Chapter 46: Upper GI Problems Flashcards
Nausea/vomiting, GERD, PUD, Gastritis
What are the most common manifestations of a GI disease?
nausea ; vomiting
M.J. calls the clinic and tells 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 HCP, she should tell M.J. to:
a. administer antiemetic drugs and assess her mother’s skin turgor
b. give her mother sips of water and elevate the head of her bed to prevent aspiration
c. offer her mother large quantities of Gatorade to decrease the risk for sodium depletion
d. give her mother a high-protein liquid supplement to drink to maintain her nutrition needs
b. give her mother sips of water and elevate the head of her bed to prevent aspiration
Which instructions would the nurse include in a teaching plan for a patient with mild GERD?
a. “The best time to take an as-needed antacid is 1 to 3 hours after meals.”
b. “A glass of warm milk at bedtime will decrease your discomfort at night.”
c. “Do not chew gum; the recess saliva will cause you to secrete more acid.”
d. “Limit your intake of food high in protein because they take longer to digest.”
a. “The best time to take an as-needed antacid is 1 to 3 hours after meals.”
The nurse monitors a patient with gastritis for pernicious anemia 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. hyperchloremia 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
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 cause oversecretion of acid, such as excess diet fats, smoking, and alcohol use
d. promoted by a combination of factors that cause erosion of the gastric mucosa, including certain drugs and H. pylori
d. promoted by a combination of factors that cause erosion of the gastric mucosa, including certain drugs and H. pylori
Several patients come to the urgent care center with nausea, vomiting, and diarrhea that began 2 hours ago while attending a large family reunion potluck dinner. You ask 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
After change-of-shift report, which patient would the nurse assess first?
a. A 42-yr-old patient who has acute gastritis and ongoing epigastric pain
b. A 70-year-old patient with a hiatal hernia who experiences frequent heartburn
c. A 60-yr-old patient with nausea and vomiting who is lethargic with dry mucosa
d. A 53-yr-old patient who has dumping syndrome after a recent partial gastrectomy
c. A 60-yr-old patient with nausea and vomiting who is lethargic with dry mucosa
Which item would the nurse offer to the patient restarting oral intake after being NPO due to nausea and vomiting?
a. Glass of orange juice
b. Dish of lemon gelatin
c. Cup of coffee with cream
d. Bowl of hot chicken broth
b. Dish of lemon gelatin
A patient who has gastroesophageal reflux disease (GERD) is experiencing increasing discomfort. Which patient statement to the nurse indicates a need for additional teaching about GERD?
a. “I quit smoking years ago, but I chew gum.”
b. “I eat small meals and have a bedtime snack.”
c. “I take antacids between meals and at bedtime each night.”
d. “I sleep with the head of the bed elevated on 4-inch blocks.”
b. “I eat small meals and have a bedtime snack.”
A patient with a stroke is unconscious and unresponsive to stimuli. After learning that the patient has a history of gastroesophageal reflux disease (GERD), which assessment would the nurse plan to make more frequently than is routine?
a. Apical pulse
b. Bowel sounds
c. Breath sounds
d. Abdominal girth
c. Breath sounds
How would the nurse explain esomeprazole (Nexium) to a patient who has recurring heartburn?
a. “It reduces gastroesophageal reflux by increasing the rate of gastric emptying.”
b. “It neutralizes stomach acid and provides relief of symptoms in a few minutes.”
c. “It coats and protects the lining of the stomach and esophagus from gastric acid.”
d. “It treats gastroesophageal reflux disease by decreasing stomach acid production.”
d. “It treats gastroesophageal reflux disease by decreasing stomach acid production.”
Which patient choice for a snack 3 hours before bedtime indicates that the nurse‘s teaching about gastroesophageal reflux disease (GERD) has been effective?
a. Chocolate pudding
b. Glass of low-fat milk
c. Cherry gelatin with fruit
d. Peanut butter and jelly sandwich
c. Cherry gelatin with fruit
Which topic would the nurse anticipate teaching to a patient who has a new report of heartburn?
a. Radionuclide tests
b. Barium swallow exam
c. Endoscopy procedures
d. Proton pump inhibitors
d. Proton pump inhibitors
Which information will the nurse provide 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. “Avoid eating between meals to reduce acid secretion.”
d. “Vigorous exercise may increase the incidence of reflux.”
b. “Keep the head of your bed elevated on blocks.”
Which nursing action would be included in the postoperative plan of care for a patient after a laparoscopic esophagectomy?
a. Reposition the NG tube if drainage stops.
b. Elevate the head of the bed to at least 30 degrees.
c. Start oral fluids when the patient has active bowel sounds.
d. Notify the doctor for any bloody nasogastric (NG) drainage.
b. Elevate the head of the bed to at least 30 degrees.
A patient vomiting blood-streaked fluid is admitted to the hospital with acute gastritis. What would the nurse ask the patient about to determine possible risk factors for gastritis?
a. The amount of saturated fat in the diet
b. A family history of gastric or colon cancer
c. Use of nonsteroidal antiinflammatory drugs
d. A history of a large recent weight gain or loss
c. Use of nonsteroidal antiinflammatory drugs
Which statement by a patient with chronic atrophic gastritis indicates that the nurse‘s teaching regarding cobalamin injections has been effective?
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.”
b. “The cobalamin injections will prevent me from becoming anemic.”
