Lewis’s Medical-Surgical Nursing in Canada 4th , 5thEdition by
Jane Tyerman Test Bank
After change-of-shift report, which patient would the nurse assess first?
a. A 42-yr-old patient who has acute gastritis and ongoing epigastric pain
b. A 70-yr-old patient with a hiatal hernia who experiences frequent heartburn
c. A 60-yr-old patient with nausea and vomiting who is lethargic with dry mucosa
d. A 53-yr-old patient who has dumping syndrome after a recent partial gastrectomy - ANSWER: ANS:
C
A patient with nausea and vomiting who is lethargic with dry mucosa is at high risk for problems such
as aspiration, dehydration, and fluid and electrolyte disturbances. The other patients will also need to
be assessed, but the information about them indicates symptoms that are typical for their diagnoses
and are not life threatening.
DIF:CognitiveLevel: Apply (Application) TOP: NursingProcess: Assessment MSC:NCLEX: Safe and
Effective Care Environment
Which item would the nurse offer to the patient restarting 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 - ANSWER: 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:CognitiveLevel: Apply (Application) TOP: NursingProcess: Implementation MSC:NCLEX:
PhysiologicalIntegrity
A woman receiving chemotherapy for breast cancer develops a Candida albicans oral infection. Which
intervention would the nurse anticipate?
a. Nystatin tablets
b. Antiviral agents
c. Referral to a dentist
d. Hydrogen peroxide rinses - ANSWER: ANS: A
C. albicans infections are treated with an antifungal such as nystatin. Peroxide rinses would be painful.
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:CognitiveLevel: Apply (Application) MSC:NCLEX: PhysiologicalIntegrity TOP: NursingProcess:
Planning
A patient who has gastroesophageal reflux disease (GERD) is experiencing increasing discomfort.
Which patient statement to the nurse indicates a need for additional teaching about GERD?
a. "I quit smoking years ago, but I chew gum."
b. "I eat small meals and have a bedtime snack."
[c. "I take antacids between meals and at bedtime each night."
d. "I sleep with the head of the bed elevated on 4-inch blocks." - ANSWER: ANS: B
,GERD is exacerbated by eating late at night, and the nurse would plan to teach the patient to avoid
eating within 3 hours of bedtime. Smoking cessation, taking antacids, and elevating the head of the
bed are appropriate actions to control symptoms of GERD.
DIF:CognitiveLevel: Apply (Application) MSC:NCLEX: PhysiologicalIntegrity TOP: NursingProcess:
Evaluation
A patient with a stroke is unconscious and unresponsive to stimuli. After learning that the patient has
a history of gastroesophageal reflux disease (GERD), which assessment would the nurse plan to make
more frequently than is routine?
a. Apical pulse
b. Bowel sounds
c. Breath sounds
d. Abdominal girth - ANSWER: 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.
How would the nurse explain esomeprazole (Nexium) to a patient who has recurring heartburn?
a. "It reduces gastroesophageal reflux by increasing the rate of gastric emptying."
b. "It neutralizes stomach acid and provides relief of symptoms in a few minutes."
c. "It coats and protects the lining of the stomach and esophagus from gastric acid."
d. "It treats gastroesophageal reflux disease by decreasing stomach acid production." - ANSWER: 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:CognitiveLevel: Apply (Application) TOP: NursingProcess: Implementation MSC:NCLEX:
PhysiologicalIntegrity
Which patient choice for a snack 3 hours before bedtime indicates that the nurse's 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 - ANSWER: 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:CognitiveLevel: Apply (Application) MSC:NCLEX: PhysiologicalIntegrity TOP: NursingProcess:
Evaluation
Which topic would the nurse anticipate teaching to a patient who has a new report of heartburn?
a. Radionuclide tests
b. Barium swallow exam
c. Endoscopy procedures
d. Proton pump inhibitors - ANSWER: 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:CognitiveLevel: Apply (Application) MSC:NCLEX: PhysiologicalIntegrity TOP: NursingProcess:
Planning
Which information will the nurse provide 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. "Avoid eating between meals to reduce acid secretion."
d. "Vigorous exercise may increase the incidence of reflux." - ANSWER: 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:CognitiveLevel: Apply (Application) TOP: NursingProcess: Implementation MSC:NCLEX:
PhysiologicalIntegrity
Which nursing action would be included in the postoperative plan of care for a patient after a
laparoscopic esophagectomy?
a. Reposition the NG tube if drainage stops.
b. Elevate the head of the bed to at least 30 degrees.
c. Start oral fluids when the patient has active bowel sounds.
d. Notify the doctor for any bloody nasogastric (NG) drainage. - ANSWER: ANS: B
Elevation of the head of the bed decreases the risk for reflux and aspiration of gastric secretions. The
NG tube would 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:CognitiveLevel: Apply (Application) MSC:NCLEX: PhysiologicalIntegrity TOP: NursingProcess:
Planning
Which information will the nurse provide for a patient with achalasia?
a. A liquid diet will be necessary.
b. Avoid drinking fluids with meals.
c. Lying down after meals is recommended.
d. Treatment may include endoscopic procedures. - ANSWER: 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 fluids
with meals.
DIF:CognitiveLevel: Apply (Application) MSC:NCLEX: PhysiologicalIntegrity TOP: NursingProcess:
Planning
A patient vomiting blood-streaked fluid is admitted to the hospital with acute gastritis. What would
the nurse ask the patient about to determine possible risk factors for gastritis?
a. The amount of saturated fat in the diet
b. A family history of gastric or colon cancer
c. Use of nonsteroidal antiinflammatory drugs
d. A history of a large recent weight gain or loss - ANSWER: ANS: C
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.
