Ch. 41 Disorders of the Stomach
The nurse is conducting a health interview for a patient with suspected stomach cancer. Which questions are relevant in determining the diagnosis? Select all that apply. "Do you experience unexplained weight loss?" "Have you received blood transfusions in the past?" "Do you have other illnesses, such as liver cirrhosis?" "Do you have dyspepsia or intestinal gas discomfort?" "Do you have a religious preference that prohibits the use of blood?"
"Do you experience unexplained weight loss?" "Do you have dyspepsia or intestinal gas discomfort?" Patients with stomach cancer experience weight loss, dyspepsia, and intestinal gas discomfort. Asking the patient about blood transfusions in the past, whether the patient has illnesses like liver cirrhosis, and if the patient has a religious preference that prohibits the use of blood will help in the assessment of upper gastrointestinal bleeding and other conditions, but they are not specific to stomach cancer.
A patient presents with suspected upper gastrointestinal bleeding. Which questions are appropriate for the nurse to ask to assess the patient's cognitive-perceptual pattern? Select all that apply. "Do you have abdominal cramps?" "Do you experience any epigastric pain?" "Do you have a family history of bleeding?" "Do you experience weakness and fainting?" "Do you experience acute or chronic stress?"
"Do you have abdominal cramps?" "Do you experience any epigastric pain?" While assessing the effects of upper gastrointestinal bleeding on a patient's cognitive-perceptual pattern, the appropriate question to ask is whether the patient has experienced any abdominal cramps and epigastric pain. The answers help determine the effect on the nociceptor that sends signals to the brain and spinal cord. Asking the patient about his or her family history of bleeding will determine the past health history. Obtaining information from the patient about weakness and fainting will determine the activity exercise pattern. Asking the patient about any experience of acute or chronic stress will determine the patient's coping-stress tolerance pattern.
The nurse is providing instructions to a patient who has been treated for gastrointestinal bleeding and is planned for discharge. Which statement made by the patient indicates effective learning? "I should take low doses of aspirin." "I should take aspirin with omeprazole." "I should read the labels of over-the-counter drugs." "I should take the lansoprazole one hour after meals."
"I should take aspirin with omeprazole." Aspirin is a nonsteroidal antiinflammatory drug (NSAID) that reduces the prostaglandin lining of the stomach, leading to inflammation of gastric mucosa and bleeding. Therefore aspirin, taken along with proton pump inhibitors such as omeprazole and H 2 receptor blockers, can reduce the bleeding risk. Aspirin, even in the lowest dose, can cause gastrointestinal bleeding. Over-the-counter drugs contain aspirin and should not be taken because they increase the risk of bleeding. Lansoprazole is a proton pump inhibitor, which is taken before the meals to reduce the acid secretion in the stomach.
The nurse provides education to a group of student nurses about preoperative preparations for bowel surgery. Which statement made by a student nurse indicates the need for further teaching? "Administer enemas to cleanse the bowel." "Correct malnourishment in the patient prior to surgery." "Administer antibiotics to reduce the intestinal bacteria." "Transfuse packed red blood cells (RBC) to correct anemia."
"Transfuse packed red blood cells (RBC) to correct anemia." Transfusion of packed red blood cells (RBCs) to correct anemia is the preoperative preparation for stomach cancer, not bowel surgery. Administration of enemas for cleansing the bowel, correcting the malnourishment in the patient prior surgery, and administering antibiotics to reduce the intestinal bacteria are preoperative preparations for bowel surgery.
The nurse is teaching a group of high school students about the prevention of food poisoning. Which comment by the student shows understanding of foodborne illness protection? We like to mix up the ingredients so the flavors will meld before we cook our beef stew." "For a snack, I like to eat raw cookie dough from the package instead of baking the cookies." "When they gave me a pink hamburger, I sent it back and also asked for a new bun and clean plate." "We only have one cutting board, so we cut up our chicken and salad vegetables at the same time."
"When they gave me a pink hamburger, I sent it back and also asked for a new bun and clean plate." The student who did not accept the pink hamburger and asked for a new bun and clean plate understood that the pink meat may not have reached 160°F and could be contaminated with bacteria. Mixing ingredients and leaving them long enough for the flavors to meld, eating raw cookie dough from a refrigerated package, and only using one cutting board without washing it with hot soapy water between the chicken and salad vegetables could all lead to food poisoning from contamination.
The nurse reviews a patient's medication profile and identifies that which medication has a direct, irritating effect on the gastrointestinal (GI) tract? Sucralfate Alendronate Bethanechol Metoclopramide
Alendronate Alendronate has a direct, irritating effect that damages the mucosal barrier of the gastrointestinal (GI) tract. Sucralfate provides cryoprotection for the GI tract by forming a protective layer that serves as a barrier against acids, bile salts, and enzymes in the stomach. Bethanechol increases gastric emptying. Metoclopramide increases gastric motility and emptying.
