GI Exam Flashcards
Which information about an 80-yr-old male patient at the senior center is of most concern to the nurse?
a. Decreased appetite c. Difficulty chewing food
b. Unintended weight loss d. Complaints of indigestion
ANS: B
Unintentional weight loss is not a normal finding and may indicate a problem such as cancer or depression. Poor appetite, difficulty in chewing, and complaints of indigestion are common in older patients. These will need to be addressed but are not of as much concern as the weight loss.
An older patient reports chronic constipation. To promote bowel evacuation, the nurse will suggest that the patient attempt defecation
a. in the mid-afternoon.
b. after eating breakfast.
c. right after getting up in the morning.
d. immediately before the first daily meal.
ANS: B
The gastrocolic reflex is most active after the first daily meal. Arising in the morning, the anticipation of eating, and physical exercise do not stimulate these reflexes.
When caring for a patient with a history of a total gastrectomy, the nurse will monitor for
a. constipation.
b. dehydration.
c. elevated total serum cholesterol.
d. cobalamin (vitamin B12) deficiency.
ANS: D
The patient with a total gastrectomy does not secrete intrinsic factor, which is needed for cobalamin (vitamin B12) absorption. Because the stomach absorbs only small amounts of water and nutrients, the patient is not at higher risk for dehydration, elevated cholesterol, or constipation.
The nurse will plan to monitor a patient with an obstructed common bile duct for
a. melena.
b. steatorrhea.
c. decreased serum cholesterol level.
d. increased serum indirect bilirubin level.
ANS: B
A common bile duct obstruction will reduce the absorption of fat in the small intestine, leading to fatty stools. Gastrointestinal bleeding is not caused by common bile duct obstruction. Serum cholesterol levels are increased with biliary obstruction. Direct bilirubin level is increased with biliary obstruction
The nurse receives the following information about a 51-yr-old female patient who is scheduled for a colonoscopy. Which information should be communicated to the health care provider before sending the patient for the procedure?
a. The patient has a permanent pacemaker to prevent bradycardia.
b. The patient is worried about discomfort during the examination.
c. The patient has had an allergic reaction to both shellfish and iodine in the past.
d. The patient declined to drink the prescribed polyethylene glycol (GoLYTELY).
ANS: D
If the patient has had inadequate bowel preparation, the colon cannot be visualized and the procedure should be rescheduled. Because contrast solution is not used during colonoscopy, the iodine allergy is not pertinent. A pacemaker is a contraindication to magnetic resonance imaging but not to colonoscopy. The nurse should instruct the patient about the sedation used during the examination to decrease the patient’s anxiety about discomfort.
Which statement to the nurse from a patient with jaundice indicates a need for teaching?
a. “I used cough syrup several times a day last week.”
b. “I take a baby aspirin every day to prevent strokes.”
c. “I use acetaminophen (Tylenol) every 4 hours for back pain.”
d. “I need to take an antacid for indigestion several times a week”
ANS: C
Chronic use of high doses of acetaminophen can be hepatotoxic and may have caused the patient’s jaundice. The other patient statements require further assessment by the nurse but do not indicate a need for patient education.
To palpate the liver during a head-to-toe physical assessment, the nurse
a. places one hand on the patient’s back and presses upward and inward with the other hand below the patient’s right costal margin.
b. places one hand on top of the other and uses the upper fingers to apply pressure and the bottom fingers to feel for the liver edge.
c. presses slowly and firmly over the right costal margin with one hand and withdraws the fingers quickly after the liver edge is felt.
d. places one hand under the patient’s lower ribs and presses the left lower rib cage forward, palpating below the costal margin with the other hand.
ANS: A
The liver is normally not palpable below the costal margin. The nurse needs to push inward below the right costal margin while lifting the patient’s back slightly with the left hand. The other methods will not allow palpation of the liver.
Which finding by the nurse during abdominal auscultation indicates a need for a focused abdominal assessment?
a. Loud gurgles c. Absent bowel sounds
b. High-pitched gurgles d. Frequent clicking sounds
ANS: C
Absent bowel sounds are abnormal and require further assessment by the nurse. The other sounds may be heard normally.
After assisting with a needle biopsy of the liver at a patient’s bedside, the nurse should
a. put pressure on the biopsy site using a sandbag.
b. elevate the head of the bed to facilitate breathing.
c. place the patient on the right side with the bed flat.
d. check the patient’s postbiopsy coagulation studies.
