NU 322 GI Exam (Ticket to Test)

Which of the following manifestations are associated with a deficiency of vitamin B12? Select all that apply. ***

-Pernicious anemia -Macrocytic anemia -Thrombocytopenia Rationale: Decreased vitamin B12 can result in pernicious anemia, macrocytic anemia, and thrombocytopenia. Decreased iron can result in lethargy and loss of hair.

A client admitted for treatment of a gastric ulcer is being prepared for discharge. The client will follow a regimen of antacid therapy. Discharge teaching should include which instructions? Choose all that apply. ***

-"Continue to take antacids even if your symptoms subside." -"You may be prescribed H2-receptor antagonists for up to 1 year." Rationale: The client is advised to adhere to and complete the medication regimen to ensure complete healing of the ulcer. Because most clients become symptom-free within 1 week, the nurse stresses the importance of following the prescribed regimen so that the healing process can continue uninterrupted and the return of chronic ulcer symptoms can be prevented. Maintenance dosages of H2-receptor antagonists are usually recommended for 1 year. Taking antacids concomitantly with other drugs should be avoided. For best results antacids should be taken 1 hour before or 2 hours after meals. Antacids will not make the client sleepy.

The nurse reviews dietary guidelines with a client who had a gastric banding. Which teaching points are included? Select all that apply. ***

-Do not eat and drink at the same time. -Drink plenty of water, from 90 minutes after each meal to 15 minutes before each meal. -Avoid fruit drinks and soda. Rationale: Total meal size should be restricted to less than 8 oz or 240 mL. Three meals a day are recommended.

The nurse is developing a plan of care for a patient with peptic ulcer disease. What nursing interventions should be included in the care plan? Select all that apply. ***

-Frequently monitoring hemoglobin and hematocrit levels -Observing stools and vomitus for color, consistency, and volume -Checking the blood pressure and pulse rate every 15 to 20 minutes Rationale: The nurse assesses the patient for faintness or dizziness and nausea, which may precede or accompany bleeding. The nurse must monitor vital signs frequently and evaluate the patient for tachycardia, hypotension, and tachypnea. Other nursing interventions include monitoring the hemoglobin and hematocrit, testing the stool for gross or occult blood, and recording hourly urinary output to detect anuria or oliguria (absence of or decreased urine production).

The nurse is caring for a client who has just returned from the PACU after surgery for peptic ulcer disease. For what potential complications does the nurse know to monitor? Select all that apply. ***

-Hemorrhage -Perforation -Penetration -Pyloric obstruction Rationale: Potential complications may include hemorrhage, perforation, penetration, and pyloric obstruction. A client who has had surgery for peptic ulcer disease may have a decreased appetite in the immediate postoperative stage, but it is not something the nurse would monitor for and would not cause cachexia. Inability to clear secretions is generally not a complication of peptic ulcer surgery.

The nurse is assessing the abdomen of the client with an undiagnosed disorder. In which sequence would the nurse conduct the abdominal assessment?

-Inspection -Auscultation -Percussion -Palpation Rationale: The nurse is correct to assess the abdomen in a specific order to be able to judge the undisturbed status of the abdominal region. Begin with inspection of the abdomen using the nurse's assessment skills. Next, auscultate the abdomen before percussing and finally palpating.

A client with peptic ulcer disease wants to know nonpharmacologic ways to prevent recurrence. Which of the following measures would the nurse recommend? Select all that apply. ***

-Smoking cessation -Avoidance of alcohol -Following a regular schedule for rest, relaxation, and meals Rationale: The likelihood of recurrence is reduced if the client avoids smoking, coffee (including decaffeinated coffee) and other caffeinated beverages, and alcohol. It is important to counsel the client to eat meals at regular times and in a relaxed setting and to avoid overeating.

A nurse is monitoring a client with peptic ulcer disease. Which assessment findings would most likely indicate perforation of the ulcer? Select all that apply.

-Tachycardia -Hypotension -A rigid, board-like abdomen Rationale: Signs and symptoms of perforation include sudden, severe upper abdominal pain (persisting and increasing in intensity); pain, which may be referred to the shoulders, especially the right shoulder, because of irritation of the phrenic nerve in the diaphragm; vomiting; collapse (fainting); extremely tender and rigid (board-like) abdomen; and hypotension and tachycardia, indicating shock. Perforation is a surgical emergency.

The nurse is providing care for a client whose peptic ulcer disease will be treated with a Billroth I procedure (gastroduodenostomy). The nurse should address which of the following topics when providing health education? Select all that apply. ***

-The procedure carries a risk for dumping syndrome -The client's vagus nerve may be altered Rationale: This surgery carries a risk for dumping syndrome and may be performed with a truncal vagotomy. Dietary modifications will be necessary but TPN is not expected. A portion of the duodenum is removed, but not the colon.

