Chapter 47: Management of Patients With Gastric and Duodenal Disorders

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? a) 2.5 L b) 1.5 L c) 1.0 L d) 2.0 L

b) 1.5 L 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).

When evaluating a client for complications of acute pancreatitis, the nurse should observe for: a) increased intracranial pressure. b) decreased urine output. c) hypertension. d) bradycardia.

b) decreased urine output. Acute pancreatitis can cause decreased urine output, which results from the renal failure that sometimes accompanies this condition. Intracranial pressure neither increases nor decreases in a client with pancreatitis. Tachycardia, not bradycardia, usually is associated with pulmonary or hypovolemic complications of pancreatitis. Hypotension can be caused by a hypovolemic complication, but hypertension usually isn't related to acute pancreatitis.

The nurse is educating a patient about the discharge medication. When should the nurse instruct the patient to take the antacid medication? a) 30 minutes before the meal b) Immediately after the meal c) 1 to 3 hours after the meal d) With the meal

c) 1 to 3 hours after the meal In addition, an effort is made to neutralize acid by eating three regular meals a day. Small, frequent feedings are not necessary as long as an antacid or a histamine blocker is taken.

The nurse is conducting preoperative teaching to a patient prior to bariatric surgery. The nurse includes that the average weight loss of patients after bariatric surgery is which percent of their presurgical body weight? a) 15 to 25% b) 5 to 15% c) 25 to 35% d) 35 to 45%

c) 25 to 35% The nurse includes that the average weight loss of a patients after bariatric surgery is 25 to 35% of their presurgical body weight.

The nurse is conducting an admission assessment and determines that the patient's BMI is 37. The nurse documents the BMI as being which of the following classes of obesity? a) Class III b) Class I c) Class II d) Overweight

c) Class II The nurse documents the BMI of 37 as class II obesity (BMI 35 to 40).The other classifications are as follows: overweight (BMI 25 to 30); class I (BMI 30 to 35); class III (BMI > 40).

The nurse is educating a patient with peptic ulcer disease about the disease process. What decreases the secretion of bicarbonate from the pancreas into the duodenum, resulting in increased acidity of the duodenum? a) Smoking b) Eating spicy foods c) Drinking carbonated beverages d) Taking antacids

c) Drinking carbonated beverages The intent of dietary modification for patients with peptic ulcers is to avoid oversecretion of acid and hypermotility in the GI tract. These can be minimized by avoiding extremes of temperature in food and beverages and overstimulation from the consumption of alcohol, coffee (including decaffeinated coffee, which also stimulates acid secretion), and other caffeinated beverages.

A client with acute gastritis asks the nurse what might have caused the problem. Which of the following are possible causes? a) Overuse of allergy medicine b) Drinking fruit juices c) Excessive alcohol intake d) Radiation therapy e) Dietary indiscretion

c) Excessive alcohol intake d) Radiation therapy e) Dietary indiscretion 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.

Which of the following is included as a dietary guideline for a patient who has had bariatric surgery? a) Eat four small meals a day. b) Limit soda to 1 can per day. c) Restrict total meal size to less than 1 cup. d) Make sure to drink liquids while eating.

c) Restrict total meal size to less than 1 cup. Dietary guidelines would include a restriction of total meal size to less than 1 cup. The patient should eat three meals per day. Avoid liquid calories such as soda. The patient should drink plenty of water, from 90 minutes after each meal to 15 minutes before the next meal.

A nurse practitioner is considering pharmacological treatment options for a client with gastritis. Which of the following might limit the use of metronidazole (Flagyl) for this client? Select all that apply. a) Diet high in dairy products b) Occupation as a landscape architect c) History of alcoholism d) Allergy to penicillin e) Current use of warfarin (Coumadin)

a) Diet high in dairy products c) History of alcoholism e) Current use of warfarin (Coumadin) Clients who take metronidazole (Flagyl) should avoid alcohol. Flagyl also increases the blood-thinning effects of warfarin (Coumadin). Amoxicillin (Amoxil) is contraindicated in clients allergic to penicillin. A diet high in dairy products would limit the use of metronidazole (Flagyl). Tetracylcine might be problematic for those who work outdoors, because it can impose a photosensitivity reaction--clients taking it would need to use sunscreen.

