Esophageal and Gastric Varices

Here is an article and test about the varices that was mentioned in lecture tonight.
http://www.nursingcenter.com/prodev/ce_article.asp?tid=533184
I will put the answers under the comments. If you want to print any tests, print from the comments page and you will not have to cut, paste, etc. and you will also get the answers on the same page.

1.
Which medication should be administered to a patient with massive bleeding related to rupture of esophageal varices?
a. Propranolol (Inderal).
b. Warfarin sodium (Coumadin).
c. Epinephrine (Adrenalin).
d. Epoiten alpha (Eopgen).

2.
Which treatment modality is used when endoscopic sclerotherapy and banding for massive bleeding fails?
a. Saline gavage.
b. Tamponade.
c. Portosytemic shunt/transplant.
d. Intrahepatic ligation.

3.
The use of the Minnesota tube is contraindicated for a patient who has
a. active bleedning from gastric varices.
b. a tear at the esophagogastric junction.
c. a history of esophageal strictures.
d. gastric variceal hemorrhage.

4.
Which of these actions should you take prior to the insertion of the Minnesota tamponade tube in a patient who has severe encephalopathy and no pharyngeal reflex?
a. Perform a tracheostomy.
b. Hyper-oxygenate the patient.
c. Administer an osmotic diuretic.
d. Insert a cuffed endotracheal tube.

5.
When applying hemostats to the balloon ports, you should ensure that
a. the balloons have already been inflated.
b. the hemostats are attached to the thicker portion of the ports.
c. sterile water is slowly injected into the port after the hemostat is attached.
d. petroleum is used to keep the ports flexible.

6.
Which of these measures is used to reduce irritation during tube insertion?
a. A tongue depressor is used to keep the tongue off the midline.
b. A topical anesthetic is applied to the nares.
c. Mineral oil is liberally applied to the inner nostrils.
d. The nostrils are taped open to maximize the space for insertion.

7.
Which of these techniques is recommended to verify tube placement?
a. Inject 20 cc of sterile water and observe the abdomen for distention.
b. Place the end of the tube in a cup of water and look for bubbles.
c. Inject 60 cc of air and listen with a stethoscope for a whooshing sound.
d. Ask the patient to swallow and watch the throat for difficulty.

8.
A potential complication of the use of over-the-bed traction is
a. patient reports of headaches.
b. difficulty swallowing.
c. limited patient mobility.
d. migration of the tube.

9.
During balloon inflation you should measure the gastric balloon pressures
a. initially and when the insertion is completed.
b. at 20 cc increments between 20 and 100 cc.
c. if the patient appears to have difficulty breathing.
d. at 100 cc increments between 100 and 500 cc.

10.
When assessing the distance to the EG junction, a nurse measures a patient from the tip of the nose, to the ear lobe, to the tip of the xiphoid process. Which alteration should the nurse make if the tube is inserted orally?
a. add 10 cm.
b. subtract 5 cm.
c. the measurement is the same.
d. eliminate the distance to the ear lobe.

11.
Endotracheal intubation is recommended prior to the insertion of the Minnesota tube to
a. reduce the risk of infection for an immunocompromised patient.
b. attain adequate sedation for an alcoholic patient.
c. reduce the risk of arrhythmias for a cardiac patient.
d. attain adequate hydration for a renal patient.

12.
When performing nasogastric lavage to improve visualization during endoscopy, the patient should be
a. prone.
b. supine.
c. left, side-lying.
d. high Fowler’s.

13.
Which of these manifestations indicates tracheal placement of the Minnesota tube?
a. Dysphagia
b. Inability to speak
c. Orbital edema
d. Dyspnea

14.
To help prevent regurgitation of gastric blood, juice, and saliva
a. apply suction prior to the inflation of the gastric balloon.
b. immediately suction the gastric port.
c. raise the head of the bed.
d. tell the patient to swallow frequently.

15.
If a patient reports chest pain after the gastric balloon is inflated,
a. raise the head of the bed.
b. administer a PRN dose of nitroclycerin.
c. administer nasal oxygen.
d. deflate the balloon.