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NCLEX Practice Exam for Gastrointestinal Diseases 4 (PM)
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Question 1
Which of the following tests is most commonly used to diagnose cholecystitis?
A
Abdominal CT scan
B
Endoscopy
C
Abdominal ultrasound
D
Barium swallow
Question 1 Explanation:
An abdominal ultrasound can show if the gallbladder is enlarged, if gallstones are present, if the gallbladder wall is thickened, or if distention of the gallbladder lumen is present. An abdominal CT scan can be used to diagnose cholecystitis, but it usually isn’t necessary. A barium swallow looks at the stomach and the duodenum. Endoscopy looks at the esophagus, stomach, and duodenum.
Question 2
A client has been taking aluminum hydroxide 30 mL six times per day at home to treat his peptic ulcer. He tells the nurse that he has been unable to have a bowel movement for 3 days. Based on this information, the nurse would determine that which of the following is the most likely cause of the client’s constipation?
A
The client is experiencing a side effect of the aluminum hydroxide.
B
The client has developed a gastrointestinal obstruction.
C
The client needs to increase his daily exercise
D
The client has not been including enough fiber in his diet
Question 2 Explanation:
It is most likely that the client is experiencing a side effect of the antacid. Antacids with aluminum salt products, such as aluminum hydroxide, form insoluble salts in the body. These precipitate and accumulate in the intestines, causing constipation. Increasing dietary fiber intake or daily exercise may be a beneficial lifestyle change for the client but is not likely to relieve the constipation caused by the aluminum hydroxide. Constipation, in isolation from other symptoms, is not a sign of bowel obstruction.
Question 3
Which of the following symptoms is common with a hiatal hernia?
A
Esophageal reflux
B
Lower back pain
C
Abdominal cramping
D
Left arm pain
Question 3 Explanation:
Esophageal reflux is a common symptom of hiatal hernia. This seems to be associated with chronic exposure of the lower esophageal sphincter to the lower pressure of the thorax, making it less effective.
Question 4
A female client complains of gnawing epigastric pain for a few hours after meals. At times, when the pain is severe, vomiting occurs. Specific tests are indicated to rule out:
A
Peptic ulcer disease
B
Pylorospasm
C
Cancer of the stomach
D
Chronic gastritis
Question 4 Explanation:
Peptic ulcer disease is characteristically gnawing epigastric pain that may radiate to the back. Vomiting usually reflects pyloric spasm from muscular spasm or obstruction. Cancer would not evidence pain or vomiting unless the pylorus was obstructed.
Question 5
Which of the following factors should be the main focus of nursing management for a client hospitalized for cholecystitis?
A
Administration of antibiotics
B
Preparation for lithotripsy
C
Assessment for complications
D
Preparation for surgery
Question 5 Explanation:
The client with acute cholecystitis should first be monitored for perforation, fever, abscess, fistula, and sepsis. After assessment, antibiotics will be administered to reduce the infection. Lithotripsy is used only for a small percentage of clients. Surgery is usually done after the acute infection has subsided.
Question 6
The client with a duodenal ulcer may exhibit which of the following findings on assessment?
A
Hematemesis
B
Melena
C
Pain with eating
D
Malnourishment
Question 6 Explanation:
The client with a duodenal ulcer may have bleeding at the ulcer site, which shows up as melena (black tarry poop). The other findings are consistent with a gastric ulcer.
Question 7
The client with peptic ulcer disease is scheduled for a pyloroplasty. The client asks the nurse about the procedure. The nurse plans to respond knowing that a pyloroplasty involves:
A
Removal of the ulcer and a large portion of the cells that produce hydrochloric acid
B
An incision and resuturing of the pylorus to relax the muscle and enlarge the opening from the stomach to the duodenum.
C
Removing the distal portion of the stomach
D
Cutting the vagus nerve
Question 7 Explanation:
An incision and resuturing of the pylorus to relax the muscle and enlarge the opening from the stomach to the duodenum describes the procedure for a pyloroplasty. A vagotomy involves cutting the vagus nerve. A subtotal gastrectomy involves removing the distal portion of the stomach. A Billroth II procedure involves removal of the ulcer and a large portion of the tissue that produces hydrochloric acid.
Question 8
A client with a peptic ulcer is scheduled for a vagotomy. The client asks the nurse about the purpose of this procedure. The nurse tells the client that the procedure:
A
Reduces the stimulus to acid secretions
B
Heals the gastric mucosa
C
Decreases food absorption in the stomach
D
Halts stress reactions
Question 8 Explanation:
A vagotomy, or cutting the vagus nerve, is done to eliminate parasympathetic stimulation of gastric secretion.
Question 9
Mucosal barrier fortifiers are used in peptic ulcer disease management for which of the following indications?
A
To stimulate hydrogen ion diffusion back into the mucosa
B
To inhibit mucus production
C
To stimulate mucus production
D
To neutralize acid production
Question 9 Explanation:
The mucosal barrier fortifiers stimulate mucus production and prevent hydrogen ion diffusion back into the mucosa, resulting in accelerated ulcer healing. Antacids neutralize acid production.
Question 10
A client is to take one daily dose of ranitidine (Zantac) at home to treat her peptic ulcer. The nurse knows that the client understands proper drug administration of ranitidine when she says that she will take the drug at which of the following times?
A
When pain occurs
B
At bedtime
C
With meals
D
Before meals
Question 10 Explanation:
Ranitidine blocks secretion of hydrochloric acid. Clients who take only one daily dose of ranitidine are usually advised to take it at bedtime to inhibit nocturnal secretion of acid. Clients who take the drug twice a day are advised to take it in the morning and at bedtime.
Question 11
Which of the following tests can be used to diagnose ulcers?
A
Barium swallow
B
Computed tomography (CT) scan
C
Esophagogastroduodenoscopy (EGD)
D
Abdominal x-ray
Question 11 Explanation:
The EGD can visualize the entire upper GI tract as well as allow for tissue specimens and electrocautery if needed. The barium swallow could locate a gastric ulcer. A CT scan and an abdominal x-ray aren’t useful in the diagnosis of an ulcer.
Question 12
After a subtotal gastrectomy, care of the client’s nasogastric tube and drainage system should include which of the following nursing interventions?
A
Monitor the client for N/V, and abdominal distention
B
Irrigate the tube with 30 ml of sterile water every hour, if needed.
C
Turn the machine to high suction of the drainage is sluggish on low suction.
D
Reposition the tube if it is not draining well
Question 12 Explanation:
Nausea, vomiting, or abdominal distention indicated that gas and secretions are accumulating within the gastric pouch due to impaired peristalsis or edema at the operative site and may indicate that the drainage system is not working properly. Saline solution is used to irrigate nasogastric tubes. Hypotonic solutions such as water increase electrolyte loss. In addition, a physician’s order is needed to irrigate the NG tube, because this procedure could disrupt the suture line. After gastric surgery, only the surgeon repositions the NG tube because of the danger of rupturing or dislodging the suture line. The amount of suction varies with the type of tube used and is ordered by the physician. High suction may create too much tension on the gastric suture line.
Question 13
The nurse is reviewing the medication record of a client with acute gastritis. Which medication, if noted on the client’s record, would the nurse question?
A
Furosemide (Lasix)
B
Indomethacin (Indocin)
C
Propranolol hydrochloride (Inderal)
D
Digoxin (Lanoxin)
Question 13 Explanation:
Indomethacin (Indocin) is a NSAID and can cause ulceration of the esophagus, stomach, duodenum, or small intestine. Indomethacin is contraindicated in a client with GI disorders.
Question 14
The pain of a duodenal ulcer can be distinguished from that of a gastric ulcer by which of the following characteristics?
A
Pain on eating
B
Early satiety
C
Pain on empty stomach
D
Dull upper epigastric pain
Question 14 Explanation:
Pain on empty stomach is relieved by taking foods or antacids. The other symptoms are those of a gastric ulcer.
Question 15
A client with peptic ulcer disease tells the nurse that he has black stools, which he has not reported to his physician. Based on this information, which nursing diagnosis would be appropriate for this client?
A
Deficient knowledge related to unfamiliarity with significant signs and symptoms
B
Constipation related to decreased gastric motility
C
Ineffective coping related to fear of diagnosis of chronic illness
D
Imbalanced nutrition: Less than body requirements due to gastric bleeding
Question 15 Explanation:
Black, tarry stools are an important warning sign of bleeding in peptic ulcer disease. Digested blood in the stomach causes it to be black. The odor of the stool is very stinky. Clients with peptic ulcer disease should be instructed to report the incidence of black stools promptly to their physician.
Question 16
After a subtotal gastrectomy, the nurse should anticipate that nasogastric tube drainage will be what color for about 12 to 24 hours after surgery?
A
Bile green
B
Cloudy white
C
Bright red
D
Dark brown
Question 16 Explanation:
About 12 to 24 hours after a subtotal gastrectomy, gastric drainage is normally brown, which indicates digested blood. Bile green or cloudy white drainage is not expected during the first 12 to 24 hours after a subtotal gastrectomy. Drainage during the first 6 to 12 hours contains some bright red blood, but large amounts of blood or excessively bloody drainage should be reported to the physician promptly.
Question 17
The nurse is caring for a client following a Billroth II procedure. On review of the post-operative orders, which of the following, if prescribed, would the nurse question and verify?
A
Leg exercises
B
Early ambulation
C
Coughing a deep breathing exercises
D
Irrigating the nasogastric tube
Question 17 Explanation:
In a Billroth II procedure the proximal remnant of the stomach is anastomased to the proximal jejunum. Patency of the NG tube is critical for preventing the retention of gastric secretions. The nurse should never irrigate or reposition the gastric tube after gastric surgery, unless specifically ordered by the physician. In this situation, the nurse would clarify the order.
Question 18
When obtaining a nursing history on a client with a suspected gastric ulcer, which signs and symptoms would the nurse expect to see? Select all that apply.
A
Relief of epigastric pain after eating
B
Vomiting
C
Weight loss
D
Epigastric pain at night
Question 18 Explanation:
Vomiting and weight loss are common with gastric ulcers. Clients with a gastric ulcer are most likely to complain of a burning epigastric pain that occurs about one hour after eating. Eating frequently aggravates the pain. Clients with duodenal ulcers are more likely to complain about pain that occurs during the night and is frequently relieved by eating.
Question 19
Which of the following would be an expected nutritional outcome for a client who has undergone a subtotal gastrectomy for cancer?
A
Resume normal dietary intake of three meals per day
B
Achieve optimal nutritional status through oral or parenteral feedings
C
Regain weight loss within 1 month after surgery
D
Control nausea and vomiting through regular use of antiemetics
Question 19 Explanation:
An appropriate expected outcome is for the client to achieve optimal nutritional status through the use of oral feedings or total parenteral nutrition (TPN). TPN may be used to supplement oral intake, or it may be used alone if the client cannot tolerate oral feedings. The client would not be expected to regain lost weight within 1 month after surgery or to tolerate a normal dietary intake of three meals per day. Nausea and vomiting would not be considered an expected outcome of gastric surgery, and regular use of antiemetics would not be anticipated.
