NURS350 CHAPTER 41

Which statements should the nurse include in the education for a client with gastroesophageal reflux disease (GERD)? Select all that apply. 1. "Eliminate the use of alcohol." 2. "Elevate the head of the bed." 3. "Eliminate the use of caffeine." 4. "Take measures to decrease the stress in your life." 5. "Eat meals at least 3 hours prior to sleeping."

1. "Eliminate the use of alcohol." 2. "Elevate the head of the bed." 5. "Eat meals at least 3 hours prior to sleeping." Explanation: 1. A client with GERD should be encouraged to eliminate alcohol to help reduce the symptoms. 2. Elevating the head of the bed will help reduce the symptoms. 3. It is not necessary to eliminate caffeine. 4. Stress does not increase the symptoms of GERD. 5. Small meals should be eaten at least 3 hours before sleep.

The nurse has provided education about peptic ulcer disease (PUD) for a client. Which statement made by the client indicates an understanding of the information? 1. "I will limit my intake of caffeine products." 2. "I will take ibuprofen (Motrin) for my headaches." 3. "I will drink more milk and limit spicy foods." 4. "I will join a gym and increase my exercise."

1. "I will limit my intake of caffeine products." Explanation: 1. Caffeine is a risk factor for peptic ulcer disease (PUD), so limiting caffeine will be beneficial in the treatment of peptic ulcer disease (PUD). 2. Nonsteroidal anti-inflammatory drugs (NSAIDs) are a primary cause of peptic ulcer disease (PUD). 3. Milk can increase acid production, and spicy foods are not an issue with peptic ulcer disease (PUD). 4. There is no correlation between exercise and the management of peptic ulcer disease (PUD).

Which information should the nurse provide a client with gastroesophageal reflux disease GERD who is reluctant to make suggested lifestyle changes? Select all that apply. 1. "The damage to your esophagus may result in esophagitis." 2. "Long-term exposure to acid increases risk for esophageal cancer." 3. "Without lifestyle changes, the prescriptions are ineffective." 4. "The lifestyle changes will be easier if you adopt them one at a time and institute them gradually." 5. "You will eventually have difficulty with swallowing if this condition is not treated."

1. "The damage to your esophagus may result in esophagitis." 2. "Long-term exposure to acid increases risk for esophageal cancer." Explanation: 1. Esophagitis is a possible complication of GERD. 2. Approximately 10% of those with GERD will develop Barrett's esophagus, which is associated with increased risk of cancer. 3. The prescriptions may be somewhat effective even if lifestyle changes are not made. 4. The nurse should not assume the client will perceive the lifestyle changes easier if they are instituted gradually. The nurse cannot assume what will occur if the treatment is not adhered to.

Which clinical condition should the nurse be concerned about for a client prescribed calcium carbonate (Tums)? 1. Anemia 2. Diarrhea 3. Kidney stones 4. Gastroesophageal reflux disease (GERD)

1. Anemia Explanation: 1. Calcium-based products can be used in the presence of anemia. 2. Calcium-based products cause constipation. 3. Calcium-based products place the client at risk for renal calculi. 4. Calcium-based products can be used as part of the treatment of GERD.

Which should the nurse recognize is a risk factor for gastroesophageal reflux disease (GERD)? 1. Obesity 2. Stress 3. Esophageal ulcers 4. Aging

1. Obesity Explanation: 1. Obesity is a risk factor for GERD. 2. Stress is not a risk factor for GERD. 3. Esophageal ulcers are a complication of GERD. 4. Although most often considered a disease of people older than age 40, GERD also occurs in a significant percentage of infants.

Which information should the nurse include in the education for a client with peptic ulcer disease prescribed omeprazole (Prilosec)? Select all that apply. 1. Omeprazole (Prilosec) should not be crushed or chewed. 2. Omeprazole (Prilosec) is best taken with yogurt. 3. Omeprazole (Prilosec) is recommended for long-term treatment of peptic ulcer disease. 4. Omeprazole (Prilosec) should be administered before meals. 5. Omeprazole (Prilosec) should be administered after meals.

