Practice Questions PT 2: Upper GI Problems
ANS: C Because the patient's nausea is associated with severe pain, it is likely that it is precipitated by stress and pain. The best treatment will be to provide adequate pain medication before dressing changes. The nurse should avoid doing painful procedures close to mealtimes, but nausea/vomiting that occur at other times also should be addressed. Keeping the patient NPO does not address the reason for the nausea and vomiting and will have an adverse effect on the patient's nutrition. Administration of antiemetics is not the best choice for a patient with nausea caused by pain.
1. A patient with deep partial-thickness burns experiences severe pain associated with nausea during dressing changes. Which action will be most useful in decreasing the patient's nausea? a. The patient NPO for 2 hours before and after dressing changes. b. Avoid performing dressing changes close to the patient's mealtimes. c. Administer the prescribed morphine sulfate before dressing changes. d. Give the ordered prochlorperazine (Compazine) before dressing changes.
ANS: D Because diagnostic testing for heartburn that is probably caused by gastroesophageal reflux disease (GERD) is expensive and uncomfortable, proton pump inhibitors are frequently used for a short period as the first step in the diagnosis of GERD. The other tests may be used but are not usually the first step in diagnosis.
10. A patient who recently has been experiencing frequent heartburn is seen in the clinic. The nurse will anticipate teaching the patient about a. barium swallow. b. radionuclide tests. c. endoscopy procedures. d. proton pump inhibitors.
ANS: C This response is open-ended and will encourage the patient to further discuss feelings of anxiety or sadness about the diagnosis. Patients with esophageal cancer have only a low survival rate, so the response "You may have quite a few years still left to live" is misleading. The response beginning, "Thinking about dying" indicates that the nurse is not open to discussing the patient's fears of dying. And the response beginning, "It is important that you be realistic," discourages the patient from feeling hopeful, which is important to patients with any life-threatening diagnosis.
11. A 62-year-old patient who has been diagnosed with esophageal cancer tells the nurse, "I know that my chances are not very good, but I do not feel ready to die yet." Which response by the nurse is most appropriate? a. "You may have quite a few years still left to live." b. "Thinking about dying will only make you feel worse." c. "Having this new diagnosis must be very hard for you." d. "It is important that you be realistic about your prognosis."
ANS: D Elevating the head of the bed will reduce the incidence of reflux while the patient is sleeping. Peppermint will lower LES pressure and increase the chance for reflux. Small, frequent meals are recommended to avoid abdominal distention. There is no need to make changes in physical activities because of GERD.
12. Which information will the nurse include when teaching a patient with newly diagnosed gastroesophageal reflux disease (GERD)? a. "Peppermint tea may be helpful in reducing your symptoms." b. "You should avoid eating between meals to reduce acid secretion." c. "Vigorous physical activities may increase the incidence of reflux." d. "It will be helpful to keep the head of your bed elevated on blocks."
ANS: A Elevation of the head of the bed decreases the risk for reflux and aspiration of gastric secretions. The NG tube should not be repositioned without consulting with the health care provider. Bloody NG drainage is expected for the first 8 to 12 hours. A swallowing study is needed before oral fluids are started.
13. A patient has just arrived on the postoperative unit after having a laparoscopic esophagectomy for treatment of esophageal cancer. Which nursing action should be included in the postoperative plan of care? a. Elevate the head of the bed to at least 30 degrees. b. Reposition the nasogastric (NG) tube if drainage stops or decreases. c. Notify the doctor immediately about bloody NG drainage. d. Start oral fluids when the patient has active bowel sounds.
ANS: C Endoscopic and laparoscopic procedures are the most effective therapy for improving symptoms caused by achalasia. Patients are advised to drink fluid with meals. Keeping the head elevated after eating will improve esophageal emptying. A semisoft diet is recommended to improve esophageal emptying.
14. The nurse will plan to teach the patient with newly diagnosed achalasia that a. a liquid or blenderized diet will be necessary. b. drinking fluids with meals should be avoided. c. endoscopic procedures may be used for treatment. d. lying down and resting after meals is recommended.
ANS: D Use of an NSAID is associated with damage to the gastric mucosa, which can result in acute gastritis. Family history, recent weight gain or loss, and fatty foods are not risk factors for acute gastritis.
15. A patient who is nauseated and vomiting up 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 fat in the diet. b. history of recent weight gain or loss. c. any family history of gastric problems. d. use of nonsteroidal anti-inflammatory drugs (NSAIDs).
ANS: A Cobalamin supplementation prevents the development of pernicious anemia. The incidence of stomach cancer is higher in patients with chronic gastritis, but cobalamin does not reduce the risk for stomach cancer. Chronic gastritis may cause achlorhydria, but cobalamin does not correct this. The loss of intrinsic factor secretion with chronic gastritis is permanent, and the patient will need lifelong supplementation with cobalamin.
16. Cobalamin injections have been prescribed for a patient with chronic atrophic gastritis. The nurse determines that teaching regarding the injections has been effective when the patient states, a. "The cobalamin injections will prevent me from becoming anemic." b. "These injections will increase the hydrochloric acid in my stomach." c. "These injections will decrease my risk for developing stomach cancer." d. "The cobalamin injections need to be taken until my inflamed stomach heals."
ANS: B The drugs used in triple drug therapy include a proton pump inhibitor such as omeprazole and the antibiotics amoxicillin and clarithromycin. The other combinations listed are not included in the protocol for H. pylori infection.
17. A patient with peptic ulcer disease associated with the presence of Helicobacter pylori is treated with triple drug therapy. The nurse will plan to teach the patient about a. sucralfate (Carafate), nystatin (Mycostatin), and bismuth (Pepto-Bismol). b. amoxicillin (Amoxil), clarithromycin (Biaxin), and omeprazole (Prilosec). c. famotidine (Pepcid), magnesium hydroxide (Mylanta), and pantoprazole (Protonix). d. metoclopramide (Reglan), bethanechol (Urecholine), and promethazine (Phenergan).
ANS: A Patients with bloody diarrhea should have a stool culture for E. coli O157:H7. NSAIDs may cause occult blood in the stools, but not diarrhea. Antidiarrheal medications usually are avoided for possible infectious diarrhea to avoid prolonging the infection. Antibiotic therapy in the treatment of infectious diarrhea is controversial because it may precipitate kidney complications.
18. A patient who has had several episodes of bloody diarrhea is admitted to the emergency department. Which action should the nurse anticipate taking? a. Obtain a stool specimen for culture. b. Administer antidiarrheal medications. c. Teach about adverse effects of nonsteroidal anti-inflammatory drugs (NSAIDs). d. Provide education about antibiotic therapy.
ANS: A Endoscopy is the primary tool for visualization and diagnosis of upper gastrointestinal (GI) bleeding. Angiography is used only when endoscopy cannot be done because it is more invasive and has more possible complications. Gastric analysis testing may help with determining the cause of gastric irritation, but it is not used for acute GI bleeding. Barium studies are helpful in determining the presence of gastric lesions, but not whether the lesions are actively bleeding.
19. A patient is hospitalized with vomiting of "coffee-ground" emesis. The nurse will anticipate preparing the patient for a. endoscopy. b. angiography. c. gastric analysis testing. d. barium contrast studies.
ANS: B Clear liquids are usually the first foods started after a patient has been nauseated. Acidic foods such as orange juice, very hot foods, and coffee are poorly tolerated when patients have been nauseated.
2. A patient who has been NPO during treatment for nausea and vomiting caused by gastric irritation is to start oral intake. Which of these should the nurse offer to the patient? a. A glass of orange juice b. A dish of lemon gelatin c. A cup of coffee with cream d. A bowl of hot chicken broth
ANS: A Ranitidine is a histamine-2 (H2) receptor blocker, which decreases the secretion of gastric acid. The response beginning, "Ranitidine constricts the blood vessels" describes the effect of vasopressin. The response beginning "Ranitidine neutralizes the acid" describes the effect of antacids. And the response beginning "Ranitidine covers the ulcer" describes the action of sucralfate (Carafate).
