Deck 33: Nursing Care of Patients With Upper Gastrointestinal Disorders

Question 1

The nurse is caring for a patient who has gastroesophageal reflux disease (GERD). Which patient statement would indicate a need for nutritional instruction?

A)"Nutrition can affect health positively or negatively."
B)"I should drink milk, as it is the perfect food."
C)"Excessive intake of a nutrient can interfere with others."
D)"Classes of nutrients are carbohydrates, fats, proteins, vitamins, minerals, and water."

Answer 1

"I should drink milk, as it is the perfect food."

Question 2

The nurse is caring for a patient on a gastrointestinal unit. The nurse would be most concerned if a patient reported which of the following?

A)"My stool is soft and dark brown; I usually move my bowels twice a day."
B)"Lately, I've had two or three loose, sticky black stools every day."
C)"My stool has been dark green and hard to pass lately."
D)"Usually I move my bowels every day and the stool is light brown."

Answer 2

"Lately, I've had two or three loose, sticky black stools every day."

Question 3

The nurse is reinforcing teaching for a patient who has a hiatal hernia. Which of the following statements by the patient would indicate a correct understanding of lifestyle modification to reduce symptoms?

A)"Perform daily aerobic exercise."
B)"Avoid nicotine and alcohol use."
C)"Carefully space activity periods with rest."
D)"Avoid high-stress situations."

Answer 3

"Avoid nicotine and alcohol use."

Question 4

The nurse is caring for a patient who has a nasogastric tube in place following gastric surgery. To irrigate the nasogastric tube, the nurse uses normal saline. What is the appropriate rationale for this?

A)It maintains fluid volume.
B)It decreases electrolytes.
C)It maintains electrolytes.
D)It increases fluid volume.

Question 5

The nurse is caring for a patient who has a duodenal peptic ulcer and vomits old blood. What description would the nurse use to document the appearance of the vomitus?

A)Duodenal fecal matter
B)Undigested particles of food
C)Coffee-ground particles
D)Chyme streaked with a black syrupy material

Question 6

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

A)Continuous low suction
B)Continuous high suction
C)Intermittent low suction
D)Intermittent high suction

Question 7

The nurse is reinforcing teaching for a patient who has dumping syndrome. Which of the following statements by the patient would indicate a correct understanding of the teaching of what this condition is?

A)"It is delayed gastric emptying."
B)"Glucose is dumped into the bloodstream."
C)"There is rapid entry of food into the jejunum."
D)"Digestive secretions enter the esophagus."

Question 8

The nurse is caring for a patient who has a sliding hiatal hernia. The nurse would expect the patient to report that symptoms are worse in which position?

A)Lying down
B)Semi-Fowler's
C)Standing
D)Sitting

Question 9

The nurse is caring for a patient who has a hiatal hernia and reports heartburn. Which of the following suggestions should the nurse provide?

A)Eat large meals.
B)Recline 1 hour before meals.
C)Sleep flat without a pillow.
D)Avoid bedtime snacks.

Question 10

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

A)"I need to eat small frequent meals."
B)"I can expect the symptoms to begin 2 hours after eating."
C)"I need to sit up for 2 hours after each meal."
D)"I should drink lots of fluids with meals."

Question 11

The nurse is reinforcing teaching for a patient who had a large portion of the stomach removed. Which of the following conditions, if stated by the patient, would indicate a correct understanding of why there usually is a need to receive vitamin B12 for life?

A)Acquired hemolytic anemia
B)Iron-deficiency anemia
C)Pernicious anemia
D)Sickle cell anemia

Question 12

A patient who has returned from surgery for a total gastrectomy has a nasogastric tube that is hooked to low intermittent suction. The patient begins to vomit bright red blood. Which of the following actions would be most appropriate for the nurse to take?

A)Increase the intravenous rate.
B)Administer oxygen.
C)Turn the patient onto his or her side.
D)Irrigate the nasogastric tube.

Question 13

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?

A)Obtain the patient's vital signs.
B)Encourage iced oral fluids.
C)Lower the head of the bed.
D)Place a cool cloth on the patient's forehead.

Question 14

A patient has 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 of the following actions would be most appropriate for the nurse to take?

A)Place suction on continuous.
B)Advance the tube.
C)Irrigate the tube.
D)Notify the RN.

Question 15

The nurse evaluates the understanding of a patient on the relationship between body position and gastroesophageal reflux after a teaching session. Which statement by the patient would indicate that the teaching has been effective?

A)"I elevate the foot of the bed 12 to 16 inches."
B)"I sleep on my stomach with my head turned to the left."
C)"I sleep on my back without a pillow under my head."
D)"I elevate the head of the bed 4 to 6 inches."

Question 16

A patient has severe trauma from an automobile accident. The nurse is checking the gastric pH and giving antacids as ordered. These interventions are prophylactic to prevent which of the following?

A)Shock
B)Metabolic acidosis
C)Stress ulcers
D)Malnutrition

Question 17

The nurse is reinforcing teaching for a patient who has a peptic ulcer. Which of the following statements by the patient would indicate a correct understanding of what ranitidine (Zantac) does?

A)"It coats your stomach."
B)"It clings to the ulcer."
C)"It neutralizes stomach acid."
D)"It reduces production of gastric acid."

Question 18

The nurse is providing care to a patient 3 days after a Billroth I procedure. Which of the following would cause the highest concern?

A)Pulse 58 beats per minute
B)Incisional pain score 4 on a 1 to 10 scale
C)Patient becomes tearful while viewing the incision
D)Reports of abdominal cramping shortly after eating

Question 19

The nurse is caring for a patient who had a radical neck dissection for cancer with a tracheostomy. What action by the nurse should take priority?

