Upper GI - Lippincotts

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? 1. Fats. 2. High-sodium foods. 3. Carbohydrates. 4. High-calcium foods.

1. Fats are assoc. with ↓ esophageal sphincter tone, which ↑ reflux Obesity contributes to the development of hiatal hernia & a ↓ low-fat diet might also aid in weight loss CHO & foods ↑ in sodium or calcium do NOT affect gastroesophageal reflux.

A client has entered a smoking cessation program to quit a two-pack-a-day cigarette habit. He tells the nurse that he has not smoked a cigarette for 3 weeks, but is afraid he is going to "slip up" and smoke because of current job pressures. What would be the most appropriate reply for the nurse to make in response to the client's comments? 1. "Don't worry about it. Everybody has difficulty quitting smoking, and you should expect to as well." 2. "If you increase your self-control, I am sure you will be able to avoid smoking." 3. "Try taking a couple of days of vacation to relieve the stress of your job." 4. "It is good that you can talk about your concerns. Try calling a friend when you want to smoke."

4. It is important for individuals who are engaged in smoking cessation efforts to feel comfortable with sharing their fears of failure with others & seeking support. Although fewer than 5% of smokers successfully quit on their first attempt, it is NOT helpful to tell a pt that he should anticipate failure. Telling the pt to exercise more self-control does not provide him with support. Taking a vacation to avoid job pressures does not address the issue of fearing he will smoke a cigarette when in a stressful situation.

Which of the following interventions is most appropriate for a client who has stomatitis? 1. Drinking hot tea at frequent intervals. 2. Gargling with antiseptic mouthwash. 3. Using an electric toothbrush. 4. Eating a soft, bland diet.

4. Pt's with stomatitis (inflammation of the mouth) have significant discomfort, which impacts their ability to eat & drink. They will be MOST comfortable eating soft, bland foods & avoiding temperature extremes in their food / liquids Gargling with an antiseptic mouthwash will be irritating to the mucosa Mouth care should include gentle brushing with a soft toothbrush and flossing.

A client is admitted to the hospital after vomiting bright red blood and is diagnosed with a bleeding duodenal ulcer. The client develops a sudden, sharp pain in the midepigastric region along with a rigid, boardlike abdomen. These clinical manifestations most likely indicate which of the following? 1. An intestinal obstruction has developed. 2. Additional ulcers have developed. 3. The esophagus has become inflamed. 4. The ulcer has perforated.

4. The body reacts to perforation of an ulcer by immobilizing the area as much as possible. This results in board-like abdominal rigidity, usually with extreme pain. Perforation is a Medical 911 requiring immediate surgical intervention because peritonitis develops quickly after perforation. An intestinal obstruction would NOT cause mid-epigastric pain. The development of additional ulcers or esophageal inflammation would NOT cause a rigid, board-like abdomen.

After a subtotal gastrectomy, the nasogastric tube drainage will be what color for about 12 to 24 hours after surgery? 1. Dark brown. 2. Bile green. 3. Bright red. 4. Cloudy white.

1. About 12-24 hrs after a subtotal gastrectomy, gastric drainage is normally BROWN, which indicates digested blood Bile green or cloudy white drainage is NOT expected during the first 12-24 hrs after a subtotal gastrectomy Drainage during the first 6-12 hrs contains some bright red blood, but large amounts of blood or excessive bloody drainage should be reported to the physician promptly.

A client with a peptic ulcer reports epigastric pain that frequently awakens her during the night. The nurse should instruct the client to do which activities? Select all that apply. 1. Obtain adequate rest to reduce stimulation. 2. Eat small, frequent meals throughout the day. 3. Take all medications on time as ordered. 4. Sit up for one hour when awakened at night. 5. Stay away from crowded areas.

1, 2, 3, 4. The nurse should encourage the pt to ↓ stimulation that may ↑ gastric secretion The nurse can also advise the pt to utilize health practices that will prevent recurrences of ulcer pain, such as avoiding fatigue & elimination of smoking Eating small, frequent meals HELPS to prevent gastric distention if not actively bleeding & ↓ distension & release of gastrin Medications should be administered PROMPTLY to maintain optimum levels. After awakening during the night, the pt should eat a small snack & return to bed, keeping the head of the bed elevated for 1 hr after eating It is not necessary to stay away from crowded areas.

The nurse is teaching a group of teenage boys who are on a baseball team about the risks of chewing tobacco. Which of the following should the nurse instruct the teenagers to report to their parents and physicians? Select all that apply. 1. Dysphagia. 2. Sensitive teeth. 3. Unexplained mouth pain. 4. Lump in the neck. 5. Decreased saliva. 6. White patch on the mucosa.

1, 3, 4, 6. Chewing tobacco has become a more common practice among teenagers. It is important that they understand that this ↑'s their risk for oral cancer. They should be instructed to inspect their mouth frequently & report any observed lesions or other changes in the oral mucosa. S/SX that are potential indicators of oral cancer are: - dysphagia - unexplained mouth pain - a lump in the neck - white patches on the mucosa (leukoplakia). Other indications may be: - a painless mouth ulcer - a reddened patch (erythroplasia) - rough patches on the mucosa Sensitive teeth & ↓ saliva are NOT associated with oral cancer

The nurse is preparing a community presentation on oral cancer. Which of the following is a primary risk factor for oral cancer that the nurse should include in the presentation? 1. Use of alcohol. 2. Frequent use of mouthwash. 3. Lack of vitamin B12. 4. Lack of regular teeth cleaning by a dentist.

