GERD NCLEX questions and answers 2024/2025 with complete solutions

GERD NCLEX questions and answers 2024/2025 with complete solutions The nurse explains to the patient with gastroesophageal reflux disease that this disorder: A. results in acid erosion and ulceration of the esophagus caused by frequent vomiting, B. will require surgical wrapping or repair of the pyloric sphincter to control the symptoms, C. is the protrusion of a portion of the stomach into to esophagus through an opening in the diaphragm, D. often involves relaxation of the lower esophageal sphincter, allowing stomach contents to back up into the espophagus D. The acidic contents of the stomach touching the inside of the esophagus are responsible for the physical sensation known as "heart-burn" that is a cardinal symptom of GERD "Which of the following types of gastritis is associated with Helicobacter pylori and duodenal ulcers? 1. Erosive (hemorrhagic) gastritis 2. Fundic gland gastritis (type A) 3. Antral gland gastritis (type B) 4.Aspiring-induced gastric ulcer 3 - Erosive (hemorrhagic) gastritis can be caused by ingestion of substances that irritate the gastric mucosa. Fundic gland gastritis (type A) is associated with diffuse severe mucosal atrophy and the presence of pernicious anemia. Antral gland gastritis (type B) is the most common form of gastritis, and is associated with Helicobacter pylori and duodenal ulcers Gastroesophageal reflux disease (GERD) weakens the lower esophageal sphincter, predisposing older persons to risk for impaired swallowing. In managing the symptoms associated with GERD, the nurse should assign the highest priority to which of the following interventions? 1. Decrease daily intake of vegetables and water, and ambulate frequently 2. Drink coffee diluted with milk at each meal, and remain in an upright position for 30 minutes. 3. Eat small, frequent meals, and remain in an upright position for at least 30 minutes after eating 4. Avoid over-the-counter drugs that have antacids in them Answer 3, Eating small and frequent meals requires less release of hydrochloric acid. Remaining in an upright position for 30 minutes after meals prevents reflux into the esophagus which is often exacerbated when lying down, expecially after a large meal which makes the patient tired The client with a hiatal hernia chronically experiences heartburn following meals. The nurse plans to teach the client to avoid which action because it is contraindicated with hiatal hernia? 1. Lying recumbent following meals 2. Taking in small, frequent, bland meals 3. Raising the head of the bed on 6-inch blocks 4. Taking H2-receptor antagonist medication Correct answer: 1 Laying recumbant following meals or at night will cause reflux and pain. Relief is usually achieved with the intake of small, bland meals, use of H2 receptor antagonists and antacids, and elevation of the thorax after meals and during sleep What response should a nurse offer to a client who asks why he's having a vagotomy to treat his ulcer? 1. To repair a hole in the stomach 2. to reduce the ability of the stomach to produce acid 3. to prevent the stomach from sliding into the chest 4. to remove a potentially malignant lesion in the stomach Answer 2: A vagotomy is perfomred to elimniate the acid-secreting stimulus to gastric cells. a perforation would be repaired with a gastric resection. Repair of hiatal hernia (fundoplication) prevents the stomach from sliding through the diaphragm. Removal of a potentially malignant tumor wouldn't reduce the entire acid-producing mechanism Which assessment data support the client's diagnosis of gastric ulcer? 1. Presence of blood in the client's stool for the past month. 2.Complaints of a burning sensation that moves like a wave. 3.Sharp pain in the upper abdomen after eating a heavy meal. 4.Comparison of complaints of pain with ingestion of food and sleep "1. The presence of blood does not specifically indicate diagnosis of an ulcer. The client could have hemorrhoids or cancer that would result in the presence of blood. 2. A wavelike burning sensation is a symptom of gastroesophageal reflus. 3. Sharp pain in the upper abdomen after eating a heavy meal is a symptom of gallbladder disease. 4. (CORRECT) In a client diagosed with a gastric ulcer, pain usually occurs 30-60 minutes after eating, but not at night. In contrast, a client with duodenal ulcer has pain durin ghte night that is often relieved by eating food. Pain occurs 1-3 hours after meals When assessing the client with the diagnosis of peptic ulcer disease, which physical examination should the nurse implement first? 