Chapter 49Upper Gastrointestinal Tract Dysfunction: Nursing Management My Nursing Test Banks

Chapter 49Upper Gastrointestinal Tract Dysfunction: Nursing Management

MULTIPLE CHOICE

1.Before administering an antacid, the nurse should instruct a client that this medication works in the:

1.

blood.

2.

stomach.

3.

small intestine.

4.

esophagus.

ANS: 2

Antacids work in the stomach to neutralize stomach acids. They do not work in the esophagus or small intestines. Antacids do not work in the blood.

PTS: 1 DIF: Apply REF: Gastroesophageal Reflux Disease: Pharmacology

2.The nurse is assessing a client diagnosed with gastroesophageal reflux disease. Which of the following should be included in this assessment?

1.

Degree of mouth burning

2.

Difficulty swallowing

3.

Presence of pyrosis

4.

Painful swallowing

ANS: 3

Mouth burning is not a symptom of gastroesophageal reflux disease. Difficulty swallowing or dysphagia is not associated with gastroesophageal reflux disease. Pain when swallowing is associated with esophagitis, not acid reflux disease. Presence of pyrosis or heartburn should be assessed in this client.

PTS: 1 DIF: Apply REF: Gastroesophageal Reflux Disease

3.During an assessment, the nurse determines a client is at risk for ulcerative stomatitis and gum disease because the client has a history of:

1.

alcohol intake.

2.

smoking.

3.

kissing.

4.

eating.

ANS: 2

Clients who smoke have seven times the risk of developing gum disease. Alcohol intake increases the risk of throat cancer. Ulcerative stomatitis and gum disease is not associated with kissing or eating.

PTS: 1 DIF: Analyze REF: Disorders of the Oral Cavity

4.A client is diagnosed with a swallowing disorder. The nurse realizes that which type of diet would be indicated for this client? ?

1.

Regular diet

2.

Clear liquid diet

3.

Mechanical soft diet

4.

Low-fat diet

ANS: 3

Some clients may need a pureed diet or mechanical soft diet, especially if their swallowing difficulty is with the oral phase. Some clients may have difficulty swallowing thin liquids and foods that are tough. The client will most likely have difficulty with a regular or low-fat diet.

PTS:1DIF:AnalyzeREFysphagia: Nutrition

5.To support the nutritional needs of a client with dysphagia, the nurse realizes that all of the following are mechanisms to provide enteral feeding EXCEPT:

1.

nasogastric tube.

2.

percutaneous endoscopic gastrostomy (PEG) tube.

3.

jejunostomy tube.

4.

hyperalimentation.

ANS: 4

Hyperalimentation is associated with parenteral nutrition, not enteral nutrition. The others are forms of administration of nutrients into the gastrointestinal tract.

PTS:1DIF:AnalyzeREFysphagia: Nutrition

6.A client is scheduled for diagnostic tests to determine the ability to swallow. Which of the following diagnostic tests will provide the best information regarding this clients status?

1.

Pulse oximetry with water

2.

Esophageal transit scintigraphy

3.

Videofluoroscopy

4.

Esophageal manometry

ANS: 3

The gold standard for evaluation of dysphagia is videofluoroscopy or a modified barium swallow. This test demonstrates the swallowing mechanism. The other tests may be prescribed; however, they do not provide as much information as the videofluoroscopy.

PTS: 1 DIF: Analyze REF: Dysphagia: Diagnostic Tests

7.A client, diagnosed with a hiatal hernia, will experience which of the following symptoms most frequently?

1.

Nausea

2.

Vomiting

3.

Diarrhea

4.

Heartburn

ANS: 4

With a hiatal hernia, stomach acids reflux into the esophagus, causing pain and irritation that the patient will associate with heartburn. Nausea, vomiting, and diarrhea are not symptoms typically associated with a hiatal hernia.

PTS:1DIF:Analyze

REF: Hiatal Hernia: Assessment with Clinical Manifestations

8.The nurse is instructing a client diagnosed with a hiatal hernia on ways to reduce the symptoms. Which of the following should be included in these instructions?

1.

Eat large meals to keep the stomach full.

2.

Drink lots of liquids so that the stomach does not have to work so hard.

3.

Avoid lying down after meals.

4.

Lie down after eating.

ANS: 3

Sitting upright or sleeping with the head of the bed elevated helps keep the stomach contents in the stomach. The meal size should be smaller, and meals should be eaten more often so as not to overfill the stomach.

PTS:1DIF:Apply

REF: Hiatal Hernia: Planning and Implementation; Patient Playbook: Patient Education for GERD

9.A client is diagnosed with burning mouth syndrome. Which of the following interventions should be included in this clients plan of care?

1.

Assess the condition of the clients teeth.

2.

Collect a saliva specimen for analysis.

3.

Tell the client to avoid vitamin supplements.

4.

Teach the client how to conduct an oral self-assessment daily.

ANS: 1

Interventions for a client diagnosed with burning mouth syndrome include assessing the condition of the teeth. A saliva specimen is not used to diagnose this disorder. Vitamin supplements do not contribute to this disorder. An oral self-assessment does not need to be completed every day.

PTS:1DIF:Apply

REF: Burning Mouth Syndrome: Planning and Implementation

10.During an assessment, the nurse learns that a client is inhaling while swallowing food. Which of the following does this assessment finding suggest to the nurse?

1.

The client is recovering from a stroke.

2.

The client is at risk for aspiration.

3.

The client will experience dyspepsia.

4.

The client has esophageal reflux disease.

