GI
A nurse is teaching a patient about prevention of peptic ulcers. What instructions should the nurse give the patient? Select all that apply. 1 Avoid smoking. 2 Consume raw uncooked food. 3 Use nonsteroidal antiinflammatory drugs (NSAIDs) for treatment of pain. 4 Wash hands thoroughly with soap after using the restroom and before eating. 5 Report symptoms of gastric irritation, such as nausea and epigastric pain, to the health care provider
1 Avoid smoking. 4 Wash hands thoroughly with soap after using the restroom and before eating. 5 Report symptoms of gastric irritation, such as nausea and epigastric pain, to the health care provider Nicotine, a component of cigarettes, causes gastric irritation, and therefore smoking should be avoided by those with peptic ulcers. Washing hands thoroughly with soap after using the restroom and before eating would help prevent the Helicobacter pylori infection that causes peptic ulcers. Any symptom of gastric irritation such as nausea and epigastric pain must be reported to the health care provider to prevent lethal consequences of peptic ulcer disease. Consumption of raw uncooked food increases the chance of H. pylori infection;. therefore, it should be avoided. NSAIDs should not be taken over a long period of time, because they are a potent gastric irritant. Text Reference - p. 946
Following a gastrectomy performed for peptic ulcer disease, the patient has recovered and is ready for discharge. What instructions should the nurse include in discharge teaching to prevent dumping syndrome? 1 Divide meals into six small feedings. 2 Take fluids along with meals. 3 Use concentrated sweets like honey, jam, and jelly. 4 Reduce protein and fats in the diet.
1 Divide meals into six small feedings. To prevent dumping syndrome after gastrectomy, the patient should avoid large meals, instead dividing meals into six small meals to avoid overloading the intestines at mealtimes. Fluids should not be taken with meals. Fluids can be taken at least 30 to 45 minutes before or after meals. This helps prevent distension or a feeling of fullness. Concentrated sweets should be avoided because they sometimes cause dizziness, diarrhea, and a sense of fullness. Protein and fats should be increased in the diet to help rebuild body tissue and to meet energy needs. Test-Taking Tip: Stay away from other nervous students before the test. Stop reviewing at least 30 minutes before the test. Take a walk, go to the library and read a magazine, listen to music, or do something else that is relaxing. Go to the test room a few minutes before class time so that you are not rushed in settling down in your seat. Tune out what others are saying. Crowd tension is contagious, so stay away from it. Text Reference - p. 950
The nurse is caring for a patient who underwent surgical therapy for peptic ulcer disease. Upon clinical examination, the primary health care provider suspected that a complication occurred due to loss of intrinsic factor. Which complication does the nurse suspect? 1 Pernicious anemia 2 Bile reflux gastritis 3 Dumping syndrome 4 Postprandial hypoglycemia
1 Pernicious anemia Pernicious anemia is a complication that occurs in a patient after undergoing a partial gastrectomy. It occurs due to loss of intrinsic factor, which is required for the production of vitamin B12. Bile reflux gastritis occurs as a complication of gastric surgery of the pylorus. Dumping syndrome occurs as a complication after surgical removal of the stomach and pylorus. Postprandial hypoglycemia is a variant of dumping syndrome that occurs due to uncontrolled gastric emptying of a bolus of fluid high in carbohydrate into the small intestine. Text Reference - p. 950
A patient with a history of peptic ulcer disease has presented to the emergency department reporting severe abdominal pain and has a rigid, board-like abdomen that prompts the health care team to suspect a perforated ulcer. What intervention should the nurse anticipate? 1 Providing intravenous (IV) fluids and inserting a nasogastric (NG) tube 2 Administering oral bicarbonate and testing the patient's gastric pH level 3 Performing a fecal occult blood test and administering IV calcium gluconate 4 Starting parenteral nutrition and placing the patient in a high-fowler's position