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. a) Diluted vinegar b) Gastric lavage c) Diluted lemon juice d) Syrup of ipecac e) Aluminum hydroxide

a) Diluted vinegar c) Diluted lemon juice 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.

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? a) Nothing by mouth b) Regular diet c) Skim milk d) Clear liquids

a) Nothing by mouth Shock and bleeding must be controlled before oral intake, so the client should receive nothing by mouth. When the bleeding is controlled, the diet is gradually increased, starting with ice chips and then clear liquids. Skim milk shouldn't be given because it increases gastric acid production, which could prolong bleeding. A clear liquid diet is the first diet offered after bleeding and shock are controlled.

A client is recovering from gastric surgery. Toward what goal should the nurse progress the client's enteral intake? a) Six small meals daily with 120 mL fluid between meals b) Six small meals and 120 mL fluid daily c) Three meals and three snacks and 120 mL fluid daily d) Three meals and 120 ml fluid daily

a) Six small meals daily with 120 mL fluid between meals 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.

The nurse is aware that hemorrhage is a common complication of peptic ulcer disease. Therefore, assessment for indicators of bleeding is an important nursing responsibility. Which of the following are indicators of bleeding? Select all that apply. a) Thirst b) Polyuria c) Bradycardia d) Mental confusion e) Tachypnea f) Melena

a) Thirst d) Mental confusion e) Tachypnea f) Melena Tachycardia and oliguria would be present with bleeding as the body tries to compensate for blood loss.

A client reports to the clinic, stating that she rapidly developed headache, abdominal pain, nausea, hiccuping, and fatigue about 2 hours ago. For dinner, she ate buffalo chicken wings and beer. Which of the following medical conditions is most consistent with the client's presenting problems? a) Duodenal ulcer b) Acute gastritis c) Gastric cancer d) Gastric ulcer

b) Acute gastritis The client with acute gastritis may have a rapid onset of symptoms, including abdominal discomfort, headache, lassitude, nausea, anorexia, vomiting, and hiccuping, which can last from a few hours to a few days. Acute gastritis is often caused by dietary indiscretion--a person eats food that is irritating, too highly seasoned, or contaminated with disease-causing microorganisms.

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 a) omeprazole (Prilosec) b) octreotide (Sandostatin) c) ranitidine (Zantac) d) vasopressin (Pitressin)

b) octreotide (Sandostatin) 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.

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) The vagus nerve is cut and gastric drainage is established. b) A sectioned portion of the stomach is joined to the jejunum. c) A partial gastrectomy is performed with anastomosis of the stomach segment to the duodenum. d) The antral portion of the stomach is removed and a vagotomy is performed.

c) A partial gastrectomy is performed with anastomosis of the stomach segment to the duodenum. A 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. The remaining segment is anastomosed to the duodenum.

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. a) Sensitivity to the use of nonsteroidal anti-inflammatory drugs (NSAIDs) b) Presence of H. pylori c) Amount of hydrochloric acid (HCL) secretion in the stomach d) Patient's age

c) Amount of hydrochloric acid (HCL) secretion in the stomach 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.

Which of the following surgical procedures for obesity utilizes a prosthetic device to restrict oral intake? a) Roux-en-Y gastric bypass b) Vertical-banded gastroplasty c) Gastric banding d) Biliopancreatic diversion with duodenal switch

c) Gastric banding In gastric banding, a prosthetic device is used to restrict oral intake by creating a small pouch of 10 to 15 milliliters that empties through the narrow outlet into the remainder of the stomach. Roux-en-Y gastric bypass uses a horizontal row of staples across the fundus of the stomach to create a pouch with a capacity of 20 to 30 mL. Vertical-banded gastroplasty involves placement of a vertical row of staples along the lesser curvature of the stomach, creating a new, small gastric pouch. Biliopancreatic diversion with duodenal switch combines gastric restriction with intestinal malabsorption.

Which diagnostic test is used first to evaluate a client with upper GI bleeding? a) Endoscopy b) Upper GI series c) Hemoglobin levels and hematocrit (HCT) d) Arteriography

c) Hemoglobin levels and hematocrit (HCT) Hemoglobin and HCT are typically performed first in clients with upper GI bleeding to evaluate the extent of blood loss. Endoscopy is then performed to directly visualize the upper GI tract and locate the source of bleeding. An upper GI series, or barium study, usually isn't the diagnostic method of choice, especially in a client with acute active bleeding who's vomiting and unstable. An upper GI series is also less accurate than endoscopy. Although an upper GI series might confirm the presence of a lesion, it wouldn't necessarily reveal whether the lesion is bleeding. Arteriography is an invasive study associated with life-threatening complications and wouldn't be used for an initial evaluation.

