume many milk and dairy products?" 4. "Have you been around anyone with a stomach virus?
Answer 2, "1. Clients with heartburn are frequently diagnosed as having GERD. GERD can occasionally cause weight loss, but not weight gain. 2. Most clients with GERD have been self- medicating with over-the-counter medications prior to seeking advice from a health-care provider. It is important to know what the client has been using to treat the problem. 3. Milk and dairy products contain lactose, which are important if considering lactose intolerance, but are not important for "heartburn." 4. Heartburn is not a symptom of a viral illness
The client is diagnosed with an acute exacerbation of ulcerative colitis. Which inter- vention should the nurse implement? 1. Provide a low-residue diet. 2.Monitor intravenous fluids. 3.Assess vital signs daily.4.Administer antacids orally
Answer 2, "1. The client's bowel should be placed on rest andno foods or fluids should be introduced intothe bowel. 2. (Correct) The client requires fluids to help prevent dehydration from diarrhea and to replacethe fluid lost through normal body func-tioning. 3.The vital signs must be taken more often thandaily in a client who is having an acute exacer-bation of ulcerative colitis. 4.The client will receive anti-inflammatory andantidiarrheal medications, not antacids, whichare used for gastroenteritis
"The nurse is caring for the client diagnosed with chronic gastritis. Which symptom(s) would support this diagnosis? 1. Rapid onset of mid-sternal discomfort. 2. Epigastric pain relieved by eating food 3. Dyspepsia and hematemesis. 4. Nausea and projectile vomiting
Answer 2, "Rationale by answer: 1. Acute gastritis is characterized by sudden epigastric pain or discomfort, not mid-sternal chest pain. 2. Chronic pain in the epigastric area that is relieved by ingesting food is a sign of chronic gastritis (CORRECT). 3. Dyspepsia (heartburn) and hematemesis (vomiting blood) are frequent symptoms of acute gastritis. 4. Projective vomiting is not a sign of chronic gastritis
"Which statement made by the client indicates to the nurse the client may be experiencing GERD? 1. "My chest hurts when I walk up the stairs in my home." 2. "I take antacid tablets with me wherever I go." 3. My spouse tells me I snore very loudly at night." 4. I drink six (6) to seven (7) soft drinks every day
Answer 2, 1. Pain in the chest when walking up stairs indicates angina. 2. Frequent use of antacids indicates an acid reflux problem. 3. Snoring loudly could indicate sleep apnea, but not GERD. 4. Carbonated beverages increase stomach pressure. Six to seven soft drinks a day would not be tolerated by a client with GERD
What response should a nurse offer to a client who asks why he's having a vagotomy to treat his ulcer? 1. To repair a hole in the stomach 2. to reduce the ability of the stomach to produce acid 3. to prevent the stomach from sliding into the chest 4. to remove a potentially malignant lesion in the stomach
Answer 2: A vagotomy is perfomred to elimniate the acid-secreting stimulus to gastric cells. a perforation would be repaired with a gastric resection. Repair of hiatal hernia (fundoplication) prevents the stomach from sliding through the diaphragm. Removal of a potentially malignant tumor wouldn't reduce the entire acid-producing mechanism
The nurse is assessing the client diagnosed with chronic gastritis. Which symptom(s) support this diagnosis? 1. Rapid onset of midsternal discomfort 2. Epigastric pain relieved by eating food 3. Dyspepsia and hematemesis 4. Nausea and projectile vomiting
Answer 2: Chronic pain in the epigastric area relieved by ingesting food is a sign of chronic gastritis
A male client is diagnosed with acute gastritis secondary to alcoholism and cirrhosis. When obtaining the client's history, the nurse gives priority to the client's statement that: 1) His pain increases after meals. 2) He experiences nausea frequently. 3) His stools have a black appearance. 4) He recently joined Alcoholics Anonymous
Answer 3, 1) Investigation of bleeding takes prioritylater the nurse should help to identify irritating foods that are to be avoided. 2) Nausea is a common symptom of gastritis, but it is not life threatening. 3) Black (tarry) stools indicate upper GI bleedingdigestive enzymes act on the blood resulting in tarry stools. Hemorrhage can occur if erosion extends to blood vessels. 4) Attempts to control alcoholism should be supported but this is a long-term goalassessment of bleeding takes priority
Gastroesophageal reflux disease (GERD) weakens the lower esophageal sphincter, predisposing older persons to risk for impaired swallowing. In managing the symptoms associated with GERD, the nurse should assign the highest priority to which of the following interventions? 1. Decrease daily intake of vegetables and water, and ambulate frequently 2. Drink coffee diluted with milk at each meal, and remain in an upright position for 30 minutes. 3. Eat small, frequent meals, and remain in an upright position for at least 30 minutes after eating 4. Avoid over-the-counter drugs that have antacids in them