The nurse is instructing the client who was newly diagnosed with peptic ulcers. Which of the following diagnostic studies would the nurse anticipate reviewing with the client? ***

Serum antibodies for H. pylori Rationale: Helicobacter pylori, a bacterium, is believed to be responsible for the majority of peptic ulcers. Blood tests are used to determine whether there are antibodies to H. pylori in the blood. A complete blood count with differential can indicate bleeding and infection associated with a bleeding ulcer. A sigmoidoscopy assesses the lower gastrointestinal tract. Gastric analysis is more common in analyzing gastric fluid in determining problems with the secretory activity of the gastric mucosa.

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. Rationale: Metronidazole (Flagyl) should be administered with meals to decrease GI upset. The client should not stop the medication without discussing it with a prescribing healthcare provider. Crushing the medication will not help the nausea because it is the same medication.

A client with gastritis required hospital treatment for an exacerbation of symptoms and receives a subsequent diagnosis of pernicious anemia due to malabsorption. When planning the client's continuing care in the home setting, what assessment question is most relevant?

"Does anyone in your family have experience at giving injections?" Rationale: Clients with malabsorption of vitamin B12 need information about lifelong vitamin B12 injections; the nurse may instruct a family member or caregiver how to administer the injections or make arrangements for the client to receive the injections from a health care provider. Questions addressing sun exposure, blood type and first aid are not directly relevant.

A client presents at the ambulatory clinic reporting recurrent sharp stomach pain that is relieved by eating. The nurse suspects that the client may have an ulcer. How should the nurse explain the formation and role of acid in the stomach to the client?

"Hydrochloric acid is secreted by glands in the stomach in response to the actual or anticipated presence of food." Rationale: The stomach, which stores and mixes food with secretions, secretes a highly acidic fluid in response to the presence or anticipated ingestion of food. The stomach does not turn food directly into acid and the esophagus is not highly alkaline. Pancreatic enzymes are not synthesized in a highly acidic environment.

An adult client with a history of dyspepsia has been diagnosed with chronic gastritis. The nurse's health education should include what guidelines? Select all that apply. ***

-Avoid drinking alcohol -Avoid nonsteroidal anti-inflammatories Rationale: Clients with chronic gastritis are encouraged to avoid alcohol and NSAIDs. Calcium gluconate is not a common treatment and the condition is not normally treated with surgery. Dietary modifications are usually recommended, but this does not necessitate a low-residue diet.

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 Rationale: As a rule, the patient with an ulcer complains of dull, gnawing pain or a burning sensation in the mid-epigastrium or the back. Although vomiting is rare in uncomplicated peptic ulcer, it may be a symptom of a complication of an ulcer.

A client with acute gastritis asks the nurse what might have caused the problem. What is a possible cause of acute gastritis? ***

-Dietary indiscretion -Excessive alcohol intake -Radiation therapy Rationale: Possible causes of gastritis include dietary indiscretion, overuse of aspirin and other nonsteroidal anti-inflammatory drugs, excessive alcohol intake, bile reflux, and radiation therapy. Allergy medicine and fruit juices are not causes of acute gastritis.

A healthcare provider prescribes a combination of three drugs to treat reoccurring 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. Rationale: The recommended triple combination of bismuth salts, antibiotics, and proton pump inhibitors will suppress or eradicate H. pylori. Prostaglandin E1 analogs enhance mucosal resistance to injury; they do not suppress or eradicate H. pylori.

A community health nurse is preparing for an initial home visit to a client discharged following a total gastrectomy for treatment of gastric cancer. What would the nurse anticipate that the plan of care is most likely to include?

Administration of injections of vitamin B12 Rationale: Since vitamin B12 is absorbed in the stomach, the client requires vitamin B12 replacement to prevent pernicious anemia. A gastrectomy precludes the use of a G tube. Since the stomach is absent, a nasogastric tube would not be indicated. As well, this is not possible in the home setting. Since there is no stomach to act as a reservoir and fluids and nutrients are passing directly into the jejunum, distension is unlikely.

The nurse practitioner suspects that a patient may have a gastric ulcer after completing a history and physical exam. Select an indicator that can be used to help establish the distinction. ***

Amount of hydrochloric acid (HCL) secretion in the stomach Rationale: A duodenal ulcer is characterized by hypersecretion of stomach acid, whereas a gastric ulcer evidences hyposecretion of stomach acid. The other three choices have similar characteristics in both types of ulcers.

A nurse is providing health promotion education to a client diagnosed with an esophageal reflux disorder. What practice should the nurse encourage the client to implement?