Jane Tyerman Test Bank
After change-of-shift report, which patient would the nurse assess first?
a. A 42-yr-old patient who has acute gastritis and ongoing epigastric pain
b. A 70-yr-old patient with a hiatal hernia who experiences frequent heartburn
c. A 60-yr-old patient with nausea and vomiting who is lethargic with dry mucosa
d. A 53-yr-old patient who has dumping syndrome after a recent partial gastrectomy - ANSWER: ANS:
C
A patient with nausea and vomiting who is lethargic with dry mucosa is at high risk for problems such
as aspiration, dehydration, and fluid and electrolyte disturbances. The other patients will also need to
be assessed, but the information about them indicates symptoms that are typical for their diagnoses
and are not life threatening.
DIF:CognitiveLevel: Apply (Application) TOP: NursingProcess: Assessment MSC:NCLEX: Safe and
Effective Care Environment
Which item would the nurse offer to the patient restarting 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 - ANSWER: 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:CognitiveLevel: Apply (Application) TOP: NursingProcess: Implementation MSC:NCLEX:
PhysiologicalIntegrity
A woman receiving chemotherapy for breast cancer develops a Candida albicans oral infection. Which
intervention would the nurse anticipate?
a. Nystatin tablets
b. Antiviral agents
c. Referral to a dentist
d. Hydrogen peroxide rinses - ANSWER: ANS: A
C. albicans infections are treated with an antifungal such as nystatin. Peroxide rinses would be painful.
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:CognitiveLevel: Apply (Application) MSC:NCLEX: PhysiologicalIntegrity TOP: NursingProcess:
Planning
A patient who has gastroesophageal reflux disease (GERD) is experiencing increasing discomfort.
Which patient statement to the nurse indicates a need for additional teaching about GERD?
a. "I quit smoking years ago, but I chew gum."
b. "I eat small meals and have a bedtime snack."
[c. "I take antacids between meals and at bedtime each night."
d. "I sleep with the head of the bed elevated on 4-inch blocks." - ANSWER: ANS: B
,GERD is exacerbated by eating late at night, and the nurse would plan to teach the patient to avoid
eating within 3 hours of bedtime. Smoking cessation, taking antacids, and elevating the head of the
bed are appropriate actions to control symptoms of GERD.
DIF:CognitiveLevel: Apply (Application) MSC:NCLEX: PhysiologicalIntegrity TOP: NursingProcess:
Evaluation
A patient with a stroke is unconscious and unresponsive to stimuli. After learning that the patient has
a history of gastroesophageal reflux disease (GERD), which assessment would the nurse plan to make
more frequently than is routine?
a. Apical pulse
b. Bowel sounds
c. Breath sounds
d. Abdominal girth - ANSWER: 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.
How would the nurse explain esomeprazole (Nexium) to a patient who has recurring heartburn?
a. "It reduces gastroesophageal reflux by increasing the rate of gastric emptying."
b. "It neutralizes stomach acid and provides relief of symptoms in a few minutes."
c. "It coats and protects the lining of the stomach and esophagus from gastric acid."
d. "It treats gastroesophageal reflux disease by decreasing stomach acid production." - ANSWER: 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:CognitiveLevel: Apply (Application) TOP: NursingProcess: Implementation MSC:NCLEX:
PhysiologicalIntegrity
Which patient choice for a snack 3 hours before bedtime indicates that the nurse's 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 - ANSWER: 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:CognitiveLevel: Apply (Application) MSC:NCLEX: PhysiologicalIntegrity TOP: NursingProcess:
Evaluation
Which topic would the nurse anticipate teaching to a patient who has a new report of heartburn?
a. Radionuclide tests
b. Barium swallow exam
c. Endoscopy procedures
d. Proton pump inhibitors - ANSWER: 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:CognitiveLevel: Apply (Application) MSC:NCLEX: PhysiologicalIntegrity TOP: NursingProcess:
Planning
Which information will the nurse provide 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. "Avoid eating between meals to reduce acid secretion."
d. "Vigorous exercise may increase the incidence of reflux." - ANSWER: 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:CognitiveLevel: Apply (Application) TOP: NursingProcess: Implementation MSC:NCLEX:
PhysiologicalIntegrity
Which nursing action would be included in the postoperative plan of care for a patient after a
laparoscopic esophagectomy?
a. Reposition the NG tube if drainage stops.
b. Elevate the head of the bed to at least 30 degrees.
c. Start oral fluids when the patient has active bowel sounds.
d. Notify the doctor for any bloody nasogastric (NG) drainage. - ANSWER: ANS: B
Elevation of the head of the bed decreases the risk for reflux and aspiration of gastric secretions. The
NG tube would 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:CognitiveLevel: Apply (Application) MSC:NCLEX: PhysiologicalIntegrity TOP: NursingProcess:
Planning
Which information will the nurse provide for a patient with achalasia?
a. A liquid diet will be necessary.
b. Avoid drinking fluids with meals.
c. Lying down after meals is recommended.
d. Treatment may include endoscopic procedures. - ANSWER: 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 fluids
with meals.
DIF:CognitiveLevel: Apply (Application) MSC:NCLEX: PhysiologicalIntegrity TOP: NursingProcess:
Planning
A patient vomiting blood-streaked fluid is admitted to the hospital with acute gastritis. What would
the nurse ask the patient about to determine possible risk factors for gastritis?
a. The amount of saturated fat in the diet
b. A family history of gastric or colon cancer
c. Use of nonsteroidal antiinflammatory drugs
d. A history of a large recent weight gain or loss - ANSWER: ANS: C
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.