Answer 3, Eating small and frequent meals requires less release of hydrochloric acid. Remaining in an upright position for 30 minutes after meals prevents reflux into the esophagus which is often exacerbated when lying down, expecially after a large meal which makes the patient tired
which is the most common upper GI problem? "1. peptic ulcer disease 2. Crohns 3. Gerd 4. ulcerative colitis
Answer 3, Gerd is the only upper GI problem
The nurse is monitoring a client with a diagnosis of peptic ulcer. Which assessment finding would most likely indicate perforation of the ulcer? 1. Bradycardia 2. Numbness in the legs 3. Nausea and vomiting 4. A rigid, board-like abdomen
Answer 4, Perforation of an ulcer is a surgical emergency and is characterized by sudden, sharp, intolerable severe pain beginning in the midepigastric area and spreading over the abdomen, which become rigid and board-like. Nausea and vomiting may occur. Tachycardia may occur as hypovolemic shock develops. Numbness in the legs is not an associated finding
The nurse is monitoring a client with a diagnosis of peptic ulcer. Which assessment finding would most likely indicate perforation of the ucler? 1. Bradycardia 2. Numbness in the legs 3. Nausea and vomiting 4. A rigid, board-like abdomen
Answer 4, Rationale: Perforation of an ulcer is a surgical emergency and is characterized by sudden, sharp, intolerable severe pain beginning in the midepigastric area and spreading over the abdomen, which becomes rigid and board-like. Nausea and vomiting may occur. Tachycardia may occur as hypovolemic shock develops. Numbness in the legs is not an associated finding
The nurse is preparing a client diagnosed with GERD for discharge following an esophagogastroduodenoscopy. Which statement indicates the client understands the discharge instructions?7 1. I should not eat for 24 hours following this procedure. 2 I can lie down whenever iI want after a meal. It own't make a difference. 3. The stomach contents won't bother my esophagus but will make me nauseous. 4. I should avoid drinking orange jice and eating tomatoes until my esophagus heals.
Answer 4, oragne and tomato juices are acidic, and the client diagnosed with GERD shouldavoid acidic foods until the esophagus hashad a chance to heal - A client hospitalized with a gastric ulcer is scheduled for discharge.
the nurse is monitoring a client with a diagnosis of peptic ulcer. which assessment finding would most likely indicate perforation of the ulcer? 1. bradycardia 2. numbness in legs 3. N&V 4. a rigid board-like abdomen
Answer 4, perforation of ulcer is a surgical emergency and is characterized by sudden, sharp, intolderable severe pain beginning in the midepigastric area and spreading over the abdomen, which becomes rigid and board-like. nausea and vomiting may also occur. tachycardia may occur as hypovolemic shock develops. numbness of the legs is not an associated finding
The nurse is monitoring a female client with a diagnosis of peptic ulcer. 1.Bradycardia 2.Numbness in the legs 3.Nausea and vomiting 4.A rigid, board-like abdomen
Answer 4,1.Tachycardia may occur as hypovolemic shock develops. 2.Numbness in the legs is not an associated finding. 3.Nausea and vomiting may occur. 4.Perforation of an ulcer is a surgical emergency and is characterized by sudden, sharp, intolerable severe pain beginning in the midepigastric area and spreading over the abdomen, which becomes rigid and board-like
"A patient with a history of peptic ulcer disease has presented to the emergency department with complaints of severe abdominal pain and a rigid, boardlike abdomen, prompting the health care team to suspect a perforated ulcer. Which of the following actions should the nurse anticipate? A. Providing IV fluids and inserting a nasogastric tube B. Administering oral bicarbonate and testing the patient's gastric pH level C. Performing a fecal occult blood test and administering IV calcium gluconate D. Starting parenteral nutrition and placing the patient in a high-Fowler's position
Answer A, A perforated peptic ulcer requires IV replacement of fluid losses and continued gastric aspiration by NG tube. Nothing is given by mouth and gastric pH testing is not a priority. Calcium gluconate is not a medication directly relevant to the patient's suspected diagnosis and parenteral nutrition is not a priority in the short term
Which of the following nursing interventions should the nurse perform for a female client receiving enteral feedings through a gastrostomy tube? "a. Change the tube feeding solutions and tubing at least every 24 hours b. Maintain the head of the bed at a 15-degree elevation continuously. c. Check the gastrostomy tube for position every 2 days. d. Maintain the client on bed rest during the feedings
