Davis Advantage A Flashcards
Which conditions may influence the development of gastroesophageal reflux disease? Select all that apply.
Pernicious anemia Obesity Loss of esophageal motility Hiatal hernia Constipation
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The lower prevalence of gastroesophageal reflux disease in underdeveloped countries is attributed to which of the following factors? Select all that apply.
Lifestyle Dietary habits Prevalence of Helicobacter pylori Reduced carbon emissions Smoking cessation
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What medications used in the treatment of gastroesophageal reflux disease work by increasing gastric emptying?
Antacids
Prokinetics
Proton pump inhibitors
Histamine receptor antagonists
?
A client with gastroesophageal reflux disease has a catheter and sensor that is placed in the nose and terminates in the distal esophagus. The client has also been asked to keep a diary of symptoms and activities. Which diagnostic test has been ordered for this client?
Twenty-four-hour ambulatory esophageal pH monitoring
Pulmonary function tests
Endoscopy
Telemetry monitoring
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What are common clinical findings associated with the presence of gastroesophageal reflux disease? Select all that apply.
Dental caries Odynophagia Hoarseness throughout the day but worse in the evening Bronchitis Pelvic pain
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what Blocks acid secretion in the last step of production in the stomach
H2RAs block acid secretion in the first step of production in the stomach,
used to treat H. pylori in addition to GERD
H2RAs are also indicated for treatment of H. pylori in addition to antibiotic therapy.
Tolerance to medication is likely to occur
H2RAs or PPIs?
H2RAs
Quicker onset of action to provide relief
H2RAs or PPIs?
H2RAs
Longer duration of action
H2RAs or PPIs?
PPIs have a delayed onset of action and a duration of action lasting up to 24 hours. H2RAs have an onset of action of 1 hour and a duration of about 12 hours
Decrease acid production of parietal cells
H2RAs or PPIs?
H2RAs decrease acid production of parietal cells in the stomach lining by blocking histamine-2 at one of the first steps of acid production.
Generic names include cimetidine, famotidine, and ranitidine
H2RAs or PPIs?
Common H2-blockers include cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR), or ranitidine (Zantac 75). Stronger prescription-strength H2-blockers are available.
Interfere with the absorption of ketoconazole, ampicillin, iron, and digoxin.
H2RAs or PPIs?
PPIs can interfere with the absorption of ketoconazole, ampicillin, iron, and digoxin. The H2RA cimetidine can interact with warfarin, phenytoin, and theophylline with long-term use.
OTC medications include lansoprazole and omeprazole.
H2RAs or PPIs?
OTC PPIs include lansoprazole (Prevacid 24HR) and omeprazole (Prilosec OTC). Prescription-strength PPIs are available.
Which client is most likely to be at risk for developing gastroesophageal reflux disease?
38-year-old male who is a vegetarian
25-year-old pregnant woman
18-year-old female who likes to eat several small meals a day
44-year-old male who has no reported comorbidities
25-year-old pregnant woman
Which foods should be avoided in a client who has already been diagnosed with gastroesophageal reflux disease? Select all that apply.
Chocolate Beer Caffeinated coffee Peppermint gum Broth or consommé
Chocolate
Beer
Caffeinated coffee
Peppermint gum
Which of these symptoms would the nurse expect to find in a client with gastroesophageal reflux disease? Select all that apply.
Atypical chest pain Sleep issues Adult-onset asthma Elevated temperature Laryngitis
Atypical chest pain
Sleep issues
Adult-onset asthma
Laryngitis
In working with clients who have been diagnosed with gastroesophageal reflux disease, which statement is accurate related to the use of proton pump inhibitors as therapeutic treatment?
It is also useful in the treatment of H. pylori.
The client is encouraged to increase fluid intake while taking this therapy to prevent dehydration from occurring.
It leads to resolution of clinical condition after two months of therapy.
Tolerance is unlikely.
Tolerance is unlikely.
