Chapter 38: Upper Digestive Tract Disorders

MULTIPLE CHOICE

1. A nurse is assessing a patient for risk factors that increase the chances of developing oral
cancer. Which information from this patient’s history indicates a risk factor?
a. Alcohol consumption
b. Chewing gum
c. Environmental pollution
d. Consumption of a high-fat diet

ANS: A
Alcohol is statistically proven to be a factor because of irritation of the oral mucosa.

DIF: Cognitive Level: Comprehension REF: p. 722 OBJ: 1

TOP: Oral Cancer KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

2. A home health nurse observes a patient with esophageal cancer tilt his head back while eating.
What might this cause?
a. Narrowing of the esophagus
b. Limiting the types of food that can be consumed
c. Increased risk of aspiration
d. A neck injury

ANS: C
Tilting the head back not only makes it more difficult to eat, but it also increases the risk of
aspiration.

DIF: Cognitive Level: Comprehension REF: p. 726 OBJ: 2

TOP: Feeding Technique with Esophageal Cancer
KEY: Nursing Process Step: Planning
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

3. A nurse is caring for a patient with esophageal surgery who has had stents placed in the
esophagus and instructs the patient how best to avoid regurgitation. What should the nurse
include in this instruction?
a. Keep the bed flat.
b. Eat only small meals.
c. Lie on the right side after meals.
d. Drink three glasses of fluid with each meal.

ANS: B
Eating small meals will help with reflux. Keeping the head of the bed raised and not taking in
excessive fluid with meals should be practiced.

DIF: Cognitive Level: Application REF: p. 727 OBJ: 1

TOP: Gastroesophageal Reflux KEY: Nursing Process Step: Planning
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease
4. A nurse is constructing a teaching plan for a patient with a hiatal hernia. What should be
included in this plan to help reduce the complaints of heartburn, regurgitation, and eructation?
a. Eating three well-balanced meals
b. Lying down 1 hour after eating
c. Sleeping without pillows
d. Eating nothing for several hours before bedtime

ANS: D
Eating just before bedtime encourages reflux into the hernia and possible aspiration.

DIF: Cognitive Level: Application REF: p. 730 OBJ: 1

TOP: Hiatal Hernia KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

5. A 60-year-old patient who has just been diagnosed with cancer of the stomach says, “I feel
blank and numb.” What is the best nursing response?
a. “Shock affects everyone that way.”
b. “I’m sure you are considering what you should do now that you have cancer.”
c. “Would you like me to bring you a sedative?”
d. “What do you mean when you say ‘blank and numb’?”

ANS: D
Patients who seem overwhelmed often need to talk and express their feelings even if they are
not sure of what their feelings are.

DIF: Cognitive Level: Application REF: p. 740 OBJ: 2

TOP: Ineffective Coping KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

6. A goal for a patient with gastritis who has experienced nausea, vomiting, and diarrhea is to
have a return of normal elimination patterns. Which statement best reflects this goal in a
measurable manner?
a. The patient will have fewer stools.
b. Diarrhea will be controlled and not return.
c. The patient will have no more than one stool per day.
d. The patient’s bowel pattern will return to normal.

ANS: D
Goals are to be specific and measurable. The patient knows his or her normal pattern.

DIF: Cognitive Level: Application REF: p. 732 OBJ: 1

TOP: Gastritis KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

7. A nurse is caring for a patient hemorrhaging from a peptic ulcer when the patient complains of
a sharp sudden pain and has a rapidly deteriorating condition. What is the best first action of
the nurse?
a. Roll the patient flat and assess the vital signs.
b. Notify the charge nurse.
c. Suction the mouth.
 d. Prepare for intravenous infusions.

ANS: A
With a rapidly deteriorating patient, the nurse should collect all the information that will need
to be reported, such as vital signs, patient condition, and subjective complaints.

DIF: Cognitive Level: Application REF: p. 732 OBJ: 1

TOP: Perforated Ulcer KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

8. A long-term care nurse is assisting a well-nourished, 80-year-old resident with the diagnosis
of esophageal cancer on methods to deal with dysphagia. What nursing intervention will best
help to improve the resident’s condition?
a. Instruct the patient to tilt his or her head slightly forward.
b. Assist patient to a semi-Fowler position.
c. Encourage the resident to eat meals in the main dining area.
d. Insert a nasogastric tube for feedings.

ANS: A
General interventions helpful in managing dysphagia include a quiet, relaxed environment and
an erect position with the head slightly tilted forward. If dysphagia prevents adequate
nutritional intake, then alternative feeding method must be used and ordered by the health care
provider.

DIF: Cognitive Level: Application REF: p. 726 OBJ: 1

TOP: Esophageal Cancer KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

9. A home health nurse is assigned to follow-up on a patient recently diagnosed with

gastroesophageal reflux disease (GERD). Which primary symptom should the nurse take into
consideration when updating the nursing interventions on this patient’s care plan?
a. Nausea
b. Vomiting
c. Anorexia
d. Heartburn

ANS: D
The onset of GERD symptoms may be sudden or gradual. Patients typically report a painful
burning sensation that moves up and down, commonly occurs after meals, and is relieved by
antacids. Acid regurgitation, intermittent dysphagia, and belching are also common.

DIF: Cognitive Level: Comprehension REF: p. 728 OBJ: 1

TOP: GERD KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

10. A patient experiencing nausea reports to the nurse that she adds ginger root to her morning tea
to calm her stomach. Which classification of medication in the patient history alerts the nurse
to provide further education?
a. Antidepressants
 b. Proton pump inhibitors
c. Anticoagulants
d. Narcotics

ANS: C
Ginger root is effective in calming upset stomach, reducing flatulence, and preventing motion
sickness. It enhances the action of anticoagulant and antiplatelet agents.

DIF: Cognitive Level: Application REF: p. 728 OBJ: 1

TOP: Complementary and Alternative Therapies
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

11. When assessing the tongue of patient in the outpatient clinic, a nurse observes bluish-white
lesions on the mucous membranes. When reviewing the patient history, the nurse notes the
patient has been on long-term antibiotic therapy for chronic prostatitis. What should the nurse
suspect?
a. Thrush
b. Aphthous stomatitis
c. Herpes simplex type I
d. Oral cancer

ANS: A
Candida albicans, a yeast-like fungus, causes the oral condition known as thrush or
candidiasis. Bluish-white lesions can be seen on the mucous membranes of the oral cavity.
Patients at high risk for candidiasis include those on steroids or long-term antibiotic therapy.

DIF: Cognitive Level: Comprehension REF: p. 721 OBJ: 1

TOP: Oral Infections KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

12. When assisting with the admission of a new resident to a long-term care facility, a nurse notes
a current history of peptic ulcer disease. What type of pain should the nurse expect the
resident to describe?
a. Sharp
b. Dull
c. Burning
d. Stabbing

ANS: C
Some patients with gastric ulcers have no pain, but others experience a burning or cramping
pain 2 to 4 hours after meals.

DIF: Cognitive Level: Comprehension REF: p. 733 OBJ: 1

TOP: Peptic Ulcer KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

MULTIPLE RESPONSE
1. A nurse is caring for a patient with achalasia. What nursing actions should be implemented to
help the patient reduce swallowing difficulty? (Select all that apply.)
a. Identify foods that cause the problem.
b. Experiment with different eating positions.
c. Elevate the head of the bed at night.
d. Suggest eating more rapidly.
e. Offer small bites of fresh vegetables.

ANS: A, B, C
Eating rapidly and eating small bites increase swallowing difficulties.

DIF: Cognitive Level: Application REF: p. 724 OBJ: 1

TOP: Achalasia KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort