Chapter 46

Which diagnostic test would the nurse anticipate for an older patient who is vomiting "coffee-ground" emesis a. Endoscopy b. Angiography c. Barium Swallow d. Gastric analysis

A. Endoscopy: primary took for visualization and diagnosis of upper gastrointestinal bleeding.

A woman receiving chemotherapy for breast cancer develops a candida albicans oral infection. Which intervention should the nurse anticipate? a. Nystatin tablets b. antiviral agents c. referral to dentist d. hydrogen peroxide rinses

A. Nystatin : albicans infections are treated with antifungals like nystatin.

Which patient would a nurse assess first after receiving morning report. a. Pt. with esophageal varices who has a rapid HR. b. Pt. with a history of gastrointestinal bleeding who has melena c. Pt. with nausea who has a dose of metoclopramide (Reglan) due d. Pt who is crying after receiving a diagnosis of esophageal cancer

A. Pt. with esophageal varices who has a rapid HR. : possible hemodynamic instability cause by GI bleed.

Which action would the nurse in the ED anticipate for a young adult who has several acute episodes of bloody diarrhea? a. Obtain a stool specimen for culture b. Administer antidiarrheal medication c. Provide teaching about antibiotic therapy d. Teach the adverse effects of acetaminophen

A: Obtain a stool specimen for culture : looking for E. Coli

Which information will the nurse include when teaching a patient with PUD about the effect of famotidine (Pepcid) a. "Famotidine absorbs the excess gastric acid" b. "Famotidine decreases gastric acid secretion" c. "Famotidine constricts the blood vessels near the ulcer" d. "Famotidine covers the ulcer with a protective material"

B "Famotidine decreases gastric acid secretion" : Famotidine is a histamine-2 receptor blocker that decreases the secretion of gastric acid. It does NOT constrict the blood vessels, absorb the gastric acid or cover the ulcer.

Which information about dietary management would the nurse include when teaching a patient with peptic ulcer disease (PUD) a. "You will need to remain on a bland diet" b. "Avoid foods that cause pain after you eat them" c. "High-protein foods are the least likely to cause you pain" d. "You should avoid eating raw fruits and vegatables"

B. "Avoid foods that cause pain after you eat them"

Which statement by a patient with chronic atrophic gastritis indicates that the nurse's teaching regarding cobalamin injections has been effective? a. "The cobalamin injections will prevent gastric inflammation" b. "The cobalamin injections will prevent me from becoming anemic " c. "These injections will increase the hydrochloric acid in my stomach" d. "These injections will decrease my risk for developing stomach cancer"

B. "The cobalamin injections will prevent me from becoming anemic " : prevents the development of pernicious anemia.

A patient admitted with a peptic ulcer has a nasogastric (NG) tube placement. When the patient develops sudden, severe upper abdominal pain, diaphoresis, and firm rigid abdomen, which action would the nurse take? a. Irrigate the NG tube b. Check the Vitals c. Give ordered antacid d. Elevate the foot of the bed

B. Check Vitals: The symptoms suggest acute perforation and the nurse should assess for signs of hypovolemic shock.

A patient who underwent a gastroduodenostomy 12 hrs ago reports increasing abdominal pain. The patient has no bowel sounds and 200 mL of bright red nasogastric (NG) drainage in the past hour. Which nursing action would be the HIGHEST priority a. Monitor drainage b. Contact Surgeon c. Irrigate the NG tubing d. Give prescribed morphine

B. Contact Surgeon : Increased pain and 200mL of bright red drainage indicates possible postop hemorrhage, and immediate action such as blood transfusion or return to surgery are needed.

