Chapter 39: Upper Digestive Tract Disorders
Linton: Introduction to Medical–Surgical Nursing, 6th Edition
MULTIPLE CHOICE
1. A nurse is preparing to give a tube feeding using a large syringe. What action should the nurse
implement before starting the infusion?
a.
Roll the patient flat.
b.
Check for a residual formula and return the residual to his or her stomach.
c.
Place the end of the tube in water and check for bubbles.
d.
Flush the tube.
2. After receiving a tube feeding, a nurse assesses the patient to be sweaty with abdominal
distention and diarrhea. What is the most likely cause of this response?
a.
Expected reaction to the tube feeding
b.
Dumping syndrome
c.
Gastric reflux syndrome
d.
Onset of gastroenteritis
3. A nurse is assessing a patient for risk factors that increase the chances of developing oral
cancer. Which information from this patient’s history indicates a risk factor?
a.
Alcohol consumption
b.
Chewing gum
c.
Environmental pollution
d.
Consumption of a high-fat diet
4. A home health nurse observes a patient with esophageal cancer tilt his head back while eating.
What might this cause?
a.
Narrowing of the esophagus
b.
Limiting the types of food that can be consumed
c.
Increased risk of aspiration
d.
A neck injury
5. A nurse is caring for a patient with esophageal surgery who has had stents placed in the
esophagus and instructs the patient how best to avoid regurgitation. What should the nurse
include in this instruction?
a.
Keep the bed flat.
b.
Eat only small meals.
c.
Lie on the right side after meals.
d.
Drink 3 glasses of fluid with each meal.
6. A nurse administers promethazine (Phenergan) for nausea. Which extra precautionary action
should the nurse implement because of the common side effect of antiemetic medications?
a.
Check vital signs for erratic blood pressure.
b.
Add a blanket to prevent chilling.
c.
Provide extra water to combat thirst.
d.
Put up side rails to prevent falls.
7. A nurse is constructing a teaching plan for a patient with a hiatal hernia. What should be
included in this plan to help reduce the complaints of heartburn, regurgitation, and eructation?
a.
Eating three well-balanced meals
b.
Lying down 1 hour after eating
c.
Sleeping without pillows
d.
Eating nothing for several hours before bedtime
8. A patient complains about the placement of the total parenteral nutrition (TPN) line and asks
why it cannot be inserted in the arm. What fact regarding the placement of this line should the
nurse base a response on?
a.
Arm would limit patient mobility.
b.
Subclavian artery allows for ease in dressing the puncture site.
c.
Arm prevents the use of large-bore cannulas.
d.
Subclavian artery allows for rapid dilution.
9. A 60-year-old patient who has just been diagnosed with cancer of the stomach says, “I feel
blank and numb.” What is the best nursing response?
a.
“Shock affects everyone that way.”
b.
“I’m sure you are considering what you should do now that you have cancer.”
c.
“Would you like me to bring you a sedative?”
d.
“What do you mean when you say ‘blank and numb’?”
10. A goal for a patient with gastritis who has experienced nausea, vomiting, and diarrhea is to
have a return of normal elimination patterns. Which statement best reflects this goal in a
measurable manner?
a.
The patient will have fewer stools.
b.
Diarrhea will be controlled and not return.
c.
The patient will have no more than one stool per day.
d.
The patient’s bowel pattern will return to normal.
11. A nurse is caring for a patient hemorrhaging from a peptic ulcer when the patient complains
of a sharp sudden pain and has a rapidly deteriorating condition. What is the best first action
of the nurse?
a.
Roll the patient flat and assess the vital signs.
b.
Notify the charge nurse.
c.
Suction the mouth.
d.
Prepare for intravenous infusions.
12. A patient inquires if this newer type of gastric analysis is going to require passage of a
nasogastric tube. What is the nurse’s most accurate reply?
a.
“Yes, but just for the instillation of the dye.”
b.
“No. You take a dye orally, which will be excreted in the urine in approximately 2
hours.”
c.
“Yes. You will take the dye orally, and then several gastric withdrawals through
the tube will show the dye.”
d.
“Yes. Only one withdrawal will be made through the tube, which will be treated
with dye and read in approximately 2 hours.”
13. A long-term care nurse is assisting a well-nourished, 80-year-old resident with the diagnosis
of esophageal cancer on methods to deal with dysphagia. What nursing intervention will best
help to improve the resident’s condition?
a.
Instruct the patient to tilt his or her head slightly forward.
b.
Assist patient to a semi-Fowler position.
c.
Encourage the resident to eat meals in the main dining area.
d.
Insert a nasogastric tube for feedings.
14. A home health nurse is assigned to follow-up on a patient recently diagnosed with
gastroesophageal reflux disease (GERD). Which primary symptom should the nurse take into
consideration when updating the nursing interventions on this patient’s care plan?
a.
Nausea
b.
Vomiting
c.
Anorexia
d.
Heartburn
15. A patient experiencing nausea reports to the nurse that she adds ginger root to her morning tea
to calm her stomach. Which classification of medication in the patient history alerts the nurse
to provide further education?
a.
Antidepressants
b.
Proton pump inhibitors
c.
Anticoagulants
d.
Narcotics
16. A nurse is caring for a patient receiving total parenteral nutrition (TPN). Which nursing action
is most appropriate to implement?
a.
Use a clean technique for site care.
b.
Infuse the solution rapidly.
c.
Administer medications through the TPN line.
d.
Monitor the temperature for elevation.
17. A patient is diagnosed with Vincent infection. What treatment should the nurse anticipate
being prescribed for this patient?
a.
Intravenous antibiotic therapy
b.
Diet restriction
c.
Mouthwash rinse
d.
Increased activity
18. When assessing the tongue of patient in the outpatient clinic, a nurse observes bluish-white
lesions on the mucous membranes. When reviewing the patient history, the nurse notes the
patient has been on long-term antibiotic therapy for chronic prostatitis. What should the nurse
suspect?
a.
Thrush
b.
Aphthous stomatitis
c.
Herpes simplex type I
d.
Oral cancer
19. When assisting with the admission of a new resident to a long-term care facility, a nurse notes
a current history of peptic ulcer disease. What type of pain should the nurse expect the
resident to describe?
a.
Sharp
b.
Dull
c.
Burning
d.
Stabbing
20. Which patient assessment indicates hyperglycemia with TPN feeding?
a.
Increase of urine output
b.
Sudden diarrhea
c.
Abdominal distention
d.
Tachycardia
21. The TPN feeding is running at 20 mL and is 1 hour behind schedule. What is the most
appropriate initial nursing intervention?
a.
Increase the flow rate to 22 mL/hr (10%) and inform the charge nurse.
b.
Reposition the patient to the right side and lower the head of the bed.
c.
Dilute the thick feeding formula with 10 mL of sterile water and inform the charge
nurse.
d.
Document the event and inform the charge nurse.
MULTIPLE RESPONSE
22. What information about when and where specific digestion of food takes place should be
included in a patient teaching plan? (Select all that apply.)
a.
Renin breaks down milk protein in the stomach.
b.
Lipase breaks down fats in the stomach.
c.
Pepsin begins to break down proteins in the stomach.
d.
Liver and pancreatic secretions break down fats in the small bowel.
e.
Ptyalin (amylase) breaks down carbohydrates in the colon.
23. A nurse is caring for a patient with achalasia. What nursing actions should be implemented to
help the patient reduce swallowing difficulty? (Select all that apply.)
a.
Identify foods that cause the problem.
b.
Experiment with different eating positions.
c.
Elevate the head of the bed at night.
d.
Suggest eating more rapidly.
e.
Offer small bites of fresh vegetables.
