GI QUiz

The nurse is caring for a client with gastrointestinal reflux disease (GERD). Which information would the nurse provide the client to prevent worsening of the disorder? Select all that apply. One, some, or all responses may be correct.

• Eat a snack before bed.

• Include vigorous exercise.

• Wear loose-fitting clothing.

• Begin a weight-loss program.

• Sleep with head of bed elevated.

The nurse provided education to a client with peptic ulcer disease (PUD) regarding foods and substances to avoid that would increase the secretion of gastric acid. Which food choice for breakfast selection made by the client indicates a need for further teaching?

• Coffee and Toast

• Grapes and Cheese

• Apple juice and pancakes

• Cheese and Crackers

Which is the priority intervention for a dependent client with peptic ulcer disease (PUD) who is vomiting bright red blood?

• Place the client in side-lying position.

• Administer packed red blood cells.

• Assess the client's pulse and blood pressure.

• Apply oxygen.

Answer explanation

Recall the airway-breathing-circulation (ABCs) of priority care. The client who needs assistance to manage self-care (dependent) should be placed in the side-lying position when vomiting to prevent aspiration. The use of supplemental oxygen may support oxygen saturation in the client with decreased hemoglobin because of gastrointestinal bleeding. However, in the dependent client who is vomiting, applying oxygen is of lower priority than placing the client in a side-lying position. The nurse should anticipate a prescription for packed red blood cells in the client with a significant gastrointestinal bleed. Restoring circulation, however, is of lower priority than protecting the airway in a dependent client whose airway is at risk. The immediate physical examination of the client with active gastrointestinal bleeding includes evaluation of vital signs as a means of assessing for shock. Assessing for adequate circulation would not take priority over protecting the airway.

The nurse is preparing to assess a client with peptic ulcer disease (PUD). Which assessment finding indicates a need for immediate health care provider notification?

• Mild and intermittent abdominal discomfort
• Nausea and vomiting that subsides after a few hours
• Decreased heart rate and blood pressure
• Presence of sudden and intense severe abdominal pain
• Black, Tarry Stools

Answer explanation

Black stools indicate the presence of blood in the stool and sudden severe pain could indicate a rupture and needs to be immediately reported to the health care provider. Nausea, dyspepsia, and dull abdominal pain are minor clinical manifestations and can be managed with medications.

Which question would the nurse ask when assessing the client's needs related to a recent diagnosis of cancerous lesions?

• Are you having difficulty sleeping?

• Do you feel like your gums are inflamed?

• How frequently are you seeing the dentist?

• Have you noticed any change in your appetite?

Answer explanation

Problems involving the oral cavity often result in nutritional problems and weight loss requiring nursing intervention. The question, "Have you noticed any change in your appetite?" will elicit more information. The nurse needs to determine a client’s past and current appetite and nutritional status. Difficulty sleeping is not usually a characteristic symptom of cancer of the oral cavity, although it may occur after the diagnosis because of anxiety. Gum infections are not typically an early problem after an oral cancer diagnosis. Although a dentist may be the first to identify oral cancer, the need for medical treatment exists.

A client admitted to the hospital with a small bowel obstruction is scheduled to have an intestinal tube inserted. When preparing the client for the procedure, which action would the nurse take?

• Place the client in the right side-lying position.

• Instruct the client about techniques for mouth breathing.

• Spray the client’s oropharynx with a local anesthetic solution.

• Reassure the client that the procedure will not cause discomfort.

Answer explanation

Breathing by mouth helps decrease the gag reflex thereby easing the passage of the intestinal tube. Lying on the right side does not take advantage of gravity and makes the client’s naso-oral cavity less accessible to tube passage. Spraying the oropharynx with a local anesthetic solution will make it more comfortable, but it will interfere with swallowing, which is necessary during passage of an intestinal tube. Reassuring the client that passage of an intestinal tube will not cause discomfort is false reassurance; the procedure is not painful, but it is uncomfortable.

A client with a rigid, painful abdomen is diagnosed with a perforated peptic ulcer. A nasogastric tube is inserted, and surgery is scheduled. Before surgery, the nurse would place the client in which position?

• Left lateral recumbent

• Flat-lying

• Semi-Fowler

• Dorsal recumbent

Answer explanation

The semi-Fowler position will localize spilled stomach contents in the lower part of the abdominal cavity. The modified left lateral recumbent position will exert pressure on the abdomen, which may be uncomfortable for the client. Lying flat in bed exerts pressure against the diaphragm from abdominal organs; this will inhibit breathing and intensify discomfort. Also, it allows spilled stomach contents to spread throughout the abdominal cavity. The dorsal recumbent position exerts pressure against the diaphragm from abdominal organs; this will inhibit breathing and intensify discomfort. Also, this position allows spilled stomach contents to spread throughout the abdominal cavity.

The nurse is developing a plan of care for a client who underwent extensive oral surgery for head and neck cancer. Which interventions would the nurse include in the plan to prevent infection? Select all that apply. One, some, or all responses may be correct.

• 
  Protect incision site.

• Elevate head of the bed.

• Offer small frequent feedings.

• Remove thick secretions.

• Provide oral care at least every 4 hours.

Answer explanation

The nurse must take care to protect the incision site, remove thick secretions, and provide oral care at least every 4 hours to prevent infection. Elevating the head of the bed prevents aspiration. When the client can initiate oral intake, small, frequent feedings prevent aspiration.

A client with esophageal varices experiences severe hematemesis, and a Sengstaken-Blakemore tube is inserted. Which design and purpose does the tube have?

• Single-lumen; for gastric lavage

• 
  

  Double-lumen; for intestinal decompression

• Triple-lumen; for esophageal compression

• 
  

  Multi-lumen; for gastric and intestinal decompression

Answer explanation

The Sengstaken-Blakemore is a triple-lumen tube; one lumen inflates the esophageal balloon that compresses the esophagus, the second inflates the gastric balloon, and the third is attached to suction to decompress the stomach. The Sengstaken-Blakemore is not a single-lumen tube. The Sengstaken-Blakemore is not a double-lumen tube; the stomach, not the intestine, is decompressed. The intestine is not decompressed with a Sengstaken-Blakemore tube.

Which rationale explains why the nurse also monitors a client with a history of gastroesophageal reflux disease (GERD) for clinical manifestations of heart disease?

• Esophageal pain may imitate the symptoms of a heart attack.

• 
  GERD may predispose the client to the development of heart disease.

• 
  Strenuous exercise may exacerbate reflux problems.

• 
  Similar laboratory study changes may occur in both problems.

Answer explanation

Clients may interpret symptoms associated with myocardial infarction as esophageal reflux and ignore them. GERD does not predispose the client to heart disease. Exercise does not seem to exacerbate esophageal reflux problems unless the stomach is full when exercising. Exercising to maintain a healthy weight helps reduce esophageal reflux. Laboratory workups help differentiate these 2 diagnoses. Tests, such as cardiac enzymes, can help reveal a myocardial infarction, thereby facilitating differentiation between these problems.