The nurse is performing an admission assessment on a client diagnosed with GERD

Disorders

1. A nurse is caring for a patient who just has been diagnosed with a peptic ulcer. When teachinpatient about his new diagnosis, how should the nurse best describe a peptic ulcer? g the A) Inflammation of the lining of the stomach B) Erosion of the lining of the stomach or intestine C) Bleeding from the mucosa in the stomach D) Viral invasion of the stomach wall Ans: B Feedback: A peptic ulcer is erosion of the lining of the stomach or intestine. Peptic ulcers are bleeding and inflammation, but these are not the definitive characteristics. often accompanied by
2. A patient comes to the clinic complaining of pain in the epigastric region. What assessduring the health interview would most help the nurse determine if the patient has a peptic ment questionulcer? A) Does your pain resolve when you have something to eat? B) Do over-the-counter pain medications help your pain? C) Does your pain get worse if you get up and do some exercise? D) Do you find that your pain is worse when you need to have a bowel movement? Ans: A Feedback: Pain relief after eating is associated with duodenal ulcers. The pain of peptic ulceunrelated to activity or bowel function and may or may not respond to analgesics is generally
3. A patient with a diagnosis of peptic ulcer disease has just been prescribed omeprazoshould the nurse best describe this medications therapeutic action? le (Prilosec). How A) This medication will reduce the amount of acid secreted in your stomach.

B) This medication will make the lining of your stomach more resistant to damage. C) This medication will specifically address the pain that accompanies peptic ulcer disease. D) This medication will help your stomach lining to repair itself. Ans: A Feedback: Proton pump inhibitors like Prilosec inhibit the synthesis of stomach acid. PPIs do not increadurability of the stomach lining, relieve pain, or stimulate tissue repair. se the

1. A nurse is admitting a patient diagnosed with late-stage gastric cancer. The patiand angry that she was not diagnosed earlier in the course of her disease. What factor contrients family is distraughtbutes to the fact that gastric cancer is often detected at a later stage? A) Gastric cancer does not cause signs or symptoms until metastasis has occurred. B) Adherence to screening recommendations for gastric cancer is exceptionally low. C) Early symptoms of gastric cancer are usually attributed to constipation. D) The early symptoms of gastric cancer are usually not alarming or highly unusual. Ans: D Feedback: Symptoms of early gastric cancer, such as pain relieved by antacids, resemble those of are seldom definitive. Symptoms are rarely a cause for alarm or for detailed diagnostic testing ulcers and Symptoms precede metastasis, however, and do not include constipation.
2. A nurse is preparing to discharge a patient after recovery from gastric surgery. Whatdischarge outcome for this patient? is an appropriate

A) The patients bowel movements maintain a loose consistency. B) The patient is able to tolerate three large meals a day. C) The patient maintains or gains weight. D) The patient consumes a diet high in calcium.

Nicotine reduces secretion of pancreatic bicarbonate, which inhibits neutralizatcan underlie gastritis. Protein drinks do not result in gastric inflammation. Antacidion of gastric acid and use is a response to experiencing symptoms of gastritis, not the etiology of gastritis. Alcohol ingestion can leahowever, this generally occurs in patients with a history of consumption of alcohol on a daily basisd to gastritis;.

1. A nurse in the postanesthesia care unit admits a patient following resection of a gasimmediate recovery, the patient should be placed in which position to facilitate patientric tumor. Followingt comfort and gastric emptying? A) Fowlers B) Supine C) Left lateral D) Left Sims Ans: A Feedback: Positioning the patient in a Fowlers position postoperatively promotes comfort and faciliof the stomach following gastric surgery. Any position that involves lying down delays stomachtates emptying emptying and is not recommended for this type of patient. Supine positioning and the left lateral Sims) position do not achieve this goal. (left

2. A community health nurse is preparing for an initial home visit to a patient discharged fogastrectomy for treatment of gastric cancer. What would the nurse anticipate that the plan of care is mostllowing a total likely to include? A) Enteral feeding via gastrostomy tube (G tube) B) Gastrointestinal decompression by nasogastric tube C) Periodic assessment for esophageal distension D) Monthly administration of injections of vitamin B 12 Ans: D Feedback: Since vitamin Bpernicious anemia. A gastrectomy precludes the use of a G tube. Since the stomach is abse 12 is absorbed in the stomach, the patient requires vitamin B 12 replacement to preventnt, a nasogastric tube would not be indicated. As well, this is not possible in the home setting. Sinceno stomach to act as a reservoir and fluids and nutrients are passing directly into the jejunum, distension there is