Question 20
While caring for a client with peptic ulcer disease, the client reports that he has been nauseated most of the day and is now feeling lightheaded and dizzy. Based upon these findings, which nursing actions would be most appropriate for the nurse to take? Select all that apply.
A
Initiating oxygen therapy
B
Administering an antacid hourly until nausea subsides.
C
Reassessing the client on an hour
D
Notifying the physician of the client’s symptoms
E
Monitoring the client’s vital signs
Question 20 Explanation:
The symptoms of nausea and dizziness in a client with peptic ulcer disease may be indicative of hemorrhage and should not be ignored. The appropriate nursing actions at this time are for the nurse to monitor the client’s vital signs and notify the physician of the client’s symptoms. To administer an antacid hourly or to wait one hour to reassess the client would be inappropriate; prompt intervention is essential in a client who is potentially experiencing a gastrointestinal hemorrhage. The nurse would notify the physician of assessment findings and then initiate oxygen therapy if ordered by the physician.
Question 21
Which of the following symptoms best describes Murphy’s sign?
A
Periumbilical eccymosis exists
B
On deep inspiration, pain is elicited and breathing stops
C
On deep palpitation and release, pain in elicited
D
Abdominal muscles are tightened in anticipation of palpation
Question 21 Explanation:
Murphy’s sign is elicited when the client reacts to pain and stops breathing. It’s a common finding in clients with cholecystitis. Periumbilical ecchymosis, Cullen’s sign, is present in peritonitis. Pain on deep palpation and release is rebound tenderness. Tightening up abdominal muscles in anticipation of palpation is guarding.
Question 22
A client has been diagnosed with adenocarcinoma of the stomach and is scheduled to undergo a subtotal gastrectomy (Billroth II procedure). During pre-operative teaching, the nurse is reinforcing information about the procedure. Which of the following explanations is most accurate?
A
The procedure will result in repositioning of the vagus nerve
B
The procedure will result in removal of the duodenum
C
The procedure will result in anastomosis of the gastric stump to the jejunum
D
The procedure will result in enlargement of the pyloric sphincter
Question 22 Explanation:
A Billroth II procedure bypasses the duodenum and connects the gastric stump directly to the jejunum. The pyloric sphincter is removed, along with some of the stomach fundus.
Question 23
A 40-year-old male client has been hospitalized with peptic ulcer disease. He is being treated with a histamine receptor antagonist (cimetidine), antacids, and diet. The nurse doing discharge planning will teach him that the action of cimetidine is to:
A
Inhibit the production of hydrochloric acid (HCl)
B
Reduce gastric acid output
C
Inhibit vagus nerve stimulation
D
Protect the ulcer surface
Question 23 Explanation:
These drugs inhibit action of histamine on the H2 receptors of parietal cells, thus reducing gastric acid output.
Question 24
The nurse would assess the client experiencing an acute episode of cholecysitis for pain that is located in the right
A
Lower quadrant and radiates to the back
B
Upper quadrant and radiates to the right scapula and shoulder
C
Lower quadrant and radiates to the umbilicus
D
Upper quadrant and radiates to the left scapula and shoulder
Question 24 Explanation:
During an acute “gallbladder attack,” the client may complain of severe right upper quadrant pain that radiates to the right scapula and shoulder. This is governed by the pattern on dermatones in the body.
Question 25
Which of the following best describes the method of action of medications, such as ranitidine (Zantac), which are used in the treatment of peptic ulcer disease?
A
Stimulate gastrin release
B
Protect the mucosal barrier
C
Neutralize acid
D
Reduce acid secretions
Question 25 Explanation:
Ranitidine is a histamine-2 receptor antagonist that reduces acid secretion by inhibiting gastrin secretion.
Question 26
The most important pathophysiologic factor contributing to the formation of esophageal varices is:
A
Decreased albumin formation by the liver
B
Increased central venous pressure
C
Portal hypertension
D
Decreased prothrombin formation
Question 26 Explanation:
As the liver cells become fatty and degenerate, they are no longer able to accommodate the large amount of blood necessary for homeostasis. The pressure in the liver increases and causes increased pressure in the venous system. As the portal pressure increases, fluid exudes into the abdominal cavity. This is called ascites.
Question 27
Which of the following conditions can cause a hiatal hernia?
A
Weakness of the diaphragmic muscle
B
Weakness of the esophageal muscle
C
Increased esophageal muscle pressure
D
Increased intrathoracic pressure
Question 27 Explanation:
A hiatal hernia is caused by weakness of the diaphragmic muscle and increased intra-abdominal—not intrathoracic—pressure. This weakness allows the stomach to slide into the esophagus. The esophageal supports weaken, but esophageal muscle weakness or increased esophageal muscle pressure isn’t a factor in hiatal hernia.
Question 28
A client being treated for chronic cholecystitis should be given which of the following instructions?
A
Increase rest
B
Use anticholinergics as prescribed
C
Increase protein in diet
D
Avoid antacids
Question 28 Explanation:
Conservative therapy for chronic cholecystitis includes weight reduction by increasing physical activity, a low-fat diet, antacid use to treat dyspepsia, and anticholinergic use to relax smooth muscles and reduce ductal tone and spasm, thereby reducing pain.
Question 29
The hospitalized client with GERD is complaining of chest discomfort that feels like heartburn following a meal. After administering an ordered antacid, the nurse encourages the client to lie in which of the following positions?
A
On the stomach with the head flat
B
On the right side with the head of the bed elevated 30 degrees.
C
On the left side with the head of the bed elevated 30 degrees
D
Supine with the head of the bed flat
Question 29 Explanation:
The discomfort of reflux is aggravated by positions that compress the abdomen and the stomach. These include lying flat on the back or on the stomach after a meal of lying on the right side. The left side-lying position with the head of the bed elevated is most likely to give relief to the client.
Question 30
Which of the following tests can be performed to diagnose a hiatal hernia?
A
Barium swallow
B
Lower GI series
C
Abdominal x-rays
D
Colonoscopy
Question 30 Explanation:
A barium swallow with fluoroscopy shows the position of the stomach in relation to the diaphragm. A colonoscopy and a lower GI series show disorders of the intestine.
Question 31
The nurse provides medication instructions to a client with peptic ulcer disease. Which statement, if made by the client, indicates the best understanding of the medication therapy?
A
“Omeprazole (Prilosec) will coat the ulcer and help it heal.”
B
“Sucralfate (Carafate) will change the fluid in my stomach.”
C
“The cimetidine (Tagamet) will cause me to produce less stomach acid.”
D
“Antacids will coat my stomach.”
Question 31 Explanation:
Cimetidine (Tagamet), a histamine H2 receptor antagonist, will decrease the secretion of gastric acid. Sucralfate (Carafate) promotes healing by coating the ulcer. Antacids neutralize acid in the stomach. Omeprazole (Prilosec) inhibits gastric acid secretion.
Question 32
When a client has peptic ulcer disease, the nurse would expect a priority intervention to be:
A
Assisting in inserting an arterial pressure line
B
Inserting an I.V.
C
Inserting a nasogastric tube
D
Assisting in inserting a Miller-Abbott tube
Question 32 Explanation:
An NG tube insertion is the most appropriate intervention because it will determine the presence of active GI bleeding. A Miller-Abbott tube is a weighted, mercury-filled ballooned tube used to resolve bowel obstructions. There is no evidence of shock or fluid overload in the client; therefore, an arterial line is not appropriate at this time and an IV is optional.
Question 33
Which of the following measures should the nurse focus on for the client with esophageal varices?
A
Recognizing hemorrhage
B
Encouraging nutritional intake
C
Controlling blood pressure
D
Teaching the client about varices
Question 33 Explanation:
Recognizing the rupture of esophageal varices, or hemorrhage, is the focus of nursing care because the client could succumb to this quickly. Controlling blood pressure is also important because it helps reduce the risk of variceal rupture. It is also important to teach the client what varices are and what foods he should avoid such as spicy foods.
Question 34
A client is taking an antacid for treatment of a peptic ulcer. Which of the following statements best indicates that the client understands how to correctly take the antacid?
A
“I need to decrease my intake of fluids so that I don’t dilute the effects of my antacid.”
B
“It is best for me to take my antacid 1 to 3 hours after meals.”
C
“My antacid will be most effective if I take it whenever I experience stomach pains.”
D
“I should take my antacid before I take my other medications.”
Question 34 Explanation:
Antacids are most effective if taken 1 to 3 hours after meals and at bedtime. When an antacid is taken on an empty stomach, the duration of the drug’s action is greatly decreased. Taking antacids 1 to 3 hours after a meal lengthens the duration of action, thus increasing the therapeutic action of the drug. Antacids should be administered about 2 hours after other medications to decrease the chance of drug interactions. It is not necessary to decrease fluid intake when taking antacids.
Question 35
When counseling a client in ways to prevent cholecystitis, which of the following guidelines is most important?
A
Eat a low-fat, low-cholesterol diet
B
Keep weight proportionate to height
C
Eat a low-protein diet
D
Limit exercise to 10 minutes/day
Question 35 Explanation:
Obesity is a known cause of gallstones, and maintaining a recommended weight will help protect against gallstones. Excessive dietary intake of cholesterol is associated with the development of gallstones in many people. Dietary protein isn’t implicated in cholecystitis. Liquid protein and low-calorie diets (with rapid weight loss of more than 5 lb [2.3kg] per week) are implicated as the cause of some cases of cholecystitis. Regular exercise (30 minutes/three times a week) may help reduce weight and improve fat metabolism. Reducing stress may reduce bile production, which may also indirectly decrease the chances of developing cholecystitis.
Question 36
A client is admitted to the hospital after vomiting bright red blood and is diagnosed with a bleeding duodenal ulcer. The client develops a sudden, sharp pain in the midepigastric area along with a rigid, boardlike abdomen. These clinical manifestations most likely indicate which of the following?
A
The esophagus has become inflamed
B
Additional ulcers have developed
C
An intestinal obstruction has developed
D
The ulcer has perforated
Question 36 Explanation:
The body reacts to perforation of an ulcer by immobilizing the area as much as possible. This results in boardlike muscle rigidity, usually with extreme pain. Perforation is a medical emergency requiring immediate surgical intervention because peritonitis develops quickly after perforation. An intestinal obstruction would not cause midepigastric pain. Esophageal inflammation or the development of additional ulcers would not cause a rigid, boardlike abdomen.
Question 37
Which of the following tasks should be included in the immediate postoperative management of a client who has undergone gastric resection?
A
Providing nutritional support
B
Monitoring for symptoms of hemorrhage
C
Assessing for bowel sounds
D
Monitoring gastric pH to detect complications
Question 37 Explanation:
The client should be monitored closely for signs and symptoms of hemorrhage, such as bright red blood in the nasogastric tube suction, tachycardia, or a drop in blood pressure. Gastric pH may be monitored to evaluate the need for histamine-2 receptor antagonists. Bowel sounds may not return for up to 72 hours postoperatively. Nutritional needs should be addressed soon after surgery.
