GERD and NG Tube Practice Questions
The client is scheduled to have an upper gastrointestinal tract series of x-rays. Following the x-rays, the nurse should instruct the client to: 1.Take a laxative. 2.Follow a clear liquid diet. 3.Administer an enema. 4.Take an antiemetic
1. The client should take a laxative after an upper gastrointestinal series to stimulate a bowel movement. This examination involves the administration of barium, which must be promptly eliminated from the body because it may harden and cause an obstruction. A clear liquid diet would have no effect on stimulating removal of the barium. The client should not have nausea and an antiemetic would not be necessary; additionally, the antiemetic will decrease peristalsis and increase the likelihood of eliminating the barium. An enema would be ineffective because the barium is too high in the gastrointestinal tract.
The nurse checks for residual before administering a bolus tube feeding to a client with a nasogastric tube and obtains a residual amount of 150 mL. What is the most appropriate action for the nurse to take? 1. Hold the feeding 2. Reinstill the amount and continue with administering the feeding 3. Elevate the client's head at least 45 degrees and administer the feeding 4. Discard the residual amount and proceed with administering the feeding
1. Hold the feeding Rationale-Unless specifically indicated, residual amounts more than 100 mL, require holding the feeding. In addition, the feeding is not discarded unless its contents are abnormal in color or characteristics.
The nurse is preparing a client diagnosed with GERD for surgery. Which information warrants notifying the HCP? 1. The client's Bernstein esophageal test was positive. 2. The client's abdominal x-ray shows a hiatal hernia. 3. The client's WBC count is 14,000/mm3 . 4. The client's hemoglobin is 13.8 g/dL.
1. In a Bernstein test, acid is instilled into the distal esophagus, causing immediate heartburn for a client diagnosed with GERD. This would not warrant notifying the HCP. 2. Hiatal hernias are frequently the cause of GERD; therefore, this finding would not warrant notifying the HCP. 3. The client's WBC count is elevated, indicating a possible infection, which warrants notifying the HCP. 4. This is a normal hemoglobin result and would not warrant notifying the HCP. TEST-TAKING HINT: When the test taker is deciding when to notify a health-care provider, the answer should be data not normal for the disease process or signaling a potential or life-threatening complication
The nurse is caring for an adult client diagnosed with GERD. Which condition is the most common comorbid disease associated with GERD? 1. Adult-onset asthma. 2. Pancreatitis. 3. Peptic ulcer disease. 4. Increased gastric emptying
1. Of adult-onset asthma cases, 80% to 90% are caused by gastroesophageal reflux disease (GERD). 2. Pancreatitis is not related to GERD. 3. Peptic ulcer disease is related to H. pylori bacterial infections and can lead to increased levels of gastric acid, but it is not related to reflux. 4. GERD is not related to increased gastric emptying. Increased gastric emptying would be a benefit to a client with decreased functioning of the lower esophageal sphincter. TEST-TAKING HINT: Some questions are knowledge based. There are no test-taking strategies for knowledge-based questions.
The nurse is administering morning medications at 0730. Which medication should have priority? 1. A proton pump inhibitor. 2. A nonnarcotic analgesic. 3. A histamine receptor antagonist. 4. A mucosal barrier agent.
1. Proton pump inhibitors can be administered at routine dosing times, usually 0900 or after breakfast. 2. Pain medication is important, but a nonnarcotic medication, such as Tylenol, can be administered after a medication, which must be timed. 3. A histamine receptor antagonist can be administered at routine dosing times. 4. A mucosal barrier agent must be administered on an empty stomach for the medication to coat the stomach. TEST-TAKING HINT: Basic knowledge of how medications work is required to administer medications for peak effectiveness. There are very few medications requiring a specific time.
The nurse is performing an admission assessment on a client diagnosed with GERD. Which signs and symptoms would indicate GERD? 1. Pyrosis, water brash, and flatulence. 2. Weight loss, dysarthria, and diarrhea. 3. Decreased abdominal fat, proteinuria, and constipation. 4. Midepigastric pain, positive H. pylori test, and melena.
