Medsurg 55 & 60
Which disorder in older adults may have a direct association with mucosa-associated lymphoid tissue (MALT) lymphoma? 1 Uremia 2 Crohn's disease 3 Atrophic gastritis 4 Graft versus host disease
Atrophic gastritis Atrophic gastritis is a form of chronic gastritis often found in older adults that can lead to gastric cancer and MALT lymphoma. Uremia, Crohn's disease, and graft versus host disease are systemic disorders that can precipitate chronic gastritis.
Which nutrient supplement should be taken by the patient with swollen, bleeding gums? 1 Protein 2 Folic acid 3 Vitamin A 4 Vitamin C
Vitamin C
The endoscopy of a patient reveals a reddened and thick mucosal membrane around the stomach with prominent rugae. What condition does the patient have? 1 Acute gastritis 2 Atrophic gastritis 3 Type A chronic gastritis 4 Type B chronic gastritis
Acute Gastritis In acute gastritis, the gastric mucosa becomes red and thickened with prominent rugae due to inflammation from being exposed to local irritants. Chronic gastritis appears as a patchy, spread out inflammation of mucosal lining of the stomach. Atrophic gastritis is a type of chronic gastritis most often found in older adults. Type A chronic gastritis is also associated with inflammation of glands, whereas Type B chronic gastritis mainly involves the glands of the antrum.
Which hormone is responsible for sensitizing insulin? 1 Leptin 2 Ghrelin 3 Adiponectin 4 Cholecystokinin
Adiponectin Adiponectin is an anti-inflammatory and insulin-sensitizing hormone. Leptin is a hormone released by fat cells and possibly gastric cells; it acts on the hypothalamus to control appetite. Ghrelin is called the "hunger hormone;" it is secreted in the stomach. Ghrelin increases in a fasting state and decreases after a meal. Cholecystokinin is a hormone that stimulates digestive juices.
Which is the most serious complication of peptic ulcer disease that a nurse should check for in an older patient? 1 Perforation 2 Hemorrhage 3 Pyloric obstruction 4 Intractable disease
Hemorrhage
Which area of the body is a location for gastric ulcers? 1 Muscularis propria 2 Proximal duodenum 3 In the antrum of the stomach 4 Upper portion of the duodenum
In the antrum of the stomach
A patient with a history of heart failure is to be prescribed an antacid to help with symptoms of peptic ulcer disease. Which antacid does the nurse expect the provider to order for this patient? 1 Magaldrate 2 Calcium carbonate 3 Aluminum hydroxide 4 Magnesium hydroxide
Magaldrate Magaldrate contains the lowest sodium concentration and should be ordered for this patient. Patients with a history of heart failure should avoid antacids with a high sodium content such as aluminum hydroxide and magnesium hydroxide. Calcium carbonate is not recommended as an antacid because of the risk of rebound acid secretion.
The laboratory report of a patient with acute gastritis states there are traces of blood in the stool. What term does the nurse use to document this finding? 1 Melena 2 Dyspepsia 3 Peritonitis 4 Hematemesis
Melena
The nurse is assessing the nature of abdominal pain in a patient with a suspected peptic ulcer. What feature of the pain points towards a diagnosis of gastric ulcer? The pain is on the right of the epigastrium. The pain is worsened by the ingestion of food. The pain often occurs about 2 hours after a meal. The pain often awakens the patient around 1 AM
The pain is worsened by the ingestion of food.
Which patient assessment data frequently correlates with a diagnosis of chronic gastritis? Hematemesis Gastric hemorrhage Frequent use of corticosteroids Treatment with radiation therapy
Treatment with radiation therapy
Which clinical findings may help differentiate upper gastrointestinal bleeding from duodenal ulcer bleeding? Select all that apply. a. Tarry or dark sticky stools b. High gastric acid secretion c. Decreased blood pressure d. Dizziness or light-headedness e. Bright red or coffee-ground vomitus f. Low pH levels in the duodenum for long periods
a. Tarry or dark sticky stools c. Decreased blood pressure d. Dizziness or light-headedness e. Bright red or coffee-ground vomitus Patients with upper gastrointestinal bleeding primarily complain about tarry or dark sticky stools and bright red vomitus. The patient may feel dizzy due to decreased blood pressure. Laboratory findings of patients suffering from duodenal ulcers would indicate high gastric acid secretion and low pH levels in the duodenum for long periods.
