Upper GI Nclex Questions- GERD& Hernias, Gastritis & Peptic Ulcer Dis-

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The male client tells the nurse he has been experiencing "heart-
burn" at night that awakens him. Which assessment question What have you done to alleviate the heartburn?
should the nurse ask?
Most clients with GERD have been self medicating with over-the
-"how much weight have you gained recently?" counter medications prior to seeking advice from a healthcare
-"what have you done to alleviate the heartburn" provider. It is important to know what the client has been using
-"Do you consume many milk and dairy products" to treat the problem
-"Have you been around anyone with a stomach virus"
Gastroesophageal reflux disease (GERD) weakens the lower
esophageal sphincter, predisposing older persons to risk for im-
paired swallowing. In managing the symptoms associated with
GERD, the nurse should assign the highest priority to which of
the following interventions?
Eat small, frequent meals, and remain in an upright position for at
least 30 minutes after eating.
a. Decrease daily intake of vegetables and water, and ambulate
frequently.
Small, frequent feedings requires less release of hydrochloric
acid. Remaining in an upright position for 30 minutes after meals
b. Drink coffee diluted with milk at each meal, and remain in an
prevents reflux into the esophagus
upright position for 30 minutes.

c. Eat small, frequent meals, and remain in an upright position for

at least 30 minutes after eating.

d. Avoid over-the-counter drugs that have antacids in them.

The nurse is performing an admission assessment on a client
diagnosed with GERD. Which sign and symptoms would indicate
GERD? -Pyrosis (heartburn), water brash, and flatulence

-Pyrosis, water brash, and flatulence Pyrosis is heartburn, water brash is the feeling of saliva secretion
-Weight loss, dysarthria, and diarrhea as a result of reflux, and flatulence is gas-all symptoms of GERD.
-Decreased abdominal fat, proteinuria, and constipation
-Midepigastric pain, positive H pylori test, and melena
Lying recumbent after meals
A client with hiatal hernia chronically experiences heartburn after
meals. Which should the nurse teach the client to avoid? Hiatal hernia is caused by a protrusion of a portion of the stomach
above the diaphragm, where the esophagus usually is positioned.
"Which statement made by the client indicates to the nurse the
client may be experiencing GERD?
2. "I take antacid tablets with me wherever I go."
1. "My chest hurts when I walk up the stairs in my home." 2. "I take
antacid tablets with me wherever I go." Frequent use of antacids indicates an acid reflux problem.
3. My spouse tells me I snore very loudly at night."
4. I drink six (6) to seven (7) soft drinks every day
Which diagnostic results support the diagnosis of peptic ulcer
disease (PUD)? (Select all that apply.)
a. Low hemoglobin (Hgb)
a. Low hemoglobin (Hgb)
c. Low hematocrit (Hct)
b. Low white blood cell (WBC) level
d. Positive for H. pylori bacteria
c. Low hematocrit (Hct)
d. Positive for H. pylori bacteria
e. Low potassium of 3.4 mEq/L

As the patient prepares for discharge, the nurse provides educa-

tion about behaviors that reduce symptoms and aggravate peptic
ulcers. Which teaching does the nurse provide? (Select all that a. Sit upright 30 to 60 minutes after meals.
apply.) d. Extreme vomiting should be reported to your physician.
e. H. pylori can be a concern in patients with peptic ulcers.
a. Sit upright 30 to 60 minutes after meals.
b. Spices should be added to food to enhance flavor.

