Question 1

What is the location of the vomiting centre that coordinates the multiple components involved in vomiting?

Accepted Answer

The vomiting centre is located in the brainstem, specifically in the medulla oblongata. It receives input from multiple sources including the chemoreceptor zone, vestibular area, and visceral receptors from afferent fibres in the GI tract, and coordinates the multiple components involved in vomiting.

Question 2

A patient who has recently been experiencing frequent heartburn is seen in the clinic.The nurse will anticipate teaching the patient about which of the following?

Accepted Answer

Frequent heartburn is a common symptom of gastroesophageal reflux disease (GERD), which is often treated with proton pump inhibitors. Endoscopy procedures and barium swallow may be ordered to diagnose GERD, but teaching about these procedures is not indicated based solely on the symptom of heartburn. Radionuclide tests are not typically used to diagnose or treat GERD.

Question 3

The nurse teaches a patient who is trying to stop the use of smokeless tobacco to examine the mouth routinely for the danger signs of oral cancer,especially for the presence of which of the following signs?

Accepted Answer

A red, velvety patch in the mouth can be a warning sign of oral cancer and should be examined by a healthcare professional. Acutely sore ulcers can be a sign of irritation or infection, but may not necessarily be indicative of cancer. White, curdlike plaques may indicate a fungal infection such as thrush. A reddened and swollen tongue can be a sign of inflammation or infection, but again may not necessarily indicate cancer.

Question 4

Which information about a patient who has just been admitted to the hospital with nausea and vomiting will require the most rapid nursing intervention?

Accepted Answer

The patient being lethargic and difficult to arouse indicates that they may be experiencing dehydration or electrolyte imbalance, which can be life-threatening. Rapid nursing intervention is necessary in this situation to prevent further complications.

Question 5

The nurse identifies the nursing diagnosis of deficient fluid volume for a patient with prolonged vomiting.Which of the following nursing assessments is most helpful in determining the source of the vomiting?

Accepted Answer

Asking the times when the vomiting occurs can help identify patterns or triggers related to the vomiting, which can be crucial in determining its source.

Question 6

A patient tells the nurse that when he feels nauseous,he takes ginger.The nurse should instruct the patient that he should not take ginger if he is also taking which one of the following medications?

Accepted Answer

Ginger may interfere with the absorption of digoxin, leading to decreased effectiveness of the medication. Therefore, the patient should avoid taking ginger if they are also taking digoxin.

Question 7

Which information will the nurse include when teaching a patient with newly diagnosed GERD?

Accepted Answer

Elevating the head of the bed may help prevent stomach acid from entering the esophagus while sleeping. Peppermint tea may actually aggravate symptoms due to its relaxing effect on the lower esophageal sphincter. Eating smaller, frequent meals may be recommended instead of avoiding food altogether. Vigorous physical activity may not necessarily increase reflux, but it can worsen symptoms if done immediately after meals.

Question 8

A patient who has been on nothing by mouth (NPO)status during treatment for nausea and vomiting related to gastric irritation is to start oral intake of clear liquids.To promote tolerance to oral fluids,what should the nurse first offer the patient?

Accepted Answer

Offering a dish of lemon gelatin is the best choice as it is a clear liquid and also has a sour taste which can help to reduce nausea. Orange juice and coffee may be too acidic for a patient with gastric irritation, whereas hot chicken broth may be too heavy for a patient who is just starting oral intake after being NPO.

Question 9

A patient with recurring heartburn tells the nurse that he has used over-the-counter antacids and famotidine (Pepcid),but the physician has now prescribed esomeprazole (Nexium).In teaching the patient about this medication,what should the nurse explain about this drug?

Accepted Answer

Esomeprazole is a proton pump inhibitor that works by decreasing the production of stomach acid. It is used to treat GERD and provides long-lasting relief of symptoms. It does not increase the rate of gastric emptying or coat the stomach to protect against gastric acid, and it is typically more expensive than antacids and H2 blockers like famotidine.

Question 10

Which of the following will the nurse plan to teach the patient with newly diagnosed achalasia?

Accepted Answer

Endoscopic procedures, such as pneumatic dilation or botulinum toxin injection, are common treatments for achalasia to help relax the lower esophageal sphincter and improve swallowing.

Question 11

A 62-year-old man with weight loss,difficulty chewing,and malaise has been diagnosed with squamous cell carcinoma of the oral cavity.Which of the following information obtained from the patient during the nursing history is the most significant risk factor for oral cancer?