1. Pyrosis is heartburn, water brash is the feeling of saliva secretion as a result of reflux, and flatulence is gas—all symptoms of GERD. 2. Gastroesophageal reflux disease does not cause weight loss. 3. There is no change in abdominal fat, no proteinuria (the result of a filtration problem in the kidney), and no alteration in bowel elimination for the client diagnosed with GERD. 4. Midepigastric pain, a positive H. pylori test, and melena are associated with gastric ulcer disease. TEST-TAKING HINT: Frequently, incorrect answer options will contain the symptoms of a disease of the same organ system.
Bethanechol has been prescribed for a client with gastroesophageal reflux disease (GERD). The nurse should assess the client for which of the following adverse effects?1.Constipation. 2.Urinary urgency. 3.Hypertension. 4.Dry oral mucosa.
2 Bethanechol, a cholinergic drug, may be used in GERD to increase lower esophageal sphincter pressure and facilitate gastric emptying. Cholinergic adverse effects may include urinary urgency, diarrhea, abdominal cramping, hypotension, and increased salivation. To avoid these adverse effects, the client should be closely monitored to establish the minimum effective dose
The nurse is teaching the patient a client with a peptic ulcer discharge instructions. The client asks the nurse which type of analgesic he may take. Which of the following responses by the nurse would be most accurate? 1. Aspirin 2. Acetaminophen 3. Naproxen 4. Ibuprofen
2. Acetaminophen is recommended for pain relief because it does no promote irritation of the mucosa. Aspirin, and non-steroidal anti-inflammatory drugs such as naproxen and ibuprofen, may cause irritation of the mucosa and subsequent bleeding
Which of the following factors would most likely contribute to the development of a client's hiatal hernia? 1.Having a sedentary desk job. 2.Being 5 feet, 3 inches tall (160 cm) and weighing 190 lb (86.2 kg). 3.Using laxatives frequently. 4.Being 40 years old
2.Being 5 feet, 3 inches tall (160 cm) and weighing 190 lb (86.2 kg). Any factor that increases intra-abdominal pressure, such as obesity, can contribute to the development of hiatal hernia. Other factors include abdominal straining, frequent heavy lifting, and pregnancy. Hiatal hernia is also associated with older age and occurs in women more frequently than in men. Having a sedentary desk job, using laxatives frequently, or being 40 years old is not likely to be a contributing factor in development of a hiatal hernia.
In developing a teaching plan for the client with a hiatal hernia, the nurse's assessment of which work-related factors would be most useful? 1.Number and length of breaks. 2.Body mechanics used in lifting. 3.Temperature in the work area. 4.Cleaning solvents used.
2.Body mechanics used in lifting. Bending, especially after eating, can cause gastroesophageal reflux. Lifting heavy objects increases intra-abdominal pressure. Assessing the client's lifting techniques enables the nurse to evaluate the client's knowledge of factors contributing to hiatal hernia and how to prevent complications. Number and length of breaks, temperature in the work area, and cleaning solvents used are not directly related to treatment of hiatal hernia.
Which of the following nursing interventions would most likely promote self-care behaviors in the client with a hiatal hernia?1.Introduce the client to other people who are successfully managing their care. 2.Include the client's daughter in the teaching so that she can help implement the plan. 3.Ask the client to identify other situations in which the client changed health care habits. 4.Provide reassurance that the client will be able to implement all aspects of the plan successfully
3.Ask the client to identify other situations in which the client changed health care habits. Self-responsibility is the key to individual health maintenance. Using examples of situations in which the client has demonstrated self-responsibility can be reinforcing and supporting. The client has ultimate responsibility for personal health habits. Meeting other people who are managing their care and involving family members can be helpful, but individual motivation is more important. Reassurance can be helpful but is less important than individualization of care
The client has been taking magnesium hydroxide (milk of magnesia) to control hiatal hernia symptoms. The nurse should assess the client for which of the following conditions most commonly associated with the ongoing use of magnesium-based antacids?1.Anorexia. 2.Weight gain. 3.Diarrhea. 4.Constipation
3.Diarrhea. The magnesium salts in magnesium hydroxide are related to those found in laxatives and may cause diarrhea. Aluminum salt products can cause constipation. Many clients find that a combination product is required to maintain normal bowel elimination. The use of magnesium hydroxide does not cause anorexia or weight gain
The nurse is inserting a nasogastric tube in an adult client. During the procedure, the client begins to cough and has difficulty breathing. What is the most appropriate nursing action? 1. Quickly insert the tube 2. Notify the health care provider immediately 3. Remove the tube and reinsert when the respiratory distress subsides 4. Pull back on the tube and wait until the respiratory distress subsides.
