Chapter 40: Management of Patients with Gastric and Duodenal Disorders
A client is prescribed tetracycline to treat peptic ulcer disease. Which instruction would the nurse give the client?
"Be sure to wear sunscreen while taking this medicine."
38. A patient with gastritis required hospital treatment for an exacerbation of symptoms and receives a subsequent diagnosis of pernicious anemia due to malabsorption. When planning the patient's continuing care in the home setting, what assessment question is most relevant?
"Does anyone in your family have experience at giving injections?"
2. A patient comes to the clinic complaining of pain in the epigastric region. What assessment question during the health interview would most help the nurse determine if the patient has a peptic ulcer?
"Does your pain resolve when you have something to eat?"
A client with an H. pylori infection asks why bismuth subsalicylate is prescribed. Which response will the nurse make?
"It aids in the healing of the stomach lining."
40. A patient has come to the clinic complaining of pain just above her umbilicus. When assessing the patient, the nurse notes Sister Mary Joseph's nodules. The nurse should refer the patient to the primary care provider to be assessed for what health problem?
A GI malignancy
A nurse is monitoring a client with peptic ulcer disease. Which assessment findings would most likely indicate perforation of the ulcer? Select all that apply.
A rigid, board-like abdomen Tachycardia Hypotension
18. A patient has experienced symptoms of dumping syndrome following bariatric surgery. To what physiologic phenomenon does the nurse attribute this syndrome?
A sudden release of peptides
Which ulcer is associated with extensive burn injury?
Curling ulcer
A client sustained second- and third-degree burns over 30% of the body surface area approximately 72 hours ago. What type of ulcer should the nurse be alert for while caring for this client?
Curling's ulcer
17. A patient is receiving education about his upcoming Billroth I procedure (gastroduodenostomy). This patient should be informed that he may experience which of the following adverse effects associated with this procedure?
Diarrhea and feelings of fullness
Clients with Type O blood are at higher risk for which of the following GI disorders?
Duodenal ulcers
16. A patient is one month postoperative following restrictive bariatric surgery. The patient tells the clinic nurse that he has been having "trouble swallowing" for the past few days. What recommendation should the nurse make?
Eating more slowly and chewing food more thoroughly
A health care provider suspects that a client has peptic ulcer disease. With which diagnostic procedure would the nurse most likely prepare to assist?
Endoscopy
1. A nurse is caring for a patient who has just been diagnosed with a peptic ulcer. When teaching the patient about his new diagnosis, how should the nurse best describe a peptic ulcer?
Erosion of the lining of the stomach or intestine
14. A patient was treated in the emergency department and critical care unit after ingesting bleach. What possible complication of the resulting gastritis should the nurse recognize?
Esophageal or pyloric obstruction related to scarring
29. A nurse is performing the admission assessment of a patient whose high body mass index (BMI) corresponds to class III obesity. In order to ensure empathic and patient-centered care, the nurse should do which of the following?
Examine one's own attitudes towards obesity in general and the patient in particular.
21. A nurse is providing anticipatory guidance to a patient who is preparing for bariatric surgery. The nurse learns that the patient is anxious about numerous aspects of the surgery. What intervention is most appropriate to alleviate the patient's anxiety?
Facilitate the patient's contact with a support group.
30. A patient has been prescribed orlistat (Xenical) for the treatment of obesity. When providing relevant health education for this patient, the nurse should ensure the patient is aware of what potential adverse effect of treatment?
Flatus with oily discharge
8. A nurse in the postanesthesia care unit admits a patient following resection of a gastric tumor. Following immediate recovery, the patient should be placed in which position to facilitate patient comfort and gastric emptying?
Fowler's
The nurse is assessing a client with an ulcer for signs and symptoms of hemorrhage. The nurse interprets which condition as a sign/symptom of possible hemorrhage?
