Question 1

A patient with a hiatal hernia is experiencing heartburn.Which should the nurse suggest to this patient?

Accepted Answer

Treatment for hiatal hernia includes avoiding bedtime snacks.A.Small meals that pass easily through the esophagus should be eaten.C.The head of the bed should be elevated 6 to 12 inches to prevent reflux.D.Reclining for 1 hour after eating should be avoided.

Question 2

The nurse is teaching a patient about gastric surgery and dumping syndrome.Which statement indicates that the patient understands dumping syndrome?

Accepted Answer

Treatment for dumping syndrome includes teaching the patient to eat small,frequent meals that are high in protein and fat and low in carbohydrates,especially refined sugars.B.The patient should be taught to avoid fluids 1 hour before meals,with meals,or for 2 hours after meals to prevent rapid gastric emptying.C.It is best for the patient to lie down after meals to delay gastric emptying.D.The symptoms occur 5 to 30 minutes after eating.

Question 3

A patient with a nasogastric tube to low intermittent suction after surgery begins to vomit bright red blood.Which action should the nurse take first?

Accepted Answer

Protection of the airway during vomiting is a priority to prevent aspiration.Those at risk of aspiration are persons who are unconscious,older,and experiencing gag reflex impairments.Place these types of persons on their side when they begin to vomit.This allows the gastric contents to be expelled from the mouth rather than pooling at the back of the throat and being aspirated.A.The patient does not necessarily need oxygen at this time.B.The patient could aspirate while the nurse is irrigating the nasogastric tube.C.There is no reason to increase the patient's intravenous infusion at this time.

Question 4

A patient with a duodenal peptic ulcer vomits old blood.What description should the nurse use to document the appearance of the vomitus?

Accepted Answer

When blood mixes with hydrochloric acid and enzymes in the stomach,a dark,granular material resembling coffee grounds is produced.This indicates old bleeding,as fresh bleeding would be red in color.A.C.D.The nurse should not document the appearance of the patient's emesis as being duodenal fecal matter,undigested food particles or a chyme mixture.

Question 5

The nurse is providing care to a patient 3 days after a Billroth I procedure.About which observation should the nurse be most concerned?

Accepted Answer

Dumping syndrome is a complication of Billroth I procedure and occurs 5 to 30 minutes after eating.Symptoms include dizziness,tachycardia,fainting,sweating,nausea,diarrhea,a feeling of fullness,and abdominal cramping.A.A pulse of 58 beats per minute could be within the patient's normal pulse range.B.C.Pain and the emotional reaction to the incision are psychosocial concerns and are not the highest priority at this time.

Question 6

The nurse is caring for a patient with a sliding hiatal hernia.In which position should the nurse expect the patient to report that the symptoms are more acute?

Accepted Answer

In a sliding hiatal hernia,the stomach slides up into the thoracic cavity when a patient is supine and then goes back into the abdominal cavity when upright.Sliding hiatal hernia symptoms are worse when lying down.A.B.D.The symptoms of a hiatal hernia are not worse when sitting,standing,or in the semi-Fowler's position.

Question 7

The nurse is reinforcing teaching with a patient who had a large portion of the stomach removed.Which patient statement indicates understanding of why the patient will need to receive vitamin B₁₂ for life?

Accepted Answer

Vitamin B₁₂ deficiency can occur after some or all of the stomach is removed because intrinsic factor secretion is reduced or gone.Normally,vitamin B₁₂ combines with intrinsic factor to prevent its digestion in the stomach and promote its absorption in the intestines.Lifelong administration of vitamin B₁₂ is required to prevent the development of pernicious anemia.A.C.D.Removal of part of the stomach will not lead to the development of sickle cell anemia,iron-deficiency anemia,or acquired hemolytic anemia.

Question 8

The nurse is reinforcing teaching provided to a patient with dumping syndrome.Which patient statement indicates a correct understanding of this condition?

Accepted Answer

Dumping syndrome occurs with the rapid entry of food into the jejunum without proper mixing of the food with digestive juices.On entering the jejunum,the food draws extracellular fluid into the bowel from the circulating blood volume to dilute the high concentration of electrolytes and sugars.A.Delayed gastric emptying does not described dumping syndrome.B.With dumping syndrome glucose is not dumped into the blood stream.C.Digestive secretions entering the esophagus describe gastroesophageal reflux disease.

Question 9

The nurse is reinforcing teaching provided to a patient scheduled for pyloroplasty.Which patient statement indicates a correct understanding of the procedure?

Accepted Answer

Pyloroplasty widens the exit of the pylorus to improve emptying of the stomach.A.Suturing part of the stomach is part of Bariatric surgery.B.Cutting the nerve to the stomach is a vagotomy.C.There is no surgery to narrow the pylorus.

Question 10

The nurse is caring for a patient who has a nasogastric tube in place following gastric surgery.Why should the nurse use normal saline to irrigate the nasogastric tube?

Accepted Answer

Normal saline is used for irrigation to prevent electrolyte loss and imbalance.A.C.D.Irrigating a nasogastric tube with normal saline is not done to decrease electrolytes,maintain fluid volume,or increase fluid volume.

