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Ch. 42 Nursing Management: Upper Gastrointestinal Problems practice questions
Terms in this set (26)
A 72-year-old patient was admitted with epigastric pain caused by a gastric ulcer. Which patient assessment warrants an urgent change in the nursing plan of care?
1 Chest pain relieved with eating or drinking water
2 Back pain three or four hours after eating a meal
3 Burning epigastric pain 90 minutes after breakfast
4 Rigid abdomen and vomiting following indigestion
A rigid abdomen with vomiting in a patient who has a gastric ulcer indicates a perforation of the ulcer, especially if the manifestations of perforation appear suddenly. Midepigastric pain is relieved by eating, drinking water, or antacids with duodenal ulcers, not gastric ulcers. Back pain three to four hours after a meal is more likely to occur with a duodenal ulcer. Burning epigastric pain one to two hours after a meal is from an expected manifestation with a gastric ulcer related to increased gastric secretions and does not cause an urgent change in the nursing plan of care.
Text Reference - p. 944
The nurse is assisting a patient who has been admitted with severe abdominal pain. Suddenly, the patient vomits a large amount of emesis that looks similar to coffee grounds. Which action by the nurse is a priority?
1 Ask the patient about the timing of the last meal.
2 Offer the patient sips of water to prevent dehydration.
3 Monitor the patient for any further episodes of nausea and vomiting.
4 Notify the primary health care provider about the patient's condition
Vomitus with a "coffee ground" appearance is related to gastric bleeding, where blood changes to dark brown as a result of its interaction with HCl acid. The primary health care provider needs to be notified immediately about this change in the patient's condition. Asking the patient about the timing of the last meal and monitoring the patient are appropriate, but not the priority. The nurse should not offer water just in case the patient may have to have a diagnostic study that requires nothing by mouth (NPO) status.
Text Reference - p. 925
The results of a patient's recent endoscopy indicate the presence of peptic ulcer disease (PUD). Which teaching point should the nurse provide to the patient based on this new diagnosis?
1 "You'll need to drink at least two to three glasses of milk daily."
2 "It would likely be beneficial for you to eliminate drinking alcohol."
3 "Many people find that a minced or pureed diet eases their symptoms of PUD."
4 "Your medications should allow you to maintain your present diet while minimizing symptoms."
Alcohol increases the amount of stomach acid produced so it should be avoided. Milk may exacerbate PUD, so two to three glasses would not be recommended. There is no reason to puree or mince food, and a current diet is likely to be altered to minimize symptoms.
Text Reference - p. 948
The patient undergoing chemotherapy is nauseated and can have promethazine (Phenergan)12.5--25 mg intravenous (IV) push q4-6h as needed (PRN) for nausea. On hand is a vial labeled "25 mg/mL." How many milliliters should the nurse administer to give a 12.5-mg dose?
1 0.25 mL
2 0.5 mL
3 1 mL
4 5 mL
Using ratio and proportion, multiply 25 by x and multiply 12.5 × 1 to yield 25x = 25. Divide 25 by 12.5 to yield 0.5 mL.
Text Reference - p. 926
The patient has a prescription for rabeprazole (Aciphex). The nurse would assess the effectiveness of the medication by noting whether the patient obtained relief from which symptom?
1 Abdominal pain
Rabeprazole is a proton pump inhibitor that provides relief of gastric discomfort and heartburn by neutralizing gastric acid. This medication would not be effective in the treatment of abdominal pain, flatulence, or constipation.
Text Reference - p. 934
A patient presents to the outpatient clinic with concerns over persistent signs and symptoms of heartburn (pyrosis). What is the most appropriate response for the nurse?
1 "Give the medication time to take effect. You will be feeling better really soon."
2 "I know it is uncomfortable for you. Have you been taking your medication as prescribed and making the necessary dietary adjustments?"
3 "Are you waking up during the night coughing and choking?"
4 "Is your throat sore?"
