Upper GI
Avoid tea and coffee maintain a low-fat diet avoid smoking cigarettes In an obese person, the intraabdominal pressure is increased, which can exacerbate GERD. Maintaining a low-fat diet could help in losing weight and therefore relieve the condition. Tea, coffee, and nicotine (a component of cigarettes) are known to decrease the lower esophageal sphincter pressure, aggravating GERD. Patients with GERD are prescribed cholinergic drugs to relieve their condition. Anticholinergic drugs, on the other hand, affect the lower esophageal sphincter pressure and may therefore cause GERD. Lying down immediately after eating food may promote the movement of food toward the esophageal sphincter and increase the pressure on it, therefore exacerbating the condition.
A nurse is teaching an obese patient with gastroesophageal reflux disease (GERD) measures that should be taken to prevent complications. What instructions should the nurse give? Select all that apply. 1 Avoid tea and coffee. 2 Maintain a low-fat diet. 3 Avoid smoking cigarettes. 4 Lie down immediately after having food. 5 Use anticholinergic drugs, as prescribed.
Helicobacter pylori H. pylori infection is highest in underdeveloped countries and in people of low socioeconomic status. Infection likely occurs during childhood with transmission from family members to the child, possibly through a fecal-oral or oral-oral route. Syphilis, cytomegalovirus, and Mycobacterium species also are causes of chronic gastritis, but they are not as common as H. pylori.
Linked to stomach cancer and non-Hodgkin's lymphoma, what is a common cause of gastritis? 1 Syphilis 2 Cytomegalovirus 3 Helicobacter pylori 4 Mycobacterium species
Nizatidine Nizatidine is available only for oral administration but not for intravenous (IV) administration; the medication is used to promote ulcer healing. Ranitidine, cimetidine, and famotidine are histamine (H2) blockers that can be given orally or through IV.
Which histamine-receptor blocker is available only for oral administration? 1 Nizatidine 2 Ranitidine 3 Cimetidine 4 Famotidine
to improve nutrition status Endoscopic stents are placed to improve nutrition and hydration. Placing the patient in an upright position will help prevent regurgitation and improve gastric emptying. Using an incentive spirometer will help prevent respiratory complications.
Why does a primary health care provider place stents endoscopically while preparing a patient with esophageal cancer for surgery? 1 To prevent regurgitation 2 To improve nutrition status 3 To improve gastric emptying 4 To prevent respiratory complications
rigid abdomen and vomiting following indigestion A rigid abdomen with vomiting in a patient who has a gastric ulcer indicates a perforation of the ulcer, especially if the manifestations of perforation appear suddenly. Midepigastric pain is relieved by eating, drinking water, or antacids with duodenal ulcers, not gastric ulcers. Back pain three to four hours after a meal is more likely to occur with a duodenal ulcer. Burning epigastric pain one to two hours after a meal is from an expected manifestation with a gastric ulcer related to increased gastric secretions and does not cause an urgent change in the nursing plan of care.
A 72-year-old patient was admitted with epigastric pain caused by a gastric ulcer. Which patient assessment warrants an urgent change in the nursing plan of care? 1 Chest pain relieved with eating or drinking water 2 Back pain three or four hours after eating a meal 3 Burning epigastric pain 90 minutes after breakfast 4 Rigid abdomen and vomiting following indigestion
With tube feedings, the patient should be observed for signs of intolerance of feeding or leakage of the feeding into the mediastinum. Symptoms that indicate leakage are pain, dyspnea, and increased temperature. Feeding is done through the tube in an upright position; therefore, the chance of acid reflux is unlikely. Tachycardia doesn't occur immediately as a sign of leakage into the mediastinum.
A patient has had esophageal surgery, and a jejunostomy feeding tube is inserted to administer oral fluids. The nurse has been told to check for signs of intolerance and leakage of feeding into the mediastinum. Which signs should the nurse be observant for? Select all that apply. 1 Pain 2 Dyspnea 3 Acid reflux 4 Tachycardia 5 Increased temperature
Monitor the vital signs continuously administer intravenous fluids and electrolytes insert a nasogastric tube connected to suction The vital signs should be monitored continuously to determine the physiologic state of the patient. Patients with persistent vomiting should immediately be put on NPO status (no food or liquid by mouth) and should be given intravenous fluids to prevent dehydration. A nasogastric tube should be placed for aspiration of stomach contents. Opioids induce vomiting and hence should not be administered. Persistent vomiting would induce fatigue, and physical activity would worsen the condition of the patient.
