Question A 55-year-old male patient presents to the emergency department with acute onset of severe epigastric pain that radiates to the back, nausea, and vomiting. The patient’s lips are dry, and his skin turgor is poor. Which of the following conditions is most likely responsible for his symptoms?
A) Cholecystitis

B) Pancreatitis

C) Gastroesophageal reflux disease (GERD)

D) Peptic ulcer disease

E) Appendicitis
Rationale: The patient’s symptoms of severe epigastric pain radiating to the back, nausea, vomiting, and signs of dehydration (dry lips and poor skin turgor) are characteristic of pancreatitis. Pancreatitis often presents with acute, severe upper abdominal pain that can radiate to the back, accompanied by nausea and vomiting, which are results of the inflammation of the pancreas. Unlike cholecystitis or appendicitis, which typically present with right upper quadrant or right lower quadrant pain, respectively, pancreatitis is centered in the epigastric region. GERD and peptic ulcer disease can cause epigastric pain but are less likely to cause the severe back-radiating pain and the systemic signs of dehydration seen in pancreatitis. Correct Answer: B) Pancreatitis

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Question A 67-year-old woman with a history of chronic gastroesophageal reflux disease (GERD) is concerned about her risk for developing Barrett’s esophagus. Which of the following factors is most predictive of Barrett’s esophagus in patients with GERD?
A) Intermittent dyspepsia

B) Duration of GERD symptoms

C) Presence of a hiatal hernia

D) Use of proton pump inhibitors

E) Frequency of nocturnal reflux symptoms
Rationale: Among the options provided, the duration of GERD symptoms is most predictive of the development of Barrett’s esophagus. Barrett’s esophagus is a condition in which the esophageal lining changes, becoming more like the lining of the intestine, as a result of chronic exposure to stomach acid due to GERD. The longer a patient has had GERD, the greater the risk of developing Barrett’s esophagus, as the chronic acid exposure over time can lead to these cellular changes. While factors such as the presence of a hiatal hernia, use of proton pump inhibitors, and frequency of nocturnal reflux symptoms can influence the severity of GERD and its management, they do not directly predict the development of Barrett’s esophagus as strongly as the duration of GERD symptoms does.

Question A 45-year-old patient reports a 3-month history of dysphagia, particularly with solid foods, and occasional regurgitation of undigested food. The patient denies weight loss, but reports a sensation of food sticking in the mid-chest area. Which of the following is the most appropriate initial diagnostic test?
A) Barium swallow study

B) Upper endoscopy

C) 24-hour pH monitoring

D) Esophageal manometry

E) CT scan of the chest
Rationale: The patient’s symptoms of dysphagia (difficulty swallowing) particularly with solids and regurgitation of undigested food, without significant weight loss or severe pain, suggest a structural issue such as a stricture or ring. A barium swallow study is the most appropriate initial diagnostic test because it can visualize the esophagus and reveal abnormalities like strictures, rings, or other structural anomalies causing the dysphagia. Upper endoscopy is also useful, especially for direct visualization and biopsy, but a barium swallow is a less invasive and a good first step to identify the problem. Esophageal manometry and 24-hour pH monitoring are more specific for motility disorders and acid reflux disease, respectively, and a CT scan is not the first choice for investigating dysphagia without evidence of systemic disease or suspected malignancy. Correct Answer: A) Barium swallow study

Question A patient diagnosed with peptic ulcer disease (PUD) reports taking nonsteroidal anti-inflammatory drugs (NSAIDs) regularly for chronic knee pain. The nurse recognizes that the use of NSAIDs is associated with PUD due to which of the following mechanisms?
A) Stimulation of acid secretion in the stomach

B) Inhibition of prostaglandin synthesis

C) Increase of pyloric sphincter tone

D) Direct irritation of the gastric mucosa

E) Decrease in gastric mucosal blood flow
Correct Answer: B) Inhibition of prostaglandin synthesis
Rationale: NSAIDs contribute to the development of peptic ulcer disease through the inhibition of prostaglandin synthesis. Prostaglandins play a protective role in the gastric mucosa by stimulating the secretion of mucus and bicarbonate, promoting mucosal blood flow, and maintaining tight junctions between epithelial cells. By inhibiting prostaglandin synthesis, NSAIDs reduce these protective mechanisms, making the gastric and duodenal mucosa more susceptible to injury from gastric acid. This mechanism differs from direct irritation of the gastric mucosa or stimulation of acid secretion, making inhibition of prostaglandin synthesis the primary way through which NSAIDs increase the risk of PUD.

Question A 60-year-old man with a history of alcohol abuse presents with hematemesis. His vital signs are stable, and he has no signs of hypovolemic shock. Which of the following is the most likely diagnosis?
A) Esophageal varices

B) Acute gastritis

C) Peptic ulcer disease

D) Mallory-Weiss tear

E) Gastric cancer
Rationale: In a patient with a history of alcohol abuse presenting with hematemesis, esophageal varices are the most likely diagnosis. Esophageal varices are dilated submucosal veins in the esophagus that develop in patients with underlying portal hypertension, often due to chronic liver disease, such as that caused by alcohol abuse. These varices are prone to rupture, leading to bleeding that can manifest as hematemesis. While peptic ulcer disease, acute gastritis, Mallory-Weiss tear, and gastric cancer can also cause upper gastrointestinal bleeding, the history of alcohol abuse strongly points towards esophageal varices as the most likely cause. Correct Answer: A) Esophageal varices