1. Auscultate the client's bowel sounds in all four quadrants. 2.Palpate the abdominal area for tenderness. 3.Percuss the abdominal borders to identify organs. 4.Assess the tender area progressing to nontender Correct answer: #1. Auscultation should be used prior to palpa-tion or percussion when assessing the abdomen. If the nurse manipulates the abdomen, the bowel sounds can be altered and give false information The nurse is monitoring a client with a diagnosis of peptic ulcer. Which assessment finding would most likely indicate perforation of the ulcer? 1. Bradycardia 2. Numbness in the legs 3. Nausea and vomiting 4. A rigid, board-like abdomen Answer 4, Perforation of an ulcer is a surgical emergency and is characterized by sudden, sharp, intolerable severe pain beginning in the midepigastric area and spreading over the abdomen, which become rigid and board-like. Nausea and vomiting may occur. Tachycardia may occur as hypovolemic shock develops. Numbness in the legs is not an associated finding Which of the following nursing interventions should the nurse perform for a female client receiving enteral feedings through a gastrostomy tube? a. Change the tube feeding solutions and tubing at least every 24 hours b. Maintain the head of the bed at a 15-degree elevation continuously. c. Check the gastrostomy tube for position every 2 days. d. Maintain the client on bed rest during the feedings Answer A, Answer A. Tube feeding solutions and tubing should be changed every 24 hours, or more frequently if the feeding requires it. Doing so prevents contamination and bacterial growth. The head of the bed should be elevated 30 to 45 degrees continuously to prevent aspiration. Checking for gastrostomy tube placement is performed before initiating the feedings and every 4 hours during continuous feedings. Clients may ambulate during feedings The nurse is teaching the patient a client with a peptic ulcer discharge instructions. The client asks the nurse which type of analgesic he may take. Which of the following responses by the nurse would be most accurate? 1. Aspirin 2. Acetaminophen 3. Naproxen 4. Ibuprofen 2.Acetaminophen is recommended for pain relief because it does no promote irritation of the mucosa. Aspirin, and nonsteroidal anti- inflammatory drugs suchs as naproxen and ibuprofen, may cause irritation of the mucosa and subsequent bleeding The nurse is planning the care of a client diagnosed with lower esophageal sphincter dysfunction. Which dietary modifications should be included in the plan of care? 1. Allow any of the client's favorite foods as long as the amount is limited. 2. Have the client perform eructation exercises several times a day. 3. Eat four (4) to six (6) small meals a day and limit fluids during mealtimes. 4. Encourage the client to consume a glass of red wine with one (1) meal a day "1. The client is instructed to avoid spicy and acidic foods and any food producing symptoms. 2. Eructation means belching, which is a symptom of GERD. 3. Clients should eat small, frequent meals and limit fluids with the meals to prevent reflux into the esophagus from a distended stomach.CORRECT 4. Clients are encouraged to forgo all alcoholic beverages because alcohol relaxes the lower esophageal sphincter and increases the risk of reflux Which of the following types of gastritis ic associated with Helicobacter pylori and duodenal ulcers? 1. Erosive (hemorrhagic) gastritis 2. Fundic gland gastritis (type A) 3. Antral gland gastritis (type B) 4. Aspiring-induced gastric ulcer Correct answer: Antral gland gastritis ( type B). Rationale: Antral gland gastritis is the most common form of gastritis and is associated with Helicobacter pylori and duodenal ulcers The client with hiatal hernia chronically experiences heartburn following meals. The nurse plans to teach the client to avoid which action because it is contraindicated with a hiatal hernia? 1. Lying recumbent following meals. 2. Taking in small, frequent bland meals. 3. Raising the head of the bed on 6-inch block. 4. Taking H2-receptor antagonist medication Answer 1,Hiatal hernia is caused by a protrusion of a portion of the stomach above the diaphragm where the esophagus is normally positioned. he client usually experiences pain from reflux caused by ingestion of irritating foods, lying flat following meals or at night, and eating large or fatty meals. Option 2-4, and actually elevating the thorax after a meal, provide relief The nurse teaches the client about an anti-ulcer diet. Which of the following statements by the client indicates to the nurse that dietary teaching was successful? 1. "I must eat bland foods to help my stomach heal." 2. "I can eat most foods, as long as they don't bother my stomach." 3. "I cannot eat fruits and vegetables because they cause too much gas." 4. "I should eat a low-fiber diet to delay gastric emptying - The answer is 2. Which assessment data support to the the nurse the client's diagnosis of gastric ulcer? A. Presence of blood in the client's stool for the past month? B. Reports of a burning sensation moving like a wave. C. Sharp pain in the upper abdomen after eating a heavy meal. D. Complaints of epigastric pain 30-60 minutes after ingesting food - Answer: D In a client diagnosed with a gastric ulcer, pain usually occurs 30-60 minutes after eating, but not at night. In contrast, a client with a duodenal ulcer has pain during the night often relieved by eating foods. Other answers: the presence of blood does not specifically indicate diagnose of an ulcer. The client could have hemorrhoids or cancer. A waveline burning sensation is a symptom of GERD. Sharp pain in the upper abdomen after eating a heavy meal is a symptom of gallbladder disease A patient with a history of peptic ulcer disease has presented to the emergency department with complaints of severe abdominal pain and a rigid, boardlike abdomen, prompting the health care team to suspect a perforated ulcer. Which of the following actions should the nurse anticipate? A. Providing IV fluids and inserting a nasogastric tube B. Administering oral bicarbonate and testing the patient's gastric pH level. C. Performing a fecal occult blood test and administering IV calcium gluconate. D. Starting parenteral nutrition and placing the patient in high-Fowler's position Answer A, A perforated peptic ulcer requires IV replacement of fluid losses and continued gastric aspiration by NG tube. Nothing is given by mouth and gastric pH testing is not a priority. Calcium gluconate is not a medication directly relevant to the patient's suspected diagnosis and parenteral nutrition is not a priority in the short term The nurse is caring for a female client with active upper GI bleeding. What is the appropriate diet for this client during the first 24 hours after admission? a. regular diet b. skim milk c. nothing by mouth d. clear liquids Answer C, Answer C. Shock and bleeding must be controlled before oral intake, so the client should receive nothing by mouth. A regular diet is incorrect. When the bleeding is controlled, the diet is gradually increased, starting with ice chips and then clear liquids. Skim milk shouldn't be given because it increases gastric acid production, which could prolong bleeding. A liquid diet is the first diet offered after bleeding and shock are controlled The teaching plan for the patient being discharged following an acute episode of upper GI bleeding will concern information concerning the importance of (select all that apply) a. only taking aspirin with milk or bread products b. avoiding taking aspirin and drugs containing aspirin c. taking only drugs prescribed by the health care provider d. taking all drugs 1 hour before mealtime to prevent further bleeding e. reading all OTC drug labels to avoid those containing stearic acid and calcium Correct answers: b, c Rationale: Before discharge, the patient with upper gastrointestinal (GI) bleeding and the caregiver should be taught how to avoid future bleeding episodes. Ulcer disease, drug or alcohol abuse, and liver and respiratory diseases can cause upper GI bleeding. Help make the patient and caregiver aware of the consequences of noncompliance with drug therapy. Emphasize that no drugs (especially aspirin and nonsteroidal antiinflammatory drugs [NSAIDs]) other than those prescribed by the health care provider should be taken. Smoking and alcohol should be eliminated because they are sources of irritation and interfere with tissue repair. The male client tells the nurse he has been experiencing "heartburn" at night that awakens him. Which assessment question should the nurse ask? A. How much weight have you gained recently? B. What have you done to alleviate the heartburn? C. Do you consume many milk and dairy products? D Have you been around anyone with a stomach virus Correct answer is B,Most clients with GERD have been self medicating with over-the counter medications prior to seeking advice from a healthcare provider. It is important to know what the client has been using to treat the problem A patient has a vagotomy with antrectomy to treat a duodenal ulcer. Postoperatively, the patient develops dumping syndrome. Which of the following statements, if made by the patient, should indicate to the nurse that further dietary teaching is needed? 