Test Bank - Lewis's Medical Surgical Nursing (11th Edition by Harding) 478
Chapter 41: Upper Gastrointestinal Problems
Test Bank
MULTIPLE CHOICE
1. A 53-year-old male patient with deep partial-thickness burns from a chemical spill in the workplace
experiences severe pain followed by nausea during dressing changes. Which action will be most useful in
decreasing the patients nausea?
a. Keep the patient NPO for 2 hours before and after dressing changes.
b. Avoid performing dressing changes close to the patients mealtimes.
c. Administer the prescribed morphine sulfate before dressing changes.
d. Give the ordered prochlorperazine (Compazine) before dressing changes.
ANS: C
Because the patients nausea is associated with severe pain, it is likely that it is precipitated by stress and pain.
The best treatment will be to provide adequate pain medication before dressing changes. The nurse should
avoid doing painful procedures close to mealtimes, but nausea/vomiting that occur at other times also should
be addressed. Keeping the patient NPO does not address the reason for the nausea and vomiting and will have
an adverse effect on the patients nutrition. Administration of antiemetics is not the best choice for a patient
with nausea caused by pain.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
2. Which item should the nurse offer to the patient who is to restart 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.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
3. A 38-year old woman receiving chemotherapy for breast cancer develops a Candida albicans oral infection.
,Test Bank - Lewis's Medical Surgical Nursing (11th Edition by Harding) 479
The nurse will anticipate the need for
a. hydrogen peroxide rinses.
b. the use of antiviral agents.
c. administration of nystatin (Mycostatin) tablets.
d. referral to a dentist for professional tooth cleaning.
ANS: C
Candida albicans is treated with an antifungal such as nystatin. Oral saltwater rinses may be used but will not
cure the infection. Antiviral agents are used for viral infections such as herpes simplex. Referral to a dentist is
indicated for gingivitis but not for Candida infection.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
4. Which finding in the mouth of a patient who uses smokeless tobacco is suggestive of oral cancer?
a. Bleeding during tooth brushing
b. Painful blisters at the lip border
c. Red, velvety patches on the buccal mucosa
d. White, curdlike plaques on the posterior tongue
ANS: C
A red, velvety patch suggests erythroplasia, which has a high incidence (greater than 50%) of progression to
squamous cell carcinoma. The other lesions are suggestive of acute processes (e.g., gingivitis, oral candidiasis,
herpes simplex).
DIF: Cognitive Level: Understand (comprehension)
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
5. Which information will the nurse include when teaching adults to decrease the risk for cancers of the tongue
and buccal mucosa?
a. Avoid use of cigarettes and smokeless tobacco.
b. Use sunscreen when outside even on cloudy days.
c. Complete antibiotic courses used to treat throat infections.
,Test Bank - Lewis's Medical Surgical Nursing (11th Edition by Harding) 480
d. Use antivirals to treat herpes simplex virus (HSV) infections.
ANS: A
Tobacco use greatly increases the risk for oral cancer. Acute throat infections do not increase the risk for oral
cancer, although chronic irritation of the oral mucosa does increase risk. Sun exposure does not increase the
risk for cancers of the buccal mucosa. Human papillomavirus (HPV) infection is associated with an increased
risk, but HSV infection is not a risk factor for oral cancer.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance
6. A 46-year-old female with gastroesophageal reflux disease (GERD) is experiencing increasing discomfort.
Which patient statement indicates that additional teaching about GERD is needed?
a. I take antacids between meals and at bedtime each night.
b. I sleep with the head of the bed elevated on 4-inch blocks.
c. I eat small meals during the day and have a bedtime snack.
d. I quit smoking several years ago, but I still chew a lot of gum.
ANS: C
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.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity
7. A 68-year-old male patient with a stroke is unconscious and unresponsive to stimuli. After learning that the
patient has a history of gastroesophageal reflux disease (GERD), the nurse will plan to do frequent assessments
of the patients
a. apical pulse.
b. bowel sounds.
c. breath sounds.
d. abdominal girth.
ANS: C
Because GERD may cause aspiration, the unconscious patient is at risk for developing aspiration pneumonia.
Bowel sounds, abdominal girth, and apical pulse will not be affected by the patients stroke or GERD and do
not require more frequent monitoring than the routine.
, Test Bank - Lewis's Medical Surgical Nursing (11th Edition by Harding) 481
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
8. The nurse explaining esomeprazole (Nexium) to a patient with recurring heartburn describes that the
medication
a. reduces gastroesophageal reflux by increasing the rate of gastric emptying.
b. neutralizes stomach acid and provides relief of symptoms in a few minutes.
c. coats and protects the lining of the stomach and esophagus from gastric acid.
d. 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.
DIF: Cognitive Level: Understand (comprehension)
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
9. Which patient choice for a snack 2 hours before bedtime indicates that the nurses teaching about
gastroesophageal reflux disease (GERD) has been effective?
a. Chocolate pudding
b. Glass of low-fat milk
c. Cherry gelatin with fruit
d. Peanut butter and jelly sandwich
ANS: C
Gelatin and fruit are low fat and will not decrease lower esophageal sphincter (LES) pressure. Foods such as
chocolate are avoided because they lower LES pressure. Milk products increase gastric acid secretion. High-fat
foods such as peanut butter decrease both gastric emptying and LES pressure.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity
10. The nurse will anticipate teaching a patient experiencing frequent heartburn about
a. a barium swallow.
b. radionuclide tests.
