Question 1

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

Accepted Answer

A)   substitution of acetaminophen ( Tylenol )  for the NSAID.
B)   use of enteric-coated NSAIDs to reduce gastric irritation.
C)   reasons for using corticosteroids to treat the rheumatoid arthritis.
D)   the benefits of misoprostol ( Cytotec )  in protecting the gastrointestinal ( GI )  mucosa. D

Question 2

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

Accepted Answer

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. D

Question 3

The health care provider orders intravenous ( IV ) ranitidine ( Zantac ) for a patient with gastrointestinal ( GI ) bleeding caused by peptic ulcer disease. When teaching the patient about the effect of the medication, which information will the nurse include?

Accepted Answer

A)   "Ranitidine decreases secretion of gastric acid."
B)   "Ranitidine neutralizes the acid in the stomach."
C)   "Ranitidine constricts the blood vessels in the stomach and decreases bleeding."
D)   "Ranitidine covers the ulcer with a protective material that promotes healing." A

Question 4

A patient who is nauseated and vomiting up blood-streaked fluid is admitted to the hospital with acute gastritis. To determine possible risk factors for gastritis, the nurse will ask the patient about

Accepted Answer

A)   the amount of fat in the diet.
B)   history of recent weight gain or loss.
C)   any family history of gastric problems.
D)   use of nonsteroidal anti-inflammatory drugs (NSAIDs) .

Question 5

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

Accepted Answer

A)   apical pulse.
B)   bowel sounds.
C)   breath sounds.
D)   abdominal girth.

Question 6

To decrease the risk for cancers of the tongue and buccal mucosa, which information will the nurse include when teaching a patient who is seen for an annual physical exam in the outpatient clinic?

Accepted Answer

A)   Avoid use of cigarettes and smokeless tobacco.
B)   Use sunscreen when outside even on cloudy days.
C)   Complete antibiotics used to treat throat infections.
D)   Use antivirals to treat herpes simplex virus (HSV)  infections.

Question 7

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

Accepted Answer

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

Question 8

A patient is hospitalized with vomiting of "coffee-ground" emesis. The nurse will anticipate preparing the patient for

Accepted Answer

A)   endoscopy.
B)   angiography.
C)   gastric analysis testing.
D)   barium contrast studies.

Question 9

The health care provider prescribes antacids and sucralfate (Carafate) for treatment of a patient's peptic ulcer. The nurse will teach the patient to take

Accepted Answer

A)   antacids 30 minutes before the sucralfate.
B)   sucralfate at bedtime and antacids before meals.
C)   antacids after eating and sucralfate 30 minutes before eating.
D)   sucralfate and antacids together 30 minutes before each meal.

Question 10

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

Accepted Answer

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

Question 11

A patient who is receiving chemotherapy develops a Candida albicans oral infection. The nurse will anticipate the need for

Accepted Answer

A)   hydrogen peroxide rinses.
B)   the use of antiviral agents.
C)   referral to a dentist for professional tooth cleaning.
D)   administration of nystatin (Mycostatin)  oral tablets.

Question 12

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)   Bleeding during tooth brushing
B)   Painful blisters at the border of the lips
C)   Red, velvety patches on the buccal mucosa
D)   White, curdlike plaques on the posterior tongue

Question 13

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)   "Persistent heartburn is expected after surgery."
B)   "I will try to drink liquids along with my meals."
C)   "Vitamin supplements may be needed to prevent problems with anemia."
D)   "I will need to choose foods that are low in fat and high in carbohydrate."

Question 14

A patient with a recent 20-pound unintended weight loss is diagnosed with stomach cancer. Which nursing action will be included in the plan of care?

Accepted Answer

A)   Refer the patient for hospice services.
B)   Infuse IV fluids through a central line.
C)   Teach the patient about antiemetic therapy.
D)   Offer supplemental feedings between meals.

Question 15

A patient who recently has been experiencing frequent heartburn is seen in the clinic. The nurse will anticipate teaching the patient about

Accepted Answer

A)   barium swallow.
B)   radionuclide tests.
C)   endoscopy procedures.
D)   proton pump inhibitors.

Question 16

The nurse will plan to teach the patient with newly diagnosed achalasia that

Accepted Answer

A)   a liquid or blenderized diet will be necessary.
B)   drinking fluids with meals should be avoided.
C)   endoscopic procedures may be used for treatment.
D)   lying down and resting after meals is recommended.

Question 17

The health care provider prescribes the following therapies for a patient who has been admitted with dehydration and hypotension after 3 days of nausea and vomiting. Which order will the nurse implement first?

Accepted Answer

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

Question 18

A patient who has had several episodes of bloody diarrhea is admitted to the emergency department. Which action should the nurse anticipate taking?

Accepted Answer

A)   Obtain a stool specimen for culture.
B)   Administer antidiarrheal medications.
C)   Teach about adverse effects of nonsteroidal anti-inflammatory drugs (NSAIDs) .
D)   Provide education about antibiotic therapy.

Question 19

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

Accepted Answer

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

Question 20

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?

Accepted Answer

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.

Exam 42: Nursing Management: Upper Gastrointestinal Problems