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c. A vagotomy will be needed in the future
d. Extreme vomiting should be reported to your physician.
f. The goal of initial intervention is to control symptoms and prevent
e. H. pylori can be a concern in patients with peptic ulcers.
further complications.
f. The goal of initial intervention is to control symptoms and prevent
further complications.
What is the nursing priority in the management of a patient with
an active upper G.I. bleed?
A. Obtain vital signs.
A. Obtain vital signs.
All other interventions can be applied after vital signs have been
B. Apply oxygen by nasal cannula.
checked because this will help determine the other intervention...
C. Type and crossmatch the patient for blood products.
D. Notify the physician.
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? b. Heartburn
a. Diarrhea
b. Heartburn
c. Constipation
d. Lower abdominal pain
The nurse determines that a patient has experienced the ben-
eficial effects of therapy with famotidine (Pepcid) when which
Epigastric pain
symptom is relieved?
Famotidine is an H2-receptor antagonist that inhibits parietal cell
Nausea
output of HCl acid and minimizes damage to gastric mucosa
Belching
related to hyperacidity, thus relieving epigastric pain.
Epigastric pain
Difficulty swallowing
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
a. Providing IV fluids and inserting a nasogastric (NG) tube A perforated peptic ulcer requires IV replacement of fluid losses
b. Administering oral bicarbonate and testing the patient's gastric and continued gastric aspiration by NG tube.
pH level
c. Performing a fecal occult blood test and administering IV calci-
um gluconate
d. Starting parenteral nutrition and placing the patient in a
high-Fowler's position
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? b. "It would likely be beneficial for you to eliminate drinking alco-
hol."
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 alco- Although there is no specific recommended dietary modification
hol." for PUD, most patients find it necessary to make some sort of
c. "Many people find that a minced or pureed diet eases their dietary modifications to minimize symptoms. Milk may exacerbate
symptoms of PUD." PUD and alcohol is best avoided because it can delay healing.
d. "Your medications should allow you to maintain your present
diet while minimizing symptoms."

A 72-year-old patient was admitted with epigastric pain due to

d. Rigid abdomen and vomiting following indigestion
a gastric ulcer. Which patient assessment warrants an urgent
change in the nursing plan of care?
A rigid abdomen with vomiting in a patient who has a gastric ulcer
indicates a perforation of the ulcer, especially if the manifestations
a. Chest pain relieved with eating or drinking water
of perforation appear suddenly.
b. Back pain 3 or 4 hours after eating a meal

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c. Burning epigastric pain 90 minutes after breakfast
d. Rigid abdomen and vomiting following indigestion
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
c. NG will have bloody drainage, and it should not be repositioned.
returns to the nursing unit?
The patient will have bloody drainage from the nasogastric (NG)
a. Turn, deep breathe, cough, and use spirometer every 4 hours.
tube for 8 to 12 hours, and it should not be repositioned or rein-
b. Maintain an upright position for at least 2 hours after eating.
serted without contacting the surgeon
c. NG will have bloody drainage, and it should not be repositioned.
d. Keep in a supine position to prevent movement of the anasto-
mosis.
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?
c. Antibiotic(s), proton pump inhibitor
a. Antibiotic(s), antacid, and corticosteroid
Two antibiotics and a proton pump inhibitor
b. Antibiotic(s), aspirin, and antiulcer/protectant
c. Antibiotic(s), proton pump inhibitor
d. Antibiotic(s) and nonsteroidal antiinflammatory drugs (NSAIDs)
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, palpi- c. Dumping syndrome
tations, and dizziness 15 to 30 minutes after eating?
After a Billroth I operation, dumping syndrome may occur 15 to 30
a. Malnutrition minutes after eating because of the hypertonic fluid going to the
b. Bile reflux gastritis intestine and additional fluid being drawn into the bowel.
c. Dumping syndrome
d. Postprandial hypoglycemia
A 46-year-old female with gastroesophageal reflux disease
(GERD) is experiencing increasing discomfort. Which patient
c. "I eat small meals during the day and have a bedtime snack."
statement indicates that additional teaching about GERD is need-
ed?
GERD is exacerbated by eating late at night, and the nurse should
a. "I take antacids between meals and at bedtime each night."
plan to teach the patient to avoid eating at bedtime. The other
b. "I sleep with the head of the bed elevated on 4-inch blocks."
patient actions are appropriate to control symptoms of GERD.
c. "I eat small meals during the day and have a bedtime snack."
d. "I quit smoking several years ago, but I still chew a lot of gum."
The nurse will anticipate teaching a patient experiencing frequent
d. proton pump inhibitors.
heartburn about
Because diagnostic testing for heartburn that is probably caused
a. barium swallow.
by gastroesophageal reflux disease (GERD) is expensive and
b. radionuclide tests.
uncomfortable, proton pump inhibitors are frequently used for a
c. endoscopy procedures.
short period as the first step in the diagnosis of GERD.
d. proton pump inhibitors.
At his first postoperative checkup appointment after a gastroje-
junostomy (Billroth II), a patient reports that dizziness, weakness,
and palpitations occur about 20 minutes after each meal. The
c. lie down for about 30 minutes after eating.
nurse will teach the patient to
The patient is experiencing symptoms of dumping syndrome,
a. increase the amount of fluid with meals.
which may be reduced by lying down after eating.
b. eat foods that are higher in carbohydrates.
c. lie down for about 30 minutes after eating.
d. drink sugared fluids or eat candy after meals.