Avoid carbonated drinks. Rationale: For a client diagnosed with esophageal reflux disorder, the nurse should instruct the client to keep the head of the bed elevated. Carbonated drinks, caffeine, and tobacco should be avoided. Protein limitation is not necessary.

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 Rationale: The client with a gastric ulcer often awakens between 1 to 2 AM with pain, and ingestion of food brings relief. Vomiting is uncommon in clients with duodenal ulcer. Hemorrhage is less likely in clients with duodenal ulcer than those with gastric ulcer. The client with a duodenal ulcer may experience weight gain.

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

Client with blood type O Rationale: Clients with blood type O are more susceptible to peptic ulcers than those with blood types A, B, and AB.

A client reports diarrhea after having bariatric surgery. What nonpharmacologic treatment can the nurse suggest to decrease the incidence of diarrhea?

Decrease the fat content in the diet. Rationale: Clients may complain of either diarrhea or constipation postprocedure. Diarrhea is more common an occurrence post bariatric surgery, particularly after malabsorptive procedures (Mechanick et al., 2008). Both may be prevented if the patient consumes a nutritious diet that is high in fiber. Steatorrhea also may occur as a result of rapid gastric emptying, which prevents adequate mixing with pancreatic and biliary secretions. In mild cases, reducing the intake of fat and administering an antimotility medication (e.g., loperamide [Imodium]) may control symptoms.

A client with gastric cancer has been scheduled for a total gastrectomy. During the preoperative assessment, the client confides in the nurse that she feels like she will be "mutilated by the surgery." The nurse should plan interventions that address what nursing diagnosis? ***

Deficient Knowledge related to risks and expectations of surgery Rationale: The client's choice of words ("mutilated") suggests a change in body image. This may or may not be rooted in anxiety or a lack of knowledge. It may cause an eventual reduction in self-esteem but the essence of the statement is the client's body image.

A client was treated in the emergency department and critical care unit after ingesting bleach. What possible complication of the resulting gastritis should the nurse recognize? ***

Esophageal or pyloric obstruction related to scarring Rationale: A severe form of acute gastritis is caused by the ingestion of strong acid or alkali, which may cause the mucosa to become gangrenous or to perforate. Scarring can occur, resulting in pyloric stenosis (narrowing or tightening) or obstruction. Chronic referred pain to the lower abdomen is a symptom of peptic ulcer disease, but would not be an expected finding for a client who has ingested a corrosive substance. Bacterial proliferation and hyperacidity would not occur.

An adult client is scheduled for an upper GI series that will use a barium swallow. What teaching should the nurse include when the client has completed the test?

Fluids must be increased to facilitate the evacuation of the stool. Rationale: Postprocedural client education includes information about increasing fluid intake; evaluating bowel movements for evacuation of barium; and noting increased number of bowel movements, because barium, due to its high osmolarity, may draw fluid into the bowel, thus increasing the intraluminal contents and resulting in greater output. Yellow stool, diarrhea, and anal bleeding are not expected.

A client is recovering from gastric surgery. What is the correct position for the nurse to place this client? ***

Fowler's Rationale: Placing the client in the Fowler's position after gastric surgery promotes comfort and allows emptying of the stomach.

A few hours after eating hot and spicy chicken wings, a client presents with lower chest pain. He wonders if he is having a heart attack. How should the nurse proceed first? ***

Further investigate the initial complaint. Rationale: While fatty foods can cause discomfort similar to chest pain, the nurse must fully assess all the client's symptoms. Investigation of chief complaint begins with a complete history. The underlying cause of pain influences the characteristics, duration, pattern, location, and distribution of pain.

Which diagnostic test would be used first to evaluate a client with upper GI bleeding?

Hemoglobin and hematocrit Rationale: The nurse assesses for faintness or dizziness and nausea, which may precede or accompany bleeding. It is important to monitor vital signs frequently and to evaluate for tachycardia, hypotension, and tachypnea. Other nursing interventions include monitoring the hemoglobin and hematocrit, testing the stool for gross or occult blood, and recording hourly urinary output to detect anuria or oliguria (absence of or decreased urine production). If bleeding cannot be managed by the measures described, other treatment modalities such as endoscopy may be used to halt bleeding and avoid surgical intervention. There is debate regarding how soon endoscopy should be performed. Some clinicians believe endoscopy should be performed within the first 24 hours after hemorrhaging has ceased. Others believe endoscopy may be performed during acute bleeding, as long as the esophageal or gastric area can be visualized (blood may decrease visibility). An upper GI is less accurate than endoscopy and would not reveal a bleed. Arteriography is an invasive study associated with life-threatening complications and would not be used for an initial evaluation.