ANS: C
After a biopsy, the patient lies on the right side with the bed flat to splint the biopsy site. Coagulation studies are checked before the biopsy. A sandbag does not exert adequate pressure to splint the site.
A 42-yr-old patient is admitted to the outpatient testing area for an ultrasound of the gallbladder. Which information obtained by the nurse indicates that the ultrasound may need to be rescheduled?
a. The patient took a laxative the previous evening.
b. The patient had a high-fat meal the previous evening.
c. The patient has a permanent gastrostomy tube in place.
d. The patient ate a low-fat bagel 4 hours ago for breakfast.
ANS: D
Food intake can cause the gallbladder to contract and result in a suboptimal study. The patient should be NPO for 8 to 12 hours before the test. A high-fat meal the previous evening, laxative use, or a gastrostomy tube will not affect the results of the study.
The nurse is assessing an alert and independent 78-yr-old patient for malnutrition risk. Which is the most appropriate initial question?
a. “How do you get to the store to buy your food?”
b. “Can you tell me the food that you ate yesterday?”
c. “Do you have any difficulty in preparing or eating food?”
d. “Are you taking any medications that alter your taste for food?”
ANS: B
This question is the most open-ended and will provide the best overall information about the patient’s daily intake and risk for poor nutrition. The other questions may be asked, depending on the patient’s response to the first question.
A patient has just arrived in the recovery area after an upper endoscopy. Which information collected by the nurse is most important to communicate to the health care provider?
a. The patient is very drowsy.
b. The patient reports a sore throat.
c. The oral temperature is 101.4°F.
d. The apical pulse is 100 beats/minute.
ANS: C
A temperature elevation may indicate that an acute perforation has occurred. The other assessment data are normal immediately after the procedure.
A 30-yr-old male patient with a body mass index (BMI) of 22 kg/m2 is being admitted to the hospital for elective knee surgery. Which assessment finding is important to report to the health care provider?
a. Tympany on percussion of the abdomen
b. Liver edge 3 cm below the costal margin
c. Bowel sounds of 20/minute in each quadrant
d. Aortic pulsations visible in the epigastric area
ANS: B
Normally the lower border of the liver is not palpable below the ribs, so this finding suggests hepatomegaly. The other findings are within normal range for the physical assessment.
A 58-yr-old patient has just returned to the nursing unit after an esophagogastroduodenoscopy (EGD). Which action by unlicensed assistive personnel (UAP) requires that the registered nurse (RN) intervene?
a. Offering the patient a pitcher of water
b. Positioning the patient on the right side
c. Checking the vital signs every 30 minutes
d. Swabbing the patient’s mouth with a wet cloth
ANS: A
Immediately after EGD, the patient will have a decreased gag reflex and is at risk for aspiration. Assessment for return of the gag reflex should be done by the RN. The other actions by the UAP are appropriate.
A patient is being scheduled for endoscopic retrograde cholangiopancreatography (ERCP) as soon as possible. Which prescribed action should the nurse take first?
a. Place the patient on NPO status.
b. Administer sedative medications.
c. Ensure the consent form is signed.
d. Teach the patient about the procedure.
ANS: A
The patient will need to be NPO for 8 hours before the ERCP is done, so the nurse’s initial action should be to place the patient on NPO status. The other actions can be done after the patient is NPO.
While interviewing a young adult patient, the nurse learns that the patient has a family history of familial adenomatous polyposis (FAP). The nurse will plan to assess the patient’s knowledge about
a. preventing noninfectious hepatitis.
b. treating inflammatory bowel disease.
c. risk for developing colorectal cancer.
d. using antacids and proton pump inhibitors.
ANS: C
FAP is a genetic condition that greatly increases the risk for colorectal cancer. Noninfectious hepatitis, use of medications that treat increased gastric pH, and inflammatory bowel disease are not related to FAP.
Which area of the abdomen shown in the accompanying figure will the nurse palpate to assess for splenomegaly?
a. 1
b. 2
c. 3
d. 4
ANS: B
The spleen is usually not palpable, but when palpated, it is located in left upper quadrant of abdomen.
Which finding for a young adult who follows a vegan diet may indicate the need for cobalamin supplementation?
a. Paresthesias c. Dry, scaly skin
b. Ecchymoses d. Gingival swelling
ANS: A
Cobalamin (vitamin B12) cannot be obtained from foods of plant origin, so the patient will be most at risk for signs of cobalamin deficiency, such as paresthesias, peripheral neuropathy, and anemia. The other symptoms listed are associated with other nutritional deficiencies but would not be associated with a vegan diet.