Regurgitation is defined as what? A forceful expulsion of stomach contents without nausea A feeling of discomfort in the epigastrium with a conscious desire to vomit An effortless process in which partially digested food slowly comes up from the stomach Involuntary wavelike movements occurring within the alimentary canal that force contents onward
An effortless process in which partially digested food slowly comes up from the stomach An effortless process in which partially digested food slowly comes up from the stomach is the definition of regurgitation. A forceful expulsion of stomach contents without nausea is the definition of projectile vomiting. The feeling of discomfort in the epigastrium with a conscious desire to vomit is the definition of nausea. Involuntary wavelike movements occurring within the alimentary canal that force contents onward are defined as peristalsis.
The nurse suspects that a patient is experiencing upper gastrointestinal bleeding after undergoing endoscopic therapy. Which diagnostic test is best to confirm the nurse's suspicion? Biopsy Angiography Laparoscopy Endoscopic ultrasound
Angiography An angiography is used to diagnose upper gastrointestinal bleeding when the bleeding persists after endoscopy. During this procedure, a catheter is placed in the left gastric or superior mesenteric artery and is advanced until the source of the bleeding is discovered. A tissue biopsy and subsequent histologic examination are important to help diagnose stomach cancer. A laparoscopy is used to determine the peritoneal spread. An endoscopic ultrasound is used to stage the disease.
The patient with chronic gastritis is being put on a combination of medications to eradicate Helicobacter pylori. The nurse should know that which drugs probably will be used for this patient? Antibiotic(s), antacid, and corticosteroid Antibiotic(s), aspirin, and antiulcer/protectant Antibiotic(s), proton pump inhibitor, and bismuth Antibiotic(s) and nonsteroidal antiinflammatory drugs (NSAIDs)
Antibiotic(s), proton pump inhibitor, and bismuth To eradicate H. pylori, a combination of antibiotics, a proton pump inhibitor, and possibly bismuth (for quadruple therapy) will be used. Corticosteroids, aspirin, and NSAIDs are drugs that can cause gastritis and do not affect H. pylori. An antiulcer medication would not be effective in eradicating H. pylori.
Which medication causes gastritis? Aspirin Amoxicillin Lansoprazole Metronidazole
Aspirin Aspirin is a nonsteroidal antiinflammatory drug (NSAID) that causes gastritis by decreasing prostaglandin in the lining of the stomach. Amoxicillin is used in the treatment of H. pylori infections. Lansoprazole and metronidazole are used in the treatment of gastritis.
While reviewing the laboratory reports of a patient believed to have stomach cancer, the nurse finds that the patient has vitamin B 12 deficiency. Which does the nurse suspect in the patient? Hiatal hernia Bile reflux gastritis Autoimmune gastritis Gastroesophageal reflux disease (GERD)
Autoimmune gastritis Autoimmune gastritis is an inherited disorder that occurs due to loss of parietal cells, resulting in cobalamin (vitamin B 12) deficiency. Hiatal hernia is herniation of a portion of the stomach into the esophagus. It is caused by a weakening of muscles in the diaphragm. Factors that may predispose a patient to a hiatal hernia are pregnancy, ascites, tumors, and obesity. Bile reflux gastritis is a postoperative disorder of gastrectomy, which occurs due to bile reflux in to the stomach. Gastroesophageal reflux disease (GERD) occurs due to an incompetent lower esophageal sphincter (LES); it is characterized by heartburn.
A chronic smoker reports chest tightness, loss of appetite, feeling of fullness, and epigastric pain. The laboratory reports of the patient reveal low levels of chloride. Which is the most likely diagnosis for this patient? Stomach cancer Bile reflux gastritis Esophageal cancer Autoimmune gastritis
Autoimmune gastritis Chest tightness, loss of appetite, a feeling of fullness, and epigastric pain indicate gastritis. Low levels of chloride are observed in autoimmune gastritis. In autoimmune gastritis, there is a loss of parietal cells, leading to a fall in chloride levels. Chronic smoking also causes stomach cancer, but that is manifested by weight loss, anemia, weakness, dizziness, and supraclavicular lymph nodes. Esophageal cancer is also observed in chronic smokers, but that involves pain in the substernal, epigastric, or back area that radiates to the neck, jaws, ears, and shoulders. Bile reflux gastritis is a postoperative complication of gastrectomy, which is characterized by epigastric distress after meals.
The nurse is caring for a patient with variceal bleeding. Which procedure should be used for this patient? Gastrectomy Billroth I and II Radiation therapy Balloon tamponade
Balloon tamponade A balloon tamponade involves the insertion of balloons into the esophagus or stomach by endoscopy to alleviate refractory bleeding; this method should be used to treat a patient with variceal bleeding. Gastrectomy is a procedure involving the removal of the stomach, which is done in patients with stomach cancer if the lesion is located in the fundus. The Billroth I and II procedure is used for patients with stomach cancer to treat lesions located in the antrum or the pyloric region. Radiation therapy is a treatment option for patient with stomach cancer.
The nurse recognizes that which therapy is used to treat lesions in the pyloric region? Billroth I Chemotherapy Radiation therapy Total gastrectomy with esophagojejunostomy
Billroth I Lesions in the pyloric region can be treated with Billroth I surgery. Billroth I involves pylorus removal and anastomosis of the gastric stump to the duodenum and the jejunum. Chemotherapy and radiation therapy are used in tandem to reduce recurrence of cancer and decrease the tumor mass to provide temporary relief of obstruction. A total gastrectomy with esophagojejunostomy is used to treat lesions in the fundus.