A patient has had persistent nausea and vomiting for the last five days. Which immediate nursing interventions available are appropriate for this patient? Select all that apply. 1 Monitor the vital signs continuously. 2 Encourage patient to do physical activity. 3 Administer opioid drugs to sedate the patient. 4 Administer intravenous fluids and electrolytes. 5 Insert a nasogastric tube connected to suction.
Insert a nasogastric (NG) tube into the stomach. The immediate focus of management for a patient with a perforation is to stop the spillage of gastric or duodenal contents into the peritoneal cavity and restore blood volume. An NG tube is inserted into the stomach to provide continuous aspiration and gastric decompression to stop spillage through the perforation and thereby prevent peritonitis. Administering nitrates to such a patient will not be helpful in relieving the condition. Administration of pain medications and preparations for laparoscopic surgery are done later.
A patient is admitted to the hospital with a severe duodenal ulcer. The patient suddenly complains of severe pain spreading over the entire abdomen, likely due to a perforation. What should be the most immediate intervention by the nurse, if prescribed? 1 Administer nitrates. 2 Administer pain medication. 3 Prepare for laparoscopic surgery. 4 Insert a nasogastric (NG) tube into the stomach.
endoscopic biopsy Because of this patient's history of excessive alcohol intake, smoking, hemoptysis, and the current choking episode, cancer may be present. A biopsy is necessary to make a definitive diagnosis of carcinoma, so an endoscope will be used to obtain a biopsy and observe other abnormalities as well. A barium swallow may show narrowing of the esophagus, but it is more diagnostic for achalasia. Capsule endoscopy can show alterations in the esophagus, but more often is used for small intestine problems. An endoscopic ultrasonography may be used to stage esophageal cancer. A barium swallow, capsule endoscopy, and endoscopic ultrasonography cannot provide a definitive diagnosis for cancer when it is suspected.
A patient is seeking emergency care after choking on a piece of steak. The nursing assessment reveals a history of alcoholism, cigarette smoking, and hemoptysis. Which diagnostic study is most likely to be performed on this patient? 1 Barium swallow 2 Endoscopic biopsy 3 Capsule endoscopy 4 Endoscopic ultrasonography
tissue biopsy A tissue biopsy involves examining tissue removed from the stomach to detect gastric carcinoma. Radiology is not the best method because superficial mucosa is generally involved and changes will not show up clearly on x-ray examination. Rapid urease testing is used to detect the presence of urease in Helicobacter pylori infections. An endoscopic ultrasound is used to stage the disease of stomach cancer.
A patient presents with suspected gastric carcinoma. The nurse anticipates that which diagnostic test will be prescribed? 1 Radiology 2 Tissue biopsy 3 Rapid urease testing 4 Endoscopic ultrasound
Epigastric pain 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. Famotidine is not indicated for nausea, belching, and dysphagia.
The nurse determines that a patient has experienced the beneficial effects of therapy with famotidine when which symptom is relieved? 1 Nausea 2 Belching 3 Epigastric pain 4 Difficulty swallowing
Prostaglandins Prostaglandins are a class of medications that cause uterine rupture in pregnancy. Uterine rupture in pregnancy leads to miscarriage. Therefore the nurse suspects prostaglandins to be the cause of miscarriage. Cholinergics cause syncope, diarrhea, stomach cramps, and dizziness. Antiulcer agents such as sucralfate cause constipation. Headache, abdominal pain, constipation, and diarrhea are the side effects of histamine (H2) receptor blockers.