Which item would the nurse offer to the patient restarting oral intake after being NPO due to nausea and vomiting. a. glass of orange juice b. dish of lemon gelatin c. cup of coffee with cream d. bowl of hot chicken broth

B. Dish of lemon gelatin : Clear Cool Liquids are usually the first food to start after pt. has been nauseated.

Which information will the nurse provide for a patient with newly diagnosed GERD? a. "peppermint may reduce your symptoms" b. "keep the head of your bed elevated on blocks" c. "avoid eating between meals to reduce acid secretion" d. "vigorous exercise may increase incidence of reflux"

B. Elevation Head of Bed: will reduce the incidence of reflux while the patient is sleeping.

A patient has been admitted with hypotension and dehydration after 3 days of nausea and vomiting. Which prescription action will the nurse implement first? a. Insert a NG tube b. Infuse normal saline at 250 mL/hr. c. Administer IV ondansetron (Zofran) d. Provide oral care with moistened swabs.

B. Infuse normal saline at 250 mL/hr. : the patient is more than likely severely dehydrated, rehydration with IV fluid is the priority

A patient with a family history of stomach cancer asks the nurse about ways to decrease the risk for developing stomach cancer. What would the nurse teach the patient to avoid? a. Emotionally stressful situations b. Smoked foods such as ham or bacon c. Foods that cause distention or bloating d. Chronic use of H2 blocking medications.

B. Smoked foods such as ham or bacon: increase the risk for stomach cancer. The other answers are not risk factors for stomach cancer

The nurse is assessing a patient who had a total gastrectomy 8 hrs. ago. Which information is most important to report to a healthcare provider? a. Hemoglobin 10.8g/dL b. Temperature 102.1 c. Absent bowel sounds in all quadrants d. Scant nasogastric (NG) tube drainage

B. Temperature of 102.1 : may indicate leakage at the anastomosis may require pt. to return to surgery or keep NPO

The RN and LPD are working together to care for a pt. who had a esophagectomy 2 days ago. Which action by the LPN requires RN intervention? a. The LPN uses soft swabs to provide oral care b. The LPN positions the head of the bed in a flat position c. The LPN includes the enteral feeding volume when calculating intake d. The LPN encourages the patient to use pain medication before coughing.

B. The LPN positions the head of the bed in a flat position : the patients bed would be in Fowlers position to prevent reflux and aspiration. The other actions by the LPN are appropriate.

The nurse is administering IV fluid boluses and nasogastric irrigation to a patient with acute gastrointestinal bleeding. Which assessment finding is most important for the nurse to communicate to the health care provider. a. The bowel sounds are hyperactive in all 4 quads b. The patients lungs have crackles audible to the mid-chest c. The NG suction is returning coffee-ground material d. The patients B/P is 142/84

B. The patients lungs have crackles audible to the mid-chest. indication of pulmonary edema and may be developing due to rapid infusion of IV fluid and that fluid infusion rate would be slowed.

A patient who has gastroesophageal reflux disease (GERD) is experiencing increasing discomfort. Which patient statement to the nurse indicates a need for additional teaching about GERD. a. "I quit smoking years ago, but I chew gum" b. "I eat small meals and have bedtime snack" c. "I take antacids between meals and at bedtime each night" D. "I sleep with the head of my bed elevated on 4 inch blocks"

B: "I eat small meals and have bedtime snack": GERD is exasperated by eating late at night. Teach no food within 3 hrs. of bedtime

Which nursing action would be included in the postop care plan for a pt. after laparoscopic esophagectomy? a. reposition the ng tube if drainage stops b. Elevate the head of the bed at least 30 degrees c. Start oral fluids when the patient has active bowel sounds d. Notify the provider for any bloody nasogastric (NG) drainage

B: Elevation of head of the bed decreases the risk for reflux and aspiration of gastric secretions.

Which prescribed action will the nurse implement first for a patient who has vomited 1100 mL of blood. a. Give an IV H2 receptor antagonist b. Draw blood for type an crossmatch c. Administer 1 L of LR solution d. Insert NG tube and connect to suction

C. Administer 1 L of LR solution : because pt. have vomited a large amount of blood, correction of hypovolemia and prevention of hypovolemic shock are priorities

An adult with E. coli O157:H7 food poisoning is admitted to the hospital with bloody diarrhea and dehydration. Which prescribed action will the nurse question? a. Infuse lactated Ringer's solution at 250 mL/hr. b. Monitor blood urea nitrogen and creatinine daily. c. Administer loperamide (Imodium) after each stool. d. Provide a clear liquid diet and progress diet as tolerated.