Which pathophysiologic condition is associated with duodenal ulcers? Shock Sepsis Cirrhosis Large hiatal hernia
Cirrhosis Cirrhosis and pancreatitis are the pathophysiologic conditions associated with duodenal ulcers. Shock, sepsis, and large hiatal hernia are conditions that cause gastritis.
The nurse is caring for a patient with chronic gastritis. Which of these symptoms is associated specifically with this condition? Severe diarrhea Gastric hemorrhage Nausea and vomiting Cobalamin deficiency
Cobalamin deficiency In chronic gastritis the manifestations are similar to those described for acute gastritis. Patients with acute gastritis and chronic gastritis may experience nausea and vomiting or hemorrhage. However, with chronic gastritis, when the parietal cells are lost as a result of atrophy, the source of intrinsic factor is also lost. The loss of intrinsic factor, a substance essential for the absorption of cobalamin in the terminal ileum, ultimately results in cobalamin deficiency. With time, the body's storage of cobalamin in the liver becomes depleted, and a state of deficiency exists. Diarrhea is not associated with gastritis.
A patient experiences chronic gastritis with a loss of parietal cells due to atrophy. The nurse determines that the patient is at risk for a complication associated with the loss of the parietal cells. Which diagnostic test will assist in making this determination? Liver enzyme studies Complete blood count Secretin stimulation test Serum amylase determination
Complete blood count When parietal cells are lost because of atrophy, there is a loss of the source of intrinsic factor. This results in cobalamin deficiency, which leads to pernicious anemia. A complete blood count can indicate anemia from blood loss or loss of intrinsic factor. Liver enzyme studies are used to determine liver problems such as cirrhosis. A secretin stimulation test is used to differentiate patients with gastrinoma from those with hypergastrinemia. Serum amylase determination identifies pancreatic function.
During rounds, the nurse notes that a patient who had a total gastrectomy the day before has a very small amount of fluid draining from the nasogastric (NG) tube. What is the nurse's priority action? Increase the power on the suction device. Irrigate the NG tube with 50 mL of sterile saline. Notify the primary health care provider immediately. Continue to monitor the patient and NG tube drainage.
Continue to monitor the patient and NG tube drainage. After total gastrectomy, the NG tube does not drain a large quantity of secretions because removal of the stomach has eliminated the reservoir capacity. The nurse will only need to continue to monitor the patient and the NG tube drainage. Increasing the level of suction places the patient at higher risk for acid-base imbalance. Irrigating the NG tube is not necessary. The health care provider does not need to be notified, because this is a normal finding.
The nurse is preparing to administer a dose of octreotide to a patient who is experiencing an acute episode of upper gastrointestinal (GI) bleeding and is waiting for an endoscopy procedure. The nurse knows that the octreotide will have which mechanism of action? Select all that apply. Decreases blood flow to the GI tract Increases the production of mucus in the stomach Causes tissue edema and pressure on the source of bleeding Decreases hydrochloric acid secretion by decreasing the release of gastrin Causes vasoconstriction, reducing pressure in the portal circulation and stopping bleeding
Decreases blood flow to the GI tract Decreases hydrochloric acid secretion by decreasing the release of gastrin Octreotide is a somatostatin analog that works by reducing blood flow to the GI tract and reduces hydrochloric acid secretion by reducing the release of gastrin. Octreotide does not increase production of mucus in the stomach. Epinephrine, when injected during an endoscopy procedure, produces hemostasis by causing tissue edema and pressure on the source of bleeding. Vasopressin works by causing vasoconstriction, reducing pressure in the portal circulation and stopping the bleeding.
A patient undergoes gastrectomy. What should the nurse recommend to decrease the symptoms of dumping syndrome? Drinking no fluids with meals Remaining in a high Fowler's position after meals Increasing the carbohydrate intake with each meal Consuming a large amount of water with each meal
Drinking no fluids with meals Avoiding fluids with meals prevents dilution and liquefaction of food and thus slows the movement of food into the jejunum. Postgastrectomy patients are often instructed to eat "dry" meals. Remaining in a high Fowler's position after meals may increase the risk for dumping syndrome. A diet high in carbohydrates, especially simple carbohydrates, increases the risk of dumping syndrome. Taking fluids with meals causes stomach contents to empty more rapidly into the jejunum, resulting in dumping syndrome.
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, palpitations, and dizziness 15 to 30 minutes after eating? Malnutrition Bile reflux gastritis Dumping syndrome Postprandial hypoglycemia
Dumping syndrome After a Billroth I operation, dumping syndrome may occur 15 to 30 minutes after eating because of the hypertonic fluid going to the intestine and additional fluid being drawn into the bowel. Malnutrition may occur but does not cause these symptoms. Bile reflux gastritis cannot happen when the stomach has been removed. Postprandial hypoglycemia occurs with similar symptoms, but two hours after eating.
The nurse reviews the medical record of a patient and notes documentation of gastrointestinal (GI) bleeding from an ulceration. The nurse anticipates that which medication will be prescribed? Etoposide Octreotide Epinephrine Vasopressin
Epinephrine Epinephrine is used to treat gastrointestinal (GI) bleeding from ulceration by producing tissue edema, which results in pressure on the source of the bleeding. Etoposide is used in stomach cancer chemotherapy. Octreotide and vasopressin are used to treat upper gastrointestinal bleeding caused by esophageal varices.
