Upper GI Disorder (Chapt 23) MCQs
An older adult patient had a gastrectomy performed several weeks ago and is being followed closely by the care team. Due to potential complications of this surgery, the nurse should closely monitor the patient's levels of: A. Iron and vitamin B12 B. Prealbumin and bilirubin C. Ionized calcium and C-reactive protein D. Creatinine and blood urea nitrogen (BUN)
A Dietary deficiencies associated with gastrectomy include malabsorption of organic iron, which may require supplementation with oral or parenteral iron, and a low serum level of vitamin B12, which may require supplementation by the intramuscular route. The other given blood values are not directly affected by gastrectomy.
Which of the following is the most successful treatment for gastric cancer? A. Removal of the tumor B. Chemotherapy C. Radiation D. Palliation
A There is no successful treatment for gastric carcinoma except removal of the tumor. If the tumor can be removed while it is still localized to the stomach, the patient may be cured. If the tumor has spread beyond the area that can be excised, cure is less likely.
A patient comes to the clinic complaining of pain in the epigastric region. The nurse suspects that the patient's pain is related to a peptic ulcer when the patient states the pain is relieved by what? A. Suppressing emesis B. Drinking milk C. Having a bowel movement D. Eating
D Taking antacids, eating, or vomiting often relieves the pain. Pain occurs about 2 hours after eating. Milk is contraindicated in relieving peptic ulcer pain.
What assessment finding supports a client's diagnosis of gastric ulcer? A. Presence of blood in the client's stool for the past month B. Complaints of sharp pain in the abdomen after eating a heavy meal C. Periods of pain shortly after eating any food. D. Complaints of epigastric burning that moves like a wave
C RATIONALE: Experiencing sharp pain 30 to 60 minutes after meals is common with gastric ulcers; patients with duodenal ulcers can have night pain that is relieved by eating.
A nurse is completing an assessment of a client who has GERD. Which of the following is an expected finding? A. Absence of saliva B. Painful swallowing C. Sweet taste in mouth D. Absence of eructation
B Painful swallowing is an expected finding d/t esophageal stricture of inflammation. Other expected findings are hypersalivation, bitter taste, and increased burping.
A client with an H. pylori infection asks why bismuth subsalicylate is prescribed. Which response will the nurse make? A. "It helps propel food from the stomach into the duodenum." B. "It improves digestion in the stomach." C. "It enhances the function of the pyloric sphincter." D. "It aids in the healing of the stomach lining."
D Bismuth subsalicylate suppresses H. pylori bacteria in the gastric mucosa and assists with healing of mucosal ulcers. It does not affect digestion, enhance the function of the pyloric sphincter, or propel food from the stomach into the duodenum.
Which of the following appears to be a significant factor in the development of gastric cancer? A. Age B. Ethnicity C. Gender D. Diet
D Diet seems to be a significant factor: a diet high in smoked, salted, or pickled foods and low in fruits and vegetables may increase the risk of gastric cancer. The typical patient with gastric cancer is between 50 and 70 years of age. Men have a higher incidence than women. Native Americans, Hispanic Americans, and African Americans are twice as likely as European Americans to develop gastric cancer.
A nurse is assessing a client who is experiencing perforation of a peptic ulcer. Which of the following manifestations should the nurse expect? A. Increased BP B. Decreased HR C. Yellowing of the skin D. Boardlike abdomen
D For perforation d/t PUD, the nurse should expect symptoms such as boardlike abdomen and severe pain in the abdomen or back that radiates to the right shoulder.
A patient is scheduled for a Billroth I procedure for ulcer management. What does the nurse understand will occur when this procedure is performed? A. A partial gastrectomy is performed with anastomosis of the stomach segment to the duodenum. B. A sectioned portion of the stomach is joined to the jejunum. C. The antral portion of the stomach is removed and a vagotomy is performed. D. The vagus nerve is cut and gastric drainage is established.
A A Billroth I procedure involves removal of the lower portion of the antrum of the stomach (which contains the cells that secrete gastrin) as well as a small portion of the duodenum and pylorus. The remaining segment is anastomosed to the duodenum. A vagotomy severs the vagus nerve; a Billroth I procedure may be performed in conjunction with a vagotomy. If the remaining part of the stomach is anastomosed to the jejunum, the procedure is a Billroth II.