It is important to ascertain the patient's adherence to prescribed medication and dietary parameters first. Instructing the patient to allow time for the medication to take affect is not addressing the dietary aspect of care. Although a sore throat and nocturnal episodes of coughing and choking are symptoms associated with pyrosis, they are not the initial questions the nurse should ask.
Text Reference - p. 945
TEST-TAKING TIP: Look for answers that focus on the client or are directed toward feelings.
The nurse is aware that the primary symptoms of a sliding hiatus hernia are associated with reflux and should assess the patient for:
1 Jaundice, ascites, and edema
2 Heartburn, regurgitation, and dysphagia
3 Abdominal cramps, diarrhea, and anorexia
4 Pelvic pain, fever, and boardlike abdominal rigidity
The most common symptom of a hiatal hernia is heartburn, also known as pyrosis. It results from reflux of gastric secretions into the esophagus. Regurgitation of gastric contents and dysphagia are other common symptoms. Jaundice, ascites, and edema are associated with liver disorders. Abdominal cramps, diarrhea, and anorexia are associated with gastroenteritis. Low abdominal pain, fever, and boardlike abdominal rigidity are symptoms of appendicitis, ruptured ovarian cyst, and peritonitis.
Text Reference - p. 936
After administering a dose of promethazine (Phenergan), the nurse explains that which common temporary adverse effect may occur?
1 Urinary retention
4 Sensation of falling
Although being given to this patient as an antiemetic, promethazine also has sedative and amnesic properties. For this reason, the patient is likely to experience drowsiness as an adverse effect of the medication. Urinary retention, tinnitus, and a sensation of falling are not considered common adverse effects of promethazine.
Text Reference - p. 925
Following a gastrectomy performed for peptic ulcer disease, the patient has recovered and is ready for discharge. What instructions should the nurse include in discharge teaching to prevent dumping syndrome?
1 Divide meals into six small feedings.
2 Take fluids along with meals.
3 Use concentrated sweets like honey, jam, and jelly.
4 Reduce protein and fats in the diet.
To prevent dumping syndrome after gastrectomy, the patient should avoid large meals, instead dividing meals into six small meals to avoid overloading the intestines at mealtimes. Fluids should not be taken with meals. Fluids can be taken at least 30 to 45 minutes before or after meals. This helps prevent distension or a feeling of fullness. Concentrated sweets should be avoided because they sometimes cause dizziness, diarrhea, and a sense of fullness. Protein and fats should be increased in the diet to help rebuild body tissue and to meet energy needs.
Which technique should the nurse use to effectively administer a dose of promethazine (Phenergan) by the intramuscular (IM) route?
1 Numb the area with ice before injection.
2 Administer in the flank area to increase absorption.
3 Inject at a 45-degree angle.
4 Use the Z-track technique
Promethazine can be irritating to tissues; therefore, the medication should be injected into the upper outer quadrant of the buttock with the use of the Z-track technique. It is not required to numb the area before injection. This medication should not be administered subcutaneously in the flank because of irritation to tissues. Intramuscular injections always should be administered at a 90-degree angle.
Text Reference - p. 925
The patient history indicates the patient was taking ondansetron (Zofran) at home before admission. The nurse inquires as to the effectiveness of this medication in treating which symptom?
4 Leg cramps
Ondansetron is an antiemetic. The nurse would inquire as to its effectiveness in reducing the patient's nausea.
M.J. calls to tell the nurse that her 85-year-old mother has been nauseated all day and has vomited twice. Before the nurse hangs up and calls the health care provider, she should instruct M.J. to
a. administer antispasmodic drugs and observe skin turgor.
b. give her mother sips of water and elevate the head of her bed to prevent aspiration.
c. offer her mother a high-protein liquid supplement to drink to maintain her nutritional needs.
d. offer her mother large quantities of Gatorade to drink because older adults are at risk for sodium depletion.
