N309 Quiz 16 GI 1
What is the cause of late dumping syndrome?
c. Release of an excessive amount of insulin
After an esophagectomy, what is the nurse's priority for pt care?
c. Respiratory care
Which statement about esophageal trauma caused by chemical injury is accurate?
c. Strong alkalis can cause full perforation of the esophagus within 1 min
Three days after admission to the hospital for a brain attack (CVA), a client has a nasogastric tube inserted and is receiving continuous tube feedings. What should the nurse do to best evaluate whether the feeding is being absorbed?
1. Aspirate for a residual volume
A nurse is providing discharge instructions for a client with a diagnosis of GERD. What should the nurse advise the client to do to limit symptoms of GERD? SATA.
1. Avoid heavy lifting 3. Avoid drinking alcohol 4. Eat small, frequent meals
A client with GERD is to receive metoclopramide (Reglan) 15 mg orally before meals. The concentrated solution contains 10 mg/mL. How much solution should the nurse administer?
1.5 mL
A client is admitted with a tentative diagnosis of pancreatitis. The medical and nursing measures for this client are aimed toward maintaining nutrition, promoting rest, maintaining fluid and electrolyte balance, and decreasing anxiety. Which interventions should the nurse implement? SATA.
2. Administer analgesics 3. Teach relaxation exercises 5. Monitor cardiac rate and rhythm
A client with GERD reports having difficulty sleeping at night. What should the nurse instruct the client to do?
2. Elevate the head of the bed on blocks
A nurse is obtaining a history and performing a physical assessment of a client who has cancer of the tongue. Which clinical findings should the nurse expect to identify? SATA.
2. Leukoplakia 5. Alterations in taste 6. Enlarged cervical lymph nodes
A client has a nasogastric feeding tube inserted, and the health care provider orders the prescribed feeding to be instituted immediately. What should the nurse do first?
2. Obtain an x-ray to verify that the tube is in the stomach
A client has a fractured mandible that is immobilized with wires. For which life-threatening postoperative problem should the nurse monitor this client?
2. Vomiting
A client with GERD should make diet and lifestyle changes. What instructions should the nurse include in the client's discharge teaching? SATA.
3. Avoid caffeine-containing products 5. Chew thoroughly while eating slowly
A client with esophageal cancer is to receive total parenteral nutrition. A right subclavian catheter is inserted. What should the nurse consider is the primary reason why the health care provider ordered a central line?
4. The large amount of blood helps to dilute the concentrated solution
A client who had an incision and drainage of an oral abscess is to be discharged. For which additional finding, if it should occur, should the nurse instruct the client to notify the health care provider?
3. Pain with swelling after one week
A client is receiving hypertonic tube feedings. What should the nurse consider to be the main reason this client may experience diarrhea?
4. High osmolarity of the feedings
A nurse is collecting a health history from a client who has a diagnosis of cancer of the tongue. For which risk factor commonly associated with cancer of the tongue should the nurse assess when collecting the client's history?
4. Large consumption of alcohol
A health care provider orders intermittent nasogastric tube feeding to supplement a client's oral nutritional intake. Which hazard associated with a nasogastric tube feeding will be reduced if the nurse administers this feeding over 30-60 mins?
4. Regurgitation
During administration of an enema, a client reports having intestinal cramps. What should the nurse do?
4. Stop the fluid until the cramps subside
The nurse is assessing a pt's nasogastric drainage following a conventional fundoplication procedure. How does the nurse expect the drainage to appear in the first 8 hrs after surgery?
A. Dark brown
The nurse is assessing a pt who has had a total gastrectomy today and notes bright-red blood in the nasogastric tube and abd distention. What does the nurse do next?
c. Inform the surgeon of these findings
The nurse is teaching a pt about health promotion and maintenance to prevent gastritis. Which information does the nurse include? SATA.
a. "A balanced diet can help prevent gastritis." c. "If you stop smoking, there is less of a change that you will develop gastritis." d. "Yoga has been found to be effective in preventing gastritis." f. "To prevent gastritis, alcohol should be avoided."
The nurse is providing discharge teaching for a pt after a gastrectomy. Which teaching points will the nurse include to help the pt minimize dumping syndrome? SATA.
a. "Eat small frequent meals." c. "Eliminate alcohol and caffeine from your diet." d. "Lie flat for a short time after eating." e. "Take B12 injections as prescribed by your health care provider." f. "Begin a smoking cessation program."
Which statements will the nurse include when providing health teaching for a pt with hiatal hernia? SATA.
a. "Elevate the head of your bed at least 6 inches for sleeping at night." b. "Remain in the upright position for several hours after eating." c. "Avoid straining or excessive vigorous exercise." e. "Avoid wearing clothing that is tight around the abd." f. "Avoid eating in the late evening."