1. Omeprazole (Prilosec) should not be crushed or chewed. 4. Omeprazole (Prilosec) should be administered before meals. Explanation: 1. Omeprazole is enteric coated and needs to dissolve in the intestine; it should not be crushed or chewed. 2. Yogurt may help replace beneficial bacteria, but the prescription should not be taken with the yogurt. 3. Omeprazole is recommended for short-term, not long-term use. 4. Omeprazole should be administered before meals. 5. Omeprazole should be administered before, not after, meals in order to be most effective.

Where does the pyloric sphincter regulate the flow of food into? 1. Small intestine 2. Stomach 3. Esophagus 4. Rectum

1. Small intestine Explanation: 1. The pyloric sphincter regulates food out of the stomach into the small intestine. 2. The pyloric sphincter is where food moves out of the stomach. 3. The cardiac sphincter keeps food from moving back into the esophagus. 4. The pyloric sphincter regulates food out of the stomach, not the rectum.

A client asks the nurse why esomeprazole (Nexium) works better than cimetidine (Tagamet). Which response should the nurse provide the client? 1. "It is about the same but a lot cheaper than your cimetidine (Tagamet)." 2. "It decreases acid in your stomach better than cimetidine (Tagamet)." 3. "It is about the same but has fewer side effects than your cimetidine (Tagamet)." 4. "It is not as effective as cimetidine (Tagamet) but kills bacteria better."

2. "It decreases acid in your stomach better than cimetidine (Tagamet)." Explanation: 1. Esomeprazole (Nexium) is not cheaper than cimetidine (Tagamet). 2. Proton-pump inhibitors reduce acid secretion to a greater extent than H2-receptor antagonists, and have a longer duration of action. 3. Esomeprazole (Nexium) does not have fewer side effects than cimetidine (Tagamet). 4. Esomeprazole (Nexium) is more effective than cimetidine (Tagamet) but will not kill bacteria.

The client treated for GERD says, "I seem to have been getting many more colds and coughs." Which statements should the nurse include in the discussion? Select all that apply. 1. "Be sure to get your flu shot." 2. "The medicine you are on for GERD changes your gastric pH." 3. "You need to avoid crowds until your GERD is under control." 4. "You may be more susceptible to respiratory infection while taking this medication." 5. "You may be having an allergic reaction to your medicine."

2. "The medicine you are on for GERD changes your gastric pH." 4. "You may be more susceptible to respiratory infection while taking this medication." Explanation: 1. Getting immunized against influenza is important, but the client is not at higher risk for contracting the flu. 2. The prescriptions for GERD change gastric pH, which increases risk for respiratory illnesses. 3. There is no reason to avoid crowds. 4. The prescriptions used to treat hyperacidic conditions raise the gastric pH and impact the body's normal defense mechanisms against respiratory pathogens. 5. A client experiencing an increase in coughs and colds is not having an allergic reaction to the prescription.

Which describes the mechanism of action of proton-pump inhibitors? 1. Neutralize the acid in the stomach 2. Block the enzyme that secretes acid in the stomach 3. Block H2 receptors in the stomach 4. Decrease the amount of Helicobacter pylori

2. Block the enzyme that secretes acid in the stomach Explanation: 1. The mechanism of action of proton-pump inhibitors is to block the enzyme that secretes acid in the stomach. 2. The mechanism of action of proton-pump inhibitors is to block the enzyme that secretes acid in the stomach. 3. The mechanism of action of proton-pump inhibitors is to block the enzyme that secretes acid in the stomach. 4. The mechanism of action of proton-pump inhibitors is to block the enzyme that secretes acid in the stomach.

Which client assessment finding should the nurse associate with a duodenal ulcer? 1. Nausea and lower right quadrant abdominal pain 2. Burning pain several hours after eating a meal 3. Anorexia and weight loss 4. Nausea and vomiting

2. Burning pain several hours after eating a meal Explanation: 1. Nausea and lower right quadrant abdominal pain are more likely associated with appendicitis. 2. Duodenal ulcers are associated with burning upper abdominal pain after a meal. 3. Anorexia and weight loss are more common with gastric, not duodenal, ulcers. 4. Duodenal ulcers are not associated with nausea and vomiting.

A client with peptic ulcer disease and positive for H. pylori asks the nurse why the healthcare provider would like to treat them with a combination therapy. Which information should the nurse provide the client? 1. Combination therapy has the best outcomes when antibiotics are used with antacids. 2. Combination therapy has the best outcomes when antibiotics are used with proton-pump inhibitors. 3. The use of sucralfate (Carafate) along with antibiotics is the best combination therapy for peptic ulcer disease (PUD). 4. Various antibiotics are used to eradicate the bacteria that are responsible for the development of peptic ulcer disease (PUD).

