Adult 2- Upper GI Problems practice questions

What is an accurate description of eosinophilic esophagitis? a. Adenocarcinoma or squamous cell tumors of the esophagus b. Dilated veins in the esophagus caused by portal hypertension c. Inflammation of the esophagus from irritants or gastric reflux d. Swelling of the esophagus caused by an allergic response to food or environmental triggers

d. Swelling of the esophagus caused by an allergic response to food or environmental triggers Rationale: Eosinophilic esophagitis is swelling of the esophagus caused by infiltration of eosinophils in response to food triggers or environmental allergens. Esophageal cancer is usually caused by adenocarcinoma. The rest are squamous cell tumors. Esophageal varices are dilated veins in the esophagus caused by portal hypertension. Esophagitis is inflammation of the esophagus commonly seen with GERD.

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 need to lie down for 30 to 60 minutes after my meals"

a. "I should eat bread and jam with every meal." Rationale: Dietary control of dumping syndrome includes 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 delay stomach emptying, preventing the rapid movement of a high-carbohydrate food bolus into the small intestine

Which instructions would the nurse include in a teaching plan for a patient with mild gastroesophageal reflux disease (GERD)? a. "The best time to take an as-needed antacid is 1 to 3 hours after meals." b. "A glass of warm milk at bedtime will decrease your discomfort at night." c. "Do not chew gum; the excess saliva will cause you to secrete more acid." d. "Limit your intake of foods high in protein because they take longer to digest."

a. "The best time to take an as-needed antacid is 1 to 3 hours after meals." Rationale: Patients who use an as-needed antacid should do so 1 to 3 hours after eating. Teach patients that the increased saliva production associated with chewing gum will help with GERD symptoms. The patient should not eat meals within 3 hours of bedtime. Some foods, such as red wine, decrease lower esophageal sphincter pressure and aggravate symptoms. Milk increases gastric acid secretion. There is no need for the patient to limit protein intake.

Match the descriptions with the following surgical procedures used to treat peptic ulcer disease. a. often done after vagotomy to increase gastric emptying b. severing of a parasympathetic nerve to decrease gastric secretion c. removal of distal two-thirds of stomach with anastomosis to jejunum d. removal of distal two-thirds of stomach with anastomosis to duodenum 1. Billroth I 2. Billroth II 3. Pyloroplasty 4. Vagotomy

a. 3- pyloroplasty b. 4- vagotomy c. 2- Billroth II d. 1- Billroth I

Which patient is at highest risk for having a gastric ulcer? a. 55-year-old female, smoker, with nausea and vomiting b. 45-year-old female admitted for illicit drug detoxification c. 37-year-old male, smoker, who fell while looking for a job d. 27-year old male who is being divorced and has back pain

a. 55-year-old female, smoker, with nausea and vomiting Rationale: The 55-year-old female smoker experiencing nausea and vomiting is more likely to have a gastric ulcer. The other patients are not in the highest-risk age range or do not have enough risk factors. Although lower socioeconomic status, smoking, and drug use increase the risk of gastric ulcers, these patients are more likely to have duodenal ulcers but further assessment is needed.

Regardless of the precipitating factor, what causes the injury to mucosal cells in peptic ulcers? a. Acid back diffusion into the mucosa b. The release of histamine from GI cells c. Ammonia formation in the mucosal wall d. Breakdown of the gastric mucosal barrier

a. Acid back diffusion into the mucosa Rationale: The ultimate damage to the tissues of the stomach and duodenum, precipitating ulceration, is acid back diffusion into the mucosa. The gastric mucosal barrier is protective of the mucosa but without the acid environment and damage, ulceration does not occur. Ammonia formation by H. pylori and release of histamine impair the barrier but are not directly responsible for tissue injury.

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. Autoimmune metaplastic atrophic gastritis

a. Acute gastritis Rationale: Acute gastritis is most likely to occur with an isolated drinking binge. Chronic gastritis is usually caused by Helicobacter pylori or viral and fungal infections. Autoimmune gastritis is an inherited condition.

The nurse is planning to teach the patient with gastroesophageal reflux disease (GERD) about foods or beverages that decrease lower esophageal sphincter (LES) pressure. What should be included in this list (select all that apply)? a. Alcohol b. Root beer c. Chocolate d. Citrus fruits e. Fatty foods f. Cola sodas

a. Alcohol c. Chocolate e. Fatty foods f. Cola sodas Rationale: Alcohol, chocolate, fatty foods, and cola sodas (caffeine) as well as peppermint and spearmint will decrease LES pressure. Root beer and herbal tea do not have caffeine. Citrus fruits will not affect LES pressure.

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 best action by the nurse? a. Check 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. Check the patency of the NG tube. Rationale: If symptoms of gastric outlet obstruction, such as nausea, vomiting, and stomach distension, occur while the patient is on NPO status or has an NG tube, the patency of the NG tube should first be assessed. A recumbent 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 or perforation is suspected. Deep breathing and relaxation may help some patients with nausea, but not when stomach contents are obstructed from flowing into the small intestine.