What assessment finding is commonly seen with marasmus? 1 Normal body weight 2 Decrease in serum protein 3 Wastage of body fat 4 Chronic starvation
Wastage of body fat Marasmus is a caloric malnutrition in which the patient's body fat and protein is wasted. Serum proteins are often preserved. The patient with kwashiorkor, another form of malnutrition, has normal body weight with a decrease in serum protein. The patient with marasmic-kwashiorkor has combined protein and energy malnutrition; this patient is chronically starved.
Which ulcers usually develop due to H. pylori infection? Stress ulcers Gastric ulcers and stress ulcers Duodenal ulcers and stress ulcers Gastric ulcers and duodenal ulcers
Gastric ulcers and duodenal ulcers
A patient has been diagnosed with gastritis. What statement about this disorder is accurate? 1 Gastritis is a tumor of the gastric mucosa. 2 Gastritis is caused by release of prostaglandin. 3 Gastritis is the inflammation of gastric mucosa. 4 Gastritis is a tumor that is associated with pylori infection
Gastritis is the inflammation of the gastric mucosa
The nurse is teaching a patient how to prevent recurrent chronic gastritis symptoms before discharge. Which statement by the patient demonstrates a correct understanding of the nurse's instruction? 1 "I should avoid alcohol and tobacco." 2 "I should eat small meals about six times a day." 3 "I will need to take vitamin B 12 shots for the rest of my life." 4 "It is okay to continue to drink coffee in the morning when I get to work."
"I should avoid alcohol and tobacco" The patient with chronic gastritis should avoid alcohol and tobacco. The patient should eliminate caffeine from the diet. The patient will need to take vitamin B 12 shots only if he or she has pernicious anemia. The patient should not eat six small meals daily; this practice may actually stimulate gastric acid secretion.
The nurse has placed a nasogastric (NG) tube in a patient with upper gastrointestinal bleeding to administer gastric lavage. The patient asks the nurse about the purpose of the NG tube for the procedure. What is the nurse's best response? 1 "Saline goes down the tube to help clean out your stomach." 2 "Medication goes down the tube to help clean out your stomach." 3 "We'll start feeding you through it once your stomach is cleaned out." 4 "The provider requested the tube to be placed just in case it was needed."
"Saline goes down the tube to help clean out your stomach."
A patient with peptic ulcer disease (PUD) asks the nurse whether licorice and slippery elm might be useful in managing the disease. What is the nurse's best response? 1 "No, they probably won't be useful. You should use only prescription medications in your treatment plan." 2 "These herbs could be helpful. However, you should talk with your provider before adding them to your treatment regimen." 3 "Yes, these are known to be effective in managing this disease, but make sure you research the herbs thoroughly before taking them." 4 "No, herbs are not useful for managing this disease. You can use any type of over-the-counter drugs though. They have been shown to be safe."
"These herbs could be helpful. However, you should talk with your provider before adding them to your treatment regimen." Although licorice and slippery elm may be helpful in managing PUD, the patient should consult his or her health care provider before making a change in the treatment regimen. Alternative therapies may or may not be helpful in managing PUD. The patient should not use over-the-counter medications without first discussing it with his or her provider.
Which statements should the nurse include when teaching patients and their families regarding prevention of gastritis? Select all that apply. 1 "Eating a well-balanced diet is important." 2 "Alcoholic beverages in excessive amounts should be avoided." 3 "Intake foods with strong spices such as pepper and mustard if necessary." 4 "Proton pump inhibitors may be used to suppress gastric acid secretion." 5 "Excessive intake of coffee or even decaffeinated drinks should be avoided." 6 "Protection against exposure to toxic substances in the workplace should be practiced."
1,2,56 "Eating a well-balanced diet is important." "Alcoholic beverages in excessive amounts should be avoided." "Excessive intake of coffee or even decaffeinated drinks should be avoided." "Protection against exposure to toxic substances in the workplace should be practiced."