21. The health care provider orders intravenous (IV) ranitidine (Zantac) for a patient with gastrointestinal (GI) bleeding caused by peptic ulcer disease. When teaching the patient about the effect of the medication, which information will the nurse include? a. "Ranitidine decreases secretion of gastric acid." b. "Ranitidine neutralizes the acid in the stomach." c. "Ranitidine constricts the blood vessels in the stomach and decreases bleeding." d. "Ranitidine covers the ulcer with a protective material that promotes healing."
ANS: B Famotidine is administered to prevent the development of physiologic stress ulcers, which are associated with a major physiologic insult such as massive trauma. Famotidine does not decrease nausea or vomiting, prevent aspiration, or prevent H. pylori infection.
22. The family member of a patient who has suffered massive abdominal trauma in an automobile accident asks the nurse why the patient is receiving famotidine (Pepcid). The nurse will explain that the medication will a. prevent aspiration of gastric contents. b. inhibit the development of stress ulcers. c. lower the chance for H. pylori infection. d. decrease the risk for nausea and vomiting.
ANS: A The purpose for antacids is to increase gastric pH. Checking gastric pH is the most direct way of evaluating the effectiveness of the medication. Arterial blood gases may change slightly, but this does not directly reflect the effect of antacids on gastric pH. Because the patient has upper gastrointestinal (GI) bleeding, occult blood in the stools will appear even after the acute bleeding has stopped. The amount of residual stomach contents is not a reflection of resolution of bleeding or of gastric pH.
23. A patient with a bleeding duodenal ulcer has a nasogastric (NG) tube in place, and the health care provider orders 30 mL of aluminum hydroxide/magnesium hydroxide (Maalox) to be instilled through the tube every hour. To evaluate the effectiveness of this treatment, the nurse a. periodically aspirates and tests gastric pH. b. monitors arterial blood gas values on a daily basis. c. checks each stool for the presence of occult blood. d. measures the amount of residual stomach contents hourly.
ANS: B The patient's symptoms suggest acute perforation, and the nurse should assess for signs of hypovolemic shock. Irrigation of the NG tube, administration of antacids, or both would be contraindicated because any material in the stomach will increase the spillage into the peritoneal cavity. The nurse should assess the bowel sounds, but this is not the first action that should be taken.
24. A patient with a peptic ulcer who has a nasogastric (NG) tube develops sudden, severe upper abdominal pain, diaphoresis, and a very firm abdomen. Which action should the nurse take next? a. Irrigate the NG tube. b. Obtain the vital signs. c. Listen for bowel sounds. d. Give the ordered antacid.
ANS: A Increased pain and 200 mL of bright red NG drainage 12 hours after surgery indicate possible postoperative hemorrhage, and immediate actions such as blood transfusion and/or return to surgery are needed. Because the NG is draining, there is no indication that irrigation is needed. The patient may need morphine, but this is not the highest priority action. Continuing to monitor the NG drainage is not an adequate response.
25. Twelve hours after undergoing a gastroduodenostomy (Billroth I), a patient complains of increasing abdominal pain. The patient has absent bowel sounds and 200 mL of bright red nasogastric (NG) drainage in the last hour. The most appropriate action by the nurse at this time is to a. notify the surgeon. b. irrigate the NG tube. c. administer the prescribed morphine. d. continue to monitor the NG drainage.
ANS: C Cobalamin deficiency may occur after partial gastrectomy, and the patient may need to receive cobalamin via injections or nasal spray. Foods that have moderate fat and low carbohydrate should be chosen to prevent dumping syndrome. Ingestion of liquids with meals is avoided to prevent dumping syndrome. Although peptic ulcer disease may recur, persistent heartburn is not expected after surgery and the patient should call the health care provider if this occurs.
26. The nurse implements discharge teaching for a patient following a gastroduodenostomy for treatment of a peptic ulcer. Which patient statement indicates that the teaching has been effective? a. "Persistent heartburn is expected after surgery." b. "I will try to drink liquids along with my meals." c. "Vitamin supplements may be needed to prevent problems with anemia." d. "I will need to choose foods that are low in fat and high in carbohydrate."
ANS: A The patient is experiencing symptoms of dumping syndrome, which may be reduced by lying down after eating. Increasing fluid intake and choosing high carbohydrate foods will increase the risk for dumping syndrome. Having a sweet drink or hard candy will correct the hypoglycemia that is associated with dumping syndrome but will not prevent dumping syndrome.
27. A patient recovering from a gastrojejunostomy (Billroth II) for treatment of a duodenal ulcer develops dizziness, weakness, and palpitations about 20 minutes after eating. To avoid recurrence of these symptoms, the nurse teaches the patient to a. lie down for about 30 minutes after eating. b. choose foods that are high in carbohydrates. c. increase the amount of fluid intake with meals. d. drink sugared fluids or eat candy after each meal.
ANS: D Misoprostol, a prostaglandin analog, reduces acid secretion and incidence of upper GI bleeding associated with NSAID use. Enteric coating of NSAIDs does not reduce the risk for GI bleeding. Corticosteroids increase the risk for ulcer development and will not be substituted for NSAIDs for this patient. Acetaminophen will not be effective in treating the patient's rheumatoid arthritis.
28. A patient who requires daily use of a nonsteroidal anti-inflammatory drug (NSAID) for management of severe rheumatoid arthritis has recently developed melena. The nurse will anticipate teaching the patient about a. substitution of acetaminophen (Tylenol) for the NSAID. b. use of enteric-coated NSAIDs to reduce gastric irritation. c. reasons for using corticosteroids to treat the rheumatoid arthritis. d. the benefits of misoprostol (Cytotec) in protecting the gastrointestinal (GI) mucosa.
ANS: C Sucralfate is most effective when the pH is low and should not be given with or soon after antacid. Antacids are most effective when taken after eating. Administration of sucralfate 30 minutes before eating and antacids just after eating will ensure that both drugs can be most effective. The other regimens will decrease the effectiveness of the medications.
29. The health care provider prescribes antacids and sucralfate (Carafate) for treatment of a patient's peptic ulcer. The nurse will teach the patient to take a. antacids 30 minutes before the sucralfate. b. sucralfate at bedtime and antacids before meals. c. antacids after eating and sucralfate 30 minutes before eating. d. sucralfate and antacids together 30 minutes before each meal.
ANS: A The best information is that each individual should choose foods that are not associated with postprandial discomfort. Raw fruits and vegetables may irritate the gastric mucosa, but chewing well seems to decrease this and some patients may tolerate these well. High-protein foods help to neutralize acid, but they also stimulate hydrochloric (HCl) acid secretion and may increase discomfort for some patients. Bland diets may be recommended during an acute exacerbation of PUD, but there is little scientific evidence to support their use.
30. Which information will be best for the nurse to include when teaching a patient with peptic ulcer disease (PUD) about dietary management of the disease? a. "Avoid foods that cause pain after you eat them." b. "High-protein foods are least likely to cause pain." c. "You will need to remain on a bland diet indefinitely." d. "You should avoid eating many raw fruits and vegetables."
ANS: D The patient data indicate a poor nutritional state and improvement in nutrition will be helpful in improving response to therapies such as surgery, chemotherapy, or radiation. Nausea and vomiting are not common clinical manifestations of stomach cancer. There is no indication that the patient requires hospice or IV fluid infusions.
31. A patient with a recent 20-pound unintended weight loss is diagnosed with stomach cancer. Which nursing action will be included in the plan of care? a. Refer the patient for hospice services. b. Infuse IV fluids through a central line. c. Teach the patient about antiemetic therapy. d. Offer supplemental feedings between meals.