A 76-yr-old woman with a body mass index (BMI) of 17 kg/m2 and a low serum albumin level is being admitted by the nurse. Which assessment finding will the nurse expect to find?
a. Restlessness c. Pitting edema
b. Hypertension d. Food allergies
ANS: C
Edema occurs when serum albumin levels and plasma oncotic pressure decrease. The blood pressure and level of consciousness are not directly affected by malnutrition. Food allergies are not an indicator of nutritional status.
Which menu choice best indicates that the patient is implementing the nurse’s suggestion to choose high-calorie, high-protein foods?
a. Baked fish with applesauce
b. Beef noodle soup and canned corn
c. Fresh fruit salad with yogurt topping
d. Fried chicken with potatoes and gravy
ANS: D
Foods that are high in calories include fried foods and those covered with sauces. High-protein foods include meat and dairy products. The other choices are lower in calories and protein.
A patient has a body mass index (BMI) of 31 kg/m2, a normal C-reactive protein level, and low serum transferrin and albumin levels. The nurse will plan patient teaching to increase the patient’s intake of foods that are high in
a. iron. c. calories.
b. protein. d. carbohydrate.
ANS: B
The patient’s C-reactive protein and transferrin levels indicate low protein stores. The BMI is in the obese range, so increasing caloric intake is not indicated. The data do not indicate a need for increased carbohydrate or iron intake.
A patient who has just been started on tube feedings of full-strength formula at 100 mL/hr has 6 diarrhea stools the first day. Which action should the nurse plan to take?
a. Slow the infusion rate of the tube feeding.
b. Check gastric residual volumes more frequently.
c. Change the enteral feeding system and formula every 8 hours.
d. Discontinue administration of water through the feeding tube.
ANS: A
Loose stools indicate poor absorption of nutrients and indicate a need to slow the feeding rate or decrease the concentration of the feeding. Water should be given when patients receive enteral feedings to prevent dehydration. When a closed enteral feeding system is used, the tubing and formula are changed every 24 hours. High residual volumes do not contribute to diarrhea.
A young adult with extensive facial injuries from a motor vehicle crash is receiving tube feedings through a percutaneous endoscopic gastrostomy (PEG). Which action will the nurse include in the plan of care?
a. Keep the patient positioned on the left side.
b. Check the gastric residual volume every 4 to 6 hours.
c. Avoid giving bolus tube feedings through the PEG tube.
d. Obtain a daily abdominal radiographs to verify tube placement.
ANS: B
The gastric residual volume is assessed every 4 to 6 hours to decrease the risk for aspiration. The patient does not need to be positioned on the left side. Bolus feedings can be administered through a PEG tube. An x-ray is obtained immediately after placement of the PEG tube to check position, but daily are not needed.
A malnourished patient is receiving a parenteral nutrition (PN) infusion containing amino acids and dextrose from a bag that was hung with a new tubing and filter 24 hours ago. The nurse observes that about 50 mL remain in the PN container. Which action is best for the nurse to take?
a. Add a new container of PN using the current tubing and filter.
b. Hang a new container of PN and change the IV tubing and filter.
c. Infuse the remaining 50 mL and then hang a new container of PN.
d. Ask the health care provider to clarify the written PN prescription.
ANS: A
All PN solutions are changed at 24 hours. PN solutions containing dextrose and amino acids require a change in tubing and filter every 72 hours rather than daily. Infusion of the additional 50 mL will increase patient risk for infection. Changing the IV tubing and filter more frequently than required will unnecessarily increase costs. The nurse (not the health care provider) is responsible for knowing the indicated times for tubing and filter changes.
A patient’s capillary blood glucose level is 120 mg/dL 6 hours after the nurse initiated a parenteral nutrition (PN) infusion. The appropriate action by the nurse is to
a. obtain a venous blood glucose specimen.
b. slow the infusion rate of the PN infusion.
c. recheck the capillary blood glucose level in 4 to 6 hours.
d. contact the health care provider for infusion rate changes.
ANS: C
Mild hyperglycemia is expected during the first few days after PN is started and requires ongoing monitoring. Because the glucose elevation is small and expected, infusion rate changes are not needed. There is no need to obtain a venous specimen for comparison. Slowing the rate of the infusion is beyond the nurse’s scope of practice and will decrease the patient’s nutritional intake.
