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

1. Increased intrathoracic pressure

2. Weakness of the esophageal muscle
3. Increased esophageal muscle pressure
4. Weakness of the diaphragmatic muscle

2. 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?

1. Obesity
2. Volvulus
3. Constipation
4. Intestinal obstruction

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

1. Left arm pain

2. Lower back pain
3. Esophageal reflux
4. Abdominal cramping

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

1. Colonoscopy
2. Lower GI series
3. Barium swallow
4. Abdominal x-rays

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

1. Recognizing hemorrhage
2. Controlling blood pressure
3. Encouraging nutritional intake
4. Teaching the client about varices

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

1. Abdominal x-ray
2. Barium swallow
3. Computed tomography (CT) scan
4. Esophagogastroduodenoscopy (EGD)

7. 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?

1. Neutralize acid
2. Reduce acid secretions
3. Stimulate gastrin release
4. Protect the mucosal barrier

8. 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?

1. Supine with the head of the bed flat

2. On the stomach with the head flat
3. On the left side with the head of the bed elevated 30 degrees
4. On the right side with the head of the bed elevated 30 degrees.

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?

1. Irrigating the nasogastric tube

2. Coughing a deep breathing exercises
3. Leg exercises
4. Early ambulation
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?

1. Eat high-carbohydrate foods

2. Limit the fluids taken with meals
3. Ambulate following a meal
4. Sit in a high-Fowler’s position during meals

11. 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?

1. Assess the oral cavity each time mouth care is given and record observations
2. Use a soft toothbrush to brush the client’s teeth after each meal
3. Swab the client’s tongue, gums, and lips with a soft foam applicator every 2 hours.
4. Rinse the client’s mouth with mouthwash several times a day.

12. 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?

1. The client complains of a sore throat

2. The client displays signs of sedation
3. The client experiences a sudden increase in temperature
4. The client demonstrates a lack of appetite

13. 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?

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

2. The procedure will result in anastomosis of the gastric stump to the jejunum
3. The procedure will result in removal of the duodenum
4. The procedure will result in repositioning of the vagus nerve
14. After a subtotal gastrectomy, the nurse should anticipate that nasogastric tube
drainage will be what color for about 12 to 24 hours after surgery?

1. Dark brown
2. Bile green
3. Bright red
4. Cloudy white

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

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

2. Reposition the tube if it is not draining well
3. Monitor the client for N/V, and abdominal distention
4. Turn the machine to high suction of the drainage is sluggish on low suction.

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

1. Regain weight loss within 1 month after surgery

2. Resume normal dietary intake of three meals per day
3. Control nausea and vomiting through regular use of antiemetics
4. Achieve optimal nutritional status through oral or parenteral feedings

17. 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?

1. Development of laryngeal cancer

2. Irritation of the esophagus
3. Esophageal scar tissue formation
4. Aspiration of gastric contents

18. Which of the following dietary measures would be useful in preventing

esophageal reflux?
1. Eating small, frequent meals
2. Increasing fluid intake
3. Avoiding air swallowing with meals
4. Adding a bedtime snack to the dietary plan

19. 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?

1. An intestinal obstruction has developed

2. Additional ulcers have developed
3. The esophagus has become inflamed
4. The ulcer has perforated

20. 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.

1. Epigastric pain at night

2. Relief of epigastric pain after eating
3. Vomiting
4. Weight loss

21. The nurse is caring for a client who has had a gastroscopy. Which of the
following symptoms may indicate that the client is developing a complication related
to the procedure? Select all that apply.

1. The client complains of a sore throat

2. The client has a temperature of 100*F
3. The client appears drowsy following the procedure
4. The client complains of epigastric pain
5. The client experiences hematemesis

22. A client with peptic ulcer disease tells the nurse that he has black stools, which
he has not reported to his physician. Based on this information, which nursing
diagnosis would be appropriate for this client?
1. Ineffective coping related to fear of diagnosis of chronic illness
2. Deficient knowledge related to unfamiliarity with significant signs and symptoms
3. Constipation related to decreased gastric motility
4. Imbalanced nutrition: Less than body requirements due to gastric bleeding

23. A client with a peptic ulcer reports epigastric pain that frequently awakens her at
night, a feeling of fullness in the abdomen, and a feeling of anxiety about her health.
Based on this information, which nursing diagnosis would be most appropriate?

