GI Practice questions from saunders / nurse sara Questions and Answers 2023

GI Practice questions from saunders / nurse sara Questions and Answers 2023 What is the biggest cause of ulcers in the stomach and duodenum? - H. Pylori Priority Nursing diagnoses for pt with numerous episodes of diarrhea from duping syndrome in the past 24 hours? - Fluid volume deficit Nurse is assessing a pt just admitted with SBO which bowel sound would be auscultated on this pt? - Hyperactive above and hypoactive below the obstruction Dumping syndrome S+S - Dehydration - Hypotension - Lightheadedness - N/D - Occur 30 minutes after eating a meal or 1-3 hrs after eating o Late hypoglycemia shakiness, HA, irritability, weakness, anxiousness can result in coma, death, lethargy · 1. In the stomach lining, the parietal cells release _________ and the chief cells release __________ which both play a role in peptic ulcer disease.* o A. pepsin, hydrochloric acid o B. pepsinogen, pepsin o C. pepsinogen, gastric acid o D. hydrochloric acid, and pepsinogen o D. hydrochloric acid, and pepsinogen 2. A patient has developed a duodenal ulcer. As the nurse, you know that which of the following plays a role in peptic ulcer formation. Select ALL that apply:* A. Spicy foods B. Helicobacter pylori C. NSAIDs D. Milk E. Zollinger-Ellison Syndrome B C E · 3. You're educating a group of patients at an outpatient clinic about peptic ulcer formation. Which statement is correct about how peptic ulcers form?* o A. "An increase in gastric acid is the sole cause of peptic ulcer formation." o B. "Peptic ulcers can form when acid penetrates unprotected stomach mucosa. This causes histamine to be released which signals to the parietal cells to release more hydrochloric acid which erodes the stomach lining further." o C. "Peptic ulcers form when acid penetrates unprotected stomach mucosa. This causes pepsin to be released which signals to the parietal cells to release more pepsinogen which erodes the stomach lining further." o D. "The release of prostaglandins cause the stomach lining to breakdown which allows ulcers to form." o B. "Peptic ulcers can form when acid penetrates unprotected stomach mucosa. This causes histamine to be released which signals to the parietal cells to release more hydrochloric acid which erodes the stomach lining further." · 5. Helicobacter pylori can live in the stomach's acidic conditions because it secretes ___________ which neutralizes the acid.* o A. ammonia o B. urease o C. carbon dioxide o D. bicarbonate o B. urease · 6. The physician orders a patient with a duodenal ulcer to take a UREA breath test. Which lab value will the test measure to determine if h. pylori is present?* o A. Ammonia o B. Urea o C. Hydrochloric acid o D. Carbon dioxide o D. Carbon dioxide · 7. A patient arrives to the clinic for evaluation of epigastric pain. The patient describes the pain to be relieved by food intake. In addition, the patient reports awaking in the middle of the night with a gnawing pain in the stomach. Based on the patient's description this appears to be what type of peptic ulcer?* o A. Duodenal o B. Gastric o C. Esophageal o D. Refractory o A. Duodenal · 15. A patient with a peptic ulcer is suddenly vomiting dark coffee ground emesis. On assessment of the abdomen you find bloating and an epigastric mass in the abdomen. Which complication may this patient be experiencing?* o A. Obstruction of pylorus o B. Upper gastrointestinal bleeding o C. Perforation o D. Peritonitis o B. Upper gastrointestinal bleeding 13. Select all the medications a physician may order to treat a H. Pylori infection that is causing a peptic ulcer? · A. Proton-Pump Inhibitors · B. Antacids · C. Anticholinergics · D. 5-Aminosalicylates · E. Antibiotics · F. H2 Blockers G. Bismuth Subsalicylates A, E, F, G The initial symptom of abdominal pain described by the client in which of the following ways would lead the nurse to suspect a small bowel obstruction? Sharp, knife-like Rebound, squeezing Dull, aching Colicky, crampy Colicky, crampy The nurse is aware that the most common cause of small bowel obstruction is which of the following? Volvulus Neoplasms Adhesions Hernias Adhesions The nurse anticipates that the initial treatment for small bowel obstruction will involve which of the following? Insertion of a rectal tube for drainage Surgical intervention Colonoscopy and irrigation Decompression of bowel via nasogastric tube Decompression of bowel via nasogastric tube Potassium chloride may be administered in the client with small bowel obstruction and dehydration to correct hypokalemia. The nurse knows that a client experiencing decreased potassium levels would exhibit which of the