Lewis Chapter 41: Upper GI
Problems NCLEX Exam/58
Questions and Answers/Verified.
1. A patient with deep partial-thickness burns experiences severe pain
associated with nausea during dressing changes. Which action will be
most useful in decreasing the patient's nausea?
a. The patient NPO for 2 hours before and after dressing changes.
b. Avoid performing dressing changes close to the patient's mealtimes.
c. Administer the prescribed morphine sulfate before dressing changes.
d. Give the ordered prochlorperazine (Compazine) before dressing
changes. - -ANS: C
Because the patient's nausea is associated with severe pain, it is likely
that it is precipitated by stress and pain. The best treatment will be to
provide adequate pain medication before dressing changes. The nurse
should avoid doing painful procedures close to mealtimes, but
nausea/vomiting that occur at other times also should be addressed.
Keeping the patient NPO does not address the reason for the nausea
and vomiting and will have an adverse effect on the patient's nutrition.
Administration of antiemetics is not the best choice for a patient with
nausea caused by pain.
-2. A patient who has been NPO during treatment for nausea and
vomiting caused by gastric irritation is to start oral intake. Which of
these should the nurse offer to the patient?
a. A glass of orange juice
b. A dish of lemon gelatin
c. A cup of coffee with cream
d. A bowl of hot chicken broth - -ANS: B
Clear 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.
-6. The nurse is assessing a patient with gastroesophageal reflux
disease (GERD) who is experiencing increasing discomfort. Which
patient statement indicates that additional patient education 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 quit smoking several years ago, but I still chew a lot of gum."
d. "I eat small meals throughout the day and have a bedtime snack." - -
ANS: D
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.
, -7. When admitting a patient with a stroke who is unconscious and
unresponsive to stimuli, the nurse learns from the patient's family that
the patient has a history of gastroesophageal reflux disease (GERD).
The nurse will plan to do frequent assessments of the patient's
a. apical pulse.
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 patient's stroke or GERD
and do not require more frequent monitoring than the routine.
-8. A patient with recurring heartburn receives a new prescription for
esomeprazole (Nexium). In teaching the patient about this medication,
the nurse explains that this drug
a. neutralizes stomach acid and provides relief of symptoms in a few
minutes.
b. reduces the reflux of gastric acid by increasing the rate of gastric
emptying.
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.
-9. After the nurse teaches a patient with gastroesophageal reflux
disease (GERD) about recommended dietary modifications, which diet
choice for a snack 2 hours before bedtime indicates that the teaching
has been effective?
a. Chocolate pudding
b. Glass of low-fat milk
c. Peanut butter sandwich
d. Cherry gelatin and fruit - -ANS: D
Gelatin and fruit are low fat and will not decrease lower esophageal
sphincter (LES) pressure. Foods like 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.
-10. A patient who recently has been experiencing frequent heartburn
is seen in the clinic. The nurse will anticipate teaching the patient
about
a. barium swallow.
b. radionuclide tests.
c. endoscopy procedures.
, d. proton pump inhibitors. - -ANS: D
Because diagnostic testing for heartburn that is probably caused by
gastroesophageal reflux disease (GERD) is expensive and
uncomfortable, proton pump inhibitors are frequently used for a short
period as the first step in the diagnosis of GERD. The other tests may
be used but are not usually the first step in diagnosis.
-11. A 62-year-old patient who has been diagnosed with esophageal
cancer tells the nurse, "I know that my chances are not very good, but I
do not feel ready to die yet." Which response by the nurse is most
appropriate?
a. "You may have quite a few years still left to live."
b. "Thinking about dying will only make you feel worse."
c. "Having this new diagnosis must be very hard for you."
d. "It is important that you be realistic about your prognosis." - -ANS: C
This response is open-ended and will encourage the patient to further
discuss feelings of anxiety or sadness about the diagnosis. Patients
with esophageal cancer have 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 patient's fears of dying. And the response
beginning, "It is important that you be realistic," discourages the
patient from feeling hopeful, which is important to patients with any
life-threatening diagnosis.
-12. Which information will the nurse include when teaching a patient
with newly diagnosed gastroesophageal reflux disease (GERD)?
a. "Peppermint tea may be helpful in reducing your symptoms."
b. "You should avoid eating between meals to reduce acid secretion."
c. "Vigorous physical activities may increase the incidence of reflux."
d. "It will be helpful to keep the head of your bed elevated on blocks." -
-ANS: D
Elevating the head of the bed will reduce the incidence of reflux while
the patient is sleeping. Peppermint will lower 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.
-13. A patient has just arrived on the postoperative unit after having a
laparoscopic esophagectomy for treatment of esophageal cancer.
Which nursing action should be included in the postoperative plan of
care?
a. Elevate the head of the bed to at least 30 degrees.
b. Reposition the nasogastric (NG) tube if drainage stops or decreases.
c. Notify the doctor immediately about bloody NG drainage.
d. Start oral fluids when the patient has active bowel sounds. - -ANS: A
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
Problems NCLEX Exam/58
Questions and Answers/Verified.