is unlikely. 10. A nurse is assessing a patient who has peptic ulcer disease. The patient requests the typical causes of Helicobacter pylori infection. What would it be appropriate for the nurse to instructmore information about the patient? A) Most affected patients acquired the infection during international travel. B) Infection typically occurs due to ingestion of contaminated food and water. C) Many people possess genetic factors causing a predisposition to H. pylori infection. D) The H. pylori microorganism is endemic in warm, moist climates. Ans: B Feedback: Most peptic ulcers result from infection with the gram-negative bacteria acquired through ingestion of food and water. The organism is endemic to all areas of the UnitedH. pylori, which may be States. Genetic factors have not been identified. 11. A patient who experienced an upper GI bleed due to gastritis has had the bleeding controlled and thepatients condition is now stable. For the next several hours, the nurse caring for this patient should assess for what signs and symptoms of recurrence? A) Tachycardia, hypotension, and tachypnea B) Tarry, foul-smelling stools C) Diaphoresis and sudden onset of abdominal pain D) Sudden thirst, unrelieved by oral fluid administration Ans: A Feedback: Tachycardia, hypotension, and tachypnea are signs of recurrent bleeding. Patients who have had one GIbleed are at risk for recurrence. Tarry stools are expected short-term findings after a hemorrhage. Hemorrhage is not normally associated with sudden thirst or diaphoresis. 12. A patient presents to the walk-in clinic complaining of vomiting and burning in her mid-epigastnurse knows that in the process of confirming peptic ulcer disease, the physician is likely to order aria. The diagnostic test to detect the presence of what? A) Infection with Helicobacter pylori

Ans: A Feedback: A severe form of acute gastritis is caused by the ingestion of strong acid or alkali, whicmucosa to become gangrenous or to perforate. Scarring can occur, resulting in pyloric stenosish may cause the (narrowing or tightening) or obstruction. Chronic referred pain to the lower abdomen is a symptom peptic ulcer disease, but would not be an expected finding for a patient who has ingested a corrosiveof substance. Bacterial proliferation and hyperacidity would not occur. 15. A patient who underwent gastric banding 3 days ago is having her diet progressed on a daily basis her latest meal, the patient complains of dizziness and palpitations. Inspection reveals that the patient is diaphoretic. What is the nurses best action? A) Insert a nasogastric tube promptly. B) Reposition the patient supine. C) Monitor the patient closely for further signs of dumping syndrome. D) Assess the patient for signs and symptoms of aspiration. Ans: C Feedback: The patients symptoms are characteristic of dumping syndrome, which results in a sensaweakness, faintness, dizziness, palpitations, diaphoresis, cramping pains, and diarrhea. Aspiration is ation of fullness, less likely cause for the patients symptoms. Supine positioning will likely exacerbateinsertion of an NG tube is contraindicated due to the nature of the patients surgery. the symptoms and

1. A patient is one month postoperative following restrictive bariatric surgery. The patnurse that he has been having trouble swallowing for the past few days. What recommendation shouldient tells the clinic the nurse make? A) Eating more slowly and chewing food more thoroughly B) Taking an OTC antacid or drinking a glass of milk prior to each meal C) Chewing gum to cause relaxation of the lower esophageal sphincter D) Drinking at least 12 ounces of liquid with each meal Ans: A

Feedback: Dysphagia may be prevented by educating patients to eat slowly, to chew food thoroughly, and to avoideating tough foods such as steak or dry chicken or doughy bread. After bariatric procedures, patients should normally not drink beverages with meals. Medications or chewing gum will not alleviateproblem. this

1. A patient is receiving education about his upcoming Billroth I procedure (gastroduodenostomy). Thpatient should be informed that he may experience which of the following adverse effects associatedis with this procedure? A) Persistent feelings of hunger and thirst B) Constipation or bowel incontinence C) Diarrhea and feelings of fullness D) Gastric reflux and belching Ans: C Feedback: Following a Billroth I, the patient may have problems with feelings of fullness, dumping syndromediarrhea. Hunger and thirst, constipation, and gastric reflux are not adverse effects associated with this, and procedure.
2. A patient has experienced symptoms of dumping syndrome following bariatric surgery. To whatphysiologic phenomenon does the nurse attribute this syndrome?

A) Irritation of the phrenic nerve due to diaphragmatic pressure B) Chronic malabsorption of iron and vitamins A and C C) Reflux of bile into the distal esophagus D) A sudden release of peptides Ans: D Feedback: For many years, it had been theorized that the hypertonic gastric food boluses that quickly transithe intestines drew extracellular fluid from the circulating blood volume into the small intestines tot into dilute the high concentration of electrolytes and sugars, resulting in symptoms. Now, it is ththis rapid transit of the food bolus from the stomach into the small intestines instead causes a rapid andought that

1. A nurse is providing anticipator guidance to a patient who is preparing for bariatric surgerlearns that the patient is anxious about numerous aspects of the surgery. What intervention isy. The nurse most appropriate to alleviate the patients anxiety? A) Emphasize the fact that bariatric surgery has a low risk of complications. B) Encourage the patient to focus on the benefits of the surgery. C) Facilitate the patients contact with a support group. D) Obtain an order for a PRN benzodiazepine. Ans: C Feedback: Support groups can be highly beneficial in relieving preoperative and postoperative anxiety and inpromoting healthy coping. This is preferable to antianxiety medications. Downplaying the risks of surgery or focusing solely on the benefits is a simplistic and patronizing approach.