The nurse is planning to teach a client with gastroesophageal reflux disease (GERD) about substances to avoid. Which items should the nurse include on this list? Select all that apply. a. Coffee b. Chocolate c. Peppermint d. Nonfat milk e. Fried chicken f. Scrambled eggs

a. Coffee b. Chocolate c. Peppermint e. Fried chicken Rationale: Foods that decrease lower esophageal sphincter (LES) pressure and irritate the esophagus will increase reflux and exacerbate the symptoms of GERD and therefore should be avoided. Aggravating substances include coffee, chocolate, peppermint, fried or fatty foods, carbonated beverages, and alcohol. Options d and f do not promote this effect.

Which medications are used to decrease gastric or hydrochloric acid secretion (select all that apply)? a. Famotidine (Pepcid) b. Sucralfate (Carafate) c. Omeprazole (Prilosec) d. Misoprostol (Cytotec) e. Bethanechol (Urecholine)

a. Famotidine (Pepcid) c. Omeprazole (Prilosec) d. Misoprostol (Cytotec) Rationale: Famotidine (Pepcid) reduces HCl secretion by blocking histamine and omeprazole (Prilosec) decreases gastric acid secretion by blocking adenosine triphosphate (ATPase) enzyme. Misoprostol (Cytotec) has antisecretory effects. Sucralfate (Carafate) coats the ulcer to protect it from acid erosion. Bethanechol (Urecholine) for GERD increases LES pressure and facilitates gastric emptying.

What are characteristics of gingivitis? a. Formation of abscesses with loosening of teeth b. Caused by upper respiratory tract viral infection c. Shallow, painful vesicular ulcerations of lips and mouth d. Infectious ulcers of mouth and lips as a result of systemic disease

a. Formation of abscesses with loosening of teeth Rationale: When gingivitis is untreated, abscesses form, and teeth are loosened with periodontitis. Herpes simplex is a viral infection related to the upper respiratory system and has shallow, painful vesicular ulceration of lips and mouth. Aphthous stomatitis has infectious ulcers of the mouth and lips with a defined erythematous base occurring because of systemic disease.

A client with hiatal hernia chronically experiences heartburn following meals. The nurse should plan to teach the client to avoid which action because it is contraindicated with a hiatal hernia? a. Lying recumbent following meals b. Consuming small, frequent, bland meals c. Taking H2-receptor antagonist medication d. Raising the head of the bed on 6-inch (15 cm) blocks

a. Lying recumbent following meals Rationale: Hiatal hernia is caused by a protrusion of a portion of the stomach above the diaphragm where the esophagus usually is positioned. The client usually experiences pain from reflux caused by ingestion of irritating foods, lying flat following meals or at night, and eating large or fatty meals. Relief is obtained with the intake of small, frequent, and bland meals; use of H2-receptor antagonists and antacids; and elevation of the thorax following meals and during sleep.

What type of bleeding will a patient with peptic ulcer disease with a slow upper GI source of bleeding have? a. Melena b. Occult blood c. Coffee-ground emesis d. Profuse bright-red hematemesis

a. Melena Rationale: Melena is black, tarry stools from slow bleeding from an upper GI source when blood passes through the GI tract and is digested. Occult blood is the presence of guaiac-positive stools or gastric aspirate. Coffee-ground emesis is blood that has been in the stomach for some time and has reacted with gastric secretions. Profuse bright-red hematemesis is arterial blood that has not been in contact with gastric secretions, as in esophageal or oral bleeding.

Duodenal and gastric ulcers have similar as well as differentiating features. What are characteristics unique to duodenal ulcers (select all that apply)? a. Pain is relieved with eating food. b. They have a high recurrence rate. c. Increased gastric secretion occurs. d. Associated with Helicobacter pylori infection. e. Hemorrhage, perforation, and obstruction may result. f. There is burning and cramping in the midepigastric area.

a. Pain is relieved with eating food. c. Increased gastric secretion occurs. f. There is burning and cramping in the midepigastric area. Rationale: Duodenal ulcers have increased HCl gastric secretion, which causes the burning and cramping in the midepigastric area; the pain is relieved with food. The other options occur with both duodenal and gastric ulcers.

The nurse is monitoring a client for the early signs and symptoms of dumping syndrome. Which findings indicate this occurrence? a. Sweating and pallor b. Bradycardia and indigestion c. Double vision and chest pain d. Abdominal cramping and pain

a. Sweating and pallor Rationale: Early manifestations of dumping syndrome occur 5 to 30 minutes after eating. Symptoms include vertigo, tachycardia, syncope, sweating, pallor, palpitations, and the desire to lie down.

A patient treated for vomiting is to begin oral intake when the symptoms have subsided. To promote rehydration, the nurse plans to administer which fluid first? a. Water b. Hot tea c. Gatorade d. Warm broth

a. Water Rationale: 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.