Question 38
The client being treated for esophageal varices has a Sengstaken-Blakemore tube inserted to control the bleeding. The most important assessment is for the nurse to:
A
Check that the balloon is deflated on a regular basis
B
Monitor IV fluids for the shift
C
Check that the hemostat is on the bedside
D
Regularly assess respiratory status
Question 38 Explanation:
The respiratory system can become occluded if the balloon slips and moves up the esophagus, putting pressure on the trachea. This would result in respiratory distress and should be assessed frequently. Scissors should be kept at the bedside to cut the tube if distress occurs. This is a safety intervention.
Question 39
The nurse instructs the nursing assistant on how to provide oral hygiene for a client who cannot perform this task for himself. Which of the following techniques should the nurse tell the assistant to incorporate into the client’s daily care?
A
Assess the oral cavity each time mouth care is given and record observations
B
Swab the client’s tongue, gums, and lips with a soft foam applicator every 2 hours.
C
Use a soft toothbrush to brush the client’s teeth after each meal
D
Rinse the client’s mouth with mouthwash several times a day.
Question 39 Explanation:
A soft toothbrush should be used to brush the client’s teeth after each meal and more often as needed. Mechanical cleaning is necessary to maintain oral health, simulate gingiva, and remove plaque. Assessing the oral cavity and recording observations is the responsibility of the nurse, not the nursing assistant. Swabbing with a safe foam applicator does not provide enough friction to clean the mouth. Mouthwash can be a drying irritant and is not recommended for frequent use.
Question 40
The nurse is caring for a client with chronic gastritis. The nurse monitors the client, knowing that this client is at risk for which of the following vitamin deficiencies?
A
Vitamin B12
B
Vitamin C
C
Vitamin A
D
Vitamin E
Question 40 Explanation:
Chronic gastritis causes deterioration and atrophy of the lining of the stomach, leading to the loss of the functioning parietal cells. The source of the intrinsic factor is lost, which results in the inability to absorb vitamin B12. This leads to the development of pernicious anemia.
Question 41
If a gastric acid perforates, which of the following actions should not be included in the immediate management of the client?
A
Blood replacement
B
Fluid and electrolyte replacement
C
Antacid administration
D
Nasogastric tube suction
Question 41 Explanation:
Antacids aren’t helpful in perforation. The client should be treated with antibiotics as well as fluid, electrolyte, and blood replacement. NG tube suction should also be performed to prevent further spillage of stomach contents into the peritoneal cavity.
Question 42
A client with a peptic ulcer reports epigastric pain that frequently awakens her at night, a feeling of fullness in the abdomen, and a feeling of anxiety about her health. Based on this information, which nursing diagnosis would be most appropriate?
A
Imbalanced Nutrition: Less than Body Requirements related to anorexia.
B
Ineffective Coping related to exacerbation of duodenal ulcer
C
Activity Intolerance related to abdominal pain
D
Disturbed Sleep Pattern related to epigastric pain
Question 42 Explanation:
Based on the data provided, the most appropriate nursing diagnosis would be Disturbed Sleep pattern. A client with a duodenal ulcer commonly awakens at night with pain. The client’s feelings of anxiety do not necessarily indicate that she is coping ineffectively.
Question 43
The client has orders for a nasogastric (NG) tube insertion. During the procedure, instructions that will assist in the insertion would be:
A
Instruct the client to hold his chin down, then back for insertion of the tube
B
After insertion into the nostril, instruct the client to extend his neck
C
Instruct the client to tilt his head back for insertion in the nostril, then flex his neck for the final insertion
D
Introduce the tube with the client’s head tilted back, then instruct him to keep his head upright for final insertion
Question 43 Explanation:
NG insertion technique is to have the client first tilt his head back for insertion into the nostril, then to flex his neck forward and swallow. Extension of the neck will impede NG tube insertion.
Question 44
The nurse is assessing a client 24 hours following a cholecystectomy. The nurse notes that the T-tube has drained 750ml of green-brown drainage. Which nursing intervention is most appropriate?
A
Notify the physician
B
Document the findings
C
Irrigate the T-tube
D
Clamp the T-tube
Question 44 Explanation:
Following cholecystectomy, drainage from the T-tube is initially bloody and then turns to green-brown. The drainage is measured as output. The amount of expected drainage will range from 500 to 1000 ml per day. The nurse would document the output.
Question 45
The nurse is caring for a client who has had a gastroscopy. Which of the following symptoms may indicate that the client is developing a complication related to the procedure? Select all that apply.
A
The client appears drowsy following the procedure
B
The client has a temperature of 100ºF
C
The client experiences hematemesis
D
The client complains of epigastric pain
E
The client complains of a sore throat
Question 45 Explanation:
Following a gastroscopy, the nurse should monitor the client for complications, which include perforation and the potential for aspiration. An elevated temperature, complaints of epigastric pain, or the vomiting of blood (hematemesis) are all indications of a possible perforation and should be reported promptly. A sore throat is a common occurrence following a gastroscopy. Clients are usually sedated to decrease anxiety and the nurse would anticipate that the client will be drowsy following the procedure.
Question 46
Risk factors for the development of hiatal hernias are those that lead to increased abdominal pressure. Which of the following complications can cause increased abdominal pressure?
A
Volvulus
B
Intestinal obstruction
C
Obesity
D
Constipation
Question 46 Explanation:
Obesity may cause increased abdominal pressure that pushes the lower portion of the stomach into the thorax.
Question 47
Which of the following dietary measures would be useful in preventing esophageal reflux?
A
Eating small, frequent meals
B
Increasing fluid intake
C
Adding a bedtime snack to the dietary plan
D
Avoiding air swallowing with meals
Question 47 Explanation:
Esophageal reflux worsens when the stomach is overdistended with food. Therefore, an important measure is to eat small, frequent meals. Fluid intake should be decreased during meals to reduce abdominal distention. Avoiding air swallowing does not prevent esophageal reflux. Food intake in the evening should be strictly limited to reduce the incidence of nighttime reflux, so bedtime snacks are not recommended.
Question 48
A client with suspected gastric cancer undergoes an endoscopy of the stomach. Which of the following assessments made after the procedure would indicate the development of a potential complication?
A
The client complains of a sore throat
B
The client displays signs of sedation
C
The client demonstrates a lack of appetite
D
The client experiences a sudden increase in temperature
Question 48 Explanation:
The most likely complication of an endoscopic procedure is perforation. A sudden temperature spike with 1 to 2 hours after the procedure is indicative of a perforation and should be reported immediately to the physician. A sore throat is to be anticipated after an endoscopy. Clients are given sedatives during the procedure, so it is expected that they will display signs of sedation after the procedure is completed. A lack of appetite could be the result of many factors, including the disease process.
Question 49
The nurse is providing discharge instructions to a client following gastrectomy. Which measure will the nurse instruct the client to follow to assist in preventing dumping syndrome?
A
Ambulate following a meal
B
Limit the fluids taken with meals
C
Sit in a high-Fowlers position during meals
D
Eat high-carbohydrate foods
Question 49 Explanation:
The nurse should instruct the client to decrease the amount of fluid taken at meals and to avoid high carbohydrate foods including fluids such as fruit nectars; to assume a low-Fowler’s position during meals; to lie down for 30 minutes after eating to delay gastric emptying; and to take antispasmidocs as prescribed.
Question 50
The client with GERD complains of a chronic cough. The nurse understands that in a client with GERD this symptom may be indicative of which of the following conditions?
A
Development of laryngeal cance
B
Aspiration of gastric contents
C
Irritation of the esophagus
D
Esophageal scar tissue formation
Question 50 Explanation:
Clients with GERD can develop pulmonary symptoms such as coughing, wheezing, and dyspnea that are caused by the aspiration of gastric contents. GERD does not predispose the client to the development of laryngeal cancer. Irritation of the esophagus and esophageal scar tissue formation can develop as a result of GERD. However, GERD is more likely to cause painful and difficult swallowing.
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NCLEX Practice Exam for Gastrointestinal Diseases 4 (EM)
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Question 1
The most important pathophysiologic factor contributing to the formation of esophageal varices is:
A
Decreased albumin formation by the liver
B
Portal hypertension
C
Increased central venous pressure
D
Decreased prothrombin formation
Question 1 Explanation:
As the liver cells become fatty and degenerate, they are no longer able to accommodate the large amount of blood necessary for homeostasis. The pressure in the liver increases and causes increased pressure in the venous system. As the portal pressure increases, fluid exudes into the abdominal cavity. This is called ascites.
Question 2
A female client complains of gnawing epigastric pain for a few hours after meals. At times, when the pain is severe, vomiting occurs. Specific tests are indicated to rule out:
A
Pylorospasm
B
Peptic ulcer disease
C
Cancer of the stomach
D
Chronic gastritis
Question 2 Explanation:
Peptic ulcer disease is characteristically gnawing epigastric pain that may radiate to the back. Vomiting usually reflects pyloric spasm from muscular spasm or obstruction. Cancer would not evidence pain or vomiting unless the pylorus was obstructed.
Question 3
When counseling a client in ways to prevent cholecystitis, which of the following guidelines is most important?
A
Eat a low-protein diet
B
Keep weight proportionate to height
C
Eat a low-fat, low-cholesterol diet
D
Limit exercise to 10 minutes/day
Question 3 Explanation:
Obesity is a known cause of gallstones, and maintaining a recommended weight will help protect against gallstones. Excessive dietary intake of cholesterol is associated with the development of gallstones in many people. Dietary protein isn’t implicated in cholecystitis. Liquid protein and low-calorie diets (with rapid weight loss of more than 5 lb [2.3kg] per week) are implicated as the cause of some cases of cholecystitis. Regular exercise (30 minutes/three times a week) may help reduce weight and improve fat metabolism. Reducing stress may reduce bile production, which may also indirectly decrease the chances of developing cholecystitis.
Question 4
Which of the following conditions can cause a hiatal hernia?
A
Weakness of the esophageal muscle
B
Weakness of the diaphragmic muscle
C
Increased intrathoracic pressure
D
Increased esophageal muscle pressure
Question 4 Explanation:
A hiatal hernia is caused by weakness of the diaphragmic muscle and increased intra-abdominal—not intrathoracic—pressure. This weakness allows the stomach to slide into the esophagus. The esophageal supports weaken, but esophageal muscle weakness or increased esophageal muscle pressure isn’t a factor in hiatal hernia.
Question 5
The nurse instructs the nursing assistant on how to provide oral hygiene for a client who cannot perform this task for himself. Which of the following techniques should the nurse tell the assistant to incorporate into the client’s daily care?
A
Use a soft toothbrush to brush the client’s teeth after each meal
B
Rinse the client’s mouth with mouthwash several times a day.
