H&C Prep U CH: 46 Management of Patients With Gastric and Duodenal Disorders

A morbidly obese client asks the nurse if medications are available to assist with weight loss. The nurse knows that the client would not be a candidate for phentermine if the following is part of the client's health history

Coronary artery disease

A client with gastric cancer is having a resection. What is the nursing management priority for this client

Correcting nutritional deficits

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

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.

The Zollinger-Ellison syndrome (ZES) consists of severe peptic ulcers, extreme gastric hyperacidity, and gastrin-secreting benign or malignant tumors of the pancreas. The nurse recognizes that an agent that is used to decrease bleeding and decrease gastric acid secretions is

octreotide (Sandostatin).

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."

The nurse determines that teaching for the client with peptic ulcer disease has been effective when the client makes which statement

"I have learned some relaxation strategies that decrease my stress."

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.)

"You may have ingested some irritating foods." • "Is it possible that you are overusing aspirin." • "It can be caused by ingestion of strong acids."

A client with peptic ulcer disease must begin triple medication therapy. For how long will the client follow this regimen

10 to 14 days

A nursing student is preparing a teaching plan about peptic ulcer disease. The student knows to include teaching about the percentage of clients with peptic ulcers who experience bleeding. The percentage is

15%

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 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

Black and tarry

The nurse is assessing a client with a bleeding gastric ulcer. When examining the client's stool, which characteristic would the nurse be most likely to find

Black and tarry appearance

The nurse is assessing an 80-year-old client for signs and symptoms of gastric cancer. The nurse differentiates which as a sign/symptom of gastric cancer in the geriatric client, but not in a client under the age of 75

Agitation

A patient comes to the clinic with the complaint, "I think I have an ulcer." What is a characteristic associated with peptic ulcer pain that the nurse should inquire about? Select all that apply

Burning sensation localized in the back or mid-epigastrium - Feeling of emptiness that precedes meals from 1 to 3 hours - Severe gnawing pain that increases in severity as the day progresses

Which of the following clients is at highest risk for peptic ulcer disease

Client with blood type O.

A client has recently been diagnosed with gastric cancer. On palpation, the nurse would note what two signs that confirm metastasis to the liver? Select all that apply

Ascites Hepatomegaly

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

Assess the client's abdomen and vital signs.

The nurse is evaluating a client's ulcer symptoms to differentiate ulcer as duodenal or gastric. Which symptom should the nurse at attribute to a duodenal ulcer

Awakening in pain

A 66-year-old African-American client has recently visited a physician to confirm a diagnosis of gastric cancer. The client has a history of tobacco use and was diagnosed 10 years ago with pernicious anemia. He and his family are shocked about the possibility of cancer because he was asymptomatic prior to recent complaints of pain and multiple gastrointestinal symptoms. On the basis of knowledge of disease progression, the nurse assumes that organs adjacent to the stomach are also affected. Which of the following organs may be affected? Choose all that apply

Duodenum Pancreas Liver

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

Which medication is classified as a histamine-2 receptor antagonist

Famotidine

A client has been taking famotidine at home. What teaching should the nurse include with the client

Famotidine will inhibit gastric acid secretions.

A nurse is caring for a client with active upper GI bleeding. What is the appropriate diet for this client during the first 24 hours after admission

Nothing by mouth

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

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

A client taking metronidazole for the treatment of H. pylori states that the medication is causing nausea. What teaching should the nurse provide to the client to alleviate the nausea

Take the medication with meals to decrease the nausea.

A healthcare provider prescribes a combination of three drugs to treat reoccuring peptic ulcer disease, and the client asks the nurse the reason for all the medications. What teaching should the nurse review with the client

The bismuth salts, antibiotics, and proton pump inhibitors will work together to suppress or eradicate H. pylori.

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."

A nurse is performing discharge teaching with a client who had a total gastrectomy. Which statement indicates the need for further teaching

"I will have to take vitamin B12 shots up to 1 year after surgery."

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."

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

Review the following four examples of ideal body weight (IBW), actual weight, and body mass index (BMI). Using three criteria for each example, select the body weight that indicates morbid obesity

IBW = 145 lbs; weight = 290 lbs; BMI = 31 kg/m2

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.

Peptic ulcer disease occurs more frequently in people with which blood type

O

Which medication classification represents a proton (gastric acid) pump inhibitor

Omeprazole

Which of the following medications is classified as a proton pump inhibitor (PPI)

Omeprazole

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 (Prilosec)

Which of the following is the most successful treatment for gastric cancer

Removal of the tumor

A client weighs 215 lbs and is 5' 8" tall. What would the nurse calculate this client's body mass index (BMI) as being

32.7

Which of the following are characteristics associated with the Zollinger-Ellison syndrome (ZES)? Select all that apply

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

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

A client with severe peptic ulcer disease has undergone surgery and is several hours postoperative. During assessment, the nurse notes that the client has developed cool skin, tachycardia, labored breathing, and appears to be confused. Which complication has the client most likely developed

Hemorrhage

The nurse in the ED admits a client with suspected gastric outlet obstruction. The client's symptoms include nausea and vomiting. The nurse anticipates that the physician will issue which order

Nasogastric tube insertion

After teaching a client who has had a Roux-en-Y gastric bypass, which client statement indicates the need for additional teaching

"I need to drink 8 ounces of water before eating."

A client comes to the clinic after developing a headache, abdominal pain, nausea, hiccuping, and fatigue about 2 hours ago. The client tells the nurse that the last food was buffalo chicken wings and beer. Which medical condition does the nurse find to be most consistent with the client's presenting problems

Acute gastritis

Which of the following appears to be a significant factor in the development of gastric cancer

Diet

A client who had a Roux-en-Y bypass procedure for morbid obesity ate a chocolate chip cookie after a meal. After ingestion of the cookie, the client reported cramping pains, dizziness, and palpitation. After having a bowel movement, the symptoms resolved. What should the nurse educate the client about regarding this event

Dumping syndrome

Clients with Type O blood are at higher risk for which of the following GI disorders

Duodenal ulcers

The nursing student approaches his instructor to discuss the plan of care for his client diagnosed with peptic ulcer disease. The student asks what is the most common site for peptic ulcer formation? The instructor would state which one of the following

Duodenum

Rebleeding may occur from a peptic ulcer and often warrants surgical interventions. Signs of bleeding include which of the following

Mental confusion

Which is a true statement regarding gastric cancer

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

The nurse is teaching a client with peptic ulcer disease who has been prescribed misoprostol. What information from the nurse would be most accurate about misoprostol

Prevents ulceration in clients taking nonsteroidal anti-inflammatory drugs (NSAIDs)

The nurse advises the patient who has just been diagnosed with acute gastritis to

Refrain from food until the GI symptoms subside.

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

The nurse recognizes that the client diagnosed with a duodenal ulcer will likely experience

pain 2 to 3 hours after a meal.