A patient has peptic ulcer disease associated with Helicobacter pylori. Which medications will the nurse plan to teach the patient?
a. Sucralfate (Carafate), nystatin, and bismuth (Pepto-Bismol)
b. Metoclopramide (Reglan), bethanechol, and promethazine
c. Amoxicillin (Amoxil), clarithromycin, and omeprazole (Prilosec)
d. Famotidine (Pepcid), magnesium hydroxide (Mylanta), and pantoprazole
c. Amoxicillin (Amoxil), clarithromycin, and omeprazole (Prilosec)
Which action would the nurse in the emergency department anticipate for a young adult patient who has had several acute episodes of bloody diarrhea?
a. Obtain a stool specimen for culture.
b. Administer antidiarrheal medication.
c. Provide teaching about antibiotic therapy.
d. Teach the adverse effects of acetaminophen (Tylenol).
a. Obtain a stool specimen for culture.
Which diagnostic test would the nurse anticipate for an older patient who is vomiting “coffee-ground” emesis?
a. Endoscopy
b. Angiography
c. Barium studies
d. Gastric analysis
a. Endoscopy
An adult with E. coli O157:H7 food poisoning is admitted to the hospital with bloody diarrhea and dehydration. Which prescribed action will the nurse question?
a. Infuse lactated Ringer‘s solution at 250 mL/hr.
b. Monitor blood urea nitrogen and creatinine daily.
c. Administer loperamide (Imodium) after each stool.
d. Provide a clear liquid diet and progress diet as tolerated.
c. Administer loperamide (Imodium) after each stool.
Which information will the nurse include when teaching a patient with peptic ulcer disease about the effect of famotidine (Pepcid)?
a. “Famotidine absorbs the excess gastric acid.”
b. “Famotidine decreases gastric acid secretion.”
c. “Famotidine constricts the blood vessels near the ulcer.”
d. “Famotidine covers the ulcer with a protective material.”
b. “Famotidine decreases gastric acid secretion.”
A young adult patient is hospitalized with massive abdominal trauma from a motor vehicle crash. The patient asks about the purpose of receiving famotidine (Pepcid). Which information would the nurse explain about the action of the medication?
a. “It decreases nausea and vomiting.”
b. “It inhibits development of stress ulcers.”
c. “It lowers the risk for H. pylori infection.”
d. “It prevents aspiration of gastric contents.”
b. “It inhibits development of stress ulcers.”`
Which patient statement indicates that the nurse‘s postoperative teaching after a gastroduodenostomy has been effective?
a. “I will drink more liquids with my meals.”
b. “I should choose high carbohydrate foods.”
c. “Vitamin supplements may prevent anemia.”
d. “Persistent heartburn is expected after surgery.”
c. “Vitamin supplements may prevent anemia.”
The health care provider prescribes antacids and sucralfate (Carafate) for treatment of a patient‘s peptic ulcer. Which medication schedule would the nurse teach the patient?
a. Sucralfate at bedtime and antacids before each meal
b. Sucralfate and antacids together 0 minutes before meals
c. Antacids 30 minutes before each dose of sucralfate is taken
d. Antacids after meals and sucralfate 30 minutes before meals
d. Antacids after meals and sucralfate 30 minutes before meals
Which information about dietary management would the nurse include when teaching a patient with peptic ulcer disease (PUD)?
a. “You will need to remain on a bland diet.”
b. “Avoid foods that cause pain after you eat them.”
c. “High-protein foods are least likely to cause pain.”
d. “You should avoid eating raw fruits and vegetables.”
b. “Avoid foods that cause pain after you eat them.”
A patient has just been admitted to the emergency department with nausea and vomiting.
Which information requires the most rapid intervention by the nurse?
a. The patient has been vomiting for 4 days.
b. The patient takes antacids 8 to 10 times a day.
c. The patient is lethargic and difficult to arouse.
d. The patient had a small intestinal resection 2 years ago.
c. The patient is lethargic and difficult to arouse.
A young adult has been admitted to the emergency department with nausea and vomiting.
Which action could the RN delegate to assistive personnel (AP)?
a. Auscultate the bowel sounds.
b. Assess for signs of dehydration.
c. Assist the patient with oral care.
d. Ask more questions about the nausea.
c. Assist the patient with oral care.
A patient has been admitted with hypotension and dehydration after 3 days of nausea and vomiting. Which prescribed action will the nurse implement first?
a. Insert a nasogastric (NG) tube.
b. Infuse normal saline at 250 mL/hr.
c. Administer IV ondansetron (Zofran).
d. Provide oral care with moistened swabs.
b. Infuse normal saline at 250 mL/hr.
Which patient would the nurse assess first after receiving change-of-shift report?
a. A patient with esophageal varices who has a rapid heart rate
b. A patient with a history of gastrointestinal bleeding who has melena
c. A patient with nausea who has a dose of metoclopramide (Reglan) due
d. A patient who is crying after receiving a diagnosis of esophageal cancer
a. A patient with esophageal varices who has a rapid heart rate
Which assessment would the nurse perform first for a patient who just vomited bright red blood?
a. Measuring the quantity of emesis
b. Palpating the abdomen for distention
c. Auscultating the chest for breath sounds
d. Taking the blood pressure (BP) and pulse
d. Taking the blood pressure (BP) and pulse
Which prescribed action will the nurse implement first for a patient who has vomited 1100 mL of blood?
a. Give an IV H2 receptor antagonist.
b. Draw blood for type and crossmatch.
c. Administer 1L of lactated Ringer‘s solution.
d. Insert a nasogastric (NG) tube and connect to suction.
c. Administer 1L of lactated Ringer‘s solution.
An 80-yr-old patient who is hospitalized with peptic ulcer disease develops new-onset auditory hallucinations. Which prescribed medication will the nurse discuss with the health care provider before administration?
a. Sucralfate (Carafate)
b. Aluminum hydroxide
c. Omeprazole (Prilosec)
d. Metoclopramide (Reglan)
d. Metoclopramide (Reglan)