Question A 50-year-old female patient presents with chronic, burning epigastric pain that improves with eating but worsens 2-3 hours after meals. She also reports nocturnal symptoms. Which of the following medications is most appropriate for the management of her condition?
A) Antacids

B) Proton pump inhibitors (PPIs)

C) H2 receptor antagonists

D) Sucralfate

E) Misoprostol
Rationale: The patient’s symptoms of chronic, burning epigastric pain that improves with eating but worsens 2-3 hours after meals and nocturnal symptoms are suggestive of peptic ulcer disease. Proton pump inhibitors (PPIs) are the most appropriate medication for this condition as they reduce gastric acid secretion more effectively than other options, promoting healing of the ulcer and relief of symptoms. PPIs are considered the first-line treatment for peptic ulcer disease due to their superior acid-suppressive effects compared to H2 receptor antagonists and their ability to promote healing in both gastric and duodenal ulcers. Antacids can provide symptomatic relief but do not promote ulcer healing to the extent PPIs do, while sucralfate and misoprostol have more specific uses and are not as effective as PPIs in the initial management of peptic ulcer disease. Correct Answer: B) Proton pump inhibitors (PPIs)

Question A 72-year-old patient presents with a one-week history of black, tarry stools and fatigue. Laboratory tests reveal iron deficiency anemia. Which of the following is the most likely source of this patient’s gastrointestinal bleeding?
A) Esophageal varices

B) Angiodysplasia

C) Gastric cancer

D) Duodenal ulcer

E) Colonic polyps
Rationale: The presence of black, tarry stools (melena) and iron deficiency anemia in this patient suggests a source of upper gastrointestinal bleeding. Duodenal ulcers are a common cause of upper gastrointestinal bleeding and can present with melena due to the slow bleeding of the ulcer, which allows the blood to be digested as it moves through the GI tract, turning the stool black and tarry. While esophageal varices, gastric cancer, and angiodysplasia can also cause upper GI bleeding, the presentation of iron deficiency anemia and melena is most characteristic of a bleeding peptic ulcer, such as a duodenal ulcer. Colonic polyps are more likely to cause lower GI bleeding, which typically presents as red or maroon-colored stools rather than melena. Correct Answer: D) Duodenal ulcer

Question A patient diagnosed with Zollinger-Ellison syndrome (ZES) is experiencing severe peptic ulcer disease that is resistant to standard treatments. Which of the following is the most effective treatment option for managing the gastric hypersecretion associated with ZES?
A) Antacids

B) Proton pump inhibitors (PPIs)

C) H2 receptor antagonists

D) Prostaglandin analogs

E) Bismuth subsalicylate
Rationale: Zollinger-Ellison syndrome (ZES) is characterized by gastric hypersecretion due to gastrin-secreting tumors (gastrinomas), leading to severe peptic ulcer disease. Proton pump inhibitors (PPIs) are the most effective treatment for managing the gastric hypersecretion associated with ZES. PPIs work by irreversibly blocking the hydrogen-potassium ATPase enzyme system on the gastric parietal cells, leading to a significant reduction in gastric acid secretion. This action makes PPIs superior in efficacy for conditions associated with excessive acid production, such as ZES, compared to other options like H2 receptor antagonists, antacids, prostaglandin analogs, and bismuth subsalicylate, which do not provide the same level of acid suppression. Correct Answer: B) Proton pump inhibitors (PPIs)

Question A 58-year-old patient with a history of chronic GERD presents with dysphagia, weight loss, and a sensation of food sticking in the throat. Which of the following conditions is the patient most likely developing?
A) Achalasia

B) Esophageal cancer

C) Esophageal stricture

D) Hiatal hernia

E) Barrett’s esophagus
Rationale: The patient’s history of chronic gastroesophageal reflux disease (GERD), combined with new symptoms of dysphagia, weight loss, and the sensation of food sticking in the throat, suggests the development of Barrett’s esophagus. Barrett’s esophagus is a condition where the normal esophageal lining changes to a type of intestinal lining, which occurs due to long-standing acid exposure from GERD. This condition can lead to dysphagia and an increased risk of esophageal adenocarcinoma. While esophageal cancer, esophageal stricture, achalasia, and hiatal hernia can cause similar symptoms, the patient’s chronic GERD and the specific combination of symptoms strongly point towards Barrett’s esophagus as the most likely diagnosis. Correct Answer: E) Barrett’s esophagus

Question A 33-year-old patient presents with acute onset of upper abdominal pain, nausea, and vomiting after consuming a large, fatty meal. The pain is localized to the right upper quadrant and radiates to the right shoulder. Which of the following is the most likely diagnosis?
A) Acute pancreatitis

B) Cholecystitis

C) Peptic ulcer disease

D) Appendicitis

E) Gastroenteritis
Rationale: The patient’s presentation of acute onset of upper abdominal pain following a fatty meal, localized to the right upper quadrant and radiating to the right shoulder, is characteristic of cholecystitis, an inflammation of the gallbladder. Fatty meals can trigger gallbladder contraction, exacerbating symptoms in the presence of gallstones or inflammation, leading to cholecystitis. Acute pancreatitis typically presents with epigastric pain radiating to the back, while peptic ulcer disease pain does not have a clear association with fatty meals. Appendicitis presents with lower abdominal pain, and gastroenteritis is typically associated with diarrhea, which is not mentioned in this case, making cholecystitis the most likely diagnosis. Correct Answer: B) Cholecystitis

GI Disorders

gERD causes and symptoms

Gastroesophageal reflux disease or GERD is a condition when stomach acid flows up into the esophagus. A common cause of this condition is decreased pressure of the lower esophageal sphincter, the muscle that prevents acid from flowing (reflux) up into the stomach. Symptoms of GERD include heartburn, nausea, epigastric pain, and cough.

