Chapter 41 Upper Gastrointestinal Problems PDF

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TestBank-Medical-SurgicalNursing:AssessmentandManagementofClinicalProblems10e

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Chapter41:UpperGastrointestinalProblems TestBank MULTIPLECHOICE 1.A53-year-oldmalepatientwithdeeppartial-thicknessburnsfromachemicalspillintheworkplace experiencesseverepainfollowedbynauseaduringdressingchanges.Whichactionwillbemostusefulin decreasingthepatientsnausea? a.

KeepthepatientNPOfor2hoursbeforeandafterdressingchanges.

b.

Avoidperformingdressingchangesclosetothepatientsmealtimes.

c.

Administertheprescribedmorphinesulfatebeforedressingchanges.

d.

Givetheorderedprochlorperazine(Compazine)beforedressingchanges.

ANS:C Becausethepatientsnauseaisassociatedwithseverepain,itislikelythatitisprecipitatedbystressandpain. Thebesttreatmentwillbetoprovideadequatepainmedicationbeforedressingchanges.Thenurseshould avoiddoingpainfulproceduresclosetomealtimes,butnausea/vomitingthatoccuratothertimesalsoshould beaddressed.KeepingthepatientNPOdoesnotaddressthereasonforthenauseaandvomitingandwillhave anadverseeffectonthepatientsnutrition.Administrationofantiemeticsisnotthebestchoiceforapatient withnauseacausedbypain. DIF:CognitiveLevel:Apply(application)REF:896 TOP:NursingProcess:ImplementationMSC:NCLEX:PhysiologicalIntegrity 2.WhichitemshouldthenurseoffertothepatientwhoistorestartoralintakeafterbeingNPOduetonausea andvomiting? a.

Glassoforangejuice

b.

Dishoflemongelatin

c.

Cupofcoffeewithcream

d.

Bowlofhotchickenbroth

ANS:B Clearcoolliquidsareusuallythefirstfoodsstartedafterapatienthasbeennauseated.Acidicfoodssuchas orangejuice,veryhotfoods,andcoffeearepoorlytoleratedwhenpatientshavebeennauseated. DIF:CognitiveLevel:Apply(application)REF:897 TOP:NursingProcess:ImplementationMSC:NCLEX:PhysiologicalIntegrity 3.A38-yearoldwomanreceivingchemotherapyforbreastcancerdevelopsaCandidaalbicansoralinfection.

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Thenursewillanticipatetheneedfor a.

hydrogenperoxiderinses.

b.

theuseofantiviralagents.

c.

administrationofnystatin(Mycostatin)tablets.

d.

referraltoadentistforprofessionaltoothcleaning.

ANS:C Candidaalbicansistreatedwithanantifungalsuchasnystatin.Oralsaltwaterrinsesmaybeusedbutwillnot curetheinfection.Antiviralagentsareusedforviralinfectionssuchasherpessimplex.Referraltoadentistis indicatedforgingivitisbutnotforCandidainfection. DIF:CognitiveLevel:Apply(application)REF:897 TOP:NursingProcess:PlanningMSC:NCLEX:PhysiologicalIntegrity 4.Whichfindinginthemouthofapatientwhousessmokelesstobaccoissuggestiveoforalcancer? a.

Bleedingduringtoothbrushing

b.

Painfulblistersatthelipborder

c.

Red,velvetypatchesonthebuccalmucosa

d.

White,curdlikeplaquesontheposteriortongue

ANS:C Ared,velvetypatchsuggestserythroplasia,whichhasahighincidence(greaterthan50%)ofprogressionto squamouscellcarcinoma.Theotherlesionsaresuggestiveofacuteprocesses(e.g.,gingivitis,oralcandidiasis, herpessimplex). DIF:CognitiveLevel:Understand(comprehension)REF:898 TOP:NursingProcess:AssessmentMSC:NCLEX:PhysiologicalIntegrity 5.Whichinformationwillthenurseincludewhenteachingadultstodecreasetheriskforcancersofthetongue andbuccalmucosa? a.