1. I should eat bread with each meal 2. I should eat smaller meals more frequently. 3. I should lie down after eating. 4. I should avoid drinking fluids with my meals Answer 1, Patient should decrease intake of carbohydrates The results of a patient's recent endoscopy indicate the presence of peptic ulcer disease (PUD). Which of the following teaching points should the nurse provide to the patient in light of his new diagnosis? A) "You'll need to drink at least two to three glasses of milk daily." B) "It would likely be beneficial for you to eliminate drinking alcohol." C) "Many people find that a minced or pureed diet eases their symptoms of PUD." D) "Your medications should allow you to maintain your present diet while minimizing symptoms 2 Alcohol increases the amount of stomach acid produced so it should be avoided. Milk may exacerbate PUD, so two to three glasses would not be recommended. There is no reason to puree or mince food, and a current diet is likely to be altered to minimize symptoms. The client with hiatal hernia chronically experiences heartburn following meals. The nurses plans to teach the client to avoid which action because it is contraindicated with a hiatal hernia? 1. Lying recumbent following meals 2. Taking in small, frequent, bland meals 3. Raising the head of bed on 6-inch blocks 4. Taking H2-receptor antagonist medication Answer 1, Hiatal hernia is caused by a protrusion of a portion of the stomach above the diaphragm where the esophagus usually is positioned. The client usually experiences pain from reflux caused by ingestion of irritating foods, lying flat following meals or at night, and eating large or fatty meals. Relief is obtained with the intake of small, frequent meals, use of H2-receptor antagonists and antacids, and elevation of the thorax following meals and during sleep "The nurse has instructed the client who is experiencing diarrhea associated with irritable bowel syndrome on dietary changes to prevent diarrhea. The nurse knows the client understands the dietary changes if the client selects which of the following menu choices? a) Yogurt, crackers and sweet tea b) Salad with chicken, whole wheat crackers c) Bacon, tomato, lettuce with mayonnaise and a soft drink d) Tuna on white bread and coconut cake Answer B Rationale: Bacon tomato lettuce with mayonnaise and soft drink is high in fat and the soft drink is hyperosmolar both contributing to diarrhea. Salad, whole wheat crackers may decrease diarrhea due to increased fiber. Dairy increases diarrhea. Food high in carbohydrates increase diarrhea. Coconut may increase diarrhea A client receives a local anesthetic to suppress the gag reflex for a diagnostic procedure of the upper GI tract. Which of the following nursing interventions is advised for this patient? a The client should be monitored for any breathing related disorder or discomforts b) The client should not be given any food and fluids until the gag reflex returns, c. The client should be monitored for cramping or abdominal distention, d) The client's fluid output should be measured for at least 24 hours after the procedure ANSWER: B For a client receiving a local anesthetic that suppresses the gag reflex, the nurse is advised to withhold food and fluids until the reflex returns The results of a patient's recent endoscopy indicate the presence of peptic ulcer disease (PUD). Which of the following teaching points should the nurse provide to the patient in light of his new diagnosis? A. You'll need to drink at least two to three glasses of milk daily. B."It would likely be beneficial for you to eliminate drinking alcohol." C. Many people find that a minced or pureed diet eases their symptoms of PUD. D. Your medications should allow you to maintain your present diet while minimizing symptoms CORRECT ANSWER: B Although there is no specific recommended dietary modification for PUD, most patients find it necessary to make some sort of dietary modifications to minimize symptoms. Milk may exacerbate PUD and alcohol is best avoided because it can delay healing "The nurse is caring for a 68 year old patient admitted with abdominal pain, nausea, and vomiting. The patient has an abdominal mass and a bowel obstruction is suspected. The nurse auscultating the abdomen listens for which of the following types of bowel sounds that is consistent with the patient's clinical picture? " A. low pitched and rumbling above the area of obstruction B. High pitched and hypoactive below the area of obstruction C. low pitched and hyperactive below the