Correct answer: b
Rationale: Excessive replacement of fluid and electrolytes may result in adverse consequences for an older person who has heart failure or renal disease. An older adult with a decreased level of consciousness may be at high risk for aspiration of vomitus. The elderly are particularly susceptible to the central nervous system (CNS) side effects of antiemetic drugs; these drugs may produce confusion. Dosages should be reduced and efficacy closely evaluated. Older patients are more likely to have cardiac or renal insufficiency, which increases their risk for life-threatening fluid and electrolyte imbalances. High-protein drinks or high-sodium liquids may be contraindicated.
The nurse explains to the patient with Vincent's infection that treatment will include
a. smallpox vaccinations.
b. viscous lidocaine rinses.
c. amphotericin B suspension.
d. topical application of antibiotics.
Correct answer: d
Rationale: Vincent's infection is treated with topical applications of antibiotics. Other treatments include rest (physical and mental); avoidance of tobacco and alcoholic beverages; soft, nutritious diet; correct oral hygiene habits; and mouth irrigations with hydrogen peroxide and saline solutions.
The nurse teaching young adults about behaviors that put them at risk for oral cancer includes
a. discouraging use of chewing gum.
b. avoiding use of perfumed lip gloss.
c. avoiding use of smokeless tobacco.
d. discouraging drinking of carbonated beverages.
Correct answer: c
Rationale: Oral cancer has several predisposing risks factors:
•Lip: constant overexposure to sun, ruddy and fair complexion, recurrent herpetic lesions, irritation from pipe stem, syphilis, and immunosuppression
•Tongue: tobacco, alcohol, chronic irritation, and syphilis
•Oral cavity: poor oral hygiene, tobacco use (e.g., pipe and cigar smoking, snuff, chewing tobacco), chronic alcohol intake, chronic irritation (e.g., jagged tooth, ill-fitting prosthesis, chemical or mechanical irritants, and human papillomavirus [HPV] infection)
The nurse explains to the patient with gastroesophageal reflux disease (GERD) that this disorder
a. results in acid erosion of the esophagus from frequent
b. will require surgical wrapping or repair of the pyloric sphincter to control the symptoms.
c. is the protrusion of a portion of the stomach into the esophagus through an opening in the diaphragm.
d. often involves relaxation of the lower esophageal sphincter, allowing stomach contents to back up into the esophagus.
Correct answer: d
Rationale: Gastroesophageal reflux disease (GERD) results when the defenses of the esophagus are overwhelmed by the reflux of acidic gastric contents into the lower esophagus. An incompetent lower esophageal sphincter (LES) is a common cause of gastric reflux.
A patient who has undergone an esophagectomy for esophageal cancer develops increasing pain, fever, and dyspnea when a full liquid diet is started postoperatively. The nurse recognizes that these symptoms are most indicative of
a. an intolerance to the feedings.
b. extension of the tumor into the aorta.
c. leakage of fluid or foods into the mediastinum.
d. esophageal perforation with fistula formation into the lung.
Correct answer: c
Rationale: After esophageal surgery, the nurse should observe the patient for signs of leakage from the feeding tube into the mediastinum. Symptoms that indicate leakage are pain, increased temperature, and dyspnea.
The pernicious anemia that may accompany gastritis is due to
a. chronic autoimmune destruction of cobalamin stores in the body.
b. progressive gastric atrophy from chronic breakage in the
mucosal barrier and blood loss.
c. a lack of intrinsic factor normally produced by acid-secreting cells of the gastric mucosa.
d. hyperchlorhydria resulting from an increase in acid-secreting parietal cells and degradation of RBCs.
Correct answer: c
Rationale: Gastritis may cause a loss of parietal cells as a result of atrophy. The source of intrinsic factor is also lost; the loss of intrinsic factor, a substance essential for the absorption of cobalamin in the terminal ileum, ultimately results in cobalamin deficiency. With time, the body's storage of cobalamin is depleted, and a deficiency state exists. Because cobalamin is essential for the growth and maturation of red blood cells, the lack of cobalamin results in pernicious anemia and neurologic complications.
