Upper GI, Obesity

What type of leading of a patient with peptic also disease with the slow upper G.I. source of bleeding have? A. Melena B. Occult Blood C. Coffee ground emesis D. Profuse bright red hematemesis

A

Which type of gastritis is most likely to occur in a college student who has an isolated drinking Binge? A. Acute gastritis B. Chronic gastritis C. Helicobacter pylori gastritis D. Auto immune metaplastic atrophic gastritis

A

Which statement by a patient with dumping syndrome should lead the nurse to determine that further dietary teaching is needed? A. I should eat bread and jam with every meal B. I should avoid drinking fluids with my meals C. I should eat smaller meals about six times a day D. I should lie down for 30 to 60 minutes after my meals.

A (dietary control of dumping syndrome include small, frequent meals with low carbohydrate content and elimination of fluids with meals. The patient should also lie down for 30 to 60 minutes after meals. These measures help to delete the stomach emptying, preventing a rapid movement of a high carbohydrate food bolus into the small intestine)

A patient with a gastric outlet obstruction has been treated with NG decompression. After the first 24 hours, the patient develops nausea and increased upper abdominal bowel sounds. What is the priority action by the nurse? A. Set the patency of the NG tube B. Place the patient in a recumbent position C. Assess the patient's vital signs and circulatory status D. Encourage the patient to deep breathe and consciously relax

A (if symptoms of gastric outlet obstruction, such as nausea, vomiting, and stomach distention, occur while the patient is on NPO status or has an NG tube, the patency The NG tube should be first assessed. Avery come back position should not be used in a patient with a gastric outlet obstruction because it increases abdominal pressure on the stomach. Vital signs and circulatory status assessment are important if hemorrhage for perforation is expected. Deep breathing and relaxation may help some patients with nausea but not when stomach contents are obstructed from flowing into the small intestine.)

Patient treated for vomiting is to begin oral intake when the symptoms have subsided. To promote rehydration, the nurse plans to Mr which fluid first? A. Water B. Hot tea C. Gatorade D. Warm broth

A (water is the fluid of choice for rehydration by mouth. Very hot or cold liquids are not usually well-tolerated. Although broth and Gatorade have been used for the patient with severe vomiting, these substances are high in sodium and should be administered with caution.)

Which medications are used to decrease gastric or hydrochloric acid secretion? Select all that apply A. Famitidine (Pepcid) B. Sulcrafate (Carafate) C. Omeprazole (Prilosec) D. Misoprostil (Cytotec) E. Bethanechol (Urecholine)

A C D (Famotitine (Pepcid) reduce is hydrochloric acid secretion by blocking histamine. Omaprazole (Prilosec) Decreases gastric acid secretion by blocking adenosine triphosphatase enzyme. Misoprostol (Cytotec) has antisecretory effects. Sulcrafate coats the ulcer to protect it from acid erosion. Bethanechol for GERD increases lower esophageal sphincter pressure and facilitates gastric emptying.)

Duodenal and Gastric ulcers have similar as well as differentiating features. What are the characteristics unique to duodenal ulcers? SATA A. Pain is relieved with eating food B. They have a high recurrence rate C. Increased gastric acid secretion occurs D. Associated with H.pylori infection E. Hemorrhage, perforation, and obstruction may result F. There is a burning and cramping in the mid epigastric region

A C D F (Duodenal ulcers have increased HCL acid gastric secretion, which causes burning and cramping in the midepigastric area. The pain is relieved the food. 90 to 95% patients have H. Pylori Infection. The other option is occur with both Duodenal and gastric ulcers.)

The nurse is planning to teach the patient with gastroesophageal reflux disease about Foods or beverages that decrease LES pressure. What should be included in this list? Select all that apply A. Alcohol B. Root beer C. Chocolate chocolate D. Citrus fruits E. Fatty foods F. Cola sodas

ACEF (Alcohol, chocolate, fatty foods, and cola sodas caffeine as well as peppermint and spearmint will decrease lower esophageal sphincter pressure. Repair an herbal teas do not have caffeine. Citrus fruits will not affect LES pressure)

What should the nurse emphasize when teaching patients at risk for upper G.I. bleeding to prevent bleeding episodes? A. All stores and vomitus must be tested for the presence of blood B. The use of over-the-counter medications of any kind should be avoided C. Antacids should be taken with all prescription medications. D.Misoprostol Should be used to protect the gastric mucosa in individuals with peptic ulcers

All over the counter drugs should be avoided because their contacts may include drugs that are contraindicated because of the irritating affects on the gastric mucosa. Patients are taught to test some of the sponsors or store for occult blood. But all stores do not have to be tested. Antacids cannot be taken with all medications because they prevent the absorption of many drugs. Patient with a history of ulcers we must take low-dose aspirin or prescribe misoprostol to protect the gastric mucosa.

