GI 1
Which information about an 80-yr-old male patient at the senior center is of most concern to the nurse?
a. Decreased appetite
b. Occasional indigestion
c. Unintended weight loss
d. Difficulty chewing food
ANS: C
Unintentional weight loss is not a normal finding and may indicate a problem such as cancer or depression. Poor appetite, difficulty in chewing, and indigestion are common in older patients. These will need to be addressed but are not of as much concern as the weight loss.
An older patient reports chronic constipation. To promote bowel evacuation, when should the nurse suggest that the patient attempt defecation?
a. In the mid-afternoon
b. After eating breakfast
c. Right after awakening in the morning
d. Immediately before the first daily meal
ANS: B
The gastrocolic reflex is most active after the first daily meal. Awakening, the anticipation of eating, and mid-afternoon timing do not stimulate these reflexes.
Which finding by the nurse during abdominal auscultation indicates a need for a focused abdominal assessment?
a. Loud gurgles
b. High-pitched gurgles
c. Absent bowel sounds
d. Frequent clicking sounds
ANS: C
Absent bowel sounds are abnormal and require further assessment by the nurse. The other sounds may be heard normally.
Which finding for a young adult who follows a vegan diet may indicate the need for cobalamin supplementation?
a. Paresthesias
b. Ecchymoses
c. Dry, scaly skin
d. Gingival swelling
ANS: A
Cobalamin (vitamin B12) cannot be obtained from foods of plant origin, so the patient will be most at risk for signs of cobalamin deficiency, such as paresthesias, peripheral neuropathy, and anemia. The other symptoms listed are associated with other nutritional deficiencies but would not be associated with a vegan diet.
A young adult has been admitted to the emergency department with nausea and vomiting. Which action could the RN delegate to unlicensed assistive personnel (UAP)?
a. Auscultate the bowel sounds.
b. Assess for signs of dehydration.
c. Assist the patient with oral care.
d. Ask the patient about the nausea.
ANS: C
Oral care is included in UAP education and scope of practice. The other actions are all assessments that require more education and a higher scope of nursing practice.
What condition should the nurse anticipate when caring for a patient with a history of a total gastrectomy?
a. Constipation
b. Dehydration
c. Elevated total serum cholesterol
d. Cobalamin (vitamin B12) deficiency
ANS: D
The patient with a total gastrectomy does not secrete intrinsic factor, which is needed for cobalamin (vitamin B12) absorption. Because the stomach absorbs only small amounts of water and nutrients, the patient is not at higher risk for dehydration, elevated cholesterol, or constipation.
Which item should the nurse offer to the patient restarting oral intake after being NPO due to nausea and vomiting?
a. Glass of orange juice
b. Dish of lemon gelatin
c. Cup of coffee with cream
d. Bowl of hot chicken broth
ANS: B
Clear cool liquids are usually the first foods started after a patient has been nauseated. Acidic foods such as orange juice, very hot foods, and coffee are poorly tolerated when patients have been nauseated.
A patient vomiting blood-streaked fluid is admitted to the hospital with acute gastritis. What should the nurse ask the patient about to determine possible risk factors for gastritis?
a. The amount of saturated fat in the diet
b. A family history of gastric or colon cancer
c. Use of nonsteroidal antiinflammatory drugs
d. A history of a large recent weight gain or loss
ANS: C
Use of an NSAID is associated with damage to the gastric mucosa, which can result in acute gastritis. Family history, recent weight gain or loss, and fatty foods are not risk factors for acute gastritis.
Which information about dietary management should the nurse include when teaching a patient with peptic ulcer disease (PUD)?
a. “You will need to remain on a bland diet.”
b. “Avoid foods that cause pain after you eat them.”
c. “High-protein foods are least likely to cause pain.”
d. “You should avoid eating any raw fruits and vegetables.”
ANS: B
The best information is that each person should choose foods that are not associated with postprandial discomfort. Raw fruits and vegetables may irritate the gastric mucosa but chewing well seems to decrease this problem and some patients may tolerate these foods well. High-protein foods help neutralize acid, but they also stimulate hydrochloric (HCl) acid secretion and may increase discomfort for some patients. Bland diets may be recommended during an acute exacerbation of PUD, but there is little evidence to support their use.
A 74-yr-old male patient tells the nurse that growing old causes constipation, so he has been using a suppository to prevent constipation every morning. Which action should the nurse take first?
a. Encourage the patient to increase oral fluid intake.
b. Question the patient about risk factors for constipation.
c. Suggest that the patient increase intake of high-fiber foods.
d. Teach the patient that a daily bowel movement is unnecessary.