Accepted Answer

Tobacco use is the most significant risk factor for oral cancer, accounting for up to 80% of cases. Neglected oral hygiene and recurrent herpes simplex infections are not significant risk factors for oral cancer, and chronic overexposure to the sun is a risk factor for skin cancer but not for oral cancer.

Question 12

A patient with oral squamous cell carcinoma is transferred to the postoperative surgical unit after a hemiglossectomy and radical neck procedure.When planning care,the nurse will anticipate the need to do which of the following?

Accepted Answer

A hemiglossectomy involves the removal of half of the tongue, which can significantly impair speech and communication. Therefore, the nurse would anticipate the need to use an alphabet board or other communication aids to assist the patient. Choices A, C, and D are not appropriate for immediate post-operative care after a hemiglossectomy and radical neck procedure. A long-term central venous catheter for parenteral nutrition may be needed for patients with prolonged inability to take oral feedings, while chemotherapy is typically not initiated immediately after surgery. Reinforcing pressure dressings may be necessary but is not the priority in this situation.

Question 13

A patient returns to the surgical unit following an abdominal Nissen fundoplication for treatment of GERD.Four hours postoperatively,which one of the following is it most important for the nurse to address?

Accepted Answer

Dyspnea and absent breath sounds in one lung could indicate a potential pulmonary complication, such as pneumothorax, which requires immediate intervention. This takes priority over the other options, which may be addressed after addressing the patient's respiratory distress.

Question 14

A patient with chronic gastroesophageal reflux disease (GERD)is experiencing increasing discomfort.During assessment of the patient's current management of the problem,the nurse determines that further teaching is needed when the patient makes which following statement?

Accepted Answer

Eating a bedtime snack can exacerbate GERD symptoms by increasing stomach acid production and allowing acid to reflux into the esophagus when lying down.

Question 15

A patient who is on NPO status and has been receiving parenteral nutrition for 2 weeks develops bilateral pain in the area of the ears.The nurse recognizes that the patient is at risk for development of which of the following conditions?

Accepted Answer

The patient is at risk for developing parotitis, which is inflammation of the parotid gland. This can occur in patients receiving parenteral nutrition due to decreased salivary flow and potential bacterial overgrowth. Bilateral pain in the area of the ears is a common symptom of parotitis. Stomatitis, oral candidiasis, and Vincent's infection are not typically associated with bilateral ear pain.

Question 16

A patient undergoes an esophagectomy with a synthetic graft replacement for treatment of esophageal cancer.Following his return to the surgical unit,why should the nurse place the patient in a semi-Fowler's position?

Accepted Answer

To prevent reflux of gastric secretions

Question 17

When teaching a patient with GERD about recommended dietary modifications,the nurse explains that which of the following foods decreases lower esophageal sphincter (LES)pressure and should be avoided?

Accepted Answer

Coffee, tea, and chocolate decrease LES pressure and should be avoided in patients with GERD. Acidic and pickled foods, spicy and highly seasoned foods, and milk and other dairy products can also exacerbate symptoms for some individuals. However, these foods do not specifically decrease LES pressure.

Question 18

A 62-year-old patient develops an acute gastritis caused by the nonsteroidal anti-inflammatory drug (NSAID)she uses to treat her arthritis.In teaching the patient about the effects of these drugs on the stomach's mucosal barrier,what should the nurse explain?

Accepted Answer

NSAIDs inhibit the synthesis of prostaglandins, which are responsible for decreasing acid secretion in the stomach. This inhibition leads to increased acid production and decreased mucosal protection, which can result in acute gastritis.

Question 19

When admitting a patient with a stroke who is unconscious and unresponsive to stimuli,the nurse learns from the patient's wife that the patient has a history of GERD.About which of the following will the nurse complete frequent assessments?

Accepted Answer

The patient's history of GERD makes the nurse concerned about aspiration, so the nurse will complete frequent assessments of breath sounds to monitor for signs of respiratory distress or pneumonia.

Question 20

When a patient with persistent nausea and severe vomiting is admitted to the hospital for control of the symptoms,what is the first order that the nurse should act on?

Accepted Answer

Infusing normal saline at 250 mL/hour is often a priority to correct dehydration and electrolyte imbalances that can result from severe vomiting. This helps stabilize the patient's condition and supports the effectiveness of other treatments.

Quiz 44: Nursing Management: Upper Gastrointestinal Problems