The nurse finds that a patient taking a prescribed medication for gastroesophageal reflux disease (GERD) had a miscarriage. Which medication does the nurse expect to be responsible for the miscarriage? 1 Cholinergics 2 Prostaglandins 3 Antiulcer agents 4 Histamine (H2) receptor blockers
Prednisone A burning sensation in the chest, nausea, vomiting, weight loss, and difficulty swallowing indicate eosinophilic esophagitis (EE). Corticosteroids such as prednisone are used to treat EE. Sucralfate and misoprostol are used in the treatment of gastroesophageal reflux disease (GERD). Methotrexate is used in the treatment of esophageal cancer.
The nurse finds that a patient with weight loss reports nausea, vomiting, difficulty swallowing, and a burning sensation in the chest. The biopsy and endoscopy reports reveal infiltration of eosinophils. Which medication does the nurse expect to be beneficial to the patient? 1 Sucralfate 2 Prednisone 3 Misoprostol 4 Methotrexate
2 minutes The nurse should give the IV push medication over a minimum of two minutes to administer it safely. It is not necessary to administer the drug over 5, 10, or 15 minutes.
The nurse has a prescription to give famotidine 20 mg by the intravenous (IV) push route. To administer this drug safely, the nurse should give this medication over a minimum of how many minutes? 1 2 minutes 2 5 minutes 3 10 minutes 4 15 minutes
heartburn, regurgitation, and dysphagia The most common symptom of a hiatal hernia is heartburn, also known as pyrosis. It results from reflux of gastric secretions into the esophagus. Regurgitation of gastric contents and dysphagia are other common symptoms. Jaundice, ascites, and edema are associated with liver disorders. Abdominal cramps, diarrhea, and anorexia are associated with gastroenteritis. Low abdominal pain, fever, and board-like abdominal rigidity are symptoms of appendicitis, ruptured ovarian cyst, and peritonitis.
The nurse is aware that the primary symptoms of a sliding hiatal hernia are associated with reflux and should assess the patient for which symptoms? 1 Jaundice, ascites, and edema 2 Heartburn, regurgitation, and dysphagia 3 Abdominal cramps, diarrhea, and anorexia 4 Pelvic pain, fever, and board-like abdominal rigidity
I can have warm milk at bedtime, just not chocolate milk Patients with GERD should be instructed to avoid milk, especially at bedtime, because it increases gastric acid secretion. There is not a specific diet for GERD, but rather the recommendation to avoid particular foods. Small frequent meals are recommended to prevent gastric distention. Chewing gum increases salivation and helps reduce a mild presentation of symptoms.
The nurse is giving a patient instructions regarding the management of gastroesophageal reflux disease (GERD). Which statement indicates that further teaching is required? 1 "So I don't have to follow a specific diet?" 2 "Chewing gum may help relieve my symptoms." 3 "I can have warm milk at bedtime, just not chocolate milk." 4 "Instead of eating three large meals a day, I should eat small frequent meals throughout the day."
Duodenal ulcer The symptoms of duodenal ulcers occur when gastric acid comes in contact with the ulcers. With meal ingestion, food is present to help buffer the acid. Symptoms of duodenal ulcers occur generally two to five hours after a meal. The pain is described as "burning" or "cramplike." It most often is located in the midepigastric region beneath the xiphoid process. Duodenal ulcers also can produce back pain. The discomfort generally associated with gastric ulcers is located high in the epigastrium and occurs about one to two hours after meals. The pain is described as "burning" or "gaseous." If the ulcer has eroded through the gastric mucosa, food tends to aggravate rather than alleviate the pain. For some patients, the earliest symptoms are caused by a serious complication, such as perforation. Pain and burning two to five hours after meals are not symptoms of esophagitis or chronic gastritis. A patient with a gastric ulcer will experience pain one to two hours after meals.
The nurse is obtaining a health history from a patient who comes to the office for evaluation of gastric distress. The patient indicates that the symptoms occur two to five hours after meals, and the pain is "burning" and sometimes like a cramp in the midepigastric region, just below the xiphoid process. Based on these descriptions, the nurse suspects that the patient has which disorder? 1 Esophagitis 2 Gastric ulcer 3 Duodenal ulcer 4 Chronic gastritis
I should lie down for two to three hours after eating
The nurse is teaching about home care to a patient with gastrointestinal reflux disease (GERD). Which statement made by the patient indicates the need for further teaching? 1 "I should not bend over after eating." 2 "I should sleep with the head of the bed elevated." 3 "I should lie down for two to three hours after eating." 4 "I should avoid eating within three hours of bedtime."