A pt who has been prescribed famotidine is being discharged home. Which statement by the pt indicates a need for further discharge teaching by the nurse?
a. "I will double up on the dose if I begin to feel increased heartburn."
The nurse is teaching a pt with dumping syndrome about diet. Which statement by the pt indicates that teaching has been effective?
a. "I will use sugar-free gelatin with caution."
The health care provider has prescribed quadruple therapy for a pt with PUD due to H. pylori infection. Which drugs will the nurse expect to administer? SATA.
a. A proton pump inhibitor c. Two antibiotics e. Bismuth
The nurse is collaborating with the speech-language pathologist to assist the pt with oral exercises to improve swallowing (swallowing therapy) and with the occupational therapist for feeding therapy. Which key points must be included when teaching this pt? SATA.
a. Ask the pt to suck on a lollipop to enhance tongue strength b. Teach the pt to reach for food particles on the lips of chin using the tongue d. In preparation for swallowing, remind the pt to position the head in forward flexion (chin tuck) e. Monitor the pt for sealing of the lips and for tongue movements while eating
The nurse is caring for a pt with esophageal cancer who is scheduled to undergo an esophagogastrostomy with a section of the jejunum to replace the esophagus. Which procedure does the nurse expect to perform preoperatively?
a. Complete bowel preparation
Which type of gastric ulcer does the nurse expect may occur when caring for a pt with extensive burns?
a. Curling's ulcer
Uncontrolled GERD can be a cause of which adult-onset disorders? SATA.
a. Dental decay b. Aspiration pneumonia c. Laryngitis e. Asthma f. Cardiac disease
A pt with severe GERD tells the nurse that she has pain after each meal that lasts for 45 mins and is worse when she lies down. What interventions should the nurse teach this pt? SATA.
a. Drink fluids c. Take an antacid as prescribed by your health care provider e. Maintain an upright position for at least 1 hr after you eat
The nurse is giving discharge instructions to a pt after a fundoplication procedure. The pt is instructed to avoid which activiites? SATA.
a. Drinking carbonated beverages c. Drinking with a straw d. Eating gas-producing foods f. Chewing gum
Which are the two most common manifestations of GERD? SATA.
a. Dyspepsia d. Regurgitation
When performing an assessment on a pt with an active upper GI bleed, which conditions does the nurse identify as common causes of upper GI bleeding? SATA.
a. Esophageal cancer b. Esophageal varices d. Duodenal ulcer e. Gastritis f. Gastric cancer
Which diagnostic test is the gold standard for diagnosing gastritis?
a. Esophagogastroduodenoscopy (EGD)
The pt with GERD describes painful swallowing. Which symptom does the nurse identify?
c. Odynophagia
A pt with PUD is receiving Maalox. Which actions does the nurse take when administering this medication? SATA.
a. Give the medication 2 hours after the pt's meal c. Assess the pt for a history of renal disease before giving Maalox d. Assess the pt for a history of heart failure before giving Maalox f. Do not give other drugs within 1-2 hours of antacids
What manifestations are expected when a pt has esophageal diverticula? SATA.
a. Halitosis b. Dysphagia d. Nocturnal cough e. Regurgitation
The nurse is caring for several pts with gastric and duodenal ulcers. Which differential features of gastric ulcers does the nurse identify? SATA.
a. In gastric ulcers, there is normal secretion or hyposecretion c. Hematemesis is more common than melena f. Pain occurs 30-60 minutes after a meal and at night
By which actions do drugs used to treat GERD help to decrease the pain and discomfort the pt experiences? SATA.
a. Inhibition of gastric acid production c. Accelerating gastric emptying e. Protecting the gastric mucosa
Which statement is true about Barrett's epithelium in the pt with GERD?
a. It is considered premalignant and is associated with higher risk for cancer
Which statements about Barrett's esophagus are accurate? SATA.
a. It is considered to be a premalignant condition c. It results from exposure to acid and pepsin d. It is associated with pickled and fermented foods e. Normal cells undergo dysplasia to be come cancerous
The pt with a gastric ulcer presents with a rigid, tender, and painful abd. He prefers lying in a knee-chest (fetal) position. What is the nurse's priority action at this time?
a. Notify the health care provider
An older adult with GERD is prescribed omeprazole. What priority teaching point must the nurse instruct the pt about while taking this drug?
a. Older adults taking this drug may be at increased risk for hip fracture because it interferes with calcium absorption
Which statements about GERD are correct? SATA.
a. Overweight and obese pts are at an increased risk e. It is a common upper gastrointestinal disorder in the US f. Eating large meals predisposes a pt to reflux
Drug therapy for peptic ulcer disease is implemented for which purposes? SATA.