1. Imbalanced Nutrition: Less than Body Requirements related to anorexia.

2. Disturbed Sleep Pattern related to epigastric pain
3. Ineffective Coping related to exacerbation of duodenal ulcer
4. Activity Intolerance related to abdominal pain

24. While caring for a client with peptic ulcer disease, the client reports that he has
been nauseated most of the day and is now feeling lightheaded and dizzy. Based
upon these findings, which nursing actions would be most appropriate for the nurse
to take? Select all that apply.

1. Administering an antacid hourly until nausea subsides.

2. Monitoring the client’s vital signs
3. Notifying the physician of the client’s symptoms
4. Initiating oxygen therapy
5. Reassessing the client on an hour

25. A client is to take one daily dose of ranitidine (Zantac) at home to treat her peptic
ulcer. The nurse knows that the client understands proper drug administration of
ranitidine when she says that she will take the drug at which of the following times?

1. Before meals
2. With meals
3. At bedtime
4. When pain occurs

26. A client has been taking aluminum hydroxide 30 mL six times per day at home to
treat his peptic ulcer. He tells the nurse that he has been unable to have a bowel
movement for 3 days. Based on this information, the nurse would determine that
which of the following is the most likely cause of the client’s constipation?

1. The client has not been including enough fiber in his diet
2. The client needs to increase his daily exercise
3. The client is experiencing a side effect of the aluminum hydroxide.
4. The client has developed a gastrointestinal obstruction.

27. A client is taking an antacid for treatment of a peptic ulcer. Which of the following
statements best indicates that the client understands how to correctly take the
antacid?

1. “I should take my antacid before I take my other medications.”

2. “I need to decrease my intake of fluids so that I don’t dilute the effects of my antacid.”
3. “My antacid will be most effective if I take it whenever I experience stomach pains.”
4. “It is best for me to take my antacid 1 to 3 hours after meals.”

28. 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?

1. Vitamin A
2. Vitamin B12
3. Vitamin C
4. Vitamin E

29. The nurse is reviewing the medication record of a client with acute gastritis.
Which medication, if noted on the client’s record, would the nurse question?

1. Digoxin (Lanoxin)
2. Indomethacin (Indocin)
3. Furosemide (Lasix)
4. Propranolol hydrochloride (Inderal)
30. The nurse is assessing a client 24 hours following a cholecystectomy. The nurse
notes that the T-tube has drained 750ml of green-brown drainage. Which nursing
intervention is most appropriate?

1. Notify the physician

2. Document the findings
3. Irrigate the T-tube
4. Clamp the T-tube

31. The nurse provides medication instructions to a client with peptic ulcer disease.
Which statement, if made by the client, indicates the best understanding of the
medication therapy?

1. “The cimetidine (Tagamet) will cause me to produce less stomach acid.”

2. “Sucralfate (Carafate) will change the fluid in my stomach.”
3. “Antacids will coat my stomach.”
4. “Omeprazole (Prilosec) will coat the ulcer and help it heal.”

32. The client with peptic ulcer disease is scheduled for a pyloroplasty. The client
asks the nurse about the procedure. The nurse plans to respond knowing that a
pyloroplasty involves:

1. Cutting the vagus nerve

2. Removing the distal portion of the stomach
3. Removal of the ulcer and a large portion of the cells that produce hydrochloric acid
4. An incision and resuturing of the pylorus to relax the muscle and enlarge the opening
from the stomach to the duodenum.

33. A client with a peptic ulcer is scheduled for a vagotomy. The client asks the nurse
about the purpose of this procedure. The nurse tells the client that the procedure:

1. Decreases food absorption in the stomach

2. Heals the gastric mucosa
3. Halts stress reactions
4. Reduces the stimulus to acid secretions
34. The nurse would assess the client experiencing an acute episode
of cholecystitis for pain that is located in the right

1. Upper quadrant and radiates to the left scapula and shoulder

2. Upper quadrant and radiates to the right scapula and shoulder
3. Lower quadrant and radiates to the umbilicus
4. Lower quadrant and radiates to the back

35. Which of the following tasks should be included in the immediate postoperative
management of a client who has undergone gastric resection?