Answer A, Answer A. Tube feeding solutions and tubing should be changed every 24 hours, or more frequently if the feeding requires it. Doing so prevents contamination and bacterial growth. The head of the bed should be elevated 30 to 45 degrees continuously to prevent aspiration. Checking for gastrostomy tube placement is performed before initiating the feedings and every 4 hours during continuous feedings. Clients may ambulate during feedings
The teaching plan for the patient being discharged following an acute episode of upper GI bleeding will concern information concerning the importance of (select all that apply) a. only taking aspirin with milk or bread products b. avoiding taking aspirin and drugs containing aspirin c. taking only drugs prescribed by the health care provider d. taking all drugs 1 hour before mealtime to prevent further bleeding e. reading all OTC drug labels to avoid those containing stearic acid and calcium
Answer A, C Aspirin contributes to thinning the blood and is linked to causing things like peritonitis further increasing the risk for bleeding. Taking only health care prescribed drugs can greatly reduce the risk from accidentally using OTC meds that might contribute to bleeding
The client attends two sessions with the dietitian to learn about diet modifications to minimize gastroesophageal reflux. The teaching would be considered successful if the client says that she will decrease her intake of which of the following foods? A) Fats, B)Carbohydrates, C) High-calcium foods, D) High-Sodium foods
Answer A, Fats are associated with decreased esophageal sphincter tone, which increases reflux. Obesity contributes to the development of hiatal hernia, and a low-fat diet might also aid in weight loss. Carbohydrates and foods high in sodium or calcium do not affect gastroesophageal reflux
"The nurse is reviewing the record of a client with Crohn's disease. Which stool characteristic should the nurse expect to note documented in the client's record? "a. Diarrhea b. Chronic constipation c. Constipation alternating with diarrhea d. Stool constantly oozing from the rectum
Answer A,"(A) Crohns disease is characterized by nonbloody diarrhea of usually not more than 4 or 5 stools daily. overtime the stools increase frequency duration and severity
The patient who is admitted with a diagnosis of diverticulitis and a history of irritable bowel disease and gastroesophageal reflux disease (GERD) has received a dose of Mylanta 30 ml PO. The nurse would evaluate its effectiveness by questioning the patient as to whether which of the following symptoms has been resolved? A-Diarrhea B.Heartburn C.Constipation D. Lower abdominal pain
Answer B, "Mylanta is an antacid that contains both aluminum and magnesium. It is indicated for the relief of GI discomfort, such as with heartburn associated with GERD
What statement made by the client indicates to the nurse the client may be experiencing GERD?n "A. ""My chest hurts when I walk up the stairs in my home"" B. ""I take antacid tablets with me wherever I go"" C. ""My spouse tells me I snore very loudly at night"" D. ""I drink 6 to 7 soft drinks every day
Answer B, (B) Frequent use of antacids indicates an acid reflux problem
"The nurse has instructed the client who is experiencing diarrhea associated with irritable bowel syndrome on dietary changes to prevent diarrhea. The nurse knows the client understands the dietary changes if the client selects which of the following menu choices? a) Yogurt, crackers and sweet tea b) Salad with chicken, whole wheat crackers c) Bacon, tomato, lettuce with mayonnaise and a soft drink d) Tuna on white bread and coconut cake
Answer B,Rationale: Bacon tomato lettuce with mayonnaise and soft drink is high in fat and the soft drink is hyperosmolar both contributing to diarrhea. Salad, whole wheat crackers may decrease diarrhea due to increased fiber. Dairy increases diarrhea. Food high in carbohydrates increase diarrhea. Coconut may increase diarrhea
The nurse is caring for a male client with a diagnosis of chronic gastritis. The nurse monitors the client knowing that this client is at risk for which vitamin deficiency? a. Vitamin A b. Vitamin B12 c. Vitamin C d. Vitamin E
Answer B. Chronic gastritis causes deterioration and atrophy of the lining of the stomach, leading to the loss of the function of the parietal cells. The source of the intrinsic factor is lost, which results in the inability to absorb vitamin B12. This leads to the development of pernicious anemia. The client is not at risk for vitamin A, C, or E deficiency
"The nurse determines that a patient has experienced the beneficial effects of medication therapy with famotidine (Pepcid) when which of the following symptoms is relieved? "A) Nausea B) Belching C) Epigastric pain D) Difficulty swallowing