The nurse is caring for a patient with upper gastrointestinal (GI) bleeding caused by acute hemostasis. Which medication is beneficial to this patient? Etoposide Octreotide Epinephrine Vasopressin
Epinephrine Injection therapy with epinephrine is used to treat gastrointestinal (GI) bleeding caused by acute hemostasis. Epinephrine causes tissue edema and pressure on the source of the bleeding. Etoposide is used in the chemotherapy of stomach cancer. Octreotide and vasopressin are used to treat upper GI bleeding caused by esophageal varices.
A patient presents with complaints of abdominal cramping and diarrhea, which initially was watery but is now bloody. Symptoms began three days ago after eating out with friends. You suspect the patient is experiencing which infection? Botulism Clostridial Staphylococcal toxin Escherichia coli O157:H7 infection
Escherichia coli O157:H7 infection The clinical manifestations of E. coli O157:H7 include diarrhea (often bloody) and abdominal cramping pain for two to eight days (average three to four days) after swallowing the organism. The diarrhea may start out as watery but may progress to bloody. Staphylococcal toxin has a 30 minute to seven-hour onset with nausea, abdominal cramping, and diarrhea as its clinical manifestations. Botulism has an onset of 12 to 36 hours with clinical manifestations of nausea, vomiting, abdominal pain, constipation, distention, and central nervous system alterations. Clostridial has an 8- to 24-hour onset with diarrhea, nausea, abdominal cramping, vomiting (rare), and midepigastric pain as clinical manifestations.
Assessment findings of a patient include a reflux of bile and pancreatic secretions and clinical manifestations of shock. The nurse suspects which diagnosis? Gastritis Achalasia Stomach cancer Upper gastrointestinal bleeding
Gastritis Burns, reflux of bile and pancreatic secretions, and shock are the clinical manifestations of gastritis. Achalasia is characterized by substernal chest pain, dysphasia, and nocturnal regurgitation. Early satiety, abdominal pain, and weight loss are the clinical manifestations of stomach cancer. Bloody vomitus and black, tarry stools are manifestations of upper gastrointestinal bleeding.
A patient presents with burning pain in the epigastrium accompanied by nausea. On interviewing the patient, the nurse finds that the patient has been taking nonsteroidal antiinflammatory drugs (NSAIDs) on a regular basis to relieve headaches. Which condition should the nurse suspect? Gastritis Achalasia Esophagitis Gastroesophageal reflux disease (GERD)
Gastritis Gastritis occurs as the result of a breakdown in the normal gastric mucosal barrier. NSAIDs inhibit the synthesis of prostaglandins that are protective to the gastric mucosa and thus cause gastritis. Symptoms of gastritis include anorexia, nausea and vomiting, epigastric tenderness, and a feeling of fullness. Esophagitis is usually a complication of GERD. GERD is caused by alterations in pressure in the lower esophageal sphincter, and NSAIDs do not cause these pressure changes. Achalasia is a rare disease with unknown etiology and involves absence of peristalsis of the lower two thirds of the esophagus.
A 65-year-old female patient who has been on warfarin for five years reports nausea, episodes of vomiting, and pain in the abdomen upon palpation. What could be the reason for the patient's condition? Gastritis Oral cancer Stomach cancer Peptic ulcer disease
Gastritis Nausea, vomiting, and abdominal pain are the characteristics of gastritis. Warfarin is an anticoagulant, which causes gastritis by increasing the risk of bleeding. Oral cancer is characterized by sore throat, sore mouth, and voice changes. Stomach cancer involves weight loss, anemia, weakness, dizziness, and supraclavicular lymph nodes. Peptic ulcer disease includes ulcers; this is characterized by experiencing burning pains in the abdomen after eating.
Which laboratory test is beneficial for diagnosing the presence of a small amount of blood in gastric secretions and stools? Guaiac test Liver enzyme studies Complete blood count (CBC) Serum amylase determination
Guaiac test Small amounts of blood in gastric secretions and stools indicate occult blood, and the guaiac test is used to detect traces of blood in the feces. Liver enzyme studies are performed to detect any liver problems. A complete blood count (CBC) test is used to detect anemia, which is secondary to ulcer bleeding. Serum amylase determination helps to determine pancreatic function.
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 orally. The nurse should evaluate its effectiveness by questioning the patient as to whether which symptom has resolved? Diarrhea Heartburn Constipation Lower abdominal pain
Heartburn Mylanta is an antacid that contains both aluminum and magnesium. It is indicated for the relief of gastrointestinal discomfort, such as with heartburn associated with GERD. Mylanta can cause both diarrhea and constipation as a side effect. Mylanta does not affect lower abdominal pain.
The patient has a prescription for rabeprazole. The nurse would assess the effectiveness of the medication by noting whether the patient obtained relief from which symptom? Heartburn Flatulence Constipation Abdominal pain
Heartburn Rabeprazole is a proton pump inhibitor that provides relief of gastric discomfort and heartburn by neutralizing gastric acid. This medication would not be effective in the treatment of abdominal pain, flatulence, or constipation.
