Digestive & Gastrointestinal System Disorders | NCLEX Quiz 76

1. Which of the following symptoms is common with a hiatal hernia?

Left arm pain

Lower back pain

Esophageal reflux

Abdominal cramping

Esophageal reflux is a common symptom of hiatal hernia. This seems to be associated with chronic exposure of the lower esophageal sphincter to the lower pressure of the thorax. making it less effective.

Explanation

Esophageal reflux is a common symptom of hiatal hernia. This seems to be associated with chronic exposure of the lower esophageal sphincter to the lower pressure of the thorax. making it less effective.

2. Which of the following tests can be used to diagnose ulcers?

Abdominal x-ray

Barium swallow

Computed tomography (CT) scan

Esophagogastroduodenoscopy (EGD)

The EGD can visualize the entire upper GI tract as well as allow for tissue specimens and electrocautery if needed. The barium swallow could locate a gastric ulcer. A CT scan and an abdominal x-ray aren’t useful in the diagnosis of an ulcer.

Explanation

The EGD can visualize the entire upper GI tract as well as allow for tissue specimens and electrocautery if needed. The barium swallow could locate a gastric ulcer. A CT scan and an abdominal x-ray aren’t useful in the diagnosis of an ulcer.

3. The hospitalized client with GERD is complaining of chest discomfort that feels like heartburn following a meal. After administering an ordered antacid. the nurse encourages the client to lie in which of the following positions?

Supine with the head of the bed flat

On the stomach with the head flat

On the left side with the head of the bed elevated 30 degrees

On the right side with the head of the bed elevated 30 degrees.

The discomfort of reflux is aggravated by positions that compress the abdomen and the stomach. These include lying flat on the back or on the stomach after a meal of lying on the right side. The left side-lying position with the head of the bed elevated is most likely to give relief to the client.

Explanation

The discomfort of reflux is aggravated by positions that compress the abdomen and the stomach. These include lying flat on the back or on the stomach after a meal of lying on the right side. The left side-lying position with the head of the bed elevated is most likely to give relief to the client.

4. Which of the following conditions can cause a hiatal hernia?

Increased intrathoracic pressure

Weakness of the esophageal muscle

Increased esophageal muscle pressure

Weakness of the diaphragmatic muscle

A hiatal hernia is caused by weakness of the diaphragmatic muscle and increased intra-abdominal—not intrathoracic—pressure. This weakness allows the stomach to slide into the esophagus. The esophageal supports weaken. but esophageal muscle weakness or increased esophageal muscle pressure isn’t a factor in hiatal hernia.

Explanation

A hiatal hernia is caused by weakness of the diaphragmatic muscle and increased intra-abdominal—not intrathoracic—pressure. This weakness allows the stomach to slide into the esophagus. The esophageal supports weaken. but esophageal muscle weakness or increased esophageal muscle pressure isn’t a factor in hiatal hernia.

5. Which of the following best describes the method of action of medications. such as ranitidine (Zantac). which are used in the treatment of peptic ulcer disease?

Neutralize acid

Reduce acid secretions

Stimulate gastrin release

Protect the mucosal barrier

Ranitidine is a histamine-2 receptor antagonist that reduces acid secretion by inhibiting gastrin secretion.

Explanation

Ranitidine is a histamine-2 receptor antagonist that reduces acid secretion by inhibiting gastrin secretion.

6. Risk factors for the development of hiatal hernias are those that lead to increased abdominal pressure. Which of the following complications can cause increased abdominal pressure?

Obesity

Volvulus

Constipation

Intestinal obstruction

Obesity may cause increased abdominal pressure that pushes the lower portion of the stomach into the thorax.

Explanation

Obesity may cause increased abdominal pressure that pushes the lower portion of the stomach into the thorax.

7. Which of the following tests can be performed to diagnose a hiatal hernia?

Colonoscopy

Lower GI series

Barium swallow

Abdominal x-rays

A barium swallow with fluoroscopy shows the position of the stomach in relation to the diaphragm. A colonoscopy and a lower GI series show disorders of the intestine.

Explanation

A barium swallow with fluoroscopy shows the position of the stomach in relation to the diaphragm. A colonoscopy and a lower GI series show disorders of the intestine.

8. Which of the following measures should the nurse focus on for the client with esophageal varices?

Recognizing hemorrhage

Controlling blood pressure

Encouraging nutritional intake

Teaching the client about varices

Recognizing the rupture of esophageal varices. or hemorrhage. is the focus of nursing care because the client could succumb to this quickly. Controlling blood pressure is also important because it helps reduce the risk of variceal rupture. It is also important to teach the client what varices are and what foods he should avoid such as spicy foods.

Explanation

Recognizing the rupture of esophageal varices. or hemorrhage. is the focus of nursing care because the client could succumb to this quickly. Controlling blood pressure is also important because it helps reduce the risk of variceal rupture. It is also important to teach the client what varices are and what foods he should avoid such as spicy foods.

9. The nurse is caring for a client following a Billroth II procedure. On review of the post-operative orders. which of the following. if prescribed. would the nurse question and verify?

Irrigating the nasogastric tube

Coughing a deep breathing exercises

Leg exercises

Early ambulation

In a Billroth II procedure the proximal remnant of the stomach is anastomosed to the proximal jejunum. Patency of the NG tube is critical for preventing the retention of gastric secretions. The nurse should never irrigate or reposition the gastric tube after gastric surgery. unless specifically ordered by the physician. In this situation. the nurse would clarify the order.

Explanation

In a Billroth II procedure the proximal remnant of the stomach is anastomosed to the proximal jejunum. Patency of the NG tube is critical for preventing the retention of gastric secretions. The nurse should never irrigate or reposition the gastric tube after gastric surgery. unless specifically ordered by the physician. In this situation. the nurse would clarify the order.

10. The nurse is providing discharge instructions to a client following gastrectomy. Which measure will the nurse instruct the client to follow to assist in preventing dumping syndrome?

Eat high-carbohydrate foods

Limit the fluids taken with meals

Ambulate following a meal

Sit in a high-Fowler’s position during meals

The nurse should instruct the client to decrease the amount of fluid taken at meals and to avoid high carbohydrate foods including fluids such as fruit nectars; to assume a low-Fowler’s position during meals; to lie down for 30 minutes after eating to delay gastric emptying; and to take antispasmodics as prescribed.

Explanation

The nurse should instruct the client to decrease the amount of fluid taken at meals and to avoid high carbohydrate foods including fluids such as fruit nectars; to assume a low-Fowler’s position during meals; to lie down for 30 minutes after eating to delay gastric emptying; and to take antispasmodics as prescribed.