The nurse explains to the patient with
gastroesophageal reflux disease that this
disorder:
A. results in acid erosion and ulceration of the
esophagus caused by frequent vomiting,
B. will require surgical wrapping or repair of the
pyloric sphincter to control the symptoms,
C. is the protrusion of a portion of the stomach
into to esophagus through an opening in the
diaphragm,
D. often involves relaxation of the lower
esophageal sphincter, allowing stomach contents
to back up into the espophagus
Answer: D. The acidic contents of the stomach
touching the inside of the esophagus are
responsible for the physical sensation known as
"heart-burn" that is a cardinal symptom of
GERD
The nurse is teaching the patient and family
about possible causative factors for peptic
ulcers. The nurse explains that ulcer formation
is: (Source: Medical-Surgical Nursing, LDH p.
1004)
a) caused by stressful lifestyle and other acid
producing factors such as H. pylori.
b) inherited within families and reinforced by
bacterial spread of Staphylococcus aureus in
childhood.
c) promoted by factors that tend to cause
oversecretion of acid, such as excess dietary fats,
smoking, and H. pylor.
d) promoted by a combination of possible
factors that may result in erosion of the gastric
mucosa, including certain drugs and alcohol
Peptic ulcers develop only in the presence of an
acidic environment. However, an excess of
hydrochloric acid (HCl) may not be necessary
for ulcer development. The back-diffusion of
HCl into the gastric mucosa results in cellular
destruction and inflammation. Histamine is
released from the damaged mucosa, resulting in
vasodilation and increased capillary
permeability and further secretion of acid and
pepsin. A variety of agents (i.e., certain
infections, medications, and lifestyle factors) can
damage the mucosal barrier
"Which of the following types of gastritis is
associated with Helicobacter pylori and
duodenal ulcers?
1. Erosive (hemorrhagic) gastritis
2. Fundic gland gastritis (type A)
3. Antral gland gastritis (type B)
4.Aspiring-induced gastric ulcer
Answer: 3 - Erosive (hemorrhagic) gastritis can
be
caused by ingestion of substances that irritate the
gastric mucosa. Fundic gland gastritis (type A)
is associated with diffuse severe mucosal
atrophy and the presence of pernicious anemia.
Antral gland gastritis (type B) is the most
common form of gastritis, and is associated with
Helicobacter pylori and duodenal ulcers
Caffeinated beverages and smoking are risk
factors to assess for in the development of what
condition?
A. Duodenal ulcers
B. Peptic ulcers
C. Helicobacter pylori
D. Esophageal reflux
Answer: B PUD risk factors include family
history, blood group O, smoking tobacco, and
beverages containing caffeine
Gastroesophageal reflux disease (GERD)
weakens the lower esophageal sphincter,
predisposing older persons to risk for impaired
swallowing. In managing the symptoms
associated with GERD, the nurse should assign
the highest priority to which of the following
interventions?
1. Decrease daily intake of vegetables and water,
and ambulate frequently
2. Drink coffee diluted with milk at each meal,
and remain in an upright position for 30 minutes.
3. Eat small, frequent meals, and remain in an
upright position for at least 30 minutes after
eating
4. Avoid over-the-counter drugs that have
antacids in them
Answer 3, Eating small and frequent meals
requires less release of hydrochloric acid.
Remaining in an upright position for 30 minutes
after meals prevents reflux into the esophagus
which is often exacerbated when lying down,
expecially after a large meal which makes the
patient tired
The nurse is performing an admission
assessment on a client diagnosed with
gastroesophageal reflux disease (GERD). Which
signs and symptoms would indicate GERD? 1.
Pyrosis, water brash, and flatulence 2. Weight
loss, dysarthria, and diarrhea 3. Decreased
abdominal fat, proteinuria, and constipation 4.
Mid-epigastric pain, positive H. pylori test, and
melena
Correct answer: 1 (pyrosis, water brash, and
flatulence)1. Pyrosis is heartburn, water brash is
the feeling of saliva secretion as a result of
reflux, and flatulence is gas—all symptoms of
GERD 2. Gastroesophageal reflux disease does
not cause weight loss 3. There is no change in
abdominal fat, no proteinuria (the result of a
filtration problem inthe kidney), and no
alteration in bowel elimination for the client
diagnosed with GERD 4. Mid-epigastric pain, a
positive H. pylori test, and melena are associated
with gastric ulcer disease
The client with a hiatal hernia chronically
experiences heartburn following meals. The
nurse planc to teach the client to avoid which
action because it is contraindicated with hiatal
hernia?
1. Lying recumbent following meals
2. Taking in small, frequent, bland meals
3. Raising the head of the bed on 6-inch blocks
4. Taking H2-receptor antagonist medication
Correct answer: 1Laying recumbant following
meals or at night will cause reflux and pain.
Relief is usually achieved with the intake of
small, bland meals, use of H2 receptor
antagonists and antacids, and elevation of the
thorax after meals and during sleep
What response should a nurse offer to a client
who asks why he's having a vagotomy to treat
his ulcer?
1. To repair a hole in the stomach
2. to reduce the ability of the stomach to produce
acid
3. to prevent the stomach from sliding into the
chest
4. to remove a potentially malignant lesion in the
stomach
Answer 2: A vagotomy is perfomred to
elimniate the acid-secreting stimulus to gastric
cells. a perforation would be repaired with a
gastric resection. Repair of hiatal hernia
(fundoplication) prevents the stomach from
sliding through the diaphragm. Removal of a
potentially malignant tumor wouldn't reduce the
entire acid-producing mechanism
The nurse is planning to teach a client with
GERD about substances that will increase the
LES pressure.Which item shoud the nurse
include on this list.
1. Coffee
2. Chocolate
3. Fatty Foods
4. Nonfat MIlk
Answer #4: Nonfat Milk Foods that will increase
LES pressure will decrease reflux and lessen the
symptoms of GERD. The food that will increase
LES pressure is nonfat milk. The other
substances listed decrease LES pressure, thus
increasing reflux symptoms. Aggravating
substances include the others listed and alcohol
Which assessment data support the client's
diagnosis of gastric ulcer?"
