Deck 42: Nursing Management: Upper Gastrointestinal Problems

Question 1

Which nursing action should be included in the postoperative plan of care for a patient after a laparoscopic esophagectomy?

A) Notify the doctor about bloody nasogastric (NG) drainage.
B) Elevate the head of the bed to at least 30 degrees.
C) Reposition the NG tube if drainage stops.
D) Start oral fluids when the patient has active bowel sounds.

Answer 1

Elevate the head of the bed to at least 30 degrees.

Question 2

Which information will the nurse include for a patient with newly diagnosed gastroesophageal reflux disease (GERD)?

A) "Peppermint tea may reduce your symptoms."
B) "Keep the head of your bed elevated on blocks."
C) "You should avoid eating between meals to reduce acid secretion."
D) "Vigorous physical activities may increase the incidence of reflux."

Answer 2

"Keep the head of your bed elevated on blocks."

Question 3

The nurse explaining esomeprazole (Nexium)to a patient with recurring heartburn describes that the medication

A) reduces gastroesophageal reflux by increasing the rate of gastric emptying.
B) neutralizes stomach acid and provides relief of symptoms in a few minutes.
C) coats and protects the lining of the stomach and esophagus from gastric acid.
D) treats gastroesophageal reflux disease by decreasing stomach acid production.

Answer 3

treats gastroesophageal reflux disease by decreasing stomach acid production.

Question 4

Which medications will the nurse teach the patient about whose peptic ulcer disease is associated with Helicobacter pylori?

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 5

Which information will the nurse include when teaching adults to decrease the risk for cancers of the tongue and buccal mucosa?

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

Question 6

A 68-year-old male patient with a stroke is unconscious and unresponsive to stimuli.After learning 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 7

A 58-year-old woman who recently has been diagnosed with esophageal cancer tells the nurse,"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 8

A 53-year-old male patient with deep partial-thickness burns from a chemical spill in the workplace experiences severe pain followed by nausea during dressing changes.Which action will be most useful in decreasing the patient's nausea?

A) Keep 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 9

Which patient choice for a snack 2 hours before bedtime indicates that the nurse's teaching about gastroesophageal reflux disease (GERD)has been effective?

A) Chocolate pudding
B) Glass of low-fat milk
C) Cherry gelatin with fruit
D) Peanut butter and jelly sandwich

Question 10

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."

Question 11

A 38-year old woman receiving chemotherapy for breast cancer develops a Candida albicans oral infection.The nurse will anticipate the need for

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

Question 12

Which finding in the mouth of a patient who uses smokeless tobacco is suggestive of oral cancer?

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

Question 13

A 50-year-old man vomiting 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 saturated fat in the diet.
B) any family history of gastric or colon cancer.
C) a history of a large recent weight gain or loss.
D) use of nonsteroidal antiinflammatory drugs (NSAIDs).

Question 14

Which action should the nurse in the emergency department anticipate for a 23-year-old patient who has had several episodes of bloody diarrhea?

A) Obtain a stool specimen for culture.
B) Administer antidiarrheal medication.
C) Provide teaching about antibiotic therapy.
D) Teach about adverse effects of acetaminophen (Tylenol).

Question 15

The nurse determines that teaching regarding cobalamin injections has been effective when the patient with chronic atrophic gastritis states which of the following?

A) "The cobalamin injections will prevent gastric inflammation."
B) "The cobalamin injections will prevent me from becoming anemic."
C) "These injections will increase the hydrochloric acid in my stomach."
D) "These injections will decrease my risk for developing stomach cancer."

Question 16

When a 72-year-old patient is diagnosed with achalasia,the nurse will teach the patient that

A) lying down after meals is recommended.
B) a liquid or blenderized diet will be necessary.
C) drinking fluids with meals should be avoided.
D) treatment may include endoscopic procedures.

Question 17

A 57-year-old man with Escherichia coli O157:H7 food poisoning is admitted to the hospital with bloody diarrhea and dehydration.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 18

The nurse will anticipate teaching a patient experiencing frequent heartburn about

A) a barium swallow.
B) radionuclide tests.
C) endoscopy procedures.
D) proton pump inhibitors.

