# Chapter 29: Care of Patients with Disorders of the Upper Gastrointestinal System My Nursing Test Banks

Chapter 29: Care of Patients with Disorders of the Upper Gastrointestinal System

MULTIPLE CHOICE

1. The nurse explains that the diagnosis of morbidly obese is reserved for people who are ____% above their recommended weight.

 a. 50 b. 70 c. 90 d. 100

ANS: D

Those people who weigh 100% over their recommended weight are considered morbidly obese.

DIF: Cognitive Level: Comprehension REF: 641 OBJ: 1 (theory)

TOP: Obesity: Morbid Obesity KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

2. The nurse calculates the body mass index (BMI) of a man who is 6 feet tall (1.8 meters) and weighs 150 pounds (68.1 kilograms) to be:

 a. 21.0. b. 34.8. c. 43.1. d. 66.3.

ANS: A

The formula to calculate BMI is: weight in kilograms divided by height in meters squared (68.1 kilograms 3.24 meters = 21.0).

DIF: Cognitive Level: Analysis REF: 641 OBJ: 1 (theory)

TOP: BMI: Calculation KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance

3. The nurse explains that the laparoscopic adjustable gastric banding surgery is best described as:

 a. restrictive. b. malabsorptive. c. restrictive/malabsorptive. d. obstructive.

ANS: A

The three types of bariatric surgery are restrictive, malabsorptive, and restrictive/malabsorptive. Laparoscopic adjustable gastric banding is performed by placing an inflatable band around the fundus of the stomach. This procedure may be performed laparoscopically. The band is inflated and deflated via a subcutaneous port to change the size of the stomach as the patient loses weight.

DIF: Cognitive Level: Comprehension REF: 641 OBJ: 1 (theory)

TOP: Restrictive Procedures KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

4. The nurse is discussing bariatric surgery complications with a patient. Which statement by the patient indicates understanding of a common side effect of the procedure?

 a. I understand that gastric ulcers frequently occur in patients who have bariatric surgery. b. Gallstones are a common occurrence in patients who have bariatric surgery. c. I know an umbilical hernia might happen after I have bariatric surgery. d. Unfortunately I may experience gastritis after having bariatric surgery.

ANS: B

Nutritional deficiencies caused by the banding result in the formation of gallstones in a large percentage of bariatric surgery patients. About a third of patients who undergo bariatric surgery develop gallstones.

DIF: Cognitive Level: Comprehension REF: 642 OBJ: 1 (theory)

TOP: Bariatric Surgery: Side Effects KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

5. The nurse is assessing the efficiency of swallowing in a patient with dysphagia. During the assessment, the nurse will use what finding to evaluate the process?

 a. An audible gurgle b. Rising of the larynx c. Tilting of the head backward d. Nodding of the head forward

ANS: B

An effective swallow will be accompanied by the rising of the larynx.

DIF: Cognitive Level: Application REF: 643 OBJ: 6 (theory)

TOP: Dysphagia: Evaluation of the Swallow

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

6. A patient with a gastrostomy tube gets a bolus feeding of 200 mL every 4 hours. Before giving the bolus, the nurse aspirates a residual of 100 mL. After returning the residual to the patient, the nurse should:

 a. give the 200 mL feeding. b. record the residual and give 100 mL of the feeding. c. document the residual and hold the feeding. d. position the patient in high Fowlers and give the feeding.

ANS: C

On finding a large residual, the nurse should return the residual to the patient, document the amount of the residual, and hold the feeding to avoid possible aspiration.

DIF: Cognitive Level: Application REF: 660 OBJ: 7 (theory)

TOP: Gastrostomy Feeding: Evaluating Residual

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

7. The nurse is aware that the major cause of Barretts esophagus is:

 a. esophageal reflux. b. eating hot, spicy foods. c. frequent episodes of vomiting. d. esophageal polyps.

ANS: A

A major cause of Barretts esophagus is esophageal reflux.

DIF: Cognitive Level: Comprehension REF: 645 OBJ: 8 (theory)

TOP: Barretts Esophagus: Etiology KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

8. The nurse evaluates a need for further instruction to the patient with Barretts esophagus when the patient says:

 a. I gave up smoking for my health. b. I can still have a small glass of wine with dinner. c. I am using chewing tobacco instead of smoking. d. I eat slowly and do not lie down after a meal.

ANS: C

Tobacco products of any kind should be eliminated in the treatment of Barretts esophagus.