ANS: A Smoked foods such as bacon, ham, and smoked sausage increase the risk for stomach cancer. Use of H2 blockers, stressful situations, and abdominal distention are not associated with an increased incidence of stomach cancer.
32. When counseling a patient with a family history of stomach cancer about ways to decrease risk for developing stomach cancer, the nurse will teach the patient to avoid a. smoked foods such as bacon and ham. b. foods that cause abdominal distention. c. chronic use of H2 blocking medications. d. emotionally or physically stressful situations.
ANS: D An elevation in temperature may indicate leakage at the anastomosis, which may require return to surgery or keeping the patient NPO. The other findings are expected in the immediate postoperative period for patients who have this surgery.
33. Which assessment finding in a patient who had a total gastrectomy 12 hours previously is most important to report to the health care provider? a. Absent bowel sounds b. Scant nasogastric (NG) tube drainage c. Complaints of incisional pain d. Temperature 102.1° F (38.9° C)
ANS: B A lethargic patient is at risk for aspiration, and the nurse will need to position the patient to decrease aspiration risk. The other information also is important to collect, but it does not require as quick action as the risk for aspiration.
34. Which information about a patient who has just been admitted to the hospital with nausea and vomiting will require the most rapid intervention by the nurse? a. The patient has taken only sips of water. b. The patient is lethargic and difficult to arouse. c. The patient's chart indicates a recent resection of the small intestine. d. The patient has been vomiting several times a day for the last 4 days.
ANS: A Because the patient has severe dehydration, rehydration with IV fluids is the priority. The other orders should be accomplished as quickly as possible after the IV fluids are initiated.
36. The health care provider prescribes the following therapies for a patient who has been admitted with dehydration and hypotension after 3 days of nausea and vomiting. Which order will the nurse implement first? a. Infuse normal saline at 250 mL/hr. b. Administer IV ondansetron (Zofran). c. Provide oral care with moistened swabs. d. Insert a 16-gauge nasogastric (NG) tube.
ANS: C The patient's history and blood pressure indicate possible hemodynamic instability caused by GI bleeding. The data about the other patients do not indicate acutely life-threatening complications.
37. After receiving change-of-shift report, which patient should the nurse assess first? a. A patient who was admitted yesterday with gastrointestinal (GI) bleeding and has melena b. A patient who is crying after receiving a diagnosis of esophageal cancer c. A patient with esophageal varices who has a blood pressure of 96/54 mm Hg d. A patient with nausea who has a dose of metoclopramide (Reglan) scheduled
ANS: B Decreased breath sounds on one side may indicate a pneumothorax, which requires rapid diagnosis and treatment. The abdominal pain and nausea also should be addressed but they are not as high priority as the patient's respiratory status. The patient's decreased bowel sounds are expected after surgery and require ongoing monitoring but no other action.
38. Which of these assessment findings in a patient with a hiatal hernia who returned from a laparoscopic Nissen fundoplication 4 hours ago is most important for the nurse to address immediately? a. The patient is experiencing intermittent waves of nausea. b. The patient has absent breath sounds throughout the left lung. c. The patient has decreased bowel sounds in all four quadrants. d. The patient complains of 6/10 (0 to 10 scale) abdominal pain.
ANS: D The nurse is concerned about blood loss and possible hypovolemic shock in a patient with acute gastrointestinal (GI) bleeding; BP and pulse are the best indicators of these complications. The other information also is important to obtain, but BP and pulse rate are the best indicators for hypoperfusion.
39. A patient who is vomiting bright red blood is admitted to the emergency department. Which assessment should the nurse perform first? a. Checking the level of consciousness b. Measuring the quantity of any emesis c. Auscultating the chest for breath sounds d. Taking the blood pressure (BP) and pulse
ANS: D Because the patient has vomited a large amount of blood, correction of hypovolemia and prevention of hypovolemic shock are the priorities. The other actions also are important to implement quickly but are not the highest priorities.
40. All of the following orders are received for a patient who has vomited 1500 mL of bright red blood. Which order will the nurse implement first? a. Insert a nasogastric (NG) tube and connect to suction. b. Administer intravenous (IV) famotidine (Pepcid) 40 mg. c. Draw blood for typing and crossmatching. d. Infuse 1000 mL of lactated Ringer's solution.
ANS: C The patient's lung sounds indicate that pulmonary edema may be developing as a result of the rapid infusion of IV fluid and that the fluid infusion rate should be slowed. The return of coffee-ground material in an NG tube is expected for a patient with upper GI bleeding. The BP is slightly elevated but would not be an indication to contact the health care provider immediately. Hyperactive bowel sounds are common when a patient has GI bleeding.
41. A patient with acute gastrointestinal (GI) bleeding is receiving normal saline IV at a rate of 500 mL/hr. Which assessment finding obtained by the nurse is most important to communicate immediately to the health care provider? a. The patient's blood pressure (BP) has increased to 142/94 mm Hg. b. The nasogastric (NG) suction is returning coffee-ground material. c. The patient's lungs have crackles audible to the midline. d. The bowel sounds are very hyperactive in all four quadrants.
ANS: D GERD is exacerbated by eating late at night, and the nurse should plan to teach the patient to avoid eating at bedtime. The other patient actions are appropriate to control symptoms of GERD.
6. The nurse is assessing a patient with gastroesophageal reflux disease (GERD) who is experiencing increasing discomfort. Which patient statement indicates that additional patient education about GERD is needed? a. "I take antacids between meals and at bedtime each night." b. "I sleep with the head of the bed elevated on 4-inch blocks." c. "I quit smoking several years ago, but I still chew a lot of gum." d. "I eat small meals throughout the day and have a bedtime snack."
ANS: C Because GERD may cause aspiration, the unconscious patient is at risk for developing aspiration pneumonia. Bowel sounds, abdominal girth, and apical pulse will not be affected by the patient's stroke or GERD and do not require more frequent monitoring than the routine.
7. When admitting a patient with a stroke who is unconscious and unresponsive to stimuli, the nurse learns from the patient's family that the patient has a history of gastroesophageal reflux disease (GERD). The nurse will plan to do frequent assessments of the patient's a. apical pulse. b. bowel sounds. c. breath sounds. d. abdominal girth.
ANS: D The proton pump inhibitors decrease the rate of gastric acid secretion. Promotility drugs such as metoclopramide (Reglan) increase the rate of gastric emptying. Cryoprotective medications such as sucralfate (Carafate) protect the stomach. Antacids neutralize stomach acid and work rapidly.
8. A patient with recurring heartburn receives a new prescription for esomeprazole (Nexium). In teaching the patient about this medication, the nurse explains that this drug a. neutralizes stomach acid and provides relief of symptoms in a few minutes. b. reduces the reflux of gastric acid by increasing the rate of gastric emptying. c. coats and protects the lining of the stomach and esophagus from gastric acid. d. treats gastroesophageal reflux disease by decreasing stomach acid production.
ANS: D Gelatin and fruit are low fat and will not decrease lower esophageal sphincter (LES) pressure. Foods like chocolate are avoided because they lower LES pressure. Milk products increase gastric acid secretion. High-fat foods such as peanut butter decrease both gastric emptying and LES pressure.