Question 19

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

Question 20

The nurse will anticipate preparing a 71-year-old female patient who is vomiting "coffee-ground" emesis for

A) endoscopy.
B) angiography.
C) barium studies.
D) gastric analysis.

Question 21

A 62-year-old man patient who requires daily use of a nonsteroidal antiinflammatory drug (NSAID)for the 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) misoprostol (Cytotec) to protect the gastrointestinal (GI) mucosa.

Question 22

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.

Question 23

A 68-year-old 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) monitors arterial blood gas values daily.
B) periodically aspirates and tests gastric pH.
C) checks each stool for the presence of occult blood.
D) measures the volume of residual stomach contents.

Question 24

A 50-year-old patient who underwent a gastroduodenostomy (Billroth I)earlier today complains of increasing abdominal pain.The patient has no bowel sounds and 200 mL of bright red nasogastric (NG)drainage in the last hour.The highest priority action by the nurse is to

A) contact the surgeon.
B) irrigate the NG tube.
C) monitor the NG drainage.
D) administer the prescribed morphine.

Question 25

Which order from the health care provider will the nurse implement first for a patient who has vomited 1200 mL of blood?

A) Give an IV H₂ receptor antagonist.
B) Draw blood for typing and crossmatching.
C) Administer 1000 mL of lactated Ringer's solution.
D) Insert a nasogastric (NG) tube and connect to suction.

Question 26

A 26-year-old woman has been admitted to the emergency department with nausea and vomiting.Which action could the RN delegate to unlicensed assistive personnel (UAP)?

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

Question 27

The nurse is assessing a patient who had a total gastrectomy 8 hours ago.What information is most important to report to the health care provider?

A) Absent bowel sounds
B) Complaints of incisional pain
C) Temperature 102.1° F (38.9° C)
D) Scant nasogastric (NG) tube drainage

Question 28

A patient returned from a laparoscopic Nissen fundoplication for hiatal hernia 4 hours ago.Which assessment finding is most important for the nurse to address immediately?

A) The patient is experiencing intermittent waves of nausea.
B) The patient complains of 7/10 (0 to 10 scale) abdominal pain.
C) The patient has absent breath sounds in the left anterior chest.
D) The patient has hypoactive bowel sounds in all four quadrants.

Question 29

A 26-year-old patient with a family history of stomach cancer asks the nurse about ways to decrease the risk for developing stomach cancer.The nurse will teach the patient to avoid

A) emotionally stressful situations.
B) smoked foods such as ham and bacon.
C) foods that cause distention or bloating.
D) chronic use of H₂ blocking medications.

Question 30

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) sucralfate at bedtime and antacids before each meal.
B) sucralfate and antacids together 30 minutes before meals.
C) antacids 30 minutes before each dose of sucralfate is taken.
D) antacids after meals and sucralfate 30 minutes before meals.

Question 31

Which assessment should the nurse perform first for a patient who just vomited bright red blood?

A) Measuring the quantity of emesis
B) Palpating the abdomen for distention
C) Auscultating the chest for breath sounds
D) Taking the blood pressure (BP) and pulse

Question 32

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."

Question 33

Which patient should the nurse assess first after receiving change-of-shift report?

A) A patient with nausea who has a dose of metoclopramide (Reglan) due
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 92/58 mm Hg
D) A patient admitted yesterday with gastrointestinal (GI) bleeding who has melena

Question 34

A 49-year-old man has been admitted with hypotension and dehydration after 3 days of nausea and vomiting.Which order from the health care provider will the nurse implement first?

A) Insert a nasogastric (NG) tube.
B) Infuse normal saline at 250 mL/hr.
C) Administer IV ondansetron (Zofran).
D) Provide oral care with moistened swabs.

Question 35

A family member of a 28-year-old 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) decrease nausea and vomiting.
B) inhibit development of stress ulcers.
C) lower the risk for H. pylori infection.
D) prevent aspiration of gastric contents.