1. Presence of blood in the client's stool for the
past month.
2.Complaints of a burning sensation that moves
like a wave.
3.Sharp pain in the upper abdomen after eating a
heavy meal.
4.Comparison of complaints of pain with
ingestion of food and sleep
"1. The presence of blood does not specifically
indicate diagnosis of an ulcer. The client could
have hemorrhoids or cancer that would result in
the presence of blood. 2. A wavelike burning
sensation is a symptom of gastroesophageal
reflus. 3. Sharp pain in the upper abdomen after
eating a heavy meal is a symptom of gallbladder
disease. 4. (CORRECT) In a client diagosed
with a gastric ulcer, pain usually occurs 30-60
minutes after eating, but not at night. In contrast,
a client with duodenal ulcer has pain durin ghte
night that is often relieved by eating food. Pain
occurs 1-3 hours after meals
When assessing the client with the diagnosis of
peptic ulcer disease, which physical examination
should the nurse implement first?
1.Auscultate the client's bowel sounds in all four
quadrants.
2.Palpate the abdominal area for tenderness.
3.Percuss the abdominal borders to identify
organs. 4.Assess the tender area progressing to
nontender
Correct answer: #1. Auscultation should be used
prior to palpa-tion or percussion when assessing
the abdomen. If the nurse manipulates the
abdomen, the bowel sounds can be altered and
give false information
The nurse is monitoring a client with a diagnosis
of peptic ulcer. Which assessment finding would
most likely indicate perforation of the ulcer?
1. Bradycardia
2. Numbness in the legs
3. Nausea and vomiting
4. A rigid, board-like abdomen
Answer 4, Perforation of an ulcer is a surgical
emergency and is characterized by sudden,
sharp, intolerable severe pain beginning in the
midepigastric area and spreading over the
abdomen, which become rigid and board-like.
Nausea and vomiting may occur. Tachycardia
may occur as hypovolemic shock develops.
Numbness in the legs is not an associated
finding
Which of the following nursing interventions
should the nurse perform for a female client
receiving enteral feedings through a gastrostomy
tube?
a. Change the tube feeding solutions and tubing
at least every 24 hours
b. Maintain the head of the bed at a 15-degree
elevation continuously.
c. Check the gastrostomy tube for position every
2 days.
d. Maintain the client on bed rest during the
feedings
Answer A. Tube feeding solutions and tubing
should be changed every 24 hours, or more
frequently if the feeding requires it. Doing so
prevents contamination and bacterial growth.
The head of the bed should be elevated 30 to 45
degrees continuously to prevent aspiration.
Checking for gastrostomy tube placement is
performed before initiating the feedings and
every 4 hours during continuous feedings.
Clients may ambulate during feedings
The nurse is planning to teach the client with
GERD about substance that will increase the
lower esophageal sphincter pressure. Which
item should the nurse include on this list?
Saunders NCLEX Examination Review 1.
Coffee 2. Chocolate 3. Fatty Foods 4.Nonfat
milk
4. Nonfat milk Foods that increase LES pressure
will decrease reflux and decrease symptoms.
Milk will increase LES pressure
The nurse is caring for a male client with a
diagnosis of chronic gastritis. The nurse
monitors the client knowing that this client is at
risk for which vitamin deficiency? a. Vitamin A
b. Vitamin B12 c. Vitamin C d. Vitamin E
Answer B. Chronic gastritis causes deterioration
and atrophy of the lining of the stomach, leading
to the loss of the function of the parietal cells.
The source of the intrinsic factor is lost, which
results in the inability to absorb vitamin B12.
This leads to the development of pernicious
anemia. The client is not at risk for vitamin A,
C, or E deficiency
"The nurse is teaching the patient a client with a
peptic ulcer discharge instructions. The client
asks the nurse which type of analgesic he may
take. Which of the following responses by the
nurse would be most accurate?
"1. Aspirin
2. Acetaminophen
3. Naproxen
4. Ibuprofen
2.Acetaminophen is recommended for pain
relief because it does no promote irritation
of the mucosa. Aspirin, and nonsteroidal anti-
inflammatory drugs suchs as naproxen and
ibuprofen, may cause irritation of the mucosa
and subsequent bleeding
"The nurse is planning the care of a client
diagnosed with lower esophageal sphincter
dysfunction. Which dietary modifications should
be included in the plan of care?
1. Allow any of the client's favorite foods as
long as the amount is limited.
2. Have the client perform eructation exercises
several times a day.
3. Eat four (4) to six (6) small meals a day and
limit fluids during mealtimes.
4. Encourage the client to consume a glass of red
wine with one (1) meal a day
"1. The client is instructed to avoid spicy and
acidic foods and any food producing symptoms.
2. Eructation means belching, which is a
symptom of GERD.
3. Clients should eat small, frequent meals and
limit fluids with the meals to prevent reflux into
the esophagus from a distended
stomach.CORRECT 4. Clients are encouraged to
forgo all alcoholic beverages because alcohol
relaxes the lower esophageal sphincter and
increases the risk of reflux
The nurse is assessing the client diagnosed with
chronic gastritis. Which symptom(s) support this
diagnosis? 1. Rapid onset of midsternal
discomfort 2. Epigastric pain relieved by eating
food 3. Dyspepsia and hematemesis 4. Nausea
and projectile vomiting
Answer 2: Chronic pain in the epigastric area
relieved by ingesting food is a sign of chronic
gastritis
The nurse is monitoring a client with a diagnosis
of peptic ulcer. Which assessment finding would
most likely indicate perforation of the ucler?
1. Bradycardia
2. Numbness in the legs
3. Nausea and vomiting
4. A rigid, board-like abdomen
Answer 4, Rationale: Perforation of an ulcer is a
surgical emergency and is characterized by
sudden, sharp, intolerable severe pain beginning
in the midepigastric area and spreading over the
abdomen, which becomes rigid and board-like.
