Upper GI Nclex Questions- GERD& Hernias, Gastritis & Peptic Ulcer Disease

The nurse should instruct the client to avoid which of the following drugs while taking metoclopramide hydrochloride (Reglan)? 1. Antacids. 2. Antihypertensives. 3. Anticoagulants. 4. Alcohol.

4. Alcohol. Metoclopramide hydrochloride (Reglan) can cause sedation. Alcohol and other central nervous system depressants add to this sedation. A client who is taking this drug should be cautioned to avoid driving or performing other hazardous activities for a few hours after taking the drug.

The nurse determines that a patient has experienced the beneficial effects of therapy with famotidine (Pepcid) when which symptom is relieved? Nausea Belching Epigastric pain Difficulty swallowing

Epigastric pain 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.

The nurse is performing an admission assessment on a client diagnosed with GERD. Which sign and symptoms would indicate GERD? -Pyrosis, water brash, and flatulence -Weight loss, dysarthria, and diarrhea -Decreased abdominal fat, proteinuria, and constipation -Midepigastric pain, positive H pylori test, and melena

-Pyrosis (heartburn), water brash, and flatulence Pyrosis is heartburn, water brash is the feeling of saliva secretion as a result of reflux, and flatulence is gas-all symptoms of GERD.

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. Take a laxative. 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.

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 and weighing 190 lb. 3. Using laxatives frequently. 4. Being 40 years old.

2. Being 5 feet, 3 inches tall and weighing 190 lb. 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.

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.

Which of the following instructions should the nurse include in the teaching plan for a client who is experiencing gastroesophageal reflux disease (GERD)? 1. Limit caffeine intake to two cups of coffee per day. 2. Do not lie down for 2 hours after eating. 3. Follow a low-protein diet. 4. Take medications with milk to decrease irritation.

2. Do not lie down for 2 hours after eating. The nurse should instruct the client to not lie down for about 2 hours after eating to prevent reflux.

Bethanechol (Urecholine)- Prokinetic- has been ordered 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. Urinary urgency.

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 he demonstrated responsibility for himself. 4. Reassure the client that he will be able to implement all aspects of the plan successfully.

3. Ask the client to identify other situations in which he demonstrated responsibility for himself. 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 with gastroesophageal reflux disease (GERD) complains of a chronic cough. The nurse understands that in a client with GERD this symptom may be indicative of which of the following conditions? 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.

The client is experiencing bleeding related to peptic ulcer disease (PUD). Which nursing intervention is the highest priority? A. Administering intravenous (IV) pain medication B. Starting a large-bore intravenous (IV) C. Monitoring the client's anxiety level D. Preparing equipment for intubation

Starting a large-bore intravenous (IV) A large-bore IV should be placed as requested, so that blood products can be administered.

At his first postoperative checkup appointment after a gastrojejunostomy (Billroth II), a patient reports that dizziness, weakness, and palpitations occur about 20 minutes after each meal. The nurse will teach the patient to a. increase the amount of fluid with meals. b. eat foods that are higher in carbohydrates. c. lie down for about 30 minutes after eating. d. drink sugared fluids or eat candy after meals.

c. lie down for about 30 minutes after eating. The patient is experiencing symptoms of dumping syndrome, which may be reduced by lying down after eating.

A 72-year-old patient was admitted with epigastric pain due to a gastric ulcer. Which patient assessment warrants an urgent change in the nursing plan of care? a. Chest pain relieved with eating or drinking water b. Back pain 3 or 4 hours after eating a meal c. Burning epigastric pain 90 minutes after breakfast d. Rigid abdomen and vomiting following indigestion

d. Rigid abdomen and vomiting following indigestion 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.

The nurse will anticipate teaching a patient experiencing frequent heartburn about a. barium swallow. b. radionuclide tests. c. endoscopy procedures. d. proton pump inhibitors.

d. proton pump inhibitors. 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 nurse instructs the client on health maintenance activities to help control symptoms from her hiatal hernia. Which of the following statements would indicate that the client has understood the instructions? 1. "I'll avoid lying down after a meal." 2. "I can still enjoy my potato chips and cola at bedtime." 3. "I wish I didn't have to give up swimming." 4. "If I wear a girdle, I'll have more support for my stomach."