Question 36

A 44-year-old man admitted with a peptic ulcer has a nasogastric (NG)tube in place.When the patient develops sudden,severe upper abdominal pain,diaphoresis,and a firm abdomen,which action should the nurse take?

A) Irrigate the NG tube.
B) Check the vital signs.
C) Give the ordered antacid.
D) Elevate the foot of the bed.

Question 37

A 58-year-old patient has just been admitted to the emergency department with nausea and vomiting.Which information requires the most rapid intervention by the nurse?

A) The patient has been vomiting for 4 days.
B) The patient takes antacids 8 to 10 times a day.
C) The patient is lethargic and difficult to arouse.
D) The patient has undergone a small intestinal resection.

Question 38

A 73-year-old patient is diagnosed with stomach cancer after an unintended 20-pound weight loss.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 39

Which patient statement indicates that the nurse's teaching following a gastroduodenostomy has been effective?

A) "Vitamin supplements may prevent anemia."
B) "Persistent heartburn is common after surgery."
C) "I will try to drink more liquids with my meals."
D) "I will need to choose high carbohydrate foods."

Question 40

Which information will the nurse include when teaching a patient with peptic ulcer disease about the effect of ranitidine (Zantac)?

A) "Ranitidine absorbs the gastric acid."
B) "Ranitidine decreases gastric acid secretion."
C) "Ranitidine constricts the blood vessels near the ulcer."
D) "Ranitidine covers the ulcer with a protective material."

Question 41

The nurse and a licensed practical/vocational nurse (LPN/LVN)are working together to care for a patient who had an esophagectomy 2 days ago.Which action by the LPN/LVN requires that the nurse intervene?

A) The LPN/LVN uses soft swabs to provide for oral care.
B) The LPN/LVN positions the head of the bed in the flat position.
C) The LPN/LVN encourages the patient to use pain medications before coughing.
D) The LPN/LVN includes the enteral feeding volume when calculating intake and output.

Question 42

After the nurse has completed teaching a patient with newly diagnosed eosinophilic esophagitis about the management of the disease,which patient action indicates that the teaching has been effective?

A) Patient orders nonfat milk for each meal.
B) Patient uses the prescribed corticosteroid inhaler.
C) Patient schedules an appointment for allergy testing.
D) Patient takes ibuprofen (Advil) to control throat pain.

Question 43

After change-of-shift report,which patient should the nurse assess first?

A) 42-year-old who has acute gastritis and ongoing epigastric pain
B) 70-year-old with a hiatal hernia who experiences frequent heartburn
C) 53-year-old who has dumping syndrome after a recent partial gastrectomy
D) 60-year-old with nausea and vomiting who has dry oral mucosa and lethargy

Question 44

An 80-year-old who is hospitalized with peptic ulcer disease develops new-onset auditory hallucinations.Which prescribed medication will the nurse discuss with the health care provider before administration?

A) Sucralfate (Carafate)
B) Omeprazole (Prilosec)
C) Metoclopramide (Reglan)
D) Aluminum hydroxide (Amphojel)

Question 45

In which order will the nurse take the following actions when caring for a patient who develops watery diarrhea and a fever after prolonged omeprazole (Prilosec)therapy? (Put a comma and a space between each answer choice [A,B,C,D].)

A) Contact the health care provider.
B) Assess blood pressure and heart rate.
C) Give the PRN acetaminophen (Tylenol).
D) Place the patient on contact precautions.

Question 46

Vasopressin (Pitressin)0.2 units/min infusion is prescribed for a patient with acute arterial gastrointestinal (GI)bleeding.The vasopressin label states vasopressin 100 units/250 mL normal saline.How many mL/hr will the nurse infuse?

Question 47

The nurse is administering IV fluid boluses and nasogastric irrigation to a patient with acute gastrointestinal (GI)bleeding.Which assessment finding is most important for the nurse to communicate to the health care provider?

A) The bowel sounds are hyperactive in all four quadrants.
B) The patient's lungs have crackles audible to the midchest.
C) The nasogastric (NG) suction is returning coffee-ground material.
D) The patient's blood pressure (BP) has increased to 142/84 mm Hg.