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

Accepted Answer

Because GERD may cause aspiration, the unconscious client is at risk for developing aspiration pneumonia. Bowel sounds, abdominal girth, and apical pulse will not be affected by the client's stroke or GERD and do not require more frequent monitoring than the routine.

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

Accepted Answer

Endoscopy is the primary tool for visualization and diagnosis of upper gastrointestinal (GI) bleeding. Angiography is used only when endoscopy cannot be done because it is more invasive and has more possible complications. Gastric analysis testing may help with determining the cause of gastric irritation, but it is not used for acute GI bleeding. Barium studies are helpful in determining the presence of gastric lesions, but not whether the lesions are actively bleeding.

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.

Accepted Answer

Clients with bloody diarrhea should have a stool culture for E. coli O157:H7. NSAIDs may cause occult blood in the stools, but not diarrhea. Antidiarrheal medications usually are avoided for possible infectious diarrhea to avoid prolonging the infection. Antibiotic therapy in the treatment of infectious diarrhea is controversial because it may precipitate kidney complications.

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

Accepted Answer

Because diagnostic testing for heartburn that is probably caused by gastro-esophageal reflux disease (GERD) is expensive and uncomfortable, proton pump inhibitors are frequently used for a short period as the first step in the diagnosis of GERD. The other tests may be used but are not usually the first step in diagnosis.

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

Accepted Answer

Clear liquids are usually the first foods started after a client has been nauseated. Acidic foods such as orange juice, very hot foods, and coffee are poorly tolerated when clients have been nauseated.

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.

Accepted Answer

Endoscopic and laparoscopic procedures are the most effective therapy for improving symptoms caused by achalasia. Clients are advised to drink fluid with meals. Keeping the head elevated after eating will improve esophageal emptying. A semisoft diet is recommended to improve esophageal emptying.

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.

Accepted Answer

The client would not have an intake of solid food at this time. Clear fluids would be ordered. The other orders are appropriate.

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.

Accepted Answer

It is a proton pump inhibitor that decreases the rate of gastric acid secretion. Promotility drugs such as metoclopramide increase the rate of gastric emptying. Cryoprotective medications such as sucralfate protect the stomach. Antacids neutralize stomach acid and work rapidly.

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."

Accepted Answer

Cobalamin supplementation prevents the development of pernicious anemia. The incidence of stomach cancer is higher in clients with chronic gastritis, but cobalamin does not reduce the risk for stomach cancer. Chronic gastritis may cause achlorhydria, but cobalamin does not correct this. The loss of intrinsic factor secretion with chronic gastritis is permanent, and the client will need lifelong supplementation with cobalamin.

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."

Accepted Answer

GERD is exacerbated by eating late at night, and the nurse should plan to teach the client to avoid eating at bedtime. The other client actions are appropriate to control symptoms of GERD.

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

Accepted Answer

A red, velvety patch suggests erythroplasia, which has a high incidence (90%) of progression to malignant cancer. The other lesions are suggestive of acute processes (gingivitis, oral candidiasis, and herpes simplex).

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

Accepted Answer

Candida albicans is treated with an antifungal such as nystatin. Oral saltwater rinses may be used but will not cure the infection. Antiviral agents are used for viral infections such as herpes simplex. Referral to a dentist is indicated for gingivitis but not for Candida infection.

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

Accepted Answer

The drugs used in triple drug therapy include a proton pump inhibitor such as omeprazole and the antibiotics amoxicillin and clarithromycin. The other combinations listed are not included in the protocol for H. pylori infection.

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.

Accepted Answer

The client's nausea is associated with stress and severe pain; therefore the best treatment will be to provide adequate pain medication before dressing changes. The nurse should avoid doing painful procedures close to mealtimes, but nausea or vomiting that occurs at other times also should be addressed. Keeping the client NPO does not address the reason for the nausea and vomiting and will have an adverse effect on the client's nutrition.
Administration of antiemetics is not the best choice for a client with nausea caused by pain.

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

Accepted Answer

Gelatin and fruit are low fat and will not decrease lower esophageal sphincter (LES) pressure. Foods like chocolate are avoided because they lower LES pressure. Milk products increase gastric acid secretion. High-fat foods such as peanut butter decrease both gastric emptying and LES pressure.

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."

Accepted Answer

Elevating the head of the bed will reduce the incidence of reflux while the client is sleeping. Peppermint will lower LES pressure and increase the chance for reflux. Small, frequent meals are recommended to avoid abdominal distension. There is no need to make changes in physical activities because of GERD.

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.

Accepted Answer

Tobacco use greatly increases the risk for oral cancer. Acute throat infections do not increase risk for oral cancer, although chronic irritation of the oral mucosa does increase risk. Sun exposure does not increase the risk for cancers of the buccal mucosa. Human papillomavirus (HPV) infection is associated with increased risk, but HSV infection is not a risk factor for oral cancer.

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."

Accepted Answer

This response is open-ended and will encourage the client to further discuss feelings of anxiety or sadness about the diagnosis. Clients with esophageal cancer have only a low survival rate, so the response "You may have quite a few years still left to live" is misleading. The response beginning, "Thinking about dying" indicates that the nurse is not open to discussing the client's fears of dying. And the response beginning, "It is important that you be realistic," discourages the client from feeling hopeful, which is important to clients with any life-threatening diagnosis.

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)

Accepted Answer

Use of an NSAID is associated with damage to the gastric mucosa, which can result in acute gastritis. Family history, recent weight gain or loss, and fatty foods are not risk factors for acute gastritis.

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.

Accepted Answer

Elevation of the head of the bed decreases the risk for reflux and aspiration of gastric secretions. The client should be in the Fowler's or semi-Fowler's position. The NG tube should not be repositioned without consulting with the health care provider. Bloody NG drainage is expected for the first 8-12 hours. A swallowing study is needed before oral fluids are started.

Quiz 44: Nursing Management Upper Gastro-intestinal Problems

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?

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?

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?

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?

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?

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

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?

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?

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?

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?

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?

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?

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?

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?

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?

Which of the following information should the nurse include when teaching a client with newly diagnosed gastro-esophageal reflux disease (GERD) ?

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?

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?

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?

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?