Chapter 31: Management of Clients with Digestive Disorders Nursing School Test Banks

Black & Hawks: Medical-Surgical Nursing, 8th Edition

Test Bank

Chapter 31: Management of Clients with Digestive Disorders

MULTIPLE CHOICE

1. A client needs insertion of a long tube for intestinal decompression. The tube that is inappropriate for intestinal decompression is the

a.

Cantor tube.

b.

Harris tube.

c.

Miller-Abbott tube.

d.

Salem sump tube.

ANS: D

Short tubes such as the Salem sump tube are long enough to extend into the stomach but not into the bowel.

DIF: Knowledge/Remembering REF: p. 624 OBJ: Intervention

MSC: Safe, Effective Care Environment Safety and Infection Control-Safe Use of Equipment

2. An important health promotion activity for nurses to teach clients with chronic gastritis is to

a.

avoid any spicy or overly-hot food.

b.

see the health care provider at regular intervals.

c.

stick to a regular exercise plan.

d.

take only nonsteroidal anti-inflammatory drugs for mild pain.

ANS: B

Most clients with chronic gastritis are managed at home and need to see their health care provider on a regular basis to detect complications. A client with H. pylori and atrophic gastritis is at high risk for gastric cancer, which must be caught early for a positive outcome.

DIF: Comprehension/Understanding REF: p. 628 OBJ: Intervention

MSC: Health Promotion Health Screening

3. The nurse has just finished inserting a nasogastric (NG) tube in a client who has difficulty swallowing. The best measure to test for placement of the tube is

a.

asking the client to speak.

b.

aspirating gastric contents.

c.

inspecting the posterior pharynx for correct placement.

d.

placing the end of the tube in a glass of water.

ANS: B

To verify tube placement, the nurse can aspirate gastric contents for short tubes, like a nasogastric tube. Other reliable methods for determining placement include measuring the pH of the gastric contents and checking placement with an x-ray if the tube has radiographic markings.

DIF: Application/Applying REF: pp. 624, 625 OBJ: Intervention

MSC: Safe, Effective Care Environment Safety and Infection Control-Safe Use of Equipment

4. The nurse planning to irrigate a nasogastric (NG) tube prepares to use

a.

half-strength peroxide.

b.

normal saline.

c.

sterile water.

d.

tap water.

ANS: B

Normal saline is the preferred irrigating solution because water, a hypotonic solution, increases electrolyte loss through osmotic action if the tube is irrigated frequently.

DIF: Comprehension/Understanding REF: p. 626 OBJ: Intervention

MSC: Safe, Effective Care Environment Safety and Infection Control-Safe Use of Equipment

5. A client with acute gastritis is admitted to the emergency department for GI bleeding. The nurse would anticipate the clients history will include

a.

alcohol abuse.

b.

anorexia.

c.

high-carbohydrate, high-fat diet.

d.

recent use of oral penicillin.

ANS: A

Gastritis usually stems from the ingestion of a corrosive, erosive, or infectious substance. Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), digitalis, chemotherapeutic drugs, steroids, acute alcoholism, and food poisoning (typically caused by Staphylococcus organisms) are common causes.

DIF: Comprehension/Understanding REF: p. 626 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

6. The client with chronic gastritis is experiencing abdominal pain. In order to provide the client the fastest relief, the nurse plans to administer

a.

aluminum hydroxide with magnesium trisilicate (Gaviscon).

b.

clarithromycin (Biaxin).

c.

metronidazole (Flagyl).

d.

omeprazole (Prilosec).

ANS: A

Aluminum hydroxide with magnesium trisilicate (Gaviscon), which produces soothing foam, is the best antacid for gastritis. Biaxin and metronidazole are antibiotics. Omeprazole can be used for gastritis and for the short-term management of peptic ulcer disease but it will not relieve pain as quickly as the coating effect of aluminum hydroxide.