9. After the nurse teaches a patient with gastroesophageal reflux disease (GERD) about recommended dietary modifications, which diet choice for a snack 2 hours before bedtime indicates that the teaching has been effective? a. Chocolate pudding b. Glass of low-fat milk c. Peanut butter sandwich d. Cherry gelatin and fruit
4 (A rigid abdomen with vomiting in a patient who has a gastric ulcer indicates a perforation of the ulcer, especially if the manifestations of perforation appear suddenly. Midepigastric pain is relieved by eating, drinking water, or antacids with duodenal ulcers, not gastric ulcers. Back pain three to four hours after a meal is more likely to occur with a duodenal ulcer. Burning epigastric pain one to two hours after a meal is from an expected manifestation with a gastric ulcer related to increased gastric secretions and does not cause an urgent change in the nursing plan of care. )
A 72-year-old patient was admitted with epigastric pain caused by a gastric ulcer. Which patient assessment warrants an urgent change in the nursing plan of care? 1 Chest pain relieved with eating or drinking water 2 Back pain three or four hours after eating a meal 3 Burning epigastric pain 90 minutes after breakfast 4 Rigid abdomen and vomiting following indigestion
Correct answer: C There is a potential link between proton pump inhibitors (PPIs) (e.g., omeprazole) use and bone metabolism. Long-term use or high doses of PPIs may increase the risk of fractures of the hip, wrist, and spine
A 74-yr-old female patient with osteoporosis is diagnosed with gastroesophageal reflux disease (GERD). Which over-the-counter medication to treat GERD should be used with caution? a. Sucralfate b. Cimetidine c. Omeprazole d. Metoclopramide
1, 4, 5 (Nicotine, a component of cigarettes, causes gastric irritation, and therefore smoking should be avoided by those with peptic ulcers. Washing hands thoroughly with soap after using the restroom and before eating would help prevent the Helicobacter pylori infection that causes peptic ulcers. Any symptom of gastric irritation such as nausea and epigastric pain must be reported to the health care provider to prevent lethal consequences of peptic ulcer disease. Consumption of raw uncooked food increases the chance of H. pylori infection; therefore, it should be avoided. NSAIDs should not be taken over a long period of time, because they are a potent gastric irritant. )
A nurse is teaching a patient about prevention of peptic ulcers. What instructions should the nurse give the patient? Select all that apply. 1 Avoid smoking. 2 Consume raw uncooked food. 3 Use nonsteroidal antiinflammatory drugs (NSAIDs) for treatment of pain. 4 Wash hands thoroughly with soap after using the restroom and before eating. 5 Report symptoms of gastric irritation, such as nausea and epigastric pain, to the health care provider
correct answer a Extrapyramidal side effects, including tremors and tardive dyskinesias, may occur with metoclopramide administration. Constipation, double vision, and numbness in fingers and toes are not adverse effects of metoclopramide.
A patient complaining of nausea receives a dose of metoclopramide. Which potential adverse effect should the nurse tell the patient to report? a Tremors b Constipation c Double vision d Numbness in fingers and toes
correct answer c Eating smaller meals during the day will decrease the gastric pressure and symptoms of hiatal hernia. Keeping the patient NPO or in a Trendelenburg position is not safe or realistic for a long period of time for any patient. Varying antacids will only be done with the health care provider's prescription, so this is not a nursing intervention.
A patient has a sliding hiatal hernia. What nursing intervention will reduce the symptoms of heartburn and dyspepsia? a Keeping the patient NPO b Putting the bed in the Trendelenburg position c Having the patient eat 4 to 6 smaller meals each day Correct d Giving various antacids to determine which one works for the patient
2 (Perforation results in spillage of gastric or duodenal contents into the upper peritoneal cavity. The patient experiences sudden upper abdominal pain because the spillage causes irritation of pain receptors in the visceral and parietal layers of the peritoneum. The body then attempts to protect the area by contracting the abdominal muscles, resulting in a rigid, boardlike abdomen. Pyrosis, a painful and burning sensation in the esophagus, just below the breastbone, is usually associated with regurgitation of gastric acid, also known as heartburn. Bright-red emesis may be present as a result of hemorrhage from the gastric ulcer but is not as common as the rigid, boardlike abdomen. Clay-colored stools are associated with hepatic disease, such as hepatitis, not gastric ulcer perforation. )
A patient has what is suspected to be a gastric ulcer perforation. Which symptom does the nurse expect will be present? 1 Pyrosis 2 Rigid abdomen 3 Bright-red emesis 4 Clay-colored stools
4 (The immediate focus of management for a patient with a perforation is to stop the spillage of gastric or duodenal contents into the peritoneal cavity and restore blood volume. An NG tube is inserted into the stomach to provide continuous aspiration and gastric decompression to stop spillage through the perforation and thereby prevent peritonitis. Administering nitrates to such a patient will not be helpful in relieving the condition. Administration of pain medications and preparations for laparoscopic surgery are done later. )
A patient is admitted to the hospital with a severe duodenal ulcer. The patient suddenly complains of severe pain spreading over the entire abdomen, likely due to a perforation. What should be the most immediate intervention by the nurse, if prescribed? 1 Administer nitrates. 2 Administer pain medication. 3 Prepare for laparoscopic surgery. 4 Insert a nasogastric (NG) tube into the stomach.
correct answer:b Because of this patient's history of excessive alcohol intake, smoking, and hemoptysis and the current choking episode, cancer may be present. A biopsy is necessary to make a definitive diagnosis of carcinoma, so an endoscope will be used to obtain a biopsy and observe other abnormalities as well. A barium swallow may show narrowing of the esophagus, but it is more diagnostic for achalasia. An endoscopic ultrasonography may be used to stage esophageal cancer. Capsule endoscopy can show alterations in the esophagus but is more often used for small intestine problems. A barium swallow, capsule endoscopy, and endoscopic ultrasonography cannot provide a definitive diagnosis for
A patient is seeking emergency care after choking on a piece of steak. The nursing assessment reveals a history of alcoholism, cigarette smoking, and hemoptysis. Which diagnostic study is most likely to be performed on this patient? a Barium swallow b Endoscopic biopsy c Capsule endoscopy d Endoscopic ultrasonography
4 (Diffuse superficial mucosal injury or discrete deeper ulcers in the fundus and body portions of the stomach indicate stress-related mucosal disease (SRMD), which may occur as a complication of major trauma or burns. Gastric ulcers are characterized by burning or gaseous pain in the epigastric region. Duodenal ulcers are characterized by burning or cramplike pain in mid-epigastric region. Stomach cancer is characterized by early satiety, abdominal pain, and weight loss.)
A patient presents with severe abdominal burns. Diagnostic tests reveal a discrete, deep ulcer in the fundus of the stomach. The nurse expects that the patient will be diagnosed with what? 1 Gastric ulcer 2 Duodenal ulcer 3 Stomach cancer 4 Stress-related mucosal disease (SRMD)
2 (A tissue biopsy involves examining tissue removed from the stomach to detect gastric carcinoma. Radiology is not the best method because superficial mucosa is generally involved and changes will not show up clearly on x-ray examination. Rapid urease testing is used to detect the presence of urease in Helicobacter pylori infections. An endoscopic ultrasound is used to stage the disease of stomach cancer.)
A patient presents with suspected gastric carcinoma. The nurse anticipates that what diagnostic test will be prescribed? 1 Radiology 2 Tissue biopsy 3 Rapid urease testing 4 Endoscopic ultrasound
2 (Coffee ground vomitus indicates that blood has been in the stomach for some time, which is a manifestation of hematemesis (a type of upper gastrointestinal bleeding). Melena is characterized by black tarry stools caused by digestion of blood in the gastrointestinal (GI) tract. Occult bleeding requires a guaiac test for detection. A Mallory-Weiss tear indicates esophageal bleeding.)
A patient presents with upper gastrointestinal (GI) bleeding. During the patient's assessment, the nurse notes coffee ground vomitus. How should the nurse classify the finding? 1 Melena 2 Hematemesis 3 Occult bleeding 4 Mallory-Weis tear
correct answer d A rigid abdomen with vomiting in a patient who has a gastric ulcer indicates a perforation of the ulcer, especially if the manifestations of perforation appear suddenly. Midepigastric pain is relieved by eating, drinking water, or antacids with duodenal ulcers, not gastric ulcers. Back pain 3 to 4 hours after a meal is more likely to occur with a duodenal ulcer. Burning epigastric pain 1 to 2 hours after a meal is an expected manifestation of a gastric ulcer related to increased gastric secretions and does not cause an urgent change in the nursing plan of care.