Linked to stomach cancer and non-Hodgkin's lymphoma, what is a common cause of gastritis? Syphilis Cytomegalovirus Helicobacter pylori Mycobacterium species
Helicobacter pylori H. pylori infection is highest in underdeveloped countries and in people of low socioeconomic status. Infection likely occurs during childhood with transmission from family members to the child, possibly through a fecal-oral or oral-oral route. Syphilis, cytomegalovirus, and Mycobacterium species also are causes of chronic gastritis, but they are not as common as H. pylori.
Which microorganism causes gastritis? Streptococcus Fusiform bacteria Candida albicans Helicobacter pylori
Helicobacter pylori H. pylori is a leading bacterial cause of gastritis. Streptococcus causes pharyngitis, cellulitis, and Scarlet fever. Candida albicans causes oral candidiasis. Fusiform bacteria cause Vincent's infection.
A patient presents with upper gastrointestinal (GI) bleeding. During the patient's assessment, the nurse notes coffee ground vomitus. How should the nurse classify the finding? Melena Hematemesis Occult bleeding Mallory-Weiss tear
Hematemesis Coffee ground vomitus indicates that blood has been in the stomach for some time, which is a manifestation of hematemesis (a type of upper gastrointestinal bleeding). Melena is characterized by black, tarry stools caused by digestion of blood in the gastrointestinal (GI) tract. Occult bleeding requires a guaiac test for detection. A Mallory-Weiss tear indicates esophageal bleeding.
A gastrectomy is performed on a patient with upper gastrointestinal bleeding. While assessing the patient postoperatively, the nurse suspects a leak at the anastomosis site. Which findings support the nurse's suspicion? Select all that apply. Increased dyspnea Nausea and vomiting Recurrence of bleeding Sweating and vivid hallucinations Elevation in the body temperature
Increased dyspnea Elevation in the body temperature Increased dyspnea and an elevated body temperature indicate that there is a leak at the anastomosis site. Nausea, vomiting, and recurrence of bleeding are observed when the patient is given oral nourishment. Sweating and vivid hallucinations are observed when the hemorrhage is caused by chronic alcohol abuse.
After assessing a patient with gastrointestinal bleeding, the nurse suspects shock in the patient. Which findings in the patient support the nurse's conclusion? Select all that apply. Dry skin Increased thirst Rapid, weak pulse High blood pressure Increased temperature
Increased thirst Rapid, weak pulse Shock is a life-threatening condition involving low blood perfusion to the tissues. The circulatory volume is reduced during shock, resulting in the release of antidiuretic hormone (ADH). This helps to increase the renal reabsorption, thereby increasing the blood volume. As a result, thirst is increased. The patient has a rapid, weak pulse due to a low oxygen supply to the tissues. The patient with shock has clammy skin, low blood pressure, and a temperature lower than the normal body temperature.
The nurse is caring for a patient with anorexia, nausea, vomiting, epigastric pain, and feeling of fullness. Which interventions are beneficial to the patient? Select all that apply. Inserting a nasogastric tube Administering intravenous fluids Maintaining the patient on nothing-by-mouth (NPO) status Educating the patient that fainting may occur due to cimetidine Providing the patient with nonirritating diet consisting of six small feedings a day
Inserting a nasogastric tube Administering intravenous fluids Maintaining the patient on nothing-by-mouth (NPO) status Anorexia, nausea, vomiting, epigastric pain, and a feeling of fullness are the symptoms of acute gastritis. Therefore a nasogastric tube should be inserted to irrigate the precipitating agent from the stomach, to monitor bleeding, and to keep the stomach free from noxious smell. Administration of intravenous fluids may compensate for fluid loss in patients due to vomiting. The patient with acute gastritis should be kept on nothing-by-mouth (NPO) status to prevent vomiting. Drug therapy for gastritis includes H 2 receptor blockers (ranitidine, cimetidine) and proton pump inhibitors (lansoprazole, omeprazole). The nurse should inform the patient about the therapeutic effects of the medications. Cimetidine is an H 2 receptor blocker that causes headache, abdominal pain, constipation, and diarrhea; it is not associated with fainting. Providing a nonirritating diet consisting of six small feedings per day is helpful for patients with chronic gastritis.
A patient underwent abdominal surgery four days ago and has sutures in the upper epigastric region. Which is the most appropriate initial nursing intervention to prevent pulmonary complications? Administer steam inhalation. Encourage early ambulation. Administer bronchodilator drugs. Instruct the patient to splint the incision site with a pillow while coughing.
Instruct the patient to splint the incision site with a pillow while coughing. Splinting the incision site with a pillow reduces the pain during coughing and deep breathing and should be taught first. Steam inhalation and bronchodilator drugs also prevent pulmonary complications but are more useful if the patient is not able to remove pulmonary secretions by himself. Early ambulation is also a measure to prevent pulmonary complications but is not applicable in the early phase of care.
Which diagnostic or surgical procedure can best determine the spread of stomach cancer to the peritoneum? Biopsy Ultrasound Laparoscopy Computed tomography (CT)
Laparoscopy A laparoscopy can determine the spread of cancer to the peritoneum. A biopsy of the tissue and subsequent histologic examination are important for the diagnosis of stomach cancer. Ultrasound and CT studies are used to stage the disease.