Gastritis causes and symptoms

Gastritis occurs when there is inflammation of the stomach lining. It is caused by exposure to some medications that irritate the lining, alcohol use, stress, and some medications. Symptoms of gastritis include nausea, vomiting, bloating, and abdominal pain. If gastritis is untreated gastric ulcers and bleeding may develop.

peptic ulcer disease pathophysiology

Peptic ulcer disease occurs when an ulcer develops in the lining of the stomach or the first portion of the small intestine. Although less common, the esophagus may be affected as well. The causes of peptic ulcer disease include drugs such as non-steroidal anti-inflammatory medications, steroids, alcohol, and other medications, and infection with H. pylori bacteria. Symptoms include heartburn, nausea, epigastric pain, and abdominal pain. Food often makes gastric ulcers more symptomatic, although food may improve symptoms in patients with duodenal ulcers.

Dumping syndrome

Dumping syndrome occurs after a person has undergone stomach (gastric) surgery. It occurs when food passes too quickly from the stomach in the first part of the small intestine. The symptoms include nausea, sweating, dizziness, abdominal pain, and diarrhea. Symptoms usually resolve over time. but this may take many months depending on the severity of the condition. Dietary changes may help relieve the symptoms.

Hiatal hernia

A hiatal hernia occurs when a portion of the stomach moves up into the thorax. This may be due to the weakening of the diaphragm in that area. Some patients are symptomatic. Other patients have no symptoms. Patients may report heartburn, nausea, vomiting, and difficulty swallowing.

nursing care plan for cholecystitis

Cholecystitis is inflammation of the gallbladder. It may chronic or acute. Most cases are associated with gallstones and the gallbladder does not empty bile efficiently. The gallbladder may become inflamed and bacterial infection may occur. Symptoms include right upper abdominal pain, nausea, vomiting, fever, leukocytosis, and in severe cases jaundice. Patients are usually treated with a combination of antibiotics and surgery. Nursing considerations in these patients include NPO, antiemetics, pain control, and preoperative preparation for cholecystectomy.

nursing interventions for liver cirrhosis

Cirrhosis is a chronic condition of the liver characterized by fibrosis and scarring. The liver does not function properly in these patients, and this can be detected by abnormal liver function tests. In cirrhosis, the healthy liver is replaced by scar tissue, and this blocks the blood flow through the liver. In addition, this affects the liver’s ability to process nutrients, and drugs and manage toxins. One of the most common causes of liver cirrhosis is excessive alcohol use. Other causes include viral infection or hepatitis, autoimmune diseases, and exposure to toxins. Symptoms of cirrhosis include right upper abdominal tenderness, jaundice, edema, itching, nausea, and decreased appetite. Treatment includes modifying one’s behavior to reduce exposure to the cause of cirrhosis. If left untreated, cirrhosis worsens and may lead to liver failure. One option for patients with severe liver disease and liver failure is a transplant if a suitable donor is found. Patients with liver disease should be closely monitored. Some medications should be avoided in these patients or may be given with caution. Complications of cirrhosis include ascites, esophageal varices, portal hypertension, and bleeding due to coagulation defects.

nursing care plan for pancreatitis

Pancreatitis may be acute or chronic and is characterized by inflammation of the pancreas. Inflammation of the pancreas may be caused by excess alcohol consumption, gallstones, viral infection, and hyperlipidemia for example. Inflammation of the pancreas interferes with the organ’s ability to produce insulin and digestive enzymes. Symptoms of pancreatitis include abdominal pain, nausea, vomiting, fever, and leukocytosis. Patients may become very ill. If pancreatitis is not severe it may resolve with medical treatment. Treatment usually includes bowel rest or NPO and iv fluid hydration for a period of time. Long-term management may include changes in diet or lifestyle modifications. Serious cases may involve treatment with antibiotics and prolonged hospitalization. Surgery is usually not required but may be recommended if the pancreas becomes necrotic. Pancreatitis is painful and analgesia during hospitalization may involve IV mediation in addition to antiemetics and antipyretics. After acute pancreatitis has resolved, healthy habits should be adopted to prevent a recurrence.

celiac disease nursing interventions

Celiac disease is an autoimmune disease that results in the body’s inability to tolerate gluten in the diet. Symptoms of celiac disease include abdominal cramping and pain, bloating, diarrhea, and constipation. In some patients, symptoms are mild; however, symptoms may be severe and require patients to follow a strict gluten-free diet.

stomach cancer symptoms

Stomach cancer develops in the stomach. Symptoms of stomach cancer include abdominal pain, bleeding, nausea, weight loss, and bloating. Tumors may be slow growing and larger tumors are more symptomatic and may include a palpable mass (tumor). The treatment of stomach cancer, also called gastric cancer, depends on the tissue type and may include chemotherapy, radiation, and surgery.