4. Pull back on the tube and wait until the respiratory distress subsides. Rationale-During the insertion of a nasogastric tube, if the client experiences difficulty breathing or any respiratory distress, withdraw the tube slightly, stop the tube advancement, and wait until the distress subsides. It is not necessary to notify the health care provider immediately or remove the tube completely. Quickly inserting the tube is not an appropriate action because, in this situation, it may be likely that the tube has entered the bronchus.
The client with gastroesophageal reflux disease (GERD) has a chronic cough. This symptom may be indicative of which of the following ? 1.Development of laryngeal cancer. 2.Irritation of the esophagus. 3.Esophageal scar tissue formation. 4.Aspiration of gastric contents.
4.Aspiration of gastric contents. Clients with GERD can develop pulmonary symptoms, such as coughing, wheezing, and dyspnea, that are caused by the aspiration of gastric contents. GERD does not predispose the client to the development of laryngeal cancer. Irritation of the esophagus and esophageal scar tissue formation can develop as a result of GERD. However, GERD is more likely to cause painful and difficult swallowing.
A patient reports frequent heartburn twice a week for the past 4 months. What other symptoms reported by the patient may indicate the patient has GERD? SELECT-ALL-THAT-APPLY:* A. Bitter taste in mouth B. Dry cough C. Melena D. Difficulty swallowing E. Smooth, red tongue F. Murphy's Sign
A. Bitter taste in mouth B. Dry cough D. Difficulty swallowing
You're collecting a patient's medication history that has GERD. Which medication below is NOT typically used to treat GERD?* A. Colesevelam "Welchol" B. Omeprazole "Prilosec" C. Metoclopramide "Reglan" D. Ranitidine HCL "Zantac"
A. Colesevelam "Welchol"
During a home health visit, you are helping a patient develop a list of foods they should avoid due to GERD. Which items in the patient's pantry should be avoided? SELECT-ALL-THAT-APPLY:* A. Hot and Spicy Pork Rinds B. Peppermint Patties C. Green Beans D. Tomato Soup E. Chocolate Fondue F. Almonds G. Oranges
A. Hot and Spicy Pork Rinds B. Peppermint Patties D. Tomato Soup E. Chocolate Fondue G. Oranges People should avoid food containing high amounts of citric acid such as citrus fruits such as tomatoes and oranges. People should also avoid chocolate and peppermint because these foods relax the LES, which causes acid to go up onto the esophagus. In addition people should avoid fatty, fried, and spicy foods.
The nurse teaches the client about an anti-ulcer diet. Which of the following statements by the client indicates to the nurse that dietary teaching was successful?1. "I must eat bland foods to help my stomach heal." 2. "I can eat most foods, as long as they don't bother my stomach." 3. "I cannot eat fruits and vegetables because they cause too much gas." 4. "I should eat a low-fiber diet to delay gastric emptying -
ANS: 2 "I can eat most foods, as long as they don't bother my stomach." This is the answer because you do not want to scare the client about their diet. In reality, clients do not need to just eat bland food. As long as the client is creative, but eats foods that do not contain spicy, fatty, fried, caffeine, chocolate, or peppermint, they should be fine to eat most foods.
The nurse is assessing for correct placement of a nasogastric tube. The nurse aspirates the stomach contents, checks the gastric pH, and notes a pH of 7.35. Based on this information, which action should the nurse take at this time? 1. Retest the pH using another strip. 2. Document that the nasogastric tube is in the correct place. 3. Check for placement by auscultating for air injected into the tube. 4. Call the health care provider to request a prescription for a chest radiograph.