A patient is experiencing persistent vomiting with emesis consisting of contents from the small intestine. Which alteration in blood gas will the nurse expect to occur? Metabolic alkalosis Metabolic acidosis Respiratory alkalosis Respiratory acidosis
Metabolic acidosis Metabolic acidosis occurs when contents of the small intestine are vomited because of the loss of sodium bicarbonate. Metabolic alkalosis occurs when there is a loss of gastric hydrochloric (HCL) acid. Sodium bicarbonate is secreted by the pancreas into the small intestines. The respiratory alkalosis or respiratory acidosis that would occur in the presence of the metabolic states would be a compensatory response.
Several patients are seen at an urgent care center with symptoms of nausea, vomiting, and diarrhea that began two hours ago while attending an office picnic. The nurse will question the patients about foods they ate that included which of these? Select all that apply. Milk products Fried chicken Salad dressings Cream-filled pastries Home-preserved vegetables.
Milk products Salad dressings Cream-filled pastries Staphylococcus aureus toxins provoke the onset of symptoms (e.g., vomiting, nausea, abdominal cramping, and diarrhea) within 30 minutes and up to seven hours. Meat, bakery products, cream fillings, salad dressings, and milk are the usual sources from the skin and respiratory tract of food handlers. Fried chicken and home-preserved vegetables are not correct answers; other foodborne illnesses become evident after eight hours.
A patient presents with uterine cramping, abdominal cramping, and diarrhea. The patient takes a medication for treatment of peptic ulcer disease. The nurse identifies that which medication is the likely cause of the patient's symptoms? Misoprostol Bethanechol Esomeprazole Metoclopramide
Misoprostol Uterine cramping, abdominal cramping, and diarrhea are side effects of misoprostol. Bethanechol's side effects include lightheadedness, syncope, and diarrhea. Side effects of esomeprazole are headaches, abdominal pain, and flatulence. Metoclopramide has central nervous system side effects such as anxiety and hallucinations.
The nurse reviews the rates of stomach cancer in ethnic groups. Of the four groups that the nurse reviewed, which one has the lowest rate? Hispanics Pacific Islanders Asian Americans Non-Hispanic whites
Non-Hispanic whites Non-Hispanic whites are reported to have a lower rate of stomach cancer. Hispanics, Pacific Islanders, and Asian Americans have higher rates of stomach cancer than non-Hispanic whites.
The nurse identifies that a patient is at risk for upper gastrointestinal bleeding based on the patient's history of taking medications in what drug class? Antacids Anticholinergics Tricyclic antidepressants Nonsteroidal antiinflammatory drugs (NSAIDs)
Nonsteroidal antiinflammatory drugs (NSAIDs) Nonsteroidal antiinflammatory drugs (NSAIDs) may disrupt the production of prostaglandins, which are required for the protection of the stomach's mucosal lining, and result in upper gastrointestinal bleeding. Antacids are used as an adjunct therapy for the treatment of peptic ulcers. Anticholinergic drugs are used occasionally to treat peptic ulcer disease. Tricyclic antidepressants are used to reduce gastric acid secretions associated with peptic ulcer disease.
A nurse on an inpatient medical-surgical unit is taking care of a patient with acute gastritis. The patient has a nasogastric tube (NGT) to low-intermittent suction with bilious aspirate. Upon reassessment, the nurse finds the aspirate to have become blood-tinged. What should the nurse do next? Page the physician. Assess the patient's pain. Obtain a set of vital signs. Record the information in the patient's record.
Obtain a set of vital signs. Vital sign changes coupled with sudden changes of nasogastric aspirate from bilious to bloody can signal a life-threatening situation; hemorrhage is a common adverse event that can occur with acute gastritis. Both hypotension and tachycardia are signs and symptoms of shock and should be assessed quickly in this instance. The physician should be called but only once the vital signs have been assessed. A patient may have alterations in his or her pain with acute hemorrhage, but assessing for life-threatening changes must take priority. This information should be recorded in the patient's chart once the patient's safety is ensured.
The nurse is caring for a patient who is diagnosed with gastrointestinal (GI) bleeding. Diagnostic test results indicate a Mallory-Weiss tear. The nurse anticipates that which medication will be prescribed? Cisplatin Octreotide Oxaliplatin Epinephrine
Octreotide A Mallory-Weiss tear indicates a tear in the mucous membrane where the esophagus meets the stomach; this results in upper gastrointestinal (GI) bleeding. Octreotide is used to treat this bleeding by decreasing blood flow to the GI tract. Cisplatin is used to treat stomach cancer. Injection therapy with epinephrine is used to treat GI bleeding caused by ulceration. Oxaliplatin is used to treat stomach cancer.
The nurse is caring for a patient who is diagnosed with upper gastrointestinal (GI) bleeding. The patient's medical history indicates that the bleeding is due to preexisting liver cirrhosis. Which medications will best help the patient? Select all that apply. Cisplatin Octreotide Oxaliplatin Epinephrine Vasopressin
Octreotide Vasopressin Patients with liver cirrhosis are at risk of developing gastrointestinal (GI) bleeding from esophageal varices. Octreotide and vasopressin are used to treat upper GI bleeding caused by esophageal varices. Octreotide decreases the blood flow to the GI tract, and vasopressin decreases pressure in portal circulation and stops GI bleeding. Cisplatin and oxaliplatin are chemotherapy drugs used to treat stomach cancer. Injection therapy with epinephrine is used to treat GI bleeding caused by ulceration.