2. Combination therapy has the best outcomes when antibiotics are used with proton-pump inhibitors. Explanation: 1. Combination therapy has the best outcomes when antibiotics are used with proton-pump inhibitors, not with antacids. 2. Combination therapy has the best outcomes when antibiotics are used with proton-pump inhibitors. 3. Combination therapy has the best outcomes when antibiotics are used with proton-pump inhibitors, not with sucralfate (Carafate). 4. More than one antibiotic may be used but treatment is more effective when antibiotics are used with a proton-pump inhibitor.

For which clinical conditions should the nurse recognize self-directed antacid use is not recommended? Select all that apply. 1. Decreased calcium levels 2. Diminished renal function 3. Perimenopause 4. Sodium-restricted diets 5. Coronary artery disease

2. Diminished renal function 4. Sodium-restricted diets Explanation: 1. Calcium antacids are often used as calcium supplements. 2. Self-directed antacid use is not recommended when the renal function is diminished. 3. There is no reason for perimenopausal women to avoid antacids. 4. Many over-the-counter antacids contain significant amounts of sodium, therefore, self-directed antacid use is not recommended. 5. There is no reason for those with coronary artery disease to avoid antacids.

Which condition should the nurse identify as a complication for long-term use of proton-pump inhibitors (PPIs)? 1. Anemia 2. Osteoporosis 3. Hypertension 4. Intestinal irritation

2. Osteoporosis Explanation: 1. Anemia is not a consequence of long-term use of PPIs. 2. Long-term use of PPIs increases risk of osteoporosis. 3. Hypertension is not a consequence of long-term use of PPIs. 4. Intestinal irritation is not a consequence of long-term use of PPIs.

Which electrolyte should the nurse assess for a client prescribed aluminum hydroxide (AlternaGEL)? 1. Potassium 2. Phosphate 3. Calcium 4. Sodium

2. Phosphate Explanation: 1. At high doses, aluminum products bind with phosphate in the GI tract and long-term use can result in phosphate depletion. 2. At high doses, aluminum products bind with phosphate in the GI tract and long-term use can result in phosphate depletion. 3. At high doses, aluminum products bind with phosphate in the GI tract and long-term use can result in phosphate depletion. 4. At high doses, aluminum products bind with phosphate in the GI tract and long-term use can result in phosphate depletion.

Which should the nurse anticipate to be included in the treatment plan for a client suspected to have developed peptic ulcer disease (PUD)? Select all that apply. 1. Antibiotic treatment 2. Testing for H. pylori 3. Multiple prescriptions 4. Pharmacotherapy for 4 weeks 5. Lifestyle changes

2. Testing for H. pylori 3. Multiple prescriptions 4. Pharmacotherapy for 4 weeks 5. Lifestyle changes Explanation: 1. Antibiotics are only necessary if the client has H. pylori. 2. The client should be tested for the presence of H. pylori prior to the initiation of antibiotic therapy. 3. Multiple prescriptions may be included in the treatment plan. 4. Multiple prescriptions may be included in the treatment plan. 5. Some lifestyle changes such as changing dietary habits and smoking cessation can help therapy be more successful.

A client with a peptic ulcer colonized with H. pylori asks how the prescription of bismuth (Pepto-Bismol) will help them. Which information should the nurse provide the client? Select all that apply. 1. "Bismuth (Pepto-Bismol) increases stomach acid to help kill bacteria." 2. "Bismuth (Pepto-Bismol) helps prevent the side effects of antibiotics." 3. "Bismuth (Pepto-Bismol) is effective for inhibiting bacterial growth." 4. "Bismuth (Pepto-Bismol) keeps bacteria from sticking in your stomach." 5. "Bismuth (Pepto-Bismol) helps relieve ulcer-related constipation."

3. "Bismuth (Pepto-Bismol) is effective for inhibiting bacterial growth." 4. "Bismuth (Pepto-Bismol) keeps bacteria from sticking in your stomach." Explanation: 1. Bismuth (Pepto-Bismol) does not increase stomach acid. 2. Bismuth (Pepto-Bismol) does not prevent the side effects of antibiotics. 3. Bismuth compounds (Pepto-Bismol) are added to the antibiotic regimen to inhibit bacterial growth. 4. Bismuth compounds (Pepto-Bismol) prevent H. pylori from adhering to the gastric mucosa. 5. Bismuth (Pepto-Bismol) is used to relieve diarrhea, not constipation.