NCLEX Style Questions

NCLEX GI Questions

how to prevent dumping syndrome

gastrectomy

Answers to NCLEX-style Questions

NCLEX Musculoskeletal Questions

1. B
To reduce dumping, patients will try to reduce the transit time that the food moves. Patients may recline or remain in low Fowler’s position for a period after eating. (A) and (C) may increase the symptoms of dumping syndrome.
2. D
Dumping may occur in patients who have had gastric surgery to remove a portion of the stomach. The food moves too quickly from the stomach into the intestine. Drinking between meals rather than during meals may reduce symptoms.
3. C
Low-fowler’s position reduces post-operative abdominal pain, back pain, and the risk of aspiration. It may be used post-procedure for these reasons.  Low-fowler’s position is often referred to as the “sitting” position.
4. D
Low-Fowler’s position reduces post-operative abdominal pain, back pain, and the risk of aspiration. Disadvantages of low Fowler’s positions include a decrease in venous return and an increased risk of venous embolism.
5. B
After gastrectomy, the nasogastric tube is used for decompression and to prevent post-operative ileus. Immediately after surgery, the new suture line is at risk for disruption.
6. A, B, C and D
Patients with gastroesophageal reflux disease are cautioned to avoid or eat certain foods sparingly that may worsen symptoms. These include A,B,C, and D. Some health care providers also counsel that fried foods and high fat foods should be avoided.
7. D
Esophagogastroduodenoscopy (EGD) is a procedure that uses a long scope with a light at the tip, inserted through the mouth to inspect the esophagus, stomach and duodenum. Biopsy can also be done with the EGD scope.
8. A, C and D
Upper GI series involves drinking a barium mixture and an x-ray to see the esophagus, stomach, and duodenum. It is not the preferred study to evaluate GERD, but it still has a role in some cases for evaluation. When combined with a “small bowel follow-through” it may be used to examine the small intestine.
9. B and D
After a barium study, the patient should be instructed todrink lots of fluids, eat foods high in fiber and take a laxative to encourage removal of the barium from the gastrointestinal tract.
10. A and D
Surgical procedures that involve gastric resection (removal of a portion of the stomach) and reconnection of the stomach to the small intestine may lead to postprandial low blood sugar and dumping. Symptoms include sweating, palpitations, abdominal pain and diarrhea.
11. B and D
Unlicensed assistive personnel (UAP) provide valuable patient care. Their responsibilities include documenting, and reporting, assisting with rehabilitative tasks, taking and recording vital signs, and observing patient activities.
12. C
Patients in the intensive care unit and patients who cannot provide self care require good oral care. The teeth should be brushed after every meal to maintain the dentition and gum health.
13. C
When you see “itis”, remember inflammation. Parotitis is painful inflammation of the parotid gland. This gland is located between the ear and the jaw. Patients at risk are those with lack of oral care or poor fluid intake.
14. A, B and D
Perforation is a risk of gastrointestinal endoscopic procedures. After the procedure, nurses and patients should be vigilant for an unexplained high temperature, even in the absence of abdominal pain.
15. A, C and D
Gastroesophageal reflux disease symptoms can be lessened with lifestyle changes such as  changing one’s diet and avoiding laying down immediately after eating. Weight loss may help, and one should avoid wearing constrictive clothing.
16. C and D
Heartburn is a burning pain and discomfort in the epigastric region and chest that occurs commonly with GERD and in some cases of hiatal hernia. Some patients with hiatal hernia have no symptoms. Hiatal hernia is a condition when a portion of the stomach pushes up through the diaphragm esophageal hiatus.
17. A, B and D
Jaundice is a condition with yellowing of the mucous membranes and skin. It is due to bilirubin pigment and may arise with liver disease or when there is a blockage of the bile duct. Blockages may be due to stones or tumors.
18. A
Bilirubin is a by product from the normal breakdown of red blood cells. (B) Lipid breakdown by lipase results in fatty acids. (C) Starch breakdown by amylase results in small sugars.
19. A
When you see “itis”, remember inflammation. Stomatitis is pain inflammation of the mouth and may be accompanied my sores and irritation that make it uncomfortable to drink or eat. Trauma and infection may cause stomatitis.
20. B, C and D
Perforation is a risk of peptic ulcer disease in patients with ulcers. If ulcers are untreated or worsen, perforation in the lining of the organ may occur.  Nurses and patients should be vigilant for high temperature and sharp upper abdominal pain in patients with PUD.
21. A, B, C, and D
Treatment of hiatal hernia includes all the choices listed: weight loss, medications and dietary restrictions and when these fail, surgery. Some patients with hiatal hernia have no symptoms. Medications used include proton pump inhibitors and antacids.
22. A, B and C
The treatment of GERD includes lifestyle changes and several medications , for example, H2 receptor antagonists (cimetidine, famotidine), proton pump inhibitors (omeprazole, pantoprazole) and antacids. (D) Pancrease is a medication that contains digestive enzymes to help breakdown food.
23. B, C and D
Cimetidine is prescribed orally in some cases to treat GERD. It is a histamine-2 receptor antagonists that works by reducing gastric acid secretion. (A) is incorrect. PPIs inhibit the parietal cell H+/K+ ATP pump.
24. B and D
Antacids may be used to relieve upset stomach and heartburn. Adverse effects of this medication, especially when taken in excess, include constipation, nausea, fecal impaction and electrolyte abnormalities.
25. D
Patients who have undergone gastrectomy will resume meals by starting with 6 or more small meals daily.  The food should be chewed well. It is recommended that protein is consumed with each meal and the patient should inform the health care provider if they begin to lose weight.

Can you answer the following questions?

