Prep U-Chapter 46: Management of Patients With Gastric and Duodenal Disorders

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? - Bile reflux -Dumping syndrome -Gastric outlet obstruction -Celiac disease

Dumping syndrome

A client is prescribed tetracycline to treat peptic ulcer disease. Which instruction would the nurse give the client? - "Take the medication with milk." -"Expect a metallic taste when taking this medicine, which is normal." -"Do not drive when taking this medication." -"Be sure to wear sunscreen while taking this medicine."

"Be sure to wear sunscreen while taking this medicine." :Tetracycline may cause a photosensitivity reaction in clients

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.) -"Is it possible that you are overusing aspirin." -"You may have ingested some irritating foods." - "It can be caused by ingestion of strong acids." -"It is probably your nerves." -"It is a hereditary disease."

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

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 -44.9 -24.8 -19.5

32.7 :Using the formula for BMI, the client's weight in pounds (215) is divided by the height in inches squared (68 inches squared) and then multiplied by 703.

Clients with Type O blood are at higher risk for which of the following GI disorders? -Gastric cancer -Diverticulitis -Duodenal ulcers -Esophageal varices

Acute gastritis :caused by dietary indiscretion—a person eats food that is irritating, too highly seasoned, or contaminated with disease-causing microorganisms.

Which ulcer is associated with extensive burn injury?

Curling ulcer :Curling ulcer is frequently observed about 72 hours after extensive burns and involves the antrum of the stomach or the duodenum.

A patient 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 patient? -Meckel's ulcer -Curling's ulcer -Esophageal ulcer -Peptic ulcer

Curling's ulcer

Which of the following appears to be a significant factor in the development of gastric cancer? -Age -Ethnicity -Gender -Diet

Diet :Diet seems to be a significant factor: a diet high in smoked, salted, or pickled foods and low in fruits and vegetables may increase the risk of gastric cancer. The typical patient with gastric cancer is between 50 and 70 years of age. Men have a higher incidence than women. Native Americans, Hispanic Americans, and African Americans are twice as likely as Caucasian Americans to develop gastric cancer.

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 -Bradycardia -Polyuria -Hypertension

Hematemesis

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 increases the fluid volume in your system, which irritates your digestive organs." -"Caffeine stimulates the central nervous system and thus gastric activity and secretions, which need to be minimized to promote recovery." -"Caffeine intake can cause tears in your esophagus and intestines, which can lead to hemorrhage." -"Caffeine can interfere with absorption of vitamin B12, which leads to anemia and further digestive problems."

"Caffeine stimulates the central nervous system and thus gastric activity and secretions, which need to be minimized to promote recovery."

A patient is scheduled for a Billroth I procedure for ulcer management. What does the nurse understand will occur when this procedure is performed? -The antral portion of the stomach is removed and a vagotomy is performed. -A partial gastrectomy is performed with anastomosis of the stomach segment to the duodenum. -The vagus nerve is cut and gastric drainage is established. - A sectioned portion of the stomach is joined to the jejunum.

A partial gastrectomy is performed with anastomosis of the stomach segment to the duodenum. :Billroth I procedure involves removal of the lower portion of the antrum of the stomach (which contains the cells that secrete gastrin) as well as a small portion of the duodenum and pylorus.

Symptoms associated with pyloric obstruction include all of the following except: - Diarrhea -Epigastric fullness -Anorexia -Nausea and vomiting

Diarrhea :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.

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? -Weight loss -Vomiting -Awakening in pain -Hemorrhage

Awakening in pain

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

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 -Celiac disease -Bile reflux -Gastric outlet obstruction

Dumping syndrome :Dumping syndrome is an unpleasant set of vasomotor and GI symptoms that occur in up to 76% of patients who have had bariatric surgery

A nurse is providing follow-up teaching at a clinic visit for a client recovering from gastric resection. The client reports sweating, diarrhea, nausea, palpitations, and the desire to lie down 15 to 30 minutes after meals. Based on the client's assessment, what will the nurse suspect? -A normal reaction to surgery -Peritonitis -Dumping syndrome -Dehiscence of the surgical wound

Dumping syndrome :Early manifestations of dumping syndrome occur 15 to 30 minutes after eating. Signs and symptoms include vertigo, tachycardia, syncope, sweating, pallor, palpitations, diarrhea, nausea, and the desire to lie down.

Which is an accurate statement regarding gastric cancer? - Females have a higher incidence of gastric cancers than males. -The incidence of stomach cancer continues to decrease in the United States. -Most gastric cancer-related deaths occur in people younger than 40 years. -A diet high in smoked foods and low in fruits and vegetables may decrease the risk of gastric cancer.