Nausea and vomiting may occur. Tachycardia
may occur as hypovolemic shock develops.
Numbness in the legs is not an associated
finding
The client with hiatal hernia chronically
experiences heartburn following meals. The
nurse plans to teach the client to avoid which
action because it is contraindicated with a hiatal
hernia?
1. Lying recumbent following meals.
2. Taking in small, frequent bland meals.
3. Raising the head of the bed on 6-inch block.
4. Taking H2-receptor antagonist medication
Answer 1,Hiatal hernia is caused by a protrusion
of a portion of the stomach above the diaphragm
where the esophagus is normally positioned. he
client usually experiences pain from reflux
caused by ingestion of irritating foods, lying flat
following meals or at night, and eating large or
fatty meals. Option 2-4, and actually elevating
the thorax after a meal, provide relief
The nurse is preparing a client diagnosed with
GERD for discharge following an
esophagogastroduodenoscopy. Which statement
indicates the client understands the discharge
instructions?7 1. I should not eat for 24 hours
following this procedure. 2 I can lie down
whenever iI want after a meal. It own't make a
difference. 3. The stomach contents won't bother
my esophagus but will make me nauseous. 4. I
should avoid drinking orange jice and eating
tomatoes until my esophagus heals.
Answer 4, oragne and tomato juices are acidic,
and the client diagnosed with GERD
shouldavoid acidic foods until the esophagus
hashad a chance to heal - A client hospitalized
with a gastric ulcer is scheduled for discharge.
The nurse teaches the client about an anti-ulcer
diet. Which of the following statements by the
client indicates to the nurse that dietary teaching
was successful?
1. "I must eat bland foods to help my stomach
heal."
2. "I can eat most foods, as long as they don't
bother my stomach."
3. "I cannot eat fruits and vegetables because
they cause too much gas."
4. "I should eat a low-fiber diet to delay gastric
emptying -
The answer is 2.
Which assessment data support to the the nurse
the client's diagnosis of gastric ulcer?
A. Presence of blood in the client's stool for the
past month?
B. Reports of a burning sensation moving like a
wave.
C. Sharp pain in the upper abdomen after eating
a heavy meal.
D. Complaints of epigastric pain 30-60 minutes
after ingesting food
- Answer: D In a client diagnosed with a gastric
ulcer, pain usually occurs 30-60 minutes after
eating, but not at night. In contrast, a client with
a duodenal ulcer has pain during the night often
relieved by eating foods. Other answers: the
presence of blood does not specifically indicate
diagnose of an ulcer. The client could have
hemorrhoids or cancer. A waveline burning
sensation is a symptom of GERD. Sharp pain in
the upper abdomen after eating a heavy meal is a
symptom of gallbladder disease
The client is diagnosed with an acute
exacerbation of ulcerative colitis. Which inter-
vention should the nurse implement?
1. Provide a low-residue diet.
2.Monitor intravenous fluids.
3.Assess vital signs daily.
4.Administer antacids orally
Answer 2, "1. The client's bowel should be
placed on rest andno foods or fluids should be
introduced intothe bowel.
2. (Correct) The client requires fluids to help
prevent dehydration from diarrhea and to
replacethe fluid lost through normal body func-
tioning.
3.The vital signs must be taken more often
thandaily in a client who is having an acute
exacer-bation of ulcerative colitis. 4.The client
will receive anti-inflammatory andantidiarrheal
medications, not antacids, whichare used for
gastroenteritis
"Which statement made by the client indicates to
the nurse the client may be experiencing GERD?
1. "My chest hurts when I walk up the stairs in
my home." 2. "I take antacid tablets with me
wherever I go."
3. My spouse tells me I snore very loudly at
night."
4. I drink six (6) to seven (7) soft drinks every
day
Answer 2, 1. Pain in the chest when walking up
stairs indicates angina. 2. Frequent use of
antacids indicates an acid reflux problem. 3.
Snoring loudly could indicate sleep apnea, but
not GERD. 4. Carbonated beverages increase
stomach pressure. Six to seven soft drinks a day
would not be tolerated by a client with GERD
the nurse is monitoring a client with a diagnosis
of peptic ulcer. which assessment finding would
most likely indicate perforation of the ulcer?
1. bradycardia
2. numbness in legs
3. N&V
4. a rigid board-like abdomen
Answer 4, perforation of ulcer is a surgical
emergency and is characterized by sudden,
sharp, intolderable severe pain beginning in the
midepigastric area and spreading over the
abdomen, which becomes rigid and board-like.
nausea and vomiting may also occur.
tachycardia may occur as hypovolemic shock
develops. numbness of the legs is not an
associated finding
A patient with a history of peptic ulcer disease
has presented to the emergency department with
complaints of severe abdominal pain and a rigid,
boardlike abdomen, prompting the health care
team to suspect a perforated ulcer. Which of the
following actions should the nurse anticipate?
A. Providing IV fluids and inserting a
nasogastric tube
B. Administering oral bicarbonate and testing
the patient's gastric pH level.
C. Performing a fecal occult blood test and
administering IV calcium gluconate.
D. Starting parenteral nutrition and placing the
patient in high-Fowler's position
Answer A, A perforated peptic ulcer requires IV
replacement of fluid losses and continued gastric
aspiration by NG tube. Nothing is given by
mouth and gastric pH testing is not a priority.
Calcium gluconate is not a medication directly
relevant to the patient's suspected diagnosis and
parenteral nutrition is not a priority in the short
term
The patient who is admitted with a diagnosis of
diverticulitis and a history of irritable bowel
disease and gastroesophageal reflux disease
(GERD) has received a dose of Mylanta 30 ml
PO. The nurse would evaluate its effectiveness
by questioning the patient as to whether which
of the following symptoms has been resolved?