Avoiduseofcigarettesandsmokelesstobacco.

b.

Usesunscreenwhenoutsideevenoncloudydays.

c.

Completeantibioticcoursesusedtotreatthroatinfections.

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Useantiviralstotreatherpessimplexvirus(HSV)infections.

ANS:A Tobaccousegreatlyincreasestheriskfororalcancer.Acutethroatinfectionsdonotincreasetheriskfororal cancer,althoughchronicirritationoftheoralmucosadoesincreaserisk.Sunexposuredoesnotincreasethe riskforcancersofthebuccalmucosa.Humanpapillomavirus(HPV)infectionisassociatedwithanincreased risk,butHSVinfectionisnotariskfactorfororalcancer. DIF:CognitiveLevel:Apply(application)REF:898 TOP:NursingProcess:PlanningMSC:NCLEX:HealthPromotionandMaintenance 6.A46-year-oldfemalewithgastroesophagealrefluxdisease(GERD)isexperiencingincreasingdiscomfort. WhichpatientstatementindicatesthatadditionalteachingaboutGERDisneeded? a.

Itakeantacidsbetweenmealsandatbedtimeeachnight.

b.

Isleepwiththeheadofthebedelevatedon4-inchblocks.

c.

Ieatsmallmealsduringthedayandhaveabedtimesnack.

d.

Iquitsmokingseveralyearsago,butIstillchewalotofgum.

ANS:C GERDisexacerbatedbyeatinglateatnight,andthenurseshouldplantoteachthepatienttoavoideatingat bedtime.TheotherpatientactionsareappropriatetocontrolsymptomsofGERD. DIF:CognitiveLevel:Apply(application)REF:902 TOP:NursingProcess:EvaluationMSC:NCLEX:PhysiologicalIntegrity 7.A68-year-oldmalepatientwithastrokeisunconsciousandunresponsivetostimuli.Afterlearningthatthe patienthasahistoryofgastroesophagealrefluxdisease(GERD),thenursewillplantodofrequentassessments ofthepatients a.

apicalpulse.

b.

bowelsounds.

c.

breathsounds.

d.

abdominalgirth.

ANS:C BecauseGERDmaycauseaspiration,theunconsciouspatientisatriskfordevelopingaspirationpneumonia. Bowelsounds,abdominalgirth,andapicalpulsewillnotbeaffectedbythepatientsstrokeorGERDanddo notrequiremorefrequentmonitoringthantheroutine.

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DIF:CognitiveLevel:Apply(application)REF:901 TOP:NursingProcess:AssessmentMSC:NCLEX:PhysiologicalIntegrity 8.Thenurseexplainingesomeprazole(Nexium)toapatientwithrecurringheartburndescribesthatthe medication a.

reducesgastroesophagealrefluxbyincreasingtherateofgastricemptying.

b.

neutralizesstomachacidandprovidesreliefofsymptomsinafewminutes.

c.

coatsandprotectstheliningofthestomachandesophagusfromgastricacid.

d.

treatsgastroesophagealrefluxdiseasebydecreasingstomachacidproduction.

ANS:D Theprotonpumpinhibitorsdecreasetherateofgastricacidsecretion.Promotilitydrugssuchas metoclopramide(Reglan)increasetherateofgastricemptying.Cryoprotectivemedicationssuchassucralfate (Carafate)protectthestomach.Antacidsneutralizestomachacidandworkrapidly. DIF:CognitiveLevel:Understand(comprehension)REF:903 TOP:NursingProcess:ImplementationMSC:NCLEX:PhysiologicalIntegrity 9.Whichpatientchoiceforasnack2hoursbeforebedtimeindicatesthatthenursesteachingabout gastroesophagealrefluxdisease(GERD)hasbeeneffective? a.

Chocolatepudding

b.

Glassoflow-fatmilk

c.

Cherrygelatinwithfruit

d.