ANS: B
The nurse’s initial action should be further assessment of the patient for risk factors for constipation and for his usual bowel pattern. The other actions may be appropriate but will be based on the assessment.
A patient is admitted to the outpatient testing area for an ultrasound of the gallbladder. Which information obtained by the nurse indicates that the ultrasound may need to be rescheduled?
a. The patient took a laxative the previous evening.
b. The patient had a high-fat meal the previous evening.
c. The patient has a permanent gastrostomy tube in place.
d. The patient ate a low-fat bagel 4 hours ago for breakfast.
ANS: D
Food intake can cause the gallbladder to contract and result in a suboptimal study. The patient should be NPO for 8 to 12 hours before the test. A high-fat meal the previous evening, laxative use, or a gastrostomy tube will not affect the results of the study.
A patient who has gastroesophageal reflux disease (GERD) is experiencing increasing discomfort. Which patient statement to the nurse indicates that additional teaching about GERD is needed?
a. “I quit smoking years ago, but I chew gum.”
b. “I eat small meals and have a bedtime snack.”
c. “I take antacids between meals and at bedtime each night.”
d. “I sleep with the head of the bed elevated on 4-inch blocks.”
ANS: B
GERD is exacerbated by eating late at night, and the nurse should plan to teach the patient to avoid eating at bedtime. The other patient actions are appropriate to control symptoms of GERD.
What diagnostic test should the nurse anticipate for an older patient who is vomiting “coffee-ground” emesis?
a. Endoscopy
b. Angiography
c. Barium studies
d. Gastric analysis
ANS: A
Endoscopy is the primary tool for visualization and diagnosis of upper gastrointestinal (GI) bleeding. Angiography is used only when endoscopy cannot be done because it is more invasive and has more possible complications. Barium studies are helpful in determining the presence of gastric lesions, but not whether the lesions are actively bleeding. Gastric analysis testing may help with determining the cause of gastric irritation, but it is not used for acute GI bleeding.
A patient has just been admitted to the emergency department with nausea and vomiting. Which information requires the most rapid intervention by the nurse?
a. The patient has been vomiting for 4 days.
b. The patient takes antacids 8 to 10 times a day.
c. The patient is lethargic and difficult to arouse.
d. The patient has had a small intestinal resection.
ANS: C
A lethargic patient is at risk for aspiration, and the nurse will need to position the patient to decrease aspiration risk. The other information is also important to collect, but it does not require as quick action as the risk for aspiration.
Which nursing action will be included in the plan of care for a 25-yr-old male patient with a new diagnosis of irritable bowel syndrome (IBS)?
a. Encourage the patient to express concerns and ask questions about IBS.
b. Suggest that the patient increase the intake of milk and other dairy products.
c. Teach the patient to avoid using nonsteroidal antiinflammatory drugs (NSAIDs).
d. Teach the patient about the use of alosetron (Lotronex) to reduce IBS symptoms.
ANS: A
Because psychologic and emotional factors can affect the symptoms for IBS, encouraging the patient to discuss emotions and ask questions is an important intervention. Alosetron has serious side effects and is used only for female patients who have not responded to other therapies. Although yogurt may be beneficial, milk is avoided because lactose intolerance can contribute to symptoms in some patients. NSAIDs can be used by patients with IBS.
A patient has just arrived in the recovery area after an upper endoscopy. Which information collected by the nurse is most important to communicate to the health care provider?
a. The patient is very drowsy.
b. The patient reports a sore throat.
c. The oral temperature is 101.4° F.
d. The apical pulse is 100 beats/min.
ANS: C
A temperature elevation may indicate that an acute perforation has occurred. The other assessment data are normal immediately after the procedure.
Which information will the nurse provide for a patient with newly diagnosed gastroesophageal reflux disease (GERD)?
a. “Peppermint tea may reduce your symptoms.”
b. “Keep the head of your bed elevated on blocks.”
c. “You should avoid eating between meals to reduce acid secretion.”
d. “Vigorous physical activities may increase the incidence of reflux.”
ANS: B
Elevating the head of the bed will reduce the incidence of reflux while the patient is sleeping. Peppermint will decrease lower esophageal sphincter (LES) pressure and increase the chance for reflux. Small, frequent meals are recommended to avoid abdominal distention. There is no need to make changes in physical activities because of GERD.
Which information will the nurse include when teaching a patient with peptic ulcer disease about the effect of ranitidine (Zantac)?
a. “Ranitidine absorbs the excess gastric acid.”
b. “Ranitidine decreases gastric acid secretion.”
c. “Ranitidine constricts the blood vessels near the ulcer.”
d. “Ranitidine covers the ulcer with a protective material.”
