Digestive & Gastrointestinal System Disorders | NCLEX Quiz 80

1. The nurse is caring for a client with chronic gastritis. The nurse monitors the client. knowing that this client is at risk for which of the following vitamin deficiencies?

Vitamin A

Vitamin B12

Vitamin C

Vitamin E

Peptic ulcer disease is characteristically gnawing epigastric pain that may radiate to the back. Vomiting usually reflects pyloric spasm from muscular spasm or obstruction. Cancer (1) would not evidence pain or vomiting unless the pylorus was obstructed.

Explanation

Peptic ulcer disease is characteristically gnawing epigastric pain that may radiate to the back. Vomiting usually reflects pyloric spasm from muscular spasm or obstruction. Cancer (1) would not evidence pain or vomiting unless the pylorus was obstructed.

2. The most important pathophysiologic factor contributing to the formation of esophageal varices is:

Decreased prothrombin formation

Decreased albumin formation by the liver

Portal hypertension

Increased central venous pressure

As the liver cells become fatty and degenerate. they are no longer able to accommodate a large amount of blood necessary for homeostasis. The pressure in the liver increases and causes increased pressure in the venous system. As the portal pressure increases. fluid exudes into the abdominal cavity. This is called ascites.

Explanation

As the liver cells become fatty and degenerate. they are no longer able to accommodate a large amount of blood necessary for homeostasis. The pressure in the liver increases and causes increased pressure in the venous system. As the portal pressure increases. fluid exudes into the abdominal cavity. This is called ascites.

3. The client being treated for esophageal varices has a Sengstaken-Blakemore tube inserted to control the bleeding. The most important assessment is for the nurse to:

Check that the hemostat is on the bedside

Monitor IV fluids for the shift

Regularly assess respiratory status

Check that the balloon is deflated on a regular basis

The respiratory system can become occluded if the balloon slips and moves up the esophagus. putting pressure on the trachea. This would result in respiratory distress and should be assessed frequently. Scissors should be kept at the bedside to cut the tube if distress occurs. This is a safety intervention.

Explanation

The respiratory system can become occluded if the balloon slips and moves up the esophagus. putting pressure on the trachea. This would result in respiratory distress and should be assessed frequently. Scissors should be kept at the bedside to cut the tube if distress occurs. This is a safety intervention.

4. Which of the following factors should be the main focus of nursing management for a client hospitalized for cholecystitis?

Administration of antibiotics

Assessment for complications

Preparation for lithotripsy

Preparation for surgery

The client with acute cholecystitis should first be monitored for perforation. fever. abscess. fistula. and sepsis. After assessment. antibiotics will be administered to reduce the infection. Lithotripsy is used only for a small percentage of clients. Surgery is usually done after the acute infection has subsided.

Explanation

The client with acute cholecystitis should first be monitored for perforation. fever. abscess. fistula. and sepsis. After assessment. antibiotics will be administered to reduce the infection. Lithotripsy is used only for a small percentage of clients. Surgery is usually done after the acute infection has subsided.

5. The pain of a duodenal ulcer can be distinguished from that of a gastric ulcer by which of the following characteristics?

Early satiety

Pain on eating

Dull upper epigastric pain

Pain on empty stomach

Pain on empty stomach is relieved by taking foods or antacids. The other symptoms are those of a gastric ulcer.

Explanation

Pain on empty stomach is relieved by taking foods or antacids. The other symptoms are those of a gastric ulcer.

6. The client with a duodenal ulcer may exhibit which of the following findings on assessment?

Hematemesis

Malnourishment

Melena

Pain with eating

The client with a duodenal ulcer may have bleeding at the ulcer site. which shows up as melena (black tarry stool). The other findings are consistent with a gastric ulcer.

Explanation

The client with a duodenal ulcer may have bleeding at the ulcer site. which shows up as melena (black tarry stool). The other findings are consistent with a gastric ulcer.

7. The client has orders for a nasogastric (NG) tube insertion. During the procedure. instructions that will assist in the insertion would be:

Instruct the client to tilt his head back for insertion in the nostril. then flex his neck for the final insertion

After insertion into the nostril. instruct the client to extend his neck

Introduce the tube with the client’s head tilted back. then instruct him to keep his head upright for final insertion

Instruct the client to hold his chin down. then back for insertion of the tube

NG insertion technique is to have the client first tilt his head back for insertion into the nostril. then to flex his neck forward and swallow. Extension of the neck (2) will impede NG tube insertion.

Explanation

NG insertion technique is to have the client first tilt his head back for insertion into the nostril. then to flex his neck forward and swallow. Extension of the neck (2) will impede NG tube insertion.

8. A client being treated for chronic cholecystitis should be given which of the following instructions?

Increase rest

Avoid antacids

Increase protein in diet

Use anticholinergics as prescribed

Conservative therapy for chronic cholecystitis includes weight reduction by increasing physical activity. a low-fat diet. antacid use to treat dyspepsia. and anticholinergic use to relax smooth muscles and reduce ductal tone and spasm. thereby reducing pain.

Explanation

Conservative therapy for chronic cholecystitis includes weight reduction by increasing physical activity. a low-fat diet. antacid use to treat dyspepsia. and anticholinergic use to relax smooth muscles and reduce ductal tone and spasm. thereby reducing pain.

9. When a client has peptic ulcer disease. the nurse would expect a priority intervention to be:

Assisting in inserting a Miller-Abbott tube

Assisting in inserting an arterial pressure line

Inserting a nasogastric tube

Inserting an I.V.

An NG tube insertion is the most appropriate intervention because it will determine the presence of active GI bleeding. A Miller-Abbott tube (1) is a weighted. mercury-filled ballooned tube used to resolve bowel obstructions. There is no evidence of shock or fluid overload in the client; therefore. an arterial line (2) is not appropriate at this time and an IV (4) is optional.

Explanation

An NG tube insertion is the most appropriate intervention because it will determine the presence of active GI bleeding. A Miller-Abbott tube (1) is a weighted. mercury-filled ballooned tube used to resolve bowel obstructions. There is no evidence of shock or fluid overload in the client; therefore. an arterial line (2) is not appropriate at this time and an IV (4) is optional.

10. A 40-year-old male client has been hospitalized with peptic ulcer disease. He is being treated with a histamine receptor antagonist (cimetidine). antacids. and diet. The nurse doing discharge planning will teach him that the action of cimetidine is to:

Reduce gastric acid output

Protect the ulcer surface

Inhibit the production of hydrochloric acid (HCl)

Inhibit vagus nerve stimulation

These drugs inhibit the action of histamine on the H2 receptors of parietal cells. thus reducing gastric acid output.

Explanation

These drugs inhibit the action of histamine on the H2 receptors of parietal cells. thus reducing gastric acid output.