A-Diarrhea
B.Heartburn
C.Constipation
D. Lower abdominal pain
Answer B, "Mylanta is an antacid that contains
both aluminum and magnesium. It is indicated
for the relief of GI discomfort, such as with
heartburn associated with GERD
The most frequently used diagnostic test for
persons with GERD is:
a) Barium enema
b) upper endoscopy
c) barium swallow
d) acid perfusion test
Answer C, Persons with GERD should be
referred to a primary care provider for a
thorough cardiac evaluation to rule out cardiac
disease. The most frequently used diagnostic test
is barium swallow. Upper endoscopy is the best
method to assess mucosal injury. Acid perfusion
tests usually are not necessary, and require the
placement of an esophageal probe above the
esophageal sphincter to collect esophageal
contents
The nurse is caring for a female client with
active upper GI bleeding. What is the
appropriate diet for this client during the first 24
hours after admission?
a. regular diet
b. skim milk
c. nothing by mouth
d. clear liquids
Answer C, Answer C. Shock and bleeding must
be controlled before oral intake, so the client
should receive nothing by mouth. A regular diet
is incorrect. When the bleeding is controlled, the
diet is gradually increased, starting with ice
chips and then clear liquids. Skim milk shouldn't
be given because it increases gastric acid
production, which could prolong bleeding. A
liquid diet is the first diet offered after bleeding
and shock are controlled
"The nurse is caring for the client diagnosed
with chronic gastritis. Which symptom(s)
would support this diagnosis?
1. Rapid onset of mid-sternal discomfort.
2. Epigastric pain relieved by eating food
3. Dyspepsia and hematemesis.
4. Nausea and projectile vomiting
Answer 2, "Rationale by answer: 1. Acute
gastritis is characterized by sudden
epigastric pain or discomfort, not mid-sternal
chest pain.
2. Chronic pain in the epigastric area that is
relieved by ingesting food is a sign of
chronic gastritis (CORRECT).
3. Dyspepsia (heartburn) and hematemesis
(vomiting blood) are frequent symptoms of
acute gastritis.
4. Projective vomiting is not a sign of chronic
gastritis
The teaching plan for the patient being
discharged following an acute episode of upper
GI bleeding will concern information concerning
the importance of (select all that apply)
a. only taking aspirin with milk or bread
products
b. avoiding taking aspirin and drugs containing
aspirin
c. taking only drugs prescribed by the health
care provider d. taking all drugs 1 hour before
mealtime to prevent further bleeding e. reading
all OTC drug labels to avoid those containing
stearic acid and calcium
Answer A, C Aspirin contributes to thinning the
blood and is linked to causing things like
peritonitis further increasing the risk for
bleeding. Taking only health care prescribed
drugs can greatly reduce the risk from
accidentally using OTC meds that might
contribute to bleeding
The male client tells the nurse he has been
experiencing "heartburn" at night that awakens
him. Which assessment question should the
nurse ask?
A. How much weight have you gained recently?
B. What have you done to alleviate the
heartburn?
C. Do you consume many milk and dairy
products? D Have you been around anyone with
a stomach virus
Correct answer is B,Most clients with GERD
have been self medicating with over-the counter
medications prior to seeking advice from a
healthcare provider. It is important to know what
the client has been using to treat the problem
A patient has a vagotomy with antrectomy to
treat a duodenal ulcer. Postoperatively, the
patient develops dumping syndrome. Which of
the following statements, if made by the patient,
should indicate to the nurse that further dietary
teaching is needed?
1. I should eat bread with each meal
2. I should eat smaller meals more frequently.
3. I should lie down after eating.
4. I should avoid drinking fluids with my meals
Answer 1, Patient should decrease intake of
carbohydrates
The nurse is monitoring the client with a
diagnosis of peptic ulcer. Which assessment
finding would most likely indicate perforation of
the ulcer?
1. Bradycardia
2. Numbness in Legs
3. Nausea and Vomiting
4. A rigid, board-like abdomen
4. Perforation of an ulcer is a surgical
emergency and is a sudden, sharp, intolerable
severe pain beginning in the midepigastric area
and spreading over the abdomen, which
becomes rigid and board-like. Nausea and
vomiting may occur. Tachycardia may occur as
hypovolemic shock develops. Numbness in the
leg is not an associated finding
"The nurse is caring for an adult client
diagnosed with gastroesophageal reflux
disease(GERD). Which condition is the most
common comorbid disease associated with
GERD?
1.Adult-onset asthma.
2.Pancreatitis.
3.Peptic ulcer disease.
4.Increased gastric emptying
Answer 1, "1. CORRECT - Of adult-onset
asthma cases, 80%-90% are caused by
gastroesophageal reflux disease(GERD)
2. Pancreatitis is not related to GERD
3. Peptic ulcer disease is related to H. pylori
bacterial infections and can lead to increased
levelsof gastric acid, but it is not related to
reflux.
4.GERD is not related to increased
gastricemptying. Increased gastric emptying
would bea benefit to a client with decreased
functioningof the lower esophageal sphincter
"The nurse explains to the patient with
gastroesophageal reflux disease that this
disorder:
"A. results in acid erosion of the esophagus
caused by frequent vomiting
B. Will require surgical wrapping of the pyloric
sphincter to control the symptoms
C. Is the protrusion of a portion of the stomach
into the esophagus through the opening in the
diaphragm
D. Often involves relaxation of the lower
esophageal sphincter, allowing the stomach
contents to back up into the esophagus
Answer: D. The acidic contents of the stomach
touching the inside of the esophagus are
responsible for the physical sensation known as
"heart-burn" that is a cardinal symptom of
GERD
The pernicious anemia that may accompany
gastritis is due to which of the following?