The nurse is teaching a patient how to prevent gastritis. What are the appropriate instructions for prevention? Select all that apply. 1 Avoid coffee as it contains caffeine; have tea instead. 2 Take ibuprofen whenever there is pain in the abdomen. 3 Ensure that food and water are safe and not contaminated. 4 Try complementary and alternative therapies to manage stress. 5 Stay protected against exposure to toxic substances, such as nickel, at the workplace
3,4,5 Ensure that food and water are safe and not contaminated. Try complementary and alternative therapies to manage stress. Stay protected against exposure to toxic substances, such as nickel, at the workplace Protection against exposure to nickel helps prevent gastritis. Ensuring that food and water are safe and uncontaminated helps prevent type B gastritis, which is mostly caused by H. pylori infection. Stress and anxiety may contribute to gastritis; complementary and alternative therapies help to manage stress and can prevent gastritis. Both coffee and tea are caffeine-containing beverages and can trigger gastritis; they should both be avoided. Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that inhibits prostaglandin production in the mucosal barrier and increases the risk of gastritis.
The nurse inserts a nasogastric (NG) tube for gastric lavage in a patient who is vomiting blood. What is the appropriate practice for gastric lavage? 1 A large-bore NG tube is required for gastric lavage. 2 Cold water is instilled in volumes of 200 to 300 mL. 3 Sterile saline is used rather than tap water for gastric lavage. 4 A sample of gastric contents is aspirated using a 10-mL syringe
A large-bore NG tube is required for gastric lavage A large-bore NG tube is required for gastric lavage to accommodate the large volumes of fluid flowing in and out of the tube. Water at room temperature is appropriate for lavage, not cold water. A sample of the gastric contents is aspirated using a 50-mL catheter-tipped syringe. There is no evidence that sterile saline is better than tap water for gastric lavage; either can be used.
The nurse is caring for a patient who has granular dark vomitus that resembles coffee grounds. Which type of ulcer does the nurse suspect in this patient? 1 Gastric 2 Pyloric 3 Duodenal 4 Esophageal
Gastric The vomitus of patients with a gastric ulcer is more likely to resemble coffee grounds. Patients with duodenal ulcers generally pass blood in the stool. Esophageal ulcer bleeding is usually bright red. Pyloric obstruction does present with vomiting, but not typically with blood in the vomitus.
The nurse finds a patient vomiting coffee ground-type emesis. On assessment, the patient has blood pressure of 100/74 mm Hg, is acutely confused, and has a weak and thready pulse. Which intervention is the nurse's first priority? 1 Initiating enteral nutrition 2 Administering an H 2 antagonist 3 Administering intravenous (IV) fluids 4 Administering antianxiety medication
Administering intravenous (IV) fluids Administering IV fluids is necessary to treat the hypovolemia caused by acute gastrointestinal (GI) bleeding. Administration of an H 2 antagonist will not treat the basic problem, which is upper GI bleeding. Enteral nutrition will not be part of the treatment plan for acute GI bleeding. Administration of antianxiety medication will not treat the basic problem causing the patient's change in mental status, which is hypovolemia.
A patient being evaluated for a gastric ulcer reports sharp, burning left-sided upper epigastric pain, which increases with food. The nurse notes epigastric tenderness, a soft abdomen, and normally active bowel sounds. Based on these findings, which condition does the nurse suspect? 1 Perforation 2 Gastric ulcer 3 Duodenal ulcer 4 Pyloric sphincter dysfunction
Gastric Ulcer
The nurse is caring for a patient who has just returned from an endoscopic procedure. His wife verbalizes that the patient must be hungry. Which initial action by the nurse is correct? 1 Assess for a gag reflex 2 Request a dietitian consult 3 Insert a nasogastric tube for feeding 4 Allow the wife to obtain food from the cafeteria
Assess for a gag reflex Following an endoscopic procedure, the patient should not be allowed any foods or fluids until the gag reflex has been assessed for prevention of aspiration. The patient's wife should be instructed to refrain from providing foods or fluids. It is not necessary to obtain a dietitian consult or an order for nasogastric tube insertion.
Which self-management measure will the nurse teach the patient with gastritis? 1 Avoid exposure to lead 2 Drink decaffeinated coffee 3 Limit tobacco consumption 4 Never use nonsteroidal anti-inflammatory drugs (NSAIDs)
Avoid exposure to lead Atrophic gastritis is a kind of chronic gastritis that is commonly seen in patients exposed to toxic substances such as lead. Therefore exposure to metals such as lead should be limited. The patient should avoid excessive intake of both caffeinated and decaffeinated coffee. The patient with gastritis should quit smoking or tobacco use entirely because it aggravates the condition. The patient may not need to completely avoid NSAIDs but should exercise caution when taking them.
