Chapter 41: Upper Gastrointestinal Problems Lewis:
Medical-Surgical Nursing, 10th Edition EXAM 2024-2025
QUESTIONS AND CORRECT ANSWER
Which information will the nurse include when teaching a patient with peptic ulcer disease
about the effect of ranitidine (Zantac)?
a. "Ranitidine absorbs the excess gastric acid."
b. "Ranitidine decreases gastric acid secretion."
c. "Ranitidine constricts the blood vessels near the ulcer."
d. "Ranitidine covers the ulcer with a protective material." - answer>>>ANS: B
Ranitidine is a histamine-2 (H2) receptor blocker that decreases the secretion of gastric acid.
The response beginning, "Ranitidine constricts the blood vessels" describes the effect of
vasopressin. The response "Ranitidine absorbs the gastric acid" describes the effect of antacids.
The response beginning "Ranitidine covers the ulcer" describes the action of sucralfate
(Carafate).
A young adult patient is hospitalized with massive abdominal trauma from a motor vehicle
crash. The patient asks the nurse about the purpose of receiving famotidine (Pepcid). The nurse
will explain that the medication will
a. decrease nausea and vomiting.
b. inhibit development of stress ulcers.
c. lower the risk for H. pylori infection.
,d. prevent aspiration of gastric contents. - answer>>>ANS: B
Famotidine is administered to prevent the development of physiologic stress ulcers, which are
associated with a major physiologic insult such as massive trauma. Famotidine does not
decrease nausea or vomiting, prevent aspiration, or prevent Helicobacter pylori infection.
An older patient with a bleeding duodenal ulcer has a nasogastric (NG) tube in place. The health
care provider prescribes 30 mL of aluminum hydroxide/magnesium hydroxide (Maalox) to be
instilled through the tube every hour. To evaluate the effectiveness of this treatment, the nurse
a. monitors arterial blood gas values daily.
b. periodically aspirates and tests gastric pH.
c. checks each stool for the presence of occult blood.
d. measures the volume of residual stomach contents. - answer>>>ANS: B
The purpose for antacids is to increase gastric pH. Checking gastric pH is the most direct way of
evaluating the effectiveness of the medication. Arterial blood gases may change slightly, but
this does not directly reflect the effect of antacids on gastric pH. Because the patient has upper
gastrointestinal bleeding, occult blood in the stools will appear even after the acute bleeding
has stopped. The amount of residual stomach contents is not a reflection of resolution of
bleeding or of gastric pH.
A patient admitted with a peptic ulcer has a nasogastric (NG) tube in place. When the patient
develops sudden, severe upper abdominal pain, diaphoresis, and a firm abdomen, which action
should the nurse take?
a. Irrigate the NG tube.
, b. Check the vital signs.
c. Give the ordered antacid.
d. Elevate the foot of the bed. - answer>>>ANS: B
The patient's symptoms suggest acute perforation, and the nurse should assess for signs of
hypovolemic shock. Irrigation of the NG tube, administration of antacids, or both would be
contraindicated because any material in the stomach will increase the spillage into the
peritoneal cavity. Elevating the foot of the bed may increase abdominal pressure and
discomfort, as well as making it more difficult for the patient to breathe.
A patient who underwent a gastroduodenostomy (Billroth I) 12 hours ago complains of
increasing abdominal pain. The patient has no bowel sounds and 200 mL of bright red
nasogastric (NG) drainage in the past hour. The highest priority action by the nurse is to
a. contact the surgeon.
b. irrigate the NG tube.
c. monitor the NG drainage.
d. administer the prescribed morphine. - answer>>>ANS: A
Increased pain and 200 mL of bright red NG drainage 12 hours after surgery indicate possible
postoperative hemorrhage, and immediate actions such as blood transfusion or return to
surgery are needed (or both). Because the NG is draining, there is no indication that irrigation is
needed. Continuing to monitor the NG drainage is not an adequate response. The patient may
need morphine, but this is not the highest priority action.
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