What type of pain does the nurse expect a patient with an ulcer of the posterior portion of the duodenum to experience? a. Pain that occurs after not eating all day b. Back pain that occurs 2 to 4 hours following meals c. Midepigastric pain that is unrelieved with antacids d. High epigastric burning that is relieved with food intake

b. Back pain that occurs 2 to 4 hours following meals Rationale:

Which esophageal disorder is described as a precancerous lesion associated with GERD? a. Achalasia b. Barrett's esophagus c. Esophageal strictures d. Esophageal diverticula

b. Barrett's esophagus Rationale: Barrett's esophagus is an esophageal metaplasia primarily related to GERD. Achalasia is a rare chronic disorder with delayed emptying of the lower esophagus and is associated with squamous cell cancer. Esophageal strictures are narrowing of the esophagus from scarring by many causes. Esophageal diverticula are saclike outpouchings of 1 or more layers of the esophagus. They often occur above the esophageal sphincter.

A patient with oral cancer has a history of heavy smoking, excessive alcohol intake, and personal neglect. During the patient's early postoperative course, what does the nurse anticipate that the patient may need? a. Oral nutritional supplements b. Drug therapy to prevent substance withdrawal symptoms c. Counseling about lifestyle changes to prevent recurrence of the tumor d. Less pain medication because of cross-tolerance with central nervous system (CNS) depressants

b. Drug therapy to prevent substance withdrawal symptoms Rationale: Measures to assess and treat withdrawal from alcohol should be implemented with patients who have heavy use of alcohol because alcohol withdrawal can be life threatening. Tobacco withdrawal may also be uncomfortable for the patient. Nutritional needs may have to be addressed with tube feedings postoperatively, and pain medications may have to be increased because of cross-tolerance. Counseling about lifestyle changes is not a priority in the early postoperative course.

A large number of children at a public school have developed profuse diarrhea and bloody stools. The school nurse suspects food poisoning related to food from the school cafeteria and requests analysis and culture of which food? a. Milk b. Ground beef c. Commercially canned fish d. Salads with mayonnaise dressing e. Chicken

b. Ground beef Rationale: Food poisoning caused by E. coli O147:H7 is characterized by profuse diarrhea, abdominal cramping, and bloody stools and is most often associated with undercooked, contaminated ground beef. Salmonella contamination most often occurs with poultry, staphylococcal infections occur with milk and salad dressings, and botulism occurs with fish and low-acid canned products.

A patient who has been vomiting for several days from an unknown cause is admitted to the hospital. What should the nurse anticipate will be included in collaborative care? a. Oral administration of broth and tea b. IV replacement of fluid and electrolytes c. Administration of parenteral antiemetics d. Insertion of a nasogastric (NG) tube for suction

b. IV replacement of fluid and electrolytes Rationale: The patient with sever or persistent vomiting requires IV replacement of fluids and electrolytes until able to tolerate oral intake to prevent serious dehydration and electrolyte imbalances. Oral fluids are not given until vomiting has been relieved and parenteral antiemetics are often not used until a cause of the vomiting can be established. NG intubation may be needed in some cases, but fluid and electrolyte replacement are the first priority.

A patient with cancer of the stomach at the lesser curvature undergoes a total gastrectomy with an esophagojejunostomy. Postoperatively, what should the nurse teach the patient to expect? a. Rapid healing of the surgical wound 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. Lifelong administration of cobalamin Rationale: A total gastrectomy removed 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 needs diet modifications because of dumping syndrome and postprandial hypoglycemia. Peptic ulcers are not a common finding after total gastrectomy.

Following a patient's esophagogastrostomy for cancer of the esophagus, what is most important for the nurse to do? a. Report any bloody drainage from the NG tube. b. Maintain the patient in semi-Fowler's or Fowler's position. c. Monitor for abdominal distention that may disrupt the surgical site. d. Expect to find decreased breath sounds bilaterally because of the surgical approach.

b. Maintain the patient in semi-Fowler's or Fowler's position. Rationale: Following esophageal surgery, the patient should be positioned in semi-Fowler's or Fowler's position to prevent reflux and aspiration of gastric secretions. NG drainage is expected to be bloody for 8 to 12 hours postoperatively. Abdominal distention is not a major concern following esophageal surgery, and even though the thorax may be opened during the surgery, clear breath sounds should be expected in all areas of the lungs.

Which statements describe the uses of antacids for peptic ulcer disease (select all that apply)? a. Used in patients with verified H. pylori b. Neutralize HCl in the stomach c. Produce quick, short-lived relief of heartburn d. Cover the ulcer, protecting it from erosion by acids e. High incidence of side effects and contraindications f. May be given hourly after an acute phase of GI bleeding g. Prevent conversion of pepsinogen to pepsin

b. Neutralize HCl in the stomach c. Produce quick, short-lived relief of heartburn f. May be given hourly after an acute phase of GI bleeding g. Prevent conversion of pepsinogen to pepsin Rationale: Antacids provide a quick, short-lived relief of heartburn by neutralizing HCl in the stomach that prevents the conversion of pepsinogen to pepsin. Antacids may be given hourly, orally or through an NG tube, after an acute phase of GI bleeding to neutralize HCl in the stomach. Amoxicillin/clarithromycin/omeprazole are used in patients with verified H. pylori. Sucralfate (Carafate) covers the ulcer to protect it from acid erosion. The side effects are manageable.

