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Chapter 33. Nursing Care of Patients With Upper Gastrointestinal Disorders Multiple Choice Identify the choice that best completes the statement or answers the question. ____

1. The nurse is caring for a patient who has a sliding hiatal hernia. The nurse would expect the patient to report that symptoms are worse in which position? a. Lying down b. Semi-Fowler’s c. Standing d. Sitting

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2. The nurse is reinforcing teaching for a patient who has a hiatal hernia. Which of the following statements by the patient would indicate a correct understanding of lifestyle modification to reduce symptoms? a. “Perform daily aerobic exercise.” b. “Avoid nicotine and alcohol use.” c. “Carefully space activity periods with rest.” d. “Avoid high-stress situations.”

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3. The nurse evaluates the understanding of a patient on the relationship between body position and gastroesophageal reflux after a teaching session. Which statement by the patient would indicate that the teaching has been effective? a. “I elevate the foot of the bed 12 to 16 inches.” b. “I sleep on my stomach with my head turned to the left.” c. “I sleep on my back without a pillow under my head.” d. “I elevate the head of the bed 4 to 6 inches.”

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4. The nurse is caring for a patient who has a duodenal peptic ulcer and vomits old blood. What description would the nurse use to document the appearance of the vomitus? a. Duodenal fecal matter b. Undigested particles of food c. Coffee-ground particles d. Chyme streaked with a black syrupy material

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5. The nurse is caring for a patient on a gastrointestinal unit. The nurse would be most concerned if a patient reported which of the following? a. “My stool is soft and dark brown; I usually move my bowels twice a day.” b. “Lately, I’ve had two or three loose, sticky black stools every day.” c. “My stool has been dark green and hard to pass lately.” d. “Usually I move my bowels every day and the stool is light brown.”

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6. The nurse is reinforcing teaching for a patient who had a large portion of the stomach removed. Which of the following conditions, if stated by the patient, would indicate a correct understanding of why there usually is a need to receive vitamin B12 for life? a. Acquired hemolytic anemia b. Iron-deficiency anemia c. Pernicious anemia d. Sickle cell anemia

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7. A patient who has returned from surgery for a total gastrectomy has a nasogastric tube that is hooked to low intermittent suction. The patient begins to vomit bright red blood. Which of the following actions would be most appropriate for the nurse to take?

a. b. c. d.

Increase the intravenous rate. Administer oxygen. Turn the patient onto his or her side. Irrigate the nasogastric tube.

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8. The nurse is teaching a patient about gastric surgery and dumping syndrome. Which statement indicates that the patient understands dumping syndrome? a. “I need to eat small frequent meals.” b. “I can expect the symptoms to begin 2 hours after eating.” c. “I need to sit up for 2 hours after each meal.” d. “I should drink lots of fluids with meals.”

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9. The nurse is caring for a patient who has a hiatal hernia and reports heartburn. Which of the following suggestions should the nurse provide? a. Eat large meals. b. Recline 1 hour before meals. c. Sleep flat without a pillow. d. Avoid bedtime snacks.

____ 10. The nurse is caring for a patient on who has a vented nasogastric tube ordered “to suction” after a gastrectomy. What type of suction should the nurse use to decrease the development of complications? a. Continuous low suction b. Continuous high suction c. Intermittent low suction d. Intermittent high suction ____ 11. The nurse is caring for a patient who has gastroesophageal reflux disease (GERD). Which patient statement would indicate a need for nutritional instruction? a. “Nutrition can affect health positively or negatively.” b. “I should drink milk, as it is the perfect food.” c. “Excessive intake of a nutrient can interfere with others.” d. “Classes of nutrients are carbohydrates, fats, proteins, vitamins, minerals, and water.” ____ 12. The nurse is caring for a patient who had a radical neck dissection for cancer with a tracheostomy. What action by the nurse should take priority? a. Establishing ways of communication b. Ensuring adequate nutrition c. Ensuring airway patency d. Teaching about smoking cessation ____ 13. The nurse is reinforcing teaching for a patient who has been scheduled for pyloroplasty. Which of the following statements by the patient would indicate a correct understanding of the procedure? a. “The doctor will stitch the top of my stomach to help me lose weight.” b. “The surgery will improve the movement of food from my stomach to my small intestine.” c. “The pylorus will be narrowed to prevent gastric reflux and help my ulcers heal.” d. “The doctor will cut the nerve that goes to my stomach so less acid is released.” ____ 14. A patient has a Billroth I procedure and has a nasogastric Levin tube set to low intermittent suction. As the patient turns in bed, the Levin tube is partially pulled out. Which of the following actions would be most appropriate for the nurse to take? a. Place suction on continuous. b. Advance the tube. c. Irrigate the tube.