1. Chronic & excessive use of alcohol can lead to oral cancer. Smoking & use of smokeless tobacco are other significant risk factors. Additional risk factors include chronic irritation such as a broken tooth or ill-fitting dentures, poor dental hygiene, overexposure to sun (lip cancer) & syphilis. Use of mouthwash, lack of vitamin B12 & lack of regular teeth cleaning appointments have NOT been implicated as primary risk factors for oral cancer.

The nurse instructs the client on health maintenance activities to help control symptoms from her hiatal hernia. Which of the following statements would indicate that the client has understood the instructions? 1. "I'll avoid lying down after a meal." 2. "I can still enjoy my potato chips and cola at bedtime." 3. "I wish I didn't have to give up swimming." 4. "If I wear a girdle, I'll have more support for my stomach."

1. A pt with a hiatal hernia should avoid the recumbent position immediately after meals to minimize gastric reflux. Bedtime snacks, as well as ↑ high-fat foods & carbonated beverages, should be Ø avoided. Excessive vigorous exercise also should be avoided, especially AFTER meals, but there is NO reason why the pt must give up swimming. Wearing tight, constrictive clothing such as a girdle can ↑ intra-abdominal pressure & thus lead to reflux of gastric juices.

Which of the following dietary measures would be useful in preventing esophageal reflux? 1. Eating small, frequent meals. 2. Increasing fluid intake. 3. Avoiding air swallowing with meals. 4. Adding a bedtime snack to the dietary plan.

1. Esophageal reflux worsens when the stomach is over-distended with food Therefore, an important measure is to eat small, frequent meals. Fluid intake should be ↓ during meals to ↓ abdominal distention. Avoiding air swallowing does NOT prevent esophageal reflux Food intake in the evening should be strictly limited to ↓ the incidence of night-time reflux, so bedtime snacks are NOT recommended.

The nurse is obtaining a health history from a client who has a sliding hiatal hernia associated with reflux. The nurse should ask the client about the presence of which of the following symptoms? 1. Heartburn. 2. Jaundice. 3. Anorexia. 4. Stomatitis.

1. Heartburn, the MOST common symptom of a sliding hiatal hernia, results from reflux of gastric secretions into the esophagus Regurgitation of gastric contents & dysphagia are other common symptoms. Jaundice, which results from a ↑ concentration of bilirubin in the blood, is not assoc. with hiatal hernia. Anorexia is NOT a typical symptom of hiatal hernia. Stomatitis is inflammation of the mouth.

The physician prescribes metoclopramide hydrochloride (Reglan) for the client with hiatal hernia. The nurse plans to instruct the client that this drug is used in hiatal hernia therapy to accomplish which of the following objectives? 1. Increase tone of the esophageal sphincter. 2. Neutralize gastric secretions. 3. Delay gastric emptying. 4. Reduce secretion of digestive juices.

1. Metoclopramide hydrochloride (Reglan) ↑ esophageal sphincter tone & facilitates gastric emptying; both actions ↓ the incidence of reflux. Other drugs, such as antacids or histamine receptor antagonists, may also be prescribed to help control reflux & esophagitis, and to ↓ or neutralize gastric secretions. Reglan is NOT effective in ↓ or neutralizing gastric secretions.

After surgery for gastric cancer, a client is scheduled to undergo radiation therapy. It will be most important for the nurse to include information about which of the following in the client's teaching plan? 1. Nutritional intake. 2. Management of alopecia. 3. Exercise and activity levels. 4. Access to community resources.

1. Pts who have had gastric surgery are prone to postop complications, such as: dumping syndrome & postprandial hypoglycemia; affecting nutritional intake. Vitamin absorption can also be an issue, depending on the extent of the gastric surgery. Radiation therapy to the upper GI area can also affect nutritional intake by causing anorexia, nausea & esophagitis The pt would NOT be expected to develop alopecia Exercise & activity levels as well as access to community resources are important teaching areas, but nutritional intake is a PRIORITY need.

The nurse is developing standards of care for a client with gastroesophageal reflux disease and wants to review current evidence for practice. Which one of the following resources will provide the most helpful information? 1. A review in the Cochrane Library. 2. A literature search in a database, such as the Cumulative Index to Nursing and Allied Health Literature (CINHAL). 3. An online nursing textbook. 4. The online policy and procedure manual at the health care agency.

1. The Cochrane Library provides systematic reviews of health care interventions and will provide the best resource for evidence for nursing care. CINHAL offers key word searches to published articles in nursing & allied health literature, but not reviews. A nursing textbook has information about nursing care which may include evidence-based practices, but textbooks may not have the most up-to-date information. While the policy & procedure manual may be based on evidence-based practices, the most current practices will be found in evidence-based reviews of literature.

The client is scheduled to have an upper gastrointestinal tract series of x-rays. Following the x-rays, the nurse should instruct the client to: 1. Take a laxative. 2. Follow a clear liquid diet. 3. Administer an enema. 4. Take an antiemetic.

1. The pt should take a laxative after an upper GI series to stimulate a bowel movement. This examination involves the administration of barium, which MUST be promptly eliminated from the body because it may harden & cause an obstruction. A clear liquid diet would have NO effect on stimulating removal of the barium. The pt should NOT have nausea & an antiemetic would NOT be necessary; additionally, the antiemetic will ↓ peristalsis & ↓ the likelihood of eliminating the barium An enema would be ineffective because the barium is too ↑ in the GI tract.