When caring for a patient following a glossectomy with dissection of the floor of the mouth and a radical neck dissection for cancer of the tongue, what is the nurse's primary concern? a. Relief of pain b. Patent airway c. Positive body image d. Tube feedings to provide nutrition

b. Patent airway Rationale: Because surgical treatment of oral cancers involves extensive excision, a tracheostomy is usually performed with the radical dissections. The first goal of care is that the patient will have a patent airway. The other goals are appropriate but of lesser priority.

A patient is admitted to the emergency department with profuse bright-red hematemesis. During the initial care of the patient, what is the nurse's first priority? a. Establish 2 IV sites with large-gauge catheters b. Perform a focused nursing assessment of the patient's status c. Obtain a thorough health history to assist in determining the cause of the bleeding d. Perform a gastric lavage with cool tap water in preparation for endoscopic examination

b. Perform a focused nursing assessment of the patient's status Rationale: Although all the interventions may be indicated when a patient has upper GI bleeding, the first nursing priority with bright-red (arterial) blood is to perform a focused assessment of the patient's condition, with emphasis on BP, pulse, and peripheral perfusion to determine the presence of hypovolemic shock.

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 Rationale: Stomatitis is inflammation of the mouth related to systemic diseases and cancer chemotherapy medications. There is excessive salivation, halitosis, and a sore mouth. *Parotitis is a Staphylococcus infection that may occur with prolonged NPO status and results in decreased saliva and ear pain. *Oral candidiasis is seen with prolonged antibiotic or corticosteroid therapy; it has white membranous lesions on the mucosa of the mouth and larynx. *Vincent's infection is a bacterial infection predisposed to by fatigue, stress, and poor oral hygiene. There are painful, bleeding gums and increased metallic-tasting saliva

What should the nurse emphasize when teaching patients at risk for upper GI bleeding to prevent bleeding episodes? a. All stools and vomitus must be tested for the presence of blood. b. The use of over-the-counter (OTC) medications of any kind should be avoided. c. Antacids should be taken with all prescribed medications to prevent gastric irritation. d. Misoprostol (Cytotec) should be used to protect the gastric mucosa in individuals with peptic ulcers.

b. The use of over-the-counter (OTC) medications of any kind should be avoided. Rationale: All OTC drugs should be avoided because their contents may include drugs that are contraindicated because of the irritating effects on the gastric mucosa. Patients are taught to test suspicious vomitus or stools for occult blood, but all stools 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 who must take low-dose aspirin are prescribed misoprostol to protect the gastric mucosa.

M.J. calls the clinic and tells the nurse that her 85-year-old mother has been nauseated all day and has vomited twice. Before the nurse hangs up and calls the HCP, she should tell M.J. to a. administer antiemetic drugs and observe skin turgor. b. give her mother sips of water and elevate the head of her bed to prevent aspiration. c. offer her mother a high-protein liquid supplement to drink to maintain her nutritional needs. d. offer her mother large quantities of Gatorade to decrease the risk of sodium depletion.

b. give her mother sips of water and elevate the head of her bed to prevent aspiration. Rationale: Excessive replacement of fluid and electrolytes may result in adverse consequences for an older person who has heart failure or renal disease. An older adult with a decreased level of consciousness may be at high risk for aspiration of vomitus. The elderly are particularly susceptible to the central nervous system (CNS) side effects of antiemetic drugs; these drugs may produce confusion. Dosages should be reduced and efficacy closely evaluated. Older patients are more likely to have cardiac or renal insufficiency, which increases their risk for life-threatening fluid and electrolyte imbalances. High-protein drinks and high-sodium liquids may be contraindicated.

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 nonirritating diet with six small meals a day. c. eliminate alcohol and caffeine from the diet when symptoms occur. d. use nonsteroidal antiinflammatory drugs (NSAIDs) instead of aspirin for minor pain relief.

b. maintain a nonirritating diet with six small meals a day. Rationale: A nonirritating diet with 6 small meals a day is recommended to help control the symptoms of gastritis. Antacids are often used for control of symptoms but have the best neutralizing effect if taken after meals. Alcohol and caffeine should be eliminated entirely because they may precipitate gastritis. NSAIDS are often as irritating to the stomach as aspirin and should not be used in the patient with gastritis.

Several patients are seen at an urgent care center with symptoms of nausea, vomiting, and diarrhea that began 2 hours ago while attending a large family reunion potluck dinner. You question the patients specifically about foods they ingested containing a. beef. b. meat and milk. c. poultry and eggs. d. home-preserved vegetables.

b. meat and milk. Rationale: Staphylococcus aureus toxins provoke onset of symptoms (vomiting, nausea, abdominal cramping, and diarrhea) within 30 minutes up to 7 hours. Meat, bakery products, cream fillings, salad dressings, and milk are the usual sources of these toxins from the skin and respiratory tract of food handlers.