area of obstruction (D). high pitched and hyperactive above the area of obstruction Early in intestinal obstruction, the patient's bowel sounds are hyperactive adn high pitched. This occurs because peristaltic action increases to "push past" the area of obstruction. As the obstruction becomes complete, bowel sounds decrease and finally become absent "A patient with a history of peptic ulcer disease has presented to the emergency department with complaints of severe abdominal pain and a rigid, boardlike abdomen, prompting the health care team to suspect a perforated ulcer. Which of the following actions should the nurse anticipate? A. Providing IV fluids and inserting a nasogastric tube B. Administering oral bicarbonate and testing the patient's gastric pH level C. Performing a fecal occult blood test and administering IV calcium gluconate D. Starting parenteral nutrition and placing the patient in a high-Fowler's position Answer A, A perforated peptic ulcer requires IV replacement of fluid losses and continued gastric aspiration by NG tube. Nothing is given by mouth and gastric pH testing is not a priority. Calcium gluconate is not a medication directly relevant to the patient's suspected diagnosis and parenteral nutrition is not a priority in the short term Which of these agents is a major contributing factor in the promotion of peptic ulcer disorder? A) Candida albicans. B) staphyloccus infection. C) streptococcus infection D) Helibacter pylori infection Answer: Helobacter pylori infection. Rationale: Recurrence of peptic ulcers is related to Helicobacter pylori, use of NSAIDs, smoking, and continued acid hypersecretion The nurse determines that a patient has experienced the beneficial effects of medication therapy with famotidine (Pepcid) when which of the following symptoms is relieved? 1. Ice tea 2. Dry toast 3. warm broth 4. plain hamburger B) Dry toast (Dry toast or crackers may alleviate the feeling of nausea and prevent further vomiting. Extremely hot or cold liquids and fatty foods are generally not well tolerated "A patient with a history of peptic ulcer disease has presented to the ED with complaints of severe abdominal pain and a rigid, boardlike abdomen, prompting the health care team to suspect a perforated ulcer. Which of the following actions should the nurse anticiptate? "A: Providing IV fluids and inserting a nasogastric tube B:Administering oral bicarbonate and testing patient's gastric pH level C:Performing a fecal occult blood test and administering IV calcium gluconate D: Starting parenteral nutrition and placing the patient in high-fowler's position Answer A, "A: providing IV fluids and inserting a nasogastric tube rationale: A perforated peptic ulcer requires IV replacement of fluid losses and continued gastric aspiration by NG tube. Nothing is given by mouth and gastric pH testing is not a priority. Calcium gluconate is not a medication directly relevent to the patient's suspected diagnosis and parenteral nutrition is not a priority in the short term 5. Which of the following drugs is a histamine blocker and reduces levels of gastric acid?" A. Omeprazole (Prilosec) B. Metoclopramide (Reglan) C. Cimetidine (Tagamet) D. Magnesium Hydroxide (Maalox) Answer C, Cimetidine bind to H2 in the tissue and decreases the production of gastric acid which is the most common upper GI problem? " 1. peptic ulcer disease 2. Crohns 3. Gerd 4. ulcerative colitis Answer 3, Gerd is the only upper GI problem "The nurse determines that a patient has experienced the beneficial effects of medication therapy with famotidine (Pepcid) when which of the following symptoms is relieved? " A) Nausea B) Belching C) Epigastric pain D) Difficulty swallowing Answer C, "Famotidine is an H2-receptor antagonist that inhibits parietal cell output of HCl acid and minimizes damage to gastric mucosa related to hyperacidity, thus relieving epigastric pain The nurse is reviewing the medication record of a female client with acute gastritis. Which medication, if noted on the client's record, would the nurse question? " a. Digoxin (Lanoxin) b. Furosemide (Lasix) c. Indomethacin (Indocin) d. Propranolol hydrochloride (Inderal) Answer is C, Indomethacin (Indocin) is a nonsteroidal anti-inflammatory drug and can cause ulceration of the esophagus, stomach, or small intestine. Indomethacin is contraindicated in a client with gastrointestinal disorders. Furosemide (Lasix) is a loop diuretic. Digoxin is a cardiac medication. Propranolol (Inderal) is a β-adrenergic blocker. Furosemide, digoxin, and propranolol are not contraindicated in clients with gastric disorders