"It would likely be beneficial for you to eliminate drinking alcohol." Alcohol increases the amount of stomach acid produced, so it should be avoided. Milk may exacerbate PUD, so two to three glasses would not be recommended. There is no reason to puree or mince food, and a current diet is likely to be altered to minimize symptoms.
The results of a patient's recent endoscopy indicate the presence of peptic ulcer disease (PUD). Which teaching point should the nurse provide to the patient based on this new diagnosis? 1 "You'll need to drink at least two to three glasses of milk daily." 2 "It would likely be beneficial for you to eliminate drinking alcohol." 3 "Many people find that a minced or pureed diet eases their symptoms of PUD." 4 "Your medications should allow you to maintain your present diet while minimizing symptoms."
Billroth 1 operation A Billroth I operation, also known as a gastroduodenostomy, is a partial gastrectomy in which the distal two thirds of the stomach is removed and there is an anastomosis of the gastric stump to the duodenum. A vagotomy is the severing of the vagus nerve totally or selectively. A pyloroplasty is the surgical enlargement of the pyloric sphincter in order to facilitate easy passage of contents from the stomach. A Billroth II operation is called a gastrojejunostomy; it is the removal of the distal two thirds of the stomach and anastomosis of the gastric stump to the jejunum.
What surgical procedure involves the removal of two-thirds of the stomach and anastomosis of the gastric stump to the duodenum? 1 Vagotomy 2 Pyloroplasty 3 Billroth I operation 4 Billroth II operation
Headache that is severe enough to require an analgesic medication is a common adverse effect of ondansetron. The patient should be taught to report this symptom to the nurse. Double vision and paresthesias are not adverse reactions associated with ondansetron. Nausea would indicate the ondansetron was not effective.
When administering a dose of ondansetron, the nurse would teach the patient to report which common adverse effect? 1 Nausea 2 Headache 3 Paresthesias 4 Double vision
Notify the primary health care provider immediately. The nurse should notify the primary health care provider immediately if the tube is misplaced. The nurse should not reinsert or reposition the tube without an order from the primary health care provider. Documenting the findings and continuing to administer will put the patient's safety at risk.
Which action of the nurse is appropriate if, while administering fluids through a jejunostomy feeding tube to a patient who underwent an esophageal surgery, the nurse suspects that the tube is misplaced? 1 Reinsert the tube. 2 Reposition the tube. 3 Document the findings and continue to administer. 4 Notify the primary health care provider immediately.
Bone fracture Dexlansoprazole is a proton pump inhibitor (PPI). PPIs inhibit the proton pump responsible for the secretion of hydrochloric acid, which is an important mediator of calcium absorption. Long-term use of this medication will increase the risk of a bone fracture. Syncope is the temporary loss of consciousness leading to fainting. It occurs as a side effect of cholinergic drugs. Dyskinesia is a side effect of prokinetic medications. Renal calculi are a side effect of antacids.
Which complication does the nurse expect in a patient with gastroesophageal reflux disease (GERD) who has been taking dexlansoprazole for one year? 1 Syncope 2 Dyskinesia 3 Renal calculi 4 Bone fracture
Zollinger-Ellison Syndrome Zollinger-Ellison syndrome can be diagnosed by measuring fasting serum gastrin levels, which will determine the amount of gastrin secreted by G cells of the stomach. Acute gastritis is diagnosed by endoscopic examination with biopsy. Pyloric obstruction is diagnosed by performing an endoscopy with dilated balloons. Gastric outlet obstruction is diagnosed by performing a barium contrast study.
