Chapter 42 Upper Gi and 43 Lower Gi Q Flashcards
- The nurse explaining esomeprazole (Nexium) to a patient with recurring heartburn describes that the medication
a. reduces gastroesophageal reflux by increasing the rate of gastric emptying.
b. neutralizes stomach acid and provides relief of symptoms in a few minutes.
c. coats and protects the lining of the stomach and esophagus from gastric acid.
d. treats gastroesophageal reflux disease by decreasing stomach acid production.
ANS: D
The proton pump inhibitors decrease the rate of gastric acid secretion. Promotility drugs such as metoclopramide (Reglan) increase the rate of gastric emptying. Cryoprotective medications such as sucralfate (Carafate) protect the stomach. Antacids neutralize stomach acid and work rapidly.
DIF: Cognitive Level: Understand (comprehension) REF: 934
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
10. The nurse will anticipate teaching a patient experiencing frequent heartburn about
- The nurse will anticipate teaching a patient experiencing frequent heartburn about
a. a barium swallow.
b. radionuclide tests.
c. endoscopy procedures.
d. proton pump inhibitors.
ANS: D
Because diagnostic testing for heartburn that is probably caused by gastroesophageal 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.
DIF: Cognitive Level: Apply (application) REF: 932-933
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
- Which information will the nurse include for a patient with newly diagnosed gastroesophageal reflux disease (GERD)?
a. Peppermint tea may reduce your symptoms.
b. Keep the head of your bed elevated on blocks.
c. You should avoid eating between meals to reduce acid secretion.
d. Vigorous physical activities may increase the incidence of reflux.
ANS: B
Elevating the head of the bed will reduce the incidence of reflux while the patient is sleeping. Peppermint will decrease lower esophageal sphincter (LES) pressure and increase the chance for reflux. Small, frequent meals are recommended to avoid abdominal distention. There is no need to make changes in physical activities because of GERD.
DIF: Cognitive Level: Apply (application) REF: 935
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
- Which nursing action should be included in the postoperative plan of care for a patient after a laparoscopic esophagectomy?
a. Notify the doctor about bloody nasogastric (NG) drainage.
b. Elevate the head of the bed to at least 30 degrees.
c. Reposition the NG tube if drainage stops.
d. Start oral fluids when the patient has active bowel sounds.
NS: B
Elevation of the head of the bed decreases the risk for reflux and aspiration of gastric secretions. The NG tube should not be repositioned without consulting with the health care provider. Bloody NG drainage is expected for the first 8 to 12 hours. A swallowing study is needed before oral fluids are started.
DIF: Cognitive Level: Apply (application) REF: 939
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
- A 50-year-old man vomiting blood-streaked fluid is admitted to the hospital with acute gastritis. To determine possible risk factors for gastritis, the nurse will ask the patient about
a. the amount of saturated fat in the diet.
b. any family history of gastric or colon cancer.
c. a history of a large recent weight gain or loss.
d. use of nonsteroidal antiinflammatory drugs (NSAIDs).
ANS: D
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.
DIF: Cognitive Level: Understand (comprehension) REF: 941
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
- The nurse determines that teaching regarding cobalamin injections has been effective when the patient with chronic atrophic gastritis states which of the following?
a. The cobalamin injections will prevent gastric inflammation.
b. The cobalamin injections will prevent me from becoming anemic.
c. These injections will increase the hydrochloric acid in my stomach.
d. These injections will decrease my risk for developing stomach cancer.
ANS: B
Cobalamin supplementation prevents the development of pernicious anemia. Chronic gastritis may cause achlorhydria, but cobalamin does not correct this. The loss of intrinsic factor secretion with chronic gastritis is permanent, and the patient will need lifelong supplementation with cobalamin. The incidence of stomach cancer is higher in patients with chronic gastritis, but cobalamin does not reduce the risk for stomach cancer.
DIF: Cognitive Level: Apply (application) REF: 941-942
TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity
- Which action should the nurse in the emergency department anticipate for a 23-year-old patient who has had several episodes of bloody diarrhea?
a. Obtain a stool specimen for culture.
b. Administer antidiarrheal medication.
c. Provide teaching about antibiotic therapy.
d. Teach about adverse effects of acetaminophen (Tylenol).
ANS: A
Patients with bloody diarrhea should have a stool culture for E. coli O157:H7. Antidiarrheal medications are usually 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. Acetaminophen does not cause bloody diarrhea.
DIF: Cognitive Level: Apply (application) REF: 957
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
- The nurse will anticipate preparing a 71-year-old female patient who is vomiting coffee-ground emesis for
a. endoscopy.
b. angiography.
c. barium studies.
d. gastric analysis.
ANS: A
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. Barium studies are helpful in determining the presence of gastric lesions, but not whether the lesions are actively bleeding. Gastric analysis testing may help with determining the cause of gastric irritation, but it is not used for acute GI bleeding.
DIF: Cognitive Level: Apply (application) REF: 954
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
- Which information will the nurse include when teaching a patient with peptic ulcer disease about the effect of ranitidine (Zantac)?
a. Ranitidine absorbs the gastric acid.
b. Ranitidine decreases gastric acid secretion.
c. Ranitidine constricts the blood vessels near the ulcer.
d. Ranitidine covers the ulcer with a protective material.
ANS: B
Ranitidine is a histamine-2 (H2) receptor blocker, which decreases the secretion of gastric acid. The response beginning, Ranitidine constricts the blood vessels describes the effect of vasopressin. The response Ranitidine absorbs the gastric acid describes the effect of antacids. The response beginning Ranitidine covers the ulcer describes the action of sucralfate (Carafate).