The nurse provides information to a student nurse about appropriate goals for patients with upper gastrointestinal bleeding. The identification of which goals by the student nurse indicates the need for further teaching? Select all that apply. Hemodynamic stability Optimal nutritional status Decreased hemoglobin level Minimal symptoms of pain or anxiety Absence of gastrointestinal bleeding
Optimal nutritional status Decreased hemoglobin level The initial hemoglobin in patients with acute upper GI bleeding will often be at the patient's baseline because the patient is losing whole blood. With time (typically after 24 hours or more) the hemoglobin will decline as the blood is diluted by the influx of extravascular fluid into the vascular space and by fluid administered during resuscitation. Decreased hemoglobin is not an appropriate goal. Optimal nutritional status is a goal for patients with stomach cancer. The goals for patients with upper gastrointestinal bleeding include no gastrointestinal bleeding, a return to a normal hemodynamic state, and minimization of pain or anxiety.
A registered nurse is evaluating the medication charts of four patients that have been prepared by a student nurse. Which patient's medication chart needs correction? Patient 1 Patient 2 Patient 3 Patient 4
Pt 1 Gastritis is an inflammation of the gastric mucosa due to breakdown of the gastric mucosal barrier. It may be caused by Helicobacter pylori infection. Drug therapy for this includes proton pump inhibitors (PPIs) such as omeprazole, lansoprazole, and esomeprazole and histamine (H₂) blockers such as cimetidine, famotidine, and ranitidine. Therefore the medication chart for patient 1 needs correction. Isosorbide dinitrate is a nitrate derivative used in the treatment of achalasia, a condition seen in patient 2. Achalasia is the loss of peristalsis in the lower esophagus. Calcium channel blockers such as nifedipine are also used to treat achalasia. A corticosteroid, such as prednisone, is effectively used in the treatment of eosinophilic esophagitis, which is used to treat patient 3. Omeprazole is used in the treatment of gastric esophageal reflux disease; this is seen in patient 4.
The nurse identifies that a patient is at risk for upper gastrointestinal bleeding based on the patient's history of what? Hiatal hernia Renal failure Pernicious anemia Pancreatic disease
Renal failure Renal failure causes disturbances in the serum gastrin levels, resulting in abnormal mucosal barriers in the gastrointestinal tract and gastric acid secretion. These symptoms cause upper gastrointestinal bleeding. Hiatal hernia causes gastritis. Pernicious anemia causes stomach cancer. Pancreatic disease is the predisposing factor of duodenal ulcers.
A patient reports abdominal pain, weight loss, indigestion, and a feeling of fullness in stomach. Diagnostic test results indicate atrophic gastritis. Based on the assessment findings, the nurse suspects which diagnosis? Achalasia Gastric ulcer Stomach cancer Upper gastrointestinal bleeding
Stomach cancer A patient with atrophic gastritis has an increased risk of developing stomach cancer, which is characterized by abdominal pain, weight loss, indigestion, and feeling of fullness in the stomach. Achalasia is characterized by substernal chest pain, dysphasia, and nocturnal regurgitation. A gastric ulcer has symptoms of burning or gaseous pain in the epigastric region one to two hours after eating a meal. Clinical manifestations of upper gastrointestinal bleeding include hematemesis, melena, and occult bleeding.
The nurse is caring for a patient with atrophic gastritis who has a cyanocobalamin deficiency. The nurse suspects what diagnosis? Gastric ulcer Stomach cancer Nonsteroidal-induced gastritis Upper gastrointestinal bleeding
Stomach cancer Patients with atrophic gastritis will lose parietal cells because of atrophy, which causes pernicious anemia and stomach cancer. Gastric ulcers are caused by risk factors such as bile reflux, smoking, and alcohol abuse. Patients with a history of ulcer disease who use ulcerogenic drugs and anticoagulants tend to develop nonsteroidal-induced gastritis. Upper gastrointestinal bleeding is caused by drug-induced bleeding, esophageal bleeding, and systemic diseases.
To prevent the recurrence of gastritis, what instruction should the nurse provide to the patient? Take acetaminophen and ibuprofen for pain. Stop smoking and do not consume alcoholic beverages. Consume a soft diet with moderate spices and seasonings. Stop smoking and consume alcoholic beverages in moderation.
Stop smoking and do not consume alcoholic beverages. Lifestyle modifications to prevent the recurrence of gastritis include refraining from consuming alcohol and cigarette smoking. Alcohol directly irritates the gastric mucosa, and nicotine from cigarette smoke inhibits neutralization of gastric acid. A bland diet (reduced spices and seasonings) is recommended to prevent the recurrence of gastritis. Alcohol should be eliminated from the diet, not merely reduced. Advising the patient to take acetaminophen and ibuprofen (Motrin) is incorrect because ibuprofen should not be taken by the gastritis patient.