ANS: 4. Call the health care provider to request a prescription for a chest radiograph. Rationale: If the nasogastric tube is in the stomach, the pH of the contents will be acidic. Gastric aspirates have acidic pH values and should be 3.5 or lower. ApH of 7.35 indicates a neutralpH, which may indicate that the tube is no longer in the stomach. Based on this information, the nurse should call the health care provider to request a prescription for a chest radiograph to determine if placement is accurate. Retestingthe pH using another strip is unnecessary and checking for placement by auscultating for air injected into the tube is not a definitive method of checking for tube placement. The nurse should not document that the tube is in the correct placebecause the data indicate this may not be the case.Test-Taking Strategy: Note the subject, verifying correct tube placement. Recalling that gastric contents are acidic and the definitive methods of assessing for accurate tube placement will direct you to the correct option.
Which assessment data support the client's diagnosis of gastric ulcer? 1. Presence of blood in the client's stool for the past month. 2.Complaints of a burning sensation that moves like a wave. 3.Sharp pain in the upper abdomen after eating a heavy meal. 4.Comparison of complaints of pain with ingestion of food and sleep
ANS: 4. Comparison of complaints of pain with ingestion of food and sleep "1. The presence of blood does not specifically indicate diagnosis of an ulcer. The client could have hemorrhoids or cancer that would result in the presence of blood. 2. A wavelike burning sensation is a symptom of gastroesophageal reflus. 3. Sharp pain in the upper abdomen after eating a heavy meal is a symptom of gallbladder disease. 4. (CORRECT) In a client diagosed with a gastric ulcer, pain usually occurs 30-60 minutes after eating, but not at night. In contrast, a client with duodenal ulcer has pain durin ghte night that is often relieved by eating food. Pain occurs 1-3 hours after meals
The nurse is teaching a client about risk factors for esophageal cancer. What risk factors would the nurse include? A. Alcohol intake B. Obesity C. Smoking D. Lack of fresh fruits and veggies E. Untreated GERD F. Use of NSAIDs
ANS: A, B, C, D, E All of these factors increase the risk of esophageal cancer except for the use of NSAIDs. Untreated GERD causes damage to esophageal tissue which may develop into Barrett esophagus, or precancerous cells.
The nurse is teaching a client the risk of uncontrolled or untreated GERD. What complication(s) may occur if the GERD is not successfully managed? A. Asthma B. Laryngitis C. Dental caries D. Cardiac disease E. Cancer
ANS: A, B, C, D, E Any of these complications may occur in clients who have uncontrolled or untreated GERD.
The nurse is caring for a client diagnosed with probable gastroesophageal reflux disease (GERD). What assessment finding(s) would the nurse expect? (Select all that apply.) a. Dyspepsia b. Regurgitation c. Belching d. Coughing e. Chest discomfort f. Dysphagia
ANS: A, B, C, D, E, F All of these signs and symptoms are commonly seen in clients who have GERD.
The nursing is teaching a client diagnosed with gastroesophageal reflux disease (GERD) who is planning to have an endoscopic radiofrequency (Stretta) procedure. What preprocedure health teaching would the nurse include? (Select all that apply.) A. "You will need to be on a liquid diet for the first week after the procedure." B. "Avoid taking ant NSAIDs like ibuprofen for 10 days before the procedure." C. "Contact the primary health care provider after the procedure if you have increased pain." D. "You will need a nasogastric tube for a few days after the procedure." E. "You will have a small incision in your stomach area that will have a wound closure."
ANS: B, C The client having this procedure does not have an incision and will not require a nasogastric tube (NGT). The client should avoid an NGT placement for at least a month after the procedure. A liquid diet is required for only 24 hours after the procedure and then the client should progress to include soft floods like custard and applesauce.
The nurse is caring for a client who had an open traditional esophagectomy. Which assessment findings would the nurse report immediately to the primary health care provider? (Select all that apply.) a. Nausea b. Wound dehiscence c. Fever d. Tachycardia e. Moderate pain f. Fatigue
ANS: B, C, D Wound dehiscence is a serious, potentially life-threatening problem that needs immediate attention of the primary health care provider, typically the surgeon. Fever and tachycardia may indicate that the client has a postoperative infection, another serious, potentially life-threatening complication. Indications of both of these problems need to be documented and reported by the nurse. Nausea, fatigue, and moderate pain are expected postoperative assessment findings. DIF: Analyzing TOP: Integrated Process: Nursing Process: Assessment
A client has an open traditional hiatal hernia repair this morning. What is the nurse's priority for client care at this time? A. Managing surgical pain V. Ambulating the client early C. Preventing respiratory complications D. Managing the nasogastric tube
ANS: C The client who has traditional surgery (rather than minimally invasive surgery) is at risk for respiratory complications such as atelectasis and pneumonia because he or she has an incision that may prevent the client from taking deep breaths or using an incentive spirometer. Therefore, the nurse's priority is to prevent these potentially life-threatening respiratory problems.