The nurse is caring for a client who has just had an upper GI endoscopy. The client's vital signs must be taken every 30 minutes for 2 hours after the procedure. The nurse assigns an unlicensed nursing personnel (UAP) to take the vital signs. One hour later, the UAP reports the client, who was previously afebrile, has developed a temperature of 101.8 ° F (38.8 ° C). What should the nurse do in response to this reported assessment data? 1. Promptly assess the client for potential perforation. 2. Tell the assistant to change thermometers and retake the temperature. 3. Plan to give the client acetaminophen (Tylenol) to lower the temperature. 4. Ask the assistant to bathe the client with tepid water.

1. A sudden spike in temperature following an endoscopic procedure may indicate perforation of the GI tract. The nurse should promptly conduct a further assessment of the pt, looking for further indicators of perforation, such as - a sudden onset of acute upper abdominal pain - a rigid, board-like abdomen - developing signs of shock Telling the assistant to change thermometers is NOT an appropriate action & only further delays the appropriate action of assessing the pt. The nurse would NOT administer acetaminophen w/p further assessment of the pt or w/o a physician's order a suspected perforation would require that the pt be placed on NPO status. Asking the assistant to bathe the pt before any assessment by the nurse is inappropriate.

A client has returned from surgery during which her jaws were wired as treatment for a fractured mandible. The client is in stable condition. The nurse is instructing the unliscensed nursing personnel (UAP) on how to properly position the client. Which instructions about positioning would be appropriate for the nurse to give the UAP? 1. Keep the client in a side-lying position with the head slightly elevated. 2. Do not reposition the client without the assistance of a registered nurse. 3. The client can assume any position that is comfortable. 4. Keep the client's head elevated on two pillows at all times.

1. Immediately after surgery the pt should be placed ON THE SIDE with the head slightly elevated. This position helps facilitate removal of secretions & ↓ the likelihood of aspiration should vomiting occur. an RN does NOT need to be present to reposition the pt, unless the pt's condition warrants the presence of the nurse. Although it's important to elevate the head, there is NO need to keep the pt's head elevated on 2 pillows unless that position is comfortable for the pt.

A client with peptic ulcer disease tells the nurse that he has black stools, which he has not reported to his physician. Based on this information, which nursing diagnosis would be appropriate for this client? 1. Ineffective coping related to fear of diagnosis of chronic illness. 2. Deficient knowledge related to unfamiliarity with significant signs and symptoms. 3. Constipation related to decreased gastric motility. 4. Imbalanced nutrition: Less than body requirements related to gastric bleeding.

2 Black, tarry stools are an important warning sign of bleeding in PUD Digested blood in the stool causes it to be black. The odor of the stool is VERY offensive Pts with PUD should be instructed to report the incidence of black stools PROMPTLY to their primary HCP The data does not support the other DX.

A nurse is admitting a client who has been admitted with a diagnosis of upper GI bleeding to the hosptial. The nurse should assess the client for which of the following? Select all that apply. 1. Dry, flushed skin. 2. Decreased urine output. 3. Tachycardia. 4. Widening pulse pressure. 5. Rapid respirations. 6. Thirst.

2, 3, 5, 6 The Pt who is experiencing upper GI bleeding is at risk for developing hypovolemic shock from blood loss Therefore, the S/SX the nurse should expect to find are those related to hypovolemia, including: - ↓ UO - tachycardia - rapid respirations - thirst The Pt's skin would be cool & clammy, NOT dry and flushed The Pt would also be likely to develop hypotension, which would lead to a narrowing pulse pressure, NOT a widening pulse pressure.

A client with peptic ulcer disease reports that he has been nauseated most of the day and is now feeling light-headed and dizzy. Based upon these findings, which nursing actions would be most appropriate for the nurse to take? Select all that apply. 1. Administering an antacid hourly until nausea subsides. 2. Monitoring the client's vital signs. 3. Notifying the physician of the client's symptoms. 4. Initiating oxygen therapy. 5. Reassessing the client in an hour.

2, 3. The symptoms of nausea & dizziness in a pt with PUD may be indicative of hemorrhage & should NOT be ignored The appropriate nursing actions at this time are for the nurse to monitor the pt's VS & notify the physician of the pt's symptoms. To administer an antacid hourly or to wait 1 hour to reassess the pt would be inappropriate; prompt intervention is essential in a pt who is potentially experiencing a GI hemorrhage The nurse would notify the physician of assessment findings& THEN initiate oxygen therapy IF ordered by the physician.

The nurse is caring for a client who has had a gastroscopy. Which of the following signs and symptoms may indicate that the client is developing a complication related to the procedure? Select all that apply. 1. The client has a sore throat. 2. The client has a temperature of 100 ° F (37.8 ° C). 3. The client appears drowsy following the procedure. 4. The client has epigastric pain. 5. The client experiences hematemesis.

2, 4, 5. Following a gastroscopy, the nurse should monitor the pt for complications including: - perforation & the potential for aspiration an ↑ temperature, C/O of epigastric pain, or the vomiting of blood (hematemesis) are ALL indications of a possible perforation & should be reported promptly. A sore throat is a common occurrence following a gastroscopy Pt's are usually sedated to ↓ anxiety & the nurse would anticipate that the pt will be drowsy following the procedure.

A nurse is caring for a client who has just returned from surgery to treat a fractured mandible. Which of the following items should always be available at this client's bedside? Select all that apply. 1. Nasogastric tube. 2. Wire cutters. 3. Oxygen cannula. 4. Suction equipment. 5. Code cart.

2, 4. Following surgery for a fractured mandible, the pt's jaws will be wired. The nurse should be prepared to intervene quickly in case the pt develops respiratory distress or begins to choke or vomit. Wire cutters or scissors should always be available in case the wires need to be cut in a medical 911. Suction equipment should be available to help clear the pt's airway if necessary. It is NOT necessary to keep a NG tube or oxygen cannula at the pt's bedside. Cardiopulmonary arrest is unlikely, so a code cart is not needed at the bedside.