After abdominal surgery, a patient with protein calorie malnutrition is receiving parenteral nutrition (PN). Which is the best indicator that the patient is receiving adequate nutrition?
a. Serum albumin level is 3.5 mg/dL.
b. Fluid intake and output are balanced.
c. Surgical incision is healing normally.
d. Blood glucose is less than 110 mg/dL.
ANS: C
Because poor wound healing is a possible complication of malnutrition for this patient, normal healing of the incision is an indicator of the effectiveness of the PN in providing adequate nutrition. Blood glucose is monitored to prevent the complications of hyperglycemia and hypoglycemia, but it does not indicate that the patient’s nutrition is adequate. The intake and output will be monitored, but do not indicate that the PN is effective. The albumin level is in the low-normal range but does not reflect adequate caloric intake, which is also important for the patient.
A 60-yr-old man who is hospitalized with an abdominal wound infection has been eating very little and states, “Nothing on the menu sounds good.” Which action by the nurse will be most effective in improving the patient’s oral intake?
a. Order six small meals daily.
b. Make a referral to the dietitian.
c. Teach the patient about high-calorie foods.
d. Have family members bring favorite foods.
ANS: D
The patient’s statement that the hospital foods are unappealing indicates that favorite home-cooked foods might improve intake. The other interventions may also help improve the patient’s intake, but the most effective action will be to offer the patient more appealing foods.
When caring for a patient with a soft, silicone nasogastric tube in place for enteral feedings, the nurse will
a. avoid giving medications through the feeding tube.
b. flush the tubing after checking for residual volumes.
c. replace the tube every 3 days to avoid mucosal damage.
d. administer continuous feedings using an infusion pump.
ANS: B
The soft silicone feeding tubes are small in diameter and can easily become clogged unless they are flushed after the nurse checks the residual volume. Either intermittent or continuous feedings can be given. The tubes are less likely to cause mucosal damage than the stiffer polyvinyl chloride tubes used for nasogastric suction and do not need to be replaced at certain intervals. Medications can be given through these tubes, but flushing after medication administration is important to avoid clogging.
A patient is receiving continuous enteral nutrition through a small-bore silicone feeding tube. What should the nurse plan for when this patient has a computed tomography (CT) scan ordered?
a. Ask the health care provider to reschedule the scan.
b. Shut the feeding off 30 to 60 minutes before the scan.
c. Connect the feeding tube to continuous suction before and during the scan.
d. Send a suction catheter with the patient in case of aspiration during the scan.
ANS: B
The tube feeding should be shut off 30 to 60 minutes before any procedure requiring the patient to lie flat. Because the CT scan is ordered for diagnosis of patient problems, rescheduling is not usually an option. Prevention, rather than treatment, of aspiration is needed. Small-bore feeding tubes are soft and collapse easily with aspiration or suction, making nasogastric suction of gastric contents unreliable.
A healthy adult woman who weighs 145 lb (66 kg) asks the clinic nurse about the minimum daily requirement for protein. How many grams of protein will the nurse recommend?
a. 53 c. 75
b. 66 d. 98
ANS: A
The recommended daily protein intake is 0.8 to 1 g/kg of body weight. Therefore, the minimum for this patient is 66 kg 0.8 g = 52.8 or 53 g/day.
A 20-yr-old woman is being admitted with electrolyte disorders of unknown etiology. Which assessment finding is most important to report to the health care provider?
a. The patient uses laxatives daily.
b. The patient’s knuckles are macerated.
c. The patient has a history of extreme fluctuations.
d. The patient’s serum potassium level is 2.9 mEq/L.
ANS: D
The low serum potassium level may cause life-threatening cardiac dysrhythmias, and potassium supplementation is needed rapidly. The other information will also be reported because it suggests that bulimia may be the etiology of the patient’s electrolyte disturbances, but it does not suggest imminent life-threatening complications.
Which action for a patient receiving tube feedings through a percutaneous endoscopic gastrostomy (PEG) may be delegated to a licensed practical/vocational nurse (LPN/LVN)?
a. Assessing the patient’s nutritional status weekly
b. Providing skin care to the area around the tube site
c. Teaching the patient how to administer tube feedings
d. Determining the need for adding water to the feedings
ANS: B
LPN/LVN education and scope of practice include actions such as dressing changes and wound care. Patient teaching and complex assessments (such as patient nutrition and hydration status) require registered nurse (RN)–level education and scope of practice.