Answer C, "Famotidine is an H2-receptor antagonist that inhibits parietal cell output of HCl acid and minimizes damage to gastric mucosa related to hyperacidity, thus relieving epigastric pain
The nurse is caring for a female client with active upper GI bleeding. What is the appropriate diet for this client during the first 24 hours after admission? a. regular diet b. skim milk c. nothing by mouth d. clear liquids
Answer C, Answer C. Shock and bleeding must be controlled before oral intake, so the client should receive nothing by mouth. A regular diet is incorrect. When the bleeding is controlled, the diet is gradually increased, starting with ice chips and then clear liquids. Skim milk shouldn't be given because it increases gastric acid production, which could prolong bleeding. A liquid diet is the first diet offered after bleeding and shock are controlled
5. Which of the following drugs is a histamine blocker and reduces levels of gastric acid?"A. Omeprazole (Prilosec) B. Metoclopramide (Reglan) C. Cimetidine (Tagamet) D. Magnesium Hydroxide (Maalox)
Answer C, Cimetidine bind to H2 in the tissue and decreases the production of gastric acid
The most frequently used diagnostic test for persons with GERD is:a) Barium enema b) upper endoscopy c) barium swallow d) acid perfusion test
Answer C, Persons with GERD should be referred to a primary care provider for a thorough cardiac evaluation to rule out cardiac disease. The most frequently used diagnostic test is barium swallow. Upper endoscopy is the best method to assess mucosal injury. Acid perfusion tests usually are not necessary, and require the placement of an esophageal probe above the esophageal sphincter to collect esophageal contents
Gastroesophageal reflux disease (GERD) weakens the lower esophageal spinchter, predisposing older persons to risk for impaired swallowing. In managing the symptoms associated with GERD, the nurse should assign the highest priority to which of the following interventions? A. Decrease daily intake of vegetables and water and ambulate frequently, B. drink coffee diluted with milk at each meal and remain in an upright position for thirty minutes, C. Eat small, frequent meals and remain in an upright position for thirty minutes D. Avoid OTC drugs that have antacids in them
Answer C, Rationale: Small, frequent feedings requires less release of hydrochloric acid. Remaining in an upright position for 30 minutes after meals prevents reflux into the esophagus
Gastroesophageal reflux disease (GERD) weakens the lower esophageal sphincter, predisposing older persons to risk for impaired swallowing. In managing the symptoms associated with GERD, the nurse should assign the highest priority to which of the following interventions? A) Decrease daily intake of vegetables and water, and ambulate frequently. B) Drink coffee diluted with milk at each meal, and remain in an upright position for 30 minutes. C) Eat small frequent meals, and remain in an upright position for at least 30 minutes after eating. D) Avoid over-the-counter drugs that have antacids in them
Answer C, Small, frequent feedings requires less release of hydrochloric acid. Remaining in an upright position for 30 minutes after meals prevents reflux into the esophagus
"The nurse is teaching a client with a gastric ulcer about dietary management for the disease. Teaching is successful when the client states... Source: Lippincott's Review for NCLEX-RN" "A: "I should eat a low fiber diet to delay gastric emptying." B: "I cannot eat fruits and veggies because they cause too much gas." C: "As long as they don't bother my stomach, I can eat most foods. D: "I can eat bland foods to help my stomach heal
Answer C, The correct answer is C. The antiulcer diet is not severely restricted. it is the ideal to have small frequent feedings but the client can eat foods as long as they do not cause upset. Low fiber diets are more so used in Ulcerative Colitis. A bland diet is used for severe inflammation
The nurse explains to the patient with gastroesophageal reflux disease that this disorder: A. results in acid erosion and ulceration of the esophagus caused by frequent vomiting, B. will require surgical wrapping or repair of the pyloric sphincter to control the symptoms, C. is the protrusion of a portion of the stomach into to esophagus through an opening in the diaphragm, D. often involves relaxation of the lower esophageal sphincter, allowing stomach contents to back up into the espophagus
Answer: D. The acidic contents of the stomach touching the inside of the esophagus are responsible for the physical sensation known as "heart-burn" that is a cardinal symptom of GERD
Which of these agents is a major contributing factor in the promotion of peptic ulcer disorder? A) Candida albicans. B) staphyloccus infection. C) streptococcus infection D) Helibacter pylori infection