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Question A 55-year-old male patient presents to the emergency department with acute onset of severe epigastric pain that radiates to the back, nausea, and vomiting. The patient’s lips are dry, and his skin turgor is poor. Which of the following conditions is most likely responsible for his symptoms?
A) Cholecystitis

B) Pancreatitis

C) Gastroesophageal reflux disease (GERD)

D) Peptic ulcer disease

E) Appendicitis
Rationale: The patient’s symptoms of severe epigastric pain radiating to the back, nausea, vomiting, and signs of dehydration (dry lips and poor skin turgor) are characteristic of pancreatitis. Pancreatitis often presents with acute, severe upper abdominal pain that can radiate to the back, accompanied by nausea and vomiting, which are results of the inflammation of the pancreas. Unlike cholecystitis or appendicitis, which typically present with right upper quadrant or right lower quadrant pain, respectively, pancreatitis is centered in the epigastric region. GERD and peptic ulcer disease can cause epigastric pain but are less likely to cause the severe back-radiating pain and the systemic signs of dehydration seen in pancreatitis. Correct Answer: B) Pancreatitis

POP QUIZ NCLEX Question

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4000+ Free NCLEX QUESTIONS. Go to QBankProAcademy.com FREE Qbank questions for NCLEX RN, PN, HESI Exit, Med Surg, AANP, ANCC, and HesiA2. Practice questions, quizzes, and listen to the Free Podcast. In this video, we review a question on INFECTION CONTROL in Nursing Care. Free nursing NCLEX 60-DAY CHALLENGE https://qbankpro.thinkific.com/courses/qbankpro-academy At QbankproAcademy.com our mission is to provide free QBanks, videos, and the most up to date test prep information for nurses. If you find our website helpful, please tell other aspiring nurses, nursing students, and professors. Please link to our site from your blogs, videos, and college websites, or share us on your favorite social media sites. Thank you for your support! nclex Nurses Nursing aanp qbank ancc hesi medsurg qbank

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Question A 67-year-old woman with a history of chronic gastroesophageal reflux disease (GERD) is concerned about her risk for developing Barrett’s esophagus. Which of the following factors is most predictive of Barrett’s esophagus in patients with GERD?
A) Intermittent dyspepsia

B) Duration of GERD symptoms

C) Presence of a hiatal hernia

D) Use of proton pump inhibitors

E) Frequency of nocturnal reflux symptoms
Rationale: Among the options provided, the duration of GERD symptoms is most predictive of the development of Barrett’s esophagus. Barrett’s esophagus is a condition in which the esophageal lining changes, becoming more like the lining of the intestine, as a result of chronic exposure to stomach acid due to GERD. The longer a patient has had GERD, the greater the risk of developing Barrett’s esophagus, as the chronic acid exposure over time can lead to these cellular changes. While factors such as the presence of a hiatal hernia, use of proton pump inhibitors, and frequency of nocturnal reflux symptoms can influence the severity of GERD and its management, they do not directly predict the development of Barrett’s esophagus as strongly as the duration of GERD symptoms does.

Question A 45-year-old patient reports a 3-month history of dysphagia, particularly with solid foods, and occasional regurgitation of undigested food. The patient denies weight loss, but reports a sensation of food sticking in the mid-chest area. Which of the following is the most appropriate initial diagnostic test?
A) Barium swallow study

B) Upper endoscopy

C) 24-hour pH monitoring

D) Esophageal manometry

E) CT scan of the chest
Rationale: The patient’s symptoms of dysphagia (difficulty swallowing) particularly with solids and regurgitation of undigested food, without significant weight loss or severe pain, suggest a structural issue such as a stricture or ring. A barium swallow study is the most appropriate initial diagnostic test because it can visualize the esophagus and reveal abnormalities like strictures, rings, or other structural anomalies causing the dysphagia. Upper endoscopy is also useful, especially for direct visualization and biopsy, but a barium swallow is a less invasive and a good first step to identify the problem. Esophageal manometry and 24-hour pH monitoring are more specific for motility disorders and acid reflux disease, respectively, and a CT scan is not the first choice for investigating dysphagia without evidence of systemic disease or suspected malignancy. Correct Answer: A) Barium swallow study

Question A patient diagnosed with peptic ulcer disease (PUD) reports taking nonsteroidal anti-inflammatory drugs (NSAIDs) regularly for chronic knee pain. The nurse recognizes that the use of NSAIDs is associated with PUD due to which of the following mechanisms?
A) Stimulation of acid secretion in the stomach

B) Inhibition of prostaglandin synthesis

C) Increase of pyloric sphincter tone

D) Direct irritation of the gastric mucosa

E) Decrease in gastric mucosal blood flow
Correct Answer: B) Inhibition of prostaglandin synthesis
Rationale: NSAIDs contribute to the development of peptic ulcer disease through the inhibition of prostaglandin synthesis. Prostaglandins play a protective role in the gastric mucosa by stimulating the secretion of mucus and bicarbonate, promoting mucosal blood flow, and maintaining tight junctions between epithelial cells. By inhibiting prostaglandin synthesis, NSAIDs reduce these protective mechanisms, making the gastric and duodenal mucosa more susceptible to injury from gastric acid. This mechanism differs from direct irritation of the gastric mucosa or stimulation of acid secretion, making inhibition of prostaglandin synthesis the primary way through which NSAIDs increase the risk of PUD.