The nurse in the ED admits a patient with suspected gastric outlet obstruction. The patient's symptoms include nausea and vomiting. The nurse anticipates that the physician will issue which of the following orders? a) Stool specimen b) Pelvic x-ray c) Nasogastric (NG) tube insertion d) Oral contrast

c) Nasogastric (NG) tube insertion The nurse anticipates an order for NG tube insertion to decompress the stomach. Pelvic x-ray, oral contrast, and stool specimens are not indicated at this time.

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? a) Increase the suction level. b) Reposition the tube. c) Notify the physician. d) Irrigate the tube.

c) Notify the physician. The nurse should notify the physician 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.

Which of the following medications used for obesity improves cardiovascular disease risk factors in obese patients with metabolic syndrome? a) Alli b) Sibutramine (Meridia) c) Rimonabant (Acomplia) d) Orlistat (Xenical)

c) Rimonabant (Acomplia) Acomplia is the newest medication used to treat obesity. It stimulates weight reduction and improves cardiovascular disease risk factors in obese patients with metabolic syndrome. Meridia was recently pulled from the market because of the increased risk of heart attack and stroke associated with this medication. Orlistat, available by prescription and over the counter as Alli, reduces caloric intake by binding to gastric and pancreatic lipase to prevent digestion of fats.

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 of the following explanations from the nurse would be most accurate? a) "Caffeine intake can cause tears in your esophagus and intestines, which can lead to hemorrhage." b) "Caffeine can interfere with absorption of vitamin B12, which leads to anemia and further digestive problems." c) "Caffeine increases the fluid volume in your system, which irritates your digestive organs." d) "Caffeine stimulates the central nervous system and thus gastric activity and secretions, which need to be minimized to promote recovery."

d) "Caffeine stimulates the central nervous system and thus gastric activity and secretions, which need to be minimized to promote recovery." Caffeine is a central nervous system stimulant that increases gastric activity and pepsin secretion. Caffeine is a diuretic that causes decreased fluid volume and potential dehydration. It does not lead to hemorrhage and does not interfere with absorption of vitamin B12.

The nurse is preparing the discharge of a client who is newly diagnosed with a duodenal ulcer. His diagnostic tests were negative for H. pylori. A prescription for Pepcid is included in the discharge instructions. The nurse will instruct the client that the duration of treatment with this drug for duodenal ulcers is for how long? a) 4 weeks b) 8 weeks c) 10 days d) 6 weeks

d) 6 weeks Histamine-2 (H2) receptor antagonists and proton-pump inhibitors are used to treat NSAID-induced and other ulcers not associated with H. pylori infection. H2-receptor antagonists should be used for 6 weeks for duodenal ulcer and 8 weeks for gastric ulcers. H2-receptor antagonists decrease the amount of HCL produced by the stomach by blocking action of histamine on histamine receptors of potential cells in the stomach.

A physician has written an order for ranitidine (Zantac), 300 mg once daily. The nurse schedules the medication for which time? a) Before breakfast b) With supper c) After lunch d) At bedtime

d) At bedtime 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 (eg, metronidazole [Flagyl] or amoxicillin [Amoxil] and clarithromycin [Biaxin]) plus a proton-pump inhibitor (eg, 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.

Which of the following is the most common complication associated with peptic ulcer? a) Abdominal pain b) Hemorrhage c) Vomiting d) Elevated temperature

b) Hemorrhage 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 is considering bariatric surgery in the hopes of achieving long-term weight loss. Which of the following surgical procedures would the nurse be most likely to discuss with this client? a) Biliopancreatic diversion b) Roux-en-Y c) Gastric banding d) Vertical-banded gastroplasty

b) Roux-en-Y The Roux-en-Y gastric bypass is recommended for long-term weight loss. It is a combined restrictive and malabsorptive procedure.

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? a) Stomach b) Pylorus c) Duodenum d) Esophagus

c) Duodenum Peptic ulcers occur mainly in the gastroduodenal mucosa because this tissue cannot withstand the digestive action of gastric acid (HCl) and pepsin.