The nurse is caring for a female client with active upper GI bleeding. What is the appropriate diet for this client during the first 24 hours after admission? a. regular diet b. skim milk c. nothing by mouth d. clear liquids
ANS: C Answer C. Shock and bleeding must be controlled before oral intake, so the client should receive nothing by mouth. A regular diet is incorrect. When the bleeding is controlled, the diet is gradually increased, starting with ice chips and then clear liquids. Skim milk shouldn't be given because it increases gastric acid production, which could prolong bleeding. A liquid diet is the first diet offered after bleeding and shock are controlled
Which of these client assessment findings is typically associated with oral cancer? A. Dry sticky oral membranes B. Increased appetite C. Itchy rash in oral cavity D. Painless red or raised lesions
ANS: D A painless rerd or raised lesion often indicates a diagnosis or oral cancer. The client usually has a decreased appetite and thick secretions. Itchiness is not a common finding associated with oral cancer.
A client receives a local anesthetic to suppress the gag reflex for a diagnostic procedure of the upper GI tract. Which of the following nursing interventions is advised for this patient? a The client should be monitored for any breathing related disorder or discomforts b) The client should not be given any food and fluids until the gag reflex returns, c) The client should be monitored for cramping or abdominal distention, d) The client's fluid output should be measured for at least 24 hours after the procedure
ANSWER: B For a client receiving a local anesthetic that suppresses the gag reflex, the nurse is advised to withhold food and fluids until the reflex returns
A patient with a history of peptic ulcer disease has presented to the emergency department with complaints of severe abdominal pain and a rigid, boardlike abdomen, prompting the health care team to suspect a perforated ulcer. Which of the following actions should the nurse anticipate? A. Providing IV fluids and inserting a nasogastric tube B. Administering oral bicarbonate and testing the patient's gastric pH level. C. Performing a fecal occult blood test and administering IV calcium gluconate. D. Starting parenteral nutrition and placing the patient in high-Fowler's position
Answer A, A perforated peptic ulcer requires IV replacement of fluid losses and continued gastric aspiration by NG tube. Nothing is given by mouth and gastric pH testing is not a priority. Calcium gluconate is not a medication directly relevant to the patient's suspected diagnosis and parenteral nutrition is not a priority in the short term
Which of the following nursing interventions should the nurse perform for a female client receiving enteral feedings through a gastrostomy tube? a. Change the tube feeding solutions and tubing at least every 24 hours b. Maintain the head of the bed at a 15-degree elevation continuously. c. Check the gastrostomy tube for position every 2 days. d. Maintain the client on bed rest during the feedings
Answer A, Answer A. Tube feeding solutions and tubing should be changed every 24 hours, or more frequently if the feeding requires it. Doing so prevents contamination and bacterial growth. The head of the bed should be elevated 30 to 45 degrees continuously to prevent aspiration. Checking for gastrostomy tube placement is performed before initiating the feedings and every 4 hours during continuous feedings. Clients may ambulate during feedings
"The nurse has instructed the client who is experiencing diarrhea associated with irritable bowel syndrome on dietary changes to prevent diarrhea. The nurse knows the client understands the dietary changes if the client selects which of the following menu choices? a) Yogurt, crackers and sweet tea b) Salad with chicken, whole wheat crackers c) Bacon, tomato, lettuce with mayonnaise and a soft drink d) Tuna on white bread and coconut cake
Answer B Rationale: Bacon tomato lettuce with mayonnaise and soft drink is high in fat and the soft drink is hyperosmolar both contributing to diarrhea. Salad, whole wheat crackers may decrease diarrhea due to increased fiber. Dairy increases diarrhea. Food high in carbohydrates increase diarrhea. Coconut may increase diarrhea
Which assessment data support to the the nurse the client's diagnosis of gastric ulcer? A. Presence of blood in the client's stool for the past month? B. Reports of a burning sensation moving like a wave. C. Sharp pain in the upper abdomen after eating a heavy meal. D. Complaints of epigastric pain 30-60 minutes after ingesting food