Which action should the nurse take first when preparing to teach a frail 79-yr-old Hispanic man who lives with an adult daughter about ways to improve nutrition?
a. Ask the daughter about the patient’s food preferences.
b. Determine who shops for groceries and prepares the meals.
c. Question the patient about how many meals per day are eaten.
d. Assure the patient that culturally preferred foods will be included.
ANS: B
The family member who shops for groceries and cooks will be in control of the patient’s diet, so the nurse will need to ensure that this family member is involved in any teaching or discussion about the patient’s nutritional needs. The other information will also be assessed and used but will not be useful in meeting the patient’s nutritional needs unless nutritionally appropriate foods are purchased and prepared.
After change-of-shift report, which patient will the nurse assess first?
a. A 40-yr-old woman whose parenteral nutrition infusion bag has 30 minutes of solution left
b. A 40-yr-old man with continuous enteral feedings who has developed pulmonary crackles
c. A 30-yr-old man with 4+ generalized pitting edema and severe protein-calorie malnutrition
d. A 30-yr-old woman whose gastrostomy tube is plugged after crushed medications were administered
ANS: B
The patient data suggest aspiration has occurred, and rapid assessment and intervention are needed. The other patients should also be assessed soon, but the data about them do not suggest any immediately life-threatening complications.
A patient hospitalized with chronic heart failure eats only about 50% of each meal and reports “feeling too tired to eat.” Which action should the nurse take first?
a. Teach the patient about the importance of good nutrition.
b. Serve multiple small feedings of high-calorie, high-protein foods.
c. Consult with the health care provider about parenteral nutrition (PN).
d. Obtain an order for enteral feedings of liquid nutritional supplements.
ANS: B
Eating small amounts of food frequently throughout the day is less fatiguing and will improve the patient’s ability to take in more nutrients. Teaching the patient may be appropriate, but will not address the patient’s inability to eat more because of fatigue. Tube feedings or PN may be needed if the patient is unable to take in enough nutrients orally, but increasing the oral intake should be attempted first.
A patient’s peripheral parenteral nutrition (PN) bag is nearly empty, and a new PN bag has not arrived yet from the pharmacy. Which intervention by the nurse is appropriate?
a. Monitor the patient’s capillary blood glucose every 6 hours.
b. Infuse 5% dextrose in water until a new PN bag is delivered.
c. Decrease the PN infusion rate to 10 mL/hr until a new bag arrives.
d. Flush the peripheral line with saline until a new PN bag is available.
ANS: B
To prevent hypoglycemia, the nurse should infuse a 5% dextrose solution until the next peripheral PN bag can be started. Decreasing the rate of the ordered PN infusion is beyond the nurse’s scope of practice. Flushing the line and then waiting for the next bag may lead to hypoglycemia. Monitoring the capillary blood glucose every 6 hours would not identify hypoglycemia while awaiting the new PN bag.
A 19-yr-old woman admitted with anorexia nervosa is 5 ft, 6 in (163 cm) tall and weighs 88 lb (41 kg). Laboratory tests reveal hypokalemia and iron-deficiency anemia. Which patient problem has the highest priority?
a. Risk for activity intolerance
b. Risk for electrolyte imbalance
c. Ineffective health maintenance
d. Imbalanced nutrition: less than body requirements
ANS: B
The patient’s hypokalemia may lead to life-threatening cardiac dysrhythmias. The other diagnoses are also appropriate for this patient but are not associated with immediate risk for fatal complications.
The nurse is planning care for a patient who is chronically malnourished. Which action is appropriate for the nurse to delegate to unlicensed assistive personnel (UAP)?
a. Assist the patient to choose high-nutrition items from the menu.
b. Monitor the patient for skin breakdown over the bony prominences.
c. Offer the patient the prescribed nutritional supplement between meals.
d. Assess the patient’s strength while ambulating the patient in the room.
ANS: C
Feeding the patient and assisting with oral intake are included in UAP education and scope of practice. Assessing the patient and assisting the patient in choosing high-nutrition foods require licensed practical/vocational nurse (LPN/LVN)–or registered nurse (RN)–level education and scope of practice.
A severely malnourished patient reports that he is Jewish. The nurse’s initial action to meet his nutritional needs will be to
a. have family members bring in food.
b. ask the patient about food preferences.
c. teach the patient about nutritious Kosher foods.
d. order nutrition supplements that are manufactured Kosher.
ANS: B
The nurse’s first action should be further assessment whether or not the patient follows any specific religious guidelines that impact nutrition. The other actions may also be appropriate, based on the information obtained during the assessment.
