HESI: GI

Question 1

You ask Mr. Lewin to describe his pain in more detail. Which symptom is consistent with peptic ulcer disease?

Burning epigastric pain

Heavy substernal pain

Dull suprapubic pain

Sharp pain in the lower right quadrant of the abdomen

Answer 1

Burning epigastric pain

Burning pain over the stomach region is common with peptic ulcer disease. Pain may also be described as gnawing, aching, or fullness. The pain associated with duodenal ulcers generally occurs 2-4 hours after meals, and is usually relieved with food or antacids. The pain of gastric ulcers is unpredictable, may be associated with intake of food, and relief with antacids is less likely. Mr. Lewin says his discomfort usually occurs after meals. Occasionally, he takes an antacid at night for nighttime “indigestion.”

Question 2

You read the healthcare provider’s (HCP) admission note, which describes Mr. Lewin as complaining of “pyrosis.” The layman’s term for this symptom is:

belching

heartburn

vomiting

hiccoughs

Answer 2

heartburn

Pyrosis, commonly referred to as heartburn or indigestion, generally occurs with peptic ulcer disease. It is characterized as a burning sensation in the epigastric or substernal region, secondary to the presence of acid in the esophagus, stomach, or duodenum.

Question 3

Pyrosis means

Answer 3

heartburn/ indigestion

Question 4

If Mr. Lewin has GI bleeding prior to endoscopy, gastric lavage may be needed. Which of the following should be available for gastric lavage?

Iced saline

Room-temperature saline

Answer 4

Room-temperature saline

Room-temperature saline is recommended for gastric lavage when GI bleeding is present. When upper GI bleeding is present, gastric lavage is done to clear the stomach of excess blood and clots.

Question 5

Mr. Lewin’s nasogastric (NG) tube is a vented (double lumen) type, attached to suction. The tube does not have an anti-reflux valve. You notice that gastric contents are leaking from the air vent (pigtail) port. What should you do initially?

tie off the air vent outlet

notify the HCP

instill air into the air vent

Answer 5

instill air into the air vent

With vented NG tubes, the air vent allows entry of air to decrease the effect of suction pressure on the stomach lining. The air vent needs to remain free of fluid. It is appropriate to instill air or saline (generally a volume of about 10 mL) into the air vent lumen, to clear it of fluid. Positioning the air vent above the level of the client’s stomach may be helpful in preventing future occurrences of leaking.

Question 6

You discuss the upper GI endoscopy procedure with Mr. Lewin. Which description is the most accurate?

“Secretions will be removed from your NG tube at various times and then analyzed for the amount of acid.”

“A tube will be passed through your mouth and advanced into your stomach and upper intestines.”

“You will drink a white liquid, after which x-rays will be taken.”

“You will be given a dye by vein, after which x-rays will be taken.”

Answer 6

“A tube will be passed through your mouth and advanced into your stomach and upper intestines.”

This description of an upper GI endoscopy is correct. An upper GI endoscopy
(esophagogastroduodenoscopy) permits direct visualization of the esophagus, stomach, and duodenum, using a flexible fiberoptic scope, advanced from the mouth to the intestines. Mr. Lewin’s endoscopy procedure may also involve treatment of any ulcer(s) identified.

Question 7

You prepare Mr. Lewin for the upper GI endoscopy procedure. Pre-procedure preparation involves which actions by the nurse?
Select all that apply

Insuring that NPO status is maintained

Advising Mr. Lewin that a sedative will be administered

Removing hair from Mr. Lewin’s abdomen

Obtaining written consent

Removing any dentures

Advising Mr. Lewin that a local anesthetic will be sprayed into his throat

Answer 7

Insuring that NPO status is maintained

Advising Mr. Lewin that a sedative will be administered

Obtaining written consent

Removing any dentures

Advising Mr. Lewin that a local anesthetic will be sprayed into his throat

Question 8

patient review image
An IV infusion of pantoprazole IV is prescribed for Mr. Lewin. He asks you why he has to take this medication. What is the correct response to give the client for the use of pantoprozole IV?

neutralize stomach acid

suppress gastric acid secretion

destroy bacteria in the stomach

create a protective barrier over any ulcerations

Answer 8

suppress gastric acid secretion

Pantoprazole IV is a proton pump inhibitor. Proton pump inhibitors block gastric acid secretion. When an ulcer is present and a bleeding episode has occurred, IV administration of proton pump inhibitors can help to prevent additional bleeding.

Question 9

Which nursing actions are appropriate for Mr. Lewin after his return from the endoscopy?
Select all that apply

Assessing vital signs

Offering fluids by mouth

Assessing for abdominal pain

Answer 9

Assessing vital signs

Assessing for abdominal pain

Question 10

What are major causes of peptic ulcer disease that are recognized in the current literature?
Select all that apply

dietary factors

chronic H. pylori infection

Use of nonsteroidal antiinflammatory drugs (NSAIDs)

emotional stress

smoking

Answer 10

chronic H. pylori infection

Use of nonsteroidal antiinflammatory drugs (NSAIDs)

smoking

Question 11

Clarithromycin and amoxicillin are antibiotics, prescribed to eliminate H. pylori. Omeprazole is prescribed to:

neutralize gastric acid

inhibit gastric acid secretion

increase the production of gastric mucous

decrease the production of nasal mucous

coat the stomach mucosa

Answer 11

inhibit gastric acid secretion

Omeprazole is a proton pump inhibitor. Proton pump inhibitors block the final step in gastric acid production. They are more effective than H2-receptor antagonists in suppressing gastric acid secretion. Other proton pump inhibitors include lansoprazole and pantoprazole. These drugs should be taken on an empty stomach. Headache, abdominal pain, and diarrhea may occur as side effects.