Hematemesis
The nurse is cautiously assessing a client admitted with peptic ulcer disease because the most common complication that occurs in 10% to 20% of clients is:
Hemorrhage
10. A nurse is assessing a patient who has peptic ulcer disease. The patient requests more information about the typical causes of Helicobacter pylori infection. What would it be appropriate for the nurse to instruct the patient?
Infection typically occurs due to ingestion of contaminated food and water
12. A patient presents to the walk-in clinic complaining of vomiting and burning in her mid-epigastria. The nurse knows that in the process of confirming peptic ulcer disease, the physician is likely to order a diagnostic test to detect the presence of what?
Infection with Helicobacter pylori
15. A patient who underwent gastric banding 3 days ago is having her diet progressed on a daily basis. Following her latest meal, the patient complains of dizziness and palpitations. Inspection reveals that the patient is diaphoretic. What is the nurse's best action?
Monitor the patient closely for further signs of dumping syndrome.
A client undergoes total gastrectomy. Several hours after surgery, the nurse notes that the client's nasogastric (NG) tube has stopped draining. How should the nurse respond?
Notify the health care provider.
A nurse practitioner prescribes drug therapy for a patient with peptic ulcer disease. Choose the drug that can be used for 4 weeks and has a 90% chance of healing the ulcer.
Omeprazole
28. Diagnostic imaging and physical assessment have revealed that a patient with peptic ulcer disease has suffered a perforated ulcer. The nurse recognizes that emergency interventions must be performed as soon as possible in order to prevent the development of what complication?
Peritonitis
Which of the following manifestations are associated with a deficiency of vitamin B12? Select all that apply. Pernicious anemia Macrocytic anemia Thrombocytopenia Loss of hair Lethargy
Pernicious anemia Macrocytic anemia Thrombocytopenia
The nurse advises the patient who has just been diagnosed with acute gastritis to:
Refrain from food until the GI symptoms subside.
Which of the following is the most successful treatment for gastric cancer?
Removal of the tumor
A client is recovering from gastric surgery. Toward what goal should the nurse progress the client's enteral intake?
Six small meals daily with 120 mL fluid between meals
37. A nurse is caring for a patient hospitalized with an exacerbation of chronic gastritis. What health promotion topic should the nurse emphasize?
Strategies for avoiding irritating foods and beverages
4. A nurse is admitting a patient diagnosed with late-stage gastric cancer. The patient's family is distraught and angry that she was not diagnosed earlier in the course of her disease. What factor contributes to the fact that gastric cancer is often detected at a later stage?
The early symptoms of gastric cancer are usually not alarming or highly unusual.
27. A patient with a history of peptic ulcer disease has presented to the emergency department (ED) in distress. What assessment finding would lead the ED nurse to suspect that the patient has a perforated ulcer?
The patient has a rigid, "boardlike" abdomen that is tender
5. A nurse is preparing to discharge a patient after recovery from gastric surgery. What is an appropriate discharge outcome for this patient?
The patient maintains or gains weight
A nurse is providing care for a client recovering from gastric bypass surgery. During assessment, the client exhibits pallor, perspiration, palpitations, headache, and feelings of warmth, dizziness, and drowsiness. The client reports eating 90 minutes ago. What will the nurse suspect? Vasomotor symptoms associated with dumping syndrome Dehiscence of the surgical wound Peritonitis A normal reaction to surgery
Vasomotor symptoms associated with dumping syndrome
A nurse is caring for a client who underwent a subtotal gastrectomy. To manage dumping syndrome, the nurse should advise the client to:
drink liquids only between meals.
A nurse is caring for a client who is undergoing a diagnostic workup for a suspected gastrointestinal problem. The client reports gnawing epigastric pain following meals and heartburn. What would the nurse suspect this client has?
peptic ulcer disease
A patient has been diagnosed with acute gastritis and asks the nurse what could have caused it. What is the best response by the nurse? (Select all that apply.)
"It can be caused by ingestion of strong acids." "You may have ingested some irritating foods." "Is it possible that you are overusing aspirin."