DIF: Application/Applying REF: p. 628 OBJ: Intervention

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Expected Effects

7. The nurse is caring for a client with chronic atrophic gastritis. When taking an admission history, the nurse would anticipate a history of

a.

cardiac disease.

b.

emphysema.

c.

intestinal parasites.

d.

pernicious anemia.

ANS: D

Atrophic gastritis, which occurs in all layers of the stomach, often develops in association with gastric ulcer and gastric cancer and is invariably associated with pernicious anemia because of the lack of intrinsic factor.

DIF: Comprehension/Understanding REF: p. 627 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

8. A client is taking cortisone. The nurse schedules the medication with food because cortisone can have which effect on gastric mucosa when given on an empty stomach? Cortisone will cause

a.

dramatically increased gastric pH.

b.

increased amount of GI secretions.

c.

increased transit time of GI contents.

d.

susceptibility of the mucosa to injury.

ANS: D

Anti-inflammatory agents may stimulate acid production, cause local mucosal damage, and suppress mucus secretion.

DIF: Application/Applying REF: p. 626 OBJ: Implementation

MSC: Physiologic Integrity Pharmacological and Parenteral Therapies-Adverse Effects

9. A nurse is instructing a client with a peptic ulcer on recommended dietary changes. A goal of teaching has been met when the client states that he/she will avoid which of the following beverages?

a.

Apple juice

b.

Lemonade

c.

Milk

d.

Water

ANS: C

Foods known to increase gastric acidity or cause discomfort should be avoided, such as coffee, alcohol, and milk. Patients should self-limit any other foods that cause them distress.

DIF: Application/Applying REF: pp. 631-632 OBJ: Evaluation

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

10. A nurse is caring for a client with severe burns. The client complains of abdominal pain and begins vomiting blood. The nurse anticipates diagnostic testing to determine if the client has developed

a.

a Curlings ulcer.

b.

chronic gastritis.

c.

H. pylori infection.

d.

pyloric stenosis.

ANS: A

Besides peptic and gastric ulcers, acute gastric erosion (frequently called stress ulcers or stress-erosive gastritis) can occur after an acute medical crisis. Major assaults that lead to gastroduodenal ulcerations include (a) severe trauma or major illness, (b) severe burns, (c) head injury or intracranial disease, (d) drug ingestion (e.g., aspirin, NSAIDs, alcohol) that acts on the gastric mucosa, (e) shock, and (f) sepsis.

DIF: Analysis/Analyzing REF: p. 629 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

11. A nurse is assessing a client with a history of a duodenal ulcer. Which finding is consistent with the nurses knowledge about this condition?

a.

Certain types of food increase gastric distress.

b.

Eating nearly any food causes pain.

c.

Pain may awaken the client in the middle of the night.

d.

The client complains of spitting up blood.

ANS: C

Clients with duodenal ulcers have pain on an empty stomach or in the middle of the night, and discomfort may be relieved by the ingestion of food or antacids.

DIF: Comprehension/Understanding REF: p. 631 OBJ: Assessment

MSC: Physiologic Integrity Physiological Adaptation-Pathophysiology

12. The nurse administers alternating doses of two antacids into the NG tube of a client with a duodenal ulcer. The finding that best indicates that this drug regimen has been successful is

a.

absent NG tube drainage.

b.

decreased abdominal rigidity.

c.

increased gastric pH.mild diarrhea.

d.

mild diarrhea.

ANS: C

Antacids increase gastric pH to reduce pepsin activity. Antacids would not affect NG tube drainage. Abdominal rigidity is not a sign of duodenal ulcers. Mild diarrhea might occur as a side effect of antacid administration.

DIF: Analysis/Analyzing REF: pp. 632-633 OBJ: Evaluation

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Expected Effects

13. Ranitidine (Zantac) is prescribed for a client with a gastric ulcer. The statement that best indicates to the nurse that the client understands the action of this drug is

a.

I will take this medication at bedtime to relieve pain.

b.

Ranitidine will activate protective mucous barriers.

c.

Stomach acids are neutralized by this medication.

d.

This drug reduces the acid in my stomach.