Which of the following is the most common complication associated with peptic ulcer?

Hemorrhage Rationale: Hemorrhage, the most common complication, occurs in 28% to 59% of patients with peptic ulcers. Vomiting, elevated temperature, and abdominal pain are not the most common complications of a peptic ulcer.

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. Rationale: The nurse should notify the health care provider because an NG tube that fails to drain during the postoperative period may be clogged, which could increase pressure on the suture site because fluid isn't draining adequately. Repositioning or irrigating an NG tube in a client who has undergone gastric surgery can disrupt the anastomosis. Increasing the level of suction may cause trauma to GI mucosa or the suture line.

A nurse is caring for a client who is suspected to have developed a peptic ulcer hemorrhage. Which action would the nurse perform first? ***

Place the client in a recumbent position with the legs elevated. Rationale: The treatment of hemorrhage includes complete rest for the GI tract, placing the client in a recumbent position with the legs elevated to increase blood flow to vital organs, blood transfusions, and gastric lavage with saline solution. Placing an IV, checking the client's vital signs, and notifying the healthcare provider are important, but not the priority action for the nurse when a client is actively bleeding.

A nurse is preparing to discharge a client newly diagnosed with peptic ulcer disease. The client's diagnostic test results were positive for H. pylori bacteria. The health care provider has ordered the "triple therapy" regimen. Which medications will the nurse educate the client on? ***

Proton-pump inhibitor and two antibiotics Rationale: Currently, the most commonly used therapy for peptic ulcers is a combination of antibiotics, proton-pump inhibitors, and bismuth salts that suppress or eradicate H. pylori bacteria. Recommended therapy for 10 to 14 days includes triple therapy with two antibiotics (e.g., metronidazole [Flagyl] or amoxicillin [Amoxil] and clarithromycin [Biaxin]) plus a proton-pump inhibitor (e.g., lansoprazole [Prevacid], omeprazole [Prilosec], or rabeprazole [Aciphex]), or quadruple therapy with two antibiotics (metronidazole and tetracycline) plus a proton-pump inhibitor and bismuth salts (Pepto-Bismol). Research is being conducted to develop a vaccine against H. pylori.

A client has just been diagnosed with acute gastritis after presenting in distress to the emergency department with abdominal symptoms. Which of the following actions should the nurse prioritize? ***

Providing the client with physical and emotional support Rationale: For acute gastritis, the nurse provides physical and emotional support and helps the client manage the symptoms, which may include nausea, vomiting, heartburn, and fatigue. The scenario describes a newly diagnosed client; teaching about the etiology of the disease, lifestyle modifications, or various treatment options would be best provided at a later time.

The nurse is caring for a client with chronic gastritis. The nurse monitors the client knowing that this client is at risk for which vitamin deficiency?

Vitamin B12 Rationale: Clients with chronic gastritis from vitamin deficiency usually have evidence of malabsorption of vitamin B12 caused by the production of antibodies that interfere with the binding of vitamin B12 to intrinsic factor. However, some clients with chronic gastritis have no symptoms. Vitamins A, C, and E are not affected by gastritis.

Which statement correctly identifies a difference between duodenal and gastric ulcers?

Vomiting is uncommon in clients with duodenal ulcers. Rationale: Vomiting is uncommon in clients diagnosed with duodenal ulcer. Malignancy is associated with a gastric ulcer. Weight gain may occur with a duodenal ulcer. Duodenal ulcers cause hypersecretion of stomach acid.

The nurse is conducting a community education program on peptic ulcer disease prevention. The nurse includes that the most common cause of peptic ulcers is: ***

gram-negative bacteria. Rationale: The nurse should include that the most common cause of peptic ulcers is gram-negative bacteria (Helicobacter pylori).

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) Rationale: For patients with ZES, hypersecretion of acid may be controlled with high doses of H2 receptor antagonists. These clients may require twice the normal dose, and dosages usually need to be increased with prolonged use. Octreotide (Sandostatin), a medication that suppresses gastrin levels, also may be prescribed.

The nurse is admitting a client whose medication regimen includes regular injections of vitamin B12. The nurse should question the client about a history of:

total gastrectomy Rationale: If a total gastrectomy is performed, injection of vitamin B12 will be required for life, because intrinsic factor, secreted by parietal cells in the stomach, binds to vitamin B12 so that it may be absorbed in the ileum. Bariatric surgery, diverticulitis and GERD do not necessitate total gastrectomy and subsequent vitamin B12 supplementation.

The nurse recognizes which change of the GI system is an age-related change?

weakened gag reflex Rationale: A weakened gag reflex is an age-related change of the GI system. There is decreased motility, atrophy of the small intestine, and decreased mucus secretion.