Ch 41 Upper GI Problems Questions
A large number of children at a public school have suddenly developed profuse diarrhea and bloody stools. The school nurse suspects food poisoning related to food from the school cafeteria and request analysis and culture of which food?
Ground beef
The nurse determines that teaching for the patient with peptic ulcer disease has been effective when the patient makes which statement?
I have learned some relaxation strategies that decrease my stress
Which statement by a patient with dumping syndrome should lead the nurse to determine that further dietary teaching is needed?
I should eat bread and jam with every meal
A patient with upper GI bleeding and melena is treated with several drugs. Which drugs should the nurse recognize as a priority to administer before, during, and potentially after an endoscopy?
IV esomeprazole (Nexium)
Priority Decision: A patient who has been vomiting for several days from unknown cause is admitted to the hospital. What should the nurse anticipate will first be included in interprofessional care?
IV replacement of fluid and electrolytes
What physiologically occurs with vomiting?
Immediately before the act of vomiting, activation of the parasympathetic nervous system causes increased salivation, increased gastric motility, and relaxation of LES.
which laboratory findings should the nurse expect in the patient with persistent vomiting?
Increased pH, decreased potassium, increased hematocrit
Ondansetron (Zofran) is prescribed for a patient with cancer chemotherapy-induced vomiting. What should the nurse understand about this drug?
It relieves vomiting centrally by action in the vomiting center and peripherally by promoting gastric emptying.
A patient who has undergone an esophagectomy for esophageal cancer develops increasing pain, fever, and dyspnea when a full liquid diet is started postoperatively. The nurse recognizes that these symptoms are most indicative of
Leakage of fluids into the mediastinum
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?
Lifelong administration of cobalamin
Nursing management of the patient with chronic gastritis includes teaching the patient to
Maintain a nonirritating diet with 6 small meals A-day
Following a patients esophagogastrostomy for cancer of the esophagus, what is most important for the nurse to do?
Maintain the patient and semi Fowler's or Fowler's position
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 nurses primary concern?
Maintaining a patent airway
Several patients come to the urgent care center with nausea, vomiting, and diarrhea that began 2 hours ago while attending a large family reunion potluck dinner. You ask the patients specifically about foods they ingested containing
Meat and milk
What type of bleeding will a patient with peptic ulcer disease with a slow upper GI source of bleeding have?
Melena
Following a Billroth II procedure, a patient develops dumping syndrome. The nurse should explain that the symptoms associated with this problem are caused by
Movement of fluid into the small bowel from concentrated food and fluids moving rapidly into the intestine
Which statements describe the use of antacids for peptic ulcer disease? (Select all that apply)
Neutralize HCl in the stomach Produce quick, short lived relief of heartburn Maybe given hourly after an acute phase of GI bleeding
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 1st?
Notify the surgeon to reposition or replace the tube
What should the nurse emphasize when teaching patients at risk for upper GI bleeding to prevent bleeding episodes?
The use of over the counter (OTC) medications of any kind should be avoided
The nurse explains to the patient with Vincents infection that treatment will include
Topical application of antibiotics
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 when obtaining a history?
Use of any type of tobacco products
Priority Decision: 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?
Water
Match the descriptions with the following surgical procedures used to treat peptic also disease
1. Often done after vagotomy to increase gastric emptying- Pyloroplasty 2. Severing of a parasympathetic nerve to decrease gastric secretion- Vagotomy 3. Removal of distal 2/3 of stomach within anastomosis to jejunum- Billroth II 4. Remove all of distal 2/3 of stomach with anastomosis to Duodenum- Billroth I
Which patient is at highest risk of having a gastric ulcer?
55 year old female smoker with nausea and vomiting
The pernicious anemia that may accompany gastritis is due to
A lack of intrinsic factor normally produced by acid-secreting cells of the gastric mucosa
Regardless of the precipitating factor, what causes the injury to mucosal cells in peptic ulcers?