A client has been diagnosed with adenocarcinoma of the stomach and is scheduled to undergo a subtotal gastrectomy (Billroth II procedure). During preoperative teaching, the nurse is reinforcing information about the surgical procedure. Which of the following explanations is most accurate? 1. The procedure will result in enlargement of the pyloric sphincter. 2. The procedure will result in anastomosis of the gastric stump to the jejunum. 3. The procedure will result in removal of the duodenum. 4. The procedure will result in repositioning of the vagus nerve.

2. A Billroth II procedure bypasses the duodenum & connects the gastric stump directly to the jejunum. The pyloric sphincter is REMOVED, along with some of the stomach fundus.

The nurse finds a client who has been diagnosed with a peptic ulcer surrounded by papers from his briefcase and arguing on the telephone with a coworker. The nurse's response to observing these actions should be based on knowledge that: 1. Involvement with his job will keep the client from becoming bored. 2. A relaxed environment will promote ulcer healing. 3. Not keeping up with his job will increase the client's stress level. 4. Setting limits on the client's behavior is an important nursing responsibility.

2. A relaxed environment is an essential component of ulcer healing. Nurses can help pts understand the importance of relaxation & explore with them ways to balance work & family demands to promote healing. Being involved with his work may prevent boredom; however, this pt is upset & argumentative. Not keeping up with his job will probably ↑ the pt's stress level, but the nurse's response is best if it is based on the fact that a relaxed environment is an essential component of ulcer healing. Nurses CANNOT set limits on a pt's behavior; pts MUST make the decision to make lifestyle changes.

As a result of a gastric resection, the client is at risk for development of dumping syndrome. The nurse should prepare a plan of care for this client based on knowledge that this problem stems primarily from which of the following gastrointestinal changes? 1. Excess secretion of digestive enzymes in the intestines. 2. Rapid emptying of stomach contents into the small intestine. 3. Excess glycogen production by the liver. 4. Loss of gastric enzymes.

2. After a gastric resection, ingested food moves rapidly from the remaining stomach into the duodenum or jejunum. The food has not undergone adequate preliminary digestion in the stomach. It's concentrated (hypertonic), distends the intestine, & stimulates significant secretion of insulin by the pancreas, as well as a shift of fluid into the bowel. The DUMPING SYNDROME results from these factors, which are initiated by the rapid movement of food out of the stomach. After gastric resection, excess digestive enzymes are NOT secreted & the liver does not produce glycogen. Dumping syndrome is NOT caused by loss of gastric secretions.

Which of the following would be an expected outcome for a client with peptic ulcer disease? The client will: 1. Demonstrate appropriate use of analgesics to control pain. 2. Explain the rationale for eliminating alcohol from the diet. 3. Verbalize the importance of monitoring hemoglobin and hematocrit every 3 months. 4. Eliminate contact sports from his or her lifestyle.

2. Alcohol is a gastric irritant that should be Ø eliminated from the intake of the pt with PUD Analgesics are NOT used to control ulcer pain; many analgesics are gastric irritants. The Pt's hemoglobin & hematocrit typically do not need to be monitored Q 3 months, unless GI bleeding is suspected. The Pt can maintain an active lifestyle & does not need to eliminate contact sports as long as they are not stress-inducing.

Which of the following factors would most likely contribute to the development of a client's hiatal hernia? 1. Having a sedentary desk job. 2. Being 5 feet, 3 inches tall and weighing 190 lb. 3. Using laxatives frequently. 4. Being 40 years old.

2. Any factor that ↑ intra-abdominal pressure, such as obesity, can contribute to the development of hiatal hernia. Other factors include: - abdominal straining - frequent heavy lifting - pregnancy Hiatal hernia is also assoc. with older age & occurs in women more frequently than in men. Having a sedentary desk job, using laxatives frequently, or being 40 years old is NOT likely to be a contributing factor in development of a hiatal hernia.

As part of the client's discharge planning after a subtotal gastrectomy, the nurse has identified Imbalanced nutrition: Less than body requirements as a major nursing diagnosis. To help the client meet nutritional goals at home, the nurse should develop a plan of care that includes which of the following interventions? 1. Instruct the client to increase the amount eaten at each meal. 2. Encourage the client to eat smaller amounts more frequently. 3. Explain that if vomiting occurs after a meal, nothing more should be eaten that day. 4. Inform the client that bland foods are typically less nutritional and should be used minimally.

2. Because of the pt's ↓ stomach capacity, frequent small feedings are recommended. Early satiety can result & large quantities of food are NOT well tolerated Each pt should progress at his or her own pace, gradually ↑ the amount of food eaten. The goal is 3 meals daily IF possible, but this can take 6 months or longer to achieve Nausea can be episodic & can result from eating too fast or eating too much at one time Eating less & slower, rather than not eating at all, can be a solution Bland foods are recommended as starting foods because they are easily digested & less irritating to the healing mucosa. Bland foods are not less nutritional.

In developing a teaching plan for the client with a hiatal hernia, the nurse's assessment of which work-related factors would be most useful? 1. Number and length of breaks. 2. Body mechanics used in lifting. 3. Temperature in the work area. 4. Cleaning solvents used.

2. Bending, especially after eating, can cause gastroesophageal reflux Lifting heavy objects ↑ intra-abdominal pressure. Assessing the pt's lifting techniques enables the nurse to evaluate the pt's knowledge of factors contributing to hiatal hernia & how to prevent complications. Number & length of breaks, temperature in the work area & cleaning solvents used are NOT directly related to TX of hiatal hernia.

