Question 1

The nurse explains that the diagnosis of morbidly obese is reserved for people who exceed which percentage of their recommended weight?

Accepted Answer

Those people who weigh 100% over their recommended weight are considered morbidly obese.

Question 2

The nurse explains that the laparoscopic adjustable gastric banding surgery is best described as which type of bariatric surgery?

Accepted Answer

The three types of bariatric surgery are restrictive,malabsorptive,and restrictive/malabsorptive.Laparoscopic adjustable gastric banding is performed by placing an inflatable band around the fundus of the stomach and is considered restrictive.This procedure may be performed laparoscopically.The band is inflated and deflated via a subcutaneous port to change the size of the stomach as the patient loses weight.

Question 3

The nurse is caring for a patient who is being treated for extensive burns.The nurse notes the presence of coffee-ground material in the Salem sump catheter.The nurse correctly recognizes which factor as the likely cause?

Accepted Answer

Prolonged physiologic stress produces what is known as a physiologic stress ulcer,which is believed to be the result of unrelieved stimulation of the vagus nerves and decreased perfusion to the stomach.A stress ulcer is pathologically and clinically different from a chronic peptic ulcer.It is more acute and more likely to produce hemorrhage.Perforation occurs occasionally,and pain is rare.Stress ulcers are a hazard for patients who are severely ill and in intensive care units for prolonged periods.Patients with multiple trauma,burns,or multisystem disorders are subject to physiologic stress ulcers,which may produce blood that has been in contact with gastric juices.

Question 4

The nurse is caring for a patient who is being treated for a gunshot wound to the abdomen.The patient is receiving total parenteral nutrition (TPN),and the physician has prescribed insulin coverage on a sliding scale.The patient reports he has never had diabetes before.What response is best for the nurse to make?

Accepted Answer

People on TPN are prone to hyperglycemia from the high glucose content of the solution.

Question 5

The nurse is educating a patient with Barrett esophagus.Which statement indicates that the patient requires a need for further instruction?

Accepted Answer

Care of the patient with Barrett esophagus is focused on encouraging measures to prevent GERD and on regular checkups.Patients should be encouraged not to use tobacco products and not to indulge in heavy alcohol use.

Question 6

The nurse is discussing bariatric surgery complications with a patient.Which statement indicates that the patient accurately understands the nurse's teaching about common procedural side effects?

Accepted Answer

Nutritional deficiencies caused by the banding result in the formation of gallstones in a large percentage of bariatric surgery patients.About a third of patients who undergo bariatric surgery develop gallstones.

Question 7

The nurse is caring for a patient with a Salem sump tube for decompression.The patient displays dyspnea and reports feeling full and nauseated.What action should the nurse take first?

Accepted Answer

Irrigation of the tube to restore patency is the first intervention when assessment indicates inadequate decompression.The suction should remain on low.Withdrawing the tube may cause inappropriate placement.Notifying the charge nurse is not necessary at this time.Irrigating an obstructed sump tube is a standard of care.

Question 8

The nurse is caring for a patient with a peptic ulcer.The patient also has a history of chronic bronchitis,diabetes,and arthritis.Which component of the patient's history is the most likely contributing factor to the patient's ulcer?

Accepted Answer

About 4.5 million people in the United States have experienced a peptic ulcer.H.pylori infection is the major cause.Smoking and the continued use of nonsteroidal anti-inflammatory drugs (NSAIDs)are other causes.

Question 9

The nurse is preparing a teaching plan for a patient with gastroesophageal reflux disease (GERD)who has been prescribed multi-drug therapy for treatment.Which information is most important for the nurse to obtain?

Accepted Answer

Drug therapy may include antacids,H?-receptor antagonists,proton pump inhibitors,and prokinetic drugs.Priorities related to education about medication include checking for possible drug interactions with other drugs the patient is taking and verifying that the patient can afford the drugs prescribed.(If the patient cannot afford the medications,compliance is an unrealistic expectation.)While it is important for the patient to attempt to identify triggers,commit to dietary and lifestyle modifications,and understand each medication,those are questions that can be answered over time.

Question 10

The nurse documenting the presence of pain in a patient with possible gastric ulcer would anticipate that the pain would occur at which time?

Accepted Answer

Pain occurs at bedtime because the stomach is empty,but the gastric juices are still high.Pain is absent in the morning when the digestive juices are low and when the stomach is filled with food.

Question 11

The nurse is caring for a patient who is postoperative after esophageal resection.Shortly after the nurse starts a feeding,the patient suddenly becomes dyspneic and complains of substernal pain.What should the nurse do first?