Answer: Helobacter pylori infection. Rationale: Recurrence of peptic ulcers is related to Helicobacter pylori, use of NSAIDs, smoking, and continued acid hypersecretion
The results of a patient's recent endoscopy indicate the presence of peptic ulcer disease (PUD). Which of the following teaching points should the nurse provide to the patient in light of his new diagnosis? You'll need to drink at least two to three glasses of milk daily. B."It would likely be beneficial for you to eliminate drinking alcohol." C. Many people find that a minced or pureed diet eases their symptoms of PUD. D. Your medications should allow you to maintain your present diet while minimizing symptoms
CORRECT ANSWER: B Although there is no specific recommended dietary modification for PUD, most patients find it necessary to make some sort of dietary modifications to minimize symptoms. Milk may exacerbate PUD and alcohol is best avoided because it can delay healing
A nurse provides feeding instructions to a mother of an infant diagnosed with gastroesophageal reflux disease. To assist in reducing the episodes of emesis, the nurse tells the mother to:1) Provide less frequent, larger feedings. 2) Burp the infant less frequently during feedings. 3) Thin the feedings by adding water to the formula. 4) Thicken the feedings by adding rice cereal to the formula
CORRECT: 4) Thicken the feedings by adding rice cereal to the formula. Rationale: GERD is backflow of gastric contents into the esophagus as a result of relaxation or incompetence of the lower esophageal or cardiac sphincter. Small, more frequent feedings with frequent burping often are prescibed in the treatment of GER. Feedings thickened with rice cereal may reduce episodes of emesis. If thickened formula is used, cross-cutting of the nipple may be required
The nurse is planning to teach a client with GERD about substances that will increase the LES pressure.Which item shoud the nurse include on this list.1. Coffee 2. Chocolate 3. Fatty Foods 4. Nonfat MIlk
Correct Answer: Nonfat MIlkFoods that will increase LES pressure will decrease reflux and lessen the symptoms of GERD. The food that will increase LES pressure is nonfat milk. The other substances listed decrease LES pressure, thus increasing reflux symptoms. Aggravating substances include the others listed and alcohol
The male client tells the nurse he has been experiencing "heartburn" at night that awakens him. Which assessment question should the nurse ask? A. How much weight have you gained recently? B. What have you done to alleviate the heartburn? C. Do you consume many milk and dairy products? D Have you been around anyone with a stomach virus
Correct answer is B,Most clients with GERD have been self medicating with over-the counter medications prior to seeking advice from a healthcare provider. It is important to know what the client has been using to treat the problem
When assessing the client with the diagnosis of peptic ulcer disease, which physical examination should the nurse implement first? Auscultate the client's bowel sounds in all four quadrants. 2.Palpate the abdominal area for tenderness. 3.Percuss the abdominal borders to identify organs. 4.Assess the tender area progressing to nontender
Correct answer: #1. Auscultation should be used prior to palpa-tion or percussion when assessing the abdomen. If the nurse manipulates the abdomen, the bowel sounds can be altered and give false information
The nurse is performing an admission assessment on a client diagnosed with gastroesophageal reflux disease (GERD). Which signs and symptoms would indicate GERD? 1. Pyrosis, water brash, and flatulence 2. Weight loss, dysarthria, and diarrhea 3. Decreased abdominal fat, proteinuria, and constipation 4. Mid-epigastric pain, positive H. pylori test, and melena
Correct answer: 1 (pyrosis, water brash, and flatulence)1. Pyrosis is heartburn, water brash is the feeling of saliva secretion as a result of reflux, and flatulence is gas—all symptoms of GERD 2. Gastroesophageal reflux disease does not cause weight loss 3. There is no change in abdominal fat, no proteinuria (the result of a filtration problem inthe kidney), and no alteration in bowel elimination for the client diagnosed with GERD 4. Mid-epigastric pain, a positive H. pylori test, and melena are associated with gastric ulcer disease
The client with a hiatal hernia chronically experiences heartburn following meals. The nurse planc to teach the client to avoid which action because it is contraindicated with hiatal hernia?1. Lying recumbent following meals 2. Taking in small, frequent, bland meals 3. Raising the head of the bed on 6-inch blocks 4. Taking H2-receptor antagonist medication
Correct answer: 1Laying recumbant following meals or at night will cause reflux and pain. Relief is usually achieved with the intake of small, bland meals, use of H2 receptor antagonists and antacids, and elevation of the thorax after meals and during sleep