a. Pain relief c. Eliminate H. pylori infection d. Heal ulcerations e. Prevent recurrence
A pt with chronic gastritis is being admitted. Which sign/symptom does the nurse identify as being associated with this pt's condition?
a. Pernicious anemia
Which are possible complications of chronic gastritis? SATA.
a. Pernicious anemia c. Gastric cancer d. Decreased gastric acid secretion e. Peptic ulcer disease
What is the primary focus of care after conventional surgery for hiatal hernia?
a. Prevention of respiratory complications
Which strategies does the nurse expect to implement in the management of dumping syndrome? SATA.
a. Provide more frequent smaller meals c. Eliminate liquids ingested with meals d. Increase protein and fat in the diet e. Administer acarbose to decrease carbohydrate absorption f. Subcutaneous octreotide (Sandostatin) 2-3 times a day, 30 min before meals as prescribed
A pt develops an active upper GI bleed. Which are the priority actions the nurse takes in caring for this pt? SATA.
a. Provide oxygen b. Start 1-2 large bore IV lines c. Prepare to infuse 0.9% normal saline solution e. Prepare for NG tube insertion f. Monitor hematocrit and hemoglobin
Which statement about general principles of diet therapy for pts with dumping syndrome is true?
a. Pts with dumping syndrome should have liquids between meals only
Nonsurgical treatment options for cancer of the esophagus can include which therapies? SATA.
a. Swallowing therapy b. Chemoradiation c. Targeted therapies e. Photodynamic therapy f.Endoscopic therapies
Which are symptoms of early dumping syndrome? SATA.
a. Tachycardia c. Desire to lie down d. Syncope e. Occurs 30 min after eating
The pt with esophageal cancer has an excess of HER2 protein on the cell surface. What therapy does the nurse expect will be ordered for this pt?
a. Targeted therapy with IV trastuzumab
In the postoperative period, following an open fundoplication repair for a paraesophageal (rolling) hernia, the nurse notes that with oral feedings, the pt has continuous dysphagia. What is the nurse's best interpretation of this finding?
a. The fundoplication is too tight, and dilation may be required
The nursing student caring for a pt with a duodenal ulcer is about to administer a proton pump inhibitor. Which statement about this medication is true?
a. These drugs should not be used for a prolonged period because they may contribute to osteoporotic-related fractures
The student nurse is performing a gastric lavage on a pt with an active upper GI bleed. Which action by the student requires intervention by the supervising nurse?
a. Using an ice-cold solution to perform lavage of the stomach
Which are pathologic changes associated with acute gastritis? SATA.
a. Vascular congestion b. Sever mucosal damage and ruptured vessels d. Acute inflammatory cell infiltration f. Edema
The nurse is caring for a pt who underwent gastric resection. On assessment, the nurse notes that the pt's tongue is smooth and shiny and appears "beefy." What does the nurse suspect has occurred?
a. Vitamin B12 deficiency
The nurse is teaching a pt with dumping syndrome. Which foods should the pt be instructed are permitted and encouraged? SATA.
a. White bread, rolls, and crackers c. Cooked vegetables e. Fish, poultry, beef, or pork f. Butter and salad dressings
The pt with a gastric ulcer suddenly develops sharp constant epigastric pain that spreads over the entire abd. What complication has the pt most likely developed?
c. Perforation
Which group of drugs is the main treatment for severe GERD?
c. Protein pump inhibitors
The nurse has provided postoperative teaching for a pt who underwent a laparoscopic Nissen fundoplication. Which statement by the pt indicates a need for additional teaching?
b. "I will no longer need the anti-reflux drugs after the surgery."
The nurse has provided instruction for a pt prescribed sucralfate to treat a gastric ulcer. Which statement by the pt indicates that teaching has been effective?
b. "I will take this drug on an empty stomach."
When teaching a pt about pernicious anemia, which statement does the nurse include?
b. "Pernicious anemia results from a deficiency of vitamin B12."d. ACute gastriti
The nurse is teaching a pt about ranitidine (Zantac) prescribed for gastritis. Which statement by the pt indicates effective teaching by the nurse?
b. "This drug will block the secretions of my stomach."
A pt is scheduled to have several diagnostic tests to verify the medical diagnosis of GERD. Which diagnostic test is the most accurate method of diagnosing this disorder?
b. Ambulatory pH monitoring examination
Which lifestyle adjustment may a pt have to make to best control GERD?
b. Attain and maintain ideal body weight
The nurse is caring for a postoperative pt after esophageal surgery. On assessment, the nurse discovers that the pt's temp is 101, heart rate is 120, and respiratory rate is 32. Lung sounds include bilateral crackles. What is the nurse's priority first action?
b. Call the Rapid Response Team
Which procedure would the health care provider recommend for immediate relief of dysphagia?
b. Esophageal dilation
Which types of ulcers are included in peptic ulcer disease? SATA.