Bethanechol (Urecholine) has been ordered for a client with gastroesophageal reflux disease (GERD). The nurse should assess the client for which of the following adverse effects? 1. Constipation. 2. Urinary urgency. 3. Hypertension. 4. Dry oral mucosa.

2. Bethanechol (Urecholine), a cholinergic drug, may be used in GERD to ↑ lower esophageal sphincter pressure & facilitate gastric emptying. Cholinergic adverse effects may include: - urinary urgency - diarrhea - abdominal cramping - hypotension - ↑ salivation To avoid these adverse effects, the pt should be closely monitored to establish the minimum effective dose

The client asks the nurse whether he will need surgery to correct his hiatal hernia. Which reply by the nurse would be most accurate? 1. "Surgery is usually required, although medical treatment is attempted first." 2. "Hiatal hernia symptoms can usually be successfully managed with diet modifications, medications, and lifestyle changes." 3. "Surgery is not performed for this type of hernia." 4. "A minor surgical procedure to reduce the size of the diaphragmatic opening will probably be planned."

2. MOST ps can be TX successfully with a combination of diet restrictions, medications, weight control & lifestyle modifications. Surgery to correct a hiatal hernia, which commonly produces complications, is performed ONLY when medical therapy FAILS to control the symptoms.

Which of the following lifestyle modifications should the nurse encourage the client with a hiatal hernia to include in activities of daily living? 1. Daily aerobic exercise. 2. Eliminating smoking and alcohol use. 3. Balancing activity and rest. 4. Avoiding high-stress situations.

2. Smoking & alcohol use both ↓ esophageal sphincter tone & can result in reflux They therefore should be Ø avoided by ps with hiatal hernia. Daily aerobic exercise, balancing activity & rest, & avoiding high-stress situations may ↑ the pt's general health & well-being, BUT they are NOT directly associated with hiatal hernia.

Which of the following instructions should the nurse include in the teaching plan for a client who is experiencing gastroesophageal reflux disease (GERD)? 1. Limit caffeine intake to two cups of coffee per day. 2. Do not lie down for 2 hours after eating. 3. Follow a low-protein diet. 4. Take medications with milk to decrease irritation.

2. The nurse should instruct the pt to NOT lie down for about 2 hrs AFTER eating to prevent reflux. Caffeinated beverages ↓ pressure in the lower esophageal sphincter & milk ↑ gastric acid secretion, so these beverages should be Ø avoided The pt is encouraged to follow a ↑ high-protein, ↓ low-fat diet, and Ø avoid foods that are irritating (spicy)

A client who was in a motor vehicle accident has a fractured mandible. Surgery has been performed to immobilize the injury by wiring the jaw. In the immediate postoperative phase, the nurse should: 1. Prevent nausea and vomiting. 2. Maintain a patent airway. 3. Provide frequent oral hygiene. 4. Establish a way for the client to communicate.

2. The priority of care in the immediate postop phase is to maintain a patent airway. The nurse should observe the pt carefully for signs of respiratory distress. If the pt becomes nauseated, antiemetics should be administered to ↓ the chance of vomiting with obstruction of the airway & aspiration of vomitus. Providing frequent oral hygiene & an alternative means of communication are important aspects of nursing care, but maintaining a patent airway is MOST important.

The client has been taking magnesium hydroxide (milk of magnesia) at home in an attempt to control hiatal hernia symptoms. The nurse should assess the client for which of the following conditions most commonly associated with the ongoing use of magnesium-based antacids? 1. Anorexia. 2. Weight gain. 3. Diarrhea. 4. Constipation.

3. The magnesium salts in magnesium hydroxide are related to those found in laxatives and may cause diarrhea. Aluminum salt products can cause constipation. Many clients find that a combination product is required to maintain normal bowel elimination. The use of magnesium hydroxide does NOT cause anorexia or weight gain.

35. A client who is recovering from gastric surgery is receiving I.V. fluids to be infused at 100 mL/hour. The I.V. tubing delivers 15 gtt/mL. The nurse should infuse the solution at a flow rate of how many drops per minute to ensure that the client receives 100 mL/hour? _______gtt/minute.

25 gtt/minute. To administer I.V. fluids at 100 mL/hour using tubing that has a drip factor of 15 gtt/mL, the nurse should use the following formula: 100 mL/60 minutes × 15 gtts/1 mL = 25 gtt/minute

The nurse has been assigned to provide care for four clients at the beginning of the day shift. In what order should the nurse assess these clients? 1. The client awaiting hiatal hernia repair at 11 am. 2. A client with suspected gastric cancer who is on nothing-by-mouth (NPO) status for tests. 3. A client with peptic ulcer disease experiencing sudden onset of acute stomach pain. 4. A client who is requesting pain medication 2 days after surgery to repair a fractured jaw.

3, 4, 2, 1 The pt with PUD (peptic ulcer disease) who is experiencing a sudden onset of acute stomach pain should be assessed FIRST by the nurse. - The sudden onset of stomach pain could be indicative of a perforated ulcer, which would require immediate medical attention. - It's also important for the nurse to thoroughly assess the nature of the pt's pain. The pt with the fractured jaw is experiencing pain & should be assessed next. The nurse should then assess the pt who is NPO for tests to ensure NPO status & comfort Last, the nurse can assess that pt before surgery

What should the nurse teach a client about how to avoid the dumping syndrome? Select all that apply. 1. Consume three regularly-spaced meals per day. 2. Eat a diet with high carbohydrate foods with each meal. 3. Reduce fluids with meals, but take them between meals. 4. Obtain adequate amounts of protein and fat in each meal. 5. Eat in a relaxing environment.

