CHAPTER 42 Nursing Management Upper Gastrointestinal Problems (9th Edition) // CHAPTER 41 Upper Gastrointestinal Problems (10th Edition) Flashcards
*** 1. 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.
b. give her mother sips of water and elevate the head of her bed to prevent aspiration.
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.
CHAPTER 42 Nursing Management Upper Gastrointestinal Problems (9th Edition)
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Tiana L.
*** 2. 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.
d. topical application of antibiotics.
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.
CHAPTER 42 Nursing Management Upper Gastrointestinal Problems (9th Edition)
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Ashley S.
*** 3. 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.
c. avoiding use of smokeless tobacco.
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)
CHAPTER 42 Nursing Management Upper Gastrointestinal Problems (9th Edition)
Bridge to NCLEX Examination Questions
Ashley S.
*** 4. The nurse explains to the patient with gastroesophageal reflux disease (GERD) that this disorder
a. results in acid erosion of the esophagus from frequent vomiting.
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.
d. often involves relaxation of the lower esophageal sphincter, allowing stomach contents to back up into the esophagus.
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.
CHAPTER 42 Nursing Management Upper Gastrointestinal Problems (9th Edition)
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Ariel C.
*** 5. 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.
c. leakage of fluid or foods into the mediastinum.
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.
CHAPTER 42 Nursing Management Upper Gastrointestinal Problems (9th Edition)
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Tiana L.
*** 6. 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.
c. a lack of intrinsic factor normally produced by acid-secreting cells of the gastric mucosa.
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.
CHAPTER 42 Nursing Management Upper Gastrointestinal Problems (9th Edition)
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Tiana L.
*** 7. 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.
d. promoted by a combination of factors that may result in erosion of the gastric mucosa, including certain drugs and alcohol.
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.
CHAPTER 42 Nursing Management Upper Gastrointestinal Problems (9th Edition)
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Ariel C.
*** 8. 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 resources.
d. wound and skin care, nutrition, drugs, and community resources.
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.
CHAPTER 42 Nursing Management Upper Gastrointestinal Problems (9th Edition)
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Tiana L.
*** 9. 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.
b. avoiding taking aspirin and drugs containing aspirin.
c. only taking drugs prescribed by the health care provider.
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.
CHAPTER 42 Nursing Management Upper Gastrointestinal Problems (9th Edition)
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Ariel C.
** 10. 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
a. beef.
b. meat and milk.
c. poultry and eggs.
d. home-preserved vegetables.
b. meat and milk.
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.
CHAPTER 42 Nursing Management Upper Gastrointestinal Problems (9th Edition)
Bridge to NCLEX Examination Questions
Tiana L.
*** 1. Which patients would be at highest risk for developing oral candidiasis?
a. A 74-year-old patient who has vitamin B and C deficiencies
b. A 22-year-old patient who smokes 2 packs of cigarettes per day
c. A 58-year-old patient who is receiving amphotericin B for 2 days
d. A 32-year-old patient who is receiving ciprofloxacin (Cipro) for 3 weeks
d. 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.
CHAPTER 42 Nursing Management Upper Gastrointestinal Problems (9th Edition)
Pre-Test
Ariel C.
*** 2. 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.”
a. “Pasteurized juices and milk are safe to drink.”
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.
CHAPTER 42 Nursing Management Upper Gastrointestinal Problems (9th Edition)
Pre-Test
Ashley S.
*** 3. 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?
a. Administer the medication subcutaneously for fast absorption.
b. Administer the medication into an arterial line to prevent extravasation.
c. Administer the medication deep into the muscle to prevent tissue damage.
d. Administer the medication with 0.5 mL of lidocaine to decrease injection pain.
c. Administer the medication deep into the muscle to prevent tissue damage.
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.
CHAPTER 42 Nursing Management Upper Gastrointestinal Problems (9th Edition)
Pre-Test
Ariel C.
*** 4. 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.
b. Apply a cool washcloth to the forehead and provide mouth care.
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.
CHAPTER 42 Nursing Management Upper Gastrointestinal Problems (9th Edition)
Pre-Test
Martinika M.
*** 5. 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?
a. Sucralfate (Carafate)
b. Cimetidine (Tagamet)
c. Omeprazole (Prilosec)
d. Metoclopramide (Reglan)
c. Omeprazole (Prilosec)
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.