C. Administer loperamide (Imodium) after each stool.

A patient has peptic ulcer disease (PUD) associated with H. Pylori. Which medications will the nurse plan to teach the patient? a. Sucralfate (Carafate), nystatin, and bismuth (Pepto-Bismol) b. Metoclopramide (Reglan), bethanechol, and promethazine c. Amoxicillin (Amoxil), clarithromycin, and omeprazole (Prilosec) d. Famotidine (Pepcid), magnesium hydroxide (Mylanta), and pantoprazole

C. Amoxicillin (Amoxil), clarithromycin, and omeprazole (Prilosec) : Drug therapy includes a PPI, and antibiotics.

A young adult has been admitted to the ED with nausea and vomiting. Which action could the RN delegate to assistive personnel (AP) a. Auscultate the bowel sounds b. Assess for signs of dehydration c. Assist the patient with oral care d. Ask more questions about the nausea

C. Assist the patient with oral care: Oral care is in the AP's scope of practice.

A patient with a stroke is unconscious and unresponsive to stimuli, after learning that the patient has a history of GERD, which assessment would the nurse plan to make more frequently than is routine? a. apical pulse b. bowel sounds c. breathing sounds d. abdominal girth

C. Breathing sounds: because GERD may cause aspiration. The unconscious patient is at risk for developing aspiration pneumonia

Which patient choice for a snack 3 hrs. before bedtime indicates that the nurse teaching about GERD has been effective a. Chocolate pudding b. Glass of Low- fat milk c. Cherry gelatin with fruit d. peanut butter and jelly sandwich

C. Cherry gelatin with fruit : Gelatin and fruit are low fat and will not decrease lower esophageal sphincter (LES) pressure

After change-of-shift report, which patient should the nurse assess first? a. 42yr old pt. who has acute gastritis and ongoing epigastric pain. b. 70yr old pt. with a hiatal hernia who experiences frequent heartburn c. 60yr old pt. with nausea and vomiting who is lethargic & dry mucosa d. 53yr old who has dumping syndrome after recent partial gastrectomy

C. The 60yr old pt. with nausea and vomiting who is lethargic & dry mucosa: problems with aspiration, dehydration, & fluid and electrolyte imbalance risk.

A patient returned from a laparoscopic Nissen fundoplication for a hiatal hernia 4 hours ago. Which assessment finding is most important for the nurse to address immediately? a. The patient reports 7/10 abdominal pain. b. patient is experiencing intermittent waves of nausea c. The patient has no breath sounds in the left anterior of chest d. The patient has hypoactive bowel sounds in all four quadrants

C. The patient has no breath sounds in the left anterior of chest. : ALWAY airway first. Decreased breath sounds may indicate pneumothorax.

A patient has just been admitted to the ED with nausea and vomiting. Which information requires the most rapid intervention by the nurse? a. The patient has been vomiting for 4 days b. The patient takes antacids 8-10 times a day c. The patient is lethargic and difficult to arouse d. The patient had a small intestinal resection 2 years ago.

C. The patient is lethargic and difficult to arouse : Risk for aspiration

At his first postop checkup appointment after a gastrojejunostomy, a patient reports that dizziness, weakness, and palpitations occur about 20 min after each meal. Which action would the nurse teach the patient to take? a. increase the amount of fluid with meals b. eat foods that are higher in carbs c. lie down for about 30 minutes after eating d. drink sugared fluids or eat candy after a meal.

C. lie down for about 30 minutes after eating : The patient is experiencing dumping syndrome that may be reduced by lying down for a short rest.