The nurse is teaching the patient and family that peptic ulcers are
a. caused by a stressful lifestyle and other acid-producing factors such as H. pylori.
b. inherited within families and reinforced by bacterial spread of Staphylococcus aureus in childhood.
c. promoted by factors that tend to cause oversecretion of acid, such as excess dietary fats, smoking, and H. pylori.
d. promoted by a combination of factors that may result in erosion of the gastric mucosa, including certain drugs and alcohol.
Correct answer: d
Rationale: Peptic ulcers develop only in the presence of an acidic environment. However, an excess of hydrochloric acid (HCl) may not be necessary for ulcer development. The back diffusion of HCl into the gastric mucosa results in cellular destruction and inflammation. Histamine is released from the damaged mucosa, which results in vasodilation and increased capillary permeability and further secretion of acid and pepsin. A variety of agents (certain infections, medications, and lifestyle factors) can damage the mucosal barrier. Helicobacter pylori can alter gastric secretion and produce tissue damage, which leads to peptic ulcer disease. The response to H. pylori is probably influenced by a variety of factors, including genetics, environment, and diet. Ulcerogenic drugs, such as aspirin and NSAIDs, inhibit synthesis of prostaglandins, increase gastric acid secretion, and reduce the integrity of the mucosal barrier. Patients taking corticosteroids, anticoagulants, and selective serotonin reuptake inhibitors (e.g., fluoxetine [Prozac]) are also at increased risk for ulcers. High alcohol intake stimulates acid secretion and is associated with acute mucosal lesions. Coffee (caffeinated and uncaffeinated) is a strong stimulant of gastric acid secretion. Psychologic distress, including stress and depression, can hamper the healing of ulcers after they have developed. Smoking also delays ulcer healing. In addition, infection with herpes and cytomegalovirus (CMV) in immunocompromised patients may lead to gastric ulcers
An optimal teaching plan for an outpatient with stomach cancer receiving radiation therapy should include information about
a. cancer support groups, alopecia, and stomatitis.
b. avitaminosis, ostomy care, and community resources.
c. prosthetic devices, skin conductance, and grief counseling.
d. wound and skin care, nutrition, drugs, and community
Correct answer: d
Rationale: Radiation therapy is used as an adjuvant to surgery or for palliation in treatment of stomach cancer. The nurse's role is to provide detailed instructions, to reassure the patient, and to ensure completion of the designated number of treatments. The nurse should start by assessing the patient's knowledge of radiation therapy. The nurse should teach the patient about skin care, the need for nutrition and fluid intake during therapy, and the appropriate use of antiemetic drugs.
The teaching plan for the patient being discharged after an acute episode of upper GI bleeding includes information concerning the importance of (select all that apply)
a. only taking aspirin with milk or bread products.
b. avoiding taking aspirin and drugs containing aspirin.
c. only taking drugs prescribed by the health care provider.
d. taking all drugs 1 hour before mealtime to prevent further bleeding.
e. reading all OTC drug labels to avoid those containing stearic acid and calcium.
Correct answers: b, c
Rationale: Before discharge, the patient with upper gastrointestinal (GI) bleeding and the caregiver should be taught how to avoid future bleeding episodes. Ulcer disease, drug or alcohol abuse, and liver and respiratory diseases can cause upper GI bleeding. Help make the patient and caregiver aware of the consequences of noncompliance with drug therapy. Emphasize that no drugs (especially aspirin and nonsteroidal antiinflammatory drugs [NSAIDs]) other than those prescribed by the health care provider should be taken. Smoking and alcohol should be eliminated because they are sources of irritation and interfere with tissue repair.
Several patients are seen at an urgent care center with symptoms of nausea, vomiting, and diarrhea that began 2 hours ago while attending a large family reunion potluck dinner. You question the patients specifically about foods they ingested containing
b. meat and milk.
c. poultry and eggs.
d. home-preserved vegetables.