Chapter 41: Upper Gastrointestinal Problems
Test Bank
MULTIPLE CHOICE
1. A 53-year-old male patient with deep partial-thickness burns from a chemical spill in the workplace
experiences severe pain followed by nausea during dressing changes. Which action will be most useful in
decreasing the patients nausea?
a. Keep the patient NPO for 2 hours before and after dressing changes.
b. Avoid performing dressing changes close to the patients mealtimes.
c. Administer the prescribed morphine sulfate before dressing changes.
d. Give the ordered prochlorperazine (Compazine) before dressing changes.
ANS: C
Because the patients nausea is associated with severe pain, it is likely that it is precipitated by stress and pain.
The best treatment will be to provide adequate pain medication before dressing changes. The nurse should
avoid doing painful procedures close to mealtimes, but nausea/vomiting that occur at other times also should
be addressed. Keeping the patient NPO does not address the reason for the nausea and vomiting and will have
an adverse effect on the patients nutrition. Administration of antiemetics is not the best choice for a patient
with nausea caused by pain.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
2. Which item should the nurse offer to the patient who is to restart 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.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
3. A 38-year old woman receiving chemotherapy for breast cancer develops a Candida albicans oral infection.
,Test Bank - Lewis's Medical Surgical Nursing (11th Edition by Harding) 479
The nurse will anticipate the need for
a. hydrogen peroxide rinses.
b. the use of antiviral agents.
c. administration of nystatin (Mycostatin) tablets.
d. referral to a dentist for professional tooth cleaning.
ANS: C
Candida albicans is treated with an antifungal such as nystatin. Oral saltwater rinses may be used but will not
cure the infection. Antiviral agents are used for viral infections such as herpes simplex. Referral to a dentist is
indicated for gingivitis but not for Candida infection.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
4. Which finding in the mouth of a patient who uses smokeless tobacco is suggestive of oral cancer?
a. Bleeding during tooth brushing
b. Painful blisters at the lip border
c. Red, velvety patches on the buccal mucosa
d. White, curdlike plaques on the posterior tongue
ANS: C
A red, velvety patch suggests erythroplasia, which has a high incidence (greater than 50%) of progression to
squamous cell carcinoma. The other lesions are suggestive of acute processes (e.g., gingivitis, oral candidiasis,
herpes simplex).
DIF: Cognitive Level: Understand (comprehension)
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
5. Which information will the nurse include when teaching adults to decrease the risk for cancers of the tongue
and buccal mucosa?
a. Avoid use of cigarettes and smokeless tobacco.
b. Use sunscreen when outside even on cloudy days.
c. Complete antibiotic courses used to treat throat infections.
,Test Bank - Lewis's Medical Surgical Nursing (11th Edition by Harding) 480
d. Use antivirals to treat herpes simplex virus (HSV) infections.
ANS: A
Tobacco use greatly increases the risk for oral cancer. Acute throat infections do not increase the risk for oral
cancer, although chronic irritation of the oral mucosa does increase risk. Sun exposure does not increase the
risk for cancers of the buccal mucosa. Human papillomavirus (HPV) infection is associated with an increased
risk, but HSV infection is not a risk factor for oral cancer.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance
6. A 46-year-old female with gastroesophageal reflux disease (GERD) is experiencing increasing discomfort.
Which patient statement indicates that additional teaching about GERD is needed?
a. I take antacids between meals and at bedtime each night.
b. I sleep with the head of the bed elevated on 4-inch blocks.
c. I eat small meals during the day and have a bedtime snack.
d. I quit smoking several years ago, but I still chew a lot of gum.
ANS: C
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.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity
7. A 68-year-old male patient with a stroke is unconscious and unresponsive to stimuli. After learning that the
patient has a history of gastroesophageal reflux disease (GERD), the nurse will plan to do frequent assessments
of the patients
a. apical pulse.
b. bowel sounds.
c. breath sounds.
d. abdominal girth.
ANS: C
Because GERD may cause aspiration, the unconscious patient is at risk for developing aspiration pneumonia.
Bowel sounds, abdominal girth, and apical pulse will not be affected by the patients stroke or GERD and do
not require more frequent monitoring than the routine.
, Test Bank - Lewis's Medical Surgical Nursing (11th Edition by Harding) 481
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
8. The nurse explaining esomeprazole (Nexium) to a patient with recurring heartburn describes that the
medication
a. reduces gastroesophageal reflux by increasing the rate of gastric emptying.
b. neutralizes stomach acid and provides relief of symptoms in a few minutes.
c. coats and protects the lining of the stomach and esophagus from gastric acid.
d. 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.
DIF: Cognitive Level: Understand (comprehension)
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
9. Which patient choice for a snack 2 hours before bedtime indicates that the nurses teaching about
gastroesophageal reflux disease (GERD) has been effective?
a. Chocolate pudding
b. Glass of low-fat milk
c. Cherry gelatin with fruit
d. Peanut butter and jelly sandwich
ANS: C
Gelatin and fruit are low fat and will not decrease lower esophageal sphincter (LES) pressure. Foods such as
chocolate are avoided because they lower LES pressure. Milk products increase gastric acid secretion. High-fat
foods such as peanut butter decrease both gastric emptying and LES pressure.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity
10. The nurse will anticipate teaching a patient experiencing frequent heartburn about
a. a barium swallow.
b. radionuclide tests.