ANS: D

H2-receptor antagonists inhibit gastric acid secretions by blocking H2 receptors on parietal cells.

DIF: Application/Applying REF: p. 627 OBJ: Evaluation

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Expected Effects

14. The nurse is monitoring a client who has had gastric surgery for manifestations of dumping syndrome. The nurse should be particularly watchful for the early manifestation of

a.

hypertension.

b.

pain.

c.

tenesmus.

d.

vertigo.

ANS: D

Early manifestations of dumping syndrome, which occur 5 to30 minutes after eating, involve the vasomotor disturbances of vertigo, tachycardia, syncope, sweating, pallor, palpitation, diarrhea, and nausea, with the urge to lie down. None of the other three choices are early manifestations of dumping syndrome.

DIF: Application/Applying REF: p. 637 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

15. A client asks the nurse about the prescribed diet after gastric surgery. The nurse clarifies that a high-protein, high-fat, low-carbohydrate, dry diet is the best choice after gastric surgery because this diet

a.

does not cause diarrhea.

b.

does not dilate the stomach.

c.

is quickly digested.

d.

is slow to leave the stomach.

ANS: D

The diet is slowly digested and is slow to leave the stomach because of its density and the reduction of fluid with the meal. This reduces the possibility of dumping syndrome.

DIF: Analysis/Analyzing REF: pp. 637-638 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures

16. An older male client with chronic gastritis asks the nurse, Do you think Ill get gastric cancer? The most accurate response by the nurse is

a.

As long as the chronic gastritis is diagnosed early, there is little risk of gastric cancer.

b.

Chronic gastritis is not associated with the development of gastric cancer in men over 40.

c.

Individual predictions are not possible, but chronic gastritis is associated with the development of gastric cancer.

d.

Women with chronic gastritis are more likely to get gastric cancer than men who have chronic gastritis.

ANS: C

Chronic gastritis usually heals without scarring but can cause hemorrhage and ulcer formation. The atrophic changes eventually result in minimal amounts of acid being secreted into the stomach (achlorhydria), which is a major risk factor for development of gastric cancer.

DIF: Application/Applying REF: p. 627 OBJ: Intervention

MSC: Physiological Integrity Pathophysiological Adaptation-Pathophysiology

17. Priority nursing actions to achieve critical goals in the postoperative period for a client who has just returned from a Billroth II procedure should include

a.

encouraging oral intake.

b.

ensuring frequent coughing and deep breathing.

c.

irrigating the clients NG tube every hour.

d.

maintaining the client in the semi-Fowler position.

ANS: B

Nurses should thoroughly demonstrate and discuss the importance of deep-breathing exercises or use of an incentive spirometer for any surgical client. Clients should be warned that the high abdominal incision with a Billroth II procedure makes deep breathing very uncomfortable and therefore increases the risk of respiratory complications. This client will be NPO for now and will not be allowed oral intake. Irrigation of a surgically-placed NG tube hourly is not a standard order. In the immediate postoperative period, the client will likely be supine or in a low-Fowler position.

DIF: Analysis/Analyzing REF: p. 639 OBJ: Intervention

MSC: Safe, Effective Care Environment Management of Care-Establishing Priorities

18. A nurse is caring for a patient who had surgery and will be receiving chemotherapy and radiation treatment for stage III gastric cancer. The client is planning several extensive trips after the chemotherapy and radiation are finished. Which statement by the nurse is most appropriate at this time?

a.

Before you leave, be sure your will and other advance directives are up to date.

b.

What does your family think of your travel plans?

c.

What has the physician told you about your disease and treatment?

d.

Your trip sounds wonderful! Tell me more about it.

ANS: C

The 5-year survival rate for stage III gastric cancer is less than 10%. Chemotherapy and radiation may be palliative measures for this client. The nurse needs to gently find out what the client understands about this condition and the prognosis before being able to guide the client in making appropriate plans.