Question 11

A patient is recovering from a Billroth I procedure and has a nasogastric Levin tube set to low intermittent suction.As the patient turns in bed,the Levin tube is partially pulled out.Which action should the nurse take?

Accepted Answer

The nurse needs to inform the RN or physician because the tube will need to be repositioned.The physician typically is the one that does the repositioning after gastric surgery so the suture line is not affected.B.C.D.The nurse should not irrigate the tube,advance the tube,or place the tube on continuous suction since these actions could injure the suture line.

Question 12

The nurse is reinforcing teaching provided to a patient with a hiatal hernia.Which patient statement indicates a correct understanding of lifestyle modification to reduce symptoms?

Accepted Answer

Lifestyle changes for symptomatic hiatal hernia include losing weight,antacids,eating small meals that pass easily through the esophagus,not reclining for 3-4 hours after eating,elevating the head of the bed 6 to 12 inches to prevent reflux,and avoiding bedtime snacks,spicy foods,alcohol,caffeine,and smoking.A.B.D.Stress,exercise,and rest periods are not recommendations for the patient with a hiatal hernia.

Question 13

The nurse is caring for a patient with a vented nasogastric tube ordered "to suction" after a gastrectomy.What type of suction should the nurse use to decrease the development of complications?

Accepted Answer

With a physician's order,the nasogastric tube is connected to suction equipment,usually set on low intermittent suction if the secretions are not too thick,to prevent injury to the gastric mucosa.The vent also helps prevent this injury.A.B.D.These settings for suction might cause injury to the gastric mucosa.

Question 14

The nurse is caring for a patient recovering from radical neck dissection for cancer and tracheostomy placement.What action by the nurse should take priority?

Accepted Answer

A tracheostomy is usually performed to protect the airway and prevent obstruction.The airway must be monitored and secretions controlled to prevent aspiration.B.C.D.These actions are important however do not take the priority over maintaining a patent airway.

Question 15

The nurse is reinforcing teaching provided to a patient with a peptic ulcer.Which patient statement indicates understanding of the medication ranitidine (Zantac)?

Accepted Answer

Zantac reduces production of gastric acid,which aids in healing the ulcer.A.B.C.These statements do not explain the purpose or mechanism of Zantac.

Question 16

The nurse is caring for a patient with gastroesophageal reflux disease (GERD).Which patient statement indicates a need for nutritional instruction?

Accepted Answer

A low-fat,high-protein diet is recommended because fat causes decreased functioning of the lower esophageal sphincter.Caffeine,milk products,and spicy foods should be avoided.B.C.D.These patient statements are appropriate for the patient with gastroesophageal reflux disease.

Question 17

The nurse is caring for a patient on a gastrointestinal unit.Which patient statement should cause the nurse the most concern?

Accepted Answer

The nurse should be most concerned if there were evidence of blood loss causing black tarry stools (melena).A.Stool that is dark green and hard to pass could indicate constipation caused by an iron preparation.C.D.More information is needed before becoming concerned about these descriptions.

Question 18

The nurse is caring for a patient who suddenly begins having large amounts of bright red hematemesis.After the patient is turned onto the side,what should the nurse do?

Accepted Answer

The nurse should collect data,including vital signs,to report to the RN and physician for treatment orders.A.The nurse should not give the patient anything by mouth.B.Lowering the head of the bed could lead to aspiration.D.Placing a cool cloth on the patient's forehead might be offered after the physician and RN have been notified.

Question 19

The nurse is checks the gastric pH and provides antacids as prescribed to a patient recovering from a motor vehicle crash.What is the nurse attempting to prevent by these interventions?

Accepted Answer

Critically ill patients may develop gastric or small intestinal stress ulcers from ischemia.The stress response to the illness causes reduced blood flow to the stomach and small intestine.A.C.D.These interventions are not done to prevent the development of shock,malnutrition,or metabolic acidosis.

Question 20

The nurse teaching a patient with gastroesophageal reflux about the influence of body position on the disease process.Which patient statement indicates that teaching has been effective?

Accepted Answer

Elevating the head of the bed 4 to 6 inches helps prevent reflux of gastric contents into the esophagus.B.The head of the bed does not need to be elevated 12 to 16 inches.C.D.Sleeping flat or on the stomach could exacerbate symptoms of gastroesophageal reflux.

Quiz 33: Nursing Care of Patients With Upper Gastrointestinal Disorders

A patient with a hiatal hernia is experiencing heartburn.Which should the nurse suggest to this patient?

The nurse is teaching a patient about gastric surgery and dumping syndrome.Which statement indicates that the patient understands dumping syndrome?

A patient with a nasogastric tube to low intermittent suction after surgery begins to vomit bright red blood.Which action should the nurse take first?

A patient with a duodenal peptic ulcer vomits old blood.What description should the nurse use to document the appearance of the vomitus?

The nurse is providing care to a patient 3 days after a Billroth I procedure.About which observation should the nurse be most concerned?