Peanutbutterandjellysandwich

ANS:C Gelatinandfruitarelowfatandwillnotdecreaseloweresophagealsphincter(LES)pressure.Foodssuchas chocolateareavoidedbecausetheylowerLESpressure.Milkproductsincreasegastricacidsecretion.High-fat foodssuchaspeanutbutterdecreasebothgastricemptyingandLESpressure. DIF:CognitiveLevel:Apply(application)REF:902 TOP:NursingProcess:EvaluationMSC:NCLEX:PhysiologicalIntegrity 10.Thenursewillanticipateteachingapatientexperiencingfrequentheartburnabout a.

abariumswallow.

b.

radionuclidetests.

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endoscopyprocedures.

d.

protonpumpinhibitors.

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ANS:D Becausediagnostictestingforheartburnthatisprobablycausedbygastroesophagealrefluxdisease(GERD)is expensiveanduncomfortable,protonpumpinhibitorsarefrequentlyusedforashortperiodasthefirststepin thediagnosisofGERD.Theothertestsmaybeusedbutarenotusuallythefirststepindiagnosis. DIF:CognitiveLevel:Apply(application)REF:901 TOP:NursingProcess:PlanningMSC:NCLEX:PhysiologicalIntegrity 11.A58-year-oldwomanwhorecentlyhasbeendiagnosedwithesophagealcancertellsthenurse,Idonotfee readytodieyet.Whichresponsebythenurseismostappropriate? a.

Youmayhavequiteafewyearsstilllefttolive.

b.

Thinkingaboutdyingwillonlymakeyoufeelworse.

c.

Havingthisnewdiagnosismustbeveryhardforyou.

d.

Itisimportantthatyouberealisticaboutyourprognosis.

ANS:C Thisresponseisopen-endedandwillencouragethepatienttofurtherdiscussfeelingsofanxietyorsadness aboutthediagnosis.Patientswithesophagealcancerhaveonlyalowsurvivalrate,sotheresponseYoumay havequiteafewyearsstilllefttoliveismisleading.Theresponsebeginning,Thinkingaboutdyingindicates thatthenurseisnotopentodiscussingthepatientsfearsofdying.Theresponsebeginning,Itisimportantthat youberealistic,discouragesthepatientfromfeelinghopeful,whichisimportanttopatientswithanylifethreateningdiagnosis. DIF:CognitiveLevel:Apply(application)REF:908 TOP:NursingProcess:ImplementationMSC:NCLEX:PsychosocialIntegrity 12.Whichinformationwillthenurseincludeforapatientwithnewlydiagnosedgastroesophagealreflux disease(GERD)? a.

Peppermintteamayreduceyoursymptoms.

b.

Keeptheheadofyourbedelevatedonblocks.

c.

Youshouldavoideatingbetweenmealstoreduceacidsecretion.

d.

Vigorousphysicalactivitiesmayincreasetheincidenceofreflux.

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ANS:B Elevatingtheheadofthebedwillreducetheincidenceofrefluxwhilethepatientissleeping.Peppermintwill decreaseloweresophagealsphincter(LES)pressureandincreasethechanceforreflux.Small,frequentmeals arerecommendedtoavoidabdominaldistention.Thereisnoneedtomakechangesinphysicalactivities becauseofGERD. DIF:CognitiveLevel:Apply(application)REF:904 TOP:NursingProcess:ImplementationMSC:NCLEX:PhysiologicalIntegrity 13.Whichnursingactionshouldbeincludedinthepostoperativeplanofcareforapatientafteralaparoscopic esophagectomy? a.

Notifythedoctoraboutbloodynasogastric(NG)drainage.

b.

Elevatetheheadofthebedtoatleast30degrees.

c.

RepositiontheNGtubeifdrainagestops.

d.

Startoralfluidswhenthepatienthasactivebowelsounds.