Question A 60-year-old man with a history of alcohol abuse presents with hematemesis. His vital signs are stable, and he has no signs of hypovolemic shock. Which of the following is the most likely diagnosis?
A) Esophageal varices

B) Acute gastritis

C) Peptic ulcer disease

D) Mallory-Weiss tear

E) Gastric cancer
Rationale: In a patient with a history of alcohol abuse presenting with hematemesis, esophageal varices are the most likely diagnosis. Esophageal varices are dilated submucosal veins in the esophagus that develop in patients with underlying portal hypertension, often due to chronic liver disease, such as that caused by alcohol abuse. These varices are prone to rupture, leading to bleeding that can manifest as hematemesis. While peptic ulcer disease, acute gastritis, Mallory-Weiss tear, and gastric cancer can also cause upper gastrointestinal bleeding, the history of alcohol abuse strongly points towards esophageal varices as the most likely cause. Correct Answer: A) Esophageal varices

Question A 50-year-old female patient presents with chronic, burning epigastric pain that improves with eating but worsens 2-3 hours after meals. She also reports nocturnal symptoms. Which of the following medications is most appropriate for the management of her condition?
A) Antacids

B) Proton pump inhibitors (PPIs)

C) H2 receptor antagonists

D) Sucralfate

E) Misoprostol
Rationale: The patient’s symptoms of chronic, burning epigastric pain that improves with eating but worsens 2-3 hours after meals and nocturnal symptoms are suggestive of peptic ulcer disease. Proton pump inhibitors (PPIs) are the most appropriate medication for this condition as they reduce gastric acid secretion more effectively than other options, promoting healing of the ulcer and relief of symptoms. PPIs are considered the first-line treatment for peptic ulcer disease due to their superior acid-suppressive effects compared to H2 receptor antagonists and their ability to promote healing in both gastric and duodenal ulcers. Antacids can provide symptomatic relief but do not promote ulcer healing to the extent PPIs do, while sucralfate and misoprostol have more specific uses and are not as effective as PPIs in the initial management of peptic ulcer disease. Correct Answer: B) Proton pump inhibitors (PPIs)

Question A 72-year-old patient presents with a one-week history of black, tarry stools and fatigue. Laboratory tests reveal iron deficiency anemia. Which of the following is the most likely source of this patient’s gastrointestinal bleeding?
A) Esophageal varices

B) Angiodysplasia

C) Gastric cancer

D) Duodenal ulcer

E) Colonic polyps
Rationale: The presence of black, tarry stools (melena) and iron deficiency anemia in this patient suggests a source of upper gastrointestinal bleeding. Duodenal ulcers are a common cause of upper gastrointestinal bleeding and can present with melena due to the slow bleeding of the ulcer, which allows the blood to be digested as it moves through the GI tract, turning the stool black and tarry. While esophageal varices, gastric cancer, and angiodysplasia can also cause upper GI bleeding, the presentation of iron deficiency anemia and melena is most characteristic of a bleeding peptic ulcer, such as a duodenal ulcer. Colonic polyps are more likely to cause lower GI bleeding, which typically presents as red or maroon-colored stools rather than melena. Correct Answer: D) Duodenal ulcer

Question A patient diagnosed with Zollinger-Ellison syndrome (ZES) is experiencing severe peptic ulcer disease that is resistant to standard treatments. Which of the following is the most effective treatment option for managing the gastric hypersecretion associated with ZES?
A) Antacids

B) Proton pump inhibitors (PPIs)

C) H2 receptor antagonists

D) Prostaglandin analogs

E) Bismuth subsalicylate
Rationale: Zollinger-Ellison syndrome (ZES) is characterized by gastric hypersecretion due to gastrin-secreting tumors (gastrinomas), leading to severe peptic ulcer disease. Proton pump inhibitors (PPIs) are the most effective treatment for managing the gastric hypersecretion associated with ZES. PPIs work by irreversibly blocking the hydrogen-potassium ATPase enzyme system on the gastric parietal cells, leading to a significant reduction in gastric acid secretion. This action makes PPIs superior in efficacy for conditions associated with excessive acid production, such as ZES, compared to other options like H2 receptor antagonists, antacids, prostaglandin analogs, and bismuth subsalicylate, which do not provide the same level of acid suppression. Correct Answer: B) Proton pump inhibitors (PPIs)

Question A 58-year-old patient with a history of chronic GERD presents with dysphagia, weight loss, and a sensation of food sticking in the throat. Which of the following conditions is the patient most likely developing?
A) Achalasia

B) Esophageal cancer

C) Esophageal stricture

D) Hiatal hernia

E) Barrett’s esophagus
Rationale: The patient’s history of chronic gastroesophageal reflux disease (GERD), combined with new symptoms of dysphagia, weight loss, and the sensation of food sticking in the throat, suggests the development of Barrett’s esophagus. Barrett’s esophagus is a condition where the normal esophageal lining changes to a type of intestinal lining, which occurs due to long-standing acid exposure from GERD. This condition can lead to dysphagia and an increased risk of esophageal adenocarcinoma. While esophageal cancer, esophageal stricture, achalasia, and hiatal hernia can cause similar symptoms, the patient’s chronic GERD and the specific combination of symptoms strongly point towards Barrett’s esophagus as the most likely diagnosis. Correct Answer: E) Barrett’s esophagus

Question A 33-year-old patient presents with acute onset of upper abdominal pain, nausea, and vomiting after consuming a large, fatty meal. The pain is localized to the right upper quadrant and radiates to the right shoulder. Which of the following is the most likely diagnosis?
A) Acute pancreatitis

B) Cholecystitis

C) Peptic ulcer disease

D) Appendicitis

E) Gastroenteritis
Rationale: The patient’s presentation of acute onset of upper abdominal pain following a fatty meal, localized to the right upper quadrant and radiating to the right shoulder, is characteristic of cholecystitis, an inflammation of the gallbladder. Fatty meals can trigger gallbladder contraction, exacerbating symptoms in the presence of gallstones or inflammation, leading to cholecystitis. Acute pancreatitis typically presents with epigastric pain radiating to the back, while peptic ulcer disease pain does not have a clear association with fatty meals. Appendicitis presents with lower abdominal pain, and gastroenteritis is typically associated with diarrhea, which is not mentioned in this case, making cholecystitis the most likely diagnosis. Correct Answer: B) Cholecystitis

GI Disorders

gERD causes and symptoms

Gastroesophageal reflux disease or GERD is a condition when stomach acid flows up into the esophagus. A common cause of this condition is decreased pressure of the lower esophageal sphincter, the muscle that prevents acid from flowing (reflux) up into the stomach. Symptoms of GERD include heartburn, nausea, epigastric pain, and cough.