CHAPTER 42 Nursing Management Upper Gastrointestinal Problems (9th Edition)
Pre-Test
Irma G.
*** 1. 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?
a. “You’ll need to drink at least two to three glasses of milk daily.”
b. “It would likely be beneficial for you to eliminate drinking alcohol.”
c. “Many people find that a minced or pureed diet eases their symptoms of PUD.”
d. “Your medications should allow you to maintain your present diet while minimizing symptoms.”
b. “It would likely be beneficial for you to eliminate drinking alcohol.”
Alcohol increases the amount of stomach acid produced so it should be avoided. Although there is no specific recommended dietary modification for PUD, most patients find it necessary to make some sort of dietary modifications to minimize symptoms. Milk may exacerbate PUD.
CHAPTER 42 Nursing Management Upper Gastrointestinal Problems (9th Edition)
Elseiver NCLEX Review Questions
Ariel C.
*** 2. Following administration of a dose of metoclopramide (Reglan) to the patient, the nurse determines that the medication has been effective when what is noted?
a. Decreased blood pressure
b. Absence of muscle tremors
c. Relief of nausea and vomiting
d. No further episodes of diarrhea
c. Relief of nausea and vomiting
Metoclopramide is classified as a prokinetic and antiemetic medication. If it is effective, the patient’s nausea and vomiting should resolve. Metoclopramide does not affect blood pressure, muscle tremors, or diarrhea.
CHAPTER 42 Nursing Management Upper Gastrointestinal Problems (9th Edition)
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Huyen T.
*** 3. A patient with a history of peptic ulcer disease has presented to the emergency department reporting severe abdominal pain and has a rigid, boardlike abdomen that prompts the health care team to suspect a perforated ulcer. What intervention should the nurse anticipate?
a. Providing IV fluids and inserting a nasogastric (NG) tube
b. Administering oral bicarbonate and testing the patient’s gastric pH level
c. Performing a fecal occult blood test and administering IV calcium gluconate
d. Starting parenteral nutrition and placing the patient in a high-Fowler’s position
a. Providing IV fluids and inserting a nasogastric (NG) tube
A perforated peptic ulcer requires IV replacement of fluid losses and continued gastric aspiration by NG tube. Nothing is given by mouth, and gastric pH testing is not a priority. Calcium gluconate is not a medication directly relevant to the patient’s suspected diagnosis, and parenteral nutrition is not a priority in the short term.
CHAPTER 42 Nursing Management Upper Gastrointestinal Problems (9th Edition)
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Ashley S.
*** 4. The patient who is admitted with a diagnosis of diverticulitis and a history of irritable bowel disease and gastroesophageal reflux disease (GERD) has received a dose of Mylanta 30 mL PO. The nurse should evaluate its effectiveness by questioning the patient as to whether which symptom has been resolved?
a. Diarrhea
b. Heartburn
c. Constipation
d. Lower abdominal pain
b. Heartburn
Mylanta is an antacid that contains both aluminum and magnesium. It is indicated for the relief of GI discomfort, such as heartburn associated with GERD. Mylanta can cause both diarrhea and constipation as a side effect. Mylanta does not affect lower abdominal pain.
CHAPTER 42 Nursing Management Upper Gastrointestinal Problems (9th Edition)
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Alex S.
*** 5. After administering a dose of promethazine (Phenergan) to a patient with nausea and vomiting, what common temporary adverse effect of the medication does the nurse explain may be experienced?
a. Tinnitus
b. Drowsiness
c. Reduced hearing
d. Sensation of falling
b. Drowsiness
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. Tinnitus, reduced hearing, and loss of balance are not side effects of promethazine.
CHAPTER 42 Nursing Management Upper Gastrointestinal Problems (9th Edition)
Elseiver NCLEX Review Questions
Huyen T.
*** 6. The nurse determines that a patient has experienced the beneficial effects of therapy with famotidine (Pepcid) when which symptom is relieved?
a. Nausea
b. Belching
c. Epigastric pain
d. Difficulty swallowing
c. Epigastric pain
Famotidine is an H2-receptor antagonist that inhibits parietal cell output of HCl acid and minimizes damage to gastric mucosa related to hyperacidity, thus relieving epigastric pain. Famotidine is not indicated for nausea, belching, and dysphagia.
CHAPTER 42 Nursing Management Upper Gastrointestinal Problems (9th Edition)
Elseiver NCLEX Review Questions
Alex S.
