Gastritis & Hiatal Hernia

1. Irritability 4. Tachycardia 6. Nausea Rationale: Signs and symptoms of alcohol withdrawal may include restlessness, irritability, anxiety, and agitation; anorexia, nausea, and vomiting; tremor, elevated heart rate, and increased blood pressure; insomnia, intense dreaming, nightmares, poor concentration, and impaired memory and judgment; increased sensitivity to sound, light, and tactile sensations; grand mal seizures; and hallucinations and delusions.

A client admitted to a medical unit 14 hours ago with a diagnosis of gastritis has a health history of moderate alcohol use on a weekly basis. Which symptoms assessed by a nurse suggest that a client may be experiencing alcohol withdrawal? SELECT ALL THAT APPLY: 1. Irritability 2. Polyuria 3. Hypotension 4. Tachycardia 5. Hypervigilance 6. Nausea

1. Lying recumbent following meals Rationale: Hiatal hernia is caused by a protrusion of a portion of the stomach above the diaphragm where the esophagus usually is positioned. The client usually experiences pain from reflux caused by ingestion of irritating foods, lying flat following meals or at night, and eating large or fatty meals.

A client with hiatal hernia chronically experiences heartburn following meals. The nurse should plan to teach the client to avoid which action because it is contraindicated with a hiatal hernia? 1. Lying recumbent following meals 2. Consuming small, frequent, bland meals 3. Taking H2 -receptor antagonist medication 4. Raising the head of the bed on 6-inch (15 cm) blocks

2. Assist the client to stand at the bedside to attempt to void 3. Assess the pain level of the client and administer medication appropriately if in pain 4. Assist the client to the bathroom and turn on running water within hearing distance of the client while the client attempts to void 5. Discuss relaxation techniques and ask the client to imagine being at home and voiding in his own home bathroom Rationale: The nurse should try to assist the client to void by assisting him to the normal position of standing, treating pain that may be interfering with the ability to urinate, using the sound of running water to stimulate the voiding reflex, and teaching the client relaxation techniques, including guided imagery.

A male client undergoes surgery for a hernia repair. The client has orders to be discharged to home when stable. The client has tried several times to urinate into the urinal while in bed without success. Which interventions are appropriate to promote voiding for this client? SELECT ALL THAT APPLY. 1. Apply an external catheter 2. Assist the client to stand at the bedside to attempt to void 3. Assess the pain level of the client and administer medication appropriately if in pain 4. Assist the client to the bathroom and turn on running water within hearing distance of the client while the client attempts to void 5. Discuss relaxation techniques and ask the client to imagine being at home and voiding in his own home bathroom 6. Explain that the client should void within 8 hours of surgery or return to the hospital for catheterization.

2. Intense abdominal pain When a hernia is irreducible and intestinal flow and blood supply are obstructed, the hernia is strangulated. Lack of blood supply causes severe pain in the strangulated area.

A nurse is assessing a client, with a diagnosed inguinal hernia, at a scheduled clinic visit. The nurse suspects that the client's hernia may be strangulated when which finding is noted on assessment? 1. Shortness of breath 2. Intense abdominal pain 3. Constipation 4. Hyperactive bowel sounds

3. hernia strangulation. Rationale: Like an abdominal hernia, a hiatal hernia can become strangulated. Although dysphagia and aspiration are complications of hiatal hernia, they are not emergency conditions. Esophageal edema is not a complication of hiatal hernia.

An experienced nurse is most likely to teach a new nurse that surgery to repair a hiatal hernia is becoming more common to prevent the emergency complication of: 1. severe dysphagia. 2. esophageal edema. 3. hernia strangulation. 4. aspiration

3. Esophagitis. Rationale: Cimetidine (Tagamet) is a histamine receptor antagonist that decreases the quantity of gastric secretions. It may be used in hiatal hernia therapy to prevent or treat the esophagitis and heartburn associated with reflux.

Cimetidine (Tagamet) may also be used to treat hiatal hernia. The nurse should understand that this drug is used to prevent which of the following? 1. Esophageal reflux. 2. Dysphagia. 3. Esophagitis. 4. Ulcer formation.

2. Body mechanics used in lifting. Rationale: Bending, especially after eating, can cause gastroesophageal refl ux. Lifting heavy objects increases intra-abdominal pressure. Assessing the client's lifting techniques enables the nurse to evaluate the client's knowledge of factors contributing to hiatal hernia and how to prevent complications. Number and length of breaks, temperature in the work area, and cleaning solvents used are not directly related to treatment of hiatal hernia.

