Chapter 42 NCLEX Questions Upper Gastrointestinal
1. 1.ID: 809552083
Following administration of a dose of metoclopramide (Reglan) to the patient, the nurse determines that the
medication has been effective when what is noted?
A.
Decreased blood pressure
B.
Absence of muscle tremors
C.
Relief of nausea and vomiting Correct
D.
No further episodes of diarrhea
Metoclopramide is classified as a prokinetic and antiemetic medication. If it is effective, the patient's nausea and
vomiting should resolve. Metoclopramide does not affect blood pressure, muscle tremors, or diarrhea.
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2. 2.ID: 809552071
The patient receiving chemotherapy rings the call bell and reports the onset of nausea. The nurse should prepare an
as-needed dose of which medication?
A.
Morphine sulfate
B.
Zolpidem (Ambien)
C.
Ondansetron (Zofran)* Correct
D.
Dexamethasone (Decadron)
Ondansetron is a 5-HT3 receptor antagonist antiemetic that is especially effective in reducing cancer chemotherapyinduced nausea and vomiting. Morphine sulfate may cause nausea and vomiting. Zolpidem does not relieve nausea
and vomiting. Dexamethasone is usually used in combination with ondansetron for acute and chemotherapyinduced emesis.
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3. 3.ID: 809552095
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 should evaluate its
effectiveness by questioning the patient as to whether which symptom has been resolved?
A.
Diarrhea
B.
Heartburn Correct
C.
Constipation
D.
Lower abdominal pain
Mylanta is an antacid that contains both aluminum and magnesium. It is indicated for the relief of GI discomfort,
such as heartburn associated with GERD. Mylanta can cause both diarrhea and constipation as a side effect.
Mylanta does not affect lower abdominal pain.
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4. 4.ID: 809552069
A patient complains of nausea. When administering a dose of metoclopramide (Reglan), the nurse should teach the
patient to report which potential adverse effect?
A.
Tremors Correct
B.
Constipation
C.
Double vision
D.
Numbness in fingers and toes
Extrapyramidal side effects, including tremors and tardive dyskinesias, may occur as a result of metoclopramide
(Reglan) administration. Constipation, double vision, and numbness in fingers and toes are not adverse effects of
metoclopramide.
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5. 5.ID: 809552091
After administering a dose of promethazine (Phenergan) to a patient with nausea and vomiting, what common
temporary adverse effect of the medication does the nurse explain may be experienced?
A.
Tinnitus
B.
Drowsiness Correct
C.
Reduced hearing
D.
Sensation of falling
Although being given to this patient as an antiemetic, promethazine also has sedative and amnesic properties. For
this reason, the patient is likely to experience drowsiness as an adverse effect of the medication. Tinnitus, reduced
hearing, and loss of balance are not side effects of promethazine.
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6. 6.ID: 809552093
The nurse is caring for a patient treated with IV fluid therapy for severe vomiting. As the patient recovers and begins
to tolerate oral intake, which food choice does the nurse understand would be most appropriate?
A.
Iced tea
B.
Dry toast Correct
C.
Hot coffee
D.
Plain hamburger
Dry toast or crackers may alleviate the feeling of nausea and prevent further vomiting. Water is the initial fluid of
choice. Extremely hot or cold liquids and fatty foods are generally not well tolerated.
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7. 7.ID: 809552073
The nurse determines that a patient has experienced the beneficial effects of therapy with famotidine (Pepcid) when
which symptom is relieved?
A.
Nausea
B.
Belching
C.
Epigastric pain Correct
D.
Difficulty swallowing
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. Famotidine is not indicated for nausea, belching, and
dysphagia.
8. 8.ID: 809552079
A patient reports having a dry mouth and asks for something to drink. The nurse recognizes that this symptom can
most likely be attributed to a common adverse effect of which medication that the patient is taking?
A.
Digoxin (Lanoxin)
B.
Cefotetan (Cefotan)
C.
Famotidine (Pepcid)
D.
Promethazine (Phenergan) Correct
A common adverse effect of promethazine, an antihistamine/antiemetic agent, is dry mouth; another is blurred
vision. Common side effects of digoxin are yellow halos and bradycardia. Common side effects of cefotetan are
nausea, vomiting, stomach pain, and diarrhea. Common side effects of famotidine are headache, abdominal pain,
constipation, or diarrhea.
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9. 9.ID: 809552075
A patient with a history of peptic ulcer disease has presented to the emergency department reporting severe
abdominal pain and has a rigid, boardlike abdomen that prompts the health care team to suspect a perforated ulcer.
What intervention should the nurse anticipate?
A.
Providing IV fluids and inserting a nasogastric (NG) tube Correct
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
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.
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10. 10.ID: 809552081
The results of a patient's recent endoscopy indicate the presence of peptic ulcer disease (PUD). Which teaching
point should the nurse provide to the patient based on this 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." Correct
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."
Alcohol increases the amount of stomach acid produced so it should be avoided. 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.
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11. 11.ID: 809552077
A female patient has a sliding hiatal hernia. What nursing interventions will prevent the symptoms of heartburn and
dyspepsia that she is experiencing?
A.
Keep the patient NPO.
B.
Put the bed in the Trendelenberg position.
C.
Have the patient eat 4 to 6 smaller meals each day. Correct
D.
Give various antacids to determine which one works for the patient.
Eating smaller meals during the day will decrease the gastric pressure and the symptoms of hiatal hernia. Keeping
the patient NPO or in a Trendelenberg position are not safe or realistic for a long period of time for any patient.