3, 4, 5 Dumping syndrome results in: excessive, rapid emptying of gastric contents The nurse should instruct the pt to avoid dumping syndrome by: - eating small, frequent meals rather than 3 LG meals - diet ↑ high in protein / fat & ↓ low in CHO - ↓ fluids with meals but taking them between meals - relaxing when eating The client should eat slow & regularly and rest after meals.

When obtaining a nursing history on a client with a suspected gastric ulcer, which signs and symptoms should the nurse expect to assess? Select all that apply. 1. Epigastric pain at night. 2. Relief of epigastric pain after eating. 3. Vomiting. 4. Weight loss. 5. Melena.

3, 4, 5. Vomiting & weight loss are common with gastric ulcers. The client may also have blood in the stools (melena) from gastric bleeding. Pt's with a Gastric ulcer are most likely to complain of a burning epigastric pain that occurs about 1 hr AFTER eating Eating frequently aggravates the pain Pt's with Duodenal ulcers are more likely to complain about pain that occurs during the night & is frequently relieved BY EATING

Following a gastrectomy, the nurse should postion the client in which of the following positions? 1. Prone. 2. Supine. 3. Low Fowler's. 4. Right or left Sims.

3. A pt who has had abdominal surgery is best placed in a LOW Fowler's position postop This positioning relaxes abdominal muscles & provides for maximum respiratory & cardiovascular function The prone, supine, or Sims position would NOT be tolerated by a pt who has had abdominal surgery, nor do those positions support respiratory or cardiovascular functioning.

Cimetidine (Tagamet) may also be used to treat hiatal hernia. The nurse should understand that this drug is used to prevent which of the following? 1. Esophageal reflux. 2. Dysphagia. 3. Esophagitis. 4. Ulcer formation.

3. CimetiDINE (Tagamet) is a histamine receptor antagonist that ↓ the quantity of gastric secretions. It may be used in hiatal hernia therapy to prevent or TX the esophagitis & heartburn associated with reflux. Cimetidine is NOT used to prevent reflux, dysphagia, or ulcer development.

The nurse is preparing to teach a client with a peptic ulcer about the diet that should be followed after discharge. The nurse should explain that the diet will most likely consist of which of the following? 1. Bland foods. 2. High-protein foods. 3. Any foods that are tolerated. 4. Large amounts of milk.

3. Diet therapy for ulcer disease is a controversial issue. There is NO scientific evidence that diet therapy promotes healing. Most clients are instructed to follow a diet that they can tolerate. There is NO need for the pt to ingest only a bland or ↑ high-protein diet Milk may be included in the diet, but it is NOT recommended in ↑ excessive amounts.

A client has been taking aluminum hydroxide (Amphojel) 30 mL six times per day at home to treat his peptic ulcer. He tells the nurse that he has been unable to have a bowel movement for 3 days. Based on this information, the nurse would determine that which of the following is the most likely cause of the client's constipation? 1. The client has not been including enough fiber in his diet. 2. The client needs to increase his daily exercise. 3. The client is experiencing an adverse effect of the aluminum hydroxide. 4. The client has developed a gastrointestinal obstruction.

3. It is most likely that the pt is experiencing an adverse effect of the antacid. Antacids with aluminum salt products, such as aluminum hydroxide, form insoluble salts in the body. These precipitate & accumulate in the intestines, causing constipation ↑ Dietary fiber intake or daily exercise may be a beneficial lifestyle change for the pt; but is not likely to relieve the constipation caused by the aluminum hydroxide. Constipation, in isolation from other symptoms, is NOT a sign of a bowel obstruction.

After a subtotal gastrectomy, care of the client's nasogastric (NG) tube and drainage system should include which of the following nursing interventions? 1. Irrigate the tube with 30 mL of sterile water every hour, if needed. 2. Reposition the tube if it is not draining well. 3. Monitor the client for nausea, vomiting, and abdominal distention. 4. Turn the machine to high suction if the drainage is sluggish on low suction.

3. Nausea, vomiting, or abdominal distention indicates that gas & secretions are accumulating within the gastric pouch due to impaired peristalsis or edema at the operative site & may indicate that the drainage system is NOT working properly Saline solution is used to irrigate NG tubes. Hypotonic solutions such as water ↑ electrolyte loss * In addition, a physician's order is needed to irrigate the NG tube because this procedure could disrupt the suture line. After gastric surgery, ONLY the surgeon repositions the NG tube because of the danger of rupturing or dislodging the suture line. The amount of suction varies with the type of tube used & is ordered by the physician High suction may create too much tension on the gastric suture line.

Which of the following nursing interventions would most likely promote self-care behaviors in the client with a hiatal hernia? 1. Introduce the client to other people who are successfully managing their care. 2. Include the client's daughter in the teaching so that she can help implement the plan. 3. Ask the client to identify other situations in which he demonstrated responsibility for himself. 4. Reassure the client that he will be able to implement all aspects of the plan successfully.

3. Self-responsibility is the key to individual health maintenance. Using examples of situations in which the pt has demonstrated self-responsibility can be reinforcing & supporting. The pt has ultimate responsibility for his personal health habits. Meeting other people who are managing their care & involving family members can be helpful, but individual motivation is MOST important. Reassurance can be helpful but is less important than individualization of care.