Which information about dietary management should the nurse

b. "Avoid foods that cause pain after you eat them."
include when teaching a patient with peptic ulcer disease (PUD)?
The best information is that each individual should choose foods
a. "You will need to remain on a bland diet."
that are not associated with postprandial discomfort.
b. "Avoid foods that cause pain after you eat them."

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c. "High-protein foods are least likely to cause you pain."
d. "You should avoid eating any raw fruits and vegetables."
Which item should the nurse offer to the patient who is to restart
oral intake after being NPO due to nausea and vomiting?
b. Dish of lemon gelatin- clear liquids
a. Glass of orange juice
Clear cool liquids are usually the first foods started after a patient
b. Dish of lemon gelatin
has been nauseated.
c. Cup of coffee with cream
d. Bowl of hot chicken broth
A client with peptic ulcer disease (PUD) asks the nurse whether
licorice and slippery elm might be useful in managing the disease.
What is the nurse's best response?
A. "No, they probably won't be useful. You should use only pre-
scription medications in your treatment plan."
B. "These herbs could be helpful. However, you should talk with
B. "These herbs could be helpful. However, you should talk with
your provider before adding them to your treatment regimen."
your provider before adding them to your treatment regimen."
C. "Yes, these are known to be effective in managing this disease,
but make sure you research the herbs thoroughly before taking
them."
D. "No, herbs are not useful for managing this disease. You can
use any type of over-the-counter drugs though. They have been
shown to be safe."
The nurse is teaching a client how to prevent recurrent chronic
gastritis symptoms before discharge. Which statement by the
client demonstrates a correct understanding of the nurse's in-
struction?
D. "I should eat small meals about six times a day."
A. "It is okay to continue to drink coffee in the morning when I get
to work."
B. "I will need to take vitamin B12 shots for the rest of my life."
C. "Ibuprophen should be taken"
D. "I should eat small meals about six times a day."
The client is experiencing bleeding related to peptic ulcer disease
(PUD). Which nursing intervention is the highest priority?
Starting a large-bore intravenous (IV)
A. Administering intravenous (IV) pain medication
A large-bore IV should be placed as requested, so that blood
B. Starting a large-bore intravenous (IV)
products can be administered.
C. Monitoring the client's anxiety level
D. Preparing equipment for intubation
The nurse finds a client vomiting coffee ground-type material. On
assessment, the client has blood pressure of 100/74 mm Hg,
is acutely confused, and has a weak and thready pulse. Which
c. Administering intravenous (IV) fluids
intervention will be the nurse's first priority?
Administration of IV fluids is necessary to treat the hypovolemia
A. Initiating enteral nutrition
caused by acute GI bleeding.
B. Administering an H2 antagonist
C. Administering intravenous (IV) fluids
D. Administering antianxiety medication
Which of the following lifestyle modifications should the nurse
encourage the client with a hiatal hernia to include in activities of
2. Eliminating smoking and alcohol use.
daily living?
Smoking and alcohol use both reduce esophageal sphincter tone
1. Daily aerobic exercise.
and can result in reflux. They therefore should be avoided by
2. Eliminating smoking and alcohol use.
clients with hiatal hernia.
3. Balancing activity and rest.
4. Avoiding high-stress situations.
The client attends two sessions with the dietitian to learn
1. Fats.
about diet modifications to minimize gastroesophageal reflux. The
teaching would be considered successful if the client says that she
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will decrease her intake of which of the following foods?
1. Fats. Fats are associated with decreased esophageal sphincter tone,
2. High-sodium foods. which increases reflux. Obesity contributes to the development of