The nurse determines that teaching for the patient with peptic ulcer 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. "I have learned some relaxation strategies that decrease my stress." Rationale: Increased vagal stimulation from emotional stress causes hypersecretion of HCl, and stress reduction is an important part of the patient's management of peptic ulcers, especially duodenal ulcers. If side effects to medications develop, the patient should notify the HCP before altering the drug regimen. Although effective treatment will promote pain relief in several days, the treatment regimen should be continued until there is evidence that the ulcer has healed completely. Interchanging brands and preparations of antacids and histamine (H2)-receptor blockers without checking with HCPs may cause harmful side effects, and patients should take only prescribed medications.

Older patients may have cardiac or renal insufficiency and may be more susceptible to problems from vomiting and antiemetic 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. Do hourly visual checks or use a sitter to keep the patient safe. Rationale: Implementing safety precautions (placement close to the nurses' station, call bell in reach, hourly visual checks) is the priority. The patient would not be kept in a flat position because of the potential for aspiration of vomitus. 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 cardiac or renal insufficiency, the patient's fluid and electrolyte status are monitored more closely (laboratory, intake and output). Monitor vital signs along with breath sounds. Assess mucous membranes, skin turgor, and color to assess for dehydration. Assess LOC closely. Check dosing of antiemetics. Assess for weakness and fatigue.

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. Eat as normally as possible, eliminating foods that cause pain or discomfort. Rationale: There is no specific diet used for the treatment of peptic ulcers, and patient are encouraged to eat as normally as possible, eliminating foods that cause discomfort or pain. Eating 6 meals a day prevents the stomach from being totally empty and is recommended. Caffeine and alcohol should be eliminated from the diet because they are known to cause gastric irritation. Milk and milk products do not have to be avoided but they can add fat content to the diet.

A patient with esophageal cancer is scheduled for a partial esophagectomy. Which nursing intervention is likely to be of highest priority preoperatively? a. Practice turning and deep breathing. b. Brush the teeth and mouth well each day. c. Encourage a high-calorie, high-protein diet. d. Teach about postoperative tubes and cares.

c. Encourage a high-calorie, high-protein diet. Rationale: Eating a high-calorie, high-protein diet, perhaps in liquid form, is the highest priority preoperatively. Because of dysphagia, the patient often has poor nutritional status because of the inability to ingest adequate amount of food before surgery. An esophageal stent may be placed to improve the nutritional status. Turning and deep breathing will be done. The patient will need to know about postoperative care, but these are not the preoperative priorities. Meticulous oral care is done but with swabs or gauze pads to prevent the injury and pain brushing may incur.

The nurse is caring for a client following a gastrojejunostomy (Billroth II procedure). Which postoperative prescription should the nurse question and verify? a. Leg exercises b. Early ambulation c. Irrigating the nasogastric tube d. Coughing and deep-breathing exercises

c. Irrigating the nasogastric tube Rationale: In a gastrojejunostomy (Billroth II procedure), the proximal remnant of the stomach is anastomosed to the proximal jejunum. Patency of the nasogastric tube is critical for preventing the retention of gastric secretions. The nurse should never irrigate or reposition the gastric tube after gastric surgery, unless specifically prescribed by the primary health care provider. In this situation, the nurse should clarify the prescription. Options a, b, and d are appropriate postoperative interventions.

The nurse is providing discharge instructions to a client following gastrectomy and should instruct the client to take which measure to assist in preventing dumping syndrome? a. Ambulate following a meal. b. Eat high-carbohydrate foods. c. Limit the fluids taken with meals. d. Sit in a high-Fowler's position during meals.

c. Limit the fluids taken with meals. Rationale: Dumping syndrome is a term that refers to a constellation of vasomotor symptoms that occurs after eating, especially following a gastrojejunostomy (Billroth II procedure). Early manifestations usually occur within 30 minutes of eating and include vertigo, tachycardia, syncope, sweating, pallor, palpitations, and the desire to lie down. The nurse should instruct the client to decrease the amount of fluid taken at meals and to avoid high-carbohydrate foods, including fluids such as fruit nectars; to assume a low-Fowler's position during meals; to lie down for 30 minutes after eating to delay gastric emptying; and to take antispasmodics as prescribed.

The nurse is doing an admission assessment on a client with a history of duodenal ulcer. To determine whether the problem is currently active, the nurse should assess the client for which manifestation of duodenal ulcer? a. Weight loss b. Nausea and vomiting c. Pain relieved by food intake d. Pain radiating down the right arm

c. Pain relieved by food intake Rationale: A frequent symptom of duodenal ulcer is pain that is relieved by food intake. These clients generally describe the pain as a burning, heavy, sharp, or "hungry" pain that often localizes in the midepigastric area. The client with duodenal ulcer usually does not experience weight loss or nausea and vomiting. These symptoms are more typical in the client with a gastric ulcer.