ANS:B Elevationoftheheadofthebeddecreasestheriskforrefluxandaspirationofgastricsecretions.TheNGtube shouldnotberepositionedwithoutconsultingwiththehealthcareprovider.BloodyNGdrainageisexpected forthefirst8to12hours.Aswallowingstudyisneededbeforeoralfluidsarestarted. DIF:CognitiveLevel:Apply(application)REF:908 TOP:NursingProcess:PlanningMSC:NCLEX:PhysiologicalIntegrity 14.Whena72-year-oldpatientisdiagnosedwithachalasia,thenursewillteachthepatientthat a.

lyingdownaftermealsisrecommended.

b.

aliquidorblenderizeddietwillbenecessary.

c.

drinkingfluidswithmealsshouldbeavoided.

d.

treatmentmayincludeendoscopicprocedures.

ANS:D Endoscopicandlaparoscopicproceduresarethemosteffectivetherapyforimprovingsymptomscausedby achalasia.Keepingtheheadelevatedaftereatingwillimproveesophagealemptying.Asemisoftdietis recommendedtoimproveesophagealemptying.Patientsareadvisedtodrinkfluidwithmeals. DIF:CognitiveLevel:Apply(application)REF:909 TOP:NursingProcess:PlanningMSC:NCLEX:PhysiologicalIntegrity

TestBank-Medical-SurgicalNursing:AssessmentandManagementofClinicalProblems10e

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15.A50-year-oldmanvomitingblood-streakedfluidisadmittedtothehospitalwithacutegastritis.To determinepossibleriskfactorsforgastritis,thenursewillaskthepatientabout a.

theamountofsaturatedfatinthediet.

b.

anyfamilyhistoryofgastricorcoloncancer.

c.

ahistoryofalargerecentweightgainorloss.

d.

useofnonsteroidalantiinflammatorydrugs(NSAIDs).

ANS:D UseofanNSAIDisassociatedwithdamagetothegastricmucosa,whichcanresultinacutegastritis.Family history,recentweightgainorloss,andfattyfoodsarenotriskfactorsforacutegastritis. DIF:CognitiveLevel:Understand(comprehension)REF:910 TOP:NursingProcess:AssessmentMSC:NCLEX:PhysiologicalIntegrity 16.Thenursedeterminesthatteachingregardingcobalamininjectionshasbeeneffectivewhenthepatientwith chronicatrophicgastritisstateswhichofthefollowing? a.

Thecobalamininjectionswillpreventgastricinflammation.

b.

Thecobalamininjectionswillpreventmefrombecominganemic.

c.

Theseinjectionswillincreasethehydrochloricacidinmystomach.

d.

Theseinjectionswilldecreasemyriskfordevelopingstomachcancer.

ANS:B Cobalaminsupplementationpreventsthedevelopmentofperniciousanemia.Chronicgastritismaycause achlorhydria,butcobalamindoesnotcorrectthis.Thelossofintrinsicfactorsecretionwithchronicgastritisis permanent,andthepatientwillneedlifelongsupplementationwithcobalamin.Theincidenceofstomach cancerishigherinpatientswithchronicgastritis,butcobalamindoesnotreducetheriskforstomachcancer. DIF:CognitiveLevel:Apply(application)REF:910 TOP:NursingProcess:EvaluationMSC:NCLEX:PhysiologicalIntegrity 17.Whichmedicationswillthenurseteachthepatientaboutwhosepepticulcerdiseaseisassociatedwith Helicobacterpylori? a.

Sucralfate(Carafate),nystatin(Mycostatin),andbismuth(Pepto-Bismol)

b.

Amoxicillin(Amoxil),clarithromycin(Biaxin),andomeprazole(Prilosec)

c.

Famotidine(Pepcid),magnesiumhydroxide(Mylanta),andpantoprazole(Protonix)

TestBank-Medical-SurgicalNursing:AssessmentandManagementofClinicalProblems10e

d.

490

Metoclopramide(Reglan),bethanechol(Urecholine),andpromethazine(Phenergan)

ANS:B Thedrugsusedintripledrugtherapyincludeaprotonpumpinhibitorsuchasomeprazoleandtheantibiotics amoxicillinandclarithromycin.TheothercombinationslistedarenotincludedintheprotocolforH. pyloriinfection. DIF:CognitiveLevel:Understand(comprehension)REF:915 TOP:NursingProcess:PlanningMSC:NCLEX:PhysiologicalIntegrity 18.Whichactionshouldthenurseintheemergencydepartmentanticipatefora23-year-oldpatientwhohas hadseveralepisodesofbloodydiarrhea? a.