DIF: Cognitive Level: Analysis REF: 645 OBJ: 4 (theory)

TOP: Barretts Esophagus: Teaching Plan

KEY: Nursing Process Step: Evaluation MSC: NCLEX: Health Promotion and Maintenance

9. The patient who had an esophagoenterostomy 3 days ago becomes dyspneic and complains of substernal pain. The nurse suspects the patient has:

 a. a suture line leak into the mediastinum. b. an accumulation of gas in the stomach. c. a myocardial infarct. d. esophageal reflux.

ANS: A

The symptoms of substernal pain and dyspnea may indicate that there is a leak in the suture line and fluid has leaked into the mediastinum.

DIF: Cognitive Level: Application REF: 645 OBJ: 2 (clinical)

TOP: Esophagoenterostomy: Complications

KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance

10. For the patient with a hiatal hernia, the nurse recommends avoidance of fats because fats:

 a. relax the sphincter, allowing reflux. b. may cause nausea and vomiting. c. cause hypermobility of the colon. d. may initiate the strangulation of the hernia.

ANS: A

Hiatal hernia is the result of a defect in the wall of the diaphragm where the esophagus passes through. A hiatal hernia is formed by the protrusion of part of the stomach or the lower part of the esophagus up into the thoracic cavity. Intake of alcohol, chocolate, caffeine, and fatty food is limited, and smoking should be avoided. Ingestion of fats relaxes the sphincter, allowing reflux.

DIF: Cognitive Level: Application REF: 645 OBJ: 7 (theory)

TOP: Hiatal Hernia: Avoidance of Fats KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

11. The nurse will encourage the patient who has gastroesophageal reflux disease (GERD) to modify her diet by:

 a. avoiding garlic. b. drinking carbonated beverages with meals. c. using a straw to drink all fluids. d. eating three meals regularly spaced apart.

ANS: A

Avoiding highly seasoned or spicy food should be incorporated into diet changes for the patient with GERD. The avoidance of carbonated beverages with meals and the use of a straw do not reduce the impact of GERD. The frequency of dietary intake does not influence GERD.

DIF: Cognitive Level: Application REF: 645 OBJ: 1 (clinical)

TOP: GERD: Diet Modification KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

12. The nurse preparing a teaching plan for lifestyle changes for the patient with GERD would include:

 a. sleeping on the right side on a flat bed. b. wearing tight belts to reduce reflux. c. lying down after each meal for 20 minutes. d. smoking cessation.

ANS: D

Smoking stimulates gastric secretion. The patient with GERD should wait at least 2 hours after a meal to lie down and should sleep with the head of the bed elevated 4 to 6 inches. The patient should avoid restrictive clothing.

DIF: Cognitive Level: Comprehension REF: 645 OBJ: 1 (clinical)

TOP: GERD: Lifestyle Changes KEY: Nursing Process Step: Planning

MSC: NCLEX: Health Promotion and Maintenance

13. The nurse is aware that patients who have chronic gastritis from renal failure may present with the first sign of this disorder as:

 a. an increase in the WBC count. b. sudden massive hemorrhage. c. asthma-like symptoms. d. extreme dyspnea.

ANS: B

Sudden massive GI hemorrhage may be the first indication of chronic gastritis. Many of these patients do not have any symptoms at all until the hemorrhage.

DIF: Cognitive Level: Comprehension REF: 649-650 OBJ: 5 (theory)

TOP: Chronic Gastritis: Signs KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

14. The nurse would question an order for esomeprazole (Nexium) for the patient who is:

 a. taking digoxin. b. noncompliant. c. asthmatic. d. on chemotherapy for cancer.

ANS: A

Esomeprazole (Nexium) interferes with the absorption of digoxin, rabeprazole, and iron salts. In addition, the Food and Drug Administration (FDA) has issued a warning that long-term use of the proton pump inhibitors esomeprazole (Nexium) or omeprazole (Prilosec) may increase the risk of heart problems.

DIF: Cognitive Level: Application REF: 647 OBJ: 5 (theory)

TOP: Gastritis: Contraindications for Esomeprazole

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

15. The nurse is caring for a patient who is being treated for extensive burns. The nurse notes the presence of coffee-ground material in the Salem sump catheter. The nurse correctly recognizes that the probable cause is:

 a. esophagitis. b. perforated gastric ulcer. c. gastric irritation from the Salem sump tube. d. a physiologic stress ulcer.

ANS: D

Blood that has been in contact with gastric juices looks like coffee grounds. The physiologic stress ulcer appears in patients who are severely stressed by extensive trauma for a lengthy period of time. Prolonged physiologic stress produces what is known as a physiologic stress ulcer, which is believed to be the result of unrelieved stimulation of the vagus nerve and decreased perfusion to the stomach. A stress ulcer is pathologically and clinically different from a chronic peptic ulcer. It is more acute and more likely to produce hemorrhage.