A client comes to the clinic after developing a headache, abdominal pain, nausea, hiccupping, and fatigue about 2 hours ago. The client tells the nurse that the last food was buffalo chicken wings and beer. Which medical condition does the nurse find to be most consistent with the client's presenting problems? A. Acute gastritis B. Duodenal ulcer C. Gastric cancer D. Gastric ulcer
A A client with acute gastritis may have a rapid onset of symptoms, including abdominal discomfort, headache, lassitude, nausea, anorexia, vomiting, and hiccupping, which can last from a few hours to a few days. Acute gastritis is often caused by dietary indiscretion-a person eats food that is irritating, too highly seasoned, or contaminated with disease-causing microorganisms. A client with a duodenal ulcer will present with heartburn, nausea, excessive gas and vomiting. A client with gastric cancer will have persistent symptoms of nausea and vomiting, not sudden symptoms. A client with a gastric ulcer will have bloating, nausea, and vomiting, but not necessarily hiccups.
A nurse is performing discharge teaching with a client who had a total gastrectomy. Which statement indicates the need for further teaching? A. "I will have to take vitamin B12 shots up to 1 year after surgery." B. "I will call my physician if I begin to have abdominal pain." C. "I'm going to visit my pastor weekly for a while." D. "I will weight myself each day and record the weight."
A After a total gastrectomy, a client will need to take vitamin B12 shots for life. Dietary B12 is absorbed in the stomach, and the inability to absorb it could lead to pernicious anemia. Visiting clergy for emotional support is normal after receiving a cancer diagnosis. This action should be encouraged by the nurse. It's appropriate for the client to call the physician if he experiences signs and symptoms of intestinal blockage or obstruction, such as abdominal pain. Because a client with a total gastrectomy will receive enteral feedings or parenteral feedings, he should weigh himself each day and keep a record of the weights.
The nurse is performing detailed patient education with a 40-year-old woman who will be soon discharged following a Roux-en-Y gastric bypass. The nurse and other members of the interdisciplinary team have been emphasizing the need for eating small amounts of food at a sitting and eating food slowly. What is the rationale for the nurse's advice? A. Nausea and esophageal distention can result from eating too fast. B. Eating quickly is associated with weight gain. C. Eating too quickly can cause gastric ulceration. D. The cardiac sphincter is unable to dilate quickly after bariatric surgery.
A Because of the physical alterations to the upper gastrointestinal (GI) tract that are created during bariatric surgery, the patient is prone to nausea and esophageal distention if he or she eats too quickly. Eating quickly does not contribute to ulceration or weight gain following surgery. The cardiac sphincter is not modified during bariatric surgery.
The nurse is cautiously assessing a client admitted with peptic ulcer disease because the most common complication that occurs in 10% to 20% of clients is: A. Hemorrhage B. Intractable ulcer C. Perforation D. Pyloric obstruction
A Hemorrhage, the most common complication, occurs in 10% to 20% of clients with peptic ulcers. Bleeding may be manifested by hematemesis or melena.
A nurse is providing discharge instructions to a client following an upper GI series with barium contrast. Which of the following information should the nurse provide? A. Increase fluid intake B. Take OTC antidiarrheal medicatino. C. Expect black, tarry stools. D. Follow a low-fiber diet.
A Increasing fluid intake helps prevent constipation. Also helps with elimination of barium.
A nurse assesses the stools of a client diagnosed with peptic ulcer disease. Inspection reveals black, tarry stools. The nurse would use which term to document this finding? A. melena B. hematemesis C. pyrosis D. achlorhydria
A Melena is the term used to denote black, tarry stools. Hematemesis refers to blood in vomit. Pyrosis is a burning sensation in the esophagus and stomach that moves up to the mouth. Achlorhydria refers to an absence of hydrochloric acid in the stomach.
Endoscopy of a 60-year-old woman has revealed the presence of an esophageal peptic ulcer. The nurse who is providing this woman's care is assessing for risk factors that may have contributed to the development of this disease. What question most directly addresses these risk factors? A. "Have you ever been diagnosed with reflux?" B. "Do you consider yourself to have a healthy diet?" C. "Have you been prone to infections over the past few years?" D. "Do you ever find it difficult to swallow certain foods?"