2. A patient has just been diagnosed with acute gastritis after presenting in distresdepartment with abdominal symptoms. What would be the nursing care most needed by the patient ats to the emergency this time? A) Teaching the patient about necessary nutritional modification B) Helping the patient weigh treatment options C) Teaching the patient about the etiology of gastritis D) Providing the patient with physical and emotional support Ans: D Feedback: For acute gastritis, the nurse provides physical and emotional support and helps the patient masymptoms, which may include nausea, vomiting, heartburn, and fatigue. The scenario describes a newnage thely diagnosed patient; teaching about the etiology of the disease, lifestyle modifications, or treatment options would be best provided at a later time. various

3. A nurse is providing care for a patient who is postoperative day 2 following gastric surgery. The assessment should be planned in light of the possibility of what potential complications? Select all thatnurses apply. A) Malignant hyperthermia

B) Atelectasis C) Pneumonia D) Metabolic imbalances E) Chronic gastritis Ans: B, C, D Feedback: After surgery, the nurse assesses the patient for complications secondary to the surgsuch as pneumonia, atelectasis, or metabolic imbalances resulting from the GI disruption. Malignantical intervention, hyperthermia is an intraoperative complication. Chronic gastritis is not a surgical complication. 24. A patient is undergoing diagnostic testing for a tumor of the small intestine. What are symptoms that prompted the patient to first seek care? the most likely

A) Hematemesis and persistent sensation of fullness B) Abdominal bloating and recurrent constipation C) Intermittent pain and bloody stool D) Unexplained bowel incontinence and fatty stools Ans: C Feedback: When the patient is symptomatic from a tumor of the small intestine, benign tumors oftenintermittent pain. The next most common presentation is occult bleeding. The other listed signs and present with symptoms are not normally associated with the presentation of small intestinal tumors. 25. A patient is recovering in the hospital following gastrectomy. The nurse notes that the patbecome increasingly difficult to engage and has had several angry outbursts at various staffient has members in recent days. The nurses attempts at therapeutic dialogue have been rebuffed. What is the appropriate action? nurses most

A) Ask the patients primary care provider to liaise between the nurse and the patient. B) Delegate care of the patient to a colleague. C) Limit contact with the patient in order to provide privacy.

An extremely tender and rigid (boardlike) abdomen is suggestive of a perforated ulcer. None of listed signs and symptoms is suggestive of a perforated ulcer. the other

1. Diagnostic imaging and physical assessment have revealed that a patient with pepticsuffered a perforated ulcer. The nurse recognizes that emergency interventions must ulcer disease hasbe performed as soon as possible in order to prevent the development of what complication? A) Peritonitis B) Gastritis C) Gastroesophageal reflux D) Acute pancreatitis Ans: A Feedback: Perforation is the erosion of the ulcer through the gastric serosa into the peritoneal cawarning. Chemical peritonitis develops within a few hours of perforation and is followed by bacvity withoutterial peritonitis. Gastritis, reflux, and pancreatitis are not acute complications of a perforated ulcer.
2. A nurse is performing the admission assessment of a patient whose high body mass index (BMIcorresponds to class III obesity. In order to ensure empathic and patient-centered care, the nurse should) do which of the following? A) Examine ones own attitudes towards obesity in general and the patient in particular. B) Dialogue with the patient about the lifestyle and psychosocial factors that resulted in obesity. C) Describe ones own struggles with weight gain and weight loss to the patient. D) Elicit the patients short-term and long-term goals for weight loss. Ans: A Feedback: Studies suggest that health care providers, including nurses, harbor negative attitudes towapatients. Nurses have a responsibility to examine these attitudes and change them accordingly. This isrds obese foundational to all other areas of assessing this patient.
3. A patient has been prescribed orlistat (Xenical) for the treatment of obesity. When providing relevant

health education for this patient, the nurse should ensure the patient is aware of what poteneffect of treatment? tial adverse

A) Bowel incontinence B) Flatus with oily discharge C) Abdominal pain D) Heat intolerance Ans: B Feedback: Side effects of orlistat include increased frequency of bowel movements, gas with oildecreased food absorption, decreased bile flow, and decreased absorption of some vitamins. Thy discharge,is drug does not cause bowel incontinence, abdominal pain, or heat intolerance. 31. A patient who is obese has been unable to lose weight successfully using lifestyle modifimentioned the possibility of using weight-loss medications. What should the nurse teach the patcations and hasient about pharmacologic interventions for the treatment of obesity? A) Weight loss drugs have many side effects, and most doctors think theyll all be off the markfew years. et in a

B) There used to be a lot of hope that medications would help people lose weight, but its been shownto be mostly a placebo effect.