The nurse recognizes that the patient diagnosed with a duodenal ulcer will likely experience a) vomiting. b) weight loss. c) hemorrhage. d) pain 2 to 3 hours after a meal.

d) pain 2 to 3 hours after a meal. The patient with a gastric ulcer often awakens between 1 to 2 with pain, and ingestion of food brings relief. Vomiting is uncommon in the patient with duodenal ulcer. Hemorrhage is less likely in the patient with duodenal ulcer than the patient with gastric ulcer. The patient with a duodenal ulcer may experience weight gain.

Which of the following interventions are appropriate for clients with gastritis? Select all that apply. a) Discourage cigarette smoking. b) Notify the physician of indicators of hemorrhagic gastritis. c) Use a calm approach to reduce anxiety. d) Give the client food and fluids every 4 hours. e) Provide general education about how to prevent recurrences.

a) Discourage cigarette smoking. c) Use a calm approach to reduce anxiety. e) Provide general education about how to prevent recurrences. 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.

Which of the following is a true statement regarding gastric cancer? a) Women have a higher incidence of gastric cancer. b) Most cases are discovered prior to metastasis. c) The prognosis for gastric cancer is good. d) Most patients are asymptomatic during the early stage of the disease.

d) Most patients are asymptomatic during the early stage of the disease. Most patients are asymptomatic during the early stage of the disease. Men have a higher incidence of gastric cancer. The prognosis is poor because the diagnosis is usually made late because most patients are asymptomatic during the early stage. Most cases of gastric cancer are discovered only after local invasion has advanced or metastases are present.

Which of the following clients is at highest risk for peptic ulcer disease? a) Client with blood type B b) Client with blood type A c) Client with blood type AB d) Client with blood type O

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

The nurse is caring for a patient after bariatric surgery who experiences symptoms of gastric outlet obstruction. Which of the following are contraindicated? a) Surgical revision b) Balloon dilation c) Endoscopic procedure d) NG tube

d) NG tube NG tube insertion is contraindicated in patients who have had bariatric surgery. Alternative treatment options include endoscopic procedures, balloon dilation, and/or surgical revision.

A client with peptic ulcer disease must begin triple medication therapy. For how long will the client follow this regimen? a) 10 to 14 days b) 7 to 9 days c) 15 to 20 days d) 4 to 6 days

a) 10 to 14 days Recommended therapy for 10 to 14 days includes triple therapy with two antibiotics (eg, metronidazole [Flagyl] or amoxicillin [Amoxil] and clarithromycin [Biaxin]) plus a proton pump inhibitor (eg, 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).

A client with gastric cancer is having a resection. What is the nursing management priority for this client? a) Teaching about radiation treatment b) Preventing deep vein thrombosis (DVT) c) Correcting nutritional deficits d) Discharge planning

c) Correcting nutritional deficits 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 of the following would be the highest priority, immediate nursing intervention for a client just diagnosed with acute gastritis? a) Providing physical and emotional support b) Recommending bed rest c) Advising the client not to smoke d) Educating the client regarding nutrition

a) Providing physical and emotional support For the client with newly diagnosed acute gastritis, the priority nursing interventions are to provide physical and emotional support and help manage symptoms, which may include nausea, vomiting, heartburn, and fatigue. Teaching regarding nutrition and smoking cessation would be longer-term interventions, not immediate foci. Also, the nurse would not recommend bed rest.

Which of the following dietary guidelines should be followed following bariatric surgery? Select all that apply. a) Eat slowly. b) Eat three meals per day. c) Eat and drink at the same time. d) Total meal size should be 1 cup. e) Include two protein snacks per day.

a) Eat slowly. b) Eat three meals per day. e) Include two protein snacks per day. Dietary guidelines for the patient who has had bariatric surgery include eating slowly, eating three meals per day, and including two protein snacks per day. The patient should avoid eating and drinking at the same time and his or her total meal size should be less than 1 cup.

The client has been taking famotidine (Pepcid) at home. The nurse prepares a teaching plan for the client indicating that the medication acts primarily to achieve which of the following? a) Inhibit gastric acid secretions. b) Neutralize acid in the stomach. c) Improve the mixing of foods and gastric secretions. d) Shorten the time required for digestion in the stomach.

a) Inhibit gastric acid secretions. Famotidine is useful for treating and preventing ulcers and managing gastroesophageal reflux disease. It functions by inhibiting the action of histamine at the H-2 receptor site located in the gastric parietal cells, thus inhibiting gastric acid secretion.