Which condition can be diagnosed by measuring fasting serum gastrin levels? 1 Acute gastritis 2 Pyloric obstruction 3 Gastric outlet obstruction 4 Zollinger-Ellison syndrome
Hiatal hernia GERD associated with esophagitis and stenosis leads to a hiatal hernia. A hiatal hernia is a herniation of a portion of the stomach into the esophagus through a hiatus in the diaphragm. Achalasia is the absence of peristalsis in the lower two-thirds of the esophagus, characterized by nocturnal regurgitation, dysphagia, and foul-smelling breath. Esophageal stricture is the narrowing of the esophagus, which involves dysphagia, regurgitation, and weight loss. Eosinophilic esophagitis is the inflammation of the esophagus due to an infiltration of eosinophils.
Which condition does the nurse expect in a patient with gastroesophageal reflux disease (GERD) who has esophagitis and stenosis? 1 Achalasia 2 Hiatal hernia 3 Esophageal strictures 4 Eosinophilic esophagitis
Aphthous stomatitis Mouth and lip ulcers with severe pain due to chronic infection and injury indicate aphthous stomatitis. Excessive salivation and sore mouth due to trauma, pathogens, irritants, liver, and renal diseases characterize stomatitis. Lip and mouth lesions due to prolonged exposure to sunlight and/or emotional stress characterize herpes simplex. Vincent's infection involves painful and bleeding gingivae due to nutritional deficiencies and poor oral hygiene.
Which condition does the nurse suspect in a patient with a chronic infection of the pharynx who reports ulcers in the mouth and lips with severe pain? 1 Stomatitis 2 Herpes simplex 3 Vincent's infection 4 Aphthous stomatitis
Leukoplakia Leukoplakia is a precancerous lesion called "smoker's patch," characterized by a white patch on the mucosa of the mouth or tongue of patients with oral cancer. Pyrosis is heartburn, which is a burning, tight sensation felt intermittently beneath the lower sternum and spreading upward to the throat or jaw. Erythroplasia, or erythroplakia, is a red, velvety patch on the tongue or mouth of oral cancer patients. Keratinization of "smoker's patch" indicates hyperkeratosis.
Which condition does the nurse suspect in a patient with oral cancer who has "smoker's patch" on the mucosa of the mouth? 1 Pyrosis 2 Leukoplakia 3 Erythroplasia 4 Hyperkeratosis
Esophageal diverticula Esophageal diverticula are saclike outpouchings formed on one or more layers of the esophagus. Esophageal varices are dilated and tortuous veins observed in the lower portion of the esophagus due to portal hypertension. Narrowing of the esophagus is called esophageal stricture. Eosinophilic esophagitis is characterized by swelling of the esophagus.
Which condition is indicated by endoscopic findings of saclike pouches on the esophagus? 1 Esophageal varices 2 Esophageal stricture 3 Esophageal diverticula 4 Eosinophilic esophagitis
you should try chewing gum Inflammation of parotid glands is known as parotitis. Parotitis is characterized by pain in the ear, exudate from the glands, erythema, and absence of saliva. Chewing gum helps stimulate salivary glands, resulting in the secretion of saliva. Therefore the patient should chew gum. Intake of fibrous foods is beneficial for patients with gingivitis. Warm compresses are encouraged in patients with parotitis. The patient should use warm compresses and suck on hard candy.
Which instruction should the nurse provide to the patient with inflammation of the parotid glands? 1 "You should eat fibrous food." 2 "You should try chewing gum." 3 "You should avoid warm compresses." 4 "You should avoid sucking on hard candy."
Aspirin Aspirin is a nonsteroidal antiinflammatory drug (NSAID) that causes gastritis by decreasing prostaglandin in the lining of the stomach. Amoxicillin is used in the treatment of H. pylori infections. Lansoprazole and metronidazole are used in the treatment of gastritis.
Which medication causes gastritis? 1 Aspirin 2 Amoxicillin 3 Lansoprazole 4 Metronidazole
Metoclopramide Metoclopramide is a prokinetic agent that causes central nervous system side effects such as hallucinations and anxiety. Nizatidine is a histamine (H2) receptor blocker that causes abdominal pain, headache, diarrhea, and constipation. Sucralfate is an antiulcer medication that causes constipation. Omeprazole is a proton pump inhibitor that causes nausea, abdominal pain, headache, diarrhea, and flatulence.
Which medication for peptic ulcer disease causes hallucinations? 1 Nizatidine 2 Sucralfate 3 Omeprazole 4 Metoclopramide
Sucralfate Sucralfate is an antiulcer medication that forms a protective layer and serves as a barrier against acids, bile salts, and stomach enzymes. It causes constipation as a side effect. Misoprostol is a prostaglandin that causes diarrhea. Bethanechol is a cholinergic that causes diarrhea. Esomeprazole is proton pump inhibitor that causes diarrhea.
Which medication for treating gastroesophageal reflux disease (GERD) may cause constipation? 1 Sucralfate 2 Misoprostol 3 Bethanechol 4 Esomeprazole
Aspirin Fluoxetine Aspirin and fluoxetine are ulcerogenic drugs that inhibit the synthesis of prostaglandins, increase gastric acid secretion, and reduce the integrity of the mucosal barrier. These medications increase the risk of ulcer development. Misoprostol, bethanechol, and metoclopramide are used in gastroesophageal reflux disease and peptic ulcer drug therapy.
Which medications increase the risk of ulcer development? Select all that apply. 1 Aspirin 2 Fluoxetine 3 Misoprostol 4 Bethanechol 5 Metoclopramide
Streptococcus Ear pain, absence of saliva, erythema, and ulcers are manifestations of parotitis. Parotitis is the inflammation of parotid glands, which is caused by Streptococcus or Staphylococcus species. Candida albicans causes oral candidiasis. Vincent spirochetes cause Vincent's infection. Herpes simplex virus causes herpes simplex.
Which microorganism is the cause of erythema and mouth ulcers in a patient complaining of ear pain and absence of saliva? 1 Streptococcus 2 Candida albicans 3 Vincent spirochetes 4 Herpes simplex virus
Choking Hoarseness Sore throat Otolaryngologic symptoms in GERD include choking, hoarseness, and sore throat. Wheezing and dyspnea are the respiratory symptoms that occur in GERD.
Which otolaryngologic symptoms occur in gastroesophageal reflux disease (GERD)? Select all that apply. 1 Choking 2 Dyspnea 3 Wheezing 4 Hoarseness 5 Sore throat
Laparoscopic surgery Laparoscopic surgery is minimally invasive and when performed in elderly patients reduces the risk of complications and time for recovery and is beneficial. Antireflux surgery is a surgical intervention and is not recommended in elderly patients with cardiovascular and pulmonary complications. Calcium channel blocker therapy decreases lower esophageal pressure in elderly patients. Nonsteroidal antiinflammatory drugs (NSAIDs) may irritate the esophageal mucosa, which may aggravate the symptoms more.
Which treatment strategy does the nurse expect to be beneficial for an elderly patient with a hiatal hernia who has a cardiovascular complication? 1 Antireflux surgery 2 Laparoscopic surgery 3 Calcium channel blocker therapy 4 Nonsteroidal antiinflammatory drugs (NSAIDs)
Severe esophageal stenosis When there is severe narrowing of the esophagus, or stenosis, regurgitation of blood-flecked esophageal contents occurs. A tumor in the upper third of the esophagus causes sore throat, choking, and hoarseness. Achalasia occurs due to obstruction of the esophagus at the diaphragm. Cancer eroding through the esophagus and into the aorta leads to hemorrhage.
While caring for a patient with esophageal cancer, the nurse finds regurgitation of blood-flecked esophageal contents. What does the nurse expect to be the reason behind the patient's condition? 1 Severe esophageal stenosis 2 Tumor in the upper third of the esophagus 3 Obstruction of the esophagus at the diaphragm 4 Cancer eroding through the esophagus and into the aorta
Pain, Fever, Difficulty breathing When there is a leakage from the feeding tube, the patient experiences pain, high temperature, and dyspnea (difficulty breathing). Therefore these symptoms support the nurse's suspicion. Cough and regurgitation are manifestations of esophageal cancer.
While providing fluids to a postgastrectomy patient, which symptoms support the nurse's suspicion that there is leakage from a jejunostomy feeding tube? Select all that apply. 1 Pain 2 Fever 3 Cough 4 Regurgitation 5 Difficulty breathing