How should the nurse teach the patient with a hiatal hernia or GERD to control symptoms? a. Drink 10 to 12 oz 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- to 6-inch blocks d. Perform daily exercises of toe-touching, sit-ups, and weight lifting.

c. Sleep with the head of the bed elevated on 4- to 6-inch blocks Rationale: The use of blocks to elevate the HOB facilitates gastric emptying by gravity and is strongly recommended to prevent nighttime reflux. Liquids should be taken between meals to prevent gastric distention with meals. Small meals should be eaten frequently, but patients should not eat at bedtime or lie down for 2 to 3 hours after eating. Activities that involve increasing intraabdominal pressure, such as bending over, lifting, or wearing tight clothing, should be avoided.

The nurse is monitoring a client with a diagnosis of peptic ulcer. Which assessment finding would most likely indicate perforation of the ulcer? a. Bradycardia b. Numbness in the legs c. Nausea and vomiting d. A rigid, board-like abdomen

d. A rigid, board-like abdomen Rationale: Perforation of an ulcer is a surgical emergency and is characterized by sudden, sharp, intolerable severe pain beginning in the midepigastric area and spreading over the abdomen, which becomes rigid and boardlike. Nausea and vomiting may occur. Tachycardia may occur as hypovolemic shock develops. Numbness in the legs is not an associated finding.

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

c. Sudden, severe generalized abdominal pain and back pain Rationale: Perforation of an ulcer causes sudden, severe abdominal pain that becomes generalized and may be referred to the back, accompanied by a rigid, boardlike abdomen, shallow respirations, and a weak rapid heart rate. Vomiting of blood indicates hemorrhage of an ulcer. Gastric outlet obstruction is characterized by projectile vomiting of undigested food, hyperactive stomach sounds, and upper abdominal swelling.

Corticosteroid medications are associated with the development of peptic ulcers because of which probable pathophysiologic mechanism? a. The enzyme urease is produced. b. Secretion of hydrochloric acid is increased. c. The rate of mucous cell renewal is decreased. d. The synthesis of mucus and prostaglandins is inhibited.

c. The rate of mucous cell renewal is decreased. Rationale: Corticosteroids decrease the rate of mucous cell renewal. H. pylori produces the enzyme urease. Alcohol ingestion increases the secretion of HCl. Aspirin and NSAIDs inhibit the synthesis of mucus and prostaglandins

A patient is scheduled for biopsy of a painful tongue ulcer. Based on knowledge of risk factors for oral cancer, what should the nurse specifically ask the patient about during a history? a. Excessive exposure to sunlight b. Recurrent herpes simplex infections c. Use of any type of tobacco products d. Difficulty swallowing and pain in the ear

c. Use of any type of tobacco products Rationale: A positive history of use of tobacco and alcohol is the most significant etiologic factor in oral cancer. Excessive exposure to UV rays from the sun is a factor in the development of cancer of the lip. Herpes simplex infections have not been associated with oral cancer. Difficulty swallowing and ear pain are symptoms of advanced oral cancer, not risk factors.

The pernicious anemia that may accompany gastritis is due to a. chronic autoimmune destruction of cobalamin stores in the body. b. progressive gastric atrophy from chronic breakage in the mucosal barrier and blood loss. c. a lack of intrinsic factor normally produced by acid-secreting cells of the gastric mucosa. d. hyperchlorhydria from an increase in acid-secreting cells of the gastric mucosa.

c. a lack of intrinsic factor normally produced by acid-secreting cells of the gastric mucosa. Rationale: Gastritis may cause a loss of parietal cells as a result of atrophy. The source of intrinsic factor is also lost; the loss of intrinsic factor, a substance essential for the absorption of cobalamin in the terminal ileum, ultimately results in cobalamin deficiency. With time, the body's storage of cobalamin is depleted, and a deficiency state exists. Because cobalamin is essential for the growth and maturation of red blood cells, the lack of cobalamin results in pernicious anemia and neurologic complications.

The teaching plan for the patient being discharged after an acute episode of upper GI bleeding includes information concerning the importance of (select all that apply) a. limiting alcohol intake to one serving per day. b. only taking aspirin with milk or bread products. c. avoiding taking aspirin and drugs containing aspirin. d. only taking only drugs prescribed by the health care provider e. taking all drugs 1 hour before mealtime to prevent further bleeding

c. avoiding taking aspirin and drugs containing aspirin. d. only taking only drugs prescribed by the health care provider Rationale: Before discharge, the patient with upper gastrointestinal (GI) bleeding and the caregiver should be taught how to avoid future bleeding episodes. Ulcer disease and drug or alcohol abuse can cause upper GI bleeding. Help make the patient and caregiver aware of the consequences of noncompliance with drug therapy. Emphasize that no drugs (especially aspirin and nonsteroidal antiinflammatory drugs [NSAIDs]) other than those prescribed by the HCP should be taken. Alcohol should be eliminated because it is a source of irritation and interfere with tissue repair.