A nurse is caring for a client who underwent a subtotal gastrectomy. To manage dumping syndrome, the nurse should advise the client to: a) drink liquids only with meals. b) restrict fluid intake to 1 qt (1,000 ml)/day. c) don't drink liquids 2 hours before meals. d) drink liquids only between meals.

d) drink liquids only between meals. A client who experiences dumping syndrome after a subtotal gastrectomy should be advised to ingest liquids between meals rather than with meals. Taking fluids between meals allows for adequate hydration, reduces the amount of bulk ingested with meals, and aids in the prevention of rapid gastric emptying. There is no need to restrict the amount of fluids, just the time when the client drinks fluids. Drinking liquids with meals increases the risk of dumping syndrome by increasing the amount of bulk and stimulating rapid gastric emptying. Small amounts of water are allowable before 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. The nurse suspects: a) Peritonitis b) Dehiscence of the surgical wound c) Vasomotor symptoms associated with dumping syndrome d) A normal reaction to surgery

c) Vasomotor symptoms associated with 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. Dehiscence of the surgical wound is characterized by pain and a pulling or popping feeling at the surgical site. Peritonitis presents with a rigid, boardlike abdomen, tenderness, and fever. The client's signs and symptoms aren't a normal reaction to surgery.

A patient is scheduled for removal of the lower portion of the antrum of the stomach and a small portion of the duodenum and pylorus. What is the name of this surgical procedure for peptic ulcer disease? a) Billroth I b) Vagotomy c) Pyloroplasty d) Billroth II

a) Billroth I A Billroth I is a gastroduodenostomy. Refer to Table 23-4 in the text for a comparison of the four types of peptic ulcer surgery.

The health care provider prescribes a combination of three drugs to treat peptic ulcer disease. The nurse, preparing to review the drug actions and side effects with the patient, understands that the triple combination should be in which of the following order? a) Bismuth salts, antibiotics, and proton pump inhibitors b) Proton pump inhibitors, prostaglandin E1 analogs, and bismuth salts c) Antibiotics, prostaglandin E1 analogs, and bismuth salts d) Prostaglandin E1 analogs, antibiotics, and proton pump inhibitors

a) Bismuth salts, antibiotics, and proton pump inhibitors Refer to Table 23-1 in the text to review the recommended triple combination.

The nurse reviews dietary guidelines with a patient who had a gastric banding. Which of the following teaching points are included? Select all that apply. a) Limit meal size to 450 to 500 mL. b) Avoid fruit drinks and soda. c) Do not eat and drink at the same time. d) Eat six meals a day. e) Drink plenty of water, from 90 minutes after each meal to 15 minutes before each meal.

b) Avoid fruit drinks and soda. c) Do not eat and drink at the same time. e) Drink plenty of water, from 90 minutes after each meal to 15 minutes before each meal. Total meal size should be restricted to less than 8 oz or 240 mL. Three meals a day are recommended. Refer to Box 23-2 in the text.

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

c) The incidence of cancer of the stomach continues to decrease in the United States. While the incidence continues to decrease, gastric cancer still accounts for 12,800 deaths annually. While gastric cancer deaths occasionally occur in younger people, most occur in people older than 40 years of age. Males have a higher incidence of gastric cancers than females. More accurately, a diet high in smoked foods and low in fruits and vegetables may increase the risk of gastric cancer.

After teaching a client who has had a Roux-en-Y gastric bypass, which client statement indicates the need for additional teaching? a) "I should pick cereals with less than 2 g of fiber per serving." b) "A total serving should amount to be less than one cup." c) "I need to chew my food slowly and thoroughly." d) "I need to drink 8 ounces of water before eating."

d) "I need to drink 8 ounces of water before eating." After a Roux-en-Y gastric bypass, the client should not drink fluids with meals, withholding fluids for 15 minutes before eating to 90 minutes after eating. Chewing foods slowly and thoroughly, keeping total serving sizes to less than 1 cup, and choosing foods such as breads, cereals, and grains that provide less than 2 g of fiber per serving.