Which of the nurse’s assigned patients should be referred to the dietitian for a complete nutritional assessment (select all that apply)?
a. A 48-yr-old patient with rheumatoid arthritis who takes prednisone daily
b. A 23-yr-old patient who has a history of fluctuating weight gains and losses
c. A 35-yr-old patient who complains of intermittent nausea for the past 2 days
d. A 64-yr-old patient who is admitted for débridement of an infected surgical wound
e. A 52-yr-old patient admitted with chest pain and possible myocardial infarction (MI)
ANS: A, B, D
Weight fluctuations, use of corticosteroids, and draining or infected wounds all suggest that the patient may be at risk for malnutrition. Patients with chest pain or MI are not usually poorly nourished. Although vomiting that lasts 5 days places a patient at risk, nausea that has persisted for 2 days does not always indicate poor nutritional status or risk for health problems caused by poor nutrition.
The nurse is caring for a 47-yr-old female patient who is comatose and is receiving continuous enteral nutrition through a soft nasogastric tube. The nurse notes the presence of new crackles in the patient’s lungs. In which order will the nurse take action? (Put a comma and a space between each answer choice [A, B, C, D].)
a. Check the patient’s oxygen saturation.
b. Notify the patient’s health care provider.
c. Measure the tube feeding residual volume.
d. Stop administering the continuous feeding.
ANS:
D, A, C, B
The assessment data indicate that aspiration may have occurred, and the nurse’s first action should be to turn off the tube feeding to avoid further aspiration. The next action should be to check the oxygen saturation because this may indicate the need for immediate respiratory suctioning or oxygen administration. The residual volume should be obtained because it provides data about possible causes of aspiration. Finally, the health care provider should be notified and informed of all the assessment data the nurse has just obtained.
A 53-yr-old male patient with deep partial-thickness burns from a chemical spill in the workplace experiences severe pain followed by nausea during dressing changes. Which action will be most useful in decreasing the patient’s nausea?
a. Keep the patient NPO for 2 hours before dressing changes.
b. Give the ordered prochlorperazine before dressing changes.
c. Administer the prescribed morphine sulfate before dressing changes.
d. Avoid performing dressing changes close to the patient’s mealtimes.
ANS: C
Because the patient’s nausea is associated with severe pain, it is likely that it is precipitated by stress and pain. The best treatment will be to provide adequate pain medication before dressing changes. The nurse should avoid doing painful procedures close to mealtimes, but nausea or vomiting that occur at other times also should be addressed. Keeping the patient NPO does not address the reason for the nausea and vomiting and will have an adverse effect on the patient’s nutrition. Administration of antiemetics is not the best choice for a patient with nausea caused by pain. However, an antiemetic may be added later if the nausea persists despite pain management.
Which item should the nurse offer to the patient who is to restart oral intake after being NPO due to nausea and vomiting?
a. Glass of orange juice c. Cup of coffee with cream
b. Dish of lemon gelatin d. Bowl of hot chicken broth
ANS: B
Clear cool liquids are usually the first foods started after a patient has been nauseated. Acidic foods such as orange juice, very hot foods, and coffee are poorly tolerated when patients have been nauseated.
A 38-year old woman receiving chemotherapy for breast cancer develops a Candida albicans oral infection. The nurse will anticipate the need for
a. hydrogen peroxide rinses.
b. the use of antiviral agents.
c. administration of nystatin tablets.
d. referral to a dentist for professional tooth cleaning.
ANS: C
Candida albicans infections are treated with an antifungal such as nystatin. Peroxide rinses would be painful. Oral saltwater rinses may be used but will not cure the infection. Antiviral agents are used for viral infections such as herpes simplex. Referral to a dentist is indicated for gingivitis but not for Candida infection.
Which finding in the mouth of a patient who uses smokeless tobacco is suggestive of oral cancer?
a. Bleeding during tooth brushing
b. Painful blisters at the lip border
c. Red, velvety patches on the buccal mucosa
d. White, curdlike plaques on the posterior tongue
ANS: C
A red, velvety patch suggests erythroplasia, which has a high incidence (>50%) of progression to squamous cell carcinoma. The other lesions are suggestive of acute processes (e.g., gingivitis, oral candidiasis, herpes simplex).
Which information will the nurse include when teaching adults to decrease the risk for cancers of the tongue and buccal mucosa?
a. Avoid use of cigarettes and smokeless tobacco.
b. Use sunscreen when outside even on cloudy days.
c. Complete antibiotic courses used to treat throat infections.
d. Use antivirals to treat herpes simplex virus (HSV) infections.