1. Monitoring gastric pH to detect complications

2. Assessing for bowel sounds
3. Providing nutritional support
4. Monitoring for symptoms of hemorrhage

36. If a gastric acid perforates, which of the following actions should not be included
in the immediate management of the client?

1. Blood replacement
2. Antacid administration
3. Nasogastric tube suction
4. Fluid and electrolyte replacement

37. Mucosal barrier fortifiers are used in peptic ulcer disease management for which
of the following indications?

1. To inhibit mucus production

2. To neutralize acid production
3. To stimulate mucus production
4. To stimulate hydrogen ion diffusion back into the mucosa

38. When counseling a client in ways to prevent cholecystitis, which of the following
guidelines is most important?
1. Eat a low-protein diet
2. Eat a low-fat, low-cholesterol diet
3. Limit exercise to 10 minutes/day
4. Keep weight proportionate to height

39. Which of the following symptoms best describes Murphy’s sign?

1. Periumbilical ecchymosis exists

2. On deep palpation and release, pain in elicited
3. On deep inspiration, pain is elicited and breathing stops
4. Abdominal muscles are tightened in anticipation of palpation

40. Which of the following tests is most commonly used to diagnose cholecystitis?

1. Abdominal CT scan
2. Abdominal ultrasound
3. Barium swallow
4. Endoscopy

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

1. Administration of antibiotics
2. Assessment for complications
3. Preparation for lithotripsy
4. Preparation for surgery

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

1. Increase rest
2. Avoid antacids
3. Increase protein in diet
4. Use anticholinergics as prescribed
43. The client with a duodenal ulcer may exhibit which of the following findings on
assessment?

1. Hematemesis
2. Malnourishment
3. Melena
4. Pain with eating

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

1. Early satiety
2. Pain on eating
3. Dull upper epigastric pain
4. Pain on empty stomach

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

1. Instruct the client to tilt his head back for insertion in the nostril, then flex his neck for the
final insertion
2. After insertion into the nostril, instruct the client to extend his neck
3. Introduce the tube with the client’s head tilted back, then instruct him to keep his head
upright for final insertion
4. Instruct the client to hold his chin down, then back for insertion of the tube

46. The most important pathophysiologic factor contributing to the formation of

esophageal varices is:

1. Decreased prothrombin formation

2. Decreased albumin formation by the liver
3. Portal hypertension
4. Increased central venous pressure

47. 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:
1. Check that the hemostat is on the bedside
2. Monitor IV fluids for the shift
3. Regularly assess respiratory status
4. Check that the balloon is deflated on a regular basis

48. A female client complains of gnawing epigastric pain for a few hours after meals.
At times, when the pain is severe, vomiting occurs. Specific tests are indicated to
rule out:

1. Cancer of the stomach

2. Peptic ulcer disease
3. Chronic gastritis
4. Pylorospasm

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

1. Assisting in inserting a Miller-Abbott tube

2. Assisting in inserting an arterial pressure line
3. Inserting a nasogastric tube
4. Inserting an I.V.

50. 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:

1. Reduce gastric acid output

2. Protect the ulcer surface
3. Inhibit the production of hydrochloric acid (HCl)
4. Inhibit vagus nerve stimulation

Answers and Rationale

1. Answer: 4. 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.

2. Answer: 1. Obesity

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

3. Answer: 3. Esophageal reflux

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.

4. Answer: 3. Barium swallow

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.

5. Answer: 1. Recognizing hemorrhage

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.

6. Answer: 4. 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.

7. Answer: 2. Reduce acid secretions

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

8. Answer: 3. On the left 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.

9. Answer: 1. Irrigating the nasogastric tube

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. Answer: 2. Limit the fluids taken with 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.

11. Answer: 2. Use a soft toothbrush to brush the client’s teeth after each meal

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.

12. Answer: 3. The client experiences a sudden increase in temperature

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.

13. Answer: 2. The procedure will result in anastomosis of the gastric stump to the
jejunum

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.

14. Answer: 1. Dark brown

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.