In developing a teaching plan for the client with a hiatal hernia, the nurse's assessment of which work-related factors would be most useful? 1. Number and length of breaks. 2. Body mechanics used in lifting. 3. Temperature in the work area. 4. Cleaning solvents used.

2. "Hiatal hernia symptoms can usually be successfully managed with diet modifications, medications, and lifestyle changes." Rationale: Most clients can be treated successfully with a combination of diet restrictions, medications, weight control, and lifestyle modifications. Surgery to correct a hiatal hernia, which commonly produces complications, is performed only when medical therapy fails to control the symptoms.

The client asks the nurse whether he will need surgery to correct his hiatal hernia. Which reply by the nurse would be most accurate? 1. "Surgery is usually required, although medical treatment is attempted first." 2. "Hiatal hernia symptoms can usually be successfully managed with diet modifications, medications, and lifestyle changes." 3. "Surgery is not performed for this type of hernia." 4. "A minor surgical procedure to reduce the size of the diaphragmatic opening will probably be planned."

3. Diarrhea. Rationale: The magnesium salts in magnesium hydroxide are related to those found in laxatives and may cause diarrhea. Aluminum salt products can cause constipation. Many clients fi nd that a combination product is required to maintain normal bowel elimination. The use of magnesium hydroxide does not cause anorexia or weight gain.

The client has been taking magnesium hydroxide (milk of magnesia) at home in an attempt to control hiatal hernia symptoms. The nurse should assess the client for which of the following conditions most commonly associated with the ongoing use of magnesium-based antacids? 1. Anorexia. 2. Weight gain. 3. Diarrhea. 4. Constipation

1. "I'll avoid lying down after a meal." Rationale: A client with a hiatal hernia should avoid the recumbent position immediately after meals to minimize gastric refl ux. Bedtime snacks, as well as high-fat foods and carbonated beverages, should be avoided. Excessive vigorous exercise also should be avoided, especially after meals, but there is no reason why the client must give up swimming.

The nurse instructs the client on health maintenance activities to help control symptoms from her hiatal hernia. Which of the following statements would indicate that the client has understood the instructions? 1. "I'll avoid lying down after a meal." 2. "I can still enjoy my potato chips and cola at bedtime." 3. "I wish I didn't have to give up swimming." 4. "If I wear a girdle, I'll have more support for my stomach."

2. Vitamin B12 Rationale: Chronic gastritis causes deterioration and atrophy of the lining of the stomach, leading to the loss of function of the parietal cells. The source of intrinsic factor is lost, which results in an inability to absorb vit B12. This leads to the development of pernicious anemia.

The nurse is caring for a patient with a diagnosis of chronic gastritis. The nurse monitors the client, knowing that this patient is at risk for which vitamin deficiency? 1. Vitamin A 2. Vitamin B12 3. Vitamin C 4. Vitamin E

1. Heartburn. Rationale: Heartburn, the most common symptom of a sliding hiatal hernia, results from refl ux of gastric secretions into the esophagus.

The nurse is obtaining a health history from a client who has a sliding hiatal hernia associated with reflux. The nurse should ask the client about the presence of which of the following symptoms? 1. Heartburn. 2. Jaundice. 3. Anorexia. 4. Stomatitis.

1. Nuts 3. Liver 5. Lentils Rationale: Chronic gastritis causes deterioration and atrophy of the lining of the stomach, leading to the loss of function of the parietal cells. The source of intrinsic factor is lost, which results in an inability to absorb vitamin B12 , leading to development of pernicious anemia. Clients must increase their intake of vitamin B12 by increasing consumption of foods rich in this vitamin, such as nuts, organ meats, dried beans, citrus fruits, green leafy vegetables, and yeast.

The nurse is providing dietary teaching for a client with a diagnosis of chronic gastritis. The nurse instructs the client to include which foods rich in vitamin B12 in the diet? Select all that apply. 1. Nuts 2. Corn 3. Liver 4. Apples 5. Lentils 6. Bananas

2. Indomethacin (Indocin) Rationale: Indomethacin (Indocin) is a NSAID and can cause ulceration of the esophagus, stomach, duodenum, or small intestine. Indomethacin is contraindicated in a client with GI disorders.

The nurse is reviewing the medication record of a client with acute gastritis. Which medication, if noted on the client's record, would the nurse question? 1. Digoxin (Lanoxin) 2. Indomethacin (Indocin) 3. Furosemide (Lasix) 4. Propranolol hydrochloride (Inderal)

3. Antibiotic, proton pump inhibitor, and bismuth Rationale: For H. pylori treatment, Antibiotics (Tetracycline, Amoxicillin with a combination of Clarithromycin) and Proton Pump Inhibitors (Lansoprazole) is used.

