Deck 44: Nursing Management Upper Gastro-intestinal Problems

Question 1

The nurse is admitting a client with a stroke who is unconscious and unresponsive to stimuli and learns from the client's family that the client has a history of gastro-esophageal reflux disease (GERD). Which of the following assessment parameters shouldthe nurse plan to assess frequently?

A)Apical pulse
B)Bowel sounds
C)Breath sounds
D)Abdominal girth

Answer 1

Breath sounds

Question 2

The nurse is caring for a client with vomiting of "coffee-ground" emesis. Which of the following procedures should the nurse anticipate for the client?

A)Endoscopy
B)Angiography
C)Gastric analysis testing
D)Barium contrast studies

Answer 2

Endoscopy

Question 3

The nurse is admitting a client to the emergency department who has had several episodes of bloody diarrhea. Which of the following actions 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 3

Obtain a stool specimen for culture.

Question 4

The nurse is assessing a client who recently has been experiencing frequent heartburn in the clinic. Which of the following information should the nurse include in the teaching plan?

A)Barium swallow
B)Radionuclide tests
C)Endoscopy procedures
D)Proton pump inhibitors

Question 5

The nurse is caring for a client who has been NPO during treatment for nausea and vomiting caused by gastric irritation and is to start oral intake. Which of the following menu choices should the nurse offer to the client?

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 6

Which of the following information should the nurse plan to teach to a client with newly diagnosed achalasia?

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 7

The nurse is admitting a client with Escherichia coli O157:H7 food poisoning who has bloody diarrhea and dehydration. Which of the following prescriptions should the nurse question?

A)Infuse lactated Ringer's solution at 250 mL/hour.
B)Monitor blood urea nitrogen and creatinine daily.
C)High protein, high fat diet.
D)Provide a clear liquid diet and progress diet as tolerated.

Question 8

The nurse is caring for a client with recurring heartburn who receives a new prescription for esomeprazole. Which of the following information should the nurse include when teaching the client about this medication?

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

Question 9

Cobalamin injections have been prescribed for a client with chronic atrophic gastritis. Which of the following client statements indicate that the teaching regarding the injections has been effective?

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."

Question 10

The nurse is assessing a client with gastro-esophageal reflux disease (GERD) who is experiencing increasing discomfort. Which of the following client statements indicate that additional client 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 10-cm 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 11

The nurse is assessing the mouth of a client who uses smokeless tobacco for signs of oral cancer. Which of the following findings is 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 12

The nurse is caring for a client who is receiving chemotherapy and develops a Candida albicans oral infection. Which of the following actions should the nurse anticipate?

A)Hydrogen peroxide rinses
B)The use of antiviral agents
C)Referral to a dentist for professional tooth cleaning
D)Administration of nystatin oral tablets

Question 13

The nurse is caring for a client with peptic ulcer disease associated with the presence of Helicobacter pylori and is being treated with triple drug therapy. Which of the following medications should the nurse include in the client teaching?

A)Sucralfate, nystatin and bismuth
B)Amoxicillin, clarithromycin and omeprazole
C)Famotidine, magnesium hydroxide, and pantoprazole
D)Metoclopramide, bethanechol, and promethazine

Question 14

The nurse is caring for a client with deep partial-thickness burns who is anxious about the upcoming dressing change, is in severe pain, and is nauseated. Which of the following actions will be most useful in decreasing the client's nausea?

A)The client NPO for 2 hours before and after dressing changes.
B)Avoid performing dressing changes close to the client's mealtimes.
C)Administer the prescribed morphine sulphate before dressing changes.
D)Give the ordered prochlorperazine before dressing changes.

Question 15

The nurse is teaching a client with gastro-esophageal reflux disease (GERD) about recommended dietary modifications. Which of the following diet choices 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 16

Which of the following information should the nurse include when teaching a client with newly diagnosed gastro-esophageal 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 17

To decrease the risk for cancers of the tongue and buccal mucosa, which of the following information should the nurse include when teaching a client who is seen for an annual physical examination 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 18

The nurse is caring for an older-adult client who has diagnosed with esophageal cancer and the client tells the nurse, "I know that my chances are not very good, but I do not feel ready to die yet." Which of the following responses by the nurse is best?

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

The nurse is caring for a client who is nauseated, vomiting up blood-streaked fluid and has acute gastritis. Which of the following assessments should the nurse ask the client about to determine possible risk factors for gastritis?

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)

Question 20

The nurse is caring for a client who has just arrived on the postoperative unit after having a laparoscopic esophagectomy for treatment of esophageal cancer. Which of the following nursing actions 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 client has active bowel sounds.

Question 21

Twelve hours after undergoing a gastroduodenostomy (Billroth I), a client has symptoms of increasing abdominal pain. The client has absent bowel sounds and 200 mL of bright red nasogastric (NG) drainage in the last hour. Which of the following actions shouldthe nurse take next?

A)Notify the surgeon.
B)Irrigate the NG tube.
C)Administer the prescribed morphine.
D)Continue to monitor the NG drainage.

Question 22

The nurse is caring for a client with a bleeding duodenal ulcer who has a nasogastric (NG) tube in place and a prescription for 30 mL of aluminum hydroxide/magnesium hydroxide to be instilled through the tube every hour. Which of the following assessmentsshould the nurse do to evaluate the effectiveness of this treatment?