DIF: Cognitive Level: Understand (comprehension) REF: 934
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
- A family member of a 28-year-old patient who has suffered massive abdominal trauma in an automobile accident asks the nurse why the patient is receiving famotidine (Pepcid). The nurse will explain that the medication will
a. decrease nausea and vomiting.
b. inhibit development of stress ulcers.
c. lower the risk for H. pylori infection.
d. prevent aspiration of gastric contents.
ANS: B
Famotidine is administered to prevent the development of physiologic stress ulcers, which are associated with a major physiologic insult such as massive trauma. Famotidine does not decrease nausea or vomiting, prevent aspiration, or prevent H. pylori infection.
DIF: Cognitive Level: Apply (application) REF: 934
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
- A 68-year-old patient with a bleeding duodenal ulcer has a nasogastric (NG) tube in place, and the health care provider orders 30 mL of aluminum hydroxide/magnesium hydroxide (Maalox) to be instilled through the tube every hour. To evaluate the effectiveness of this treatment, the nurse
a. monitors arterial blood gas values daily.
b. periodically aspirates and tests gastric pH.
c. checks each stool for the presence of occult blood.
d. measures the volume of residual stomach contents.
ANS: B
The purpose for antacids is to increase gastric pH. Checking gastric pH is the most direct way of evaluating the effectiveness of the medication. Arterial blood gases may change slightly, but this does not directly reflect the effect of antacids on gastric pH. Because the patient has upper gastrointestinal (GI) bleeding, occult blood in the stools will appear even after the acute bleeding has stopped. The amount of residual stomach contents is not a reflection of resolution of bleeding or of gastric pH.
DIF: Cognitive Level: Apply (application) REF: 946
TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity
- A 44-year-old man admitted with a peptic ulcer has a nasogastric (NG) tube in place. When the patient develops sudden, severe upper abdominal pain, diaphoresis, and a firm abdomen, which action should the nurse take?
a. Irrigate the NG tube.
b. Check the vital signs.
c. Give the ordered antacid.
d. Elevate the foot of the bed.
ANS: B
The patients symptoms suggest acute perforation, and the nurse should assess for signs of hypovolemic shock. Irrigation of the NG tube, administration of antacids, or both would be contraindicated because any material in the stomach will increase the spillage into the peritoneal cavity. Elevating the foot of the bed may increase abdominal pressure and discomfort, as well as making it more difficult for the patient to breathe.
DIF: Cognitive Level: Apply (application) REF: 948
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
- A 50-year-old patient who underwent a gastroduodenostomy (Billroth I) earlier today complains of increasing abdominal pain. The patient has no bowel sounds and 200 mL of bright red nasogastric (NG) drainage in the last hour. The highest priority action by the nurse is to
a. contact the surgeon.
b. irrigate the NG tube.
c. monitor the NG drainage.
d. administer the prescribed morphine.
ANS: A
Increased pain and 200 mL of bright red NG drainage 12 hours after surgery indicate possible postoperative hemorrhage, and immediate actions such as blood transfusion and/or return to surgery are needed. Because the NG is draining, there is no indication that irrigation is needed. Continuing to monitor the NG drainage is not an adequate response. The patient may need morphine, but this is not the highest priority action.
DIF: Cognitive Level: Apply (application) REF: 946
OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
- Which patient statement indicates that the nurses teaching following a gastroduodenostomy has been effective?
a. Vitamin supplements may prevent anemia.
b. Persistent heartburn is common after surgery.
c. I will try to drink more liquids with my meals.
d. I will need to choose high carbohydrate foods.
ANS: A
Cobalamin deficiency may occur after partial gastrectomy, and the patient may need to receive cobalamin via injections or nasal spray. Although peptic ulcer disease may recur, persistent heartburn is not expected after surgery and the patient should call the health care provider if this occurs. Ingestion of liquids with meals is avoided to prevent dumping syndrome. Foods that have moderate fat and low carbohydrate should be chosen to prevent dumping syndrome.
DIF: Cognitive Level: Apply (application) REF: 952-953
TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity
- At his first postoperative checkup appointment after a gastrojejunostomy (Billroth II), a patient reports that dizziness, weakness, and palpitations occur about 20 minutes after each meal. The nurse will teach the patient to
a. increase the amount of fluid with meals.
b. eat foods that are higher in carbohydrates.
c. lie down for about 30 minutes after eating.
d. drink sugared fluids or eat candy after meals.
ANS: C
The patient is experiencing symptoms of dumping syndrome, which may be reduced by lying down after eating. Increasing fluid intake and choosing high carbohydrate foods will increase the risk for dumping syndrome. Having a sweet drink or hard candy will correct the hypoglycemia that is associated with dumping syndrome but will not prevent dumping syndrome.
- A 62-year-old man patient who requires daily use of a nonsteroidal antiinflammatory drug (NSAID) for the management of severe rheumatoid arthritis has recently developed melena. The nurse will anticipate teaching the patient about
a. substitution of acetaminophen (Tylenol) for the NSAID.
b. use of enteric-coated NSAIDs to reduce gastric irritation.
c. reasons for using corticosteroids to treat the rheumatoid arthritis.
d. misoprostol (Cytotec) to protect the gastrointestinal (GI) mucosa.
ANS: D
Misoprostol, a prostaglandin analog, reduces acid secretion and the incidence of upper GI bleeding associated with NSAID use. Enteric coating of NSAIDs does not reduce the risk for GI bleeding. Corticosteroids increase the risk for ulcer development, and will not be substituted for NSAIDs for this patient. Acetaminophen will not be effective in treating the patients rheumatoid arthritis.