Digestive & Gastrointestinal System Disorders | NCLEX Quiz 77

1.

The nurse instructs the nursing assistant on how to provide oral hygiene for a client who cannot perform this task for himself. Which of the following techniques should the nurse tell the assistant to incorporate into the client’s daily care?

A.

Assess the oral cavity each time mouth care is given and record observations
B.

Use a soft toothbrush to brush the client’s teeth after each meal
C.

Swab the client’s tongue. gums. and lips with a soft foam applicator every 2 hours.
D.

Rinse the client’s mouth with mouthwash several times a day.

Correct Answer
B. Use a soft toothbrush to brush the client’s teeth after each meal

Explanation
A soft toothbrush should be used to brush the client’s teeth after each meal and more often as needed. Mechanical cleaning is necessary to maintain oral health. simulate gingiva. and remove plaque. Assessing the oral cavity and recording observations is the responsibility of the nurse. not the nursing assistant. Swabbing with a safe foam applicator does not provide enough friction to clean the mouth. Mouthwash can be a drying irritant and is not recommended for frequent use.

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2.

A client with suspected gastric cancer undergoes an endoscopy of the stomach. Which of the following assessments made after the procedure would indicate the development of a potential complication?

A.

The client complains of a sore throat
B.

The client displays signs of sedation
C.

The client experiences a sudden increase in temperature
D.

The client demonstrates a lack of appetite

Correct Answer
C. The client experiences a sudden increase in temperature

Explanation
The most likely complication of an endoscopic procedure is perforation. A sudden temperature spike with 1 to 2 hours after the procedure is indicative of a perforation and should be reported immediately to the physician. A sore throat is to be anticipated after an endoscopy. Clients are given sedatives during the procedure. so it is expected that they will display signs of sedation after the procedure is completed. A lack of appetite could be the result of many factors. including the disease process.

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3.

A client has been diagnosed with adenocarcinoma of the stomach and is scheduled to undergo a subtotal gastrectomy (Billroth II procedure). During pre-operative teaching. the nurse is reinforcing information about the procedure. Which of the following explanations is most accurate?

A.

The procedure will result in enlargement of the pyloric sphincter
B.

The procedure will result in anastomosis of the gastric stump to the jejunum
C.

The procedure will result in removal of the duodenum
D.

The procedure will result in repositioning of the vagus nerve

Correct Answer
B. The procedure will result in anastomosis of the gastric stump to the jejunum

Explanation
A Billroth II procedure bypasses the duodenum and connects the gastric stump directly to the jejunum. The pyloric sphincter is removed. along with some of the stomach fundus.

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4.

After a subtotal gastrectomy. the nurse should anticipate that nasogastric tube drainage will be what color for about 12 to 24 hours after surgery?

A.

Dark brown
B.

Bile green
C.

Bright red
D.

Cloudy white

Correct Answer
A. Dark brown

Explanation
About 12 to 24 hours after a subtotal gastrectomy. gastric drainage is normally brown. which indicates digested blood. Bile green or cloudy white drainage is not expected during the first 12 to 24 hours after a subtotal gastrectomy. Drainage during the first 6 to 12 hours contains some bright red blood. but large amounts of blood or excessively bloody drainage should be reported to the physician promptly.

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5.

After a subtotal gastrectomy. care of the client’s nasogastric tube and drainage system should include which of the following nursing interventions?

A.

Irrigate the tube with 30 ml of sterile water every hour. if needed.
B.

Reposition the tube if it is not draining well
C.

Monitor the client for N/V. and abdominal distention
D.

Turn the machine to high suction of the drainage is sluggish on low suction.

Correct Answer
C. Monitor the client for N/V. and abdominal distention

Explanation
Nausea. vomiting. or abdominal distention indicated that gas and secretions are accumulating within the gastric pouch due to impaired peristalsis or edema at the operative site and may indicate that the drainage system is not working properly. Saline solution is used to irrigate nasogastric tubes. Hypotonic solutions such as water increase electrolyte loss. In addition. a physician’s order is needed to irrigate the NG tube. because this procedure could disrupt the suture line. After gastric surgery. only the surgeon repositions the NG tube because of the danger of rupturing or dislodging the suture line. The amount of suction varies with the type of tube used and is ordered by the physician. High suction may create too much tension on the gastric suture line.

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6.

Which of the following would be an expected nutritional outcome for a client who has undergone a subtotal gastrectomy for cancer?

A.

Regain weight loss within 1 month after surgery
B.

Resume normal dietary intake of three meals per day
C.

Control nausea and vomiting through regular use of antiemetics
D.

Achieve optimal nutritional status through oral or parenteral feedings

Correct Answer
D. Achieve optimal nutritional status through oral or parenteral feedings

Explanation
An appropriate expected outcome is for the client to achieve optimal nutritional status through the use of oral feedings or total parenteral nutrition (TPN). TPN may be used to supplement oral intake. or it may be used alone if the client cannot tolerate oral feedings. The client would not be expected to regain lost weight within 1 month after surgery or to tolerate a normal dietary intake of three meals per day. Nausea and vomiting would not be considered an expected outcome of gastric surgery. and regular use of antiemetics would not be anticipated.

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7.

The client with 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?

A.

Development of laryngeal cancer
B.

Irritation of the esophagus
C.

Esophageal scar tissue formation
D.

Aspiration of gastric contents

Correct Answer
D. Aspiration of gastric contents

Explanation
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.

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8.

Which of the following dietary measures would be useful in preventing esophageal reflux?

A.

Eating small. frequent meals
B.

Increasing fluid intake
C.

Avoiding air swallowing with meals
D.

Adding a bedtime snack to the dietary plan

Correct Answer
A. Eating small. frequent meals

Explanation
Esophageal reflux worsens when the stomach is overdistended with food. Therefore. an important measure is to eat small. frequent meals. Fluid intake should be decreased during meals to reduce abdominal distention. Avoiding air swallowing does not prevent esophageal reflux. Food intake in the evening should be strictly limited to reduce the incidence of nighttime reflux. so bedtime snacks are not recommended.

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9.

A client is admitted to the hospital after vomiting bright red blood and is diagnosed with a bleeding duodenal ulcer. The client develops a sudden. sharp pain in the mid epigastric area along with a rigid. board-like abdomen. These clinical manifestations most likely indicate which of the following?

A.

An intestinal obstruction has developed
B.

Additional ulcers have developed
C.

The esophagus has become inflamed
D.

The ulcer has perforated

Correct Answer
D. The ulcer has perforated

Explanation
The body reacts to perforation of an ulcer by immobilizing the area as much as possible. This results in boardlike muscle rigidity. usually with extreme pain. Perforation is a medical emergency requiring immediate surgical intervention because peritonitis develops quickly after perforation. An intestinal obstruction would not cause midepigastric pain. Esophageal inflammation or the development of additional ulcers would not cause a rigid. boardlike abdomen.

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10.

When obtaining a nursing history on a client with a suspected gastric ulcer. which signs and symptoms would the nurse expect to see? Select all that apply.

A.

Epigastric pain at night
B.

Relief of epigastric pain after eating
C.

Vomiting
D.

Weight loss

Correct Answer(s)
C. Vomiting
D. Weight loss

Explanation
Vomiting and weight loss are common with gastric ulcers. Clients with a gastric ulcer are most likely to complain of a burning epigastric pain that occurs about one hour after eating. Eating frequently aggravates the pain. Clients with duodenal ulcers are more likely to complain about pain that occurs during the night and is frequently relieved by eating.

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