A)Periodically aspirate and test gastric pH.
B)Monitor arterial blood gas values on a daily basis.
C)Check each stool for the presence of occult blood.
D)Measure the amount of residual stomach contents hourly.

Question 23

After receiving change-of-shift report, which of the following clients should the nurse assess first?

A)A client who was admitted yesterday with gastrointestinal (GI) bleeding and has melena
B)A client who is crying after receiving a diagnosis of esophageal cancer
C)A client with esophageal varices who has a blood pressure of 96/54 mm Hg
D)A client with nausea who has a dose of metoclopramide (Reglan) scheduled

Question 24

The health care provider prescribes antacids and sucralfate for treatment of a client's peptic ulcer. Which of the following information should the nurse include in the client's teaching plan?

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 25

The nurse is counselling a client with a family history of stomach cancer about risk factors. Which of the following is a risk factor for the development of stomach cancer?

A)Type A blood
B)Chronic abdominal distension
C)Long-term use of H2 blocking medications
D)Exposure to emotionally or physically stressful situations

Question 26

The nurse is caring for a client with a peptic ulcer and a nasogastric (NG) tube who develops sudden, severe upper abdominal pain, diaphoresis, and a very firm abdomen. Which of the following actions 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 27

Which of the following findings in a client 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 client is experiencing intermittent waves of nausea.
B)The client has absent breath sounds throughout the left lung.
C)The client has decreased bowel sounds in all four quadrants.
D)The client complains of 6/10 (0-10 scale) abdominal pain.

Question 28

All of the following prescriptions are received for a client who has vomited 1 500 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 40 mg.
C)Draw blood for typing and crossmatching.
D)Infuse 1 000 mL of lactated Ringer's solution.

Question 29

The nurse is providing discharge teaching for a client following a gastroduodenostomy for treatment of a peptic ulcer. Which of the following client statements indicate 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 30

The health care provider prescribes intravenous (IV) ranitidine for a client with gastrointestinal (GI) bleeding caused by peptic ulcer disease. When teaching the client about the effect of the medication, which of the following information should 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 31

Which of the following information about a client who has just been admitted to the hospital with nausea and vomiting requires the most rapid intervention by the nurse?

A)The client has taken only sips of water.
B)The client is lethargic and difficult to arouse.
C)The client's chart indicates a recent resection of the small intestine.
D)The client has been vomiting several times a day for the last 4 days.

Question 32

The health care provider prescribes the following therapies for a client who has been admitted with dehydration and hypotension after 3 days of nausea and vomiting. Which order should the nurse implement first?

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

Question 33

A client recovering from a gastrojejunostomy (Billroth II) for treatment of a duodenal ulcer develops dizziness, weakness, and palpitations about 20 minutes after eating. Which of the following information should the nurse teach to the client to avoid recurrence of these symptoms?

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 34

Which of the following information is best for the nurse to include when teaching a client 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 35

Which of the following assessment findings in a client 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 38.9°C (102°F)

Question 36

The family member of a client who has suffered massive abdominal trauma in an automobile accident asks the nurse why the client is receiving famotidine. Which of the following information should the nurse provide to the family about the medication for thisclient?

A)It prevents aspiration of gastric contents.
B)It inhibits the development of stress ulcers.
C)It lowers the chance for H. pylori infection.
D)It decreases the risk for nausea and vomiting.

Question 37

A client who requires daily use of a nonsteroidal anti-inflammatory drug (NSAID) for management of severe rheumatoid arthritis has recently developed melena. Which of the following information should the nurse include in the teaching plan?

A)Substitution of acetaminophen 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 in protecting the gastrointestinal (GI) mucosa

Question 38

The nurse is admitting a client who is vomiting bright red blood to the emergency department. Which of the following assessments 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 39

The nurse is caring for a client with stomach cancer who had a recent 9.1 kg unintended weight loss. Which of the following nursing actions should be included in the plan of care?

A)Refer the client for hospice services.
B)Infuse IV fluids through a central line.
C)Teach the client about antiemetic therapy.
D)Offer supplemental feedings between meals.

Question 40

The nurse is caring for a client with acute gastrointestinal (GI) bleeding who is receiving normal saline IV at a rate of 500 mL/hour. Which of the following findings obtained by the nurse is most important to communicate immediately to the health careprovider?

A)The client's blood pressure (BP) has increased to 142/94 mm Hg.
B)The nasogastric (NG) suction is returning coffee-ground material.
C)The client's lungs have crackles audible to the midline.
D)The bowel sounds are very hyperactive in all four quadrants.

Question 41

Which of the following symptoms should the nurse anticipate in a client with a duodenal ulcer? (Select all that apply.)

A)Decreased gastric secretion
B)Nausea and vomiting
C)Pain about 1 hour after a meal
D)Middle of the night pain
E)relief from pain with administration of an antacid

Question 42

Which of the following findings should the nurse anticipate in a client with an upper GI bleed? (Select all that apply.)

A)Increased urinary output
B)Black, tarry stool
C)Constipation
D)Diaphoresis
E)Epigastric pain