The client tells the nurse that since his diagnosis of stomach cancer, he has been having trouble sleeping and is frequently preoccupied with thoughts about how his life will change. He says, "I wish my life could stay the same." Based on this information, which one of the following nursing diagnoses would be appropriate at this time? 1. Ineffective coping related to the diagnosis of cancer. 2. Insomnia related to fear of the unknown. 3. Grieving related to the diagnosis of cancer. 4. Anxiety related to the need for gastric surgery.

3. The information presented MOST clearly supports a nursing diagnosis of Grieving The feelings expressed in this situation are more related to grieving about the changes that will occur in the Pt's life as a result of the diagnosis of gastric cancer than to fear of the unknown or anxiety about the surgery There is no evidence of ineffective coping at this time.

A client who has been diagnosed with gastroesophageal reflux disease (GERD) complains of heartburn. To decrease the heartburn, the nurse should instruct the client to eliminate which of the following items from the diet? 1. Lean beef. 2. Air-popped popcorn. 3. Hot chocolate. 4. Raw vegetables.

3. With GERD, eating substances that ↓ lower esophageal sphincter pressure causes heartburn. A ↓ in the lower esophageal sphincter pressure allows gastric contents to reflux into the lower end of the esophagus Foods that can cause a ↓ in esophageal sphincter pressure include: - fatty foods - chocolate - caffeinated beverages - peppermint - alcohol A diet ↑ in protein & ↓ in fat is recommended for pts with GERD Lean beef, popcorn & raw vegetables would be acceptable.

A client is to take one daily dose of ranitidine (Zantac) at home to treat her peptic ulcer. The client understands proper drug administration of ranitidine when she says that she will take the drug at which of the following times? 1. Before meals. 2. With meals. 3. At bedtime. 4. When pain occurs.

3. RanitiDINE blocks Ø secretion of hydrochloric acid. Pt's who take only 1 dose of ranitidine a day are usually advised to take it at BEDTIME to inhibit nocturnal secretion of acid. Pt's who take the drug 2x a day are advised to take it in the AM & P,M (morning & bedtime) It is NOT necessary to take the drug before meals. The client should take the drug REGULARLY, not just when pain occurs.

During the assessment of a client's mouth, the nurse notes the absence of saliva. The client has pain in the area of the ear. The client has been nothing-by-mouth (NPO) for several days because of the insertion of a nasogastric tube. Based on these findings, the nurse suspects that the client may be developing which of the following mouth conditions? 1. Stomatitis. 2. Oral candidiasis. 3. Parotitis. 4. Gingivitis.

3. The lack of saliva, pain near the area of the ear, and the prolonged NPO status of the pt should lead the nurse to suspect the development of parotitis, or inflammation of the parotid gland. Parotitis usually develops in cases of dehydration combined with poor oral hygiene or when pts have been NPO for an extended period. Preventive measures include the use of sugarless hard candy or gum to stimulate saliva production, adequate hydration & frequent mouth care. Stomatitis (inflammation of the mouth) produces excessive salivation & a sore mouth. Oral candidiasis (thrush) causes bluish white mouth lesions. Gingivitis can be recognized by the inflamed gingiva & bleeding that occur during toothbrushing.

A client who has had her jaws wired begins to vomit. What should be the nurse's first action? 1. Insert a nasogastric (NG) tube and connect it to suction. 2. Use wire cutters to cut the wire. 3. Suction the client's airway as needed. 4. Administer an antiemetic intravenously.

3. The nurse's FIRST action is to clear the pt's airway as necessary. Inserting an NG tube or administering an antiemetic may prevent future vomiting episodes, but these procedures are not helpful when the client is actually vomiting. Cutting the wire is done only as a last resort or in case of respiratory or cardiac arrest.

A client with suspected gastric cancer undergoes an endoscopy of the stomach. Which of the following assessments made after the procedure would indicate the development of a potential complication? 1. The client complains of a sore throat. 2. The client displays signs of sedation. 3. The client experiences a sudden increase in temperature. 4. The client demonstrates a lack of appetite.

3. The most likely complication of an endoscopic procedure is perforation. A sudden temperature spike within 1-2 hrs after the procedure is indicative of a perforation & should be reported immediately to the physician. A sore throat is to be anticipated after an endoscopy Pts are given sedatives during the procedure, so it's expected that they will display signs of sedation after the procedure is completed A lack of appetite could be the result of many factors, including the disease process.

One month following a subtotal gastrectomy for cancer, the nurse is evaluating the nursing care goal related to nutrition. Which of the following indicates that the client has attained the goal? The client has: 1. Regained weight loss. 2. Resumed normal dietary intake of three meals a day. 3. Controlled nausea and vomiting through regular use of antiemetics. 4. Achieved optimal nutritional status through oral or parenteral feedings.

4. An appropriate expected outcome is for the pt to achieve optimal nutritional status through the use of oral feedings or total parenteral nutrition (TPN) TPN may be used to supplement oral intake, or it may be used alone if the pt can't tolerate oral feedings The pt would NOT be expected to regain lost weight within 1 month after surgery or to tolerate a normal dietary intake of 3 meals a day Nausea & vomiting would NOT be considered an expected outcome of gastric surgery & regular use of antiemetics would NOT be anticipated.

To reduce the risk of dumping syndrome, the nurse should teach the client to do which of the following? 1. Sit upright for 30 minutes after meals. 2. Drink liquids with meals, avoiding caffeine. 3. Avoid milk and other dairy products. 4. Decrease the carbohydrate content of meals.

4. CHO are restricted, but protein, including meat & dairy products, IS recommended because it's digested slower Lying down for 30 mins after a meal is encouraged to slow movement of the food bolus Fluids are restricted to ↓ the bulk of food There is NO need to avoid caffeine.