Gastritis causes and symptoms

Gastritis occurs when there is inflammation of the stomach lining. It is caused by exposure to some medications that irritate the lining, alcohol use, stress, and some medications. Symptoms of gastritis include nausea, vomiting, bloating, and abdominal pain. If gastritis is untreated gastric ulcers and bleeding may develop.

peptic ulcer disease pathophysiology

Peptic ulcer disease occurs when an ulcer develops in the lining of the stomach or the first portion of the small intestine. Although less common, the esophagus may be affected as well. The causes of peptic ulcer disease include drugs such as non-steroidal anti-inflammatory medications, steroids, alcohol, and other medications, and infection with H. pylori bacteria. Symptoms include heartburn, nausea, epigastric pain, and abdominal pain. Food often makes gastric ulcers more symptomatic, although food may improve symptoms in patients with duodenal ulcers.

Dumping syndrome

Dumping syndrome occurs after a person has undergone stomach (gastric) surgery. It occurs when food passes too quickly from the stomach in the first part of the small intestine. The symptoms include nausea, sweating, dizziness, abdominal pain, and diarrhea. Symptoms usually resolve over time. but this may take many months depending on the severity of the condition. Dietary changes may help relieve the symptoms.

Hiatal hernia

A hiatal hernia occurs when a portion of the stomach moves up into the thorax. This may be due to the weakening of the diaphragm in that area. Some patients are symptomatic. Other patients have no symptoms. Patients may report heartburn, nausea, vomiting, and difficulty swallowing.

nursing care plan for cholecystitis

Cholecystitis is inflammation of the gallbladder. It may chronic or acute. Most cases are associated with gallstones and the gallbladder does not empty bile efficiently. The gallbladder may become inflamed and bacterial infection may occur. Symptoms include right upper abdominal pain, nausea, vomiting, fever, leukocytosis, and in severe cases jaundice. Patients are usually treated with a combination of antibiotics and surgery. Nursing considerations in these patients include NPO, antiemetics, pain control, and preoperative preparation for cholecystectomy.

nursing interventions for liver cirrhosis

Cirrhosis is a chronic condition of the liver characterized by fibrosis and scarring. The liver does not function properly in these patients, and this can be detected by abnormal liver function tests. In cirrhosis, the healthy liver is replaced by scar tissue, and this blocks the blood flow through the liver. In addition, this affects the liver’s ability to process nutrients, and drugs and manage toxins. One of the most common causes of liver cirrhosis is excessive alcohol use. Other causes include viral infection or hepatitis, autoimmune diseases, and exposure to toxins. Symptoms of cirrhosis include right upper abdominal tenderness, jaundice, edema, itching, nausea, and decreased appetite. Treatment includes modifying one’s behavior to reduce exposure to the cause of cirrhosis. If left untreated, cirrhosis worsens and may lead to liver failure. One option for patients with severe liver disease and liver failure is a transplant if a suitable donor is found. Patients with liver disease should be closely monitored. Some medications should be avoided in these patients or may be given with caution. Complications of cirrhosis include ascites, esophageal varices, portal hypertension, and bleeding due to coagulation defects.

nursing care plan for pancreatitis

Pancreatitis may be acute or chronic and is characterized by inflammation of the pancreas. Inflammation of the pancreas may be caused by excess alcohol consumption, gallstones, viral infection, and hyperlipidemia for example. Inflammation of the pancreas interferes with the organ’s ability to produce insulin and digestive enzymes. Symptoms of pancreatitis include abdominal pain, nausea, vomiting, fever, and leukocytosis. Patients may become very ill. If pancreatitis is not severe it may resolve with medical treatment. Treatment usually includes bowel rest or NPO and iv fluid hydration for a period of time. Long-term management may include changes in diet or lifestyle modifications. Serious cases may involve treatment with antibiotics and prolonged hospitalization. Surgery is usually not required but may be recommended if the pancreas becomes necrotic. Pancreatitis is painful and analgesia during hospitalization may involve IV mediation in addition to antiemetics and antipyretics. After acute pancreatitis has resolved, healthy habits should be adopted to prevent a recurrence.

celiac disease nursing interventions

Celiac disease is an autoimmune disease that results in the body’s inability to tolerate gluten in the diet. Symptoms of celiac disease include abdominal cramping and pain, bloating, diarrhea, and constipation. In some patients, symptoms are mild; however, symptoms may be severe and require patients to follow a strict gluten-free diet.

stomach cancer symptoms

Stomach cancer develops in the stomach. Symptoms of stomach cancer include abdominal pain, bleeding, nausea, weight loss, and bloating. Tumors may be slow growing and larger tumors are more symptomatic and may include a palpable mass (tumor). The treatment of stomach cancer, also called gastric cancer, depends on the tissue type and may include chemotherapy, radiation, and surgery.