A patient with cancer of the stomach at the lesser curvature undergoes a total gastrectomy with a esophaojejunostomy. Post operatively, what should the nurse teach the patient to expect? A. Rapid healing of the surgical B. Lifelong administration of cobalamin C. To be able to return to normal dietary habits D. Close follow-up for development of peptic ulcers in the jejunum

B (A total gastrectomy removes the parietal cells responsible for secreting intrinsic factor necessary for absorption of Cobalamin. Lifelong IM administration of cobalamin is necessary to prevent the development of pernicious anemia. Wound healing is usually impaired in the patient with a total gastrectomy performed for gastric cancer because of impaired nutritional status before surgery. Following a total gastrectomy, the patient also requires diet modifications as a result of dumping syndrome and postprandial hypoglycemia. Peptic ulcer's are not a common finding after total gastrectomy.)

What esophageal disorder is described as a precancerous lesion and yes associated with GERD? A. Achalasia B. Barrett's esophagus C. Esophageal strictures D. Esophageal diverticula

B (Barrett's Esophagus is an esophageal metaplasia primarily related to Gastro esophageal reflux disease. Achalasia is a rare chronic disorder with delayed emptying of the lower esophagus and is associated with squamous cell cancer. Esophageal stricture's are narrowing of the esophagus from scaring by many causes. Esophageal diverticulum are saclike outpouchings of one or more layers of the esophagus commonly seen above the esophageal sphincter. )

Which infection or inflammation is found related to systemic disease and cancer chemotherapy? A. Parotitis B. Stomatitis C. Oral candidiasis D. Vincent's infection

B (Stomatitis is inflammation of the mouth related to systemic diseases and cancer chemotherapy medications. There was excessive celebration, halitosis, and a sore mouth. Parotitis is a staph infection That may occur with prolonged NPO status and results in decreased saliva and ear pain. Oral candidiasis is saying with prolonged antibiotic or corticosteroid therapy. It has white membrane is lesions on the mucosa of the mouth and larynx. Vincent infection is a bacterial infection predisposed to buy fatigue, stress, and poor oral hygiene. There are painful, bleeding gums and increased metallic tasting saliva.)

The patient is admitted to the emergency department with the profuse bright red hematemesis. During the initial care of the patient what is the nurses first priority? A. Established to IV sites with large gate catheters B. Perform a focus nursing assessment of the patient's status C. A thorough health history to assist in determining the cause of bleeding D. Perform a gastric lavage with cool tapwater in preparation for endoscopic examination

B (although all of the interventions may be indicated when a patient has upper G.I. bleeding, the first nursing priority with bright red arterial blood is to perform a focused assessment of the patient's condition, with emphasis on blood pressure pulse and peripheral perfusion to determine the presence of hypovolemic shock.)

Nursing management of the patient with chronic gastritis includes teaching the patient to A. Take antacids before meals to decrease stomach acidity B. Maintain a non-irritating diet with six small meals a day C. Eliminate alcohol and caffeine from the diet when symptoms occur D. Use nonsteroidal anti-inflammatory drugs instead of aspirin for minor pain relief

B (and non-irritating diet with six small meals a day is recommended to help control symptoms of gastritis. Anacids are often used for control of symptoms but have the best neutralizing affects if taken after meals. Alcohol and caffeine should be eliminated entirely because they may precipitate gastritis. NSAIDs or often as irritating to the stomach as aspirin and should not be used in the patient with gastritis)

Which statements are characteristic of the uses of antacids for peptic ulcer disease? Select all that apply A. Used in patients with verified H.pylori B. Patients frequently noncompliant with use C. Neutralize hydrochloric acid in the stomach D. Cover the ulcer, protecting it from erosion by acids E. High incidence of side effects and contraindications F. High dose and frequency may stimulate release of gastrin

B C F (Antacids need a high dose and frequency, which may lead to noncompliance. They neutralize hydrochloric acid in the stomach that prevents the conversion of pepsinogen to pepsin. They may stimulate the release of gastrin in PUD patients. Amoxicillin, clarithromycin, omeprazole are used in patients with verified H.pylori. Sulcrafate covers the ulcer to protect it from acid erosion. The side effects are manageable)

A patient with a history of peptic also disease is hospitalized with symptoms of a perforation. During initial assessment, what should the nurse expect patient to report? A. Vomiting of bright red blood B. Projectile vomiting of undigested food C. Sudden, severe generalized abdominal and back pain D. Hyperactive bowel sounds and upper abdominal swelling

C (Perforation of ulcer cause a sudden, severe abdominal pain that comes generalized and may be referred to the back, accompanied by a rigid, board like abdomen, shallow respirations, and a week rapid heart rate. Vomiting of blood indicate hemorrhage of an ulcer. Gastric outlet obstruction is characterized by projection of undigested food, hyperactive stomach sounds, and upper abdominal swelling.)