3. Carbohydrates. hiatal hernia, and a low-fat diet might also aid in weight loss.
4. High-calcium foods.
Which of the following nursing interventions would most likely
promote self-care behaviors in the client with a hiatal hernia?
3. Ask the client to identify other situations in which he demon-
1. Introduce the client to other people who are successfully man-
strated responsibility for himself.
aging their care.
2. Include the client's daughter in the teaching so that she can help
Self-responsibility is the key to individual health maintenance.
implement the plan.
Using examples of situations in which the client has demonstrated
3. Ask the client to identify other situations in which he demon-
self-responsibility can be reinforcing and supporting.
strated responsibility for himself.
4. Reassure the client that he will be able to implement all aspects
of the plan successfully.
The client asks the nurse whether he will need surgery to correct
his hiatal hernia. Which reply by the nurse would be most accu-
rate?
2. "Hiatal hernia symptoms can usually be successfully managed
with diet modifications, medications, and lifestyle changes."
1. "Surgery is usually required, although medical treatment is
attempted first."
Most clients can be treated successfully with a combination of
2. "Hiatal hernia symptoms can usually be successfully managed
diet restrictions, medications, weight control, and lifestyle modi-
with diet modifications, medications, and lifestyle changes."
fications.
3. "Surgery is not performed for this type of hernia."
4. "A minor surgical procedure to reduce the size of the diaphrag-
matic opening will probably be planned."
Which of the following factors would most likely contribute to the 2. Being 5 feet, 3 inches tall and weighing 190 lb.
development of a client's hiatal hernia?
Any factor that increases intra-abdominal pressure, such as obe-
1. Having a sedentary desk job. sity, can contribute to the development of hiatal hernia. Other
2. Being 5 feet, 3 inches tall and weighing 190 lb. factors include abdominal straining, frequent heavy lifting, and
3. Using laxatives frequently. pregnancy. Hiatal hernia is also associated with older age and
4. Being 40 years old. occurs in women more frequently than in men.
A client who has been diagnosed with gastroesophageal reflux
3. Hot chocolate.
disease (GERD) complains of heartburn. To decrease the heart-
burn, the nurse should instruct the client to eliminate which of the
With GERD, eating substances that decrease lower esophageal
following items from the diet?
sphincter pressure causes heartburn. A decrease in the lower
esophageal sphincter pressure allows gastric contents to reflux
1. Lean beef.
into the lower end of the esophagus. Foods that can cause a
2. Air-popped popcorn.
decrease in esophageal sphincter pressure include fatty foods,
3. Hot chocolate.
chocolate, caffeinated beverages, peppermint, and alcohol.
4. Raw vegetables.
The nurse instructs the client on health maintenance activities
to help control symptoms from her hiatal hernia. Which of the 1. "I'll avoid lying down after a meal."
following statements would indicate that the client has understood
the instructions? A client with a hiatal hernia should avoid the recumbent posi-
1. "I'll avoid lying down after a meal." tion immediately after meals to minimize gastric reflux. Bedtime
2. "I can still enjoy my potato chips and cola at bedtime." snacks, as well as high-fat foods and carbonated beverages,
3. "I wish I didn't have to give up swimming." should be avoided.
4. "If I wear a girdle, I'll have more support for my stomach."
Which of the following instructions should the nurse include in the
teaching plan for a client who is experiencing gastroesophageal
reflux disease (GERD)? 2. Do not lie down for 2 hours after eating.

1. Limit caffeine intake to two cups of coffee per day. The nurse should instruct the client to not lie down for about 2
2. Do not lie down for 2 hours after eating. hours after eating to prevent reflux.
3. Follow a low-protein diet.
4. Take medications with milk to decrease irritation.