The nurse teaching young adults about behaviors that put them at risk for oral cancer includes a. discouraging use of chewing gum. b. avoiding use of perfumed lip glass. c. avoiding use of smokeless tobacco. d. discouraging drinking of carbonated beverages.

c. avoiding use of smokeless tobacco. Rationale: Oral cancer has several predisposing risks factors: • Lip: constant overexposure to sun, ruddy and fair complexion, recurrent herpetic lesions, irritation from pipe stem, syphilis, and immunosuppression • Tongue: tobacco, alcohol, chronic irritation, and syphilis • Oral cavity: poor oral hygiene, tobacco use (e.g., pipe and cigar smoking, snuff, chewing tobacco), chronic alcohol intake, chronic irritation (e.g., jagged tooth, ill-fitting prosthesis, chemical or mechanical irritants, and human papillomavirus [HPV] infection)

A patient who has undergone an esophagectomy for esophageal cancer develops increasing pain, fever, dyspnea when a full liquid diet is started postoperatively. The nurse recognizes that these symptoms are most indicative of a. an intolerance to the feedings. b. extension of the tumor into the aorta. c. leakage of fluids into the mediastinum. d. esophageal perforation with fistula formation into the lung.

c. leakage of fluids into the mediastinum. Rationale: After esophageal surgery, the nurse should observe the patient for signs of leakage into the mediastinum. Symptoms that indicate leakage are pain, increased temperature, and dyspnea.

Which laboratory findings should the nurse expect in the patient with persistent vomiting? a. ↓ pH, ↑ sodium, ↓ hematocrit b. ↑ pH, ↓ chloride, ↓ hematocrit c. ↑ pH, ↓ potassium, ↑ hematocrit d. ↓ pH, ↓ potassium, ↑ hematocrit

c. ↑ pH, ↓ potassium, ↑ hematocrit Rationale: The loss of gastric HCl causes metabolic alkalosis and an increase in pH; loss of potassium, sodium and chloride; and loss of fluid, which increases the hematocrit

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 take first? a. Irrigate the patient's NG tube. b. Notify the health care provider. c. Place the patient in high-Fowler's position. d. Assess the patient's abdomen and vital signs.

d. Assess the patient's abdomen and vital signs. Rationale: Abdominal pain that causes the knees to be drawn up and shallow, grunting respirations in a patient with peptic ulcer disease are characteristic 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 done because the added fluid may be spilled into the peritoneal cavity and the patient should be placed in a position of comfort, usually on the side with the head slightly elevated.

The nurse evaluates that management of the patient with upper GI bleeding is effective when assessment and laboratory findings reveal which result? a. Hematocrit (Hct) of 35% b. Urinary output of 20 mL/hr c. Urine specific gravity of 1.030 d. Decreasing blood urea nitrogen (BUN)

d. Decreasing blood urea nitrogen (BUN) Rationale: The patient's blood urea nitrogen (BUN is usually elevated with a significant hemorrhage because blood proteins are subjected to bacterial breakdown in the GI tract. With control of bleeding, the BUN will return to normal. During the early stage of bleeding, the hematocrit is not always a reliable indicator of the amount of blood lost or the amount of blood replaced and may be falsely high or low. A urinary output of less than or equal to 20 mL/hr indicates impaired renal perfusion and hypovolemia and a urine specific gravity of 1.030 indicates concentrated urine typical of hypovolemia.

A patient with upper GI bleeding is treated with several drugs. Which drug should the nurse recognize as an agent that is used to decrease bleeding and decrease gastric acid secretions? a. Oral nizatidine (Axid) b. Epinephrine injection c. Vasopressin (Pitressin) injection d. IV esomeprazole (Nexium)

d. IV esomeprazole (Nexium) Rationale: IV esomeprazole (Nexium) is a proton pump inhibitor (PPI) that is used to decrease acid secretion and prevent interference with clotting as a bolus before endoscopy and then a continuous infusion. *Nizatidine is a histamine (H2)-receptor blocker that decreases acid secretion but is not as effective as PPIs. *Epinephrine injection during endoscopy is effective for acute hemostasis. *Vasopressin has a vasoconstriction action useful in controlling upper GI bleeding but does not facilitate clotting.

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 (CTZ) is commonly caused by stretch and distention of hollow organs. c. Vomiting requires the coordination of activities of structures including the glottis, respiratory expiration, relaxation of the pylorus, and closure of the lower 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. 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. Rationale: The PNS causes increased salivation and gastric mobility as well as relaxation of the LES. The acid-base imbalance that occurs with vomiting is metabolic alkalosis from the loss of HCl. The vomiting center in the CTZ can be caused by chemical stimuli of drugs, toxins, and labyrinthine 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 LES, and contraction of abdominal muscles.

Ondansetron (Zofran) is prescribed for a patient with cancer chemotherapy-induced vomiting. What should the nurse understand about this drug? a. It is a derivative of cannabis and has a potential for abuse. b. It has a strong antihistamine effect that provides sedation and induces sleep. c. It is used only when other therapies are ineffective because of side effects of anxiety and hallucinations. d. It relieves vomiting centrally by action in the vomiting center and peripherally by promoting gastric emptying.

d. It relieves vomiting centrally by action in the vomiting center and peripherally by promoting gastric emptying. Rationale: Ondansetron (Zofran) is one of several serotonin antagonist that act both centrally and peripherally to reduce vomiting: centrally on the vomiting center in the brainstem and peripherally by promoting gastric emptying. Dronabinol (Marinol) is an orally active cannabinoid that causes sedation and has a potential for abuse and it is used when other therapies are ineffective. Antihistamines used as antiemetics also cause sedation.