DIF: Cognitive Level: Application REF: 650 OBJ: 7 (theory)

TOP: Physiologic Stress Ulcer: Signs KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance

16. For the patient who is taking daily doses of ibuprofen for arthritis, the amount of nonsteroidal anti-inflammatory drugs (NSAIDs) such as acetaminophen should be limited, in order to prevent a peptic ulcer, to a daily intake of _____ tablets of 500 mg.

 a. 2 b. 3 c. 4 d. 5

ANS: C

There is an increased risk of peptic ulcer in individuals taking regular doses of over-the-counter (OTC) NSAIDs such as ibuprofen and naproxen. When combined with more than 2 g of acetaminophen per day, the risk increases. Daily doses of acetaminophen over 2 g along with other NSAIDs increase the risk of upper GI bleeding by twofold.

DIF: Cognitive Level: Application REF: 650 OBJ: 6 (theory)

TOP: NSAIDs: Etiology of Peptic Ulcer KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

17. The nurse documenting the presence of pain in a patient with possible gastric ulcer would anticipate that the pain would occur:

 a. in the morning. b. erratically, without pattern. c. at bedtime. d. with meals.

ANS: C

Pain occurs at bedtime because the stomach is empty but the gastric juices are still high. Pain is absent in the morning when the digestive juices are low and when the stomach is filled with food.

DIF: Cognitive Level: Comprehension REF: 651 OBJ: 6 (theory)

TOP: Gastric Ulcer: Pain Cycle KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

18. When the patient with a Salem sump tube for decompression complains of feeling full and has dyspnea and nausea, the initial intervention by the nurse should be to:

 a. increase the amount of suction from low to high. b. notify the charge nurse. c. irrigate the tube with normal saline. d. pull the tube out about 3 inches.

ANS: C

Irrigation of the tube to restore patency is the first intervention when assessment indicates inadequate decompression. The suction should remain on low. Pulling the tube out may cause inappropriate placement. Irrigating an obstructed sump tube is a standard of care.

DIF: Cognitive Level: Analysis REF: 658 OBJ: 3 (clinical)

TOP: Salem Sump Tube: Obstruction KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

19. The nurse is caring for a patient who is being treated for a gunshot wound to the abdomen. The patient is receiving total parenteral nutrition (TPN). The physician has prescribed insulin coverage on a sliding scale. The patient reports he has never had diabetes before. What response by the nurse is indicated?

 a. It is likely you have developed diabetes as a result of your illness. b. Do you have a family history for diabetes? c. The TPN you are receiving has high amounts of glucose. d. Insulin is needed to manage your stomachs inability to adequately metabolize food at this time.

ANS: C

People on TPN are prone to hyperglycemia from the high glucose content of the solution.

DIF: Cognitive Level: Application REF: 660 OBJ: 5 (clinical)

TOP: TPN: Hyperglycemia KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

20. A patient who had gastric bypass surgery 5 weeks ago calls the office to report feelings of nausea, sweating, and diarrhea shortly after eating meals. What response by the nurse is most appropriate?

 a. This is common after the type of surgery you had. b. Try to eat your meals slower to promote absorption. c. Reduce the amount of refined sugars that you are eating. d. You may be experiencing a postoperative infection.

ANS: C

Patients who have had gastric bypass surgery are at risk for dumping syndrome, which results in nausea, weakness, sweating, and diarrhea. These symptoms tend to occur after meals that include concentrated sweets; therefore patients should be advised to avoid refined sugars. Although this is not an uncommon manifestation after this type of surgery, informing the patient that this is common provides limited information to the patient and is not the best response. Reducing the speed of eating will not provide relief from the problems being described. This is not a symptom of a postoperative infection.

DIF: Cognitive Level: Application REF: 642 OBJ: 2 (clinical)

TOP: Gastric Bypass: Complications KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

21. The nurse is caring for a patient who is suspected of having oral cancer. When reviewing the patients health history, which finding provides supportive data for the diagnosis?

 a. Presence of leukoplakia b. History of oral herpes simplex c. History of an oral yeast infection d. Reports of a dry oral cavity

ANS: A

Leukoplakia, a precancerous lesion, may occur on the tongue or mucosa.

DIF: Cognitive Level: Application REF: 644 OBJ: 2 (theory)

TOP: Gastric Bypass: Complications KEY: Nursing Process Step: Diagnosis

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

MULTIPLE RESPONSE

22. The nurse correctly recognizes that esophageal cancer is associated with: (Select all that apply.)

 a. cigarette smoking. b. diabetes. c. hypertension. d. heavy alcohol use. e. smokeless tobacco.