A client with a peptic ulcer has been instructed to avoid intense physical activity and stress. Which strategy should the client incorporate into the home care plan? 1. Conduct physical activity in the morning so that he can rest in the afternoon. 2. Have the family agree to perform the necessary yard work at home. 3. Give up jogging and substitute a less demanding hobby. 4. Incorporate periods of physical and mental rest in his daily schedule.

4. It would be MOST effective for the pt to develop a health maintenance plan that incorporates regular periods of physical & mental rest in the daily schedule. Strategies should be identified to deal with the types of physical & mental stressors that the pt needs to cope with in the home & work environments. Scheduling physical activity to occur ONLY in the morning would NOT be restful or practical. There is no need for the pt to avoid yard work or jogging if these activities are not stressful.

The nurse should instruct the client to avoid which of the following drugs while taking metoclopramide hydrochloride (Reglan)? 1. Antacids. 2. Antihypertensives. 3. Anticoagulants. 4. Alcohol.

4. Metoclopramide hydrochloride (Reglan) can cause sedation. Alcohol & other CNS depressants add to this sedation. A pt who is taking this drug should be cautioned to avoid driving or performing other hazardous activities for a few hrs AFTER taking the drug. Pts may take antacids, antihypertensives & anticoagulants while on metoclopramide.

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.

4. Pt's with GERD can develop pulmonary symptoms, such as: coughing, wheezing & dyspnea, that are caused by the aspiration of gastric contents GERD does NOT predispose the pt to the development of laryngeal cancer Irritation of the esophagus & esophageal scar tissue formation can develop as a result of GERD. However, GERD is more likely to cause painful & difficult swallowing.

A client who is recovering from a subtotal gastrectomy experiences dumping syndrome. The client asks the nurse, "When will I be able to eat three meals a day again like I used to?" Which of the following responses by the nurse is most appropriate? 1. "Eating six meals a day is time-consuming, isn't it?" 2. "You will have to eat six small meals a day for the rest of your life." 3. "You will be able to tolerate three meals a day before you are discharged." 4. "Most clients can resume their normal meal patterns in about 6 to 12 months."

4. The symptoms related to dumping syndrome that occur after a gastrectomy usually disappear by 6-12 months after surgery. Most pts can begin to resume normal meal patterns after signs of the dumping syndrome have stopped Acknowledging that eating 6 meals a day is time-consuming does not address the pt's question & makes an assumption about the pt's concerns It's not necessarily true that a 6-meal-a-day dietary pattern will be required for the rest of the pt's life Pt's will NOT be able to eat 3 meals a day BEFORE hospital discharge.

A client is taking an antacid for treatment of a peptic ulcer. Which of the following statements best indicates that the client understands how to correctly take the antacid? 1. "I should take my antacid before I take my other medications." 2. "I need to decrease my intake of fluids so that I don't dilute the effects of my antacid." 3. "My antacid will be most effective if I take it whenever I experience stomach pains." 4. "It is best for me to take my antacid 1 to 3 hours after meals."

4. Antacids are MOST effective if taken 1-3 hrs AFTER meals & at bedtime. When an antacid is taken on an empty stomach, the duration of the drug's action is greatly ↓ Taking antacids 1-3 hrs AFTER a meal lengthens the duration of action, thus↑ the therapeutic action of the drug Antacids should be administered about 2 hrs AFTER other medications to ↓ the chance of drug interactions. It is NOT necessary to ↓ fluid intake when taking antacids. If antacids are taken more frequently than recommended, the likelihood of developing adverse effects ↑ Therefore, the pt should NOT take antacids as often as "desired" to control pain

A client with peptic ulcer disease is taking ranitidine (Zantac). What is the expected outcome of this drug? 1. Heal the ulcer. 2. Protect the ulcer surface from acids. 3. Reduce acid concentration. 4. Limit gastric acid secretion.

4. Histamine-2 (H2) receptor antagonists, such as ranitiDINE, ↓ gastric acid secretion. Antisecretory, or proton-pump inhibitors, such as omeprazole (Prilosec), help ulcers heal quickly in 4-8 weeks. Cytoprotective drugs, such as sucralfate (Carafate), protect the ulcer surface against acid, bile & pepsin Antacids ↓ acid concentration & help ↓ symptoms

A client who has a history of a mitral valve prolapse tells the nurse that she is scheduled to get her teeth cleaned. Which of the following replies by the nurse is most appropriate? 1. "The physician will need to reevaluate the status of your heart condition before your dental appointment." 2. "Be sure to remind your dentist that you have a heart condition." 3. "It is important for you to care for your teeth because your heart condition makes you more susceptible to developing oral infections." 4. "We will prescribe a prophylactic antibiotic for you to take before getting your teeth cleaned."

4. Pts who are at risk for developing infective endocarditis due to cardiac conditions such as mitral valve prolapse must take prophylactic antibiotics before any dental procedure that may cause bleeding. The pt is NOT more susceptible to developing oral infections. Rather, the pt is more susceptible to developing endocarditis that results from oral bacteria that enter the circulation during the dental procedure. The physician does not necessarily need to re-evaluate the heart condition of a pt who is stable, but antibiotics must be prescribed. It is not enough to simply remind the dentist about the heart condition.

A nurse teaches a client experiencing heartburn to take 1 ½ oz of Maalox when symptoms appear. How many milliliters should the client take? ________________________ mL

45 mL

Amoxicillin trihydrate (Amoxil) 300 mg P.O. has been prescribed for a client with an oral infection. The medication is available in a liquid suspension that is available as 250 mg/ 5 mL. How many milliliters would the nurse administer? ________________________ mL.

6 mL.