Which medication option would have a longer duration of action in treating the clinical condition of gastroesophageal reflux disease?
Proton pump inhibitors
Antacids
Corticosteroids
Opioid analgesics
Proton pump inhibitors
The nurse is caring for a client experiencing dark stools with a positive Hemoccult test. The client is being prepared for an esophageal gastroduodenoscopy to rule out peptic ulcers. The client is anxious and asks where peptic ulcers are located. What should the nurse include in the response? Select all that apply.
Esophagus Stomach Duodenum Jejunum Colon
Stomach
Jejunum
The nurse asks a client with gastric ulcers to describe his symptoms. Which symptoms should the nurse anticipate? Select all that apply.
Burning pain aggravated by eating Midline epigastric pain Pain radiation to the right shoulder Worse pain when lying flat Exacerbation and remission of symptoms
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The nurse is caring for a client who has peptic ulcer disease. Which abnormal labs may be related to the condition? Select all that apply.
Anemia Metabolic acidosis Elevated liver enzymes Elevated pancreatic enzymes H. pylori
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The nurse is discharging a client who was newly diagnosed with a peptic ulcer. What should be included in the teaching? Select all that apply.
Avoid NSAIDs. Increase fluid intake. Avoid caffeine at bedtime. Increase spicy foods. Avoid eating within two hours of bedtime.
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Physiological change
Erosions or Growths?
An ulcer occurs when there is an erosion of the mucosa with considerable depth and involvement of the submucosa.
Type of peptic ulcer
duodenal or jejunal?
Duodenal ulcers are a type of peptic ulcer. They are chronic in nature and make up about 80% of peptic ulcers, affecting the proximal part of the small intestine. They are characterized by remissions and exacerbations.
Type of peptic ulcer
Esophageal or Gastric?
Gastric ulcers are a type of peptic ulcer. They are chronic in nature and make up about 20% of the peptic ulcer cases. They affect the lesser curvature of the stomach, near the pylorus.
Common cause of peptic ulcers
H. Pylori or C. Difficile
H. pylori is a bacterium that commonly causes peptic ulcers. It may be acquired by ingesting contaminated food and water. Family history has been reported as a predisposing factor.
Medication that raises risk for peptic ulcers
Acetaminophen
or
Nonsteroidal Anti- Inflammatory Drugs (NSAIDs)
By blocking the Cox-1 enzyme and disrupting the production of prostaglandins in the stomach, NSAIDs increase the risk of ulcers forming in the stomach.
Most common symptom of peptic ulcers
Pain
or
Vomiting
The pain of peptic ulcers depends on the location and age of the patient. Older adults have fewer symptoms. Pain is reported as burning in the midline epigastric area related to eating patterns, which may radiate to the costal margins into the back.
Common pattern of peptic ulcers
Exacerbation And Remission
or
Continual With Little Relief
Peptic ulcer pain occurs in intervals of weeks or months. During exacerbation, it occurs daily for a period of several weeks and then remits until the next recurrence.
Preferred procedure for diagnosis
Upper GI Endoscopy
or
Upper GI Series
Upper GI endoscopy is the preferred procedure for evaluation of peptic ulcer disease, as compared with a barium upper GI radiograph, because of its increased sensitivity and specificity.
Recommended dietary change
Small Frequent Meals
Large Meal At Mid-Day
Clients who have peptic ulcer disease are encouraged to eat small frequent meals so that their gastric secretions have food to digest.
The nurse is admitting a client with mid-epigastric pain. Which medication is most concerning from the client’s list of current medications?
H2 blockers
Antacids
Ibuprofen
Iron
Ibuprofen
The nurse is admitting a client with peptic ulcer disease. During a dietary assessment the client lists these as his favorite types of foods. What is most concerning?
Pasta with white sauce
Fresh fish and green salad
Rice with curry and spices
Ham and potatoes
Rice with curry and spices
What type of bacteria is a common cause of peptic ulcer disease?