a. Chronic autoimmune destruction of cobalamin
stores in the body
b. Progressive gastric atrophy from chronic
breakage in the mucosal barrier and blood loss
c. A lack of intrinsic factor normally produced
by acid-secreting cells of the gastric mucosa
d. Hyperchlorhydria resulting from an inrease in
acid-secreting parietal cells and degradation of
RBC's
"Correct answer: c
Rationale: Gastritis may cause a loss of parietal
cells as a result of atrophy. The source of
intrinsic factor is also lostthe loss of intrinsic
factor, a substance essential for the absorption of
cobalamin in the terminal ileum, ultimately
results in cobalamin deficiency. With time, the
body's storage of cobalamin is depleted, and a
deficiency state exists. Because it is essential for
the growth and maturation of red blood cells, the
lack of cobalamin results in pernicious anemia
and neurologic complications
"The nurse explains to the patient with
gastroesophageal reflux disease that this
disorder: "A. results in acid erosion of the
esophagus caused by frequent vomiting
B. Will require surgical wrapping of the pyloric
sphincter to control the symptoms
C. Is the protrusion of a portion of the stomach
into the esophagus through the opening in the
diaphragm
D. Often involves relaxation of the lower
esophageal sphincter, allowing the stomach
contents to back up into the esophagus
"right answer: d
Rationale: Gastroesophageal reflux disease
(GERD) results when the defenses of the
esophagus are overwhelmed by the reflux of
acidic gastric contents into the lower esophagus.
An incompetent lower esophageal sphincter
(LES) is a common cause of gastric reflux
"The results of a patient's recent endoscopy
indicate the presence of peptic ulcer disease
(PUD). Which of the following teaching points
should the nurse provide to the patient in light of
his new diagnosis? "
A) "You'll need to drink at least two to three
glasses of milk daily."
B) "It would likely be beneficial for you to
eliminate drinking alcohol."
C) "Many people find that a minced or pureed
diet eases their symptoms of PUD."
D) "Your medications should allow you to
maintain your present diet while minimizing
symptoms
Although there is no specific recommended
dietary modification for PUD, most patients find
it necessary to make some sort of dietary
modifications to minimize symptoms. Milk may
exacerbate PUD and alcohol is best avoided
because it can delay healing
A client with gastroesophageal reflux disease
complains about having difficulty sleeping at
night, what should the nurse instruct the client to
do?
A. sleep on several pillows
B. eliminate carbohydrates from the diet
C. suggest a glass of milk before retiring
D. take antacids such as sodium bicarbonate
A. sleeping on pillows raises the upper torso and
minimizes reflux of the gastic contents
Gastroesophageal reflux disease (GERD)
weakens the lower esophageal sphincter,
predisposing older persons to risk for impaired
swallowing. In managing the symptoms
associated with GERD, the nurse should assign
the highest priority to which of the following
interventions?
A) Decrease daily intake of vegetables and
water, and ambulate frequently.
B) Drink coffee diluted with milk at each meal,
and remain in an upright position for 30 minutes.
C) Eat small frequent meals, and remain in an
upright position for at least 30 minutes after
eating.
D) Avoid over-the-counter drugs that have
antacids in them
Answer C, Small, frequent feedings requires less
release of hydrochloric acid. Remaining in an
upright position for 30 minutes after meals
prevents reflux into the esophagus
The client with hiatal hernia chronically
experiences heartburn following meals. The
nurses plans to teach the client to avoid which
action because it is contraindicated with a hiatal
hernia?
1. Lying recumbent following meals
2. Taking in small, frequent, bland meals
3. Raising the head of bed on 6-inch blocks
4. Taking H2-receptor antagonist medication
Answer 1, Hiatal hernia is caused by a
protrusion of a portion of the stomach above the
diaphragm where the esophagus usually is
positioned. The client usually experiences pain
from reflux caused by ingestion of irritating
foods, lying flat following meals or at night, and
eating large or fatty meals. Relief is obtained
with the intake of small, frequent meals, use of
H2-receptor antagonists and antacids, and
elevation of the thorax following meals and
during sleep
"The nurse has instructed the client who is
experiencing diarrhea associated with irritable
bowel syndrome on dietary changes to prevent
diarrhea. The nurse knows the client understands
the dietary changes if the client selects which of
the following menu choices?
a) Yogurt, crackers and sweet tea
b) Salad with chicken, whole wheat crackers
c) Bacon, tomato, lettuce with mayonnaise and a
soft drink
d) Tuna on white bread and coconut cake
Answer B,Rationale: Bacon tomato lettuce with
mayonnaise and soft drink is high in fat and the
soft drink is hyperosmolar both contributing to
diarrhea. Salad, whole wheat crackers may
decrease diarrhea due to increased fiber. Dairy
increases diarrhea. Food high in carbohydrates
increase diarrhea. Coconut may increase
diarrhea
Gastroesophageal reflux disease (GERD)
weakens the lower esophageal spinchter,
predisposing older persons to risk for impaired
swallowing. In managing the symptoms
associated with GERD, the nurse should assign
the highest priority to which of the following
interventions?
A. Decrease daily intake of vegetables and water
and ambulate frequently,
B. drink coffee diluted with milk at each meal
and remain in an upright position for thirty
minutes,
C. Eat small, frequent meals and remain in an
upright position for thirty minutes
D. Avoid OTC drugs that have antacids in them
Answer C, Rationale: Small, frequent feedings
requires less release of hydrochloric acid.
Remaining in an upright position for 30 minutes
after meals prevents reflux into the esophagus
A client with inflammatory bowel disease
undergoes an ileostomy. On the first day after
surgery, the nurse notes that the client's stoma
appears dusky. How should the nurse interpret
this finding?"
a) The ostomy bag should be adjusted.
b) Blood supply to the stoma has been
interrupted.
c) An intestinal obstruction has occurred.
d) This is a normal finding 1 day after surgery
Correct Answer: (B), Blood supply to the stoma
has been interrupted An ileostomy stoma forms
as the ileum is brought through the abdominal
wall to the surface skin, creating an artificial
opening for waste elimination. The stoma should
appear cherry red, indicating adequate arterial
perfusion. A dusky stoma suggests decreased
perfusion. The nurse should interpret this finding
as an indication that the stoma's blood supply is
interuppted, which may lead to tissue damage or
necrosis. A dusky stoma isn't a normal finding 1
day after surgery. Adjusting the ostomy bag
wouldn't affect stoma color, which depends on
blood supply to the area. An intestinal
obstruction also wouldn't change stoma color
"The nurse is reviewing the record of a client
with Crohn's disease. Which stool characteristic
should the nurse expect to note documented
in the client's record? "
a. Diarrhea
b. Chronic constipation
c. Constipation alternating with diarrhea
d. Stool constantly oozing from the rectum
Answer A,"(A) Crohns disease is characterized
by nonbloody diarrhea of usually not more than
4 or 5 stools daily. overtime the stools
increase frequency duration and severity
What statement made by the client indicates to
the nurse the client may be experiencing GERD?