b. Gastric ulcers d. Duodenal ulcers e. Stress ulcers
Which is the most commonly reported symptom associated with PUD?
b. Indigestion
What physiologic factor contributes to GERD?
b. Irritation from reflux of stomach contents
The nurse is teaching a pt with GERD about lifestyle changes. Which key points would the nurse include? SATA.
b. Limit or eliminate alcohol and tobacco c. Eat slowly and chew food thoroughly e. Do not wear restrictive clothing f. Reduce or eliminate spicy foods that cause increased gastric acid
A pt with GERD is on a medication that raises the pH of gastric contents. Which drug does the nurse expect to administer?
b. Mylanta
Which therapy may be used as a cure for pts who have small localized tumors?
b. Photodynamic therapy
The pt tells the nurse that he is fearful of developing stomach cancer, which caused his father's death. Which foods should the nurse teach the pt to avoid?
b. Pickled and processed foods
Which instruction would the nurse be sure to give to the unlicensed assistive personnel who will be assisting a pt with an esophageal tumor to eat?
b. Position the pt in high Fowler's position before feedings
Which simple noninvasive tests can be used to detect H. pylori in a pt with peptic ulcer disease? SATA.
b. Serologic testing for antibodies c. Urea breath test d. Stool antigen test
The nurse is supervising a senior nursing student in the care of a pt after esophageal surgery. For which action by the student must the nurse intervene?
b. Student prepares to irrigate the NG tube
Which statements about gastritis are accurate? SATA.
b. The onset of infection with Helicobacter pylori can result in acute gastritis d. Atrophic gastritis is a form of chronic gastritis that is seen most in older adults e. Type B chronic gastritis affects the glands in the antrum but may affect all the stomach
A pt is undergoing a workup for carcinoma of the esophagus. What are the two primary risk factors associated with the development of this carcinoma?
b. Tobacco use and obesity
Which drug would the health care provider prescribe to treat H. pylori infection?
c. Clarithromycin
What is the most common symptom of esophageal cancer reported by pts?
c. Difficulty with swallowing
An older adult pt is admitted with an upper GI bleed. Which finding does the nurse expect to assess in the pt?
c. Dizziness
The definitive diagnosis for esophageal cancer is made with which procedure?
c. Esophageal ultrasound with fine needle aspiration
The pt develops abd bleeding along with N/V. Which complication of PUD does the nurse recognize?
c. Pyloric obstruction
The nurse has provided teaching to a pt with GERD. Which statement by the pt indicates the teaching has been effective?
d. "I won't lift any heavy objects."
The nurse is teaching a pt being discharged home about taking prescribed medications that include sucralfate. Which statement by the pt indicates teaching has been effective?
d. "Sucralfate works to heal my ulcer."
A pt has returned to the unit after a Stretta procedure for GERD. Which action by the student nurse requires the supervising nurse to intervene?
d. A nasogastric tube is prepared for insertion
A pt comes to the emergency department reporting rapid onset of pain with nausea and vomiting. The pt says the pain is worse than any heartburn he has had, and that he has not had an appetite for the past day. What does the nurse suspect this pt has?
d. Acute gastritis
Which statement about the use of antacids in the treatment of gastric ulcers is true?
d. Avoid using antacids with phenytoin
What diagnostic test best identifies a hiatal hernia?
d. Barium swallow study with fluoroscopy
Which type of NSAID is less likely to cause mucosal damage to the stomach?
d. Celecoxib
The nurse is taking a history from a pt with peptic ulcer disease. Which factor indicates the largest risk for stomach cancer?
d. History of infection with H. pylori
Which statement is true about the drug rabeprazole for treatment of GERD?
d. If once-a-day dosing does not control symptoms, it may be taken twice a day
A pt is prescribed pantoprazole. What does the nurse tell the pt is the major action of this medication?
d. It inhibits gastric acid secretion
Which peptic ulcer drug is useful to protect pts against NSAID-induced ulcers?
d. Misoprostol
The pt describes experiencing a dull and steady substernal pain, especially after drinking cool liquids. Which manifestation of esophageal cancer does the nurse recognize?
d. Odynophagia
A pt with acute gastritis is receiving treatment to block and buffer gastric acid secretions to relieve pain. Which drug does the nurse identify as an antisecretory agent (protein pump inhibitor)?
d. Omeprazole
The postoperative pt who had esophageal surgery has an NG tube in place. What intervention should the nurse delegate to the unlicensed assistive personnel?
d. Provide the pt with thorough mouth and nasal care every 2-4 hours
For which pt is radiation therapy contraindicated?
d. Pt with tracheoesophageal fistula
The nurse is caring for a pt who vomited coffee-ground emesis. Where does the nurse suspect this pt is bleeding?
d. Upper GI system