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The nurse is obtaining a health history from a client who has a
1. Heartburn.
sliding hiatal hernia associated with reflux. The nurse should ask
the client about the presence of which of the following symptoms?
Heartburn, the most common symptom of a sliding hiatal hernia,
1. Heartburn.
results from reflux of gastric secretions into the esophagus. Re-
2. Jaundice.
gurgitation of gastric contents and dysphagia are other common
3. Anorexia.
symptoms.
4. Stomatitis.
Cimetidine (Tagamet) may also be used to treat hiatal hernia. The
nurse should understand that this drug is used to prevent which 3. Esophagitis.
of the following?
Cimetidine (Tagamet) is a histamine receptor antagonist that de-
1. Esophageal reflux. creases the quantity of gastric secretions. It may be used in hiatal
2. Dysphagia. hernia therapy to prevent or treat the esophagitis and heartburn
3. Esophagitis. associated with reflux.
4. Ulcer formation.
The client with gastroesophageal reflux disease (GERD) com-
plains of a chronic cough. The nurse understands that in a client
4. Aspiration of gastric contents.
with GERD this symptom may be indicative of which of the follow-
ing conditions?
Clients with GERD can develop pulmonary symptoms, such as
1. Development of laryngeal cancer.
coughing, wheezing, and dyspnea, that are caused by the aspi-
2. Irritation of the esophagus.
ration of gastric contents.
3. Esophageal scar tissue formation.
4. Aspiration of gastric contents.
Which of the following dietary measures would be useful in pre-
venting esophageal reflux? 1. Eating small, frequent meals.

1. Eating small, frequent meals. Esophageal reflux worsens when the stomach is overdistended
2. Increasing fluid intake. with food. Therefore, an important measure is to eat small, fre-
3. Avoiding air swallowing with meals. quent meals.
4. Adding a bedtime snack to the dietary plan.
The physician prescribes metoclopramide hydrochloride (Reglan)
for the client with hiatal hernia. The nurse plans to instruct the
1. Increase tone of the esophageal sphincter.
client that this drug is used in hiatal hernia therapy to accomplish
which of the following objectives?
Metoclopramide hydrochloride (Reglan) increases esophageal
1. Increase tone of the esophageal sphincter.
sphincter tone and facilitates gastric emptying; both actions re-
2. Neutralize gastric secretions.
duce the incidence of reflux.
3. Delay gastric emptying.
4. Reduce secretion of digestive juices.
Bethanechol (Urecholine)- Prokinetic- has been ordered for a
client with gastroesophageal reflux disease (GERD). The nurse
should assess the client for which of the following adverse ef-
fects?
2. Urinary urgency.
1. Constipation.
2. Urinary urgency.
3. Hypertension.
4. Dry oral mucosa.
The nurse should instruct the client to avoid which of the following 4. Alcohol.
drugs while taking metoclopramide hydrochloride (Reglan)?
Metoclopramide hydrochloride (Reglan) can cause sedation. Al-
1. Antacids. cohol and other central nervous system depressants add to this
2. Antihypertensives. sedation. A client who is taking this drug should be cautioned to
3. Anticoagulants. avoid driving or performing other hazardous activities for a few
4. Alcohol. hours after taking the drug.
In developing a teaching plan for the client with a hiatal hernia, the 2. Body mechanics used in lifting.
nurse's assessment of which work-related factors would be most
useful? Bending, especially after eating, can cause gastroesophageal
1. Number and length of breaks. reflux. Lifting heavy objects increases intra-abdominal pressure.
2. Body mechanics used in lifting. Assessing the client's lifting techniques enables the nurse to eval-
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3. Temperature in the work area. uate the client's knowledge of factors contributing to hiatal hernia
4. Cleaning solvents used. and how to prevent complications.
The client is scheduled to have an upper gastrointestinal tract
series of x-rays. Following the x-rays, the nurse should instruct the 1. Take a laxative.
client to:
The client should take a laxative after an upper gastrointestinal
1. Take a laxative. series to stimulate a bowel movement. This examination involves
2. Follow a clear liquid diet. the administration of barium, which must be promptly eliminated
3. Administer an enema. from the body because it may harden and cause an obstruction.
4. Take an antiemetic.
The client has been taking magnesium hydroxide (milk of mag-
nesia) at home in an attempt to control hiatal hernia symptoms.
The nurse should assess the client for which of the following
conditions most commonly associated with the ongoing use of 3. Diarrhea.
magnesium-based antacids?
The magnesium salts in magnesium hydroxide are related to those
1. Anorexia. found in laxatives and may cause diarrhea.
2. Weight gain.
3. Diarrhea.
4. Constipation.

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