The nurse assesses that a patient experiences regular epigastric discomfort that usually goes away after eating. Which initial nursing action is correct? 1 Contact the provider to report these symptoms 2 Request an order for an H 2-receptor antagonist 3 Order a low-fat, bland diet to prevent discomfort 4 Teach the patient to avoid nonsteroidal anti-inflammatory drugs and aspirin
Contact the provider to report these symptoms Patients with epigastric discomfort that usually abates after eating may have chronic gastritis and should be evaluated for this disease. The nurse should report these symptoms to the provider. Ordering a low-fat diet, requesting an order for an H 2-receptor antagonist, and teaching the patient to avoid NSAIDs and aspirin are all correct actions only after a diagnosis of gastritis has been made.
Which organ is usually affected in chronic atrophic gastritis? 1 Glands of the antrum 2 Deeply located glands 3 Body of the stomach only 4 Fundus of the stomach only
Deeply Located glands Chronic atrophic gastritis causes inflammation and destruction of deeply located glands and affects all layers of the stomach. Type B chronic gastritis usually affects the glands of the antrum and can also involve the entire stomach. Type A (nonerosive) chronic gastritis leads to inflammation of the fundus and body of the stomach.
The patient presents to the emergency department with acute gastritis. The nurse suspects which organism is most likely the culprit? 1 Streptococcus 2 Escherichia coli 3 Helicobacter pylori 4 Staphylococcus aureus
Helicobacter pylori
What statement about type A gastritis is most accurate? It is associated with pernicious anemia. It is most often caused by pylori infection. It can occur due to exposure to benzene or lead. It has an autosomal recessive pattern of inheritance
It is associated with pernicious anemia
The nurse is reviewing the medications prescribed for a patient with peptic ulcer disease (PUD). Which drug is the patient taking to treat Helicobacter pylori infection? 1 Nizatidine 2 Pantoprazole 3 Metronidazole 4 Aluminum hydroxide
Metronidazole Metronidazole is an antimicrobial that treats H. pylori infection. Aluminum hydroxide is an antacid that deactivates pepsin and buffers the acid produced in the stomach. Pantoprazole is a proton pump inhibitor that suppresses the H, K-ATPase enzyme system and regulates gastric acid secretion. Nizatidine is an H 2 antagonist that blocks histamine receptors in parietal cells and decreases gastric acid secretion.
The nurse is caring for a patient and is monitoring the patient regularly for acute gastritis with bleeding. Which medication class most likely causes the nurse to believe the patient is at risk for this disorder? 1 Narcotic analgesics 2 Proton pump inhibitors (PPIs) 3 Nonsteroidal antiinflammatory drugs (NSAIDs) 4 Angiotensin-converting-enzyme (ACE) inhibitors
NSAIDs Chronic use of NSAIDs can result in gastritis and, in serious cases, bleeding or hemorrhage. ACE inhibitors have no gastric side effects. PPIs are used to treat gastritis and ulcers; they do not cause either condition. Narcotic analgesics are not implicated in gastritis.
A patient is admitted with chronic peptic ulcer disease (PUD). What sign or symptom is suggestive of a pyloric obstruction? 1 Hyperkalemia 2 Metabolic acidosis 3 Nausea and vomiting 4 Tender and board-like abdomen
Nausea and vomiting
The nurse is caring for an older adult male patient who reports stomach pain and heartburn. Which characteristic is most significant in determining whether the patient's ulceration is gastric or duodenal in origin? The patient is a man older than 50 years. Pain is worsened by the ingestion of food. The patient has a malnourished appearance. Pain occurs 1½ to 3 hours after a meal, usually at night.
