Chapter 50: Concepts of Care for Patients With Stomach Disorders

Which client statement regarding diet and nutrition after a total gastrectomy requires further teaching by the nurse? A. "I should stay sitting up for an hour after I eat." B. "I will avoid liquids with my meals." C. "I need to eat small frequent meals." D. "I need to stay away from concentrated sweets."

A

2. What health teaching will the nurse include to promote gastric health for an adult client? Select all that apply. A. "Stop smoking or using tobacco of any form." B. "Do not drink excessive amounts of alcohol." C. "Consume high-fat foods and decrease carbohydrates." D. "Avoid excessive amounts of pickled or smoked food." E. "Avoid taking large amounts of NSAIDs."

A, B, D, E

12. A client has dumping syndrome after a partial gastrectomy. Which action by the nurse would be appropriate? a. Arrange a dietary consult. b. Increase fluid intake. c. Limit the client's foods. d. Make the client NPO.

ANS: A The client with dumping syndrome after a gastrectomy has multiple dietary needs. A referral to the registered dietitian nutritionist will be extremely helpful. Food and fluid intake is complicated and needs planning. The client should not be NPO.

2. The nurse is caring for a client who has frequent gastric pain and dyspepsia. Which procedure would the nurse expect for the client to make an accurate diagnosis? a. Esophagogastroduodenoscopy (EGD) b. Abdominal arteriogram c. Nuclear medicine scan d. Magnetic resonance imaging (MRI)

ANS: A The gold standard for diagnosing disorders of the stomach is an EGD which allows direct visualization by the endoscopist into the esophagus, stomach, and duodenum.

9. The nurse is caring for a client experiencing upper gastrointestinal (GI) bleeding. What is the priority action for the client's care? a. Maintain airway, breathing, and circulation. b. Monitor vital signs, including orthostatic blood pressures. c. Draw blood for hemoglobin and hematocrit immediately. d. Insert a nasogastric (NG) tube and connect to intermittent suction.

ANS: A The priority action for any client experiencing deterioration or an emergent situation is monitor and maintain airway, breathing, and circulation (ABCs). Taking orthostatic blood pressures would not be appropriate, but the nurse would monitor vital signs carefully and draw blood for hemoglobin and hematocrit. An NG tube would also need to be inserted and connected to gastric suction to rest the GI tract. However, none of these actions take priority over maintaining ABCs.

15. Which of the following is (are) (a) risk factor(s) for gastric cancer? (Select all that apply.) a. Achlorhydria b. Chronic atrophic gastritis c. H. pylori infection d. Iron deficiency anemia e. Pernicious anemia

ANS: A, B, C, E Achlorhydria, chronic atrophic gastritis, H. pylori infection, and pernicious anemia are all risk factors for developing gastric cancer. Iron deficiency anemia is not a risk factor.

13. The nurse recalls that the risk factors for acute gastritis include which of the following? (Select all that apply.) a. Alcohol b. Caffeine c. Corticosteroids d. Fruit juice e. Nonsteroidal anti-inflammatory drugs (NSAIDs)

ANS: A, B, C, E Risk factors for acute gastritis include alcohol, caffeine, corticosteroids, and chronic NSAID use. Fruit juice is not a risk factor, although in some people it does cause distress.

18. What action(s) by the nurse is (are) appropriate to promote nutrition in a client who had a partial gastrectomy? (Select all that apply.) a. Administer vitamin B12 injections. b. Ask the primary health care provider about folic acid replacement. c. Educate the client on enteral feedings. d. Obtain consent for total parenteral nutrition. e. Provide iron supplements for the client.

ANS: A, B, E After a partial or total gastrectomy, clients are at high risk for anemia due to vitamin B12 deficiency, folic acid deficiency, or iron deficiency. The nurse would provide supplements for all these nutrients. The client does not need enteral feeding or total parenteral nutrition.

19. A nurse is preparing to administer pantoprazole intravenously to prevent stress ulcers during surgery. What action(s) by the nurse is (are) most appropriate? (Select all that apply.) a. Administer the drug through a separate IV line. b. Infuse pantoprazole using an IV pump. c. Keep the drug in its original brown container. d. Take vital signs frequently during infusion. e. Use an in-line IV filter when infusing.

ANS: A, B, E When infusing pantoprazole, use a separate IV line, a pump, and an in-line filter. A brown wrapper and frequent vital signs are not needed

16. A client has dumping syndrome. What menu selections indicate the client understands the correct diet to manage this condition? (Select all that apply.) a. Apricots b. Coffee cake c. Milk shake d. Potato soup e. Steamed broccoli

ANS: A, D Canned apricots and potato soup are appropriate selections as they are part of a high-protein, high-fat, and low- to moderate-carbohydrate diet. Coffee cake and other sweets must be avoided. Milk products and sweet drinks such as shakes must be avoided. Gas-forming foods such as broccoli must also be avoided.

7. A client who has peptic ulcer disease is prescribed quadruple drug therapy for Helicobacter pylori infection. What health teaching related to bismuth would the nurse include? a. "Report stool changes to your primary health care provider immediately." b. "Do not take aspirin or aspirin products of any kind while on bismuth." c. "Take bismuth about 30 minutes before each meal and at bedtime." d. "Be aware that bismuth can cause frequent vomiting and diarrhea."