Question 12

Which suggestions do you include in your discharge plan for Mr. Lewin to prevent exacerbation of ulcer symptoms?
Select all that apply

Avoid nonsteroidal antiinflammatory drugs (NSAIDs)

Eat a diet rich in milk and cream

Start a smoking cessation program

Switch from caffeinated to decaffeinated coffee

Avoid aspirin

Answer 12

Avoid nonsteroidal antiinflammatory drugs (NSAIDs)

Start a smoking cessation program

Avoid aspirin

Question 13

Despite treatment and attention to his diet, Mr. Lewin could still experience complications of peptic ulcer disease. What are the complications of peptic ulcer disease?
Select all that apply

bleeding from the ulcers

ulcer perforation through the GI tract wall

gastric outlet obstruction

small bowel cancer

Answer 13

bleeding from the ulcers

ulcer perforation through the GI tract wall

gastric outlet obstruction

Question 14

Mr. Lewin is advised to watch for GI bleeding. Which sign could indicate a bleeding ulcer, and should be reported?
Select all that apply

Black bowel movement

Vomiting dark brown or bloody fluid

Blood in the urine

Blood in sputum

Answer 14

Black bowel movement

Vomiting dark brown or bloody fluid

Question 15

You validate Mr. Lewin’s understanding of his upcoming surgical procedure (selective vagotomy and antrectomy with Billroth II anastamosis) when he tells you that the procedure involves:
Select all that apply

surgical cutting of the vagus nerve

surgical enlargement of the pyloric sphincter

removal of the entire stomach

removal of part of the stomach

Answer 15

surgical cutting of the vagus nerve

removal of part of the stomach

Question 16

How will the patient-controlled analgesia (PCA) contribute to Mr. Lewin’s comfort?
Select all that apply

keep him sedated so that he will experience less pain

provide a consistent level of pain relief

allow him to administer his own pain medication

provide pain relief without the use of narcotics

Answer 16

provide a consistent level of pain relief

allow him to administer his own pain medication

Question 17

Mr. Lewin has a Billroth II procedure, with general anesthesia. Which assessment should you perform first, after transferring Mr. Lewin from the OR stretcher to his bed?

Bowel sounds

Vital signs

PERRLA

Calf tenderness

Answer 17

Vital signs

Life-threatening complications such as hemorrhage, perforation, and peritonitis can occur suddenly. These can be detected early with ongoing vital signs assessments.

Question 18

Which intervention regarding Mr. Lewin’s NG tube should be included in his care plan?

Irrigate NG tube as often as necessary to keep it patent

Report bloody drainage from NG tube

If drainage is noted from vent (pigtail) lumen of NG tube, clamp it

Keep vent (pigtail) lumen of NG tube positioned above the client’s waist

Answer 18

Keep vent (pigtail) lumen of NG tube positioned above the client’s waist

Keeping the pigtail port of Mr. Lewin’s NG tube positioned above his waist will prevent gravity drainage of gastric contents through the port.

Question 19

Mr. Lewin is predisposed to dumping syndrome as a result of his surgery. Which of the following characterizes dumping syndrome?

Bradycardia after eating

Constipation

Flushing after eating

Dizziness after eating

Answer 19

Dizziness after eating

Dumping syndrome occurs after gastrectomy secondary to rapid “dumping” of hypertonic foods and fluids into the jejunum. Fluid subsequently shifts from the intravascular compartment into the lumen of the intestines. This causes release of hormones and vasoactive intestinal polypeptides. As a result, the client experiences vasomotor signs and symptoms such as palpitations, tachycardia, pallor, lightheadedness, and diaphoresis within 30 minutes of eating (early dumping syndrome). Additionally, there is a sudden increase in blood glucose which precipitates a sudden insulin release. This can result in an acute hypoglycemic reaction 2-3 hours later (late dumping syndrome). Hypoglycemia associated with dumping syndrome can cause dizziness, weakness, diaphoresis, pallor, confusion, and fainting.

Question 20

Your discharge plan for Mr. Lewin includes suggestions for preventing symptoms associated with dumping syndrome. What suggestion helps prevent symptoms of dumping syndrome?

Drink large amounts of fluids with meals

Lie down for 20-30 minutes after meals

Eat three large meals each day

Answer 20

Lie down for 20-30 minutes after meals

Lying down after meals often helps to prevent rapid stomach emptying, which causes the symptoms associated with dumping syndrome. In addition, limiting fluid intake with meals and eating small frequent low-carbohydrate meals are recommended. Complex carbohydrates are recommended over simple carbohydrates, which are quickly metabolized.