d. Notify the RN. ____ 15. The nurse is providing care to a patient 3 days after a Billroth I procedure. Which of the following would cause the highest concern? a. Pulse 58 beats per minute b. Incisional pain score 4 on a 1 to 10 scale c. Patient becomes tearful while viewing the incision d. Reports of abdominal cramping shortly after eating ____ 16. The nurse is reinforcing teaching for a patient who has dumping syndrome. Which of the following statements by the patient would indicate a correct understanding of the teaching of what this condition is? a. “It is delayed gastric emptying.” b. “Glucose is dumped into the bloodstream.” c. “There is rapid entry of food into the jejunum.” d. “Digestive secretions enter the esophagus.” ____ 17. The nurse is reinforcing teaching for a patient who has a peptic ulcer. Which of the following statements by the patient would indicate a correct understanding of what ranitidine (Zantac) does? a. “It coats your stomach.” b. “It clings to the ulcer.” c. “It neutralizes stomach acid.” d. “It reduces production of gastric acid.” ____ 18. The nurse is caring for a patient who suddenly begins having large amounts of bright red hematemesis. After the patient is turned onto the side, what should the nurse do? a. Obtain the patient’s vital signs. b. Encourage iced oral fluids. c. Lower the head of the bed. d. Place a cool cloth on the patient’s forehead. ____ 19. A patient has severe trauma from an automobile accident. The nurse is checking the gastric pH and giving antacids as ordered. These interventions are prophylactic to prevent which of the following? a. Shock b. Metabolic acidosis c. Stress ulcers d. Malnutrition ____ 20. The nurse is caring for a patient who has a nasogastric tube in place following gastric surgery. To irrigate the nasogastric tube, the nurse uses normal saline. What is the appropriate rationale for this? a. It maintains fluid volume. b. It decreases electrolytes. c. It maintains electrolytes. d. It increases fluid volume. ____ 21. The nurse is caring for a patient who has been diagnosed with gastroesophageal reflux disease (GERD) and has developed esophagitis. The nurse understands that the patient is most at risk for what other complication? a. Aspiration pneumonia b. Barrett’s esophagus c. Bronchospasm d. Laryngospasm ____ 22. The nurse is collecting data for a patient who has peptic ulcer disease and is taking Prevacid. Which data collection finding requires immediate intervention?

a. b. c. d.

A rash Constipation Changes in mental status Tarry stools

____ 23. The nurse is caring for a patient who is unconscious and begins to vomit blood. What should be the nurse’s priority intervention? a. Administer antiemetic medication. b. Use water to rinse out mouth. c. Provide oral care to the patient. d. Turn patient onto side. ____ 24. The nurse is contributing to a patient’s teaching plan on how to avoid dumping syndrome after a gastrectomy. Which of the following would be included in the teaching? a. Increase activity after eating. b. Avoid fluids with meals. c. Eat heavy meals to delay emptying. d. Increase carbohydrate intake. ____ 25. A patient with gastric bleeding who has a nasogastric (NG) tube connected to low intermittent suction and is NPO reports a dry mouth and gagging feeling. What action should the nurse take? a. Give lidocaine solution to coat the mouth. b. Offer ice chips to swallow. c. Provide oral care. d. Pull tube out 1 inch. ____ 26. The nurse is caring for a patient who has bulimia. The nurse recognizes that the patient is at highest risk for which of the following complications? a. Ischemic stroke b. Metabolic alkalosis c. Fluid overload d. Weight gain ____ 27. The nurse is reinforcing teaching for a patient who is being tested for type B gastritis. Which of the following statements by the patient would indicate a correct understanding of the test that is used to diagnose this condition? a. “Colonoscopy.” b. “Barium enema.” c. “Gastric aspirate analysis.” d. “Esophagogastroduodenoscopy.” ____ 28. The nursing assistant is delivering patient meals. The nurse would expect the assistant to deliver which of the following trays to a patient who had a gastric bypass surgery the day before? a. Clear liquids b. Full liquids c. Soft diet d. General diet ____ 29. The nurse is caring for a patient who complains of nausea related to gastric cancer. Which of the following supplements would the nurse suggest? a. Ginger b. Lemon c. Butterscotch