ANS: B Bismuth is a salicylate drug and causes stool discoloration but not vomiting and diarrhea. It does not have to be taken at a specific time relative to meals. Clients taking bismuth should not take other salicylates, such as aspirin or aspirin-containing products

10. A client has a nasogastric (NG) tube as a result of an upper gastrointestinal (GI) hemorrhage. What comfort measure would the nurse remind assistive personnel (AP) to provide? a. Lavaging the tube with ice water b. Performing frequent oral care c. Re-positioning the tube every 4 hours d. Taking and recording vital signs

ANS: B Clients with NG tubes need frequent oral care both for comfort and to prevent infection. Lavaging the tube is done by the nurse. Repositioning the tube, if needed, is also done by the nurse. The can take vital signs, but this is not a comfort measure.

4. A client who had a partial gastrectomy 3 days ago begins to experience vertigo, sweating, and tachycardia about 30 minutes after eating breakfast. What postoperative complication would the nurse suspect? a. Pyloric obstruction b. Dumping syndrome c. Delayed gastric emptying d. Pernicious anemia

ANS: B Dumping syndrome causes autonomic symptoms as food quickly leaves the stomach due to its decreased size after surgery

11. A client has a recurrence of gastric cancer and is crying. What response by the nurse is most appropriate? a. "Do you have family or friends for support?" b. "Would you tell me what you are feeling now." c. "Well, we knew this would probably happen." d. "Would you like me to refer you to hospice?"

ANS: B The nurse assesses the client's emotional state with open-ended questions and statements and shows a willingness to listen to the client's concerns. Asking about support people is very limited in nature, and "yes-or-no" questions are not therapeutic. Stating that this was expected dismisses the client's concerns. The client may or may not be ready to hear about hospice, and this is another limited, yes-or-no question.

14. The nurse is caring for a client with a long history of peptic ulcer disease. What assessment findings would the nurse anticipate if the client experiences upper gastrointestinal (GI) bleeding? (Select all that apply.) a. Decreased heart rate b. Decreased blood pressure c. Bounding radial pulse d. Dizziness e. Hematemesis f. Decreased urinary output

ANS: B, D, E, F The client who has upper GI bleeding would likely have vomiting that contains blood (hematemesis), and would have signs and symptoms of dehydration such as a decreased blood pressure, dizziness, and/or decreased urinary output. The heart rate increases rather than decreases and the pulse is weak rather than bounding in clients who are dehydrated.

6. During an interview, the client tells the nurse that the client has a duodenal ulcer. Which assessment finding would the nurse expect? a. Hematemesis b. Pain when eating c. Melena d. Weight loss

ANS: C All of the other assessment findings are more commonly seen in clients who have gastric ulcers rather than duodenal ulcers.

3. The nurse is caring for a client who has been diagnosed with peptic ulcer disease. For which complication would the nurse monitor? a. Large bowel obstruction b. Dyspepsia c. Upper gastrointestinal (GI) bleeding d. Gastric cancer

ANS: C Peptic ulcer disease (PUD) can cause gastric mucosal damage or perforation, which causes upper GI bleeding. Dyspepsia is a symptom of PUD, gastritis, and gastric cancer. PUD affects the stomach and/or duodenum, not the colon.

5. A client with peptic ulcer disease is in the emergency department and reports gastric pain that has gotten much worse over the last 24 hours. The client's blood pressure when lying down is 112/68 mm Hg and when standing is 98/52 mm Hg. What action by the nurse is most appropriate? a. Administer a proton pump inhibitor (PPI). b. Call the Rapid Response Team. c. Start a large-bore IV with normal saline. d. Tell the patient to remain lying down.

ANS: C This client has orthostatic changes to the blood pressure, indicating fluid volume loss. The nurse would start a large-bore IV with isotonic solution. PPIs are not a treatment for an ulcer. The Rapid Response Team is not needed at this point. The client should be put on safety precautions, which includes staying in bed, but this is not the most appropriate action at this time.

17. The nurse assesses a client who has possible gastritis. Which assessment finding(s) indicate(s) that the client has chronic gastritis? (Select all that apply.) a. Anorexia b. Dyspepsia c. Intolerance of fatty foods d. Pernicious anemia e. Nausea and vomiting

ANS: C, D Intolerance of fatty or spicy foods and pernicious anemia are signs of chronic gastritis. Anorexia and nausea/vomiting can be seen in both conditions. Dyspepsia is seen in acute gastritis.

8. The nurse caring for clients with gastrointestinal disorders would recall that omeprazole is a drug in which classification? a. Gastric acid inhibitor b.Histamine receptor blocker c. Mucosal barrier fortifier d. Proton pump inhibitor

ANS: D Omeprazole is a proton pump inhibitor

1. The nurse is teaching a client who has been treated for acute gastritis. What statement by the client indicates a need for further teaching? a. "I need to cut down on drinking martinis every might." b. "I should decrease my intake of caffeinated drinks, especially coffee." c. "I will only take ibuprofen once in a while when I really need it." d. "I can continue smoking cigarettes which is better than chewing tobacco."

ANS: D To prevent another episode of acute gastritis, alcohol, caffeinated drinks, and NSAIDs should be avoided or kept at a minimum. Smoking and all forms of tobacco should also be avoided.

1. The primary health care provider prescribes bismuth subsalicylate for a client as part of treating H. pylori infection. What health teaching will the nurse include for the client about this drug? A. "Do not crush this drug before taking." B. "The drug may cause your tongue and stool to turn black." C. "Take the drug at night only." D. "The drug may cause you to have diarrhea."

B

The nurse is caring for a client diagnosed with peptic ulcer disease (PUD). For which potential complications will the nurse monitor? Select all that apply. A. Pneumonia B. Peritonitis C. Anemia D. Stroke E. Hypotension F. Cirrhosis

B, C, E