Deck 42: Nursing Management: Upper Gastrointestinal Problems

Question 1

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.

Answer 1

Obtain a stool specimen for culture.

Question 2

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).

Answer 2

use of nonsteroidal anti-inflammatory drugs (NSAIDs).

Question 3

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."

Answer 3

"The cobalamin injections will prevent me from becoming anemic."

Question 4

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

Question 5

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.

Question 6

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."

Question 7

A patient who is receiving chemotherapy develops a Candida albicans oral infection. The nurse will anticipate the need for

A) hydrogen peroxide rinses.
B) the use of antiviral agents.
C) referral to a dentist for professional tooth cleaning.
D) administration of nystatin (Mycostatin) oral tablets.

Question 8

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."

Question 9

To decrease the risk for cancers of the tongue and buccal mucosa, which information will the nurse include when teaching a patient who is seen for an annual physical exam in the outpatient clinic?

A) Avoid use of cigarettes and smokeless tobacco.
B) Use sunscreen when outside even on cloudy days.
C) Complete antibiotics used to treat throat infections.
D) Use antivirals to treat herpes simplex virus (HSV) infections.

Question 10

When the nurse is assessing the mouth of a patient who uses smokeless tobacco for signs of oral cancer, which finding will be of most concern?

A) Bleeding during tooth brushing
B) Painful blisters at the border of the lips
C) Red, velvety patches on the buccal mucosa
D) White, curdlike plaques on the posterior tongue

Question 11

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.

Question 12

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.

Question 13

A 22-year-old patient with Escherichia coli O157:H7 food poisoning is admitted to the hospital with bloody diarrhea and dehydration. All of the following orders are received. Which order will the nurse question?

A) Infuse lactated Ringer's solution at 250 mL/hr.
B) Monitor blood urea nitrogen and creatinine daily.
C) Administer loperamide (Imodium) after each stool.
D) Provide a clear liquid diet and progress diet as tolerated.

Question 14

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.

Question 15

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 ).

Question 16

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.

Question 17

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.

Question 18

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."

Question 19

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

Question 20

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.

Question 21

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

Question 22

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.

Question 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.

Question 24

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.

Question 25

Which of these nursing actions should the RN working in the emergency department delegate to nursing assistive personnel who help with the care of a patient who has been admitted with nausea and vomiting?

A) Auscultate the bowel sounds.
B) Assess for signs of dehydration.
C) Ask the patient what precipitated the nausea.
D) Assist the patient with oral care after vomiting.

Question 26

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.

Question 27

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."

Question 28

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.

Question 29

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."

Question 30

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.

Question 31

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

Question 32

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.

Question 33

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.

Question 34

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 )

Question 35

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.

Question 36

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.

Question 37

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.

Question 38

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.

Question 39

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.

Question 40

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."

Question 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.

Question 42

Vasopressin (Pitressin) 0.2 units/min infusion is prescribed for a patient with acute arterial gastrointestinal (GI) bleeding. The vasopressin label states vasopressin 20 units/50 mL normal saline. How many mL/min will the nurse infuse? ____________________