DIF: Application/Applying REF: p. 640 OBJ: Intervention

MSC: Psychosocial Integrity Therapeutic Communication

19. A client in the emergency department is hemorrhaging from a peptic ulcer and is being prepared quickly for emergency surgery. The nurse notes that the client is crying and reaches for the nurse frequently. The best response by the nurse to this client is to

a.

continue working efficiently to get the client ready for the operating room.

b.

make eye contact, touch the client, and say, This must be very scary for you.

c.

send someone to find the chaplain to discuss advance directives.

d.

sit by the client and say, I have some time that I can spend with you.

ANS: B

This is an emergency situation, so the nurse must continue to prepare the client for a life-saving operation. However, in this setting, clients may be afraid and the nurse needs to respond in a caring fashion to the nonverbal behavior the client exhibits.

DIF: Application/Applying REF: p. 638 OBJ: Intervention

MSC: Psychosocial Integrity Therapeutic Communication

20. Before tube insertion, the nurse performs the NEX measurement, which is the

a.

distance from the tip of the nose to the ear lobe and to the xiphoid.

b.

length of a tube from the hub to the tip converted to centimeters.

c.

distance from the ear lobe to the umbilicus.

d.

width of the lumen of the tube multiplied by the length.

ANS: A

The NEX is the measurement from the tip of the nose to the ear lobe and to the xiphoid process used to determine the amount of tube needed for entry into the stomach.

DIF: Application/Applying REF: p. 624 OBJ: Intervention

MSC: Safe, Effective Care Environment Safety and Infection Control-Safe Use of Equipment

MULTIPLE RESPONSE

1. A nurse is teaching health promotion measures to a support group for clients who are at high risk for gastric cancer. Important health promotion measures to advise the clients include (select all that apply)

a.

avoiding alcohol.

b.

eating a diet high in nitrites.

c.

limiting salted fish and pickled foods.

d.

quitting smoking.

ANS: A, C, D

Risk factors for gastric cancer include eating carcinogens such as smoked fish or meats, pickled foods, slated, fish, and nitrates. Metal crafts workers, coal miners, and bakers have occupational risks for gastric cancer.

DIF: Application/Applying REF: p. 639 OBJ: Intervention

MSC: Health Promotion Lifestyle Choices

2. A client with a duodenal ulcer complains of a sudden onset of severe pain. In which order should the nurse perform the following activities? (select all that apply)

a.

Assess the patency of the patients IV line.

b.

Call the physician.

c.

Have the nurses aid obtain a set of vital signs.

d.

Perform a complete abdominal examination.

e.

Prepare to administer IV pain medication.

ANS: A, B, C, D, E

This patient may have experienced a perforation of the duodenal ulcer, which is a surgical emergency. The first step in the nursing process is assessment, so the nurse should perform a complete abdominal (and pain) assessment. Before calling the physician, the nurse will need this information and a set of vital signs. Since this patient is possibly going to the operating room, the nurse should next assess the IV line. Preparing to give pain medications is last because the physician may want to examine the client before the client receives any more pain medications. The client may also need to sign a permit form before receiving any pain medication.

DIF: Analysis/Analyzing REF: p. 633 OBJ: Implementation

MSC: Physiological Integrity Physiological Adaptation-Medical Emergencies

3. A nurse is inserting a nasogastric (NG) tube. Put the steps in the correct order.(select all that apply)

a.

Advance the tube into the stomach.

b.

Aspirate gastric contents and measure the pH.

c.

Assist the client into a high-Fowler position.

d.

Complete the NEX measurement and mark it on the tube.

e.

Insert the tube gently into the nares and posterior nasal pharynx.

f.

Instruct the client to swallow when the tube is in the oropharynx.

g.

Lubricate the tip of the tube.

h.

Secure the tube to the nose with a device to hold tubes or hypoallergenic tape.

ANS: A, B, C, D, E, F, G, H DIF: Application REF: p. 624

OBJ: Intervention MSC: Physiological Integrity

Elsevier items and derived items 2009 by Saunders, an imprint of Elsevier Inc.

Some material was previously published.

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