15. Answer: 3. Monitor the client for N/V, and abdominal distention

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.

16. Answer: 4. Achieve optimal nutritional status through oral or parenteral feedings
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.

17. Answer: 4. Aspiration of gastric contents

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.

18. Answer: 1. Eating small, frequent meals

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.

19. Answer: 4. The ulcer has perforated

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.

20. Answers: 3 and 4.

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.

21. Answers: 2, 4, and 5.

Following a gastroscopy, the nurse should monitor the client for complications, which
include perforation and the potential for aspiration. An elevated temperature, complaints of
epigastric pain, or the vomiting of blood (hematemesis) are all indications of a possible
perforation and should be reported promptly. A sore throat is a common occurrence
following a gastroscopy. Clients are usually sedated to decrease anxiety and the nurse
would anticipate that the client will be drowsy following the procedure.

22. Answer: 2. Deficient knowledge related to unfamiliarity with significant signs and
symptoms

Black, tarry stools are an important warning sign of bleeding in peptic ulcer disease.
Digested blood in the stomach causes it to be black. The odor of the stool is very stinky.
Clients with peptic ulcer disease should be instructed to report the incidence of black stools
promptly to their physician.

23. Answer: 2. Disturbed Sleep Pattern related to epigastric pain

Based on the data provided, the most appropriate nursing diagnosis would be Disturbed
Sleep pattern. A client with a duodenal ulcer commonly awakens at night with pain. The
client’s feelings of anxiety do not necessarily indicate that she is coping ineffectively.

24. Answers: 2 and 3.

The symptoms of nausea and dizziness in a client with peptic ulcer disease may be
indicative of hemorrhage and should not be ignored. The appropriate nursing actions at this
time are for the nurse to monitor the client’s vital signs and notify the physician of the
client’s symptoms. To administer an antacid hourly or to wait one hour to reassess the client
would be inappropriate; prompt intervention is essential in a client who is potentially
experiencing a gastrointestinal hemorrhage. The nurse would notify the physician of
assessment findings and then initiate oxygen therapy if ordered by the physician.

25. Answer: 3. At bedtime

Ranitidine blocks secretion of hydrochloric acid. Clients who take only one daily dose of
ranitidine are usually advised to take it at bedtime to inhibit nocturnal secretion of acid.
Clients who take the drug twice a day are advised to take it in the morning and at bedtime.

26. Answer: 3. The client is experiencing a side effect of the aluminum hydroxide.

It is most likely that the client is experiencing a side effect of the antacid. Antacids with
aluminum salt products, such as aluminum hydroxide, form insoluble salts in the body.
These precipitate and accumulate in the intestines, causing constipation. Increasing dietary
fiber intake or daily exercise may be a beneficial lifestyle change for the client but is not
likely to relieve constipation caused by the aluminum hydroxide. Constipation, in isolation
from other symptoms, is not a sign of bowel obstruction.

27. Answer: 4. “It is best for me to take my antacid 1 to 3 hours after meals.”

Antacids are most effective if taken 1 to 3 hours after meals and at bedtime. When an
antacid is taken on an empty stomach, the duration of the drug’s action is greatly
decreased. Taking antacids 1 to 3 hours after a meal lengthens the duration of action, thus
increasing the therapeutic action of the drug. Antacids should be administered about 2
hours after other medications to decrease the chance of drug interactions. It is not
necessary to decrease fluid intake when taking antacids.

28. Answer: 2. Vitamin B12

Chronic gastritis causes deterioration and atrophy of the lining of the stomach, leading to
the loss of the functioning parietal cells. The source of the intrinsic factor is lost, which
results in the inability to absorb vitamin B12. This leads to the development of
pernicious anemia.

29. Answer: 2. Indomethacin (Indocin)

Indomethacin (Indocin) is a NSAID and can cause ulceration of the esophagus, stomach,
duodenum, or small intestine. Indomethacin is contraindicated in a client with GI disorders.

30. Answer: 2. Document the findings

Following cholecystectomy, drainage from the T-tube is initially bloody and then turns to
green-brown. The drainage is measured as output. The amount of expected drainage will
range from 500 to 1000 ml per day. The nurse would document the output.