C
Assess the oral cavity each time mouth care is given and record observations
D
Swab the client’s tongue, gums, and lips with a soft foam applicator every 2 hours.
Question 5 Explanation:
A soft toothbrush should be used to brush the client’s teeth after each meal and more often as needed. Mechanical cleaning is necessary to maintain oral health, simulate gingiva, and remove plaque. Assessing the oral cavity and recording observations is the responsibility of the nurse, not the nursing assistant. Swabbing with a safe foam applicator does not provide enough friction to clean the mouth. Mouthwash can be a drying irritant and is not recommended for frequent use.
Question 6
A client with suspected gastric cancer undergoes an endoscopy of the stomach. Which of the following assessments made after the procedure would indicate the development of a potential complication?
A
The client displays signs of sedation
B
The client complains of a sore throat
C
The client demonstrates a lack of appetite
D
The client experiences a sudden increase in temperature
Question 6 Explanation:
The most likely complication of an endoscopic procedure is perforation. A sudden temperature spike with 1 to 2 hours after the procedure is indicative of a perforation and should be reported immediately to the physician. A sore throat is to be anticipated after an endoscopy. Clients are given sedatives during the procedure, so it is expected that they will display signs of sedation after the procedure is completed. A lack of appetite could be the result of many factors, including the disease process.
Question 7
A client is admitted to the hospital after vomiting bright red blood and is diagnosed with a bleeding duodenal ulcer. The client develops a sudden, sharp pain in the midepigastric area along with a rigid, boardlike abdomen. These clinical manifestations most likely indicate which of the following?
A
The ulcer has perforated
B
An intestinal obstruction has developed
C
Additional ulcers have developed
D
The esophagus has become inflamed
Question 7 Explanation:
The body reacts to perforation of an ulcer by immobilizing the area as much as possible. This results in boardlike muscle rigidity, usually with extreme pain. Perforation is a medical emergency requiring immediate surgical intervention because peritonitis develops quickly after perforation. An intestinal obstruction would not cause midepigastric pain. Esophageal inflammation or the development of additional ulcers would not cause a rigid, boardlike abdomen.
Question 8
A client with a peptic ulcer reports epigastric pain that frequently awakens her at night, a feeling of fullness in the abdomen, and a feeling of anxiety about her health. Based on this information, which nursing diagnosis would be most appropriate?
A
Ineffective Coping related to exacerbation of duodenal ulcer
B
Disturbed Sleep Pattern related to epigastric pain
C
Activity Intolerance related to abdominal pain
D
Imbalanced Nutrition: Less than Body Requirements related to anorexia.
Question 8 Explanation:
Based on the data provided, the most appropriate nursing diagnosis would be Disturbed Sleep pattern. A client with a duodenal ulcer commonly awakens at night with pain. The client’s feelings of anxiety do not necessarily indicate that she is coping ineffectively.
Question 9
Which of the following best describes the method of action of medications, such as ranitidine (Zantac), which are used in the treatment of peptic ulcer disease?
A
Reduce acid secretions
B
Stimulate gastrin release
C
Protect the mucosal barrier
D
Neutralize acid
Question 9 Explanation:
Ranitidine is a histamine-2 receptor antagonist that reduces acid secretion by inhibiting gastrin secretion.
Question 10
The client with a duodenal ulcer may exhibit which of the following findings on assessment?
A
Pain with eating
B
Melena
C
Malnourishment
D
Hematemesis
Question 10 Explanation:
The client with a duodenal ulcer may have bleeding at the ulcer site, which shows up as melena (black tarry poop). The other findings are consistent with a gastric ulcer.
Question 11
If a gastric acid perforates, which of the following actions should not be included in the immediate management of the client?
A
Blood replacement
B
Antacid administration
C
Fluid and electrolyte replacement
D
Nasogastric tube suction
Question 11 Explanation:
Antacids aren’t helpful in perforation. The client should be treated with antibiotics as well as fluid, electrolyte, and blood replacement. NG tube suction should also be performed to prevent further spillage of stomach contents into the peritoneal cavity.
Question 12
Which of the following measures should the nurse focus on for the client with esophageal varices?
A
Recognizing hemorrhage
B
Controlling blood pressure
C
Encouraging nutritional intake
D
Teaching the client about varices
Question 12 Explanation:
Recognizing the rupture of esophageal varices, or hemorrhage, is the focus of nursing care because the client could succumb to this quickly. Controlling blood pressure is also important because it helps reduce the risk of variceal rupture. It is also important to teach the client what varices are and what foods he should avoid such as spicy foods.
Question 13
A client being treated for chronic cholecystitis should be given which of the following instructions?
A
Avoid antacids
B
Increase rest
C
Use anticholinergics as prescribed
D
Increase protein in diet
Question 13 Explanation:
Conservative therapy for chronic cholecystitis includes weight reduction by increasing physical activity, a low-fat diet, antacid use to treat dyspepsia, and anticholinergic use to relax smooth muscles and reduce ductal tone and spasm, thereby reducing pain.
Question 14
Which of the following symptoms is common with a hiatal hernia?
A
Esophageal reflux
B
Abdominal cramping
C
Left arm pain
D
Lower back pain
Question 14 Explanation:
Esophageal reflux is a common symptom of hiatal hernia. This seems to be associated with chronic exposure of the lower esophageal sphincter to the lower pressure of the thorax, making it less effective.
Question 15
After a subtotal gastrectomy, the nurse should anticipate that nasogastric tube drainage will be what color for about 12 to 24 hours after surgery?
A
Cloudy white
B
Bright red
C
Bile green
D
Dark brown
Question 15 Explanation:
About 12 to 24 hours after a subtotal gastrectomy, gastric drainage is normally brown, which indicates digested blood. Bile green or cloudy white drainage is not expected during the first 12 to 24 hours after a subtotal gastrectomy. Drainage during the first 6 to 12 hours contains some bright red blood, but large amounts of blood or excessively bloody drainage should be reported to the physician promptly.
Question 16
The pain of a duodenal ulcer can be distinguished from that of a gastric ulcer by which of the following characteristics?
A
Early satiety
B
Pain on empty stomach
C
Dull upper epigastric pain
D
Pain on eating
Question 16 Explanation:
Pain on empty stomach is relieved by taking foods or antacids. The other symptoms are those of a gastric ulcer.
Question 17
A client is to take one daily dose of ranitidine (Zantac) at home to treat her peptic ulcer. The nurse knows that the client understands proper drug administration of ranitidine when she says that she will take the drug at which of the following times?
A
When pain occurs
B
Before meals
C
At bedtime
D
With meals
Question 17 Explanation:
Ranitidine blocks secretion of hydrochloric acid. Clients who take only one daily dose of ranitidine are usually advised to take it at bedtime to inhibit nocturnal secretion of acid. Clients who take the drug twice a day are advised to take it in the morning and at bedtime.
Question 18
After a subtotal gastrectomy, care of the client’s nasogastric tube and drainage system should include which of the following nursing interventions?
A
Irrigate the tube with 30 ml of sterile water every hour, if needed.
B
Reposition the tube if it is not draining well
C
Turn the machine to high suction of the drainage is sluggish on low suction.
D
Monitor the client for N/V, and abdominal distention
Question 18 Explanation:
Nausea, vomiting, or abdominal distention indicated that gas and secretions are accumulating within the gastric pouch due to impaired peristalsis or edema at the operative site and may indicate that the drainage system is not working properly. Saline solution is used to irrigate nasogastric tubes. Hypotonic solutions such as water increase electrolyte loss. In addition, a physician’s order is needed to irrigate the NG tube, because this procedure could disrupt the suture line. After gastric surgery, only the surgeon repositions the NG tube because of the danger of rupturing or dislodging the suture line. The amount of suction varies with the type of tube used and is ordered by the physician. High suction may create too much tension on the gastric suture line.
Question 19
A client has been diagnosed with adenocarcinoma of the stomach and is scheduled to undergo a subtotal gastrectomy (Billroth II procedure). During pre-operative teaching, the nurse is reinforcing information about the procedure. Which of the following explanations is most accurate?
A
The procedure will result in anastomosis of the gastric stump to the jejunum
B
The procedure will result in enlargement of the pyloric sphincter
C
The procedure will result in removal of the duodenum
D
The procedure will result in repositioning of the vagus nerve
Question 19 Explanation:
A Billroth II procedure bypasses the duodenum and connects the gastric stump directly to the jejunum. The pyloric sphincter is removed, along with some of the stomach fundus.
Question 20
Which of the following factors should be the main focus of nursing management for a client hospitalized for cholecystitis?
A
Administration of antibiotics
B
Preparation for lithotripsy
C
Preparation for surgery
D
Assessment for complications
Question 20 Explanation:
The client with acute cholecystitis should first be monitored for perforation, fever, abscess, fistula, and sepsis. After assessment, antibiotics will be administered to reduce the infection. Lithotripsy is used only for a small percentage of clients. Surgery is usually done after the acute infection has subsided.
Question 21
Which of the following tests can be used to diagnose ulcers?
A
Barium swallow
B
Computed tomography (CT) scan
C
Abdominal x-ray
D
Esophagogastroduodenoscopy (EGD)
Question 21 Explanation:
The EGD can visualize the entire upper GI tract as well as allow for tissue specimens and electrocautery if needed. The barium swallow could locate a gastric ulcer. A CT scan and an abdominal x-ray aren’t useful in the diagnosis of an ulcer.
Question 22
Which of the following dietary measures would be useful in preventing esophageal reflux?
A
Avoiding air swallowing with meals
B
Increasing fluid intake
C
Adding a bedtime snack to the dietary plan
D
Eating small, frequent meals
Question 22 Explanation:
Esophageal reflux worsens when the stomach is overdistended with food. Therefore, an important measure is to eat small, frequent meals. Fluid intake should be decreased during meals to reduce abdominal distention. Avoiding air swallowing does not prevent esophageal reflux. Food intake in the evening should be strictly limited to reduce the incidence of nighttime reflux, so bedtime snacks are not recommended.
Question 23
The nurse provides medication instructions to a client with peptic ulcer disease. Which statement, if made by the client, indicates the best understanding of the medication therapy?
A
“Sucralfate (Carafate) will change the fluid in my stomach.”
B
“The cimetidine (Tagamet) will cause me to produce less stomach acid.”
C
“Omeprazole (Prilosec) will coat the ulcer and help it heal.”
D
“Antacids will coat my stomach.”
Question 23 Explanation:
Cimetidine (Tagamet), a histamine H2 receptor antagonist, will decrease the secretion of gastric acid. Sucralfate (Carafate) promotes healing by coating the ulcer. Antacids neutralize acid in the stomach. Omeprazole (Prilosec) inhibits gastric acid secretion.