The patient with chronic gastritis is being put on a combination of medications to eradicate H. Pylori. Which drugs dose the nurse know will probably be used for this patient? 1. Antibiotic, antacid, and corticosteroid 2. Antibiotic, aspirin, and antiulcer/protectant 3. Antibiotic, proton pump inhibitor, and bismuth 4. Antibiotic, and NSAIDs

3. A lack of intrinsic factor normally produced by acid-secreting cells of the gastric mucosa Rationale: Gastritis may cause a loss of parietal cells as a result of atrophy. The source of intrinsic factor is also lost; intrinsic factor is essential for the absorption of cobalamin in the terminal ileum which can result in cobalamin deficiency when lost. This is essential for the growth of RBCs.

The pernicious anemia that may accompany gastritis is due to which of the following? 1. Chronic autoimmune destruction of cobalamin stores in the body 2. Progressive gastric atrophy from chronic breakage in the mucosal barrier and blood loss 3. A lack of intrinsic factor normally produced by acid-secreting cells of the gastric mucosa 4. Hyperchlorhydria resulting from an increase in acid-secreting parietal cells and degradation of RBCs

1. Increase tone of the esophageal sphincter. Rationale: Metoclopramide hydrochloride (Reglan) increases esophageal sphincter tone and facilitates gastric emptying; both actions reduce the incidence of reflux. Other drugs, such as antacids or histamine receptor antagonists, may also be prescribed to help control reflux and esophagitis and to decrease or neutralize gastric secretions.

The physician prescribes metoclopramide hydrochloride (Reglan) for the client with hiatal hernia. The nurse plans to instruct the client that this drug is used in hiatal hernia therapy to accomplish which of the following objectives? 1. Increase tone of the esophageal sphincter. 2. Neutralize gastric secretions. 3. Delay gastric emptying. 4. Reduce secretion of digestive juices.

1. Cause atrophy of the parietal cells. Rationale: Type A is caused by your immune system destroying stomach cells. And it can increase your risk of vitamin deficiencies, anemia, and cancer. Type B, the most common type, is caused by H. pylori bacteria, and can cause stomach ulcers, intestinal ulcers, and cancer.

Type A chronic gastritis can be distinguished from type B by its ability to: 1. Cause atrophy of the parietal cells. 2. Affect only the antrum of the stomach. 3. Thin the lining of the stomach walls. 4. Decrease gastric secretions.

2. Being 5 feet, 3 inches tall and weighing 190 lb. Rationale: Any factor that increases intra-abdominal pressure, such as obesity, can contribute to the development of hiatal hernia. Other factors include abdominal straining, frequent heavy lifting, and pregnancy. Hiatal hernia is also associated with older age and occurs in women more frequently than in men. Having a sedentary desk job, using laxatives frequently, or being 40 years old is not likely to be a contributing factor in development of a hiatal hernia.

Which of the following factors would most likely contribute to the development of a client's hiatal hernia? 1. Having a sedentary desk job. 2. Being 5 feet, 3 inches tall and weighing 190 lb. 3. Using laxatives frequently. 4. Being 40 years old.

2. Eliminating smoking and alcohol use. Rationale: Smoking and alcohol use both reduce esophageal sphincter tone and can result in refl ux. They therefore should be avoided by clients with hiatal hernia. Daily aerobic exercise, balancing activity and rest, and avoiding high-stress situations may increase the client's general health and well- being, but they are not directly associated with hiatal hernia

Which of the following lifestyle modifications should the nurse encourage the client with a hiatal hernia to include in activities of daily living? 1. Daily aerobic exercise. 2. Eliminating smoking and alcohol use. 3. Balancing activity and rest. 4. Avoiding high-stress situations.

3. Ask the client to identify other situations in which he demonstrated responsibility for himself. Rationale: Self-responsibility is the key to individual health maintenance. Using examples of situations in which the client has demonstrated self-responsibility can be reinforcing and supporting.

Which of the following nursing interventions would most likely promote self-care behaviors in the client with a hiatal hernia? 1. Introduce the client to other people who are successfully managing their care. 2. Include the client's daughter in the teaching so that she can help implement the plan. 3. Ask the client to identify other situations in which he demonstrated responsibility for himself. 4. Reassure the client that he will be able to implement all aspects of the plan successfully.