1 Providing intravenous (IV) fluids and inserting a nasogastric (NG) tube A perforated peptic ulcer requires IV replacement of fluid losses and continued gastric aspiration by NG tube. Oral bicarbonate would not be given, because the client would be nothing by mouth, and gastric pH testing is not a priority. Calcium gluconate is not a medication directly relevant to the patient's suspected diagnosis and parenteral nutrition is not a priority in the short term. Text Reference - p. 947
A patient is on drug therapy for a peptic ulcer. Which medication does the nurse anticipate to be prescribed to help reduce hydrochloric acid secretion? 1 Ranitidine 2 Sucralfate 3 Tetracycline 4 Aluminum hydroxide gel
1 Ranitidine Ranitidine, which is a histamine-receptor blocker, reduces hydrochloric acid (HCl) secretions by blocking histamine, a hormone responsible for HCl secretion. Sucralfate acts by forming a protective layer around the ulcer and serves as a barrier against acid, bile salts, and enzymes in the stomach. Tetracycline is an antibiotic prescribed concurrently with proton-pump inhibitors. Aluminum hydroxide gel is an antacid that neutralizes gastric HCl secretion. Text Reference - p. 946
In assessing the vital signs of a patient with an upper gastrointestinal (GI) bleed, it is important to determine whether the patient is in which kind of shock? 1 Neurogenic 2 Cardiogenic 3 Septic 4 Hypovolemic
4 Hypovolemic although fluctuations in vital signs occur in neurogenic, cardiogenic, and septic shock states, these fluctuations are not associated with blood loss. However, signs and symptoms of hypovolemic shock caused by GI blood loss, such as elevated heart rate, respiratory rate, and decreased blood pressure, would be evident. Assessment of the patient's vital signs assist the nurse in determining whether patient is in hypovolemic shock. Text Reference - p. 956
The results of a patient's recent endoscopy indicate the presence of peptic ulcer disease (PUD). Which teaching point should the nurse provide to the patient based on this new diagnosis? 1 "You'll need to drink at least two to three glasses of milk daily." 2 "It would likely be beneficial for you to eliminate drinking alcohol." 3 "Many people find that a minced or pureed diet eases their symptoms of PUD." 4 "Your medications should allow you to maintain your present diet while minimizing symptoms."
2 "It would likely be beneficial for you to eliminate drinking alcohol." Alcohol increases the amount of stomach acid produced so it should be avoided. Milk may exacerbate PUD, so two to three glasses would not be recommended. There is no reason to puree or mince food, and a current diet is likely to be altered to minimize symptoms. Text Reference - p. 948
While caring for a postoperative patient with a nasogastric tube, the nurse suspects that the tube is repositioned. What is the priority nursing intervention to prevent complications in the patient? 1 Inserting a new nasogastric tube 2 Notifying the primary health care provider immediately 3 Irrigating the nasogastric tube with normal saline solution 4 Monitoring for the symptoms of edema and inflammation
2 Notifying the primary health care provider immediately When the nurse suspects repositioning of the nasogastric tube, the primary health care provider should be called as soon as possible, because there is a danger of either perforation of the gastric mucosa or a disruption of the suture line. The nurse should not insert a new tube without the order of the primary health care provider. Irrigating the tube with normal saline solution is helpful in preventing tube clogging. Monitoring for the symptoms of edema and inflammation will put the safety of the patient at risk. Test-Taking Tip: Avoid looking for an answer pattern or code. There may be times when four or five consecutive questions have the same letter or number for the correct answer. Text Reference - p. 950
A patient has what is suspected to be a gastric ulcer perforation. Which symptom does the nurse expect will be present? 1 Pyrosis 2 Rigid abdomen 3 Bright-red emesis 4 Clay-colored stools