A patient was admitted with epigastric pain because of a gastric ulcer. Which patient assessment warrants an urgent change in the nursing plan of care? a Back pain 3 or 4 hours after eating a meal b Chest pain relieved with eating or drinking water c Burning epigastric pain 90 minutes after breakfast d Rigid abdomen and vomiting following indigestion
Correct 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
A patient with a history of peptic ulcer disease has presented to the emergency department with severe abdominal pain and a rigid, boardlike abdomen. The health care provider suspects a perforated ulcer. Which interventions should the nurse anticipate? a. Providing IV fluids and inserting a nasogastric (NG) tube Correct 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 a high-Fowler's position Incorrect
3 (The appearance of blood exposed to hydrochloric acid and other digestive enzymes in the stomach is dark brown with a coffee-ground consistency. This should be reported by the nurse. Fecal vomitus would be experienced with a total bowel obstruction. Bilious vomitus or undigested food may be seen with various gastrointestinal disturbances, such as gallbladder disease, gastroenteritis, or gastritis. )
A patient with a peptic ulcer begins vomiting. The nurse would expect and be concerned with which type of vomitus? 1 Fecal 2 Bilious 3 "Coffee ground" 4 Undigested food
correct answer a The goal for a patient with oral cancer that is not eating would be to note weight gain rather than loss. Consuming 50% of the clear liquid tray is not a realistic goal. Administering feedings, monitoring tube placement, and tolerance are interventions used to achieve the goal.
A patient with oral cancer is not eating. A small-bore feeding tube was inserted and the patient started on enteral feedings. Which patient goal would indicate improvement? a Weight gain of 1 kg in 1 week b Administer tube feeding at 25 mL/hr. c Consume 50% of clear liquid tray this shift. d Monitor for tube for placement and gastrointestinal residual
2 (Weight loss, dumping syndrome, and impaired wound healing are all consequences of a total gastrectomy. Total gastrectomy involves the resection of the lower esophagus, removal of the entire stomach, and anastomosis of the esophagus to the jejunum. Pyloroplasty consists of surgical enlargement of the pyloric sphincter to facilitate the easy passage of contents from the stomach. Partial gastrectomy involves the removal of two-thirds of the stomach and anastomosis of the gastric stump to the duodenum or jejunum. Esophagojejunostomy is the anastomosis of the esophagus with the jejunum.)
A patient with stomach cancer presents with weight loss, dumping syndrome, and impaired wound healing. The nurse suspects that which surgical treatment may have caused the patient's symptoms? 1 Pyloroplasty 2 Total gastrectomy 3 Partial gastrectomy 4 Esophagojejunostomy
3 (Metoclopramide is classified as a cholinergic and antiemetic medication. If it is effective, the patient's nausea should resolve. Metoclopramide is not effective in the treatment of migraine, vertigo, or diarrhea. )
After administering a dose of metoclopramide to the patient, the nurse determines that the medication has not been effective when which symptom is noted? 1 Migraine headache 2 Vertigo 3 Vomiting 4 Diarrhea
correct: b Although being given to this patient as an antiemetic, promethazine also has sedative and amnesic properties. For this reason, the patient is likely to experience drowsiness as an adverse effect of the medication. Tinnitus, reduced hearing, and loss of balance are not side effects of promethazine.
After administering a dose of promethazine to a patient with nausea and vomiting, what medication side effect does the nurse explain is common and expected? a Tinnitus b Drowsiness c Reduced hearing d Sensation of falling
3 (Although being given to this patient as an antiemetic, promethazine also has sedative and amnesic properties. For this reason, the patient is likely to experience drowsiness as an adverse effect of the medication. Urinary retention, tinnitus, and a sensation of falling are not considered common adverse effects of promethazine. )
After administering a dose of promethazine, the nurse explains that which common temporary adverse effect may occur? 1 Urinary retention 2 Tinnitus 3 Drowsiness 4 Sensation of falling
Correct answer: C Metoclopramide is classified as a prokinetic and antiemetic medication. If it is effective, the patient's nausea and vomiting should resolve. Metoclopramide does not affect blood pressure, muscle tremors, or diarrhea.
After administration of a dose of metoclopramide, which patient assessment finding would show the medication was effective? a. Decreased blood pressure b. Absence of muscle tremors c. Relief of nausea and vomiting d. No further episodes of diarrhea
1 (To prevent dumping syndrome after gastrectomy, the patient should avoid large meals, instead dividing meals into six small meals to avoid overloading the intestines at mealtimes. Fluids should not be taken with meals. Fluids can be taken at least 30 to 45 minutes before or after meals. This helps prevent distension or a feeling of fullness. Concentrated sweets should be avoided because they sometimes cause dizziness, diarrhea, and a sense of fullness. Protein and fats should be increased in the diet to help rebuild body tissue and to meet energy needs. )
Following a gastrectomy performed for peptic ulcer disease, the patient has recovered and is ready for discharge. What instructions should the nurse include in discharge teaching to prevent dumping syndrome? 1 Divide meals into six small feedings. 2 Take fluids along with meals. 3 Use concentrated sweets like honey, jam, and jelly. 4 Reduce protein and fats in the diet.
3 (Metoclopramide (Reglan) is classified as a prokinetic and antiemetic medication. If it is effective, the patient's nausea and vomiting should resolve. Metoclopramide does not affect blood pressure, muscle tremors, or diarrhea. )
Following administration of a dose of metoclopramide (Reglan) to the patient, the nurse determines that the medication has been effective when what is noted? 1 Decreased blood pressure 2 Absence of muscle tremors 3 Relief of nausea and vomiting 4 No further episodes of diarrhea
3 (H. pylori infection is highest in underdeveloped countries and in people of low socioeconomic status. Infection likely occurs during childhood with transmission from family members to the child, possibly through a fecal-oral or oral-oral route. Syphilis, cytomegalovirus, and Mycobacterium species also are causes of chronic gastritis, but are not as common as H. pylori. )
Linked to stomach cancer and non-Hodgkin's lymphoma, what is a common cause of gastritis? 1 Syphilis 2 Cytomegalovirus 3 Helicobacter pylori 4 Mycobacterium species
correct answer c Famotidine is an H2-receptor antagonist that inhibits parietal cell output of HCl acid and minimizes damage to gastric mucosa related to hyperacidity, thus relieving epigastric pain. It is not indicated for nausea, belching, and dysphagia.
The nurse determines a patient has experienced the beneficial effects of therapy with famotidine when which symptom is relieved? Nausea Belching Epigastric pain Difficulty swallowing
4 (Nonsteroidal antiinflammatory drugs (NSAIDs) may disrupt the production of prostaglandins, which are required for the protection of the stomach's mucosal lining, and result in upper gastrointestinal bleeding. Antacids are used as an adjunct therapy for the treatment of peptic ulcers. Anticholinergic drugs are used occasionally to treat peptic ulcer disease. Tricyclic antidepressants are used to reduce gastric acid secretions associated with peptic ulcer disease.)
The nurse identifies that a patient is at risk for upper gastrointestinal bleeding based on the patient's history of taking medications in what drug class? 1 Antacids 2 Anticholinergics 3 Tricyclic antidepressants 4 Nonsteroidal anti-inflammatory drugs (NSAIDs)
3 (Radiation therapy is concurrently used with chemotherapy to reduce recurrence and as a palliative measure to decrease tumor mass. This combination therapy provides temporary relief of obstruction. Endoscopic ultrasounds and computed tomography are used to stage the disease. Biopsies are used to perform a histologic examination. Peritoneal spread of cancer is determined by laparoscopy.)