A. ""My chest hurts when I walk up the stairs in
my home""
B. ""I take antacid tablets with me wherever I
go""
C. ""My spouse tells me I snore very loudly at
night""
D. ""I drink 6 to 7 soft drinks every day
Answer B, (B) Frequent use of antacids
indicates an acid reflux problem
22. Nurse Hannah is teaching a group of middle-
aged men about peptic ulcers. When discussing
risk factors for peptic ulcers, the nurse should
mention:
A. a sedentary lifestyle and smoking.
B. a history of hemorrhoids and smoking,
C. alcohol abuse and a history of acute renal
failure.
D. alcohol abuse and smoking
Answer D, Answer D. Risk factors for peptic
(gastric and duodenal) ulcers include alcohol
abuse, smoking, and stress. A sedentary lifestyle
and a history of hemorrhoids aren't risk factors
for peptic ulcers. Chronic renal failure, not acute
renal failure, is associated with duodenal ulcers
The male client tells the nurse he has been
experiencing "heartburn" at night that awakens
him. Which assessment question should the
nurse ask?
1. "How much weight have you gained
recently?"
2. "What have you done to alleviate the
heartburn?"
3. "Do you consume many milk and dairy
products?"
4. "Have you been around anyone with a
stomach virus?
Answer 2, "1. Clients with heartburn are
frequently diagnosed as having GERD. GERD
can occasionally cause weight loss, but not
weight gain.
2. Most clients with GERD have been self-
medicating with over-the-counter medications
prior to seeking advice from a health-care
provider. It is important to know what the client
has been using to treat the problem.
3. Milk and dairy products contain lactose,
which are important if considering lactose
intolerance, but are not important for
"heartburn."
4. Heartburn is not a symptom of a viral illness
The nurse is monitoring a female client with a
diagnosis of peptic ulcer.
1.Bradycardia
2.Numbness in the legs
3.Nausea and vomiting
4.A rigid, board-like abdomen
Answer 4,1.Tachycardia may occur as
hypovolemic shock develops. 2.Numbness in the
legs is not an associated finding. 3.Nausea and
vomiting may occur. 4.Perforation of an ulcer is
a surgical emergency and is characterized by
sudden, sharp, intolerable severe pain beginning
in the midepigastric area and spreading over the
abdomen, which becomes rigid and board-like
The nurse is administering morning medications
at 0730. Which medication should have priority?
A. a proton pump inhibitor
B. A nonnarcotic analgesic
C. A histamine receptor antagonist
D. A mucosal barrier agent
...CORRECT ANSWER: D.A. PPI's can be
administered routinely. B. Pain medication is
important but can be adminstered after a
medication that is timed. C. A histamine
receptor antagonist can be administered at
routine dosing time. D. A mucosal barrier agent
must be adminstered on an empty stomach for
the medication to coat the stomach lining
A client receives a local anesthetic to suppress
the gag reflex for a diagnostic procedure of the
upper GI tract. Which of the following nursing
interventions is advised for this patient?
a The client should be monitored for any
breathing related disorder or discomforts
b) The client should not be given any food and
fluids until the gag reflex returns,
c. The client should be monitored for cramping
or abdominal distention,
d) The client's fluid output should be measured
for at least 24 hours after the procedure
ANSWER: B For a client receiving a local
anesthetic that suppresses the gag reflex, the
nurse is advised to withhold food and fluids until
the reflex returns
The results of a patient's recent endoscopy
indicate the presence of peptic ulcer disease
(PUD). Which of the following teaching points
should the nurse provide to the patient in light of
his new diagnosis?
A. "You'll need to drink at least two to three
glasses of milk daily."
B."It would likely be beneficial for you to
eliminate drinking alcohol."
C. Many people find that a minced or pureed
diet eases their symptoms of PUD.
D. Your medications should allow you to
maintain your present diet while minimizing
symptoms
CORRECT ANSWER: B Although there is no
specific recommended dietary modification for
PUD, most patients find it necessary to make
some sort of dietary modifications to minimize
symptoms. Milk may exacerbate PUD and
alcohol is best avoided because it can delay
healing
The doctor has ordered Tagamet for a client
admitted with gastroesophageal reflux disease
(GERD). After looking up the drug in the
Physician's Desk Reference, you understand it is
being used to:1. Neutralize stomach acid. 2.
Treat a hiatal hernia. 3. Aid in the digestion of
food. Decrease stomach acid production
Answer 4, 4. Treatment for GERD includes
medications such as Tagamet to decrease
stomach acid production and promote healing of
esophagus
"Which assessment data support the client's
diagnosis of gastric ulcer?
1.Presence of blood in the client's stool for the
past month.
2.Complaints of a burning sensation that moves
like a wave.
3.Sharp pain in the upper abdomen after eating a
heavy meal.
4.Comparison of complaints of pain with
ingestion of food and sleep
(4) In a client diagnosed with a gastric ulcer,pain
usually occurs 30-60 minutes after eating, but
not at night. In contrast, a client with a duodenal
ulcer has pain during thenight that is often
relieved by eating food.Pain occurs 1-3 hours
after meals
"The nurse is caring for a 68 year old patient
admitted with abdominal pain, nausea, and
vomiting. The patient has an abdominal mass
and a bowel obstruction is suspected. The nurse
auscultating the abdomen listens for which of
the following types of bowel sounds that is
consistent with the patient's clinical picture? "
A. low pitched and rumbling above the area of
obstruction
B. High pitched and hypoactive below the area
of obstruction
C. low pitched and hyperactive below the area of
obstruction
D. high pitched and hyperactive above the area
of obstruction
Early in intestinal obstruction, the patient's
bowel sounds are hyperactive adn high pitched.
