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Upper GI, Lower GI, and Respiratory Practice Questions

Terms in this set (24)

What physiologically occurs with vomiting?

a. The acid-base imbalances most commonly associated with persistent vomiting is metabolic acidosis caused by lost bicarbonate

b. Stimulation of the vomiting center by the chemoreceptor trigger zone (CTZ) is commonly caused by stretch and distention of hollow organs.

c. Vomiting requires the coordination of activities of structures including the glottis, respiratory expiration, relaxation of the pylorus, and closure of the lower esophageal sphincter (LES)

d. Immediately before the act of vomiting, activation of the parasympathetic nervous system causes increased salivation, increased gastric motility, and relaxation of LES.
D
Which laboratory findings should the nurse expect in the patient with persistent vomiting?

a. decreased pH, increased Na+, decreased hematocrit
b. increased pH, decreased Cl-, decreased hematocrit
c. increased pH, decreased K+, increased hematocrit
d. decreased pH, decreased K+, increased hematocrit
C

Loss of gastric acid causes metabolic alkalosis
A patient who has been vomiting for several days from an unknown cause is admitted to the hospital. What should the nurse anticipate will first be included in interprofessional care?

a. Oral administration of broth and tea
b. IV replacement fluid and electrolytes
c. Administration of parenteral antiemetics
d. Insertion of nasogastric (NG) tube for suction
B
A patient treated for vomiting is to begin oral intake when the symptoms have subsided. To promote rehydration, the nurse plans to administer which fluid first?

a. Water
b. Hot tea
c. Gatorade
d. Warm broth
A
Ondansetron (Zofran) is prescribed with cancer chemotherapy-induced vomiting. What should the nurse understand about this drug?

a. It is a derivative of cannabis and has potential abuse
b. It has a strong antihistamine effect that provides sedation and induces sleep
c. It is used only when other agents are ineffective because of side effects of anxiety and hallucinations
d. It relives vomiting centrally by action in the vomiting center and peripherally by promoting gastric emptying
D
Older patients may have cardiac or renal insufficiency and be more susceptible to problems from vomiting and antiemetic drug side effects. What nursing intervention is most important to implement with these patients?

a. Keep the patient flat in bed to decrease dizziness
b. Do hourly visual checks and implement fall precautions
c. Give IV fluids as rapidly as possible to prevent dehydration
d. Keep the patient NPO until nausea and vomiting have stopped
B

Safety precautions are the priority
The nurse is planning to teach the patient with gastroesophageal reflux disease (GERD) about foods and beverages that decrease LES pressure. What should be included in this list (select all that apply)

a. Alcohol
b. Root beer
c. Chocolate
d. Citrus fruits
e. Fatty foods
f. Cola sodas
A, C, E, F

Alcohol, Chocolate, Fatty foods and cola (caffeine) along with peppermint all put pressure on the LES
How should the nurse teach the patient with a hiatal hernia or GERD to control symptoms?

a. Drink 10 to 12 ounces of water with each meal
b. Space 6 small meals a day between breakfast and bedtime
c. Sleep with the head of the bed elevated on 4-to6-inch blocks
d. Perform daily exercises of toe-touching, sit-ups, and weight lifting
B

Sleeping with head elevated facilitates gastric emptying by the use of gravity
Which esophageal disorder is described as a precancerous lesion and is associated with GERD?

a. Achalasia
b. Barrett's esophagus
c. Esophageal strictures
d. Esophageal diverticula
B

Is an esophageal metaplasia associated with GERD
What is an accurate description of eosinophilic esophagitis?

a. Adenocarcinoma or squamous cell tumors of the esophagus
b. Dilated veins in the esophagus caused by portal hypertension
c. Inflammation of the esophagus from irritants or acidic gastric reflux
d. Swelling of the esophagus from an allergic response to food or environmental triggers
D

Eosinophilic esophagus is due to environmental and food allergens
Which type of gastritis is most likely to occur in college student who has an isolated drinking binge?

a. Acute gastritis
b. Chronic gastritis
c. Helicobacter pylori gastritis
d. Autoimmune metaplastic atrophic gastritis
A

Acute gastritis is most likely to occur due to a drinking binge
Nursing management of the patient with chronic gastritis includes teaching the patient to

a. maintain a nonirritating diet with 6 small meals a day
b. take antacids before meals to decrease stomach acidity
c. eliminate alcohol and caffeine from the diet when symptoms occurs
d. Use non-steroidal anti-inflammatory drugs (NSAIDs) instead of aspirin for minor pain relief
A

Changing the diet to 6 small meals is recommended to control gastritis. Using antacids is best after a meal. Alcohol and caffeine should be avoided entirely with gastritis. NSAIDs are irritants to the stomach and should be avoided.
Duodenal and gastric ulcers have similar as well as differentiating features. What characteristics are unique to duodenal ulcers (select all that apply)

a. Pain is relieved with eating food
b. They have a high recurrent rate
c. Increased gastric acid secretion occurs
d. Associated with H.pylori infection
e. Hemorrhage, perforation, and obstruction may occur
f. There is a burning and cramping in the epigastric region
A, C, F

Duodenal ulcers have increased gastric acid secretion which leads to pain and cramping in the epigastric region; pain is relieved when food is ingested.