Which information should the nurse provide a client that asks the nurse how they got H. Pylori? 1. "Your immune system is weak." 2. "The stomach pH is too low." 3. "The bacteria has entered your body somehow." 4. "H. Pylori naturally lives in your gastrointestinal tract."

3. "The bacteria has entered your body somehow." Explanation: 1. H. Pylori is a gram-negative bacteria that has entered the body. H. Pylori is not specifically associated with a decreased immunity. 2. H. Pylori is a gram-negative bacteria that has entered the body. A low stomach pH is not specifically associated with contracting H. Pylori. 3. H. Pylori is a gram-negative bacteria that has entered the body. 4. H. Pylori is a gram-negative bacteria that has entered the body that does not naturally reside in the gastrointestinal tract.

Which clients are at risk for peptic ulcer disease? Select all that apply. 1. A client with decreased intrinsic factor 2. A client with Type O blood 3. A client that smokes 4. A client experiencing excessive psychological stress 5. A client with a low fiber diet

3. A client that smokes 4. A client experiencing excessive psychological stress Explanation: 1. A client with decreased intrinsic factor does not place them at risk for a peptic ulcer disease. 2. Risk factors for peptic ulcer disease include a client with Type O blood. 3. Risk factors for peptic ulcer disease include smoking. 4. Risk factors for peptic ulcer disease include a client experiencing psychological stress. 5. A low fiber diet does not place a client at risk for a peptic ulcer disease.

Which information should the nurse include in the education of a client prescribed an antacid? 1. Antacids can be safely administered with H2-receptor medications. 2. Antacids can be safely administered with antibiotics. 3. Administer antacids at least 2 hours before other oral medications. 4. Lie down for 30 minutes after taking antacids.

3. Administer antacids at least 2 hours before other oral medications. Explanation: 1. Administering an antacid with a H2-receptor antagonist will decrease their absorption. 2. Administering an antacid with antibiotics will decrease their absorption. 3. Administering an antacid with other oral medications can affect the absorption of the other medications; they should be taken 2 hours before other oral medications. 4. There is no need for the client to lie down after taking an antacid.

Which information should the nurse include in the teaching for a client with an increased risk for the development a Clostridium difficile infection? 1. Report any episode of diarrhea. 2. Treat diarrhea with over-the-counter antidiarrheal drugs. 3. Increase intake of active culture yogurt. 4. Avoid fatty foods. 5. Increase fluid intake.

3. Increase intake of active culture yogurt. Explanation: 1. The patient does not need to report each episode of diarrhea but should report if the amount increases or is frequent or if the stool includes mucus, blood, or pus. 2. Antidiarrheal drugs may cause retention of harmful bacteria. 3. Dairy products containing live active cultures help restore normal flora. 4. Avoidance of fatty foods is not specifically prescribed to treat this condition. 5. Increasing fluid intake is not specifically prescribed to treat this condition.

Which assessment finding should the nurse be concerned about for the client receiving Ranitidine (Zantac) for treatment of peptic ulcer disease (PUD)? 1. Constipation 2. Pain 24 hours after treatment 3. Increased diarrhea 4. Headache

3. Increased diarrhea Explanation: 1. Constipation is a common side effect of H2-receptor antagonists. 2. Adequate healing of an ulcer takes approximately 4 to 8 weeks. 3. The prescriptions used to treat hyperacidic conditions raise the gastric pH and increase the risk of Clostridium difficile. 4. A headache is the most common symptom associated with the use of ranitidine.