A RATIONALE Gastroesophageal reflux disease (GERD) is a significant risk factor for peptic ulcer disease. Poor diet, general infections, and dysphagia are less closely associated with etiology of esophageal ulcers.Reference:
The nurse in the ED admits a client with suspected gastric outlet obstruction. The client's symptoms include nausea and vomiting. The nurse anticipates that the physician will issue which order? A. Nasogastric tube insertion B. Oral contrast C. Stool specimen D. Pelvic x-ray
A The nurse anticipates an order for nasogastric tube insertion to decompress the stomach. Pelvic x-ray, oral contrast, and stool specimens are not indicated at this time.
A patient arrives to the clinic for evaluation of epigastric pain. The patient describes the pain to be relieved by food intake. In addition, the patient reports awaking in the middle of the night with a gnawing pain in the stomach. Based on the patient's description this appears to be what type of peptic ulcer? A. Duodenal B. Gastric C. Esophageal D. Refractory
A The patient signs and symptoms describe a duodenal ulcer. Gastric ulcer tend to not cause pain in the middle of the night and epigastric pain in worst with food.
A patient is recovering from discomfort from a peptic ulcer. The doctor has ordered to advance the patient's diet to solid foods. The patient's lunch tray arrives. Which food should the patient avoid eating? A. Orange B. Milk C. White rice D. Banana
A When an ulcer is actively causing signs and symptoms, the patient should avoid acidic foods like tomatoes or citric fruits/juices, chocolate, alcohol, fried foods and caffeine. These foods can irritate the ulcer site. Instead the patient should consume alkalotic or bland foods like milk, white rice or bananas.
The nurse is doing triage at the emergency department when a middle-aged patient presents with abdominal pain and heartburn. The patient states the symptoms have persisted for several days following a particularly spicy meal. When assessing the patient, the nurse notes the patient has a history of acute gastritis. What complication should the nurse assess for? A. Acute systemic infection related to peritonitis B. Esophageal or pyloric obstruction related to scarring C. Gastric hyperacidity related to excessive gastrin secretion D. Bruising on the patient's flanks
B Acute gastritis can result from dietary indiscretion, and may lead to scarring and stenosis, often requiring dilation. Acute systemic infection occurs following perforation. Perforation is not a common occurrence following ingestion of a corrosive substance. Gastrin is a hormone secreted in the stomach. It is not normally found in the esophagus. Peptic ulcer disease does not cause bruising.
A client has been taking famotidine at home. What teaching should the nurse include with the client? A. Famotidine will improve the mixing of foods and gastric secretions. B. Famotidine will inhibit gastric acid secretions. C. Famotidine will shorten the time required for digestion in the stomach. D. Famotidine will neutralize acid in the stomach.
B Famotidine is useful for treating and preventing ulcers and managing gastroesophageal reflux disease. It functions by inhibiting the action of histamine at the H-2 receptor site located in the gastric parietal cells, thus inhibiting gastric acid secretion.
A nurse practitioner prescribes drug therapy for a patient with peptic ulcer disease. Choose the drug that can be used for 4 weeks and has a 90% chance of healing the ulcer. A. Nizatidine B. Omeprazole C. Famotidine D. Cimetidine
B Omeprazole (Prilosec) is a proton pump inhibitor that, if used according to the health care provider's directions, will result in healing in 90% of patients. The other drugs are H2 receptor antagonists that need to be used for 6 weeks.
Rebleeding may occur from a peptic ulcer and often warrants surgical interventions. Signs of bleeding include which of the following? A. Bradycardia B. Mental confusion C. Bradypnea D. Hypertension
B One of significant complications of PUD is bleeding. Signs of bleeding include tachycardia, tachypnea, hypotension, mental confusion, thirst, and oliguria.