Accepted Answer

After esophageal resection,pain,increased temperature,and dyspnea may indicate leakage of the feeding into the mediastinum.The nurse should immediately discontinue the feeding,then notify the charge nurse and address any patient concerns.Ambulation is not indicated at this time; ambulation is an intervention to address gas pains.

Question 12

The nurse is educating a patient with a hiatal hernia.Which statement indicates that the patient understands the nurse's teaching?

Accepted Answer

Hiatal hernia is diagnosed by an upper gastrointestinal (GI)series.Nutritional modification indicated in patients with hiatal hernias includes limiting intake of alcohol,chocolate,caffeine,and fatty food.Other treatment includes weight reduction,avoidance of tight-fitting clothes around the abdomen,administration of antacids,histamine (H?)-receptor antagonists,or proton pump inhibitors,and elevation of the head of the bed on 6- to 8-inch blocks.The patient is instructed not to eat within 3 hours of going to bed.

Question 13

A patient who had gastric bypass surgery 5 weeks ago calls the office to report feelings of nausea,sweating,and diarrhea shortly after eating meals.What response by the nurse is most appropriate?

Accepted Answer

Some patients who have had a gastrectomy experience a complication known as the "dumping syndrome." The patient has nausea,weakness,abdominal pain,and diarrhea and may feel faint and perspire profusely or experience palpitations after eating.These sensations are caused by the rapid passage of large amounts of food and liquid into the jejunum.When a patient experiences dumping syndrome,instruction is given to avoid eating large meals and to drink a minimum of fluids during the meal.Fluids may be taken in small amounts later,between meals.If sweet foods seem to aggravate the condition-and they sometimes do-the patient should try to avoid them.Although this is not an uncommon manifestation after this type of surgery,informing the patient that this is common provides limited information to the patient and is not the best response.This problem is not connected to alcohol consumption and is not a symptom of a postoperative infection.

Question 14

The nurse calculates the body mass index (BMI)of a man who is 6 feet tall and weighs 150 pounds.Which value is correct?

Accepted Answer

The formula to calculate BMI is: weight in kilograms divided by height in meters squared (68.1 kilograms ÷ 3.24 meters = 21.0).

Question 15

The nurse is aware that patients who have chronic gastritis from renal failure may present with which first sign of this disorder?

Accepted Answer

Sudden massive GI hemorrhage may be the first indication of chronic gastritis.Many of these patients do not have any symptoms at all until the hemorrhage.

Question 16

A patient with a gastrostomy tube gets a bolus feeding of 200 mL every 4 hours.Before giving the bolus,the nurse aspirates a residual of 100 mL.Which action is most appropriate?

Accepted Answer

On finding a large residual,the nurse should return the residual to the patient,document the amount of the residual,and hold the feeding to avoid possible aspiration.

Question 17

The nurse is educating a patient who has gastroesophageal reflux disease (GERD)about dietary modification.Which information is most important for the nurse to include in the teaching plan?

Accepted Answer

Avoiding highly seasoned or spicy food should be incorporated into diet changes for the patient with GERD.The avoidance of carbonated beverages with meals and the use of a straw do not reduce the impact of GERD.The frequency of dietary intake does not influence GERD.

Question 18

The nurse is caring for a patient with suspected dysphagia.Which action is most appropriate for the nurse to take?

Accepted Answer

Dysphagia means difficulty in swallowing.The nurse should have the patient take some "practice swallows" before beginning the meal,and watch to see that the larynx rises with each swallow.Incentive spirometry usage is important or patients with dyspnea,or shortness of breath.Encouraging communication and paying attention to nonverbal cues is an effective intervention for aphasia (inability to use or understand words).Keeping a food diary may be useful in cases of polyphagia (extreme hunger),but it does not evaluate whether or not the patient can swallow effectively.

Question 19

For which patient should the nurse question an order for esomeprazole (Nexium)?

Accepted Answer

Esomeprazole (Nexium)interferes with the absorption of digoxin,rabeprazole,and iron salts.In addition,the Food and Drug Administration (FDA)has issued a warning that long-term use of the proton pump inhibitors esomeprazole (Nexium)or omeprazole (Prilosec)may increase the risk of heart problems.

Question 20

Which causative agent is the primary cause of Barrett esophagus?

Accepted Answer

A major cause of Barrett esophagus is esophageal reflux.

Quiz 28: Care of Patients with Disorders of the Upper Gastrointestinal System