nurs327 chapter 46
Which of the following interventions are appropriate for clients with gastritis? Select all that apply.
Use a calm approach to reduce anxiety. Discourage cigarette smoking. Notify the physician of inidicators of hemorrhagic gastritis. Explanation: The nurse should use a calm approach when answering questions and providing teaching. He or she should discuss smoking cessation and monitor for any indicators of hemorrhagic gastritis. The client will take nothing by mouth for up to a few days until symptoms subside. The nurse needs to develop an individualized teaching plan for the client that includes information about stress management, diet, and medications.
During assessment of a patient with gastritis, the nurse practitioner attempts to distinguish acute from chronic pathology. One criteria, characteristic of gastritis would be the:
Immediacy of the occurrence. Explanation: Acute gastritis usually develops quickly, whereas chronic gastritis results from prolonged inflammation of the stomach.
The nurse advises the patient who has just been diagnosed with acute gastritis to:
Refrain from food until the GI symptoms subside. Explanation: It usually takes 24 to 48 hours for the stomach to recover from an attack. Refraining from food until symptoms subside is recommended, but liquids should be taken in moderation. Emetics and vomiting can cause damage to the esophagus.
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." Explanation: Tetracycline may cause a photosensitivity reaction in clients. The nurse should caution the client to use sunscreen when taking this drug. Dairy products can reduce the effectiveness of tetracycline, so the nurse should not advise him or her to take the medication with milk. A metallic taste accompanies administration of metronidazole (Flagyl). Administration of tetracycline does not necessitate driving restrictions.
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." Explanation: 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. 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.
The nurse is caring for a patient who has been diagnosed with gastritis. To promote fluid balance when treating gastritis, the nurse knows that what minimal daily intake of fluids is required?
1.5 L Explanation: Daily fluid intake and output are monitored to detect early signs of dehydration (minimal fluid intake of 1.5 L/day, minimal output of 0.5 mL/kg/h).
A client with gastric cancer is having a resection. What is the nursing management priority for this client?
Correcting nutritional deficits Explanation: Clients with gastric cancer commonly have nutritional deficits and may have cachexia. Therefore, correcting nutritional deficits is a top priority. Discharge planning before surgery is important, but correcting the nutritional deficits is a higher priority. Radiation therapy hasn't been proven effective for gastric cancer, and teaching about it preoperatively wouldn't be appropriate. Preventing DVT isn't a high priority before surgery, but it assumes greater importance after surgery.
Which ulcer is associated with extensive burn injury?
Curling ulcer Explanation: Curling ulcer is frequently observed about 72 hours after extensive burns and involves the antrum of the stomach or the duodenum.
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. Explanation: Total meal size should be restricted to less than 8 oz or 240 mL. Three meals a day are recommended.
Clients with Type O blood are at higher risk for which of the following GI disorders?
Duodenal ulcers Explanation: Familial tendency also may be a significant predisposing factor. People with blood type O are more susceptible to peptic ulcers than are those with blood type A, B, or AB. Blood type is not a predisposing factor for gastric cancer, esophageal varices, and diverticulitis.
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) Explanation: Misoprostol (Cytotec) is a synthetic prostaglandin that protects the gastric mucosa against ulceration and is used in clients who take NSAIDs. Misoprostol should be taken with food. It does not improve emptying of the stomach, and it increases (not decreases) mucus production.
A client with active schizophrenia has developed acute gastritis after ingesting a strongly alkaline solution during a psychotic episode. Corrosion is extensive. Which of the following emergency treatments might the team working with this client use? Select all that apply.
Diluted lemon juice Diluted vinegar Explanation: Emergency treatment consists of diluting and neutralizing the offending agent. To neutralize acids, common antacids (eg, aluminum hydroxide) are used; to neutralize an alkali, diluted lemon juice or diluted vinegar is used. If corrosion is extensive or severe, emetics such as syrup of ipecac and lavage are avoided because of the danger of perforation and damage to the esophagus
Which medication is classified as a histamine-2 receptor antagonist?
Famotidine Explanation: Famotidine is a histamine-2 receptor antagonist. Lansoprazole and esomeprazole are proton pump inhibitors (PPIs). Metronidazole is an antibiotic
Which medication is classified as a histamine-2 receptor antagonist?
Famotidine Explanation: Famotidine is a histamine-2 receptor antagonist. Lansoprazole and esomeprazole are proton pump inhibitors (PPIs). Metronidazole is an antibiotic.
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 Explanation: Peptic ulcers occur mainly in the gastroduodenal mucosa because this tissue cannot withstand the digestive action of gastric acid (HCl) and pepsin.
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 Explanation: Hemorrhage, the most common complication, occurs in 10% to 20% of clients with peptic ulcers. Bleeding may be manifested by hematemesis or melena. Perforation is erosion of the ulcer through the gastric serosa into the peritoneal cavity without warning. Intractable ulcer refers to one that is hard to treat, relieve, or cure. Pyloric obstruction, also called gastric outlet obstruction (GOO), occurs when the area distal to the pyloric sphincter becomes scarred and stenosed from spasm or edema or from scar tissue that forms when an ulcer alternately heals and breaks down.
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 Explanation: The nurse understands that agitation, along with confusion and restlessness, may be the only signs/symptoms seen of gastric cancer in the older client. Abdominal mass, hepatomegaly, and ascites may all be signs/symptoms of advanced gastric cancer.
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 Explanation: Phentermine, which requires a prescription, stimulates central noradrenergic receptors, causing appetite suppression. It may increase blood pressure and should not be taken by people with a history of heart disease, uncontrolled hypertension, hyperthyroidism, or glaucoma.
Symptoms associated with pyloric obstruction include all of the following except:
Diarrhea Explanation: Pyloric obstruction, also called gastric outlet obstruction (GOO), occurs when the area distal to the pyloric sphincter becomes scarred and stenosed from spasm or edema or from scar tissue that forms when an ulcer alternately heals and breaks down. The client may have nausea and vomiting, constipation, epigastric fullness, anorexia, and, later, weight loss.
Which diagnostic test would be used first to evaluate a client with upper GI bleeding?
Hemoglobin and hematocrit Explanation: 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 are characteristics associated with the Zollinger-Ellison syndrome (ZES)? Select all that apply.
Severe peptic ulcers Extreme gastric hyperacidity Gastrin-secreting tumors of the pancreas Explanation: ZES consists of severe peptic ulcers, extreme gastric hyperacidity, and gastrin-secreting benign or malignant tumors of the pancreas. Diarrhea and steatorrhea may be evident. The client may have co-existing parathyroid adenomas or hyperplasia and may therefore exhibit signs of hypercalcemia.
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 Explanation: After the return of bowel sounds and removal of the nasogastric tube, the nurse may give fluids, followed by food in small portions. Foods are gradually added until the client can eat six small meals a day and drink 120 mL of fluid between meals.
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 Explanation: 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.