Question 1

A patient who is vomiting bright red blood is admitted to the emergency department. Which assessment should the nurse accomplish first?

Accepted Answer

A)  Measuring the quantity of any emesis 
B)  Checking the level of consciousness 
C)  Auscultating the chest for breath sounds 
D)  Taking the blood pressure (BP) and pulse

Question 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?

Accepted Answer

A)  A glass of orange juice 
B)  A bowl of hot chicken broth 
C)  A dish of lemon gelatin 
D)  A cup of coffee with cream

Question 3

A patient with a bleeding duodenal ulcer has an NG tube in place, and the health care provider orders 30 ml of aluminum hydroxide/magnesium hydroxide (Maalox) to be instilled through the tube every hour. To evaluate the effectiveness of this treatment, the nurse

Accepted Answer

A)  periodically aspirates and tests gastric pH. 
B)  measures the amount of residual stomach contents hourly. 
C)  monitors arterial blood gas values on a daily basis. 
D)  checks each stool for the presence of occult blood.

Question 4

All the following orders are received for a patient who has been admitted with dehydration after 3 days of nausea and vomiting. Which order will the nurse act on first?

Accepted Answer

A)  Provide oral care with moistened swabs. 
B)  Infuse normal saline at 250 ml/hr. 
C)  Insert a 16-gauge nasogastric (NG) tube. 
D)  Administer IV ondansetron (Zofran).

Question 5

A 22-year-old patient with Escherichia coli O157:H7 food poisoning is admitted to the hospital with bloody diarrhea and dehydration. All of the following orders are received. Which order will the nurse question?

Accepted Answer

A)  Infuse lactated Ringer's 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.

Question 6

A patient recovering from a gastrojejunostomy (Billroth II) for treatment of a duodenal ulcer develops dizziness, weakness, and palpitations, with an urge to defecate about 20 minutes after eating. To avoid recurrence of these symptoms, the nurse teaches the patient to

Accepted Answer

A)  increase the amount of fluid intake with meals. 
B)  lie down for about 30 minutes after eating. 
C)  drink sugared fluids or eat candy after each meal. 
D)  choose foods that are high in carbohydrates.

Question 7

The health care provider orders insertion of a 20-gauge orogastric tube for a patient experiencing massive hematemesis. As the nurse inserts the tube, resistance is met in advancing the tube. The appropriate action by the nurse is to

Accepted Answer

A)  ask the patient to hyperextend the neck. 
B)  stop and notify the health care provider of the resistance. 
C)  inject additional lubricant through the tube. 
D)  withdraw the tube a few inches and then reinsert.

Question 8

A patient who requires daily use of a nonsteroidal antiinflammatory drug (NSAID) for management of severe rheumatoid arthritis has recently developed melena. The nurse will anticipate teaching the patient about

Accepted Answer

A)  the use of ranitidine (Zantac) to decrease the risk for peptic ulcers. 
B)  reasons for using corticosteroids to treat the arthritis. 
C)  substitution of acetaminophen (Tylenol) for the NSAID. 
D)  the benefits of misoprostol (Cytotec) in protecting the GI mucosa.

Question 9

A patient has just arrived on the postoperative unit after having a laparoscopic esophagectomy for treatment of esophageal cancer. Which nursing actions should be included in the postoperative plan of care?

Accepted Answer

A)  Elevate the head of the bed to at least 30 degrees. 
B)  Reposition NG tube if drainage stops or decreases. 
C)  Notify doctor immediately about bloody NG drainage. 
D)  Start oral fluids when patient has active bowel sounds.

Question 10

A patient with acute GI bleeding is receiving normal saline IV at a rate of 500 ml/hr. Which assessment data obtained by the nurse are most important to communicate immediately to the health care provider?

Accepted Answer

A)  The NG suction is returning coffee-ground material. 
B)  The patient's lungs have crackles audible to the midline. 
C)  The patient's BP has increased to 142/94 mm Hg. 
D)  The bowel sounds are very hyperactive in all four quadrants.

