Chapter 46- Gastric Disease

Black, tarry stools Black, tarry stools are a sign of bleeding high in the GI tract, as from a gastric ulcer, and result from the action of digestive enzymes on the blood. Vomitus associated with upper GI tract bleeding commonly is described as coffee-ground-like. Clay-colored stools are associated with biliary obstruction. Bright red stools indicate lower GI tract bleeding.

A client is admitted to the health care facility with a diagnosis of a bleeding gastric ulcer. The nurse expects the client's stools to have which description? - Coffee-ground-like - Clay-colored - Black and tarry - Bright red

- Six small meals daily with 120 mL fluid between meals After the return of bowel sounds and removal of the nasogastric tube, the nurse may give fluids, followed by food in small portions. Foods are gradually added until the client can eat six small meals a day and drink 120 mL of fluid between meals.

A client is recovering from gastric surgery. Toward what goal should the nurse progress the client's enteral intake? - Three meals and 120 ml fluid daily - Three meals and three snacks and 120 mL fluid daily - Six small meals and 120 mL fluid daily - Six small meals daily with 120 mL fluid between meals

- Diarrhea Pyloric obstruction, also called gastric outlet obstruction (GOO), occurs when the area distal to the pyloric sphincter becomes scarred and stenosed from spasm or edema or from scar tissue that forms when an ulcer alternately heals and breaks down. The client may have nausea and vomiting, constipation, epigastric fullness, anorexia, and, later, weight loss.

Symptoms associated with pyloric obstruction include all of the following except: - Anorexia - Diarrhea - Nausea and vomiting - Epigastric fullness

- "I have learned some relaxation strategies that decrease my stress." The nurse assists the client to identify stressful or exhausting situations. A hectic lifestyle and an irregular schedule may aggravate symptoms and interfere with regular meals taken in relaxed settings along with the regular administration of medications.

The nurse determines that teaching for the client with peptic ulcer disease has been effective when the client makes which statement? - "I should stop all my medications if I develop any side effects." - "I should continue my treatment regimen as long as I have pain." - "I have learned some relaxation strategies that decrease my stress." - "I can buy whatever antacids are on sale because they all have the same effect."

- "Be sure to wear sunscreen while taking this medicine." Tetracycline may cause a photosensitivity reaction in clients. The nurse should caution the client to use sunscreen when taking this drug. Dairy products can reduce the effectiveness of tetracycline, so the nurse should not advise him or her to take the medication with milk. A metallic taste accompanies administration of metronidazole (Flagyl). Administration of tetracycline does not necessitate driving restrictions.

A client is prescribed tetracycline to treat peptic ulcer disease. Which instruction would the nurse give the client? - "Take the medication with milk." - "Be sure to wear sunscreen while taking this medicine." - "Expect a metallic taste when taking this medicine, which is normal." - "Do not drive when taking this medication."

- At bedtime

A health care provider has written an order for ranitidine 300 mg once daily. The nurse schedules the medication for which time? - At bedtime - After lunch - With supper - Before breakfast

- Vasomotor symptoms associated with dumping syndrome Early manifestations of dumping syndrome occur 15 to 30 minutes after eating. Signs and symptoms include vertigo, tachycardia, syncope, sweating, pallor, palpitations, diarrhea, nausea, and the desire to lie down. Dehiscence of the surgical wound is characterized by pain and a pulling or popping feeling at the surgical site. Peritonitis presents with a rigid, boardlike abdomen, tenderness, and fever. The client's signs and symptoms aren't a normal reaction to surgery.

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

- "Caffeine stimulates the central nervous system and thus gastric activity and secretions, which need to be minimized to promote recovery." Caffeine is a central nervous system stimulant that increases gastric activity and pepsin secretion. Caffeine is a diuretic that causes decreased fluid volume and potential dehydration. It does not lead to hemorrhage and does not interfere with absorption of vitamin B12.

A nurse is teaching a client with gastritis about the need to avoid the intake of caffeinated beverages. The client asks why this is so important. Which explanation from the nurse would be most accurate? - "Caffeine stimulates the central nervous system and thus gastric activity and secretions, which need to be minimized to promote recovery." - "Caffeine increases the fluid volume in your system, which irritates your digestive organs." - "Caffeine intake can cause tears in your esophagus and intestines, which can lead to hemorrhage." - "Caffeine can interfere with absorption of vitamin B12, which leads to anemia and further digestive problems."

- alcohol abuse and smoking. The nurse should mention that risk factors for peptic (gastric and duodenal) ulcers include alcohol abuse, smoking, and stress

A nurse is teaching a group of middle-aged men about peptic ulcers. When discussing risk factors for peptic ulcers, the nurse should mention: - a sedentary lifestyle and smoking. - a history of hemorrhoids and smoking. - alcohol abuse and a history of acute renal failure. - alcohol abuse and smoking.

- A partial gastrectomy is performed with anastomosis of the stomach segment to the duodenum.

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 sectioned portion of the stomach is joined to the jejunum. - The antral portion of the stomach is removed and a vagotomy is performed. - The vagus nerve is cut and gastric drainage is established.

- O

Peptic ulcer disease occurs more frequently in people with which blood type? - A - B - AB - O

- Assess the client's abdomen and vital signs. Signs and symptoms of perforation includes sudden, severe upper abdominal pain (persisting and increasing in intensity); pain may be referred to the shoulders, especially the right shoulder, because of irritation of the phrenic nerve in the diaphragm. The nurse should assess the vital signs and abdomen prior to notifying the physician.

When caring for a client with an acute exacerbation of a peptic ulcer, the nurse finds the client doubled up in bed with severe pain in the right shoulder. What is the intial appropriate action by the nurse? - Notify the health care provider. - Irrigate the client's NG tube. - Place the client in the high-Fowler's position. - Assess the client's abdomen and vital signs.

- Most clients are asymptomatic during the early stage of the disease.

Which is a true statement regarding gastric cancer? - Most clients are asymptomatic during the early stage of the disease. - Women have a higher incidence of gastric cancer. - The prognosis for gastric cancer is good. - Most cases are discovered before metastasis.

- Omeprazole Omeprazole decreases gastric acid by slowing the hydrogen-potassium adenosine triphosphatase pump on the surface of the parietal cells.

Which medication classification represents a proton (gastric acid) pump inhibitor? - Omeprazole - Sucralfate - Famotidine - Metronidazole

Severe peptic ulcers Extreme gastric hyperacidity Gastrin-secreting tumors of the pancreas

Which of the following are characteristics associated with the Zollinger-Ellison syndrome (ZES)? Select all that apply. - Constipation - Hypocalcemia - Severe peptic ulcers - Extreme gastric hyperacidity - Gastrin-secreting tumors of the pancreas

- Removal of the tumor

Which of the following is the most successful treatment for gastric cancer? - Removal of the tumor - Chemotherapy - Radiation - Palliation