31. Answer: 1 “The cimetidine (Tagamet) will cause me to produce less stomach
acid.”

Cimetidine (Tagamet), a histamine H2 receptor antagonist, will decrease the secretion of

gastric acid. Sucralfate (Carafate) promotes healing by coating the ulcer. Antacids
neutralize acid in the stomach. Omeprazole (Prilosec) inhibits gastric acid secretion.

32. Answer: 4. An incision and resuturing of the pylorus to relax the muscle and
enlarge the opening from the stomach to the duodenum.

Option 4 describes the procedure for a pyloroplasty. A vagotomy involves cutting the vagus
nerve. A subtotal gastrectomy involves removing the distal portion of the stomach. A Billroth
II procedure involves removal of the ulcer and a large portion of the tissue that produces
hydrochloric acid.

33. Answer: 4. Reduces the stimulus to acid secretions

A vagotomy, or cutting the vagus nerve, is done to eliminate parasympathetic stimulation of

gastric secretion.

34. Answer: 2. Upper quadrant and radiates to the right scapula and shoulder

During an acute “gallbladder attack,” the client may complain of severe right upper quadrant
pain that radiates to the right scapula and shoulder. This is governed by the pattern on
dermatomes in the body.

35. Answer: 4. Monitoring for symptoms of hemorrhage

The client should be monitored closely for signs and symptoms of hemorrhage, such as
bright red blood in the nasogastric tube suction, tachycardia, or a drop in blood pressure.
Gastric pH may be monitored to evaluate the need for histamine-2 receptor antagonists.
Bowel sounds may not return for up to 72 hours postoperatively. Nutritional needs should
be addressed soon after surgery.

36. Answer: 2. Antacid administration

Antacids aren’t helpful in perforation. The client should be treated with antibiotics as well as
fluid, electrolyte, and blood replacement. NG tube suction should also be performed to
prevent further spillage of stomach contents into the peritoneal cavity.

37. Answer: 3. To stimulate mucus production

The mucosal barrier fortifiers stimulate mucus production and prevent hydrogen ion
diffusion back into the mucosa, resulting in accelerated ulcer healing. Antacids neutralize
acid production.

38. Answer: 4. Keep weight proportionate to height

Obesity is a known cause of gallstones, and maintaining a recommended weight will help
protect against gallstones. Excessive dietary intake of cholesterol is associated with the
development of gallstones in many people. Dietary protein isn’t implicated in cholecystitis.
Liquid protein and low-calorie diets (with rapid weight loss of more than 5 lb [2.3kg] per
week) are implicated as the cause of some cases of cholecystitis. Regular exercise (30
minutes/three times a week) may help reduce weight and improve fat metabolism. Reducing
stress may reduce bile production, which may also indirectly decrease the chances of
developing cholecystitis.

39. Answer: 3. On deep inspiration, pain is elicited and breathing stops

Murphy’s sign is elicited when the client reacts to pain and stops breathing. It’s a common
finding in clients with cholecystitis. Periumbilical ecchymosis, Cullen’s sign, is present
in peritonitis. Pain on deep palpation and release is rebound tenderness. Tightening up
abdominal muscles in anticipation of palpation is guarding.
40. Answer: 2. Abdominal ultrasound

An abdominal ultrasound can show if the gallbladder is enlarged, if gallstones are present, if
the gallbladder wall is thickened, or if distention of the gallbladder lumen is present. An
abdominal CT scan can be used to diagnose cholecystitis, but it usually isn’t necessary. A
barium swallow looks at the stomach and the duodenum. Endoscopy looks at the
esophagus, stomach, and duodenum.

41. Answer: 2. Assessment for complications

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.

42. Answer: 4. 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.

43. Answer: 3. Melena

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.

44. Answer: 4. Pain on empty stomach

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

45. Answer: 1. Instruct the client to tilt his head back for insertion in the nostril, then
flex his neck for the final insertion
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.

46. Answer: 3. Portal hypertension

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.

47. Answer: 3. Regularly assess respiratory status

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.

48. Answer: 2. Peptic ulcer disease

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.

49. Answer: 3. Inserting a nasogastric tube

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.

50. Answer: 1. Reduce gastric acid output

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