following signs and symptoms? Increased thirst, polyuria Hypotension, muscle weakness Increased reflexes, tachycardia Hypertension, bradycardia Hypotension, muscle weakness Rationale:Signs and symptoms of hypokalemia can include hypotension, muscle weakness, fatigue, anorexia, nausea and vomiting, polyuria, decreased bowel motility and decreased BP. pg 243-245 The nurse is aware that untreated small bowel obstruction can progress to which type of shock? Cardiogenic Hypovolemic None of these Distributive Hypovolemic Rationale:The vomiting that accompanies small bowel obstruction can lead to acute fluid losses, which can lead to hypovolemic shock. Hypovolemia can occur from the fluid shifts related to the edema and congestion occurring in the bowel pg 1303 1. A patient reports frequent heartburn twice a week for the past 4 months. What other symptoms reported by the patient may indicate the patient has GERD? SELECT-ALL-THAT-APPLY:* A. Bitter taste in mouth B. Dry cough C. Melena D. Difficulty swallowing E. Smooth, red tongue F. Murphy's Sign A, B, D The answers are A, B, D. These are signs and symptoms seen with GERD. Melena is seen with gastrointestinal bleeding as in peptic ulcer disease. Smooth, red tongue is seen with vitamin B12 deficiency, and Murphy's Signs is seen with cholecystitis. 2. Your patient, who is presenting with signs and symptoms of GERD, is scheduled to have a test that assesses the function of the esophagus' ability to squeeze food down into the stomach and the closer of the lower esophageal sphincter. The patient asks you, "What is the name of the test I'm having later today?" You tell the patient the name of the test is:* A. Lower Esophageal Gastrointestinal Series B. Transesophageal echocardiogram C. Esophageal manometry D. Esophageal pH monitoring The answer is C. An esophageal manometry assesses the function of the esophagus' ability to squeeze the food down and how the lower esophageal sphincter closes. 4. During a home health visit, you are helping a patient develop a list of foods they should avoid due to GERD. Which items in the patient's pantry should be avoided? SELECT-ALL-THAT-APPLY:* A. Hot and Spicy Pork Rinds B. Peppermint Patties C. Green Beans D. Tomato Soup E. Chocolate Fondue F. Almonds G. Oranges The answers are A, B, D, E, G. Patients with GERD should avoid foods that relax the lower esophageal sphincter such as greasy/fatty foods (Hot and Spicy Pork Rinds), peppermint (peppermint patties), acidic or citrus foods/juice (tomato soup and oranges), chocolate (chocolate fondue), along with coffee and soft drinks. 5. After providing education to a patient with GERD. You ask the patient to list 4 things they can do to prevent or alleviate signs and symptoms of GERD. Which statement is INCORRECT?* A. "It is best to try to consume small meals throughout the day than eat 3 large ones." B. "I'm disappointed that I will have to limit my intake of peppermint and spearmint because I love eating those types of hard candies." C. "It is important I avoid eating right before bedtime." D. "I will try to lie down after eating a meal to help decrease pressure on the lower esophageal sphincter." The answer is D. This statement is incorrect. The patient should have said I will AVOID lying down after eating a meal to help decrease pressure on the lower esophageal sphincter. It is important a patient does not immediately lie down after eating but wait for about 1 hour 6. You're collecting a patient's medication history that has GERD. Which medication below is NOT typically used to treat GERD?* A. Colesevelam "Welchol" B. Omeprazole "Prilosec" C. Metoclopramide "Reglan" D. Ranitidine HCL "Zantac" The answer is A. Options B is a proton-pump Inhibitors (PPIs) and it decreases stomach acid and helps the esophagus heal. Option C is a type of prokinetic drug and prevents delayed gastric emptying by improving pressure in lower esophageal sphincter and it improves peristalsis of the GI tract. Option D is a histamine receptor blocker and it blocks histamine. When histamine is released it causes the parietal cells to release HCL but this response will be blocked so gastric acid secretion will be decreased. Option A is a drug used in gallbladder disease. 7. A patient is taking Bethanechol "Urecholine" for treatment of GERD. This is known as what type of drug?* A. Proton-pump inhibitor B. Histamine receptor blocker C. Prokinetic D. Mucosal Healing Agent The answer is C. This drug is known as a prokinetic drug. It prevents delayed gastric emptying by improving pressure in lower esophageal sphincter and improves peristalsis of the GI tract. 8. Which of the following does NOT play a role in the development of GERD?