Correct answer: b
Rationale: Staphylococcus aureus toxins provoke onset of symptoms (vomiting, nausea, abdominal cramping, and diarrhea) within 30 minutes up to 7 hours. Meat, bakery products, cream fillings, salad dressings, and milk are the usual sources of these toxins from the skin and respiratory tract of food handlers.
The nurse teaches senior citizens at a community center how to prevent food poisoning at their informal social events. The nurse determines that teaching is successful if a community member makes which statement?
A "Pasteurized juices and milk are safe to drink."
B "Alfalfa sprouts are safe if rinsed before eating."
C "Fresh fruits do not need to be washed before eating."
D "Ground beef is safe to eat if cooked until it is brown."
Drink only pasteurized milk, juice, or cider. Ground beef should be cooked thoroughly. Browned meat can still harbor live bacteria. Cook ground beef until a thermometer reads at least 160° F. If a thermometer is unavailable, decrease risk of illness by cooking the ground beef until there is no pink color in the middle. Fruits and vegetables should be washed thoroughly, especially those that will not be cooked. Persons who are immunocompromised or older should avoid eating alfalfa sprouts until the safety of the sprouts can be ensured.
A 74-year-old female patient with gastroesophageal reflux disease (GERD) takes over-the-counter medications. For which medication, if taken long-term, should the nurse teach about an increased risk of fractures?
There is a potential link between proton pump inhibitors (PPIs) (e.g., omeprazole) use and bone metabolism. Long-term use or high doses of PPIs may increase the risk of fractures of the hip, wrist, and spine. Lower doses or shorter duration of therapy should be considered.
Which patients would be at highest risk for developing oral candidiasis?
1. A 74-year-old patient who has vitamin B and C deficiencies
2. A 22-year-old patient who smokes 2 packs of cigarettes per day
3. A 58-year-old patient who is receiving amphotericin B for 2 days
4. A 32-year-old patient who is receiving ciprofloxacin (Cipro) for 3 weeks
Oral candidiasis is caused by prolonged antibiotic treatment (e.g., ciprofloxacin) or high doses of corticosteroids. Amphotericin B is used to treat candidiasis. Vitamin B and C deficiencies are rare but may lead to Vincent's infection. Use of tobacco products leads to stomatitis.
The nurse cares for a postoperative patient who has just vomited yellow green liquid and reports nausea. Which action would be an appropriate nursing intervention?
A. Offer the patient a herbal supplement such as ginseng.
B. Apply a cool washcloth to the forehead and provide mouth care.
C. Take the patient for a walk in the hallway to promote peristalsis.
D. Discontinue any medications that may cause nausea or vomiting.
Cleansing the face and hands with a cool washcloth and providing mouth care are appropriate comfort interventions for nausea and vomiting. Ginseng is not used to treat postoperative nausea and vomiting. Unnecessary activity should be avoided. The patient should rest in a quiet environment. Medications may be temporarily withheld until the acute phase is over, but the medications should not be discontinued without consultation with the health care provider.
The nurse receives an order for a parenteral dose of promethazine (Phenergan) and prepares to administer the medication to a 38-year-old male patient with nausea and repeated vomiting. Which action is most important for the nurse to take?
1. Administer the medication subcutaneously for fast absorption.
2. Administer the medication into an arterial line to prevent extravasation.
3. Administer the medication deep into the muscle to prevent tissue damage.
4. Administer the medication with 0.5 mL of lidocaine to decrease injection pain.
Promethazine (Phenergan) is an antihistamine administered to relieve nausea and vomiting. Deep muscle injection is the preferred route of injection administration. This medication should not be administered into an artery or under the skin because of the risk of severe tissue injury, including gangrene. When administered IV, a risk factor is that it can leach out from the vein and cause serious damage to surrounding tissue.
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