C) Medications can be helpful, but few people achieve and maintain their desired weight lomedications alone. ss with

D) Medications are rapidly become the preferred method of weight loss in people for whom dieexercise have not worked. t and

Ans: C Feedback: Though antiobesity drugs help some patients lose weight, their use rarely results in loss of 10% of total body weight. Patients are consequently unlikely to attain their desired weight thmore thanrough medication alone. They are not predicted to disappear from the market and results are not placebo effect. attributed to a

1. A patient has been diagnosed with peptic ulcer disease and the nurse is reviewing his presmedication regimen with him. What is currently the most commonly used drug regimen for pepticcribed ulcers?

C) The nurse provides detailed and accurate information about the disease. D) The nurse closely observes the patients body language. Ans: B Feedback: Encouraging the patient to discuss his or her fears and anxieties is usually the best way topatients anxiety. Presenting hypothetical situations is a surreptitious and possibly inaccurate way of assess a assessing anxiety. Observing body language is part of assessment, but it is not the complete asPresenting information may alleviate anxiety for some patients, but it is not an assessment. sessment.

1. A patient has received a diagnosis of gastric cancer and is awaiting a surgical datpreoperative period, the patient should adopt what dietary guidelines? e. During the

A) Eat small, frequent meals with high calorie and vitamin content. B) Eat frequent meals with an equal balance of fat, carbohydrates, and protein. C) Eat frequent, low-fat meals with high protein content. D) Try to maintain the pre-diagnosis pattern of eating. Ans: A Feedback: The nurse encourages the patient to eat small, frequent portions of nonirritating foods to decrirritation. Food supplements should be high in calories, as well as vitamins A and C and iron, to enease gastrichance tissue repair. 36. A nurse is caring for a patient who has a diagnosis of GI bleed. During shift assessment,the patient to betachycardic and hypotensive, and the patient has an episode of hematemesis wh the nurse findsile the nurse is in the room. In addition to monitoring the patients vital signs and level of conscious, what wouldbe a priority nursing action for this patient?

A) Place the patient in a prone position. B) Provide the patient with ice water to slow any GI bleeding. C) Prepare for the insertion of an NG tube. D) Notify the physician.

Ans: D Feedback: The nurse must always be alert for any indicators of hemorrhagic gastritis, which incl(vomiting of blood), tachycardia, and hypotension. If these occur, the physician is notified and theude hematemesis patients vital signs are monitored as the patients condition warrants. Putting the patiposition could lead to aspiration. Giving ice water is contraindicated as it would stimuent in a pronelate more vomiting. 37. A nurse is caring for a patient hospitalized with an exacerbation of chronic gastritipromotion topic should the nurse emphasize? s. What health

A) Strategies for maintaining an alkaline gastric environment B) Safe technique for self-suctioning C) Techniques for positioning correctly to promote gastric healing D) Strategies for avoiding irritating foods and beverages Ans: D Feedback: Measures to help relieve pain include instructing the patient to avoid foods and beverages thatirritating to the gastric mucosa and instructing the patient about the correct use of medications to relieve may be chronic gastritis. An alkaline gastric environment is neither possible nor desirableneed for self-suctioning. Positioning does not have a significant effect on the presence or ab. There is no plausiblesence of gastric healing. 38. A patient with gastritis required hospital treatment for an exacerbation of sympsubsequent diagnosis of pernicious anemia due to malabsorption. When planning the patients continuingtoms and receives a care in the home setting, what assessment question is most relevant? A) Does anyone in your family have experience at giving injections? B) Are you going to be anywhere with strong sunlight in the next few months? C) Are you aware of your blood type? D) Do any of your family members have training in first aid? Ans: A Feedback:

Palpable nodules around the umbilicus, called Sister Mary Josephs nodules, are a sign of a GImalignancy, usually a gastric cancer. This would not be a sign of dumping syndrome, peptic ulcer disease, or esophageal/gastric obstruction.

Which instruction should be discussed with the client diagnosed with gastroesophageal reflux disease GERD?

What is the assessment of GERD?

In what position should the nurse place a client diagnosed with gastric reflux?

Which symptoms should be assessed for in a patient suspected of having GERD?