Varying antacids will only be done with the care provider's prescription, so this is not a nursing intervention.
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12. 12.ID: 809552085
A patient is seeking emergency care after choking on a piece of steak. The nursing assessment reveals a history of
alcoholism, cigarette smoking, and hemoptysis. Which diagnostic study is most likely to be performed on this
patient?
A.
Barium swallow
B.
Endoscopic biopsy Correct
C.
Capsule endoscopy
D.
Endoscopic ultrasonography
Because of this patient's history of excessive alcohol intake, smoking, hemoptysis, and the current choking episode,
cancer may be present. A biopsy is necessary to make a definitive diagnosis of carcinoma, so an endoscope will be
used to obtain a biopsy and observe other abnormalities as well. A barium swallow may show narrowing of the
esophagus, but it is more diagnostic for achalasia. An endoscopic ultrasonography may be used to stage
esophageal cancer. Capsule endoscopy can show alterations in the esophagus but is more often used for small
intestine problems. A barium swallow, capsule endoscopy, and endoscopic ultrasonography cannot provide a
definitive diagnosis for cancer when it is suspected.
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13. 13.ID: 809552097
A 72-year-old patient was admitted with epigastric pain due to a gastric ulcer. Which patient assessment warrants
an urgent change in the nursing plan of care?
A.
Chest pain relieved with eating or drinking water
B.
Back pain 3 or 4 hours after eating a meal
C.
Burning epigastric pain 90 minutes after breakfast
D.
Rigid abdomen and vomiting following indigestion Correct
A rigid abdomen with vomiting in a patient who has a gastric ulcer indicates a perforation of the ulcer, especially if
the manifestations of perforation appear suddenly. Midepigastric pain is relieved by eating, drinking water, or
antacids with duodenal ulcers, not gastric ulcers. Back pain 3-4 hours after a meal is more likely to occur with a
duodenal ulcer. Burning epigastric pain 1-2 hours after a meal is an expected manifestation of a gastric ulcer related
to increased gastric secretions and does not cause an urgent change in the nursing plan of care.
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14. 14.ID: 809552067
The patient with chronic gastritis is being put on a combination of medications to eradicate H. pylori. Which drugs
does the nurse know will probably be used for this patient?
A.
Antibiotic(s), antacid, and corticosteroid
B.
Antibiotic(s), aspirin, and antiulcer/protectant
C.
Antibiotic(s), proton pump inhibitor, and bismuth Correct
D.
Antibiotic(s) and nonsteroidal antiinflammatory drugs (NSAIDs)
To eradicate H. pylori, a combination of antibiotics, a proton pump inhibitor, and possibly bismuth (for quadruple
therapy) will be used. Corticosteroids, aspirin, and NSAIDs are drugs that can cause gastritis and do not affect H.
pylori.
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15. 15.ID: 809552099
The patient is having an esophagoenterostomy with anastomosis of a segment of the colon to replace the resected
portion. What initial postoperative care should the nurse expect when this patient returns to the nursing unit?
A.
Turn, deep breathe, cough, and use spirometer every 4 hours.
B.
Maintain an upright position for at least 2 hours after eating.
C.
NG will have bloody drainage, and it should not be repositioned.* Correct
D.
Keep in a supine position to prevent movement of the anastomosis.
The patient will have bloody drainage from the NG tube for 8 to 12 hours, and it should not be repositioned or
reinserted without contacting the surgeon. Turning and deep breathing will be done every 2 hours, and the
spirometer will be used more often than every 4 hours. Coughing would put too much pressure in the area and
should not be done. Because the patient will have the NG tube, the patient will not be eating yet. The patient should
be kept in a semi-Fowler's or Fowler's position, not supine, to prevent reflux and aspiration of secretions.
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16. 16.ID: 809552089
The patient is having a gastroduodenostomy (Billroth I operation) for stomach cancer. What long-term complication
is occurring when the patient reports generalized weakness, sweating, palpitations, and dizziness 15 to 30 minutes
after eating?
A.
Malnutrition
B.
Bile reflux gastritis
C.
Dumping syndrome Correct
D.
Postprandial hypoglycemia
After a Billroth I operation, dumping syndrome may occur 15 to 30 minutes after eating because of the hypertonic
fluid going to the intestine and additional fluid being drawn into the bowel. Malnutrition may occur but does not
cause these symptoms. Bile reflux gastritis cannot happen when the stomach has been removed. Postprandial
hypoglycemia occurs with similar symptoms, but 2 hours after eating.
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17. 17.ID: 809552087
The nurse is teaching a group of high school students about the prevention of food poisoning. Which comment by
the student shows understanding of foodborne illness protection?
A.
"We like to mix up the ingredients so the flavors will melt before we cook our beef stew."
B.
"For a snack, I like to eat raw cookie dough from the package instead of baking the cookies."
C.
"We only have one cutting board, so we cut up our chicken and salad vegetables at the same time."
D.
"When they gave me a pink hamburger I sent it back and asked for a new bun and clean
plate." Correct
The student who did not accept the pink hamburger and asked for a new bun and clean plate understood that the
pink meat may not have reached 160° and could be contaminated with bacteria. Mixing ingredients and leaving
them long enough for the flavors to melt, eating raw cookie dough from a refrigerated package, and only using one
cutting board without washing it with hot soapy water between the chicken and salad vegetables could all lead to
food poisoning from contamination.
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