1. "I'll avoid lying down after a meal." A client with a hiatal hernia should avoid the recumbent position immediately after meals to minimize gastric reflux. Bedtime snacks, as well as high-fat foods and carbonated beverages, should be avoided.

Which of the following dietary measures would be useful in preventing esophageal reflux? 1. Eating small, frequent meals. 2. Increasing fluid intake. 3. Avoiding air swallowing with meals. 4. Adding a bedtime snack to the dietary plan.

1. Eating small, frequent meals. Esophageal reflux worsens when the stomach is overdistended with food. Therefore, an important measure is to eat small, frequent meals.

The client attends two sessions with the dietitian to learn about diet modifications to minimize gastroesophageal reflux. The teaching would be considered successful if the client says that she will decrease her intake of which of the following foods? 1. Fats. 2. High-sodium foods. 3. Carbohydrates. 4. High-calcium foods.

1. Fats. Fats are associated with decreased esophageal sphincter tone, which increases reflux. Obesity contributes to the development of hiatal hernia, and a low-fat diet might also aid in weight loss.

What is the nursing priority in the management of a patient with an active upper G.I. bleed? A. Obtain vital signs. B. Apply oxygen by nasal cannula. C. Type and crossmatch the patient for blood products. D. Notify the physician.

A. Obtain vital signs. All other interventions can be applied after vital signs have been checked because this will help determine the other intervention...

A client with peptic ulcer disease (PUD) asks the nurse whether licorice and slippery elm might be useful in managing the disease. What is the nurse's best response? A. "No, they probably won't be useful. You should use only prescription medications in your treatment plan." B. "These herbs could be helpful. However, you should talk with your provider before adding them to your treatment regimen." C. "Yes, these are known to be effective in managing this disease, but make sure you research the herbs thoroughly before taking them." D. "No, herbs are not useful for managing this disease. You can use any type of over-the-counter drugs though. They have been shown to be safe."

B. "These herbs could be helpful. However, you should talk with your provider before adding them to your treatment regimen."

The nurse is teaching a client how to prevent recurrent chronic gastritis symptoms before discharge. Which statement by the client demonstrates a correct understanding of the nurse's instruction? A. "It is okay to continue to drink coffee in the morning when I get to work." B. "I will need to take vitamin B12 shots for the rest of my life." C. "Ibuprophen should be taken" D. "I should eat small meals about six times a day."

D. "I should eat small meals about six times a day."

Gastroesophageal reflux disease (GERD) weakens the lower esophageal sphincter, predisposing older persons to risk for impaired swallowing. In managing the symptoms associated with GERD, the nurse should assign the highest priority to which of the following interventions? a. Decrease daily intake of vegetables and water, and ambulate frequently. b. Drink coffee diluted with milk at each meal, and remain in an upright position for 30 minutes. c. Eat small, frequent meals, and remain in an upright position for at least 30 minutes after eating. d. Avoid over-the-counter drugs that have antacids in them.

Eat small, frequent meals, and remain in an upright position for at least 30 minutes after eating. Small, frequent feedings requires less release of hydrochloric acid. Remaining in an upright position for 30 minutes after meals prevents reflux into the esophagus

A client with hiatal hernia chronically experiences heartburn after meals. Which should the nurse teach the client to avoid?

Lying recumbent after meals Hiatal hernia is caused by a protrusion of a portion of the stomach above the diaphragm, where the esophagus usually is positioned.