Question 11

A patient with chronic gastritis associated with the presence of Helicobacter pylori is treated with triple-drug therapy. The nurse explains to the patient that the drugs commonly included in this regimen include

Accepted Answer

A)  famotidine (Pepcid), magnesium hydroxide (Mylanta), and pantoprazole (Protonix). 
B)  amoxicillin (Amoxil ), clarithromycin (Biaxin), and omeprazole (Prilosec). 
C)  sucralfate (Carafate), nystatin (Mycostatin), and bismuth subsalicylate (Pepto-Bismol). 
D)  metoclopramide (Reglan), bethanechol (Urecholine), and promethazine (Phenergan).

Question 12

The nurse implements discharge teaching for a patient following a gastroduodenostomy for treatment of a peptic ulcer. Which patient statement indicates that the teaching has been effective?

Accepted Answer

A)  "I will need to choose foods that are low in fat and high in carbohydrate." 
B)  "I will try to drink liquids along with my meals." 
C)  "Vitamin injections may be needed to prevent problems with anemia." 
D)  "The surgery has cured my peptic ulcer disease."

Question 13

When the nurse is assessing the mouth of a patient who uses smokeless tobacco for signs of oral cancer, which finding will be of most concern?

Accepted Answer

A)  A 3-mm ulcer on the floor of the mouth 
B)  A red, velvety patch on the buccal mucosa 
C)  White, curdlike plaques on the back of the tongue 
D)  Painful blisters at the border of the lips

Question 14

The nurse suspects the possibility of Escherichia coli O157:H7 food poisoning when several individuals who have eaten in the same restaurant develop

Accepted Answer

A)  fever and chills. 
B)  hemorrhagic diarrhea. 
C)  muscular incoordination. 
D)  nausea and vomiting.

Question 15

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?

Accepted Answer

A)  "I take antacids between meals and at bedtime each night." 
B)  "I quit smoking several years ago, but I still chew a lot of gum." 
C)  "I sleep with the head of the bed elevated on 4-inch blocks." 
D)  "I eat small meals throughout the day and have a bedtime snack."

Question 16

The nurse will instruct the patient with GERD who is being discharged after a Stretta procedure that

Accepted Answer

A)  acetaminophen (Tylenol) tablets can be used for pain. 
B)  postoperative nausea is an expected symptom. 
C)  gelatin, clear broth, and tea are appropriate foods for the next 24 hours. 
D)  intake and output should be measured and reported to the health care provider.

Question 17

A patient who has intermittent epigastric distress, weight loss, and ascites is diagnosed with stomach cancer. The nurse plans care for the patient with the knowledge that these findings indicate that

Accepted Answer

A)  the patient has a poor prognosis with any therapy. 
B)  surgical intervention is not indicated for the patient. 
C)  radiation therapy is the treatment of choice for the patient. 
D)  the patient will need a referral to hospice services.

Question 18

Which information will be best for the nurse to include when teaching a patient with PUD about dietary management of the disease?

Accepted Answer

A)  "You should avoid eating many raw fruits and vegetables." 
B)  "High-protein foods are least likely to cause pain." 
C)  "Avoid foods that cause pain after you eat them." 
D)  "You will need to remain on a bland diet indefinitely."

Question 19

Which information about a patient who has just been admitted to the hospital with nausea and vomiting will require the most rapid intervention by the nurse?

Accepted Answer

A)  The patient has been vomiting several times a day for the last 4 days. 
B)  The patient is lethargic and difficult to arouse. 
C)  The patient's chart indicates a recent resection of the small intestine. 
D)  The patient has taken only sips of water.

Question 20

All of these orders are received for a patient who has vomited 1500 ml of bright red blood. Which order will the nurse act on first?

Accepted Answer

A)  Infuse 1000 ml of lactated Ringer's solution. 
B)  Administer IV famotidine (Pepcid) 40 mg. 
C)  Insert NG tube and connect to suction. 
D)  Type and cross match for 4 units of packed red blood cells.

Exam 42: Nursing Management: Upper Gastrointestinal Problems