The nurse identifies that radiation therapy is used concurrently with chemotherapy for cancer treatment for what reason? 1 To stage the disease 2 To examine histology 3 To reduce tumor mass 4 To determine peritoneal spread
4 (Vomitus with a "coffee ground" appearance is related to gastric bleeding, in which blood changes to dark brown as a result of its interaction with hydrochloric acid. The primary health care provider needs to be notified immediately about this change in the patient's condition. Asking the patient about the timing of the last meal and monitoring the patient are appropriate, but not the priority. The nurse should not offer water just in case the patient may have to have a diagnostic study that requires nothing by mouth (NPO) status. )
The nurse is assisting a patient who has been admitted with severe abdominal pain. Suddenly, the patient vomits a large amount of emesis that looks similar to coffee grounds. Which action by the nurse is a priority? 1 Ask the patient about the timing of the last meal. 2 Offer the patient sips of water to prevent dehydration. 3 Monitor the patient for any further episodes of nausea and vomiting. 4 Notify the primary health care provider about the patient's condition.
Correct answer:b Dry toast or crackers may alleviate the feeling of nausea and prevent further vomiting. Water is the initial fluid of choice. Extremely hot or cold liquids and fatty foods are generally not well tolerated.
The nurse is caring for a patient treated with IV fluid therapy for severe vomiting. As the patient recovers and begins to tolerate oral intake, which food choice would be most appropriate? Iced tea Dry toast Hot coffee Plain yogurt
2 (Dry toast or crackers may alleviate the feeling of nausea and prevent further vomiting. Water is the initial fluid of choice. Extremely hot (hot coffee) or cold liquids (iced tea) and fatty foods (hamburgers) generally are not well tolerated. )
The nurse is caring for a patient treated with intravenous (IV) fluid therapy for severe vomiting. As the patient recovers and begins to tolerate oral intake, the nurse understands that which food choice would be most appropriate? 1 Iced tea 2 Dry toast 3 Hot coffee 4 Plain hamburger
Correct Answer: a A patient with hematemesis has some degree of bleeding from an unknown source. Guaiac-positive diarrhea stools would be an expected finding. When monitoring the patient for stability, the nurse observes for signs of hypovolemic shock such as tachycardia, tachypnea, hypotension, altered level of consciousness, pallor, and cool and clammy skin. An ecchymotic peripheral IV site will require assessment to determine the need for reinsertion. Access would be critical in the immediate treatment of shock, but the ecchymotic site does not represent a decline in condition.
The nurse is caring for a patient who complains of abdominal pain and hematemesis. Which new assessment finding(s) would indicate the patient is experiencing a decline in condition? a. Pallor and diaphoresis b. Ecchymotic peripheral IV site c. Guaiac-positive diarrhea stools d. Heart rate 90, respiratory rate 20, BP 110/60
3 (Tachycardia, lower abdomen pain, nausea, and vomiting are the clinical manifestations of perforation, a complication of peptic ulcer disease. A laparoscopy involves a simple closure with an omentum graft, which will repair the perforation with appropriate source control and limit the parietal cell acid secretion. Billroth I involves a partial gastrectomy where two-thirds of the stomach is removed and there is an anastomosis of the gastric stump to the duodenum. A vagotomy involves severing the vagus nerve either totally or selectively. Pyloroplasty consists of surgical enlargement of the pyloric sphincter. )
The nurse is caring for a patient who presents with tachycardia, lower abdominal pain, and nausea and vomiting. Upon clinical examination, the primary health care provider identifies a rigid and board-like abdomen. Which surgical therapy is beneficial for the patient? 1 Billroth I 2 Vagotomy 3 Laparoscopy 4 Pyloroplasty
Correct answer: b Cleansing the face and hands with a cool washcloth and providing mouth care are appropriate comfort interventions for nausea and vomiting. Ginseng is not used to treat postoperative nausea and vomiting. Unnecessary activity should be avoided. The patient should rest in a quiet environment. Medications may be temporarily withheld until the acute phase is over, but the medications should not be discontinued without consultation with the health care provider.
The nurse is caring for a postoperative patient who has just vomited yellow green liquid and reports nausea. Which action would be an appropriate nursing intervention? a. Offer the patient an herbal supplement such as ginseng. b. Apply a cool washcloth to the forehead and provide mouth care. c, Take the patient for a walk in the hallway to promote peristalsis. d. Discontinue any medications that may cause nausea or vomiting. TERM
1, 4 (Patients with stomach cancer experience weight loss, dyspepsia, and intestinal gas discomfort. Asking the patient about blood transfusions in the past, whether the patient has illnesses like liver cirrhosis, and if the patient has a religious preference that prohibits the use of blood will help in the assessment of upper gastrointestinal bleeding and other conditions, but they are not specific to stomach cancer. )
The nurse is conducting a health interview for a patient with suspected stomach cancer. Which questions are relevant in determining the diagnosis? Select all that apply. 1 "Do you experience unexplained weight loss?" 2 "Have you received blood transfusions in the past?" 3 "Do you have other illnesses, such as liver cirrhosis?" 4 "Do you have dyspepsia or intestinal gas discomfort?" 5 "Do you have a religious preference that prohibits the use of blood?"
3 (The symptoms of duodenal ulcers occur when gastric acid comes in contact with the ulcers. With meal ingestion, food is present to help buffer the acid. Symptoms of duodenal ulcers occur generally two to five hours after a meal. The pain is described as "burning" or "cramplike." It most often is located in the midepigastric region beneath the xiphoid process. Duodenal ulcers also can produce back pain. The discomfort generally associated with gastric ulcers is located high in the epigastrium and occurs about one to two hours after meals. The pain is described as "burning" or "gaseous." If the ulcer has eroded through the gastric mucosa, food tends to aggravate rather than alleviate the pain. For some patients, the earliest symptoms are caused by a serious complication, such as perforation. Pain and burning two to five hours after meals are not symptoms of esophagitis or chronic gastritis. A patient with a gastric ulcer will experience pain one to two hours after meals. )
The nurse is obtaining a health history from a patient who comes to the office for evaluation of gastric distress. The patient indicates that the symptoms occur two to five hours after meals, and the pain is "burning" and sometimes like a cramp in the midepigastric region, just below the xiphoid process. Based on these descriptions, the nurse suspects that the patient has which disorder? 1 Esophagitis 2 Gastric ulcer 3 Duodenal ulcer 4 Chronic gastritis
d The student who did not accept the pink hamburger and asked for a new bun and clean plate understood that the pink meat may not have reached 160°F and could be contaminated with bacteria. Improperly storing cooked foods, eating raw cookie dough from a refrigerated package, and only using one cutting board without washing it with hot soapy water between the chicken and salad vegetables could all lead to food poisoning from contamination.
The nurse is teaching a group of college students how to prevent food poisoning. Which comment shows an understanding of foodborne illness protection? a "Eating raw cookie dough from the package is a great snack when you do not have time to bake." b "Since we only have one cutting board, we can cut up chicken and salad vegetables at the same time." c "To save refrigerator space, leftover food can be kept on the counter if it is in sealed containers." d "When the cafeteria gave me a pink hamburger, I sent it back and asked for a new bun and clean plate."
Correct answer: a Drink only pasteurized milk, juice, or cider. Ground beef should be cooked thoroughly. Browned meat can still harbor live bacteria. Cook ground beef until a thermometer reads at least 160° F. If a thermometer is unavailable, decrease the risk of illness by cooking the ground beef until there is no pink color in the middle. Fruits and vegetables should be washed thoroughly, especially those that will not be cooked. Persons who are immunocompromised or older should avoid eating alfalfa sprouts until the safety of the sprouts can be ensured.