This occurs because peristaltic action increases
to "push past" the area of obstruction. As the
obstruction becomes complete, bowel sounds
decrease and finally become absent
"A patient with a history of peptic ulcer disease
has presented to the emergency department with
complaints of severe abdominal pain and a rigid,
boardlike abdomen, prompting the health care
team to suspect a perforated ulcer. Which of the
following actions should the nurse anticipate?
A. Providing IV fluids and inserting a
nasogastric tube
B. Administering oral bicarbonate and testing
the patient's gastric pH level
C. Performing a fecal occult blood test and
administering IV calcium gluconate
D. Starting parenteral nutrition and placing the
patient in a high-Fowler's position
Answer A, A perforated peptic ulcer requires IV
replacement of fluid losses and continued gastric
aspiration by NG tube. Nothing is given by
mouth and gastric pH testing is not a priority.
Calcium gluconate is not a medication directly
relevant to the patient's suspected diagnosis and
parenteral nutrition is not a priority in the short
term
"The nurse is teaching the patient and family
about possible causative factors for peptic
ulcers. The nurse explains that ulcer formation is
a. caused by a stressful lifestyle and other acid-
producing factors such as H. pylori.
b. inherited within families and reinforced by
bacterial spread of Staphylococcus aureus in
childhood.
c. promoted by factors that tend to cause
oversecretion of acid, such as excess dietary fats,
smoking, and H. pylori.
d. promoted by a combination of possible factors
that may result in erosion of the gastric mucosa,
including certain drugs and alcohol
Answer D, Rationale: Peptic ulcers develop only
in the presence of an acidic environment.
However, an excess of hydrochloric acid (HCl)
may not be necessary for ulcer development.
The back-diffusion of HCl into the gastric
mucosa results in cellular destruction and
inflammation. Histamine is released from the
damaged mucosa, resulting in vasodilation and
increased capillary permeability and further
secretion of acid and pepsin. A variety of agents
(i.e., certain infections, medications, and
lifestyle factors) can damage the mucosal
barrier. Helicobacter pylori can alter gastric
secretion and produce tissue damage leading to
peptic ulcer disease. The response to H. pylori is
likely influenced by a variety of factors,
including genetics, environment, and diet.
Ulcerogenic drugs, such as aspirin and NSAIDs,
inhibit synthesis of prostaglandins, increase
gastric acid secretion, and reduce the integrity of
the mucosal barrier. Patients on corticosteroids,
anticoagulants, and selective serotonin reuptake
inhibitors (e.g., fluoxetine [Prozac]) are also at
increased risk for ulcers. High-alcohol intake is
associated with acute mucosal lesions. Alcohol
stimulates acid secretion. Coffee (caffeinated
and uncaffeinated) is a strong stimulant of
gastric acid secretion. Psychologic distress,
including stress and depression, can negatively
influence the healing of ulcers after they have
developed. Smoking also delays ulcer healing.
Infection with herpes and cytomegalovirus
(CMV) in immunocompromised patients may
also lead to gastric ulcers
In planning care for the patient with Crohn's
disease, the nurse recognizes that a major
difference between ulcerative colitis and Crohn's
disease is that Crohn's disease
a. frequently results in toxic megacolon
b. causes fewer nutritional deficiencies than does
ulcerative colitis
c. Often recurs after surgery whereas UC is
curable with colectomy
d. is manifested by rectal bleeding and anemia
more frequently than is ulcerative colitis
. Correct answer: c Rationale: Because there is a
high recurrence rate after surgical treatment of
Crohn's disease, medications are the preferred
treatment
A male client is diagnosed with acute gastritis
secondary to alcoholism and cirrhosis. When
obtaining the client's history, the nurse gives
priority to the client's statement that:
1) His pain increases after meals.
2) He experiences nausea frequently.
3) His stools have a black appearance.
4) He recently joined Alcoholics Anonymous
Answer 3, 1) Investigation of bleeding takes
prioritylater the nurse should help to identify
irritating foods that are to be avoided. 2) Nausea
is a common symptom of gastritis, but it is not
life threatening. 3) Black (tarry) stools indicate
upper GI bleedingdigestive enzymes act on the
blood resulting in tarry stools. Hemorrhage can
occur if erosion extends to blood vessels. 4)
Attempts to control alcoholism should be
supported but this is a long-term goalassessment
of bleeding takes priority
Which of these agents is a major contributing
factor in the promotion of peptic ulcer disorder?
A) Candida albicans.
B) staphyloccus infection.
C) streptococcus infection
D) Helibacter pylori infection
Answer: Helobacter pylori infection. Rationale:
Recurrence of peptic ulcers is related to
Helicobacter pylori, use of NSAIDs, smoking,
and continued acid hypersecretion
Which of the following statements are accurate
as they relate to medications used to manage
GERD? "A)Magnesium-containing antacids can
cause diarrhea.
B) Aluminum-containing antacids can cause
constipation.
C) Cimetidine (Tagamet HB) causes
osteomalacia and hypophosphatemia.
D)Misoprostol's (Cytotec) major side effect is
G.I. bleeding
A&B. Rationale: Magnesium-containing
antacids can cause diarrhea, and should be used
with caution in older persons with renal
dysfunction. Aluminum-containing antacids can
cause constipation, osteomalacia, and
hypophosphatemia. Cimetidine has the greatest
chance for adverse reactions, including erectile
dysfunction, Gynecomastia, and confusion.