A client asks the nurse how metoclopramide (Reglan) will help their peptic ulcer disease. Which mechanism of action should the nurse discuss with the client? 1. Neutralizes the stomach acid 2. Decreases the production of hydrochloric acid 3. Increases emptying time of the stomach 4. Relaxes the muscles of the gastrointestinal tract

3. Increases emptying time of the stomach Explanation: 1. Metoclopramide does not act to neutralize the stomach acid. 2. Metoclopramide does not decrease the production of hydrochloric acid. 3. Metoclopramide causes muscles in the upper intestine to contract, resulting in faster emptying of the stomach, and blocks food from re-entering the esophagus from the stomach, which is of benefit in patients with GERD. 4. Metoclopramide does not relax the muscles of the gastrointestinal tract

Which can be combined with aluminum compounds such as aluminum hydroxide (AlternaGEL) to increase their effectiveness and reduce the potential for constipation? 1. Phosphate 2. Potassium 3. Magnesium 4. Calcium

3. Magnesium Explanation: 1. Combining aluminum compounds with phosphate does not increases their effectiveness or reduce the potential for constipation. 2. Combining aluminum compounds with potassium does not increase their effectiveness or reduce the potential for constipation. 3. Combining aluminum compounds with magnesium (Gaviscon, Maalox, Mylanta) increases their effectiveness and reduces the potential for constipation. 4. Combining aluminum compounds with calcium does not increase their effectiveness or reduce the potential for constipation.

Which is the primary goal of treatment for gastroesophageal reflux disease (GERD)? 1. Promote ulcer healing 2. Prevent infection 3. Reduce gastric acid secretions 4. Decrease stomach pain

3. Reduce gastric acid secretions Explanation: 1. Promoting ulcer healing is not the goal of treatment for gastroesophageal reflux disease. 2. Preventing infection is not the goal of treatment for gastroesophageal reflux disease. 3. The primary goal is to reduce gastric secretions, which produces the reflux. 4. Gastroesophageal reflux disease is not associated with pain in the stomach.

Which information should the nurse include in the teaching for a client prescribed aluminum hydroxide (AlternaGEL)? Select all that apply. 1. You should expect this medication to take up to 2 days to start taking effect. 2. Take this medication with a glass of milk. 3. You may notice constipation as an effect of this drug. 4. Take this medication at least 2 hours before or after any other medication you are taking. 5. This medication will reduce the acid your stomach produces.

3. You may notice constipation as an effect of this drug. 4. Take this medication at least 2 hours before or after any other medication you are taking. Explanation: 1. This medication's onset of action is within 20-40 minutes. 2. There is no reason for the client to drink milk with this medication. 3. Constipation may be a side effect of this antacid. 4. Absorption may be affected if taken within 2 hours of any other drug. 5. This medication acts to neutralize acid, not to reduce its production.

The nurse has provided a client with education about intrinsic factor. Which statement indicates an understanding of the information? 1. "Intrinsic factor is secreted by the chief cells of the stomach." 2. "Intrinsic factor is necessary for absorption of vitamin B6." 3. "Intrinsic factor aids in the secretion of mucus to protect the stomach." 4. "Intrinsic factor is necessary for absorption of vitamin B12."

4. "Intrinsic factor is necessary for absorption of vitamin B12." Explanation: 1. Chief cells secrete pepsinogen and rennin, not intrinsic factor. 2. Intrinsic factor is necessary for the absorption of vitamin B12, not B6. 3. Intrinsic factor does not aid in the secretion of mucus in the stomach. Parietal cells secrete intrinsic factor, which is essential for the absorption of vitamin B12.

A client tells the nurse their "stomach pain is completely relieved after eating and returns a couple hours after the meal." Which condition should the nurse suspect the client is experiencing? 1. Gastric ulcer 2. Crohn's disease 3. Ulcerative colitis 4. Duodenal ulcer

4. Duodenal ulcer Explanation: 1. Although the pain of a gastric ulcer is relieved by food, the pain may continue even after a meal. 2. Ulceration in the distal small intestine is known as Crohn's disease and is not associated with pain relief after a meal. 3. Ulcerative colitis is erosions in the large intestine and is not associated with pain relief after a meal. 4. A duodenal ulcer is characterized by gnawing or burning upper abdominal pain that occurs 1 to 3 hours after a meal. The pain is worse when the stomach is empty and often disappears on ingestion of food.

Which condition is characterized by an erosion of the mucosal layer of the stomach or duodenum? 1. Diverticulum 2. Crohn's disease 3. Hiatal hernia 4. Peptic ulcer

4. Peptic ulcer Explanation: 1. Diverticulum occurs in the large intestine. 2. Crohn's disease occurs in the distal small intestine. 3. Hiatal hernias are an outpouching in the esophagus. 4. A peptic ulcer is erosion of the mucosal layer of the stomach or duodenum