ANS: A
Tobacco use greatly increases the risk for oral cancer. Acute throat infections do not increase the risk for oral cancer, although chronic irritation of the oral mucosa does increase risk. Sun exposure does not increase the risk for cancers of the buccal mucosa. Human papillomavirus (HPV) infection is associated with an increased risk, but HSV infection is not a risk factor for oral cancer.
A patient who has gastroesophageal reflux disease (GERD) is experiencing increasing discomfort. Which patient statement to the nurse indicates that additional teaching about GERD is needed?
a. “I take antacids between meals and at bedtime each night.”
b. “I sleep with the head of the bed elevated on 4-inch blocks.”
c. “I eat small meals during the day and have a bedtime snack.”
d. “I quit smoking several years ago, but I still chew a lot of gum.”
ANS: C
GERD is exacerbated by eating late at night, and the nurse should plan to teach the patient to avoid eating at bedtime. The other patient actions are appropriate to control symptoms of GERD.
A 68-yr-old male patient with a stroke is unconscious and unresponsive to stimuli. After learning that the patient has a history of gastroesophageal reflux disease (GERD), the nurse will plan to do frequent assessments of the patient’s
a. apical pulse. c. breath sounds.
b. bowel sounds. d. abdominal girth.
ANS: C
Because GERD may cause aspiration, the unconscious patient is at risk for developing aspiration pneumonia. Bowel sounds, abdominal girth, and apical pulse will not be affected by the patient’s stroke or GERD and do not require more frequent monitoring than the routine.
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.
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 c. Cherry gelatin with fruit
b. Glass of low-fat milk d. Peanut butter and jelly sandwich
ANS: C
Gelatin and fruit are low fat and will not decrease lower esophageal sphincter (LES) pressure. Foods such as chocolate are avoided because they lower LES pressure. Milk products increase gastric acid secretion. High-fat foods such as peanut butter decrease both gastric emptying and LES pressure.
The nurse will anticipate teaching a patient experiencing frequent heartburn about
a. a barium swallow. c. endoscopy procedures.
b. radionuclide tests. 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.
A 58-yr-old woman who was recently diagnosed with esophageal cancer tells the nurse, “I do not feel ready to die yet.” Which response by the nurse is most appropriate?
a. “You may have quite a few years still left to live.”
b. “Thinking about dying will only make you feel worse.”
c. “Having this new diagnosis must be very hard for you.”
d. “It is important that you be realistic about your prognosis.”
ANS: C
This response is open ended and will encourage the patient to further discuss feelings of anxiety or sadness about the diagnosis. Patients with esophageal cancer have a low survival rate, so the response “You may have quite a few years still left to live” is misleading. The response beginning, “Thinking about dying” indicates that the nurse is not open to discussing the patient’s fears of dying. The response beginning, “It is important that you be realistic” discourages the patient from feeling hopeful, which is important to patients with any life-threatening diagnosis.
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.
Which nursing action should 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.
ANS: 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.
When a patient is diagnosed with achalasia, the nurse will teach the patient that
a. lying down after meals is recommended.
b. a liquid or blenderized diet will be necessary.
c. drinking fluids with meals should be avoided.
d. treatment may include endoscopic procedures.
ANS: D
Endoscopic and laparoscopic procedures are the most effective therapy for improving symptoms caused by achalasia. Keeping the head elevated after eating will improve esophageal emptying. A semisoft diet is recommended to improve esophageal emptying. Patients are advised to drink fluid with meals.
A patient 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. a 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.
The nurse determines that teaching regarding cobalamin injections has been effective when the patient with chronic atrophic gastritis states
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.
A patient has peptic ulcer disease that has been associated with Helicobacter pylori. About which medications will the nurse plan to teach the patient?
a. Sucralfate (Carafate), nystatin, and bismuth (Pepto-Bismol)
b. Metoclopramide (Reglan), bethanechol (Urecholine), and promethazine
c. Amoxicillin (Amoxil), clarithromycin (Biaxin), and omeprazole (Prilosec)
d. Famotidine (Pepcid), magnesium hydroxide (Mylanta), and pantoprazole (Protonix)
ANS: C
The drugs used in triple drug therapy include a proton pump inhibitor such as omeprazole and the antibiotics amoxicillin and clarithromycin. The other combinations listed are not included in the protocol for H. pylori infection.
Which action should the nurse in the emergency department anticipate for a young adult 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 the adverse effects of acetaminophen (Tylenol).