1. A patient with deep partial-thickness burns experiences severe pain
associated with nausea during dressing changes. Which action will be
most useful in decreasing the patient's nausea?
a. The patient NPO for 2 hours before and after dressing changes.
b. Avoid performing dressing changes close to the patient's mealtimes.
c. Administer the prescribed morphine sulfate before dressing changes.
d. Give the ordered prochlorperazine (Compazine) before dressing
changes. - -ANS: C
Because the patient's nausea is associated with severe pain, it is likely
that it is precipitated by stress and pain. The best treatment will be to
provide adequate pain medication before dressing changes. The nurse
should avoid doing painful procedures close to mealtimes, but
nausea/vomiting that occur at other times also should be addressed.
Keeping the patient NPO does not address the reason for the nausea
and vomiting and will have an adverse effect on the patient's nutrition.
Administration of antiemetics is not the best choice for a patient with
nausea caused by pain.
-2. A patient who has been NPO during treatment for nausea and
vomiting caused by gastric irritation is to start oral intake. Which of
these should the nurse offer to the patient?
a. A glass of orange juice
b. A dish of lemon gelatin
c. A cup of coffee with cream
d. A bowl of hot chicken broth - -ANS: B
Clear 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.
-6. The nurse is assessing a patient with gastroesophageal reflux
disease (GERD) who is experiencing increasing discomfort. Which
patient statement indicates that additional patient education 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 quit smoking several years ago, but I still chew a lot of gum."
d. "I eat small meals throughout the day and have a bedtime snack." - -
ANS: D
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.
, -7. When admitting a patient with a stroke who is unconscious and
unresponsive to stimuli, the nurse learns from the patient's family that
the patient has a history of gastroesophageal reflux disease (GERD).
The nurse will plan to do frequent assessments of the patient's
a. apical pulse.
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 patient's stroke or GERD
and do not require more frequent monitoring than the routine.
-8. A patient with recurring heartburn receives a new prescription for
esomeprazole (Nexium). In teaching the patient about this medication,
the nurse explains that this drug
a. neutralizes stomach acid and provides relief of symptoms in a few
minutes.
b. reduces the reflux of gastric acid by increasing the rate of gastric
emptying.
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.
-9. After the nurse teaches a patient with gastroesophageal reflux
disease (GERD) about recommended dietary modifications, which diet
choice for a snack 2 hours before bedtime indicates that the teaching
has been effective?
a. Chocolate pudding
b. Glass of low-fat milk
c. Peanut butter sandwich
d. Cherry gelatin and fruit - -ANS: D
Gelatin and fruit are low fat and will not decrease lower esophageal
sphincter (LES) pressure. Foods like 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.
-10. A patient who recently has been experiencing frequent heartburn
is seen in the clinic. The nurse will anticipate teaching the patient
about
a. barium swallow.
b. radionuclide tests.
c. endoscopy procedures.
, d. proton pump inhibitors. - -ANS: D
Because diagnostic testing for heartburn that is probably caused by
gastroesophageal reflux disease (GERD) is expensive and
uncomfortable, proton pump inhibitors are frequently used for a short
period as the first step in the diagnosis of GERD. The other tests may
be used but are not usually the first step in diagnosis.
-11. A 62-year-old patient who has been diagnosed with esophageal
cancer tells the nurse, "I know that my chances are not very good, but I
do not feel ready to die yet." Which response by the nurse is most
appropriate?
a. "You may have quite a few years still left to live."
b. "Thinking about dying will only make you feel worse."
c. "Having this new diagnosis must be very hard for you."
d. "It is important that you be realistic about your prognosis." - -ANS: C
This response is open-ended and will encourage the patient to further
discuss feelings of anxiety or sadness about the diagnosis. Patients
with esophageal cancer have 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 patient's fears of dying. And the response
beginning, "It is important that you be realistic," discourages the
patient from feeling hopeful, which is important to patients with any
life-threatening diagnosis.
-12. Which information will the nurse include when teaching a patient
with newly diagnosed gastroesophageal reflux disease (GERD)?
a. "Peppermint tea may be helpful in reducing your symptoms."
b. "You should avoid eating between meals to reduce acid secretion."
c. "Vigorous physical activities may increase the incidence of reflux."
d. "It will be helpful to keep the head of your bed elevated on blocks." -
-ANS: D
Elevating the head of the bed will reduce the incidence of reflux while
the patient is sleeping. Peppermint will lower 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.
-13. A patient has just arrived on the postoperative unit after having a
laparoscopic esophagectomy for treatment of esophageal cancer.
Which nursing action should be included in the postoperative plan of
care?
a. Elevate the head of the bed to at least 30 degrees.
b. Reposition the nasogastric (NG) tube if drainage stops or decreases.
c. Notify the doctor immediately about bloody NG drainage.
d. Start oral fluids when the patient has active bowel sounds. - -ANS: A
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