* A. Pregnancy B. Hiatal hernia C. Usage of antihistamines or calcium channel blockers D. All the above play a role in GERD The answer is D. All the options above play a role in the development of GERD. These options can weaken the lower esophageal sphincter and cause it to not close properly 3. After dinner time, during hourly rounding, a patient awakes to report they feel like "food is coming up" in the back of their throat and that there is a bitter taste in their mouth. What nursing intervention will you perform next?* A. Perform deep suctioning B. Assist the patient into the Semi-Fowler's position C. Keep the patient NPO D. Instruct the patient to avoid milk products The answer is B. The patient is experiencing regurgitation. The clues in this scenario are the patient signs and symptoms along with the time of day (after dinner time...the patient just ate a meal and is sleeping..we can assume they are lying down). If a patient has reflux disease, the lower esophageal sphincter is weak and after a meal when a person lies down to sleep the food can regurgitate into the throat which will cause the patient to feel like "food in coming up" in the back of the throat and bitter taste in the mouth. Placing the patient in semi-fowler's position will help alleviate this. The nurse is assessing a client with a lactose intolerance disorder for a suspected diagnosis of hypocalcemia. Which clinical manifestation would the nurse expect to note in the client? 1.Twitching 2.Hypoactive bowel sounds 3.Negative Trousseau's sign 4.Hypoactive deep tendon reflexes twitching Signs of hypocalcemia include paresthesias followed by numbness, hyperactive deep tendon reflexes, and a positive Trousseau's or Chvostek's sign. Additional signs of hypocalcemia include increased neuromuscular excitability, muscle cramps, twitching, tetany, seizures, irritability, and anxiety. Gastrointestinal symptoms include increased gastric motility, hyperactive bowel sounds, abdominal cramping, and diarrhea. The nurse is assigned to care for a group of clients. On review of the clients' medical records, the nurse determines that which client is most likely at risk for a fluid volume deficit? 1.A client with an ileostomy 2.A client with heart failure 3.A client on long-term corticosteroid therapy 4.A client receiving frequent wound irrigations 1.A client with an ileostomy Rationale:A fluid volume deficit occurs when the fluid intake is not sufficient to meet the fluid needs of the body. Causes of a fluid volume deficit include vomiting, diarrhea, conditions that cause increased respirations or increased urinary output, insufficient intravenous fluid replacement, draining fistulas, and the presence of an ileostomy or colostomy. A client with heart failure or on long-term corticosteroid therapy or a client receiving frequent wound irrigations is most at risk for fluid volume excess. The nurse is caring for a client with a nasogastric tube that is attached to low suction. The nurse monitors the client for manifestations of which disorder that the client is at risk for? Metabolic alkalosis Rationale:Metabolic alkalosis is defined as a deficit or loss of hydrogen ions or acids or an excess of base (bicarbonate) that results from the accumulation of base or from a loss of acid without a comparable loss of base in the body fluids. This occurs in conditions resulting in hypovolemia, the loss of gastric fluid, excessive bicarbonate intake, the massive transfusion of whole blood, and hyperaldosteronism. Loss of gastric fluid via nasogastric suction or vomiting causes metabolic alkalosis as a result of the loss of hydrochloric acid. The remaining options are incorrect interpretations. A client with a 3-day history of nausea and vomiting presents to the emergency department. The client is hypoventilating and has a respiratory rate of 10 breaths per minute. The electrocardiogram (ECG) monitor displays tachycardia, with a heart rate of 120 beats per minute. Arterial blood gases are drawn and the nurse reviews the results, expecting to note which finding? 1.A decreased pH and an increased Paco2 2.An increased pH and a decreased Paco2 3.A decreased pH and a decreased HCO3- 4.An increased pH and an increased HCO3- An increased pH and an increased HCO3- Rationale:Clients experiencing nausea and vomiting would most likely present with metabolic alkalosis resulting from loss of gastric acid, thus causing the pH and HCO3- to increase. Symptoms experienced by the client would include a decrease in the respiratory rate and depth, and tachycardia. Option 1 reflects a respiratory acidotic condition. Option 2 reflects a respiratory alkalotic condition, and option 3 reflects a metabolic acidotic condition.