2 Rigid abdomen Perforation results in spillage of gastric or duodenal contents into the upper peritoneal cavity. The patient experiences sudden upper abdominal pain because the spillage causes irritation of pain receptors in the visceral and parietal layers of the peritoneum. The body then attempts to protect the area by contracting the abdominal muscles, resulting in a rigid, boardlike abdomen. Pyrosis, a painful and burning sensation in the esophagus, just below the breastbone, is usually associated with regurgitation of gastric acid, also known as heartburn. Bright-red emesis may be present as a result of hemorrhage from the gastric ulcer but is not as common as the rigid, boardlike abdomen. Clay-colored stools are associated with hepatic disease, such as hepatitis, not gastric ulcer perforation. Text Reference - p. 945
A patient with a peptic ulcer begins vomiting. The nurse would expect and be concerned with which type of vomitus? 1 Fecal 2 Bilious 3 "Coffee ground" 4 Undigested food
3 "Coffee ground" The appearance of blood exposed to hydrochloric acid and other digestive enzymes in the stomach is dark brown with a coffee-ground consistency. This should be reported by the nurse. Fecal vomitus would be experienced with a total bowel obstruction. Bilious vomitus or undigested food may be seen with various gastrointestinal disturbances, such as gallbladder disease, gastroenteritis, or gastritis. Text Reference - p. 925
The nurse is evaluating a patient after teaching about management of peptic ulcer disease. Which statement by the patient indicates the need for further teaching? Select all that apply. 1 "I should report increased vomiting or epigastric pain." 2 "I should avoid smoking, because it may delay healing of the ulcer." 3 "I should avoid spicy and acidic food that may cause epigastric distress." 4 "I should take medications that include only antisecretory class of drugs." 5 I should take over-the-counter drugs that have ingredients like aspirin."
4 "I should take medications that include only antisecretory class of drugs." 5 I should take over-the-counter drugs that have ingredients like aspirin." While teaching a patient about management of peptic ulcer disease, the nurse should instruct the patient to take medications that include both antisecretory drugs and antibiotics, because of the development of antibiotic resistance organisms; this can be reduced by using antisecretory drugs concurrently with antibiotics. Over-the-counter (OTC) drugs that contain ingredients like aspirin should be avoided, because they destroy mucosal cells and increase the risk of ulcer development. The patient should report increased vomiting or epigastric pain. The patient should avoid smoking, because it may delay ulcer healing. The patient should follow dietary modifications by avoiding spicy and acidic food that may cause epigastric distress. Text Reference - p. 949
A 72-year-old patient was admitted with epigastric pain caused by a gastric ulcer. Which patient assessment warrants an urgent change in the nursing plan of care? 1 Chest pain relieved with eating or drinking water 2 Back pain three or four hours after eating a meal 3 Burning epigastric pain 90 minutes after breakfast 4 Rigid abdomen and vomiting following indigestion
4 Rigid abdomen and vomiting following indigestion A rigid abdomen with vomiting in a patient who has a gastric ulcer indicates a perforation of the ulcer, especially if the manifestations of perforation appear suddenly. Midepigastric pain is relieved by eating, drinking water, or antacids with duodenal ulcers, not gastric ulcers. Back pain three to four hours after a meal is more likely to occur with a duodenal ulcer. Burning epigastric pain one to two hours after a meal is from an expected manifestation with a gastric ulcer related to increased gastric secretions and does not cause an urgent change in the nursing plan of care. Text Reference - p. 944
A patient is on nonsteroidal antiinflammatory drugs (NSAIDs). Which complication does the nurse anticipate? 1 Achalasia 2 Duodenal ulcer 3 Stomach cancer 4 Silent peptic ulcer
4 Silent peptic ulcer Silent peptic ulcers show no symptoms of ulcer disease until the presentation of their final, fatal illness. The ulcers occur in older patients or patients who take NSAIDs. Achalasia is a primary motility disorder characterized by the absence of peristalsis and impaired relaxation of the lower esophageal sphincter (LES) in response to swallowing. Duodenal ulcers occur due to excessive alcohol ingestion and smoking that result in increased hydrochloric acid secretion. Stomach cancer begins with a nonspecific mucosal injury as a result of infection, autoimmune-related inflammation, and tobacco use. Text Reference - p. 944