Obtainastoolspecimenforculture.

b.

Administerantidiarrhealmedication.

c.

Provideteachingaboutantibiotictherapy.

d.

Teachaboutadverseeffectsofacetaminophen(Tylenol).

ANS:A PatientswithbloodydiarrheashouldhaveastoolcultureforE.coliO157:H7.Antidiarrhealmedicationsare usuallyavoidedforpossibleinfectiousdiarrheatoavoidprolongingtheinfection.Antibiotictherapyinthe treatmentofinfectiousdiarrheaiscontroversialbecauseitmayprecipitatekidneycomplications. Acetaminophendoesnotcausebloodydiarrhea. DIF:CognitiveLevel:Apply(application)REF:926 TOP:NursingProcess:PlanningMSC:NCLEX:PhysiologicalIntegrity 19.Thenursewillanticipatepreparinga71-year-oldfemalepatientwhoisvomitingcoffee-groundemesisfor a.

endoscopy.

b.

angiography.

c.

bariumstudies.

d.

gastricanalysis.

ANS:A Endoscopyistheprimarytoolforvisualizationanddiagnosisofuppergastrointestinal(GI)bleeding. Angiographyisusedonlywhenendoscopycannotbedonebecauseitismoreinvasiveandhasmorepossible complications.Bariumstudiesarehelpfulindeterminingthepresenceofgastriclesions,butnotwhetherthe lesionsareactivelybleeding.Gastricanalysistestingmayhelpwithdeterminingthecauseofgastricirritation,

TestBank-Medical-SurgicalNursing:AssessmentandManagementofClinicalProblems10e

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butitisnotusedforacuteGIbleeding. DIF:CognitiveLevel:Apply(application)REF:923 TOP:NursingProcess:PlanningMSC:NCLEX:PhysiologicalIntegrity 20.A57-year-oldmanwithEscherichiacoliO157:H7foodpoisoningisadmittedtothehospitalwithbloody diarrheaanddehydration.Whichorderwillthenursequestion? a.

InfuselactatedRingerssolutionat250mL/hr.

b.

Monitorbloodureanitrogenandcreatininedaily.

c.

Administerloperamide(Imodium)aftereachstool.

d.

Provideaclearliquiddietandprogressdietastolerated.

ANS:C Useofantidiarrhealagentsisavoidedwiththistypeoffoodpoisoning.Theotherordersareappropriate. DIF:CognitiveLevel:Apply(application)REF:927 TOP:NursingProcess:ImplementationMSC:NCLEX:PhysiologicalIntegrity 21.Whichinformationwillthenurseincludewhenteachingapatientwithpepticulcerdiseaseabouttheeffect ofranitidine(Zantac)? a.

Ranitidineabsorbsthegastricacid.

b.

Ranitidinedecreasesgastricacidsecretion.

c.

Ranitidineconstrictsthebloodvesselsneartheulcer.

d.

Ranitidinecoverstheulcerwithaprotectivematerial.

ANS:B Ranitidineisahistamine-2(H2)receptorblocker,whichdecreasesthesecretionofgastricacid.Theresponse beginning,Ranitidineconstrictsthebloodvesselsdescribestheeffectofvasopressin.TheresponseRanitidine absorbsthegastricaciddescribestheeffectofantacids.TheresponsebeginningRanitidinecoverstheulcer describestheactionofsucralfate(Carafate). DIF:CognitiveLevel:Understand(comprehension)REF:903 TOP:NursingProcess:ImplementationMSC:NCLEX:PhysiologicalIntegrity 22.Afamilymemberofa28-year-oldpatientwhohassufferedmassiveabdominaltraumainanautomobile accidentasksthenursewhythepatientisreceivingfamotidine(Pepcid).Thenursewillexplainthatthe medicationwill a.

decreasenauseaandvomiting.

TestBank-Medical-SurgicalNursi...