Duodenal ulcers

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? - Pyloric obstruction -Perforation -Penetration -Hemorrhage

Hemorrhage :Signs of hemorrhage following surgery include cool skin, confusion, increased heart rate, labored breathing, and blood in the stool

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 = 132 lbs; weight = 184 lbs; BMI = 28 kg/m2 -IBW = 150 lbs; weight = 190 lbs; BMI = 26 kg/m2 -IBW = 175 lbs; weight = 265 lbs; BMI = 29 kg/m2 -IBW = 145 lbs; weight = 290 lbs; BMI = 31 kg/m2

IBW = 145 lbs; weight = 290 lbs; BMI = 31 kg/m2 :The criteria for morbid obesity are a body weight that is twice IBW and a BMI that exceeds 30 kg/m2.

A nurse is teaching a group of middle-aged men about peptic ulcers. When discussing risk factors for peptic ulcers, the nurse should mention: -Women have a higher incidence of gastric cancer. -Most clients are asymptomatic during the early stage of the disease. -The prognosis for gastric cancer is good. -Most cases are discovered before metastasis.

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

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? - Pelvic x-ray -Nasogastric tube insertion -Stool specimen -Oral contrast

Nasogastric tube insertion

Which medication classification represents a proton (gastric acid) pump inhibitor? -Metronidazole -Omeprazole -Famotidine -Sucralfate

Omeprazole :Omeprazole decreases gastric acid by slowing the hydrogen-potassium adenosine triphosphatase pump on the surface of the parietal cells -Sucralfate is a cytoprotective drug. -Famotidine is a histamine-2 receptor antagonist. -Metronidazole is an antibiotic, specifically an amebicide.

The nurse is conducting a community education class on gastritis. The nurse includes that chronic gastritis caused by Helicobacter pylori is implicated in which disease/condition? - Pernicious anemia -Systemic infection -Colostomy -Peptic ulcers

Peptic ulcers :Chronic gastritis caused by Helicobacter pylori is implicated in the development of peptic ulcers

A client is in the hospital for the treatment of peptic ulcer disease. The client reports vomiting and a sudden severe pain in the abdomen. The nurse then assesses a board-like abdomen. What does the nurse suspect these symptoms indicate? - Ineffective treatment for the peptic ulcer -Perforation of the peptic ulcer -Gastric penetration -A reaction to the medication given for the ulcer

Perforation of the peptic ulcer

Which of the following is the most successful treatment for gastric cancer? -Removal of the tumor -Palliation -Chemotherapy -Radiation

Removal of the tumor :If the tumor can be removed while it is still localized to the stomach, the patient may be cured.

A health care provider counsels a client about bariatric surgery and recommends the Roux-en-Y gastric bypass. What is the best response by the nurse to further explain this procedure to the client? - Separation of the jejunum with an anastomosis -Gastric banding that incorporates a prosthetic device to restrict oral intake -Gastroplasty with a vertical band allowing for a pouch with a 15 to 20 mL capacity -Biliopancreatic diversion with a duodenal switch

Separation of the jejunum with an anastomosis :The Roux-en-Y gastric bypass is recommended for long-term weight loss because it uses a combined restrictive and malabsorptive procedure.

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 -Six small meals and 120 mL fluid daily -Three meals and 120 ml fluid daily -Three meals and three snacks and 120 mL fluid daily

Six small meals daily with 120 mL fluid between meals

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 -A normal reaction to surgery -Dehiscence of the surgical wound -Peritonitis

Vasomotor symptoms associated with dumping syndrome

A nurse is teaching a group of middle-aged men about peptic ulcers. When discussing risk factors for peptic ulcers, the nurse should mention: -a history of hemorrhoids and smoking. -a sedentary lifestyle and smoking. -alcohol abuse and a history of acute renal failure. -alcohol abuse and smoking.

alcohol abuse and smoking. :nurse should mention that risk factors for peptic (gastric and duodenal) ulcers include alcohol abuse, smoking, and stress.

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 initial appropriate action by the nurse? - Notify the health care provider. -Assess the client's abdomen and vital signs. -Place the client in the high-Fowler's position. -Irrigate the client's NG tube.

Assess the client's abdomen and vital signs.

Which of the following clients is at highest risk for peptic ulcer disease? -Client with blood type B -Client with blood type O -Client with blood type AB -Client with blood type A

Client with blood type O