Lewis's Medical Surgical Nursing Test Bank 11th Edition [Harding]
Chapter 41 - Upper Gastrointestinal Problems
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 (Comparzne) before dressing changes.
Answer: C
Explanation: 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.
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
Answer: B
Explanation: 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.
3. A 38-year old woman receiving chemotherapy for breast cancer develops a
Candida albicans oral infection. 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.
,Answer: C
Explanation: 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.
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
Answer: C
Explanation: 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).
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.
D. Use antivirals to treat herpes simplex virus (HSV) infections.
Answer: A
Explanation: 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.
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.
,Answer: C
Explanation: 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. 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.
Answer: C
Explanation: 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.
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.
Answer: D
Explanation: 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. 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
, Answer: C
Explanation: 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.
10. The nurse will anticipate teaching a patient experiencing frequent heartburn
about
A. a barium swallow.
B. radionuclide tests.
C. endoscopy procedures.
D. proton pump inhibitors.
Answer: D
Explanation: 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 58-year-old woman who recently has been diagnosed with esophageal cancer
tells the nurse, 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.
Answer: C
Explanation: 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 life-threatening diagnosis.
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.
Chapter 41 - Upper Gastrointestinal Problems
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 (Comparzne) before dressing changes.
Answer: C
Explanation: 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.
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
Answer: B
Explanation: 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.
3. A 38-year old woman receiving chemotherapy for breast cancer develops a
Candida albicans oral infection. 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.
,Answer: C
Explanation: 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.
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
Answer: C
Explanation: 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).
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.
D. Use antivirals to treat herpes simplex virus (HSV) infections.
Answer: A
Explanation: 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.
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.
,Answer: C
Explanation: 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. 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.
Answer: C
Explanation: 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.
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.
Answer: D
Explanation: 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. 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
, Answer: C
Explanation: 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.
10. The nurse will anticipate teaching a patient experiencing frequent heartburn
about
A. a barium swallow.
B. radionuclide tests.
C. endoscopy procedures.
D. proton pump inhibitors.
Answer: D
Explanation: 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 58-year-old woman who recently has been diagnosed with esophageal cancer
tells the nurse, 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.
Answer: C
Explanation: 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 life-threatening diagnosis.
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.