While caring for a patient following a subtotal gastrectomy with a gastroduodenostomy anastomosis, the nurse determines that the NG tube is obstructed. Which action should the nurse take first? a. Replace the tube with a new one. b. Irrigate the tube until return can be aspirated. c. Reposition the tube and then attempt irrigation. d. Notify the surgeon to reposition or replace the tube.

d. Notify the surgeon to reposition or replace the tube. Rationale: If the patient's NG tube becomes obstructed following a gastrectomy with an intestinal anastomosis, gastric secretions may put a strain on the sutured anastomosis and cause serious complications. Be sure that the suction is working and because of the danger of perforating the gastric mucosa or disrupting the suture line, the nurse should notify the surgeon. Periodic gentle irrigation with normal saline solution may be ordered or the surgeon may choose to reposition or replace the NG tube.

What is the rationale for treating acute exacerbation of peptic ulcer disease with NG intubation? a. Stop spillage of GI 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. Remove stimulation for hydrochloric acid and pepsin secretion by keeping the stomach empty Rationale: NG intubation is used with acute exacerbation of peptic ulcer disease (PUD) to remove the stimulation for HCl and pepsin secretion by keeping the stomach empty. Stopping the spillage of GI contents into the peritoneal cavity is used for peritonitis. Removing excess fluids and undigested food from the stomach is the rationale for using NG intubation for gastric outlet obstruction.

Following a Billroth II 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. movement of fluid into the small bowel because concentrated food and fluids move rapidly into the intestine. Rationale: Because there is no sphincter control of food taken into the stomach following a Billroth II procedure, concentrated food and fluid move 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 and distending the bowel. Postprandial hypoglycemia occurs when the concentrated carbohydrate bolus in the small intestine results in 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 meals, not dumping syndrome.

The nurse is teaching the patient and family that peptic ulcers are a. caused by a stressful lifestyle and other acid-producing factors such as H. pylori. b. inherited within families and reinforced by bacterial spread of Staphylococcus aureus in childhood. c. promoted by factors that tend to cause oversecretion of acid, such as excess dietary fats, smoking and H. pylori. d. promoted by a combination of factors that may result in erosion of the gastric mucosa, including certain drugs and alcohol.

d. promoted by a combination of factors that may result in erosion of the gastric mucosa, including certain drugs and alcohol. Rationale: Peptic ulcers develop only in the presence of an acidic environment. However, an excess of hydrochloric acid (HCl) may not be necessary for ulcer development. The back diffusion of HCl into the gastric mucosa results in cellular destruction and inflammation. Histamine is released from the damaged mucosa, which results in vasodilation and increased capillary permeability and further secretion of acid and pepsin. A variety of agents (certain infections, medications, and lifestyle factors) can damage the mucosal barrier. Helicobacter pylori can alter gastric secretion and produce tissue damage, which leads to peptic ulcer disease. Ulcerogenic drugs, such as aspirin and NSAIDs, inhibit synthesis of prostaglandins, increase gastric acid secretion, and reduce the integrity of the mucosal barrier. Patients taking corticosteroids, anticoagulants, and selective serotonin reuptake inhibitors are at increased risk for ulcers. High alcohol intake stimulates acid secretion and is associated with acute mucosal lesions. Coffee (caffeinated and uncaffeinated) is a strong stimulant of gastric acid secretion.

The nurse explains to the patient with Vincent's infection that treatment will include a. tetanus vaccinations. b. viscous lidocaine rinses. c. amphotericin B suspension. d. topical application of antibiotics.

d. topical application of antibiotics. Rationale: Vincent's infection is treated with topical applications of antibiotics. Other treatments include rest (physical and mental); avoidance of tobacco and alcoholic beverages; soft, nutritious diet; correct oral hygiene habits; and mouth irrigations with hydrogen peroxide and saline solutions.

An optimal teaching plan for an outpatient with stomach cancer receiving radiation therapy should include information about a. cancer support groups, alopecia, and stomatitis. b. nutrition supplements, ostomy care, and support groups. c. prosthetic devices, wound and skin care, and grief counseling. d. wound and skin care, nutrition, drugs, and community resources.

d. wound and skin care, nutrition, drugs, and community resources. Rationale: Radiation therapy is used as an adjuvant to surgery or for palliation in treatment of stomach cancer. The nurse's role is to provide detailed instructions, to reassure the patient, and to ensure completion of the designated number of treatments. The nurse should start by assessing the patient's knowledge of radiation therapy. The nurse should teach the patient about skin care, the need for nutrition and fluid intake during therapy, and the appropriate use of antiemetic drugs.