Question 24
The nurse would assess the client experiencing an acute episode of cholecysitis for pain that is located in the right
A
Lower quadrant and radiates to the back
B
Upper quadrant and radiates to the right scapula and shoulder
C
Lower quadrant and radiates to the umbilicus
D
Upper quadrant and radiates to the left scapula and shoulder
Question 24 Explanation:
During an acute “gallbladder attack,” the client may complain of severe right upper quadrant pain that radiates to the right scapula and shoulder. This is governed by the pattern on dermatones in the body.
Question 25
A client has been taking aluminum hydroxide 30 mL six times per day at home to treat his peptic ulcer. He tells the nurse that he has been unable to have a bowel movement for 3 days. Based on this information, the nurse would determine that which of the following is the most likely cause of the client’s constipation?
A
The client has not been including enough fiber in his diet
B
The client needs to increase his daily exercise
C
The client has developed a gastrointestinal obstruction.
D
The client is experiencing a side effect of the aluminum hydroxide.
Question 25 Explanation:
It is most likely that the client is experiencing a side effect of the antacid. Antacids with aluminum salt products, such as aluminum hydroxide, form insoluble salts in the body. These precipitate and accumulate in the intestines, causing constipation. Increasing dietary fiber intake or daily exercise may be a beneficial lifestyle change for the client but is not likely to relieve the constipation caused by the aluminum hydroxide. Constipation, in isolation from other symptoms, is not a sign of bowel obstruction.
Question 26
Which of the following tests is most commonly used to diagnose cholecystitis?
A
Barium swallow
B
Endoscopy
C
Abdominal ultrasound
D
Abdominal CT scan
Question 26 Explanation:
An abdominal ultrasound can show if the gallbladder is enlarged, if gallstones are present, if the gallbladder wall is thickened, or if distention of the gallbladder lumen is present. An abdominal CT scan can be used to diagnose cholecystitis, but it usually isn’t necessary. A barium swallow looks at the stomach and the duodenum. Endoscopy looks at the esophagus, stomach, and duodenum.
Question 27
The nurse is providing discharge instructions to a client following gastrectomy. Which measure will the nurse instruct the client to follow to assist in preventing dumping syndrome?
A
Eat high-carbohydrate foods
B
Sit in a high-Fowlers position during meals
C
Ambulate following a meal
D
Limit the fluids taken with meals
Question 27 Explanation:
The nurse should instruct the client to decrease the amount of fluid taken at meals and to avoid high carbohydrate foods including fluids such as fruit nectars; to assume a low-Fowler’s position during meals; to lie down for 30 minutes after eating to delay gastric emptying; and to take antispasmidocs as prescribed.
Question 28
Which of the following tasks should be included in the immediate postoperative management of a client who has undergone gastric resection?
A
Monitoring for symptoms of hemorrhage
B
Monitoring gastric pH to detect complications
C
Assessing for bowel sounds
D
Providing nutritional support
Question 28 Explanation:
The client should be monitored closely for signs and symptoms of hemorrhage, such as bright red blood in the nasogastric tube suction, tachycardia, or a drop in blood pressure. Gastric pH may be monitored to evaluate the need for histamine-2 receptor antagonists. Bowel sounds may not return for up to 72 hours postoperatively. Nutritional needs should be addressed soon after surgery.
Question 29
Mucosal barrier fortifiers are used in peptic ulcer disease management for which of the following indications?
A
To inhibit mucus production
B
To stimulate mucus production
C
To neutralize acid production
D
To stimulate hydrogen ion diffusion back into the mucosa
Question 29 Explanation:
The mucosal barrier fortifiers stimulate mucus production and prevent hydrogen ion diffusion back into the mucosa, resulting in accelerated ulcer healing. Antacids neutralize acid production.
Question 30
The client with peptic ulcer disease is scheduled for a pyloroplasty. The client asks the nurse about the procedure. The nurse plans to respond knowing that a pyloroplasty involves:
A
An incision and resuturing of the pylorus to relax the muscle and enlarge the opening from the stomach to the duodenum.
B
Cutting the vagus nerve
C
Removal of the ulcer and a large portion of the cells that produce hydrochloric acid
D
Removing the distal portion of the stomach
Question 30 Explanation:
An incision and resuturing of the pylorus to relax the muscle and enlarge the opening from the stomach to the duodenum describes the procedure for a pyloroplasty. A vagotomy involves cutting the vagus nerve. A subtotal gastrectomy involves removing the distal portion of the stomach. A Billroth II procedure involves removal of the ulcer and a large portion of the tissue that produces hydrochloric acid.
Question 31
The nurse is reviewing the medication record of a client with acute gastritis. Which medication, if noted on the client’s record, would the nurse question?
A
Digoxin (Lanoxin)
B
Indomethacin (Indocin)
C
Propranolol hydrochloride (Inderal)
D
Furosemide (Lasix)
Question 31 Explanation:
Indomethacin (Indocin) is a NSAID and can cause ulceration of the esophagus, stomach, duodenum, or small intestine. Indomethacin is contraindicated in a client with GI disorders.
Question 32
A 40-year-old male client has been hospitalized with peptic ulcer disease. He is being treated with a histamine receptor antagonist (cimetidine), antacids, and diet. The nurse doing discharge planning will teach him that the action of cimetidine is to:
A
Inhibit vagus nerve stimulation
B
Reduce gastric acid output
C
Protect the ulcer surface
D
Inhibit the production of hydrochloric acid (HCl)
Question 32 Explanation:
These drugs inhibit action of histamine on the H2 receptors of parietal cells, thus reducing gastric acid output.
Question 33
Which of the following tests can be performed to diagnose a hiatal hernia?
A
Lower GI series
B
Colonoscopy
C
Abdominal x-rays
D
Barium swallow
Question 33 Explanation:
A barium swallow with fluoroscopy shows the position of the stomach in relation to the diaphragm. A colonoscopy and a lower GI series show disorders of the intestine.
Question 34
A client is taking an antacid for treatment of a peptic ulcer. Which of the following statements best indicates that the client understands how to correctly take the antacid?
A
“I should take my antacid before I take my other medications.”
B
“My antacid will be most effective if I take it whenever I experience stomach pains.”
C
“I need to decrease my intake of fluids so that I don’t dilute the effects of my antacid.”
D
“It is best for me to take my antacid 1 to 3 hours after meals.”
Question 34 Explanation:
Antacids are most effective if taken 1 to 3 hours after meals and at bedtime. When an antacid is taken on an empty stomach, the duration of the drug’s action is greatly decreased. Taking antacids 1 to 3 hours after a meal lengthens the duration of action, thus increasing the therapeutic action of the drug. Antacids should be administered about 2 hours after other medications to decrease the chance of drug interactions. It is not necessary to decrease fluid intake when taking antacids.
Question 35
A client with a peptic ulcer is scheduled for a vagotomy. The client asks the nurse about the purpose of this procedure. The nurse tells the client that the procedure:
A
Heals the gastric mucosa
B
Decreases food absorption in the stomach
C
Halts stress reactions
D
Reduces the stimulus to acid secretions
Question 35 Explanation:
A vagotomy, or cutting the vagus nerve, is done to eliminate parasympathetic stimulation of gastric secretion.
Question 36
When obtaining a nursing history on a client with a suspected gastric ulcer, which signs and symptoms would the nurse expect to see? Select all that apply.
A
Relief of epigastric pain after eating
B
Epigastric pain at night
C
Vomiting
D
Weight loss
Question 36 Explanation:
Vomiting and weight loss are common with gastric ulcers. Clients with a gastric ulcer are most likely to complain of a burning epigastric pain that occurs about one hour after eating. Eating frequently aggravates the pain. Clients with duodenal ulcers are more likely to complain about pain that occurs during the night and is frequently relieved by eating.
Question 37
A client with peptic ulcer disease tells the nurse that he has black stools, which he has not reported to his physician. Based on this information, which nursing diagnosis would be appropriate for this client?
A
Imbalanced nutrition: Less than body requirements due to gastric bleeding
B
Constipation related to decreased gastric motility
C
Deficient knowledge related to unfamiliarity with significant signs and symptoms
D
Ineffective coping related to fear of diagnosis of chronic illness
Question 37 Explanation:
Black, tarry stools are an important warning sign of bleeding in peptic ulcer disease. Digested blood in the stomach causes it to be black. The odor of the stool is very stinky. Clients with peptic ulcer disease should be instructed to report the incidence of black stools promptly to their physician.
Question 38
The nurse is caring for a client with chronic gastritis. The nurse monitors the client, knowing that this client is at risk for which of the following vitamin deficiencies?
A
Vitamin A
B
Vitamin B12
C
Vitamin E
D
Vitamin C
Question 38 Explanation:
Chronic gastritis causes deterioration and atrophy of the lining of the stomach, leading to the loss of the functioning parietal cells. The source of the intrinsic factor is lost, which results in the inability to absorb vitamin B12. This leads to the development of pernicious anemia.
Question 39
The nurse is caring for a client who has had a gastroscopy. Which of the following symptoms may indicate that the client is developing a complication related to the procedure? Select all that apply.
A
The client has a temperature of 100ºF
B
The client appears drowsy following the procedure
C
The client experiences hematemesis
D
The client complains of a sore throat
E
The client complains of epigastric pain
Question 39 Explanation:
Following a gastroscopy, the nurse should monitor the client for complications, which include perforation and the potential for aspiration. An elevated temperature, complaints of epigastric pain, or the vomiting of blood (hematemesis) are all indications of a possible perforation and should be reported promptly. A sore throat is a common occurrence following a gastroscopy. Clients are usually sedated to decrease anxiety and the nurse would anticipate that the client will be drowsy following the procedure.
Question 40
When a client has peptic ulcer disease, the nurse would expect a priority intervention to be:
A
Inserting an I.V.
B
Assisting in inserting a Miller-Abbott tube
C
Assisting in inserting an arterial pressure line
D
Inserting a nasogastric tube
Question 40 Explanation:
An NG tube insertion is the most appropriate intervention because it will determine the presence of active GI bleeding. A Miller-Abbott tube is a weighted, mercury-filled ballooned tube used to resolve bowel obstructions. There is no evidence of shock or fluid overload in the client; therefore, an arterial line is not appropriate at this time and an IV is optional.
Question 41
Which of the following symptoms best describes Murphy’s sign?
A
On deep palpitation and release, pain in elicited
B
Periumbilical eccymosis exists
C
On deep inspiration, pain is elicited and breathing stops
D
Abdominal muscles are tightened in anticipation of palpation
Question 41 Explanation:
Murphy’s sign is elicited when the client reacts to pain and stops breathing. It’s a common finding in clients with cholecystitis. Periumbilical ecchymosis, Cullen’s sign, is present in peritonitis. Pain on deep palpation and release is rebound tenderness. Tightening up abdominal muscles in anticipation of palpation is guarding.