ANS: 2

In clients with dysphagia, inspiration commonly occurs during swallowing. This increases the risk for aspiration. This assessment finding does not indicate that the client is recovering from a stroke. This assessment finding does not indicate that the client will experience dyspepsia or that the client has esophageal reflux disease.

PTS:1DIF:Analyze

REF: Dysphagia: Assessment with Clinical Manifestations

11.A client is experiencing brash water. The nurse realizes this symptom is associated with:

1.

oral cancer.

2.

gastric ulcers.

3.

dysphagia.

4.

Barretts esophagus.

ANS: 4

Brash water, or the sensation of the mouth filling with saliva because of acid backflow into the esophagus, is a symptom of Barretts esophagus. Brash water is not associated with oral cancer, gastric ulcers, or dysphagia.

PTS:1DIF:AnalyzeREF:Barretts Esophagus

12.A client has been prescribed Zantac for gastroesophageal reflux disease. The nurse realizes this medication is classified as a:

1.

histamine H2-receptor antagonist.

2.

proton pump inhibitor.

3.

prokinetic agent.

4.

antihistamine.

ANS: 1

Zantac is a histamine H2-receptor antagonist. This medication is not classified as being a proton pump inhibitor, prokinetic agent, or antihistamine.

PTS: 1 DIF: Analyze REF: Gastroesophageal Reflux Disease: Pharmacology

13.A client is diagnosed with peptic ulcer disease caused by NSAID use. Which of the following would be indicated for this client?

1.

Antibiotic therapy

2.

Treatment similar to a client with peptic ulcer disease

3.

Preparation for surgery

4.

Insertion of a nasogastric tube for gastric lavage

ANS: 2

For clients diagnosed with peptic ulcer disease caused by NSAID use, the anti-inflammatory medication should be discontinued and the client should receive treatment similar to that of peptic ulcer disease. Surgery is not indicated. Antibiotics are not indicated. Gastric lavage is not indicated.

PTS:1DIF:Analyze

REF: Peptic-Ulcer Dyspepsia: Complications of PUD and the Subsequent Therapy

MULTIPLE RESPONSE

1.The nurse is instructing a client about symptoms associated with peptic ulcer disease. Which of the following should be included in these instructions? (Select all that apply.)

1.

Abdominal pain

2.

Pain in the middle of the night

3.

Weight loss

4.

Poor appetite

5.

Bloating

6.

Constipation

ANS: 1, 2, 3, 4, 5

Symptoms of peptic ulcer disease include abdominal pain, pain in the middle of the night; weight loss; poor appetite; and bloating. Constipation is not a symptom of peptic ulcer disease.

PTS:1DIF:Apply

REF: Peptic-Ulcer Dyspepsia: Etiology; Assessment with Clinical Manifestations

2.The nurse is planning care for a client diagnosed with oral ulcers. Which of the following should be included in this clients plan of care? (Select all that apply.)

1.

Encourage frequent oral hygiene.

2.

Rinse mouth with chlorhexidine.

3.

Increase consumption of hot fluids.

4.

Instruct in the use of topical corticosteroids.

5.

Encourage the client to limit smoking.

6.

Avoid the use of dental floss.

ANS: 1, 2, 4

Good oral hygiene is essential, and rinsing the mouth with chlorhexidine is recommended. Topical corticosteroids can promote resolution of the ulcers. Drinking hot fluids and smoking may aggravate oral ulcerations and are not included in the plan of care. The client should be instructed to not smoke at all. Dental floss will not cause oral ulcers.

PTS:1DIF:Apply

REFisorders of the Oral Cavity: Planning and Implementation

3.The nurse is instructing a client on conducting an oral self-assessment. Which of the following should be included in the nurses instructions? (Select all that apply.)

1.

Check the face for symmetry.

2.

Check skin on the face for changes.

3.

Check the neck for swellings or lumps.

4.

Check inside of cheeks for tenderness.

5.

Check the tongue for changes.

6.

Check urine for change in color.

ANS: 1, 2, 3, 4, 5

When instructing a client on an oral self-assessment, the nurse should include having the client check the face for symmetry; the skin on the face for changes; the neck for swellings or lumps; the inside of the cheeks for tenderness; and the tongue for changes. The urine is not checked when doing an oral self-assessment.

PTS: 1 DIF: Apply REF: Patient Playbook: Oral Cancer Self-Assessment

4.The nurse is assisting a client with indirect techniques to improve swallowing. Which of the following are techniques included in the nurses assistance? (Select all that apply.)

1.

Tongue mobility exercises

2.

Application of ice

3.

Repetitive head lift exercises

4.

Positioning

5.

Range-of-motion exercises for the neck

6.

Range-of-motion exercises for the shoulders

ANS: 1, 2, 3

Indirect techniques to improve swallowing include tongue mobility exercises, application of ice, and repetitive head lift exercises. Positioning is a compensatory mechanism. Range-of-motion exercises for the neck or shoulders does not help improve swallowing.

PTS: 1 DIF: Apply REF: Box 49-4 Techniques of Swallowing Therapy

5.A client is diagnosed with esophageal pain. Which of the following medications would be indicated for this client? (Select all that apply.)

1.

Vasodilators

2.

Calcium channel blockers

3.

Isosorbide dinitrate

4.

Antibiotics

5.

Antipyretics

6.

Antihistamines

ANS: 1, 2, 3

The first line of treatment for esophageal pain is often the same medications used to treat angina of cardiac origin and would include vasodilators, calcium channel blockers, and isosorbide dinitrate. Antibiotics, antipyretics, and antihistamines are not medications used to treat esophageal pain.

PTS: 1 DIF: Analyze REF: Esophageal Pain and Achalasia: Pharmacology

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