A client sustained second- and third-degree burns over 30% of the body surface area approximately 72 hours ago. What type of ulcer should the nurse be alert for while caring for this client? A. Meckel's ulcer B. Esophageal ulcer C. Curling's ulcer D. Peptic ulcer
C Curling's ulcer is frequently observed about 72 hours after extensive burns and involves the antrum of the stomach or the duodenum. Peptic, esophageal, and Meckel's ulcers are not related to burn injuries.
A 70-year-old woman with a complex medical history made an appointment with her primary care provider because she has recently been experiencing heartburn, abdominal pain, and nausea. The clinician has identified that the woman's symptoms are characteristic of acute gastritis. Which of the woman's following statements is suggestive of the etiology of her problem? A. "I've been taking glucosamine supplements because I've been told they'll help my arthritis." B. "I've changed from taking Tylenol for my arthritis pain to taking aspirin." C. "I remember my father often complaining about heartburn and indigestion." D. "My endocrinologist recently increased my dose of metformin that I take for my diabetes."
B Overuse of aspirin is frequently implicated in cases of acute gastritis. Family history and the use of glucosamine and metformin are not common contributors to acute gastritis.
A client reports diarrhea after having bariatric surgery. What nonpharmacologic treatment can the nurse suggest to decrease the incidence of diarrhea? A. Decrease the fat content in the diet. B. Increase the fiber content in the diet. C. Decrease the amount of fluid the patient is drinking. D. Increase the protein content in the diet.
B RATIONALE Clients may complain of either diarrhea or constipation postprocedure. Diarrhea is more common an occurrence post bariatric surgery, particularly after malabsorptive procedures (Mechanick et al., 2008). Both may be prevented if the patient consumes a nutritious diet that is high in fiber. Steatorrhea also may occur as a result of rapid gastric emptying, which prevents adequate mixing with pancreatic and biliary secretions. In mild cases, reducing the intake of fat and administering an antimotility medication (e.g., loperamide [Imodium]) may control symptoms.
The nurse is planning for the discharge of a client with peptic ulcer disease. Which outcome must be included in the plan of care? A. The client's pain is controlled with NSAIDs. B. The client understands and maintains lifestyle modifications. C. The client takes antacids around the clock. D. The client has no episodes of GI bleeding.
B RATIONALE: Maintaining the lifestyle adjustments of eating an appropriate diet, reducing stress, decreasing or stopping smoking, and following a medication regimen are the goal to treat and prevent complications Patients should not take NSAID for pain relief, due to risk of exacerbating ulcers. Also antacids do not treat ulcers.
A 47-year-old man with epigastric pain is being admitted to the hospital. During the admission assessment and interview, what specific information should the nurse obtain from the patient, who is suspected of having peptic ulcer disease? A. Any allergies to food or medications B. Use of nonsteroidal anti-inflammatory drugs (NSAIDs) C. Medical history for two previous generations D. History of side effects of all medications
B RATIONALE: Use of NSAIDs in the patient suspected of peptic ulcer disease increases the risk of GI bleeding.
A patient with a peptic ulcer is suddenly vomiting dark coffee ground emesis. On assessment of the abdomen you find bloating and an epigastric mass in the abdomen. Which complication may this patient be experiencing? A. Obstruction of pylorus B. Upper gastrointestinal bleeding C. Perforation D. Peritonitis
B This patient is most likely experiencing an upper GI bleeding. Signs and symptoms of a possible GI bleeding with a peptic ulcer include: vomiting coffee ground emesis along with bloating, and abdominal mass.
A 30-year-old obese female patient who underwent gastric banding 3 days ago is getting ready to go home. Essential postoperative teaching for this patient should include instruction related to the importance of abstaining from what for the next 2 years? A. Control-top panty hose B. Antidepressants C. Pregnancy D. Multivitamin supplements
C
A patient with chronic peptic ulcer disease underwent a gastric resection 1 month ago and is reporting nausea, bloating, and diarrhea 30 minutes after eating. What condition is this patient most likely experiencing? A. Gastroparesis B. Fascia dehiscence C. Dumping Syndrome D. Somogyi effect
C After a gastric resection the stomach is not able to regulate the movement of food due to the removal of sections of the stomach (usually the pyloric valve and duodenum). Therefore, the food enters into the small intestine too fast before the stomach can finish digesting it. The partially digested food will act hypertonically and cause water from the blood to enter jejunum. This will cause a fluid shift leading to bowel swelling, diarrhea, and nausea etc.
A health care provider suspects that a client has peptic ulcer disease. With which diagnostic procedure would the nurse most likely prepare to assist? A. Gastric secretion study B. Barium study of the upper gastrointestinal tract C. Endoscopy D. Stool antigen test
C Barium study of the upper GI tract may show an ulcer; however, endoscopy is the preferred diagnostic procedure because it allows direct visualization of inflammatory changes, ulcers, and lesions. Through endoscopy, a biopsy of the gastric mucosa and of any suspicious lesions can be obtained. Endoscopy may reveal lesions that, because of their size or location, are not evident on x-ray studies. Less invasive diagnostic measures for detecting H. pylori include serologic testing for antibodies against the H. pylori antigen, stool antigen test, and urea breath test.
A client is admitted to the health care facility with a diagnosis of a bleeding gastric ulcer. The nurse expects the client's stools to have which description? A. Coffee-ground-like B. Clay-colored C. Black and tarry D. Bright red
C Black, tarry stools are a sign of bleeding high in the GI tract, as from a gastric ulcer, and result from the action of digestive enzymes on the blood. Vomitus associated with upper GI tract bleeding commonly is described as coffee-ground-like. Clay-colored stools are associated with biliary obstruction. Bright red stools indicate lower GI tract bleeding.
Clients with Type O blood are at higher risk for which of the following GI disorders? A. Gastric cancer B. Diverticulitis C. Duodenal ulcers D. Esophageal varices
C Familial tendency also may be a significant predisposing factor. People with blood type O are more susceptible to peptic ulcers than are those with blood type A, B, or AB. Blood type is not a predisposing factor for gastric cancer, esophageal varices, and diverticulitis.
The nurse is completing a health history on a patient whose diagnosis is chronic gastritis. Which of the data below should the nurse consider most significantly related to the etiology of the patient's health problem? A. Consumes one or more protein drinks daily B. Takes over-the-counter antacids frequently C. Smokes two packs of cigarettes daily D. Reports a history of social drinking on a weekly basis
C Smoking is a significant risk factor for chronic gastritis. Alcohol ingestion can lead to gastritis; however, this generally occurs in patients with a history of daily consumption of alcohol. Protein drinks do not result in gastric inflammation. Antacids do not contribute to the etiology of chronic gastritis.
The nurse is evaluating a client's ulcer symptoms to differentiate ulcer as duodenal or gastric. Which symptom should the nurse at attribute to a duodenal ulcer? A. Vomiting B. Hemorrhage C. Awakening in pain D. Constipation
C The client with a duodenal ulcer is more likely to awaken with pain during the night than is the client with a gastric ulcer. Vomiting, constipation, diarrhea, and bleeding are symptoms common to both gastric and duodenal ulcers.
The nurse recognizes that the client diagnosed with a duodenal ulcer will likely experience A. vomiting. B. hemorrhage. C. pain 2 to 3 hours after a meal. D. weight loss.
C The client with a duodenal ulcer often awakens between 1 and 2 with pain, and ingestion of food brings relief. Vomiting is uncommon in the client with duodenal ulcer. Hemorrhage is less likely in the client with duodenal ulcer than in the client with gastric ulcer. The client with a duodenal ulcer may experience weight gain.
The nurse instructs a client with a peptic ulcer on modifications to make to their diet. Which statement indicates to the nurse that teaching has been effective? A. "I will limit my alcohol intake to two drinks a day." B. "I will begin eating small frequent meals." C. "I will stop drinking decaffeinated coffee." D. "I will eat a hot meal before it cools to room temperature."
C The intent of dietary modification for clients with peptic ulcers is to avoid oversecretion of acid and hypermotility in the GI tract. These can be minimized by overstimulation from the consumption of coffee, including decaffeinated coffee, which also stimulates acid secretion. Small, frequent feedings are not necessary as long as an antacid or an H2 blocker is taken. Alcohol will cause the overstimulation of acid and hypermotility in the GI tract. Extremes of temperature in foods will cause oversecretion of acid and hypermotility in the GI tract.