The nurse teaches senior citizens at a community center how to prevent food poisoning at social events. Which community member statement reflects accurate understanding? a. "Pasteurized juices and milk are safe to drink." b. "Alfalfa sprouts are safe if rinsed before eating." c. "Fresh fruits do not need to be washed before eating." d. "Ground beef is safe to eat if cooked until it is brown."
2
The patient has a new prescription to receive omeprazole 20 mg daily. Available are 40 mg tablets. How many tablets should the nurse administer? 1 0.25 tablet 2 0.5 tablet 3 1.5 tablets 4 2 tablets
3 (30 mL)
The patient has a prescription for amoxicillin 750 mg by mouth. Available is 125 mg/5 mL. How many milliliters should the nurse administer? 1 0.3 mL 2 13 mL 3 30 mL 4 3 mL
4 (Rabeprazole is a proton pump inhibitor that provides relief of gastric discomfort and heartburn by neutralizing gastric acid. This medication would not be effective in the treatment of abdominal pain, flatulence, or constipation. )
The patient has a prescription for rabeprazole. The nurse would assess the effectiveness of the medication by noting whether the patient obtained relief from which symptom? 1 Abdominal pain 2 Flatulence 3 Constipation 4 Heartburn
2 (Ondansetron is an antiemetic. The nurse would inquire as to its effectiveness in reducing the patient's nausea. Ondansetron will not treat headaches, pain, or leg cramps. )
The patient history indicates the patient was taking ondansetron at home before admission. The nurse inquires as to the effectiveness of this medication in treating which symptom? 1 Headache 2 Nausea 3 Pain 4 Leg cramps
c The patient will have bloody drainage from the nasogastric (NG) tube for 8 to 12 hours, and it should not be repositioned or reinserted without contacting the surgeon. Turning and deep breathing will be done every 2 hours, and the spirometer will be used more often than every 4 hours. Coughing would put too much pressure in the area and should not be done. Because the patient will have the NG tube, the patient will not be eating yet. The patient should be kept in a semi-Fowler's or Fowler's position, not supine, to prevent reflux and aspiration of secretions.
The patient is having an esophagoenterostomy with anastomosis of a segment of the colon to replace the resected portion. What initial postoperative care should the nurse expect when this patient returns to the nursing unit? a Turn, deep breathe, cough, and use spirometer every 4 hours. b Maintain an upright position for at least 2 hours after eating. c NG will have bloody drainage and it should not be repositioned. d Keep in a supine position to prevent movement of the anastomosis.
Correct answer: b Ondansetron is a 5-HT3 receptor antagonist antiemetic that is especially effective in reducing cancer chemotherapy-induced nausea and vomiting. Morphine sulfate may cause nausea and vomiting. Zolpidem does not relieve nausea and vomiting. Dexamethasone is usually used in combination with ondansetron for acute and chemotherapy-induced emesis.
The patient receiving chemotherapy rings the call bell and reports the onset of nausea. The nurse should prepare an as-needed dose of which medication? a. Zolpidem b. Ondansetron c. Dexamethasone d. Morphine sulfate
correct answer:b Mylanta is an antacid that contains both aluminum and magnesium. It is indicated for the relief of gastrointestinal discomfort, such as heartburn associated with GERD. Mylanta can cause both diarrhea and constipation as a side effect. Mylanta does not affect lower abdominal pain.
The patient who is admitted with a diagnosis of diverticulitis and a history of irritable bowel disease and gastroesophageal reflux disease (GERD) has received a dose of Mylanta 30 mL PO. The nurse will determine the medication was effective when which symptom has been resolved? a Diarrhea b Heartburn c Constipation d Lower abdominal pain
2 (Mylanta is an antacid that contains both aluminum and magnesium. It is indicated for the relief of gastrointestinal discomfort, such as with heartburn associated with GERD. Mylanta can cause both diarrhea and constipation as a side effect. Mylanta does not affect lower abdominal pain. )
The patient who is admitted with a diagnosis of diverticulitis and a history of irritable bowel disease and gastroesophageal reflux disease (GERD) has received a dose of Mylanta 30 mL orally. The nurse should evaluate its effectiveness by questioning the patient as to whether which symptom has resolved? 1 Diarrhea 2 Heartburn 3 Constipation 4 Lower abdominal pain
c To eradicate H. pylori, a combination of antibiotics, a proton pump inhibitor, and possibly bismuth (for quadruple therapy) will be used. Corticosteroids, aspirin, and NSAIDs are drugs that can cause gastritis and do not affect H. pylori.
The patient with chronic gastritis is being put on a combination of medications to eradicate Helicobacter pylori. Which drugs does the nurse know will probably be used? a Antibiotic(s), antacid, and corticosteroid b Antibiotic(s), aspirin, and antiulcer/protectant c Antibiotic(s), proton pump inhibitor, and bismuth d Antibiotic(s) and nonsteroidal antiinflammatory drugs (NSAIDs)
2 (Pantoprazole is a proton-pump inhibitor which decreases acid production in the stomach. It minimizes damage to the gastric mucosa while the patient is on bed rest and hospitalized after surgery. Pantoprazole will not prevent gas pains and will not prevent stomach bleeding from surgery. Heartburn is not a side effect of diabetes. )
The postoperative patient states that he or she has never taken pantoprozole in the past. The patient asks why he or she is getting this medication if the patient has never had heartburn. What is the best response by the nurse? 1 "The stress of surgery is likely to cause stomach bleeding if you do not receive it." 2 "This will reduce the amount of acid in your stomach until you can eat a regular diet again." 3 "This will prevent the heartburn that occurs as a side effect of your diabetes." 4 "This will prevent gas pains from the excess air in your small intestine."
2 (Alcohol increases the amount of stomach acid produced so it should be avoided. Milk may exacerbate PUD, so two to three glasses would not be recommended. There is no reason to puree or mince food, and a current diet is likely to be altered to minimize symptoms. )
The results of a patient's recent endoscopy indicate the presence of peptic ulcer disease (PUD). Which teaching point should the nurse provide to the patient based on this new diagnosis? 1 "You'll need to drink at least two to three glasses of milk daily." 2 "It would likely be beneficial for you to eliminate drinking alcohol." 3 "Many people find that a minced or pureed diet eases their symptoms of PUD." 4 "Your medications should allow you to maintain your present diet while minimizing symptoms."
Correct answer: a Alcohol increases the amount of stomach acid produced. so it should be avoided. Although there is no specific recommended dietary modification for PUD, most patients find it necessary to make some sort of dietary modifications to minimize symptoms. Milk may exacerbate PUD.
The results of a patient's recent endoscopy indicate the presence of peptic ulcer disease (PUD). Which teaching point should the nurse provide to the patient based on this new diagnosis? a "It would be beneficial for you to eliminate drinking alcohol." Correct b "You'll need to drink at least two to three glasses of milk daily." c "Many people find that a minced or pureed diet eases their symptoms of PUD." d "Taking medication will allow you to keep your present diet while minimizing symptoms."