Question 42
The client has orders for a nasogastric (NG) tube insertion. During the procedure, instructions that will assist in the insertion would be:
A
Introduce the tube with the client’s head tilted back, then instruct him to keep his head upright for final insertion
B
Instruct the client to tilt his head back for insertion in the nostril, then flex his neck for the final insertion
C
Instruct the client to hold his chin down, then back for insertion of the tube
D
After insertion into the nostril, instruct the client to extend his neck
Question 42 Explanation:
NG insertion technique is to have the client first tilt his head back for insertion into the nostril, then to flex his neck forward and swallow. Extension of the neck will impede NG tube insertion.
Question 43
Which of the following would be an expected nutritional outcome for a client who has undergone a subtotal gastrectomy for cancer?
A
Resume normal dietary intake of three meals per day
B
Control nausea and vomiting through regular use of antiemetics
C
Achieve optimal nutritional status through oral or parenteral feedings
D
Regain weight loss within 1 month after surgery
Question 43 Explanation:
An appropriate expected outcome is for the client to achieve optimal nutritional status through the use of oral feedings or total parenteral nutrition (TPN). TPN may be used to supplement oral intake, or it may be used alone if the client cannot tolerate oral feedings. The client would not be expected to regain lost weight within 1 month after surgery or to tolerate a normal dietary intake of three meals per day. Nausea and vomiting would not be considered an expected outcome of gastric surgery, and regular use of antiemetics would not be anticipated.
Question 44
The client being treated for esophageal varices has a Sengstaken-Blakemore tube inserted to control the bleeding. The most important assessment is for the nurse to:
A
Check that the balloon is deflated on a regular basis
B
Monitor IV fluids for the shift
C
Check that the hemostat is on the bedside
D
Regularly assess respiratory status
Question 44 Explanation:
The respiratory system can become occluded if the balloon slips and moves up the esophagus, putting pressure on the trachea. This would result in respiratory distress and should be assessed frequently. Scissors should be kept at the bedside to cut the tube if distress occurs. This is a safety intervention.
Question 45
The nurse is assessing a client 24 hours following a cholecystectomy. The nurse notes that the T-tube has drained 750ml of green-brown drainage. Which nursing intervention is most appropriate?
A
Notify the physician
B
Clamp the T-tube
C
Irrigate the T-tube
D
Document the findings
Question 45 Explanation:
Following cholecystectomy, drainage from the T-tube is initially bloody and then turns to green-brown. The drainage is measured as output. The amount of expected drainage will range from 500 to 1000 ml per day. The nurse would document the output.
Question 46
The nurse is caring for a client following a Billroth II procedure. On review of the post-operative orders, which of the following, if prescribed, would the nurse question and verify?
A
Coughing a deep breathing exercises
B
Irrigating the nasogastric tube
C
Leg exercises
D
Early ambulation
Question 46 Explanation:
In a Billroth II procedure the proximal remnant of the stomach is anastomased to the proximal jejunum. Patency of the NG tube is critical for preventing the retention of gastric secretions. The nurse should never irrigate or reposition the gastric tube after gastric surgery, unless specifically ordered by the physician. In this situation, the nurse would clarify the order.
Question 47
The hospitalized client with GERD is complaining of chest discomfort that feels like heartburn following a meal. After administering an ordered antacid, the nurse encourages the client to lie in which of the following positions?
A
On the right side with the head of the bed elevated 30 degrees.
B
On the left side with the head of the bed elevated 30 degrees
C
Supine with the head of the bed flat
D
On the stomach with the head flat
Question 47 Explanation:
The discomfort of reflux is aggravated by positions that compress the abdomen and the stomach. These include lying flat on the back or on the stomach after a meal of lying on the right side. The left side-lying position with the head of the bed elevated is most likely to give relief to the client.
Question 48
Risk factors for the development of hiatal hernias are those that lead to increased abdominal pressure. Which of the following complications can cause increased abdominal pressure?
A
Volvulus
B
Intestinal obstruction
C
Constipation
D
Obesity
Question 48 Explanation:
Obesity may cause increased abdominal pressure that pushes the lower portion of the stomach into the thorax.
Question 49
The client with GERD complains of a chronic cough. The nurse understands that in a client with GERD this symptom may be indicative of which of the following conditions?
A
Irritation of the esophagus
B
Aspiration of gastric contents
C
Esophageal scar tissue formation
D
Development of laryngeal cance
Question 49 Explanation:
Clients with GERD can develop pulmonary symptoms such as coughing, wheezing, and dyspnea that are caused by the aspiration of gastric contents. GERD does not predispose the client to the development of laryngeal cancer. Irritation of the esophagus and esophageal scar tissue formation can develop as a result of GERD. However, GERD is more likely to cause painful and difficult swallowing.
Question 50
While caring for a client with peptic ulcer disease, the client reports that he has been nauseated most of the day and is now feeling lightheaded and dizzy. Based upon these findings, which nursing actions would be most appropriate for the nurse to take? Select all that apply.
A
Notifying the physician of the client’s symptoms
B
Monitoring the client’s vital signs
C
Reassessing the client on an hour
D
Initiating oxygen therapy
E
Administering an antacid hourly until nausea subsides.
Question 50 Explanation:
The symptoms of nausea and dizziness in a client with peptic ulcer disease may be indicative of hemorrhage and should not be ignored. The appropriate nursing actions at this time are for the nurse to monitor the client’s vital signs and notify the physician of the client’s symptoms. To administer an antacid hourly or to wait one hour to reassess the client would be inappropriate; prompt intervention is essential in a client who is potentially experiencing a gastrointestinal hemorrhage. The nurse would notify the physician of assessment findings and then initiate oxygen therapy if ordered by the physician.
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1. Which of the following conditions can cause a hiatal hernia?
Increased intrathoracic pressure
Weakness of the esophageal muscle
Increased esophageal muscle pressure
Weakness of the diaphragmic muscle
2. Risk factors for the development of hiatal hernias are those that lead to increased abdominal pressure. Which of the following complications can cause increased abdominal pressure?
Obesity
Volvulus
Constipation
Intestinal obstruction
3. Which of the following symptoms is common with a hiatal hernia?
Left arm pain
Lower back pain
Esophageal reflux
Abdominal cramping
4. Which of the following tests can be performed to diagnose a hiatal hernia?
Colonoscopy
Lower GI series
Barium swallow
Abdominal x-rays
5. Which of the following measures should the nurse focus on for the client with esophageal varices?
Recognizing hemorrhage
Controlling blood pressure
Encouraging nutritional intake
Teaching the client about varices
6. Which of the following tests can be used to diagnose ulcers?
Abdominal x-ray
Barium swallow
Computed tomography (CT) scan
Esophagogastroduodenoscopy (EGD)
7. Which of the following best describes the method of action of medications, such as ranitidine (Zantac), which are used in the treatment of peptic ulcer disease?
Neutralize acid
Reduce acid secretions
Stimulate gastrin release
Protect the mucosal barrier
8. The hospitalized client with GERD is complaining of chest discomfort that feels like heartburn following a meal. After administering an ordered antacid, the nurse encourages the client to lie in which of the following positions?
Supine with the head of the bed flat
On the stomach with the head flat
On the left side with the head of the bed elevated 30 degrees
On the right side with the head of the bed elevated 30 degrees.
9. The nurse is caring for a client following a Billroth II procedure. On review of the post-operative orders, which of the following, if prescribed, would the nurse question and verify?
Irrigating the nasogastric tube
Coughing a deep breathing exercises
Leg exercises
Early ambulation
10. The nurse is providing discharge instructions to a client following gastrectomy. Which measure will the nurse instruct the client to follow to assist in preventing dumping syndrome?
Eat high-carbohydrate foods
Limit the fluids taken with meals
Ambulate following a meal
Sit in a high-Fowlers position during meals
11. The nurse instructs the nursing assistant on how to provide oral hygiene for a client who cannot perform this task for himself. Which of the following techniques should the nurse tell the assistant to incorporate into the client’s daily care?
Assess the oral cavity each time mouth care is given and record observations
Use a soft toothbrush to brush the client’s teeth after each meal
Swab the client’s tongue, gums, and lips with a soft foam applicator every 2 hours.
Rinse the client’s mouth with mouthwash several times a day.
12. A client with suspected gastric cancer undergoes an endoscopy of the stomach. Which of the following assessments made after the procedure would indicate the development of a potential complication?
The client complains of a sore throat
The client displays signs of sedation
The client experiences a sudden increase in temperature
The client demonstrates a lack of appetite
13. A client has been diagnosed with adenocarcinoma of the stomach and is scheduled to undergo a subtotal gastrectomy (Billroth II procedure). During pre-operative teaching, the nurse is reinforcing information about the procedure. Which of the following explanations is most accurate?
The procedure will result in enlargement of the pyloric sphincter
The procedure will result in anastomosis of the gastric stump to the jejunum
The procedure will result in removal of the duodenum
The procedure will result in repositioning of the vagus nerve
14. After a subtotal gastrectomy, the nurse should anticipate that nasogastric tube drainage will be what color for about 12 to 24 hours after surgery?
Dark brown
Bile green
Bright red
Cloudy white
15. After a subtotal gastrectomy, care of the client’s nasogastric tube and drainage system should include which of the following nursing interventions?
Irrigate the tube with 30 ml of sterile water every hour, if needed.
Reposition the tube if it is not draining well
Monitor the client for N/V, and abdominal distention
Turn the machine to high suction of the drainage is sluggish on low suction.
16. Which of the following would be an expected nutritional outcome for a client who has undergone a subtotal gastrectomy for cancer?
Regain weight loss within 1 month after surgery
Resume normal dietary intake of three meals per day
Control nausea and vomiting through regular use of antiemetics
Achieve optimal nutritional status through oral or parenteral feedings
17. The client with GERD complains of a chronic cough. The nurse understands that in a client with GERD this symptom may be indicative of which of the following conditions?
Development of laryngeal cancer
Irritation of the esophagus
Esophageal scar tissue formation
Aspiration of gastric contents
18. Which of the following dietary measures would be useful in preventing esophageal reflux?
Eating small, frequent meals
Increasing fluid intake
Avoiding air swallowing with meals
Adding a bedtime snack to the dietary plan
19. A client is admitted to the hospital after vomiting bright red blood and is diagnosed with a bleeding duodenal ulcer. The client develops a sudden, sharp pain in the midepigastric area along with a rigid, boardlike abdomen. These clinical manifestations most likely indicate which of the following?
An intestinal obstruction has developed
Additional ulcers have developed
The esophagus has become inflamed
The ulcer has perforated
20. When obtaining a nursing history on a client with a suspected gastric ulcer, which signs and symptoms would the nurse expect to see? Select all that apply.
Epigastric pain at night
Relief of epigastric pain after eating
Vomiting
Weight loss
21. The nurse is caring for a client who has had a gastroscopy. Which of the following symptoms may indicate that the client is developing a complication related to the procedure? Select all that apply.
The client complains of a sore throat
The client has a temperature of 100*F
The client appears drowsy following the procedure
The client complains of epigastric pain
The client experiences hematemesis
22. A client with peptic ulcer disease tells the nurse that he has black stools, which he has not reported to his physician. Based on this information, which nursing diagnosis would be appropriate for this client?