A client with a peptic ulcer is about to begin a therapeutic regimen that includes a bland diet, antacids, and famotidine. Before the client is discharged, the nurse should provide which instruction? A. "Stop taking the drugs when your symptoms subside." B. "Increase your intake of fluids containing caffeine." C. "Avoid aspirin and products that contain aspirin." D. "Eat three balanced meals every day."
C The nurse should instruct the client to avoid aspirin because it's a gastric irritant and should not be taken by clients with peptic ulcer to prevent further erosion of the stomach lining. The client should eat small, frequent meals rather than three large ones. Antacids prevent acid accumulation in the stomach; they should be taken even after symptoms subside. Caffeine should be avoided because it increases acid production in the stomach.
A nurse is completing discharge teaching for a client who has an infection due to H. pylori. Which of the following statements by the client indicates understanding of the teaching? A. "I will continue my prescription for corticosteriods." B. "I will schedule a CT scan to monitor improvement." C. "I will take a combination of medications for treatment." D. "I will have my throat swabbed to recheck for this bacteria."
C A combination of Abx and H2 antagonist is used to treat an infection caused by H. pylori.
A nurse is completing an assessment of a client who has a gastric ulcer. Which of the following findings should the nurse expect? (Select 3 that apply) A. Client reports pain relieved by eating. B. Client states that pain often occurs at night. C. Client reports sensation of bloating. D. Client states that pain occurs 30 min to 1 hr after a meal. E. Client experiences pain upon palpation of the epigastric region.
C,D,E The other two options are symptoms of duodenal ulcer.
A client is preparing for discharge to home following a partial gastrectomy and vagotomy. Which is the best rationale for the client being taught to lie down for 30 minutes after each meal? A. Allows for better absorption of vitamin B12 B. Provides much needed rest C. Removes tension on internal suture line D. Slows gastric emptying
D Dumping syndrome is a common complication following subtotal gastrectomy. To avoid the rapid emptying of stomach contents, resting after meals can be helpful. Promoting rest after a major surgery is helpful in recovery but not the reason for resting after meals. Following this type of surgery, clients will have a need for vitamin B12 supplementation due to absence of production of intrinsic factor in the stomach. Resting does not increase absorption of B12 or remove tension on suture line.
The client with a peptic ulcer is admitted to the hospital's intensive care unit with obvious gastric bleeding. What is the priority intervention for the nurse? A. Keep an accurate record of intake and output. B. Provide for quiet environment, restrict visitors. C. Prepare the client for an endoscopy. D. Monitor vital signs and observe for signs of hypovolemia.
D RATIONALE: The goal is to directly stop the bleeding and remove blood/clots/secretions from GI tract so that an endoscopy can be performed and the patient does not vomit and aspirate gastric contents.
When caring for a client with an acute exacerbation of a peptic ulcer, the nurse finds the client doubled up in bed with severe pain in the right shoulder. What is the initial appropriate action by the nurse? A. Notify the health care provider. B. Place the client in the high-Fowler's position. C. Irrigate the client's NG tube. D. Assess the client's abdomen and vital signs.
D Signs and symptoms of perforation (one of the more serious complications of peptic ulcer) includes sudden, severe upper abdominal pain (persisting and increasing in intensity); pain may be referred to the shoulders, especially the right shoulder, because of irritation of the phrenic nerve in the diaphragm. The nurse should assess the vital signs and abdomen prior to notifying the physician. Irrigation of the NG tube should not be performed because the additional fluid may be spilled into the peritoneal cavity, and the client should be placed in a position of comfort, usually on the side with the head slightly elevated.
During a home visit the nurse notes that a client recovering from peptic ulcer disease is experiencing cool clammy skin and has a heart rate of 96 beats a minute. Which action will the nurse take? A. Discuss the types of foods the client has been eating. B. Encourage the client to drink a warm beverage. C. Provide a dose of a proton pump inhibitor. D. Notify the primary health care provider.
D The client with peptic ulcer disease is demonstrating signs of hemorrhage which include cool skin and tachycardia. The health care provider should be immediately notified. The client should not be given any additional medication. A warm beverage could enhance bleeding. It is inappropriate to provide any teaching while the client is experiencing an acute condition.