The male client tells the nurse he has been experiencing "heartburn" at night that awakens him. Which assessment question should the nurse ask? -"how much weight have you gained recently?" -"what have you done to alleviate the heartburn" -"Do you consume many milk and dairy products" -"Have you been around anyone with a stomach virus"

What have you done to alleviate the heartburn? 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

A patient with a history of peptic ulcer disease has presented to the emergency department reporting severe abdominal pain and has a rigid, boardlike abdomen that prompts the health care team to suspect a perforated ulcer. What intervention should the nurse anticipate? a. Providing IV fluids and inserting a nasogastric (NG) 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 a high-Fowler's position

a. Providing IV fluids and inserting a nasogastric (NG) tube A perforated peptic ulcer requires IV replacement of fluid losses and continued gastric aspiration by NG tube.

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

b. "Avoid foods that cause pain after you eat them." The best information is that each individual should choose foods that are not associated with postprandial discomfort.

The patient is having a gastroduodenostomy (Billroth I operation) for stomach cancer. What long-term complication is occurring when the patient reports generalized weakness, sweating, palpitations, and dizziness 15 to 30 minutes after eating? a. Malnutrition b. Bile reflux gastritis c. Dumping syndrome d. Postprandial hypoglycemia

c. Dumping syndrome 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.

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.

c. NG will have bloody drainage, and it should not be repositioned. 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

The nurse is obtaining a health history from a client who has a sliding hiatal hernia associated with reflux. The nurse should ask the client about the presence of which of the following symptoms? 1. Heartburn. 2. Jaundice. 3. Anorexia. 4. Stomatitis.

1. Heartburn. Heartburn, the most common symptom of a sliding hiatal hernia, results from reflux of gastric secretions into the esophagus. Regurgitation of gastric contents and dysphagia are other common symptoms.

The client asks the nurse whether he will need surgery to correct his hiatal hernia. Which reply by the nurse would be most accurate? 1. "Surgery is usually required, although medical treatment is attempted first." 2. "Hiatal hernia symptoms can usually be successfully managed with diet modifications, medications, and lifestyle changes." 3. "Surgery is not performed for this type of hernia." 4. "A minor surgical procedure to reduce the size of the diaphragmatic opening will probably be planned."

2. "Hiatal hernia symptoms can usually be successfully managed with diet modifications, medications, and lifestyle changes." Most clients can be treated successfully with a combination of diet restrictions, medications, weight control, and lifestyle modifications.

Which of the following lifestyle modifications should the nurse encourage the client with a hiatal hernia to include in activities of daily living? 1. Daily aerobic exercise. 2. Eliminating smoking and alcohol use. 3. Balancing activity and rest. 4. Avoiding high-stress situations.

2. Eliminating smoking and alcohol use. Smoking and alcohol use both reduce esophageal sphincter tone and can result in reflux. They therefore should be avoided by clients with hiatal hernia.

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. "You'll need to drink at least two to three glasses of milk daily." b. "It would likely be beneficial for you to eliminate drinking alcohol." c. "Many people find that a minced or pureed diet eases their symptoms of PUD." d. "Your medications should allow you to maintain your present diet while minimizing symptoms."

b. "It would likely be beneficial for you to eliminate drinking alcohol." 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 and alcohol is best avoided because it can delay healing.

The nurse finds a client vomiting coffee ground-type material. On assessment, the client has blood pressure of 100/74 mm Hg, is acutely confused, and has a weak and thready pulse. Which intervention will be the nurse's first priority? A. Initiating enteral nutrition B. Administering an H2 antagonist C. Administering intravenous (IV) fluids D. Administering antianxiety medication

c. Administering intravenous (IV) fluids Administration of IV fluids is necessary to treat the hypovolemia caused by acute GI bleeding.

"Which statement made by the client indicates to the nurse the client may be experiencing GERD? 1. "My chest hurts when I walk up the stairs in my home." 2. "I take antacid tablets with me wherever I go." 3. My spouse tells me I snore very loudly at night." 4. I drink six (6) to seven (7) soft drinks every day

2. "I take antacid tablets with me wherever I go." Frequent use of antacids indicates an acid reflux problem.

The client has been taking magnesium hydroxide (milk of magnesia) at home in an attempt 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.

Cimetidine (Tagamet) may also be used to treat hiatal hernia. The nurse should understand that this drug is used to prevent which of the following? 1. Esophageal reflux. 2. Dysphagia. 3. Esophagitis. 4. Ulcer formation.