ANS: A
Patients with bloody diarrhea should have a stool culture for Escherichia 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.
The nurse will anticipate preparing an older patient who is vomiting “coffee-ground” emesis for
a. endoscopy. c. barium studies.
b. angiography. 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.
An adult with Escherichia 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.
ANS: C
Use of antidiarrheal agents is avoided with this type of food poisoning. The other orders are appropriate.
Which information will the nurse include when teaching a patient with peptic ulcer disease about the effect of ranitidine (Zantac)?
a. “Ranitidine absorbs the excess 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 that 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).
A young adult patient is hospitalized with massive abdominal trauma from a motor vehicle crash. The patient asks the nurse about the purpose of 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 Helicobacter pylori infection.
An older patient with a bleeding duodenal ulcer has a nasogastric (NG) tube in place. The health care provider prescribes 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 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.
A patient 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. c. Give the ordered antacid.
b. Check the vital signs. d. Elevate the foot of the bed.
ANS: B
The patient’s 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.
A patient who underwent a gastroduodenostomy (Billroth I) 12 hours ago complains of increasing abdominal pain. The patient has no bowel sounds and 200 mL of bright red nasogastric (NG) drainage in the past 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 or return to surgery are needed (or both). 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.
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 common after surgery.”
ANS: C
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.
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 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 rheumatoid arthritis.
The health care provider prescribes antacids and sucralfate (Carafate) for treatment of a patient’s peptic ulcer. The nurse will teach the patient to take
a. sucralfate at bedtime and antacids before each meal.
b. sucralfate and antacids together 30 minutes before meals.
c. antacids 30 minutes before each dose of sucralfate is taken.
d. antacids after meals and sucralfate 30 minutes before meals.
ANS: D
Sucralfate is most effective when the pH is low and should not be given with or soon after antacids. Antacids are most effective when taken after eating. Administration of sucralfate 30 minutes before eating and antacids just after eating will ensure that both drugs can be most effective. The other regimens will decrease the effectiveness of the medications.
Which information about dietary management should 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 you pain.”
d. “You should avoid eating any raw fruits and vegetables.”
ANS: B
The best information is that each individual should choose foods that are not associated with postprandial discomfort. Raw fruits and vegetables may irritate the gastric mucosa, but chewing well seems to decrease this problem and some patients may tolerate these foods well. High-protein foods help neutralize acid, but they also stimulate hydrochloric (HCl) acid secretion and may increase discomfort for some patients. Bland diets may be recommended during an acute exacerbation of PUD, but there is little scientific evidence to support their use.
A 73-yr-old patient is diagnosed with stomach cancer after an unintended 20-lb weight loss. Which nursing action will be included in the plan of care?
a. Refer the patient for hospice services.
b. Infuse IV fluids through a central line.
c. Teach the patient about antiemetic therapy.
d. Offer supplemental feedings between meals.
ANS: D
The patient data indicate a poor nutritional state and improvement in nutrition will be helpful in improving the response to therapies such as surgery, chemotherapy, or radiation. Nausea and vomiting are not common clinical manifestations of stomach cancer. There is no indication that the patient requires hospice or IV fluid infusions.
A 26-yr-old patient with a family history of stomach cancer asks the nurse about ways to decrease the risk for developing stomach cancer. The nurse will teach the patient to avoid
a. emotionally stressful situations.
b. smoked foods such as ham and bacon.
c. foods that cause distention or bloating.
d. chronic use of H2 blocking medications.
ANS: B
Smoked foods such as bacon, ham, and smoked sausage increase the risk for stomach cancer. Stressful situations, abdominal distention, and use of H2 blockers are not associated with an increased incidence of stomach cancer.
The nurse is assessing a patient who had a total gastrectomy 8 hours ago. What information is most important to report to the health care provider?
a. Hemoglobin (Hgb) 10.8 g/dL
b. Temperature 102.1°F (38.9°C)
c. Absent bowel sounds in all quadrants
d. Scant nasogastric (NG) tube drainage
ANS: B
An elevation in temperature may indicate leakage at the anastomosis, which may require return to surgery or keeping the patient NPO. The other findings are expected in the immediate postoperative period for patients who have this surgery and do not require any urgent action.
A 58-yr-old 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 has had a small intestinal resection.
ANS: C
A lethargic patient is at risk for aspiration, and the nurse will need to position the patient to decrease aspiration risk. The other information is also important to collect, but it does not require as quick action as the risk for aspiration.