1 (Lifestyle modifications to prevent the recurrence of gastritis include refraining from consuming alcohol and cigarette smoking. Alcohol directly irritates the gastric mucosa, and nicotine from cigarette smoke inhibits neutralization of gastric acid. A bland diet (reduced spices and seasonings) is recommended to prevent the recurrence of gastritis. Alcohol should be eliminated from the diet, not merely reduced. Advising the patient to take acetaminophen and ibuprofen (Motrin) is incorrect, because ibuprofen should not be taken by the gastritis patient. )
To prevent the recurrence of gastritis, what instruction should the nurse provide to the patient? 1 Stop smoking and do not consume alcoholic beverages. 2 Consume a soft diet with moderate spices and seasonings. 3 Stop smoking and consume alcoholic beverages in moderation. 4 Take acetaminophen and ibuprofen for pain
3 (A Billroth I operation, also known as a gastroduodenostomy, is a partial gastrectomy in which the distal two thirds of the stomach is removed and there is an anastomosis of the gastric stump to the duodenum. A vagotomy is the severing of the vagus nerve totally or selectively. A pyloroplasty is the surgical enlargement of the pyloric sphincter in order to facilitate easy passage of contents from the stomach. A Billroth II operation is called a gastrojejunostomy; it is the removal of the distal two thirds of the stomach and anastomosis of the gastric stump to the jejunum)
What surgical procedure involves the removal of two-thirds of the stomach and anastomosis of the gastric stump to the duodenum? 1 Vagotomy 2 Pyloroplasty 3 Billroth I operation 4 Billroth II operation
2 (Xerostomia is dryness of the mouth. Scopolamine is an anticholinergic (antimuscarinic) medication that causes xerostomia. Granisetron is a serotonin (5-HT3) antagonist that causes diarrhea. Perphenazine causes constipation, dry mouth, rashes, and sedative effects. Domperidone causes anxiety, hallucinations, tremors, and dyskinesias. )
Which antiemetic medication causes xerostomia as a side effect? 1 Granisetron 2 Scopolamine 3 Perphenazine 4 Domperidone
4 (A barium contrast study is used to diagnose gastric outlet obstruction in patients with peptic ulcer disease. An endoscopy is performed to determine the degree of ulcer healing after the treatment of ulcer. A urea breath test is a noninvasive method used to detect active infection. Rapid urease testing is used to check for a Helicobacter pylori infection. )
Which diagnostic test is best suited to diagnosing gastric outlet obstruction? 1 Endoscopy 2 Urea breath test 3 Rapid urease testing 4 Barium contrast study
2 (Urease activates the immune response with body antibody production and the release of inflammatory cytokines, resulting in mucosal edema. Pepsin is an enzyme released in the stomach that degrades food particles into peptides. Bile salts are released by liver cells, which bind with cholestyramine and cause gastric irritation. Serum amylase levels determine pancreatic function.)
Which enzyme activates the immune response with antibody production and the release of inflammatory cytokines? 1 Pepsin 2 Urease 3 Bile salts 4 Serum amylase
1 (Small amounts of blood in gastric secretions and stools indicate occult blood, and the guaiac test is used to detect traces of blood in the feces. Liver enzyme studies are performed to detect any liver problems. A complete blood count (CBC) test is used to detect anemia, which is secondary to ulcer bleeding. Serum amylase determination helps to determine pancreatic function.)
Which laboratory test is beneficial for diagnosing the presence of a small amount of blood in gastric secretions and stools? 1 Guaiac test 2 Liver enzyme studies 3 Complete blood count (CBC) 4 Serum amylase determination
1 (Aspirin is a nonsteroidal antiinflammatory drug (NSAID) that causes gastritis by decreasing prostaglandin in the lining of the stomach. Amoxicillin is used in the treatment of H. pylori infections. Lansoprazole and metronidazole are used in the treatment of gastritis.)
Which medication causes gastritis? 1 Aspirin 2 Amoxicillin 3 Lansoprazole 4 Metronidazole
4 (Metoclopramide is a prokinetic agent that causes central nervous system side effects such as hallucinations and anxiety. Nizatidine is a histamine (H2)-receptor blocker that causes abdominal pain, headache, diarrhea, and constipation. Sucralfate is an antiulcer medication that causes constipation. Omeprazole is a proton pump inhibitor that causes nausea, abdominal pain, headache, diarrhea, and flatulence.)
Which medication for peptic ulcer disease causes hallucinations? 1 Nizatidine 2 Sucralfate 3 Omeprazole 4 Metoclopramide
3 (Prokinetic agents such as domperidone increase gastric motility and gastric emptying. Droperidol is a butyrophenone that blocks neurochemicals triggering nausea and vomiting. Scopolamine is an anticholinergic that blocks cholinergic pathways to the vomiting center, but does not increase gastric motility and emptying. Dexamethasone is a corticosteroid used in the management of acute and delayed chemotherapy-induced vomiting.)
Which medication increases gastric motility and gastric emptying? 1 Droperidol 2 Scopolamine 3 Domperidone 4 Dexamethasone
2 (Sucralfate provides cryoprotection for the esophagus, stomach, and duodenum by forming a protective layer and serves as a barrier against acids, bile salts, and enzymes. Tofranil is a tricyclic antidepressant that provides pain relief in peptic ulcer disease. Cimetidine is a histamine blocker that provides ulcer healing. Misoprostol is prescribed to prevent gastric ulcers caused by nonsteroidal antiinflammatory drugs.)
Which medication is prescribed for cryoprotective drug therapy? 1 Tofranil 2 Sucralfate 3 Cimetidine 4 Misoprostol
1, 2 (Aspirin and fluoxetine are ulcerogenic drugs that inhibit the synthesis of prostaglandins, increase gastric acid secretion, and reduce the integrity of the mucosal barrier. These medications increase the risk of ulcer development. Misoprostol, bethanechol, and metoclopramide are used in gastroesophageal reflux disease and peptic ulcer drug therapy.)
Which medications increase the risk of ulcer development? Select all that apply. 1 Aspirin 2 Fluoxetine 3 Misoprostol 4 Bethanechol 5 Metoclopramide
2 (Staphylococcus causes gastritis. H. pylori causes stomach cancer. Candida albicans causes oral candidiasis. Fusiform bacteria cause Vincent's infection )
Which microorganism causes gastritis? 1 Helicobacter pylori 2 Staphylococcus 3 Candida albicans 4 Fusiform bacteria
3 (Cirrhosis and pancreatitis are the pathophysiologic conditions associated with duodenal ulcers. Shock, sepsis, and large hiatal hernia are conditions that cause gastritis.)
Which pathophysiologic condition is associated with duodenal ulcers? 1 Shock 2 Sepsis 3 Cirrhosis 4 Large hiatal hernia.
Correct answer: C Oral candidiasis is caused by prolonged antibiotic treatment (e.g., ciprofloxacin) or high doses of corticosteroids. Amphotericin B is used to treat candidiasis. Vitamin B and C deficiencies may lead to Vincent's infection. Use of tobacco products leads to stomatitis, not candidiasis.
Which patient would be at highest risk for developing oral candidiasis? a. A 74-yr-old patient who has vitamin B and C deficiencies b. A 22-yr-old patient who smokes 2 packs of cigarettes per day c. A 32-yr-old patient who is receiving ciprofloxacin for 3 weeks d. A 58-yr-old patient who is receiving amphotericin B for 2 days
2 (An endoscopy with balloon dilations is used in the treatment of pyloric obstruction. A vagotomy is the severing of the vagus nerve either totally or selectively to decrease gastric acid secretion. A gastrojejunostomy involves a partial gastrectomy with removal of two-thirds of the stomach and an anastomosis of the gastric stump to the jejunum. Gastroduodenostomy is a partial gastrectomy with removal of two-thirds of the stomach and an anastomosis of the gastric stump to the duodenum.)
Which surgical therapy is used to treat pyloric obstruction? 1 Vagotomy 2 Endoscopy 3 Gastrojejunostomy 4 Gastroduodenostomy
c After a Billroth I operation, dumping syndrome may occur 15 to 30 minutes after eating because of the hypertonic fluid going to the intestine and additional fluid being drawn into the bowel. Malnutrition may occur but does not cause these symptoms. Bile reflux gastritis cannot happen when the stomach has been removed. Postprandial hypoglycemia occurs with similar symptoms, but 2 hours after eating.
a patient who had a gastroduodenostomy (Billroth I operation) for stomach cancer reports generalized weakness, sweating, palpitations, and dizziness 15 to 30 minutes after eating. What long-term complication does the nurse suspect is occurring? Malnutrition Bile reflux gastritis Dumping syndrome Postprandial hypoglycemia