Which patient statement indicates that the nurses postop teaching after a gastroduodenostomy has been effective? a. "I will drink more liquids with my meals" b. "I should choose high carb foods" c. "Vitamin supplements may prevent anemia" d. "persistent heartburn is expected after surgery"

C: "Vitamin supplements may prevent anemia" Cobalamin deficiency may occur after partial gastrectomy

How would the nurse explain esomeprazole (Nexium) to a patient who has recurring heartburn? a." It reduces gastroesophageal reflux by increasing the rate of gastric emptying" b. "It neutralizes stomach acid and provides relief of symptoms in a few minutes" c. "It coats and protects the lining of the stomach and esophagus from gastric acid" d. "It treats gastroesophageal reflux disease by decreasing stomach acid production"

D. "It treats gastroesophageal reflux disease by decreasing stomach acid production" : Proton Pump Inhibitors decrease the rate of gastric acid secretion

The health care provider prescribed antacids and sucralfate (Carafate) for treatment of a patients peptic ulcer. What medication schedule would the nurse teach the patient? a. Sucralfate at bedtime and antacids before each meal b. Sucralfate and antacids together 0 minutes before meals c. Antacids 30 min before each dose of sucralfate is taken d. Antacids after meals and sucralfate 30 minutes before meals

D. Antacids after meals and sucralfate 30 minutes before meals. : sucralfate is most effective when the pH is low and should not be given with or soon after antacids. Antacids are most effective when taken after eating. Administering sucralfate 30 minutes before eating and antacids after eating will ensure both drugs can be most effective

80yr old pt. who is hospitalized with PUD develops new -onset auditory hallucinations. Which personal medication will the nurse discuss with the health care team before administration? a. Sucralfate (Carafate) b. Aluminum hydroxide c. Omeprazole (Prilosec) d. Metoclopramide (Reglan)

D. Metoclopramide (Reglan) : can cause central nervous system side effects ranging from anxiety to hallucinations.

A patient takes a NSAID daily for the management of severe rheumatoid arthritis has recently developed melena. What would the nurse anticipate teaching that patient: a. Substitution of acetaminophen for the NSAID b. Use of enteric-coated NSAID to reduce gastric irritation c. Reasons for using corticosteroids to treat rheumatoid arthritis d. Misoprostol (Cytotec) to protect the gastrointestinal mucosa

D. Misoprostol (Cytotec) to protect the gastrointestinal mucosa : Misoprostol reduces acid secretion and incidence of upper GI bleeding associated with NSAID use.

A patient is diagnosed with stomach cancer after an unintended 20-lb weight loss. which action would the nurse include in the plan of care? a. Refer the patient for hospice services b. Infuse IV fluids through the central line c. Teach patient about antiemetic therapy d. Offer supplemental feedings between meals.

D. Offer supplemental feedings between meals : patient data indicates poor nutritional state and improvement in nutrition will be helpful in improving the response to therapies

Which assessment would the nurse perform first for a patient who just vomited red blood? a. Measuring the quantity of emesis b. Palpating the abdomen for distention c. auscultating the chest for breathing sounds. d. Taking the blood pressure and pulse

D. Taking the blood pressure and pulse : concern about blood loss and possible hypovolemic shock in pt. w/ acute gastrointestinal bleeding.

A patient vomiting blood-streaked fluid is admitted to the hospital with acute gastritis. To determine possible risk factors for gastritis, the nurse will ask the patient about a. the amount of saturated fat in the diet. b. a family history of gastric or colon cancer. c. a history of a large recent weight gain or loss. d. use of nonsteroidal antiinflammatory drugs (NSAIDs).

D. use of nonsteroidal anti-inflammatory drugs (NSAIDS) is associated with damage to the gastric mucosa that can result in acute gastritis

Which topic would the nurse anticipate teaching to a patient who has a new report of heartburn? a. Radionuclide test b. barium swallow exam c. Endoscopy procedure D. PPI's

D: PPI's : Proton pump inhibitors are the least invasive for a new diagnosis. Usually short term and first step for GERD