Which laboratory findings should the nurse expect the patient with persistent vomiting? A. ⬇️pH, ⬆️ Na, ⬇️ hct B. ⬆️pH, ⬇️ chloride, ⬇️hct C. ⬆️pH, ⬇️ K, ⬆️ hct D. ⬇️pH, ⬇️K, ⬆️hct

C (The loss of gastric hydrochloric acid causes metabolic alkalosis and an increase in pH. Loss potassium, sodium, and chloride. Loss of fluid, which increases the hematocrit)

What does the nurse include when teaching a patient with newly diagnosed peptic ulcer disease? A. Maintain a bland, soft, low residue diet B. Use alcohol and caffeine in moderation and always with food C. Eat as normally as possible, eliminating foods that cause pain or discomfort D. Avoid milk and milk products because they stimulate gastric acid production

C (There is no specific diet used for the treatment of peptic uclers, and patients are encouraged to eat as normally as possible, eliminating foods that cause discomfort or pain. Eating six meals a day prevents the stomach from being totally empty and it's also recommended. Caffeine and alcohol should be eliminating from the diet because they are known to cause a gastric irritation. Milk and milk products do not have to be avoided but they can add fat content to the diet.

How should the nurse teach the patient with a hiatal hernia or GERD to control symptoms? A. Drink 10 to 12 ounces of water with each meal. B. Space six small meals a day between breakfast and bedtime C. Sleep with the head of the bed elevated on 4 to6 inch blocks D. Perform daily exercises of toe touching sit ups and weightlifting

C (do use a blocks to elevate the head of the bed facilitates gastric emptying by gravity and is strongly recommended to prevent night time reflux. Liquids should be taken between meals to prevent gastric distention with meals. Small meals should be eating frequently, but patient should not eat at bedtime or lie down for 2 to 3 hours after eating. Activities that involve increasing intra-abdominal pressure, such as bending over, lifting, or wearing tight clothing, should be avoided.)

The nurse determines that teaching for the patient with peptic also disease has been effective when the patient makes which statement? A. I should stop all my medications if I develop any side effects B. I should continue my treatment regimen as long as I have pain C. I have learned some relaxation strategies that decrease my stress D. I can buy whatever antacids are on sale because they all have the same effect

C (Increased vagel stimulation from emotional stress causes hypersecretion of HCl, and stress reduction is an important part of the patients management of peptic ulcers, especially to duodenal ulcers. If side effects to medications developed, the patient should notify the HCP. Before altering the drug regimen. Although effective treatment the permit pain relief in several days, the treatment regimen should be continued until there is evidence that the ulcer has healed completely. Interchanging brands and preparation of antacids and histamine blockers with out checking with HCP May cause harmful side effects, and patients should take only prescribed medications)

Older patients may have cardiac insufficiency and maybe more susceptible to problems from vomiting and anti-emetic drug side effects. What nursing intervention is most important to implement with these patients? A. Keep the patient flat in bed to decrease dizziness B. Keep the patient NPO until nausea and vomiting has stopped C. Do hourly visual checks or use a sitter to keep the patient safe D. Administer IV fluids as rapidly as possible to prevent dehydration

C. (implementing safety precautions is the priority. The patient would not be kept in a flat position because of the potential for aspiration. Keeping the patient NPO. would be done for all patients but is not the priority with this older patient. Because the older patient is more likely to have a cardiac or renal insufficiency, the patients fluid and electrolyte status on monitored more closely. Monitor vital signs along with breath sounds. Assess mucous membranes, skin turgor, and color to assess for the hydration. Assessed level of consciousness closely. Check dosing of anti-emetics. Assessed for weakness and fatigue)

Following a Billroth two procedure, a patient develops dumping syndrome. The nurse should explain that the symptoms associated with this problem are caused by: A. Distention of the smaller stomach by too much food and fluid intake B. Hyperglycemia caused by uncontrolled gastric emptying into the small intestine C. Irritation of the stomach lining by reflux of bile salts because the pylorus has been removed D. Movement of fluid into the small bowel from concentrated food and fluids moving rapidly into the intestine

D (Because there is no sphincter control Of food taken into the stomach following a build up to procedure, concentrated food and fluid moves rapidly into the small intestine, creating a hypertonic environment that Pulls fluid from the bowel wall into the lumen of the intestine, reducing plasma volume understanding the bowel. Postprandial hyperglycemia occurs when the concentrated carbohydrate Bolus in the small intestine results and hyperglycemia and the release of excessive amounts of insulin into the circulation, resulting in symptoms of hypoglycemia. Irritation of the stomach by bile salts causes epigastric distress after meal, not dumping syndrome.)