Pain occurs 1½ to 3 hours after a meal, usually at night
A patient who has chronic gastritis is at increased risk for which condition? 1 Appendicitis 2 Pernicious anemia 3 Chronic constipation 4 Irritable bowel syndrome
Pernicious anemia
The nurse is reviewing orders for a patient admitted to the intensive care unit with perforation of a duodenal ulcer. Which order does the nurse implement first? 1 Apply antiembolism stockings 2 Insert an indwelling catheter, and check output hourly 3 Place a nasogastric (NG) tube, and connect to suction 4 Give famotidine 20 mg intravenously (IV) every 12 hours
Place a nasogastric (NG) tube, and connect to suction To decrease spillage of duodenal contents into the peritoneum, NG suction should be rapidly initiated. This will minimize the risk for peritonitis. Antiembolism stockings will need to be applied, monitoring output is important, and famotidine will need to be administered, but the nurse's first priority is to minimize the risk for peritonitis.
Which potential nutrition deficiency can cause decreased pigmentation of hair? 1 Zinc 2 Protein 3 Vitamin C 4 Vitamin A
Protein Deficiency of protein leads to a decreased pigmentation of the hair. Deficiency of zinc results in alopecia. Corkscrew hair is a result of vitamin C deficiency. Vitamin A deficiency causes Bitot's spots in the eyes
The nurse provides information to an unlicensed assistive personnel (UAP) about proper feeding techniques for older patients. What should the nurse include in the teaching? 1 Give the patient a warm cup of juice. 2 Encourage the patient to finish eating quickly. 3 Provide mouth care before feeding the patient. 4 Keep the emesis basin close to the patient's bed
Provide mouth care before feeding the patient The unlicensed assistive personnel (UAP) should be instructed to provide adequate mouth care before the patient is fed. The presence of ill-fitting dentures, ulcers, or decayed teeth can cause pain and reduce the patient's appetite; therefore, proper mouth care is necessary to ensure adequate feeding, especially in older patients. Care should be taken to give the patient food at an appropriate temperature. It is appropriate to serve cool juices and warm soups. The patient should be given sufficient time to eat and should not be rushed to prevent difficulty swallowing and to decrease the risk of aspiration. Emesis basins and urinals should be kept out of a patient's sight while eating. It is unhygienic and inappropriate to keep an emesis basin near the patient during a meal.
A patient is experiencing bleeding related to peptic ulcer disease (PUD). Which nursing intervention is the highest priority? 1 Starting a large-bore IV 2 Administering IV pain medication 3 Preparing equipment for intubation 4 Monitoring the patient's anxiety level
Starting a large-bore IV A large-bore IV should be placed as ordered so that blood products can be administered. IV pain medication is not a recommended treatment for gastrointestinal bleeding. Intubation is not a recommended treatment for bleeding related to PUD. The mental status of the patient should be monitored, but it is not necessary to monitor the anxiety level of the patient.
The nurse is caring for a patient with peptic ulcer disease (PUD). What signs and symptoms in the patient suggest a surgical emergency? Select all that apply. 1 Black, tarry stool 2 Assuming the knee-chest position 3 Tender, rigid, board-like abdomen 4 Sudden, sharp pain in the mid-epigastrium 5 Vomiting of bright red or coffee-ground blood
Sudden, sharp pain in the mid-epigastrium Tender, Rigid board-like abdomen Assuming the knee-chest position
The nurse is assessing a patient who reports episodes of pain in the abdomen. What feature suggests the possibility of a duodenal ulcer? 1 The patient is 35 years old. 2 The patient has type O blood. 3 The patient is likely malnourished. 4 The patient experiences more pain after eating food.
The patient has type O blood Patients with duodenal ulcers most often have type O blood. They are usually 50 years or older and are often well-nourished. Another key feature of a duodenal ulcer is a high secretion of gastric acid; abdominal pain due to a duodenal ulcer is therefore relieved by the ingestion of food. Pain usually occurs again about 90 minutes to 3 hours after eating food.
The nurse is teaching a patient about self-management of gastritis. Which piece of education is appropriate? 1 "Drink decaffeinated coffee." 2 "Eat tomato products and onions." 3 "Use complementary and alternative therapies." 4 "Take aspirin instead of nonsteroidal anti-inflammatory drugs (NSAIDs) for pain."
Use complementary and alternative therapies Using complementary and alternative therapies such as relaxation and meditation can help manage stress and discomfort, both of which can cause gastritis to worsen. Drinking coffee, whether it is caffeinated or decaffeinated, should be avoided because coffee contains peptides that stimulate gastrin release. Tomato products and onions are common irritating foods and should be avoided. Aspirin and other NSAIDs should be avoided because they may enhance acid production and further agitate gastritis.