A client recovering from the removal of a gastric tumor asks why radiation therapy is needed. Which response will the nurse provide?
"It is to kill any remaining cancer cells."
31. A patient who is obese has been unable to lose weight successfully using lifestyle modifications and has mentioned the possibility of using weight-loss medications. What should the nurse teach the patient about pharmacologic interventions for the treatment of obesity?
"Medications can be helpful, but few people achieve and maintain their desired weight loss with medications alone."
A client with a peptic ulcer is diagnosed with Helicobacter pylori infection. The nurse is teaching the client about the medications prescribed, including metronidazole, omeprazole, and clarithromycin. Which statement by the client indicates the best understanding of the medication regimen?
"The medications will kill the bacteria and stop the acid production."
A client being treated for a peptic ulcer seeks medical attention for vomiting blood. Which statement indicates to the nurse the reason for the client developing hematemesis?
"The pain stopped so I stopped taking the medications."
3. A patient with a diagnosis of peptic ulcer disease has just been prescribed omeprazole (Prilosec). How should the nurse best describe this medication's therapeutic action?
"This medication will reduce the amount of acid secreted in your stomach." .
26. A patient has been admitted to the hospital after diagnostic imaging revealed the presence of a gastric outlet obstruction (GOO). What is the nurse's priority intervention?
-Insertion of an NG tube for decompression
A patient is scheduled for a Billroth I procedure for ulcer management. What does the nurse understand will occur when this procedure is performed?
A partial gastrectomy is performed with anastomosis of the stomach segment to the duodenum.
A client diagnosed with a peptic ulcer says, "Now I have something else I have to worry about." Which actions will the nurse take to help reduce the client's anxiety? Select all that apply. Interact with the client in a relaxed manner. Help identify the client's current stressors. Discuss potential coping techniques with the client. Offer information about relaxation methods. Inform the client the medication will solve the problem.
Interact with the client in a relaxed manner. Help identify the client's current stressors. Discuss potential coping techniques with the client. Offer information about relaxation methods.
20. A nurse is providing patient education for a patient with peptic ulcer disease secondary to chronic nonsteroidal anti-inflammatory drug (NSAID) use. The patient has recently been prescribed misoprostol (Cytotec). What would the nurse be most accurate in informing the patient about the drug?
It protects the stomach's lining
9. A community health nurse is preparing for an initial home visit to a patient discharged following a total gastrectomy for treatment of gastric cancer. What would the nurse anticipate that the plan of care is most likely to include?
Monthly administration of injections of vitamin B12
23. A nurse is providing care for a patient who is postoperative day 2 following gastric surgery. The nurse's assessment should be planned in light of the possibility of what potential complications? Select all that apply.
-Atelectasis -Pneumonia -Metabolic imbalances
24. A patient is undergoing diagnostic testing for a tumor of the small intestine. What are the most likely symptoms that prompted the patient to first seek care? A) Hematemesis and persistent sensation of fullness B) Abdominal bloating and recurrent constipation C) Intermittent pain and bloody stool D) Unexplained bowel incontinence and fatty stools
-Intermittent pain and bloody stool
39. A nurse is presenting a class at a bariatric clinic about the different types of surgical procedures offered by the clinic. When describing the implications of different types of surgeries, the nurse should address which of the following topics? Select all that apply.
-Specific lifestyle changes associated with each procedure -Implications of each procedure for eating habits -Effects of different surgeries on bowel function
19. A patient comes to the bariatric clinic to obtain information about bariatric surgery. The nurse assesses the obese patient knowing that in addition to meeting the criterion of morbid obesity, a candidate for bariatric surgery must also demonstrate what?
Adequate understanding of required lifestyle changes
32. A patient has been diagnosed with peptic ulcer disease and the nurse is reviewing his prescribed medication regimen with him. What is currently the most commonly used drug regimen for peptic ulcers?