d. Black licorice Multiple Response Identify one or more choices that best complete the statement or answer the question. ____ 30. The nurse is caring for a patient who has a bleeding gastric ulcer. Which of the following patient statements would indicate correct understanding of beverages to avoid after treatment of a bleeding gastric ulcer? (Select all that apply.) a. Iced tea b. Lemonade c. Beer d. Diet soda pop e. Coffee f. Milk ____ 31. Which of these factors meet established criteria for the use of surgery in the treatment of obesity? (Select all that apply.) a. Failure to reduce weight with other forms of therapy b. Body weight 50% above ideal weight c. Gross obesity for 5 years d. Presence of gallstones e. Psychiatric and social stability f. Hypertension ____ 32. The nurse has instructed a patient prescribed omeprazole (Prilosec) for peptic ulcer disease on use of the medication. What statements by the patient indicate understanding of the instructions? (Select all that apply.) a. “I will take the capsule before eating a meal in the morning.” b. “If I wish, I can open the capsule and sprinkle it on food.” c. “I will report any abdominal pain, diarrhea, or bleeding that occurs.” d. “I will need to take this drug for 3 weeks for my ulcer to heal.” e. “I’ll have to have regular blood counts and tests of my liver enzymes.” f. “I should not take antacids while I’m on this medication.” ____ 33. The nurse is caring for a patient who has a nursing diagnosis of acute postoperative pain after a gastrectomy. The patient has a nasogastric (NG) tube. What interventions should the nurse implement? (Select all that apply.) a. Evaluate pain regularly and report changes to the RN. b. Reposition NG tube once a shift. c. Monitor NG tube functioning. d. Provide pain medication as ordered. e. Encourage total bedrest. f. Start a regular diet once bowel sounds are detected. ____ 34. The nurse is providing care to a patient anticipating radiation therapy for head and neck cancer. Which of these would the nurse include in pretherapy education? (Select all that apply.) a. “It is important that you visit the dentist before radiation therapy begins.” b. “Artificial saliva can be used if the radiation therapy causes drying of the mouth.” c. “Tooth decay occurs less frequently when oral tissues are dry.” d. “Water is an appropriate substitute for saliva.” e. “Good oral hygiene habits are important to prevent decay.” f. “All of your teeth will need to be pulled before you start radiation therapy.”

____ 35. The nurse is caring for a patient who has aphthous stomatitis. What care should the nurse provide? (Select all that apply.) a. Apply a topical anesthetic. b. Teach to avoid irritating foods. c. Place on fluid restriction. d. Suggest stress management techniques. e. Make patient NPO. Completion Complete each statement. 36. A body mass index of greater than ____________________ is considered obese. 37. Weight that is ____________________ percent or more above ideal body weight is obesity.

Chapter 33. Nursing Care of Patients With Upper Gastrointestinal Disorders Answer Section MULTIPLE CHOICE 1. ANS: A In a sliding hiatal hernia, the stomach slides up into the thoracic cavity when a patient is supine and then goes back into the abdominal cavity when upright. Sliding hiatal hernia symptoms are worse when lying down. PTS: 1 DIF: Easy REF: Page 727 KEY: Client Need: PHYS—Physiological Adaptation | Cognitive Level: Comprehension | Integrated Processes: Clinical Problem-Solving Process | Question to Guide Your Learning: 5 2. ANS: B Substances to avoid with a hiatal hernia because they relax the cardiac sphincter include fat, caffeine, peppermint, spearmint, chocolate, alcohol, and nicotine. PTS: 1 DIF: Easy REF: Page 728 KEY: Client Need: PHYS—Physiological Adaptation | Cognitive Level: Analysis | Integrated Processes: Teaching and Learning | Question to Guide Your Learning: 7 3. ANS: D Elevating the head of the bed 4 to 6 inches helps prevent reflux of gastric contents into the esophagus. PTS: 1 DIF: Hard REF: Page 728 KEY: Client Need: PHYS—Physiological Adaptation | Cognitive Level: Analysis | Integrated Processes: Teaching and Learning | Question to Guide Your Learning: 7 4. ANS: C When blood mixes with hydrochloric acid and enzymes in the stomach, a dark, granular material resembling coffee grounds is produced. This indicates old bleeding, as fresh bleeding would be red in color. PTS: 1 DIF: Medium REF: Page 736 KEY: Client Need: PHYS—Physiological Adaptation | Cognitive Level: Application | Integrated Processes: Communication and Documentation | Question to Guide Your Learning: 7 5. ANS: B The nurse would be most concerned if there were evidence of blood loss causing black tarry stools (melena). PTS: 1 DIF: Medium REF: Page 736 KEY: Client Need: PHYS—Physiological Adaptation | Cognitive Level: Application | Integrated Processes: Clinical Problem-Solving Process | Question to Guide Your Learning: 5 6. ANS: C Vitamin B12 deficiency can occur after some or all of the stomach is removed because intrinsic factor secretion is reduced or gone. Normally, vitamin B12 combines with intrinsic factor to prevent its digestion in the stomach and promote its absorption in the intestines. Lifelong administration of vitamin B12 is required to prevent the development of pernicious anemia. PTS: 1 DIF: Medium REF: Page 740 KEY: Client Need: PHYS—Reduction of Risk Potential | Cognitive Level: Analysis | Integrated Processes: Teaching and Learning | Question to Guide Your Learning: 7 7. ANS: C