The other options occur in both gastric and duodenal ulcers.
Which patient is at highest risk for a gastric ulcer?

a. a 55-year old female smoker with nausea and vomiting
b. a 45-year old female admitted for illicit drug detoxification
c. a 27-year old male who is being divorced and has back pain
d. 37-year old male smoker who was in an accident while looking for a job
A

The smoker with vomiting and nausea is the most likely to have a gastric ulcer
Corticosteroid medications are associated with the development of peptic ulcers because of which pathophysiologic mechanism?

a. The enzyme urease is produced
b. Secretion of hydrochloric acid is increased
c. The rate of mucus cell renewal is decreased
d. The synthesis of mucus and prostaglandins is inhibited
C

Corticosteroids decrease mucus cell renewal
Regardless of the precipitating factor, what causes the injury to mucosal cells in peptic ulcers?

a. Acid back diffusion into the mucosa
b. The release of histamine from gastrointestinal (GI) cells
c. Ammonia formation in the mucosal wall
d. Breakdown of the gastric mucosal barrier
A
What does the nurse include when teaching a patient with newly diagnosed peptic ulcer disease?

a. Maintain a bland, soft, low-residue diet
b. Use alcohol and caffeine in moderation and always with food
c. Eat as normally as possible, eliminating foods that cause pain or discomfort
d. Avoid milk and milk products because they stimulate gastric acid production
C

There is no specific diet to be followed for PUD but offending foods that cause pain should be avoided.
What is the rationale for treating acute exacerbation of peptic ulcer disease with NG intubation?

a. Stop spillage of GI content into the peritoneal cavity
b. Remove excess fluids and undigested foods from the stomach
c. Feed the patient with the nutrients missing from the lack of ingestion
d. Remove stimulation of HCL and pepsin secretion by keeping the stomach empty
D
Which statements describe the use of antacids for peptic ulcer disease (select all that apply)

a. Used in patients with verified H. pylori
b. Neutralize HCL in the stomach
c. Produces quick, short lived relief of heartburn
d. Cover the ulcer, protecting it from erosion by acids
e. High incidence of side effects and contraindications
f. May be given hourly after an acute phase of GI bleeding
B, C, F
Which medications are used to decrease gastric of HCl secretion (select all that apply)

a. Famotidine (pepcid)
b. Sucralfate (carafate)
c. Omeprazole (prilosec)
d. Misoprostol (Cytolec)
d. Bethanechol (Urecholine)
A, C, D

Sucralfate coats the stomach, it does not reduce acid
Bethanechol loweres LES pressure
The nurse determines that teaching for the patient with peptic ulcer disease has been effective when the patient makes which statement?

a. " I should stop all my medications if I develop any side effects"
b. " I should continue my treatment regimen as long as I have pain"
c. " I have learned some relaxation strategies that decrease my stress"
d. " I can buy whatever antacids are on sale because they all have the same effect"
C

Vagal stimulation from stress can increase secretion of HCl. Management of stress can help with managing peptic ulcers
A patient with a history of peptic ulcer disease is hospitalized with symptoms of a perforation. During the initial assessment, what should the nurse expect the patient to report?

a. Vomiting of bright red blood
b. Projectile vomiting of undigested food
c. Sudden, severe generalized abdominal and back pain
d; Hyperactive bowl sounds and upper abdominal swelling
C
A patient with a gastric outlet obstruction has been treated with NG decompression. After the first 24 hours, the patient develops nausea and increased upper abdominal bowl sounds. What is the priority action by the nurse?

a. Check the patency of the NG tube
b. Place the patient in a recumbent position
c. Asses the patient's vital signs and circulatory status
d. Encourage the patient to deep breathe and consciously relax
C

If symptoms of gastric outlet obstruction, such as nausea, vomiting, and stomach distention, occur while the patient is on NPO status or has an NG tube, the patency of the NG tube should first be assessed.
When caring for a patient with an acute exacerbation of a peptic ulcer, the nurse finds the patient doubled up in bed with shallow, grunting respirations. Which action should the nurse take first?

a. Irrigate the patient's NG tube
b. Notify the health care provider
c. Place the patient in high-Fowler's position
d. Assess the patient's abdomen and vital signs
D

Abdominal pain that causes the knees to be drawn up and shallowing grunting respirations could be an indication of a perforation. The nurse should first assess vital signs and pain
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