Misoprostol's major side effects are diarrhea and
abdominal pain
The nurse determines that a patient has
experienced the beneficial effects of medication
therapy with famotidine (Pepcid) when which of
the following symptoms is relieved?
1. Ice tea
2. Dry toast
3. warm broth
4. plain hamburger
B) Dry toast (Dry toast or crackers may alleviate
the feeling of nausea and prevent further
vomiting. Extremely hot or cold liquids and fatty
foods are generally not well tolerated
"A patient with a history of peptic ulcer disease
has presented to the ED with complaints of
severe abdominal pain and a rigid, boardlike
abdome, prompting the health care team to
suspect a perforated ulcer. Which of the
following actions should the nurse anticiptate?
source: http://quizlet.com/20002414/nclex-
review-lower-gi-problems-ibd-crohns-disease-
ulcerative-colitis-flash-cards/ or Lewis chapt. 42
Upper GI NCLEX" "
A: Providing IV fluids and inserting a
nasogastric tube
B:Administering oral bicarbonate and testing
patient's gastric pH level
C:Performing a fecal occult blood test and
administering IV calcium gluconate
D: Starting parenteral nutrition and placing the
patient in high-fowler's position
Answer A, "A: providing IV fluids and inserting
a nasogastric tube
rationale: A perforated peptic ulcer requires IV
replacement of fluid losses and continued gastric
aspiration by NG tube. Nothing is given by
mouth and gastric pH testing is not a priority.
Calcium gluconate is not a medication directly
relevent to the patient's suspected diagnosis and
parenteral nutrition is not a priority in the short
term
"The nurse is teaching a client with a gastric
ulcer about dietary management for the disease.
Teaching is successful when the client states...
Source: Lippincott's Review for NCLEX-RN" "
A: "I should eat a low fiber diet to delay gastric
emptying."
B: "I cannot eat fruits and veggies because they
cause too much gas."
C: "As long as they don't bother my stomach, I
can eat most foods.
D: "I can eat bland foods to help my stomach
heal
Answer C, The correct answer is C. The
antiulcer diet is not severely restricted. it is the
ideal to have small frequent feedings but the
client can eat foods as long as they do not cause
upset. Low fiber diets are more so used in
Ulcerative Colitis. A bland diet is used for
severe inflammation
5. Which of the following drugs is a histamine
blocker and reduces levels of gastric acid?"
A. Omeprazole (Prilosec)
B. Metoclopramide (Reglan)
C. Cimetidine (Tagamet)
D. Magnesium Hydroxide (Maalox)
Answer C, Cimetidine bind to H2 in the tissue
and decreases the production of gastric acid
The client attends two sessions with the dietitian
to learn about diet modifications to minimize
gastroesophageal reflux. The teaching would be
considered successful if the client says that she
will decrease her intake of which of the
following foods?
A) Fats,
B)Carbohydrates,
C) High-calcium foods,
D) High-Sodium foods
Answer A, Fats are associated with decreased
esophageal sphincter tone, which increases
reflux. Obesity contributes to the development
of hiatal hernia, and a low-fat diet might also aid
in weight loss. Carbohydrates and foods high in
sodium or calcium do not affect
gastroesophageal reflux
which is the most common upper GI problem? "
1. peptic ulcer disease
2. Crohns
3. Gerd
4. ulcerative colitis
Answer 3, Gerd is the only upper GI problem
The client with gastroesophageal reflux disease
(GERD) complains of a chronic cough. The
nurse understands that in a client with GERD
this symptom may be indicative of which of the
following conditions? "1. Development of
laryngeal cancer.
2. Irritation of the esophagus. 3. Esophageal scar
tissue formation. 4. Aspiration of gastric
contents
Answer 4, "Clients with GERD can develop
pulmonary symptoms, such as coughing,
wheezing, and dyspnea, that are caused by the
aspiration of gastric contents. GERD does not
predispose the client
to the development of laryngeal cancer. Irritation
of the esophagus and esophageal scar tissue
formation can develop as a result of GERD.
However, GERD is more likely to cause painful
and difficult swallowing
The nurse determines that a patient has
experienced the beneficial effects
of medication therapy with famotidine (Pepcid)
when which of the following
symptoms is relieved?
A) Nausea
B) Belching
C) Epigastric pain
D) Difficulty swallowing
Answer C, "Famotidine is an H2-receptor
antagonist that inhibits parietal cell
output of HCl acid and minimizes damage to
gastric mucosa related to
hyperacidity, thus relieving epigastric pain
A nurse provides feeding instructions to a
mother of an infant diagnosed with
gastroesophageal reflux disease. To assist in
reducing the episodes of emesis, the nurse tells
the mother to:
1) Provide less frequent, larger feedings.
2) Burp the infant less frequently during
feedings.
3) Thin the feedings by adding water to the
formula.
4) Thicken the feedings by adding rice cereal to
the formula
CORRECT: 4) Thicken the feedings by adding
rice cereal to the formula. Rationale: GERD is
backflow of gastric contents into the esophagus
as a result of relaxation or incompetence of the
lower esophageal or cardiac sphincter. Small,
more frequent feedings with frequent burping
often are prescibed in the treatment of GER.
Feedings thickened with rice cereal may reduce
episodes of emesis. If thickened formula is used,
cross-cutting of the nipple may be required
The nurse is reviewing the medication record of
a female client with acute gastritis. Which
medication, if noted on the client's record, would
the nurse question? "
a. Digoxin (Lanoxin)
b. Furosemide (Lasix)
c. Indomethacin (Indocin)
d. Propranolol hydrochloride (Inderal)
Answer is C, Indomethacin (Indocin) is a
nonsteroidal anti-inflammatory drug and can
cause ulceration of the esophagus, stomach, or
small intestine. Indomethacin is contraindicated
in a client with gastrointestinal disorders.
Furosemide (Lasix) is a loop diuretic. Digoxin is
a cardiac medication. Propranolol (Inderal) is a
β-adrenergic blocker. Furosemide, digoxin, and
propranolol are not contraindicated in clients
with gastric disorders