ANS: A, D, E

Cigarette smoking is a major cause of esophageal cancer in the United States. When combined with heavy alcohol consumption, the risk for esophageal cancer greatly increases. Both substances are irritants to the mucosa of the esophagus. Smokeless tobacco is also associated with esophageal cancer.

DIF: Cognitive Level: Comprehension REF: 645 OBJ: 2 (theory)

TOP: Cancer of the Esophagus: Etiology and Pathophysiology

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

23. The nurse instructs the patient on the weight reduction drug sibutramine (Meridia) that side effects will include: (Select all that apply.)

 a. dry mouth. b. hypoglycemia. c. constipation. d. facial rash. e. insomnia.

ANS: A, C, E

Sibutramine (Meridia) is a commonly used appetite suppressant. It is a selective serotonin reuptake inhibitor, which enhances the feeling of fullness when eating. Drug suppressants increase metabolism and cause dry mouth, constipation, and insomnia.

DIF: Cognitive Level: Comprehension REF: 641 OBJ: 1 (theory)

TOP: Appetite Suppressants: Side Effects

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

24. The nurse explains that the medically supervised approach to weight reduction will include: (Select all that apply.)

 a. medications to suppress the appetite. b. an exercise program. c. participation in a support group. d. stress reduction. e. change in concepts about food.

ANS: B, C, D, E

Medications to suppress the appetite are not typically a part of medically supervised weight reduction programs. All other options listed will be part of the medically supervised weight reduction program.

DIF: Cognitive Level: Comprehension REF: 641 OBJ: 1 (theory)

TOP: Weight Loss Programs: Characteristics

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

25. The nurse is presenting a program discussing bulimia nervosa to a group of student nurses. After the program, the participants correctly identify the methods of treatment including: (Select all that apply.)

 a. antianxiety mediations. b. antidepressant medications. c. psychotherapy. d. behavior modification. e. increased exercise.

ANS: B, C, D

Bulimia nervosa is a psychological disorder. The bulimic patient consumes large quantities of food and then induces vomiting to get rid of it so that weight is not gained. Laxatives may be taken to purge the system after an eating binge. Some patients with anorexia nervosa also are bulimic. Some individuals practice bulimia occasionally, without harm. When it is practiced frequently, it can lead to severe fluid and electrolyte imbalances, starvation, and death. Treatment of bulimia includes psychotherapy, antidepressant medication, and behavior modification.

DIF: Cognitive Level: Application REF: 640 OBJ: 2 (clinical)

TOP: Bulimia Nervosa: Characteristics KEY: Nursing Process Step: Evaluation

MSC: NCLEX: Health Promotion and Maintenance

26. To assist the patient with dysphagia to eat a meal, the nurse can: (Select all that apply.)

 a. encourage practice swallowing before the meal. b. coach the patient to chew thoroughly. c. assist the patient to sit upright with the head forward and chin tucked. d. offer fluid during the meal. e. give the patient thin liquids, such as water.

ANS: A, B, C, D

Thickened liquids should be administered to a patient with dysphagia. All other options listed would be assistive to the person with dysphagia.

DIF: Cognitive Level: Application REF: 643 OBJ: 6 (theory)

TOP: Dysphagia: Techniques to Assist KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

27. The nurse caring for a 70-year-old patient with gastroenteritis following a camping trip to Mexico would anticipate which signs and symptoms? (Select all that apply.)

 a. Positive stool culture for Giardia or Shigella b. Abdominal cramping c. Fat in the stool d. Mucus in stool e. Blood in stool

ANS: A, B, D, E

Fat in the stool is not symptomatic of gastroenteritis.

DIF: Cognitive Level: Application REF: 649 OBJ: 5 (theory)

TOP: Gastroenteritis: Signs and Symptoms

KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

COMPLETION

28. The nurse cautions that increased morbidity from hypertension and cardiac disease, even in children, is related to the modifiable risk factor of __________.

ANS:

obesity

Obesity contributes to the morbidity of hypertension and cardiac disease. There are 300,000 deaths a year attributed to hypertension and cardiac diseases in the obese.

DIF: Cognitive Level: Comprehension REF: 640-641 OBJ: 1 (theory)

TOP: Obesity: Morbidity KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

29. The nurse demonstrates that the person whose recommended weight is 150 pounds based on height, age, and body type would be considered obese if the person weighed a minimum of ______ pounds.

ANS:

180

A person is considered obese if his or her weight exceeds 20% of the recommended weight for his or her height, age, and body type. (Recommended weight of 150 pounds .20 is 30 pounds; 150 pounds + 30 pounds = 180 pounds.)

DIF: Cognitive Level: Application REF: 641 OBJ: 1 (theory)

TOP: Obesity: Calculation KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance