Chapter 39: Upper Digestive Tract Disorders Nursing School Test Banks

Chapter 39: Upper Digestive Tract Disorders
Linton: Introduction to Medical-Surgical Nursing, 6th Edition

MULTIPLE CHOICE

1. A nurse is preparing to give a tube feeding using a large syringe. What action should the nurse implement before starting the infusion?
a. Roll the patient flat.
b. Check for a residual formula and return the residual to his or her stomach.
c. Place the end of the tube in water and check for bubbles.
d. Flush the tube.
ANS: B
Verifying tube placement by pulling up the residual formula is a standard of care for a tube feeding.

DIF: Cognitive Level: Application REF: p. 788 OBJ: 4
TOP: Tube Feeding KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

2. After receiving a tube feeding, a nurse assesses the patient to be sweaty with abdominal distention and diarrhea. What is the most likely cause of this response?
a. Expected reaction to the tube feeding
b. Dumping syndrome
c. Gastric reflux syndrome
d. Onset of gastroenteritis
ANS: B
Dumping syndrome is caused by infusing a tube feeding too fast or infusing a tube feeding that is too rich a formula.

DIF: Cognitive Level: Application REF: p. 788 OBJ: 3
TOP: Dumping Syndrome KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

3. A nurse is assessing a patient for risk factors that increase the chances of developing oral cancer. Which information from this patients history indicates a risk factor?
a. Alcohol consumption
b. Chewing gum
c. Environmental pollution
d. Consumption of a high-fat diet
ANS: A
Alcohol is statistically proven to be a factor because of irritation of the oral mucosa.

DIF: Cognitive Level: Comprehension REF: p. 801 OBJ: 2
TOP: Oral Cancer KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

4. A home health nurse observes a patient with esophageal cancer tilt his head back while eating. What might this cause?
a. Narrowing of the esophagus
b. Limiting the types of food that can be consumed
c. Increased risk of aspiration
d. A neck injury
ANS: C
Tilting the head back not only makes it more difficult to eat, but it also increases the risk of aspiration.

DIF: Cognitive Level: Comprehension REF: p. 805 OBJ: 3
TOP: Feeding Technique with Esophageal Cancer
KEY: Nursing Process Step: Planning
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

5. A nurse is caring for a patient with esophageal surgery who has had stents placed in the esophagus and instructs the patient how best to avoid regurgitation. What should the nurse include in this instruction?
a. Keep the bed flat.
b. Eat only small meals.
c. Lie on the right side after meals.
d. Drink 3 glasses of fluid with each meal.
ANS: B
Eating small meals will help with reflux. Keeping the head of the bed raised and not taking in excessive fluid with meals should be practiced.

DIF: Cognitive Level: Application REF: p. 806 OBJ: 4
TOP: Gastroesophageal Reflux KEY: Nursing Process Step: Planning
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

6. A nurse administers promethazine (Phenergan) for nausea. Which extra precautionary action should the nurse implement because of the common side effect of antiemetic medications?
a. Check vital signs for erratic blood pressure.
b. Add a blanket to prevent chilling.
c. Provide extra water to combat thirst.
d. Put up side rails to prevent falls.
ANS: D
Most antiemetic medications cause drowsiness because of their effects on the central nervous system, resulting in dizziness and confusion.

DIF: Cognitive Level: Application REF: p. 806 OBJ: 4
TOP: Antiemetic Therapy KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

7. A nurse is constructing a teaching plan for a patient with a hiatal hernia. What should be included in this plan to help reduce the complaints of heartburn, regurgitation, and eructation?
a. Eating three well-balanced meals
b. Lying down 1 hour after eating
c. Sleeping without pillows
d. Eating nothing for several hours before bedtime
ANS: D
Eating just before bedtime encourages reflux into the hernia and possible aspiration.

DIF: Cognitive Level: Application REF: p. 809 OBJ: 5
TOP: Hiatal Hernia KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

8. A patient complains about the placement of the total parenteral nutrition (TPN) line and asks why it cannot be inserted in the arm. What fact regarding the placement of this line should the nurse base a response on?
a. Arm would limit patient mobility.
b. Subclavian artery allows for ease in dressing the puncture site.
c. Arm prevents the use of large-bore cannulas.
d. Subclavian artery allows for rapid dilution.
ANS: D
The rich TPN solution is rapidly diluted in the larger vessel, preventing phlebitis.

DIF: Cognitive Level: Comprehension REF: p. 792-793 OBJ: 3
TOP: TPN KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

9. A 60-year-old patient who has just been diagnosed with cancer of the stomach says, I feel blank and numb. What is the best nursing response?
a. Shock affects everyone that way.
b. Im sure you are considering what you should do now that you have cancer.
c. Would you like me to bring you a sedative?
d. What do you mean when you say blank and numb?
ANS: D
Patients who seem overwhelmed often need to talk and express their feelings even if they are not sure of what their feelings are.

DIF: Cognitive Level: Application REF: p. 818-819 OBJ: 5
TOP: Ineffective Coping KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

10. A goal for a patient with gastritis who has experienced nausea, vomiting, and diarrhea is to have a return of normal elimination patterns. Which statement best reflects this goal in a measurable manner?
a. The patient will have fewer stools.
b. Diarrhea will be controlled and not return.
c. The patient will have no more than one stool per day.
d. The patients bowel pattern will return to normal.
ANS: D
Goals are to be specific and measurable. The patient knows his or her normal pattern.

DIF: Cognitive Level: Application REF: p. 811 OBJ: 4
TOP: Gastritis KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

11. A nurse is caring for a patient hemorrhaging from a peptic ulcer when the patient complains of a sharp sudden pain and has a rapidly deteriorating condition. What is the best first action of the nurse?
a. Roll the patient flat and assess the vital signs.
b. Notify the charge nurse.
c. Suction the mouth.
d. Prepare for intravenous infusions.
ANS: A
With a rapidly deteriorating patient, the nurse should collect all the information that will need to be reported, such as vital signs, patient condition, and subjective complaints.

DIF: Cognitive Level: Application REF: p. 814 OBJ: 3
TOP: Perforated Ulcer KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

12. A patient inquires if this newer type of gastric analysis is going to require passage of a nasogastric tube. What is the nurses most accurate reply?
a. Yes, but just for the instillation of the dye.
b. No. You take a dye orally, which will be excreted in the urine in approximately 2 hours.
c. Yes. You will take the dye orally, and then several gastric withdrawals through the tube will show the dye.
d. Yes. Only one withdrawal will be made through the tube, which will be treated with dye and read in approximately 2 hours.
ANS: B
Dye is given orally, and if hydrochloric acid is present, the dye will be excreted in the urine in approximately 2 hours. The older method of taking serial gastric samples every 15 minutes through a nasogastric tube may still be used.

DIF: Cognitive Level: Application REF: p. 789-790 OBJ: 1
TOP: Newer Method of Gastric Analysis KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

13. A long-term care nurse is assisting a well-nourished, 80-year-old resident with the diagnosis of esophageal cancer on methods to deal with dysphagia. What nursing intervention will best help to improve the residents condition?
a. Instruct the patient to tilt his or her head slightly forward.
b. Assist patient to a semi-Fowler position.
c. Encourage the resident to eat meals in the main dining area.
d. Insert a nasogastric tube for feedings.
ANS: A
General interventions helpful in managing dysphagia include a quiet, relaxed environment and an erect position with the head slightly tilted forward. If dysphagia prevents adequate nutritional intake, then alternative feeding method must be used and ordered by the health care provider.

DIF: Cognitive Level: Application REF: p. 805 OBJ: 4
TOP: Esophageal Cancer KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

14. A home health nurse is assigned to follow-up on a patient recently diagnosed with gastroesophageal reflux disease (GERD). Which primary symptom should the nurse take into consideration when updating the nursing interventions on this patients care plan?
a. Nausea
b. Vomiting
c. Anorexia
d. Heartburn
ANS: D
The onset of GERD symptoms may be sudden or gradual. Patients typically report a painful burning sensation that moves up and down, commonly occurs after meals, and is relieved by antacids. Acid regurgitation, intermittent dysphagia, and belching are also common.

DIF: Cognitive Level: Comprehension REF: p. 810 OBJ: 4
TOP: GERD KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

15. A patient experiencing nausea reports to the nurse that she adds ginger root to her morning tea to calm her stomach. Which classification of medication in the patient history alerts the nurse to provide further education?
a. Antidepressants
b. Proton pump inhibitors
c. Anticoagulants
d. Narcotics
ANS: C
Ginger root is effective in calming upset stomach, reducing flatulence, and preventing motion sickness. It enhances the action of anticoagulant and antiplatelet agents.

