Lewis Medical Surgical Nursing: Chap 46
Upper GI Problems
After change-of-shift report, which patient would the nurse assess first?
a. A 42-yr-old patient who has acute gastritis and ongoing epigastric pain
b. A 70-yr-old patient with a hiatal hernia who experiences frequent heartburn c. A 60-yr-old
patient with nausea and vomiting who is lethargic with dry mucosa
d. A 53-yr-old patient who has dumping syndrome after a recent partial gastrectomy - ANS
ANS: C A patient with nausea and vomiting who is lethargic with dry mucosa is at high risk for
problems such as aspiration, dehydration, and fluid and electrolyte disturbances. The other
patients will also need to be assessed, but the information about them indicates symptoms that
are typical for their diagnoses and are not life threatening.
Which item would the nurse offer to the patient restarting 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 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.
A woman receiving chemotherapy for breast cancer develops a Candida albicans oral infection.
Which intervention would the nurse anticipate?
a. Nystatin tablets
b. Antiviral agents
c. Referral to a dentist
d. Hydrogen peroxide rinses - ANS ANS: A C. albicans infections are treated with an antifungal
such as nystatin. Peroxide rinses would be painful. 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
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 patches on the buccal mucosa
d. Curdlike plaques on the posterior tongue - ANS ANS: C A red, velvety patch suggests
erythroplasia, which has a high incidence (>50%) of progression to squamous cell carcinoma.
, The other lesions are suggestive of acute processes (e.g., gingivitis, oral candidiasis, herpes
simplex).
Which information will the nurse include when teaching adults to decrease the risk for cancers
of the tongue and buccal mucosa?
a. Use sunscreen even on cloudy days.
b. Avoid cigarettes and smokeless tobacco.
c. Complete antibiotic courses used to treat throat infections.
d. Use antivirals to treat herpes simplex virus (HSV) infections - ANS ANS: B 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, although it increases risk for cancer of the
lip. Human papillomavirus (HPV) infection is associated with an increased risk, but HSV
infection is not a risk factor for oral cancer
A patient who has gastroesophageal reflux disease (GERD) is experiencing increasing
discomfort. Which patient statement to the nurse indicates a need for additional teaching about
GERD?
a. ―I quit smoking years ago, but I chew gum.‖
b. ―I eat small meals and have a bedtime snack.‖
c. ―I take antacids between meals and at bedtime each night.‖
d. ―I sleep with the head of the bed elevated on 4-inch blocks.‖ - ANS ANS: B GERD is
exacerbated by eating late at night, and the nurse would plan to teach the patient to avoid
eating within 3 hours of bedtime. Smoking cessation, taking antacids, and elevating the head of
the bed are appropriate actions to control symptoms of GERD.
A patient with a stroke is unconscious and unresponsive to stimuli. After learning that the patient
has a history of gastroesophageal reflux disease (GERD), which assessment would the nurse
plan to make more frequently than is routine?
a. Apical pulse
b. Bowel sounds
c. Breath sounds
d. Abdominal girth - ANS 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 patient's stroke or GERD and do not require more
frequent monitoring than the routine.
How would the nurse explain esomeprazole (Nexium) to a patient who has recurring heartburn?
a. ―It reduces gastroesophageal reflux by increasing the rate of gastric emptying.‖
b. ―It neutralizes stomach acid and provides relief of symptoms in a few minutes.‖
c. ―It coats and protects the lining of the stomach and esophagus from gastric acid.‖
d. ―It treats gastroesophageal reflux disease by decreasing stomach acid production.‖ - ANS
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
Upper GI Problems
After change-of-shift report, which patient would the nurse assess first?
a. A 42-yr-old patient who has acute gastritis and ongoing epigastric pain
b. A 70-yr-old patient with a hiatal hernia who experiences frequent heartburn c. A 60-yr-old
patient with nausea and vomiting who is lethargic with dry mucosa
d. A 53-yr-old patient who has dumping syndrome after a recent partial gastrectomy - ANS
ANS: C A patient with nausea and vomiting who is lethargic with dry mucosa is at high risk for
problems such as aspiration, dehydration, and fluid and electrolyte disturbances. The other
patients will also need to be assessed, but the information about them indicates symptoms that
are typical for their diagnoses and are not life threatening.
Which item would the nurse offer to the patient restarting 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 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.
A woman receiving chemotherapy for breast cancer develops a Candida albicans oral infection.
Which intervention would the nurse anticipate?
a. Nystatin tablets
b. Antiviral agents
c. Referral to a dentist
d. Hydrogen peroxide rinses - ANS ANS: A C. albicans infections are treated with an antifungal
such as nystatin. Peroxide rinses would be painful. 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
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 patches on the buccal mucosa
d. Curdlike plaques on the posterior tongue - ANS ANS: C A red, velvety patch suggests
erythroplasia, which has a high incidence (>50%) of progression to squamous cell carcinoma.
, The other lesions are suggestive of acute processes (e.g., gingivitis, oral candidiasis, herpes
simplex).
Which information will the nurse include when teaching adults to decrease the risk for cancers
of the tongue and buccal mucosa?
a. Use sunscreen even on cloudy days.
b. Avoid cigarettes and smokeless tobacco.
c. Complete antibiotic courses used to treat throat infections.
d. Use antivirals to treat herpes simplex virus (HSV) infections - ANS ANS: B 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, although it increases risk for cancer of the
lip. Human papillomavirus (HPV) infection is associated with an increased risk, but HSV
infection is not a risk factor for oral cancer
A patient who has gastroesophageal reflux disease (GERD) is experiencing increasing
discomfort. Which patient statement to the nurse indicates a need for additional teaching about
GERD?
a. ―I quit smoking years ago, but I chew gum.‖
b. ―I eat small meals and have a bedtime snack.‖
c. ―I take antacids between meals and at bedtime each night.‖
d. ―I sleep with the head of the bed elevated on 4-inch blocks.‖ - ANS ANS: B GERD is
exacerbated by eating late at night, and the nurse would plan to teach the patient to avoid
eating within 3 hours of bedtime. Smoking cessation, taking antacids, and elevating the head of
the bed are appropriate actions to control symptoms of GERD.
A patient with a stroke is unconscious and unresponsive to stimuli. After learning that the patient
has a history of gastroesophageal reflux disease (GERD), which assessment would the nurse
plan to make more frequently than is routine?
a. Apical pulse
b. Bowel sounds
c. Breath sounds
d. Abdominal girth - ANS 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 patient's stroke or GERD and do not require more
frequent monitoring than the routine.
How would the nurse explain esomeprazole (Nexium) to a patient who has recurring heartburn?
a. ―It reduces gastroesophageal reflux by increasing the rate of gastric emptying.‖
b. ―It neutralizes stomach acid and provides relief of symptoms in a few minutes.‖
c. ―It coats and protects the lining of the stomach and esophagus from gastric acid.‖
d. ―It treats gastroesophageal reflux disease by decreasing stomach acid production.‖ - ANS
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