A)Establishing ways of communication
B)Ensuring adequate nutrition
C)Ensuring airway patency
D)Teaching about smoking cessation

Question 20

The nurse is reinforcing teaching for a patient who has been scheduled for pyloroplasty. Which of the following statements by the patient would indicate a correct understanding of the procedure?

A)"The doctor will stitch the top of my stomach to help me lose weight."
B)"The surgery will improve the movement of food from my stomach to my small intestine."
C)"The pylorus will be narrowed to prevent gastric reflux and help my ulcers heal."
D)"The doctor will cut the nerve that goes to my stomach so less acid is released."

Question 21

The nursing assistant is delivering patient meals. The nurse would expect the assistant to deliver which of the following trays to a patient who had a gastric bypass surgery the day before?

A)Clear liquids
B)Full liquids
C)Soft diet
D)General diet

Question 22

The nurse is contributing to a patient's teaching plan on how to avoid dumping syndrome after a gastrectomy. Which of the following would be included in the teaching?

A)Increase activity after eating.
B)Avoid fluids with meals.
C)Eat heavy meals to delay emptying.
D)Increase carbohydrate intake.

Question 23

A patient with gastric bleeding who has a nasogastric (NG) tube connected to low intermittent suction and is NPO reports a dry mouth and gagging feeling. What action should the nurse take?

A)Give lidocaine solution to coat the mouth.
B)Offer ice chips to swallow.
C)Provide oral care.
D)Pull tube out 1 inch.

Question 24

Which of these factors meet established criteria for the use of surgery in the treatment of obesity? (Select all that apply.?

A)Failure to reduce weight with other forms of therapy
B)Body weight 50% above ideal weight
C)Gross obesity for 5 years
D)Presence of gallstones
E)Psychiatric and social stability
F)Hypertension

Question 25

The nurse is caring for a patient who has a bleeding gastric ulcer. Which of the following patient statements would indicate correct understanding of beverages to avoid after treatment of a bleeding gastric ulcer? (Select all that apply.?

A)Iced tea
B)Lemonade
C)Beer
D)Diet soda pop
E)Coffee
F)Milk

Question 26

A body mass index of greater than ________________is considered obese.

Question 27

The nurse is caring for a patient who is unconscious and begins to vomit blood. What should be the nurse's priority intervention?

A)Administer antiemetic medication.
B)Use water to rinse out mouth.
C)Provide oral care to the patient.
D)Turn patient onto side.

Question 28

Weight that is ________________percent or more above ideal body weight is obesity.

Question 29

The nurse is caring for a patient who has a nursing diagnosis of acute postoperative pain after a gastrectomy. The patient has a nasogastric (NG) tube. What interventions should the nurse implement? (Select all that apply.?

A)Evaluate pain regularly and report changes to the RN.
B)Reposition NG tube once a shift.
C)Monitor NG tube functioning.
D)Provide pain medication as ordered.
E)Encourage total bedrest.
F)Start a regular diet once bowel sounds are detected.

Question 30

The nurse is caring for a patient who complains of nausea related to gastric cancer. Which of the following supplements would the nurse suggest?

A)Ginger
B)Lemon
C)Butterscotch
D)Black licorice
Multiple Response
Identify one or more choices that best complete the statement or answer the question.

Question 31

The nurse has instructed a patient prescribed omeprazole (Prilosec) for peptic ulcer disease on use of the medication. What statements by the patient indicate understanding of the instructions? (Select all that apply.?

A)"I will take the capsule before eating a meal in the morning."
B)"If I wish, I can open the capsule and sprinkle it on food."
C)"I will report any abdominal pain, diarrhea, or bleeding that occurs."
D)"I will need to take this drug for 3 weeks for my ulcer to heal."
E)"I'll have to have regular blood counts and tests of my liver enzymes."
F)"I should not take antacids while I'm on this medication."

Question 32

The nurse is providing care to a patient anticipating radiation therapy for head and neck cancer. Which of these would the nurse include in pretherapy education? (Select all that apply.?

A)"It is important that you visit the dentist before radiation therapy begins."
B)"Artificial saliva can be used if the radiation therapy causes drying of the mouth."
C)"Tooth decay occurs less frequently when oral tissues are dry."
D)"Water is an appropriate substitute for saliva."
E)"Good oral hygiene habits are important to prevent decay."
F)"All of your teeth will need to be pulled before you start radiation therapy."

Question 33

The nurse is caring for a patient who has been diagnosed with gastroesophageal reflux disease (GERD) and has developed esophagitis. The nurse understands that the patient is most at risk for what other complication?

A)Aspiration pneumonia
B)Barrett's esophagus
C)Bronchospasm
D)Laryngospasm

Question 34

The nurse is collecting data for a patient who has peptic ulcer disease and is taking Prevacid. Which data collection finding requires immediate intervention?

A)A rash
B)Constipation
C)Changes in mental status
D)Tarry stools

Question 35

The nurse is reinforcing teaching for a patient who is being tested for type B gastritis.Which of the following statements by the patient would indicate a correct understanding of the test that is used to diagnose this condition?

A)"Colonoscopy."
B)"Barium enema."
C)"Gastric aspirate analysis."
D)"Esophagogastroduodenoscopy."

Question 36

The nurse is caring for a patient who has aphthous stomatitis. What care should the nurse provide? (Select all that apply.?

A)Apply a topical anesthetic.
B)Teach to avoid irritating foods.
C)Place on fluid restriction.
D)Suggest stress management techniques.
E)Make patient NPO.Completion
Complete each statement.

Question 37

The nurse is caring for a patient who has bulimia. The nurse recognizes that the patient is at highest risk for which of the following complications?

A)Ischemic stroke
B)Metabolic alkalosis
C)Fluid overload
D)Weight gain