3. Esophagitis. Cimetidine (Tagamet) is a histamine receptor antagonist that decreases the quantity of gastric secretions. It may be used in hiatal hernia therapy to prevent or treat the esophagitis and heartburn associated with reflux.

A client who has been diagnosed with gastroesophageal reflux disease (GERD) complains of heartburn. To decrease the heartburn, the nurse should instruct the client to eliminate which of the following items from the diet? 1. Lean beef. 2. Air-popped popcorn. 3. Hot chocolate. 4. Raw vegetables.

3. Hot chocolate. With GERD, eating substances that decrease lower esophageal sphincter pressure causes heartburn. A decrease in the lower esophageal sphincter pressure allows gastric contents to reflux into the lower end of the esophagus. Foods that can cause a decrease in esophageal sphincter pressure include fatty foods, chocolate, caffeinated beverages, peppermint, and alcohol.

Which diagnostic results support the diagnosis of peptic ulcer disease (PUD)? (Select all that apply.) a. Low hemoglobin (Hgb) b. Low white blood cell (WBC) level c. Low hematocrit (Hct) d. Positive for H. pylori bacteria e. Low potassium of 3.4 mEq/L

a. Low hemoglobin (Hgb) c. Low hematocrit (Hct) d. Positive for H. pylori bacteria

A 46-year-old female with gastroesophageal reflux disease (GERD) is experiencing increasing discomfort. Which patient statement indicates that additional teaching 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 eat small meals during the day and have a bedtime snack." d. "I quit smoking several years ago, but I still chew a lot of gum."

c. "I eat small meals during the day and have a bedtime snack." 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.

The patient with chronic gastritis is being put on a combination of medications to eradicate H. pylori. Which drugs does the nurse know will probably be used for this patient? a. Antibiotic(s), antacid, and corticosteroid b. Antibiotic(s), aspirin, and antiulcer/protectant c. Antibiotic(s), proton pump inhibitor d. Antibiotic(s) and nonsteroidal antiinflammatory drugs (NSAIDs)

c. Antibiotic(s), proton pump inhibitor Two antibiotics and a proton pump inhibitor

The physician prescribes metoclopramide hydrochloride (Reglan) for the client with hiatal hernia. The nurse plans to instruct the client that this drug is used in hiatal hernia therapy to accomplish which of the following objectives? 1. Increase tone of the esophageal sphincter. 2. Neutralize gastric secretions. 3. Delay gastric emptying. 4. Reduce secretion of digestive juices.

1. Increase tone of the esophageal sphincter. Metoclopramide hydrochloride (Reglan) increases esophageal sphincter tone and facilitates gastric emptying; both actions reduce the incidence of reflux.

As the patient prepares for discharge, the nurse provides education about behaviors that reduce symptoms and aggravate peptic ulcers. Which teaching does the nurse provide? (Select all that apply.) a. Sit upright 30 to 60 minutes after meals. b. Spices should be added to food to enhance flavor. c. A vagotomy will be needed in the future d. Extreme vomiting should be reported to your physician. e. H. pylori can be a concern in patients with peptic ulcers. f. The goal of initial intervention is to control symptoms and prevent further complications.

a. Sit upright 30 to 60 minutes after meals. d. Extreme vomiting should be reported to your physician. e. H. pylori can be a concern in patients with peptic ulcers. f. The goal of initial intervention is to control symptoms and prevent further complications.

Which item should the nurse offer to the patient who is to restart oral intake after being NPO due to nausea and vomiting? a. Glass of orange juice b. Dish of lemon gelatin c. Cup of coffee with cream d. Bowl of hot chicken broth

b. Dish of lemon gelatin- clear liquids Clear cool liquids are usually the first foods started after a patient has been nauseated.

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 should evaluate its effectiveness by questioning the patient as to whether which symptom has been resolved? a. Diarrhea b. Heartburn c. Constipation d. Lower abdominal pain

b. Heartburn