A patient presents with severe abdominal burns. Diagnostic tests reveal a discrete, deep ulcer in the fundus of the stomach. The nurse expects that the patient will be diagnosed with what? Gastric ulcer Duodenal ulcer Stomach cancer Stress-related mucosal disease (SRMD)
Stress-related mucosal disease (SRMD) Diffuse superficial mucosal injury or discrete deeper ulcers in the fundus and body portions of the stomach indicate stress-related mucosal disease (SRMD), which may occur as a complication of major trauma or burns. Gastric ulcers are characterized by burning or gaseous pain in the epigastric region. Duodenal ulcers are characterized by burning or cramplike pain in midepigastric region. Stomach cancer is characterized by early satiety, abdominal pain, and weight loss.
The nurse reviews a patient's medical record and notes a history of traumatic injuries as a result of a car fire that occurred one month prior to the current admission. The nurse recognizes that the patient is at risk for which condition? Gastritis Duodenal ulcer Stomach cancer Stress-related mucosal disease (SRMD)
Stress-related mucosal disease (SRMD) Severe trauma and burns can lead to stress-related mucosal disease (SRMD). Burns cause hypersecretion of gastric acid and mucosal damage, resulting in SRMD. Shock, renal failure, and hiatal hernia are the risk factors for gastritis. Duodenal ulcers are caused by chronic obstructive pulmonary disease, pancreatic disease, and chronic renal failure. Atrophic gastritis, pernicious anemia, and adenomatous polyps cause stomach cancer.
A patient presents with suspected gastric carcinoma. The nurse anticipates that which diagnostic test will be prescribed? Radiology Tissue biopsy Rapid urease testing Endoscopic ultrasound
Tissue biopsy A tissue biopsy involves examining tissue removed from the stomach to detect gastric carcinoma. Radiology is not the best method because superficial mucosa is generally involved and changes will not show up clearly on x-ray examination. Rapid urease testing is used to detect the presence of urease in Helicobacter pylori infections. An endoscopic ultrasound is used to stage the disease of stomach cancer.
The nurse identifies that radiation therapy is used concurrently with chemotherapy for cancer treatment for what reason? To stage the disease To examine histology To reduce tumor mass To determine peritoneal spread
To reduce tumor mass Radiation therapy is concurrently used with chemotherapy to reduce recurrence and as a palliative measure to decrease tumor mass. This combination therapy provides temporary relief of obstruction. Endoscopic ultrasounds and computed tomography are used to stage the disease. Biopsies are used to perform a histologic examination. Peritoneal spread of cancer is determined by laparoscopy.
A patient with stomach cancer presents with weight loss, dumping syndrome, and impaired wound healing. The nurse suspects that which surgical treatment may have caused the patient's symptoms? Pyloroplasty Total gastrectomy Partial gastrectomy Esophagojejunostomy
Total gastrectomy Weight loss, dumping syndrome, and impaired wound healing are all consequences of a total gastrectomy. Total gastrectomy involves the resection of the lower esophagus, removal of the entire stomach, and anastomosis of the esophagus to the jejunum. Pyloroplasty consists of surgical enlargement of the pyloric sphincter to facilitate the easy passage of contents from the stomach. Partial gastrectomy involves the removal of two-thirds of the stomach and anastomosis of the gastric stump to the duodenum or jejunum. Esophagojejunostomy is the anastomosis of the esophagus with the jejunum.
What is the mechanism of action of vasopressin, a peptide hormone formed in the hypothalamus? Tissue edema Vasoconstriction Decreased hydrochloric acid secretion Decreased esophageal and gastric mucosal irritation
Vasoconstriction Vasopressin causes vasoconstriction, which decreases pressure in the portal circulation and stops bleeding. Epinephrine causes tissue edema and pressure on the source of bleeding. Octreotide decreases hydrochloric acid by decreasing the release of gastrin. Histamine blockers decrease esophageal and gastric mucosal irritation.
A patient presents to the ambulatory clinic complaining of "stomach upset" that has occurred intermittently for the past several months. The patient does not want an invasive workup and would prefer to avoid medication therapy. Working with the patient, which goals would the nurse discuss and document in the care plan? Select all that apply. Weight reduction by 15 lb Smoking cessation within the next 60 days Avoiding caffeinated and alcoholic beverages Exercise three times a week for 30 minutes or more Increase of fruit consumption with citrus and tomato-based products daily
Weight reduction by 15 lb Smoking cessation within the next 60 days Avoiding caffeinated and alcoholic beverages Weight reduction in an overweight patient may help mitigate symptoms of many stomach disorders. If the patient smokes, he or she should quit because nicotine is a trigger for many individuals with acid reflex since it lowers the lower esophageal sphincter (LES) pressure and put patients at risk for gastritis and PUD. Caffeine and alcohol both can trigger acid reflux by lowering LES pressure as well as causing adverse effects in patients with peptic ulcer disease (PUD) and gastritis. Exercise is an excellent recommendation for overall health and cardiovascular fitness which may help weight loss; however, it will not directly mitigate stomach symptoms. While the patient may need dietary changes, increasing consumption of acidic foods may aggravate symptoms; lifestyle management for many stomach disorders includes limiting foods with high acid content like orange juice and tomato-based foods.