ANS: B
Ranitidine is a histamine-2 (H2) receptor blocker that decreases the secretion of gastric acid. Ranitidine does not constrict the blood vessels, absorb the gastric acid, or cover the ulcer.
Which assessment should the nurse perform first for a patient who just vomited bright red blood?
a. Measuring the quantity of emesis
b. Palpating the abdomen for distention
c. Auscultating the chest for breath sounds
d. Taking the blood pressure (BP) and pulse
ANS: D
The nurse is concerned about blood loss and possible hypovolemic shock in a patient with acute gastrointestinal bleeding. BP and pulse are the best indicators of these complications. The other information is important to obtain, but BP and pulse rate are the best indicators for assessing intravascular volume.
A patient is admitted to the emergency department with severe abdominal pain and rebound tenderness. Vital signs include temperature 102° F (38.3° C), pulse 120 beats/min, respirations 32 breaths/min, and blood pressure (BP) 82/54 mm Hg. Which prescribed intervention should the nurse implement first?
a. Administer IV ketorolac 15 mg for pain relief.
b. Send a blood sample for a complete blood count (CBC).
c. Infuse a liter of lactated Ringer’s solution over 30 minutes.
d. Send the patient for an abdominal computed tomography (CT) scan.
ANS: C
The priority for this patient is to treat the patient’s hypovolemic shock with fluid infusion. The other actions should be implemented after starting the fluid infusion.
How should the nurse explain esomeprazole (Nexium) to a patient with recurring heartburn?
a. “It reduces gastroesophageal reflux by increasing the rate of gastric emptying.”
b. “It neutralizes stomach acid and provides relief of symptoms in a few minutes.”
c. “It coats and protects the lining of the stomach and esophagus from gastric acid.”
d. “It treats gastroesophageal reflux disease by decreasing stomach acid production.”
ANS: D
The proton pump inhibitors decrease the rate of gastric acid secretion. Promotility drugs such as metoclopramide (Reglan) increase the rate of gastric emptying. Cryoprotective medications such as sucralfate (Carafate) protect the stomach. Antacids neutralize stomach acid and work rapidly.
A patient has peptic ulcer disease that has been associated with Helicobacter pylori. About which medications will the nurse plan to teach the patient?
a. Sucralfate (Carafate), nystatin, and bismuth (Pepto-Bismol)
b. Metoclopramide (Reglan), bethanechol (Urecholine), and promethazine
c. Amoxicillin (Amoxil), clarithromycin (Biaxin), and omeprazole (Prilosec)
d. Famotidine (Pepcid), magnesium hydroxide (Mylanta), and pantoprazole (Protonix)
ANS: C
The drugs used in triple drug therapy include a proton pump inhibitor such as omeprazole and the antibiotics amoxicillin and clarithromycin. The other combinations listed are not included in the protocol for H. pylori infection.
The health care provider prescribes antacids and sucralfate (Carafate) for treatment of a patient’s peptic ulcer. What should the nurse teach the patient to take?
a. Sucralfate at bedtime and antacids before each meal
b. Sucralfate and antacids together 30 minutes before meals
c. Antacids 30 minutes before each dose of sucralfate is taken
d. Antacids after meals and sucralfate 30 minutes before meals
ANS: D
Sucralfate is most effective when the pH is low and should not be given with or soon after antacids. Antacids are most effective when taken after eating. Administration of sucralfate 30 minutes before eating and antacids just after eating will ensure that both drugs can be most effective. The other regimens will decrease the effectiveness of the medications.
Which patient should the nurse assess first after receiving change-of-shift report?
a. A patient with esophageal varices who has a rapid heart rate
b. A patient with a history of gastrointestinal bleeding who has melena
c. A patient with nausea who has a dose of metoclopramide (Reglan) due
d. A patient who is crying after receiving a diagnosis of esophageal cancer
ANS: A
A patient with esophageal varices and a rapid heart rate indicate possible hemodynamic instability caused by GI bleeding. The other patients do not indicate acutely life-threatening complications.
Which patient should the nurse assess first after receiving change-of-shift report?
a. A 30-yr-old patient who has a distended abdomen and tachycardia
b. A 60-yr-old patient whose ileostomy has drained 800 mL over 8 hours
c. A 40-yr-old patient with ulcerative colitis who had six liquid stools in 4 hours
d. A 50-yr-old patient with familial adenomatous polyposis who has occult blood in the stool
ANS: A
The patient’s abdominal distention and tachycardia suggest hypovolemic shock caused by problems such as peritonitis or intestinal obstruction, which will require rapid intervention. The other patients should be assessed as quickly as possible, but the data do not indicate any life-threatening complications associated with their diagnoses.