If vomiting occurs, turn the patient onto his or her side to prevent aspiration. PTS: 1 DIF: Medium REF: Page 717 KEY: Client Need: PHYS—Reduction of Risk Potential | Cognitive Level: Application | Integrated Processes: Clinical Problem-Solving Process | Question to Guide Your Learning: 7 8. ANS: A Treatment for dumping syndrome includes teaching the patient to eat small, frequent meals that are high in protein and fat and low in carbohydrates, especially refined sugars. PTS: 1 DIF: Medium REF: Page 722 KEY: Client Need: PHYS—Physiological Adaptation | Cognitive Level: Analysis | Integrated Processes: Teaching and Learning | Question to Guide Your Learning: 7 9. ANS: D Treatment for hiatal hernia includes antacids, eating small meals that pass easily through the esophagus, not reclining for 1 hour after eating, elevating the head of the bed 6 to 12 inches to prevent reflux, and avoiding bedtime snacks. PTS: 1 DIF: Easy REF: Page 722 KEY: Client Need: PHYS—Reduction of Risk Potential | Cognitive Level: Application | Integrated Processes: Clinical Problem-Solving Process | Question to Guide Your Learning: 7 10. ANS: C With a physician’s order, the nasogastric tube is connected to suction equipment, usually set on low intermittent suction if the secretions are not too thick, to prevent injury to the gastric mucosa. The vent also helps prevent this injury. PTS: 1 DIF: Easy REF: Page 738 KEY: Client Need: PHYS—Reduction of Risk Potential | Cognitive Level: Application | Integrated Processes: Clinical Problem-Solving Process | Question to Guide Your Learning: 7 11. ANS: B A low-fat, high-protein diet is recommended because fat causes decreased functioning of the lower esophageal sphincter. Caffeine, milk products, and spicy foods should be avoided. PTS: 1 DIF: Hard REF: Page 728 KEY: Client Need: PHYS—Basic Care and Comfort | Cognitive Level: Analysis | Integrated Processes: Teaching and Learning | Question to Guide Your Learning: 7 12. ANS: C A tracheostomy is usually performed to protect the airway and prevent obstruction. The airway must be monitored and secretions controlled to prevent aspiration. PTS: 1 DIF: Medium REF: Page 726 KEY: Client Need: PHYS—Reduction of Risk Potential | Cognitive Level: Analysis | Integrated Processes: Clinical Problem-Solving Process | Question to Guide Your Learning: 7 13. ANS: B Pyloroplasty widens the exit of the pylorus to improve emptying of the stomach. PTS: 1 DIF: Hard REF: Page 740 KEY: Client Need: PHYS—Physiological Adaptation | Cognitive Level: Analysis | Integrated Processes: Teaching and Learning | Question to Guide Your Learning: 7 14. ANS: D

Inform the RN or physician as the tube will need to be repositioned. The physician typically is the one that does the repositioning after gastric surgery so the suture line is not affected. PTS: 1 DIF: Hard REF: Page 737 KEY: Client Need: SECE—Safety and Infection Control | Cognitive Level: Application | Integrated Processes: Clinical Problem-Solving Process | Question to Guide Your Learning: 7 15. ANS: D Dumping syndrome is a complication of Billroth I procedure and occurs 5 to 30 minutes after eating. Symptoms include dizziness, tachycardia, fainting, sweating, nausea, diarrhea, a feeling of fullness, and abdominal cramping. Pain and the emotional reaction to the incision are psychosocial concerns and are not the highest priority at this time. PTS: 1 DIF: Easy REF: Page 737 KEY: Client Need: PHYS—Physiological Adaptation | Cognitive Level: Analysis | Integrated Processes: Clinical Problem-Solving Process | Question to Guide Your Learning: 7 16. ANS: C Dumping syndrome occurs with the rapid entry of food into the jejunum without proper mixing of the food with digestive juices. On entering the jejunum, the food draws extracellular fluid into the bowel from the circulating blood volume to dilute the high concentration of electrolytes and sugars. PTS: 1 DIF: Medium REF: Page 739 KEY: Client Need: PHYS—Physiological Adaptation | Cognitive Level: Analysis | Integrated Processes: Teaching and Learning | Question to Guide Your Learning: 7 17. ANS: D Zantac reduces production of gastric acid, which aids in healing the ulcer. PTS: 1 DIF: Easy REF: Page 729 KEY: Client Need: PHYS—Pharmacological Therapies | Cognitive Level: Analysis | Integrated Processes: Teaching and Learning | Question to Guide Your Learning: 6 18. ANS: A Collect data including vital signs to report to RN and physician for treatment orders. PTS: 1 DIF: Medium REF: Page 730 KEY: Client Need: PHYS—Reduction of Risk Potential | Cognitive Level: Application | Integrated Processes: Clinical Problem-Solving Process | Question to Guide Your Learning: 7 19. ANS: C Critically ill patients may develop gastric or small intestinal stress ulcers from ischemia. The stress response to the illness...