Acid back diffusion into the mucosa
Which type of gastritis is most likely to occur in a college student who has an isolated drinking binge?
Acute gastritis
The nurse is planning to teach the patient with the gastroesophageal reflux disease (GERD) about foods or beverages that decrease LES pressure. What should be included in this list? (Select all that apply)
Alcohol Chocolate Fatty foods Cola soda
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 1st?
Assess the patient's abdomen and vital signs
The teaching plan for the patient being discharged for an acute episode of upper GI bleeding includes information about the importance of (select all that apply)
Avoiding taking aspirin and drugs containing aspirin Dial only taking drugs prescribed by the health care provider
The nurse teaching young adults about behaviors that put them at risk for oral cancer includes
Avoiding use of smokeless tobacco
Which esophageal disorder is described as a precancerous lesion and is associated with GERD?
Barrett's esophagus
A patient with a gastric outlet obstruction has been treated with NG decompression. After the 1st 24 hours, the patient develops nausea and increased upper abdominal bowel sounds. What is the priority action by the nurse?
Check the patency of the NG tube
Priority Decision: Older patients may have cardiac or renal insufficiency and be more susceptible to problems from vomiting and antiemetic drug side effects. What nursing intervention is most important to implement with these patients?
Do hourly visual checks and implement fall precautions.
The nurse evaluates that management of the patient with upper GI bleeding as affected when assessment and laboratory findings reveal which result?
Decreasing blood urea nitrogen (BUN)
What does the nurse include when teaching a patient with newly diagnosed peptic ulcer disease?
Eat as normally as possible, eliminating foods that cause pain or discomfort
A patient with us esophageal cancer is scheduled for a partial esophagectomy. Which nursing intervention has highest priority preoperatively?
Encourage a high-calorie, high-protein diet
Which medications are used to decrease gastric or HCl secretions? (Select all that apply)
Famotidine (Pepcid) Omeprazole (Prilosec) Misoprostol (Cytotec)
What are characteristics of gingivitis?
Formation of abscesses with loosening of teeth
MJ 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 MJ to
Give her mother sips of water and elevate the head of her bed to prevent aspiration
Duodenal and gastric ulcers have similar as well as differentiating features. What characteristics are unique to duodenal ulcer? (Select all that apply)
Pain is relieved with eating food Increased gastric acid secretion occurs There is burning and cramping in the mid epigastric area
A patient is admitted to the emergency department with profuse bright-red hematemesis. During the initial care of the patient, what is the nurses 1st priority?
Perform a focused nursing assessment of the patient's status
The nurse is teaching the patient and family that peptic ulcers are
Promoted by a combination of factors that cause erosion of the gastric mucosa, including certain drugs and H pylori
What is the rationale for treating acute exacerbation of peptic ulcer disease with NG intubation?
Remove stimulation for hydrochloric acid (HCl) and pepsin secretion by keeping the stomach empty
How should the nurse teach the patient with a hiatal hernia or GERD to control symptoms?
Sleep with the head of the bed elevated on 4 to 6" blocks
Which infection or inflammation is found related to systemic disease and cancer chemotherapy?
Stomatitis
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?
Sudden, severe generalized abdominal and back pain
What is an accurate description of eosinophilic esophagitis?
Swelling of the esophagus caused by an allergic response to food or environmental triggers
Which instructions would the nurse include in a teaching plan for a patient with mild gastroesophageal reflux disease (GERD)?
The best time to take an as needed antacid is 1 to 3 hours after meals
Corticosteroid medications are associated with the development of peptic ulcers because of which pathophysiologic mechanism?
The rate of mucous cell renewal is decreased
An optimal teaching plan for an outpatient with stomach cancer receiving radiation therapy should include information about
Wound and skin care, nutrition, drugs, and community resources
A patient with oral cancer has a history of heavy smoking, excess alcohol intake, and personal neglect. During the patients early postoperative course, what does the nurse anticipate that the patient may need?
drug therapy to prevent substance withdrawal symptoms