C. difficile
H. pylori
E. coli
Streptococcus
H. pylori
Which complications are associated with untreated peptic ulcer disease? Select all that apply.
Inflammation Perforation Peritonitis Localized abcess Vomiting
Inflammation
Perforation
Peritonitis
Localized abcess
Which assessment changes might the nurse observe in a client with peptic ulcer disease?
Intermittent abdominal pain, fluctuating with food intake
Nausea and vomiting
Right lower quadrant pain with rebound tenderness
Heartburn when lying flat in bed at night
Intermittent abdominal pain, fluctuating with food intake
Which nursing actions should a nurse perform when caring for a patient with peptic ulcer disease? Select all that apply.
Include bedtime snacks for the patient.
Document and notify the primary health-care provider about symptoms of dumping syndrome.
Administer proton pump inhibitors (PPIs) after meals.
Administer antacids 1 to 3 hours after meals.
Prepare the patient for an upper endoscopy or surgery per order.
Document and notify the primary health-care provider about symptoms of dumping syndrome.
Administer antacids 1 to 3 hours after meals.
Prepare the patient for an upper endoscopy or surgery per order.
Which diagnostic tests are used to detect an active infection with Helicobacter pylori? Select all that apply.
Radiological test Urea breath test Barium x-ray test Serological test Fecal antigen test
Fecal antigen test
Urea breath test
Serological test- enzme test
The nurse is caring for a patient with a peptic ulcer. Which symptom would suggest that it is in the duodenum?
The patient is dizzy, sweating, and has palpations.
The patient has ulcer-like pain that cannot be relieved by antacids.
The patient has burning epigastric pain, which can be relieved after taking antacids.
The patient feels stomach fullness.
The patient has burning epigastric pain, which can be relieved after taking antacids.
A patient is hospitalized to rule out peptic ulcer disease (PUD). He asks the nurse what types of noninvasive tests the provider will perform. Which test should the nurse say is most commonly performed?
Upper-endoscopy test
Liver function test
Esophagogastroduodenoscopy (EGD)
Stool antigen test
Stool antigen test
A patient with peptic ulcer disease is being discharged on several new medications. When performing medication education, which medication should the nurse say helps block gastric secretions?
Antacids
H2-receptor antagonists
Metoclopramide
Sucralfate
H2-receptor antagonists
After receiving hand-off report, the nurse begins reflecting on the possible complications that can occur in the patient with peptic ulcer disease. Which considerations should the nurse make? Select all that apply.
Ulcer crater penetrating through adjacent organs
Gastrointestinal (GI) contents entering the peritoneum
Edema, spasm, or contraction of scar tissue
Abdominal distention and third spacing
Abdomen tender when palpating
Ulcer crater penetrating through adjacent organs
Gastrointestinal (GI) contents entering the peritoneum
Edema, spasm, or contraction of scar tissue
Abdominal distention and third spacing
Abdomen tender when palpating
A nurse is proving community education about peptic ulcer disease, its causes, treatment, and symptoms. Which statement by the nurse is incorrect?
“The most common form of chronic gastritis is caused by Helicobacter pylori infection.”
“The incidence of H pylori infection increases in patients who are older than 60.”
“H pylori infection is more prevalent in industrialized countries than in developing countries.”
“Urea breath testing can be used to detect active infection with H pylori.”
“H pylori infection is more prevalent in industrialized countries than in developing countries.”
The nurse is creating a plan of care for a patient with peptic ulcer disease. What is important to include? Select all that apply.
Advise the patient to refrain from caffeine intake.
Advise the patient to limit the use of aspirin.
Advise the patient to limit bedtime snacks.
Administer antacids 1 hour before meals.
Administer proton pump inhibitors (PPIs) before breakfast.
Advise the patient to refrain from caffeine intake.
Administer proton pump inhibitors (PPIs) before breakfast.
The nurse is discussing dietary considerations with a patient diagnosed with peptic ulcer disease. Which responses made by the patient indicate the need for further discussion?