Answer: D In a client diagnosed with a gastric ulcer, pain usually occurs 30-60 minutes after eating, but not at night. In contrast, a client with a duodenal ulcer has pain during the night often relieved by eating foods. Other answers: the presence of blood does not specifically indicate diagnose of an ulcer. The client could have hemorrhoids or cancer. A waveline burning sensation is a symptom of GERD. Sharp pain in the upper abdomen after eating a heavy meal is a symptom of gallbladder disease
The nurse is assessing a patient with gastroesophageal reflux disease (GERD). Which findings does the nurse expect to observe? (Select all that apply) A. Blood-tinged sputum B. Dyspepsia C. Excessive salivation D. Flatulence E. Regurgitation
B. Dyspepsia C. Excessive salivation D. Flatulence E. Regurgitation When assessing a patient for GERD, the nurse expects to find dyspepsia (heartburn), excessive salivation, flatulence which is common after eating, and regurgitation (backward flow of food and fluid into the throat).Blood-tinged sputum and excessive salivation are not symptoms of GERD.
A patient is taking Bethanechol "Urecholine" for treatment of GERD. This is known as what type of drug?*A. Proton-pump inhibitor B. Histamine receptor blocker C. Prokinetic D. Mucosal Healing Agent
C. Prokinetic
The male client tells the nurse he has been experiencing "heartburn" at night that awakens him. Which assessment question should the nurse ask? A. How much weight have you gained recently? B. What have you done to alleviate the heartburn? C. Do you consume many milk and dairy products? D Have you been around anyone with a stomach virus
Correct answer is B Most clients with GERD have been self medicating with over-the counter medications prior to seeking advice from a healthcare provider. It is important to know what the client has been using to treat the problem
The teaching plan for the patient being discharged following an acute episode of upper GI bleeding will concern information concerning the importance of (select all that apply) a. only taking aspirin with milk or bread products b. avoiding taking aspirin and drugs containing aspirin c. taking only drugs prescribed by the health care provider d. taking all drugs 1 hour before mealtime to prevent further bleeding e. reading all OTC drug labels to avoid those containing stearic acid and calcium
Correct answers: b, c Rationale: Before discharge, the patient with upper gastrointestinal (GI) bleeding and the caregiver should be taught how to avoid future bleeding episodes. Ulcer disease, drug or alcohol abuse, and liver and respiratory diseases 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 health care provider should be taken. Smoking and alcohol should be eliminated because they are sources of irritation and interfere with tissue repair.
Which of the following does NOT play a role in the development of GERD?* A. Pregnancy B. Hiatal hernia C. Usage of antihistamines or calcium channel blockers D. All the above play a role in GERD
D. All the above play a role in GERD
What does pyrosis mean?
Heartburn
The registered nurse is preparing to insert a nasogastric tube in an adult client. To determine the accurate measurement of the length of the tube to be inserted, the nurse should take which action? 1. Mark the tube at 10 inches (25.5 cm). 2. Mark the tube at 32 inches (81 cm). 3. Place the tube at the tip of the nose and measure by extending the tube to the earlobe and then down to the xiphoid process. 4. Place the tube at the tip of the nose and measure by extending the tube to the earlobe and then down to the top of the sternum.
Rationale: Measuring the length of a nasogastric tube needed is done by placing the tube at the tip of the client's nose and extending the tube to the earlobe and then down to the xiphoid process. The average length for an adult is about 22 to 26 inches(56 to 66 cm). The remaining options identify incorrect procedures for measuring the length of the tube.--------------------------------------------------Test-Taking Strategy: Focus on the subject, insertion of a nasogastric tube, and visualize this procedure. Eliminate options 1 and 2 first because 10 inches (25.5 cm) is short and 32 inches (81 cm) is too long. Also, remember the abbreviation NEX, which stands for nose, earlobe, and xiphoid process, to assist in answering questions similar to this one.