Antibiotics, proton pump inhibitors, and bismuth salts
13. A patient with a peptic ulcer disease has had metronidazole (Flagyl) added to his current medication regimen. What health education related to this medication should the nurse provide?
Avoid drinking alcohol while taking the drug.
33. A patient who is obese is exploring bariatric surgery options and presented to a bariatric clinic for preliminary investigation. The nurse interviews the patient, analyzing and documenting the data. Which of the following nursing diagnoses may be a contraindication for bariatric surgery?
Deficient Knowledge Related to Risks and Expectations of Surgery
The nurse is preparing to administer ondansetron to an older adult client. Which safety warning(s) should the nurse consider when administering the medication? Select all that apply.
Do not use if the client has a heart block or prolonged QT interval. It increases sedation if used with opiates. Emphasize prevention. The client must take consistently to prevent nausea and vomiting.
6. A nurse caring for a patient who has had bariatric surgery is developing a teaching plan in anticipation of the patient's discharge. Which of the following is essential to include?
Eat several small meals daily spaced at equal intervals.
The nurse is caring for a client who has developed dumping syndrome while recovering from a gastrectomy. What recommendation should the nurse make to the client?
Eat several small meals daily spaced at equal intervals.
35. A patient has received a diagnosis of gastric cancer and is awaiting a surgical date. During the preoperative period, the patient should adopt what dietary guidelines?
Eat small, frequent meals with high calorie and vitamin content
25. A patient is recovering in the hospital following gastrectomy. The nurse notes that the patient has become increasingly difficult to engage and has had several angry outbursts at various staff members in recent days. The nurse's attempts at therapeutic dialogue have been rebuffed. What is the nurse's most appropriate action?
Make appropriate referrals to services that provide psychosocial support.
The nurse visits the home of a client recovering from acute gastritis. Which observation indicates that teaching about the disorder was effective?
Medications placed in a pillbox
Rebleeding may occur from a peptic ulcer and often warrants surgical interventions. Signs of bleeding include which of the following?
Mental confusion
A client is prescribed a histamine (H2)-receptor antagonist. The nurse understands that this might include which medication(s)? Select all that apply.
Nizatidine Famotidine Cimetidine
36. A nurse is caring for a patient who has a diagnosis of GI bleed. During shift assessment, the nurse finds the patient to be tachycardic and hypotensive, and the patient has an episode of hematemesis while the nurse is in the room. In addition to monitoring the patient's vital signs and level of consciousness, what would be a priority nursing action for this patient?
Notify the physician.
During a home visit the nurse notes that a client recovering from peptic ulcer disease is experiencing cool clammy skin and has a heart rate of 96 beats a minute. Which action will the nurse take?
Notify the primary health care provider.
22. A patient has just been diagnosed with acute gastritis after presenting in distress to the emergency department with abdominal symptoms. What would be the nursing care most needed by the patient at this time?
Providing the patient with physical and emotional support
A client is preparing for discharge to home following a partial gastrectomy and vagotomy. Which is the best rationale for the client being taught to lie down for 30 minutes after each meal?
Slows gastric emptying
7. A nurse is completing a health history on a patient whose diagnosis is chronic gastritis. Which of the data should the nurse consider most significantly related to the etiology of the patient's health problem?
Smokes one pack of cigarettes daily.
11. A patient who experienced an upper GI bleed due to gastritis has had the bleeding controlled and the patient's condition is now stable. For the next several hours, the nurse caring for this patient should assess for what signs and symptoms of recurrence?
Tachycardia, hypotension, and tachypnea
A client with peptic ulcer disease has been prescribed sucralfate. What health education should the nurse provide to this client?
Take the medication 2 hours before or after other medications
34. A patient has recently received a diagnosis of gastric cancer; the nurse is aware of the importance of assessing the patient's level of anxiety. Which of the following actions is most likely to accomplish this?
The patient is encouraged to express fears openly.