Ineffective coping related to fear of diagnosis of chronic illness
Deficient knowledge related to unfamiliarity with significant signs and symptoms
Constipation related to decreased gastric motility
Imbalanced nutrition: Less than body requirements due to gastric bleeding
23. A client with a peptic ulcer reports epigastric pain that frequently awakens her at night, a feeling of fullness in the abdomen, and a feeling of anxiety about her health. Based on this information, which nursing diagnosis would be most appropriate?
Imbalanced Nutrition: Less than Body Requirements related to anorexia.
Disturbed Sleep Pattern related to epigastric pain
Ineffective Coping related to exacerbation of duodenal ulcer
Activity Intolerance related to abdominal pain
24. While caring for a client with peptic ulcer disease, the client reports that he has been nauseated most of the day and is now feeling lightheaded and dizzy. Based upon these findings, which nursing actions would be most appropriate for the nurse to take? Select all that apply.
Administering an antacid hourly until nausea subsides.
Monitoring the client’s vital signs
Notifying the physician of the client’s symptoms
Initiating oxygen therapy
Reassessing the client on an hour
25. A client is to take one daily dose of ranitidine (Zantac) at home to treat her peptic ulcer. The nurse knows that the client understands proper drug administration of ranitidine when she says that she will take the drug at which of the following times?
Before meals
With meals
At bedtime
When pain occurs
26. A client has been taking aluminum hydroxide 30 mL six times per day at home to treat his peptic ulcer. He tells the nurse that he has been unable to have a bowel movement for 3 days. Based on this information, the nurse would determine that which of the following is the most likely cause of the client’s constipation?
The client has not been including enough fiber in his diet
The client needs to increase his daily exercise
The client is experiencing a side effect of the aluminum hydroxide.
The client has developed a gastrointestinal obstruction.
27. A client is taking an antacid for treatment of a peptic ulcer. Which of the following statements best indicates that the client understands how to correctly take the antacid?
“I should take my antacid before I take my other medications.”
“I need to decrease my intake of fluids so that I don’t dilute the effects of my antacid.”
“My antacid will be most effective if I take it whenever I experience stomach pains.”
“It is best for me to take my antacid 1 to 3 hours after meals.”
28. The nurse is caring for a client with chronic gastritis. The nurse monitors the client, knowing that this client is at risk for which of the following vitamin deficiencies?
Vitamin A
Vitamin B12
Vitamin C
Vitamin E
29. The nurse is reviewing the medication record of a client with acute gastritis. Which medication, if noted on the client’s record, would the nurse question?
Digoxin (Lanoxin)
Indomethacin (Indocin)
Furosemide (Lasix)
Propranolol hydrochloride (Inderal)
30. The nurse is assessing a client 24 hours following a cholecystectomy. The nurse notes that the T-tube has drained 750ml of green-brown drainage. Which nursing intervention is most appropriate?
Notify the physician
Document the findings
Irrigate the T-tube
Clamp the T-tube
31. The nurse provides medication instructions to a client with peptic ulcer disease. Which statement, if made by the client, indicates the best understanding of the medication therapy?
“The cimetidine (Tagamet) will cause me to produce less stomach acid.”
“Sucralfate (Carafate) will change the fluid in my stomach.”
“Antacids will coat my stomach.”
“Omeprazole (Prilosec) will coat the ulcer and help it heal.”
32. The client with peptic ulcer disease is scheduled for a pyloroplasty. The client asks the nurse about the procedure. The nurse plans to respond knowing that a pyloroplasty involves:
Cutting the vagus nerve
Removing the distal portion of the stomach
Removal of the ulcer and a large portion of the cells that produce hydrochloric acid
An incision and resuturing of the pylorus to relax the muscle and enlarge the opening from the stomach to the duodenum.
33. A client with a peptic ulcer is scheduled for a vagotomy. The client asks the nurse about the purpose of this procedure. The nurse tells the client that the procedure:
Decreases food absorption in the stomach
Heals the gastric mucosa
Halts stress reactions
Reduces the stimulus to acid secretions
34. The nurse would assess the client experiencing an acute episode of cholecysitis for pain that is located in the right
Upper quadrant and radiates to the left scapula and shoulder
Upper quadrant and radiates to the right scapula and shoulder
Lower quadrant and radiates to the umbilicus
Lower quadrant and radiates to the back
35. Which of the following tasks should be included in the immediate postoperative management of a client who has undergone gastric resection?
Monitoring gastric pH to detect complications
Assessing for bowel sounds
Providing nutritional support
Monitoring for symptoms of hemorrhage
36. If a gastric acid perforates, which of the following actions should not be included in the immediate management of the client?
Blood replacement
Antacid administration
Nasogastric tube suction
Fluid and electrolyte replacement
37. Mucosal barrier fortifiers are used in peptic ulcer disease management for which of the following indications?
To inhibit mucus production
To neutralize acid production
To stimulate mucus production
To stimulate hydrogen ion diffusion back into the mucosa
38. When counseling a client in ways to prevent cholecystitis, which of the following guidelines is most important?
Eat a low-protein diet
Eat a low-fat, low-cholesterol diet
Limit exercise to 10 minutes/day
Keep weight proportionate to height
39. Which of the following symptoms best describes Murphy’s sign?
Periumbilical eccymosis exists
On deep palpitation and release, pain in elicited
On deep inspiration, pain is elicited and breathing stops
Abdominal muscles are tightened in anticipation of palpation
40. Which of the following tests is most commonly used to diagnose cholecystitis?
Abdominal CT scan
Abdominal ultrasound
Barium swallow
Endoscopy
41. Which of the following factors should be the main focus of nursing management for a client hospitalized for cholecystitis?
Administration of antibiotics
Assessment for complications
Preparation for lithotripsy
Preparation for surgery
42. A client being treated for chronic cholecystitis should be given which of the following instructions?
Increase rest
Avoid antacids
Increase protein in diet
Use anticholinergics as prescribed
43. The client with a duodenal ulcer may exhibit which of the following findings on assessment?
Hematemesis
Malnourishment
Melena
Pain with eating
44. The pain of a duodenal ulcer can be distinguished from that of a gastric ulcer by which of the following characteristics?
Early satiety
Pain on eating
Dull upper epigastric pain
Pain on empty stomach
45. The client has orders for a nasogastric (NG) tube insertion. During the procedure, instructions that will assist in the insertion would be:
Instruct the client to tilt his head back for insertion in the nostril, then flex his neck for the final insertion
After insertion into the nostril, instruct the client to extend his neck
Introduce the tube with the client’s head tilted back, then instruct him to keep his head upright for final insertion
Instruct the client to hold his chin down, then back for insertion of the tube
46. The most important pathophysiologic factor contributing to the formation of esophageal varices is:
Decreased prothrombin formation
Decreased albumin formation by the liver
Portal hypertension
Increased central venous pressure
47. The client being treated for esophageal varices has a Sengstaken-Blakemore tube inserted to control the bleeding. The most important assessment is for the nurse to:
Check that the hemostat is on the bedside
Monitor IV fluids for the shift
Regularly assess respiratory status
Check that the balloon is deflated on a regular basis
48. A female client complains of gnawing epigastric pain for a few hours after meals. At times, when the pain is severe, vomiting occurs. Specific tests are indicated to rule out:
Cancer of the stomach
Peptic ulcer disease
Chronic gastritis
Pylorospasm
49. When a client has peptic ulcer disease, the nurse would expect a priority intervention to be:
Assisting in inserting a Miller-Abbott tube
Assisting in inserting an arterial pressure line
Inserting a nasogastric tube
Inserting an I.V.
50. A 40-year-old male client has been hospitalized with peptic ulcer disease. He is being treated with a histamine receptor antagonist (cimetidine), antacids, and diet. The nurse doing discharge planning will teach him that the action of cimetidine is to:
Reduce gastric acid output
Protect the ulcer surface
Inhibit the production of hydrochloric acid (HCl)
Inhibit vagus nerve stimulation
Answers and Rationales
D. A hiatal hernia is caused by weakness of the diaphragmic muscle and increased intra-abdominal—not intrathoracic—pressure. This weakness allows the stomach to slide into the esophagus. The esophageal supports weaken, but esophageal muscle weakness or increased esophageal muscle pressure isn’t a factor in hiatal hernia.
A. Obesity may cause increased abdominal pressure that pushes the lower portion of the stomach into the thorax.
C. Esophageal reflux is a common symptom of hiatal hernia. This seems to be associated with chronic exposure of the lower esophageal sphincter to the lower pressure of the thorax, making it less effective.
C. A barium swallow with fluoroscopy shows the position of the stomach in relation to the diaphragm. A colonoscopy and a lower GI series show disorders of the intestine.
A. Recognizing the rupture of esophageal varices, or hemorrhage, is the focus of nursing care because the client could succumb to this quickly. Controlling blood pressure is also important because it helps reduce the risk of variceal rupture. It is also important to teach the client what varices are and what foods he should avoid such as spicy foods.
D. The EGD can visualize the entire upper GI tract as well as allow for tissue specimens and electrocautery if needed. The barium swallow could locate a gastric ulcer. A CT scan and an abdominal x-ray aren’t useful in the diagnosis of an ulcer.
B. Ranitidine is a histamine-2 receptor antagonist that reduces acid secretion by inhibiting gastrin secretion.
C. The discomfort of reflux is aggravated by positions that compress the abdomen and the stomach. These include lying flat on the back or on the stomach after a meal of lying on the right side. The left side-lying position with the head of the bed elevated is most likely to give relief to the client.
A. In a Billroth II procedure the proximal remnant of the stomach is anastomased to the proximal jejunum. Patency of the NG tube is critical for preventing the retention of gastric secretions. The nurse should never irrigate or reposition the gastric tube after gastric surgery, unless specifically ordered by the physician. In this situation, the nurse would clarify the order.
B. The nurse should instruct the client to decrease the amount of fluid taken at meals and to avoid high carbohydrate foods including fluids such as fruit nectars; to assume a low-Fowler’s position during meals; to lie down for 30 minutes after eating to delay gastric emptying; and to take antispasmidocs as prescribed.
B. A soft toothbrush should be used to brush the client’s teeth after each meal and more often as needed. Mechanical cleaning is necessary to maintain oral health, simulate gingiva, and remove plaque. Assessing the oral cavity and recording observations is the responsibility of the nurse, not the nursing assistant. Swabbing with a safe foam applicator does not provide enough friction to clean the mouth. Mouthwash can be a drying irritant and is not recommended for frequent use.
C. The most likely complication of an endoscopic procedure is perforation. A sudden temperature spike with 1 to 2 hours after the procedure is indicative of a perforation and should be reported immediately to the physician. A sore throat is to be anticipated after an endoscopy. Clients are given sedatives during the procedure, so it is expected that they will display signs of sedation after the procedure is completed. A lack of appetite could be the result of many factors, including the disease process.
B. A Billroth II procedure bypasses the duodenum and connects the gastric stump directly to the jejunum. The pyloric sphincter is removed, along with some of the stomach fundus.
A. About 12 to 24 hours after a subtotal gastrectomy, gastric drainage is normally brown, which indicates digested blood. Bile green or cloudy white drainage is not expected during the first 12 to 24 hours after a subtotal gastrectomy. Drainage during the first 6 to 12 hours contains some bright red blood, but large amounts of blood or excessively bloody drainage should be reported to the physician promptly.
C. Nausea, vomiting, or abdominal distention indicated that gas and secretions are accumulating within the gastric pouch due to impaired peristalsis or edema at the operative site and may indicate that the drainage system is not working properly. Saline solution is used to irrigate nasogastric tubes. Hypotonic solutions such as water increase electrolyte loss. In addition, a physician’s order is needed to irrigate the NG tube, because this procedure could disrupt the suture line. After gastric surgery, only the surgeon repositions the NG tube because of the danger of rupturing or dislodging the suture line. The amount of suction varies with the type of tube used and is ordered by the physician. High suction may create too much tension on the gastric suture line.
D. An appropriate expected outcome is for the client to achieve optimal nutritional status through the use of oral feedings or total parenteral nutrition (TPN). TPN may be used to supplement oral intake, or it may be used alone if the client cannot tolerate oral feedings. The client would not be expected to regain lost weight within 1 month after surgery or to tolerate a normal dietary intake of three meals per day. Nausea and vomiting would not be considered an expected outcome of gastric surgery, and regular use of antiemetics would not be anticipated.
D. Clients with GERD can develop pulmonary symptoms such as coughing, wheezing, and dyspnea that are caused by the aspiration of gastric contents. GERD does not predispose the client to the development of laryngeal cancer. Irritation of the esophagus and esophageal scar tissue formation can develop as a result of GERD. However, GERD is more likely to cause painful and difficult swallowing.
A. Esophageal reflux worsens when the stomach is overdistended with food. Therefore, an important measure is to eat small, frequent meals. Fluid intake should be decreased during meals to reduce abdominal distention. Avoiding air swallowing does not prevent esophageal reflux. Food intake in the evening should be strictly limited to reduce the incidence of nighttime reflux, so bedtime snacks are not recommended.
D. The body reacts to perforation of an ulcer by immobilizing the area as much as possible. This results in boardlike muscle rigidity, usually with extreme pain. Perforation is a medical emergency requiring immediate surgical intervention because peritonitis develops quickly after perforation. An intestinal obstruction would not cause midepigastric pain. Esophageal inflammation or the development of additional ulcers would not cause a rigid, boardlike abdomen.
C and D. Vomiting and weight loss are common with gastric ulcers. Clients with a gastric ulcer are most likely to complain of a burning epigastric pain that occurs about one hour after eating. Eating frequently aggravates the pain. Clients with duodenal ulcers are more likely to complain about pain that occurs during the night and is frequently relieved by eating.
B, D, and E. Following a gastroscopy, the nurse should monitor the client for complications, which include perforation and the potential for aspiration. An elevated temperature, complaints of epigastric pain, or the vomiting of blood (hematemesis) are all indications of a possible perforation and should be reported promptly. A sore throat is a common occurrence following a gastroscopy. Clients are usually sedated to decrease anxiety and the nurse would anticipate that the client will be drowsy following the procedure.
B. Black, tarry stools are an important warning sign of bleeding in peptic ulcer disease. Digested blood in the stomach causes it to be black. The odor of the stool is very stinky. Clients with peptic ulcer disease should be instructed to report the incidence of black stools promptly to their physician.
B. Based on the data provided, the most appropriate nursing diagnosis would be Disturbed Sleep pattern. A client with a duodenal ulcer commonly awakens at night with pain. The client’s feelings of anxiety do not necessarily indicate that she is coping ineffectively.
B and C. The symptoms of nausea and dizziness in a client with peptic ulcer disease may be indicative of hemorrhage and should not be ignored. The appropriate nursing actions at this time are for the nurse to monitor the client’s vital signs and notify the physician of the client’s symptoms. To administer an antacid hourly or to wait one hour to reassess the client would be inappropriate; prompt intervention is essential in a client who is potentially experiencing a gastrointestinal hemorrhage. The nurse would notify the physician of assessment findings and then initiate oxygen therapy if ordered by the physician.
C. Ranitidine blocks secretion of hydrochloric acid. Clients who take only one daily dose of ranitidine are usually advised to take it at bedtime to inhibit nocturnal secretion of acid. Clients who take the drug twice a day are advised to take it in the morning and at bedtime.
C. It is most likely that the client is experiencing a side effect of the antacid. Antacids with aluminum salt products, such as aluminum hydroxide, form insoluble salts in the body. These precipitate and accumulate in the intestines, causing constipation. Increasing dietary fiber intake or daily exercise may be a beneficial lifestyle change for the client but is not likely to relieve the constipation caused by the aluminum hydroxide. Constipation, in isolation from other symptoms, is not a sign of bowel obstruction.
D. Antacids are most effective if taken 1 to 3 hours after meals and at bedtime. When an antacid is taken on an empty stomach, the duration of the drug’s action is greatly decreased. Taking antacids 1 to 3 hours after a meal lengthens the duration of action, thus increasing the therapeutic action of the drug. Antacids should be administered about 2 hours after other medications to decrease the chance of drug interactions. It is not necessary to decrease fluid intake when taking antacids.
B. Chronic gastritis causes deterioration and atrophy of the lining of the stomach, leading to the loss of the functioning parietal cells. The source of the intrinsic factor is lost, which results in the inability to absorb vitamin B12. This leads to the development of pernicious anemia.
B. Indomethacin (Indocin) is a NSAID and can cause ulceration of the esophagus, stomach, duodenum, or small intestine. Indomethacin is contraindicated in a client with GI disorders.
B. Following cholecystectomy, drainage from the T-tube is initially bloody and then turns to green-brown. The drainage is measured as output. The amount of expected drainage will range from 500 to 1000 ml per day. The nurse would document the output.
A. Cimetidine (Tagamet), a histamine H2 receptor antagonist, will decrease the secretion of gastric acid. Sucralfate (Carafate) promotes healing by coating the ulcer. Antacids neutralize acid in the stomach. Omeprazole (Prilosec) inhibits gastric acid secretion.
D. An incision and resuturing of the pylorus to relax the muscle and enlarge the opening from the stomach to the duodenum describes the procedure for a pyloroplasty. A vagotomy involves cutting the vagus nerve. A subtotal gastrectomy involves removing the distal portion of the stomach. A Billroth II procedure involves removal of the ulcer and a large portion of the tissue that produces hydrochloric acid.
D. A vagotomy, or cutting the vagus nerve, is done to eliminate parasympathetic stimulation of gastric secretion.
B. During an acute “gallbladder attack,” the client may complain of severe right upper quadrant pain that radiates to the right scapula and shoulder. This is governed by the pattern on dermatones in the body.
D. The client should be monitored closely for signs and symptoms of hemorrhage, such as bright red blood in the nasogastric tube suction, tachycardia, or a drop in blood pressure. Gastric pH may be monitored to evaluate the need for histamine-2 receptor antagonists. Bowel sounds may not return for up to 72 hours postoperatively. Nutritional needs should be addressed soon after surgery.
B. Antacids aren’t helpful in perforation. The client should be treated with antibiotics as well as fluid, electrolyte, and blood replacement. NG tube suction should also be performed to prevent further spillage of stomach contents into the peritoneal cavity.
C. The mucosal barrier fortifiers stimulate mucus production and prevent hydrogen ion diffusion back into the mucosa, resulting in accelerated ulcer healing. Antacids neutralize acid production.
D. Obesity is a known cause of gallstones, and maintaining a recommended weight will help protect against gallstones. Excessive dietary intake of cholesterol is associated with the development of gallstones in many people. Dietary protein isn’t implicated in cholecystitis. Liquid protein and low-calorie diets (with rapid weight loss of more than 5 lb [2.3kg] per week) are implicated as the cause of some cases of cholecystitis. Regular exercise (30 minutes/three times a week) may help reduce weight and improve fat metabolism. Reducing stress may reduce bile production, which may also indirectly decrease the chances of developing cholecystitis.
C. Murphy’s sign is elicited when the client reacts to pain and stops breathing. It’s a common finding in clients with cholecystitis. Periumbilical ecchymosis, Cullen’s sign, is present in peritonitis. Pain on deep palpation and release is rebound tenderness. Tightening up abdominal muscles in anticipation of palpation is guarding.
B. An abdominal ultrasound can show if the gallbladder is enlarged, if gallstones are present, if the gallbladder wall is thickened, or if distention of the gallbladder lumen is present. An abdominal CT scan can be used to diagnose cholecystitis, but it usually isn’t necessary. A barium swallow looks at the stomach and the duodenum. Endoscopy looks at the esophagus, stomach, and duodenum.
B. The client with acute cholecystitis should first be monitored for perforation, fever, abscess, fistula, and sepsis. After assessment, antibiotics will be administered to reduce the infection. Lithotripsy is used only for a small percentage of clients. Surgery is usually done after the acute infection has subsided.
D. Conservative therapy for chronic cholecystitis includes weight reduction by increasing physical activity, a low-fat diet, antacid use to treat dyspepsia, and anticholinergic use to relax smooth muscles and reduce ductal tone and spasm, thereby reducing pain.
C. The client with a duodenal ulcer may have bleeding at the ulcer site, which shows up as melena (black tarry poop). The other findings are consistent with a gastric ulcer.
D. Pain on empty stomach is relieved by taking foods or antacids. The other symptoms are those of a gastric ulcer.
A. NG insertion technique is to have the client first tilt his head back for insertion into the nostril, then to flex his neck forward and swallow. Extension of the neck will impede NG tube insertion.
C. As the liver cells become fatty and degenerate, they are no longer able to accommodate the large amount of blood necessary for homeostasis. The pressure in the liver increases and causes increased pressure in the venous system. As the portal pressure increases, fluid exudes into the abdominal cavity. This is called ascites.
C. The respiratory system can become occluded if the balloon slips and moves up the esophagus, putting pressure on the trachea. This would result in respiratory distress and should be assessed frequently. Scissors should be kept at the bedside to cut the tube if distress occurs. This is a safety intervention.
B. Peptic ulcer disease is characteristically gnawing epigastric pain that may radiate to the back. Vomiting usually reflects pyloric spasm from muscular spasm or obstruction. Cancer would not evidence pain or vomiting unless the pylorus was obstructed.
C. An NG tube insertion is the most appropriate intervention because it will determine the presence of active GI bleeding. A Miller-Abbott tube is a weighted, mercury-filled ballooned tube used to resolve bowel obstructions. There is no evidence of shock or fluid overload in the client; therefore, an arterial line is not appropriate at this time and an IV is optional.
A. These drugs inhibit action of histamine on the H2 receptors of parietal cells, thus reducing gastric acid output.