NCLEX Style Questions

NCLEX GI Questions

how to prevent dumping syndrome

gastrectomy

Answers to NCLEX-style Questions

NCLEX Musculoskeletal Questions

1. B
To reduce dumping, patients will try to reduce the transit time that the food moves. Patients may recline or remain in low Fowler’s position for a period after eating. (A) and (C) may increase the symptoms of dumping syndrome.
2. D
Dumping may occur in patients who have had gastric surgery to remove a portion of the stomach. The food moves too quickly from the stomach into the intestine. Drinking between meals rather than during meals may reduce symptoms.
3. C
Low-fowler’s position reduces post-operative abdominal pain, back pain, and the risk of aspiration. It may be used post-procedure for these reasons.  Low-fowler’s position is often referred to as the “sitting” position.
4. D
Low-Fowler’s position reduces post-operative abdominal pain, back pain, and the risk of aspiration. Disadvantages of low Fowler’s positions include a decrease in venous return and an increased risk of venous embolism.
5. B
After gastrectomy, the nasogastric tube is used for decompression and to prevent post-operative ileus. Immediately after surgery, the new suture line is at risk for disruption.
6. A, B, C and D
Patients with gastroesophageal reflux disease are cautioned to avoid or eat certain foods sparingly that may worsen symptoms. These include A,B,C, and D. Some health care providers also counsel that fried foods and high fat foods should be avoided.
7. D
Esophagogastroduodenoscopy (EGD) is a procedure that uses a long scope with a light at the tip, inserted through the mouth to inspect the esophagus, stomach and duodenum. Biopsy can also be done with the EGD scope.
8. A, C and D
Upper GI series involves drinking a barium mixture and an x-ray to see the esophagus, stomach, and duodenum. It is not the preferred study to evaluate GERD, but it still has a role in some cases for evaluation. When combined with a “small bowel follow-through” it may be used to examine the small intestine.
9. B and D
After a barium study, the patient should be instructed todrink lots of fluids, eat foods high in fiber and take a laxative to encourage removal of the barium from the gastrointestinal tract.
10. A and D
Surgical procedures that involve gastric resection (removal of a portion of the stomach) and reconnection of the stomach to the small intestine may lead to postprandial low blood sugar and dumping. Symptoms include sweating, palpitations, abdominal pain and diarrhea.
11. B and D
Unlicensed assistive personnel (UAP) provide valuable patient care. Their responsibilities include documenting, and reporting, assisting with rehabilitative tasks, taking and recording vital signs, and observing patient activities.
12. C
Patients in the intensive care unit and patients who cannot provide self care require good oral care. The teeth should be brushed after every meal to maintain the dentition and gum health.
13. C
When you see “itis”, remember inflammation. Parotitis is painful inflammation of the parotid gland. This gland is located between the ear and the jaw. Patients at risk are those with lack of oral care or poor fluid intake.
14. A, B and D
Perforation is a risk of gastrointestinal endoscopic procedures. After the procedure, nurses and patients should be vigilant for an unexplained high temperature, even in the absence of abdominal pain.
15. A, C and D
Gastroesophageal reflux disease symptoms can be lessened with lifestyle changes such as  changing one’s diet and avoiding laying down immediately after eating. Weight loss may help, and one should avoid wearing constrictive clothing.
16. C and D
Heartburn is a burning pain and discomfort in the epigastric region and chest that occurs commonly with GERD and in some cases of hiatal hernia. Some patients with hiatal hernia have no symptoms. Hiatal hernia is a condition when a portion of the stomach pushes up through the diaphragm esophageal hiatus.
17. A, B and D
Jaundice is a condition with yellowing of the mucous membranes and skin. It is due to bilirubin pigment and may arise with liver disease or when there is a blockage of the bile duct. Blockages may be due to stones or tumors.
18. A
Bilirubin is a by product from the normal breakdown of red blood cells. (B) Lipid breakdown by lipase results in fatty acids. (C) Starch breakdown by amylase results in small sugars.
19. A
When you see “itis”, remember inflammation. Stomatitis is pain inflammation of the mouth and may be accompanied my sores and irritation that make it uncomfortable to drink or eat. Trauma and infection may cause stomatitis.
20. B, C and D
Perforation is a risk of peptic ulcer disease in patients with ulcers. If ulcers are untreated or worsen, perforation in the lining of the organ may occur.  Nurses and patients should be vigilant for high temperature and sharp upper abdominal pain in patients with PUD.
21. A, B, C, and D
Treatment of hiatal hernia includes all the choices listed: weight loss, medications and dietary restrictions and when these fail, surgery. Some patients with hiatal hernia have no symptoms. Medications used include proton pump inhibitors and antacids.
22. A, B and C
The treatment of GERD includes lifestyle changes and several medications , for example, H2 receptor antagonists (cimetidine, famotidine), proton pump inhibitors (omeprazole, pantoprazole) and antacids. (D) Pancrease is a medication that contains digestive enzymes to help breakdown food.
23. B, C and D
Cimetidine is prescribed orally in some cases to treat GERD. It is a histamine-2 receptor antagonists that works by reducing gastric acid secretion. (A) is incorrect. PPIs inhibit the parietal cell H+/K+ ATP pump.
24. B and D
Antacids may be used to relieve upset stomach and heartburn. Adverse effects of this medication, especially when taken in excess, include constipation, nausea, fecal impaction and electrolyte abnormalities.
25. D
Patients who have undergone gastrectomy will resume meals by starting with 6 or more small meals daily.  The food should be chewed well. It is recommended that protein is consumed with each meal and the patient should inform the health care provider if they begin to lose weight.

Can you answer the following questions?