What is the rationale for treating acute exacerbation a peptic ulcer disease with NG intubation? A. Stop spillage of G.I. contents into the peritoneal cavity B. Remove excess fluids and undigested food from the stomach C. Feed the patient the nutrients missing from the lack of ingestion D. Remove stimulation for hydrochloric acid and pepsin secretion by keeping the stomach empty

D (NG tube is used with acute exacerbation a peptic ulcer disease to remove the stimulation for hydrochloric acid and pepsin secretion by keeping the stomach empty. Stopping the spillage a G.I. contents into the peritoneal cavity is used for peritonitis. Removing excess fluid and undigested food from the stomach is the rationale for using NG intubation for gastric outlet obstruction.)

What physiologically occurs with vomiting? A. The acid-base imbalance most commonly associated with persistent vomiting is metabolic acidosis caused by loss of bicarbonate B. Stimulation of the vomiting center by the chemoreceptor trigger zone is commonly caused by stress and distention of hollow organs. C. Vomiting requires the coordination of activities of structures including the glottis, respiratory expiration, relaxation of the pylorus, and closer at the lower is Esophageal sphincter. D. Immediately before the act of vomiting, activation of the parasympathetic nervous system causes increased salivation, increased gastric motility, and relaxation of the lower esophageal sphincter.

D (The parasympathetic nervous system causes increased salivation and gastric mobility as well as relaxation of the lower esophageal sphincter. The acid-base imbalance that occurs with Anna thing is metabolic alkalosis from the loss of HCl. The vomiting center in the chemoreceptor trigger zone can be caused by chemical stimuli of drugs, Toxins, and labyrinethine stimulation. Vomiting requires the coordination of closing the glottis, deep inspiration with contraction of the diaphragm in the inspiratory position, closure of the pylorus, relaxation of the stomach and lower esophageal sphincter, and contraction of abdominal muscles

When caring for a patient with an acute exacerbation of a peptic ulcer, the nurse finds the patient doubled up in bed with shallow, grunting respirations. Which action should the nurse first take? A.Irrigate the patient's NG tube B. Place the patient in High Fowler's C. Notify the healthcare provider D. Assess the patient's abdomen and vital signs

D (abdominal pain that causes the knees to be drawn up and shallow, grunting respiration in a patient with a peptic also disease are characteristics of perforation and the nurse should assess the patient's vital signs and abdomen before notifying the HCP. Irrigation of the NG tube should not be performed because the additional fluid may be spelled into the peritoneal cavity and the patient should be placed in a position of comfort, usually on the side with the head slightly elevated.)

Ondansetron is prescribed for a patient with cancer chemotherapy induced vomiting. What should the nurse understands about this drug? A. It is a derivative of cannabis and has a potential for abuse B. It has a strong anti-histamine effect that provide sedation and induces sleep C. It is used only with other therapies are any Factive because of side effects of anxiety and hallucinations. D. It relieves vomiting centrally by action in the vomiting center and preferably by promoting gastric emptying

D. (Ondansetron is one of several serotonin antagonist The act both centrally and peripherally to reduce vomiting. Centrally on the vomiting center in the brain stem. Preferably by promoting gastric emptying. Dronabinol (Marinol) is an orderly active cannabinoid that causes sedation and have a potential for abuse and it is used with other therapies are ineffective. Antihistamines used as antiemetics also cause sedation.)

A patient with esophageal cancer is scheduled for a partial Esophagectomy. Nursing intervention is likely to be of the highest priority preoperatively? A. Practice turning and deep breathing B. Brush the teeth and mouth well each day C. Teach about post operative tubes and care D. Encourage a high calorie high-protein diet

D. (eating a high calorie, high-protein diet, perhaps in liquid form, is the highest priority preoperatively. Because of dysphasia, the patient frequently has poor nutritional status because of the inability to ingest adequate amounts of food before surgery. And esophageal stent may be placed to improve the nutritional status. Turning and deep breathing will be done and the patient will need to know about post operative care, but these are not the pre-operative priorities. Meticulous all care is done but with swabs or gods pads super bad the injury and pain brushing may incur.