“I must refrain from drinking coffee.”
“I should consume six small meals a day.”
“I must limit my alcohol consumption.”
“I must restrict my intake of fluids.”
“I must restrict my intake of fluids.”
A patient is diagnosed with medication-induced nonsteroidal anti-inflammatory drug (NSAID) peptic ulcer disease. Which clinical finding is the nurse most likely to find in the patient?
Decrease in pepsin secretion
Increase in bicarbonate levels
Decrease in mucus production
Increase in gastric mucosal blood flow
Decrease in mucus production
Which medication can help to decrease the gag reflex if administered to a patient with stomatitis?
IV acyclovir
Viscous lidocaine
Nystatin
Histamine receptor agonists
Viscous lidocaine
A nurse is teaching a patient with stomatitis about the precautionary measures that can promote rapid healing. Which comments by the patient indicate a need for further teaching? Select all that apply.
“I should use a hard-bristled toothbrush to clean the mouth.”
“I should apply water soluble lubricants for lips and mouth.”
“I should use lemon-glycerin swabs to clean the mouth.”
“I should remove dentures and other oral appliances if pain persists.”
“I should limit intake of protein-rich foods in the diet.”
“I should use a hard-bristled toothbrush to clean the mouth.”
“I should use lemon-glycerin swabs to clean the mouth.”
“I should limit intake of protein-rich foods in the diet.”
Which clinical manifestations should a nurse look for in a patient with type II hiatal hernia? Select all that apply.
Feeling full after eating Regurgitation Chest pain like angina Feeling of suffocation Belching
Feeling full after eating
Chest pain like angina
Feeling of suffocation
Which action taken by the nurse may cause aspiration in a patient with oral cancer?
Providing elixir form of medications
Instructing the patient to refrain from talking when eating
Lowering the head of the bed
Assessing the patient’s ability to swallow
Lowering the head of the bed
Which is true regarding leukoplakia?
It is a malignant lesion found commonly on the mandibular mucosa.
It occurs mostly in newborns.
It is more prevalent in women than men.
It looks like nonremovable, slightly raised, sharply rounded white plaques.
It looks like non removable, slightly raised, sharply rounded white plaques
A nurse is reviewing the risk factors that may increase the risk for developing esophageal cancer. Which risk factor listed indicates a need for further training?
Nutritional deficiency
Barrett’s esophagus
Weight loss
Gastroesophageal reflux disease (GERD)
Weight loss
Which is true regarding xerostomia? Select all that apply.
It may be also termed as wet mouth as it increases the flow of saliva in the mouth.
It occurs in patients receiving significant radiation exposure to the salivary glands during radiotherapy.
It is a symptom of several diseases as well as a side effect of many different medications.
It decreases the risk of contracting candidiasis and developing stomatitis.
It may be caused by removal of the salivary glands, dehydration, and diabetes.
It occurs in patients receiving significant radiation exposure to the salivary glands during radiotherapy
It is a symptom of several diseases as well as a side effect of many different medications
It may be caused by removal of the salivary glands, dehydration, and diabetes
Which is true regarding H2 receptor antigen antagonists in treating gastroesophageal reflux disease? Select all that apply.
Some patients may develop a tolerance.
They have a delayed onset of action and a longer duration of action.
They reduce acid production longer than antacids but are slower to take effect.
They are more effective in suppressing gastric acid secretion than proton pump inhibitors.
They decrease acid production of parietal cells in the stomach lining by blocking histamine 2 at one of the first steps of acid production.
Some patients develop a tolerance
They reduce acid production longer than antacids but are slower to take effect
They decrease acid production of parietal cells in the stomach lining by blocking histamine 2 at one of the first steps of acid production
Which is true of the action of proton pump inhibitors (PPIs) in treating gastroesophageal reflux disease?
They block gastric acid production.
They increase gastric pH.
They increase gastric emptying.
They are short-acting medications that decrease gastric acid production.
They block gastric acid production.