The nurse is caring for a patient with a sliding hiatal hernia.In which position should the nurse expect the patient to report that the symptoms are more acute?

The nurse is reinforcing teaching with a patient who had a large portion of the stomach removed.Which patient statement indicates understanding of why the patient will need to receive vitamin B₁₂ for life?

The nurse is reinforcing teaching provided to a patient with dumping syndrome.Which patient statement indicates a correct understanding of this condition?

The nurse is reinforcing teaching provided to a patient scheduled for pyloroplasty.Which patient statement indicates a correct understanding of the procedure?

The nurse is caring for a patient who has a nasogastric tube in place following gastric surgery.Why should the nurse use normal saline to irrigate the nasogastric tube?

A patient is recovering from a Billroth I procedure and has a nasogastric Levin tube set to low intermittent suction.As the patient turns in bed,the Levin tube is partially pulled out.Which action should the nurse take?

The nurse is reinforcing teaching provided to a patient with a hiatal hernia.Which patient statement indicates a correct understanding of lifestyle modification to reduce symptoms?

The nurse is caring for a patient with a vented nasogastric tube ordered "to suction" after a gastrectomy.What type of suction should the nurse use to decrease the development of complications?

The nurse is caring for a patient recovering from radical neck dissection for cancer and tracheostomy placement.What action by the nurse should take priority?

The nurse is reinforcing teaching provided to a patient with a peptic ulcer.Which patient statement indicates understanding of the medication ranitidine (Zantac) ?

The nurse is caring for a patient with gastroesophageal reflux disease (GERD) .Which patient statement indicates a need for nutritional instruction?

The nurse is caring for a patient on a gastrointestinal unit.Which patient statement should cause the nurse the most concern?

The nurse is caring for a patient who suddenly begins having large amounts of bright red hematemesis.After the patient is turned onto the side,what should the nurse do?

The nurse is checks the gastric pH and provides antacids as prescribed to a patient recovering from a motor vehicle crash.What is the nurse attempting to prevent by these interventions?

The nurse teaching a patient with gastroesophageal reflux about the influence of body position on the disease process.Which patient statement indicates that teaching has been effective?

Quiz 33: Nursing Care of Patients With Upper Gastrointestinal Disorders

A patient with a hiatal hernia is experiencing heartburn.Which should the nurse suggest to this patient?

The nurse is teaching a patient about gastric surgery and dumping syndrome.Which statement indicates that the patient understands dumping syndrome?

A patient with a nasogastric tube to low intermittent suction after surgery begins to vomit bright red blood.Which action should the nurse take first?

A patient with a duodenal peptic ulcer vomits old blood.What description should the nurse use to document the appearance of the vomitus?

The nurse is providing care to a patient 3 days after a Billroth I procedure.About which observation should the nurse be most concerned?

The nurse is caring for a patient with a sliding hiatal hernia.In which position should the nurse expect the patient to report that the symptoms are more acute?

The nurse is reinforcing teaching with a patient who had a large portion of the stomach removed.Which patient statement indicates understanding of why the patient will need to receive vitamin B12 for life?

The nurse is reinforcing teaching provided to a patient with dumping syndrome.Which patient statement indicates a correct understanding of this condition?

The nurse is reinforcing teaching provided to a patient scheduled for pyloroplasty.Which patient statement indicates a correct understanding of the procedure?

The nurse is caring for a patient who has a nasogastric tube in place following gastric surgery.Why should the nurse use normal saline to irrigate the nasogastric tube?

A patient is recovering from a Billroth I procedure and has a nasogastric Levin tube set to low intermittent suction.As the patient turns in bed,the Levin tube is partially pulled out.Which action should the nurse take?

The nurse is reinforcing teaching provided to a patient with a hiatal hernia.Which patient statement indicates a correct understanding of lifestyle modification to reduce symptoms?

The nurse is caring for a patient with a vented nasogastric tube ordered "to suction" after a gastrectomy.What type of suction should the nurse use to decrease the development of complications?

The nurse is caring for a patient recovering from radical neck dissection for cancer and tracheostomy placement.What action by the nurse should take priority?

The nurse is reinforcing teaching provided to a patient with a peptic ulcer.Which patient statement indicates understanding of the medication ranitidine (Zantac) ?

The nurse is caring for a patient with gastroesophageal reflux disease (GERD) .Which patient statement indicates a need for nutritional instruction?

The nurse is caring for a patient on a gastrointestinal unit.Which patient statement should cause the nurse the most concern?

The nurse is caring for a patient who suddenly begins having large amounts of bright red hematemesis.After the patient is turned onto the side,what should the nurse do?

The nurse is checks the gastric pH and provides antacids as prescribed to a patient recovering from a motor vehicle crash.What is the nurse attempting to prevent by these interventions?

The nurse teaching a patient with gastroesophageal reflux about the influence of body position on the disease process.Which patient statement indicates that teaching has been effective?

The nurse is reinforcing teaching with a patient who had a large portion of the stomach removed.Which patient statement indicates understanding of why the patient will need to receive vitamin B₁₂ for life?