DIF: Cognitive Level: Application REF: p. 807 OBJ: 3
TOP: Complementary and Alternative Therapies
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

16. A nurse is caring for a patient receiving total parenteral nutrition (TPN). Which nursing action is most appropriate to implement?
a. Use a clean technique for site care.
b. Infuse the solution rapidly.
c. Administer medications through the TPN line.
d. Monitor the temperature for elevation.
ANS: D
Temperature should be monitored for signs of potential infection. When caring for a patient receiving TPN, sterile technique is used for site care. If solution is given too rapidly, the patient may have circulatory overload. The TPN catheter should NEVER be used for medication administration.

DIF: Cognitive Level: Application REF: p. 792-793 OBJ: 4
TOP: TPN KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

17. A patient is diagnosed with Vincent infection. What treatment should the nurse anticipate being prescribed for this patient?
a. Intravenous antibiotic therapy
b. Diet restriction
c. Mouthwash rinse
d. Increased activity
ANS: C
Vincent infection is caused by bacteria and causes a metallic taste and bleeding ulcers in the mouth, foul breath, and increased salivation. It is typically treated with topical antibiotics and mouthwashes, rest, a nutritious diet, and good oral hygiene.

DIF: Cognitive Level: Application REF: p. 800 OBJ: 3
TOP: Oral Infections KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

18. When assessing the tongue of patient in the outpatient clinic, a nurse observes bluish-white lesions on the mucous membranes. When reviewing the patient history, the nurse notes the patient has been on long-term antibiotic therapy for chronic prostatitis. What should the nurse suspect?
a. Thrush
b. Aphthous stomatitis
c. Herpes simplex type I
d. Oral cancer
ANS: A
Candida albicans, a yeast-like fungus, causes the oral condition known as thrush or candidiasis. Bluish-white lesions can be seen on the mucous membranes of the oral cavity. Patients at high risk for candidiasis include those on steroids or long-term antibiotic therapy.

DIF: Cognitive Level: Comprehension REF: p. 800 OBJ: 3
TOP: Oral Infections KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

19. When assisting with the admission of a new resident to a long-term care facility, a nurse notes a current history of peptic ulcer disease. What type of pain should the nurse expect the resident to describe?
a. Sharp
b. Dull
c. Burning
d. Stabbing
ANS: C
Some patients with gastric ulcers have no pain, but others experience a burning or cramping pain 2 to 4 hours after meals.

DIF: Cognitive Level: Comprehension REF: p. 812 OBJ: 4
TOP: Peptic Ulcer KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

20. Which patient assessment indicates hyperglycemia with TPN feeding?
a. Increase of urine output
b. Sudden diarrhea
c. Abdominal distention
d. Tachycardia
ANS: A
Increased urine output would indicate a probable increase in blood glucose.

DIF: Cognitive Level: Comprehension REF: p. 793 OBJ: 3
TOP: TPN KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

21. The TPN feeding is running at 20 mL and is 1 hour behind schedule. What is the most appropriate initial nursing intervention?
a. Increase the flow rate to 22 mL/hr (10%) and inform the charge nurse.
b. Reposition the patient to the right side and lower the head of the bed.
c. Dilute the thick feeding formula with 10 mL of sterile water and inform the charge nurse.
d. Document the event and inform the charge nurse.
ANS: D
Increasing the speed of giving TPN feedings is never a consideration because doing so will cause hyperglycemia. The event should be documented and the charge nurse informed.

DIF: Cognitive Level: Application REF: p. 793 OBJ: 3 | 4
TOP: TPN KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

MULTIPLE RESPONSE

22. What information about when and where specific digestion of food takes place should be included in a patient teaching plan? (Select all that apply.)
a. Renin breaks down milk protein in the stomach.
b. Lipase breaks down fats in the stomach.
c. Pepsin begins to break down proteins in the stomach.
d. Liver and pancreatic secretions break down fats in the small bowel.
e. Ptyalin (amylase) breaks down carbohydrates in the colon.
ANS: A, B, C, D
Ptyalin (amylase) breaks down carbohydrates in the mouth.

DIF: Cognitive Level: Knowledge REF: p. 785-786 OBJ: 4
TOP: Digestive Process KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

23. A nurse is caring for a patient with achalasia. What nursing actions should be implemented to help the patient reduce swallowing difficulty? (Select all that apply.)
a. Identify foods that cause the problem.
b. Experiment with different eating positions.
c. Elevate the head of the bed at night.
d. Suggest eating more rapidly.
e. Offer small bites of fresh vegetables.
ANS: A, B, C
Eating rapidly and eating small bites increase swallowing difficulties.

DIF: Cognitive Level: Application REF: p. 799 OBJ: 4
TOP: Achalasia KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

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