Nursing 2 - Our Solutions Training and Support JACQUELINEexpand_more CoursePoint+ Logo Lippincott CoursePoint+ for Honan: Focus on Adult Health: Medical-Surgical Nursing, Second Edition Nursing II SP 22
Endoscopy of a 60-year-old woman has revealed the presence of an esophageal peptic ulcer. The nurse who is providing this woman's care is assessing for risk factors that may have contributed to the development of this disease. What question most directly addresses these risk factors?
"Have you ever been diagnosed with reflux?" Explanation: Gastroesophageal reflux disease (GERD) is a significant risk factor for peptic ulcer disease. Poor diet, general infections, and dysphagia are less closely associated with etiology of esophageal ulcers.
The nurse determines that teaching for the client with peptic ulcer disease has been effective when the client makes which statement?
"I have learned some relaxation strategies that decrease my stress." Explanation: The nurse assists the client to identify stressful or exhausting situations. A hectic lifestyle and an irregular schedule may aggravate symptoms and interfere with regular meals taken in relaxed settings along with the regular administration of medications. The client may benefit from regular rest periods during the day, at least during the acute phase of the disease. Biofeedback, hypnosis, behavior modification, massage, or acupuncture may be helpful.
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.)
"It can be caused by ingestion of strong acids." "You may have ingested some irritating foods." "Is it possible that you are overusing aspirin."
A client with gastric ulcers caused by H. pylori is prescribed metronidazole. Which client statement indicates to the nurse that teaching about this medication was effective?
"It might cause a metallic taste in my mouth." Explanation: Metronidazole is a synthetic antibacterial and antiprotozoal agent that assists with eradicating H. pylori bacteria in the gastric mucosa when given with other antibiotics and proton pump inhibitors. This medication may cause a metallic taste in the mouth. It should not be taken with anticoagulants as it will increase the blood thinning effects of warfarin. Alcohol should be avoided while taking this medication. This medication may cause anorexia and not an increased appetite.
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?
"It might cause a metallic taste in my mouth." Explanation: Metronidazole is a synthetic antibacterial and antiprotozoal agent that assists with eradicating H. pylori bacteria in the gastric mucosa when given with other antibiotics and proton pump inhibitors. This medication may cause a metallic taste in the mouth. It should not be taken with anticoagulants as it will increase the blood thinning effects of warfarin. Alcohol should be avoided while taking this medication. This medication may cause anorexia and not an increased appetite.
An obese male patient has sought advice from the nurse about the possible efficacy of medications in his efforts to lose weight. What should the nurse teach the patient about pharmacologic interventions for the treatment of obesity?
"Medications may be of some use, but they don't tend to resolve obesity on their own." Explanation: Medications for obesity rarely result in loss of more than 10% of total body weight. They are not intended as a substitute for exercise or a healthy diet. They are not solely intended for those individuals who have undergone bariatric surgery.
A client being treated for a peptic ulcer seeks medical attention for vomiting blood. Which statement indicates to the nurse the reason for the client developing hematemesis?
"The pain stopped so I stopped taking the medications." Explanation: The client should be instructed to adhere to and complete the medication regimen to ensure complete healing of the peptic ulcer. Because most clients become symptom free within a week, it should be stressed to the client the importance of following the prescribed regimen so that the healing process can continue uninterrupted and the return of symptoms can be prevented. Since the client stopped taking the medication, the ulcer was not healed and became worse. The statements about soda, being nauseated, and eating only one meal would not explain the reason for the client's new onset of hematemesis during treatment for a peptic ulcer.
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 partial gastrectomy is performed with anastomosis of the stomach segment to the duodenum. Explanation: 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. A vagotomy severs the vagus nerve; a Billroth I procedure may be performed in conjunction with a vagotomy. If the remaining part of the stomach is anastomosed to the jejunum, the procedure is a Billroth II.
A client is admitted with a new onset of pyloric obstruction. What client symptoms should the nurse anticipate? Select all that apply.
Anorexia Nausea and vomiting Epigastric fullness
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?
Assess the client's abdomen and vital signs. Explanation: Signs and symptoms of perforation includes sudden, severe upper abdominal pain (persisting and increasing in intensity); pain may be referred to the shoulders, especially the right shoulder, because of irritation of the phrenic nerve in the diaphragm. The nurse should assess the vital signs and abdomen prior to notifying the physician. Irrigation of the NG tube should not be performed because the additional fluid may be spilled into the peritoneal cavity, and the client should be placed in a position of comfort, usually on the side with the head slightly elevated.
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 Explanation: Black, tarry stools are a sign of bleeding high in the GI tract, as from a gastric ulcer, and result from the action of digestive enzymes on the blood. Vomitus associated with upper GI tract bleeding commonly is described as coffee-ground-like. Clay-colored stools are associated with biliary obstruction. Bright red stools indicate lower GI tract bleeding.
A client 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 client?
Curling's ulcer Explanation: Curling's ulcer is frequently observed about 72 hours after extensive burns and involves the antrum of the stomach or the duodenum. Peptic, esophageal, and Meckel's ulcers are not related to burn injuries.
A health care provider suspects that a client has peptic ulcer disease. With which diagnostic procedure would the nurse most likely prepare to assist?
Endoscopy Explanation: Barium study of the upper GI tract may show an ulcer; however, endoscopy is the preferred diagnostic procedure because it allows direct visualization of inflammatory changes, ulcers, and lesions. Through endoscopy, a biopsy of the gastric mucosa and of any suspicious lesions can be obtained. Endoscopy may reveal lesions that, because of their size or location, are not evident on x-ray studies. Less invasive diagnostic measures for detecting H. pylori include serologic testing for antibodies against the H. pylori antigen, stool antigen test, and urea breath test.
The nurse is doing triage at the emergency department when a middle-aged patient presents with abdominal pain and heartburn. The patient states the symptoms have persisted for several days following a particularly spicy meal. When assessing the patient, the nurse notes the patient has a history of acute gastritis. What complication should the nurse assess for?
Esophageal or pyloric obstruction related to scarring Explanation: Acute gastritis can result from dietary indiscretion, and may lead to scarring and stenosis, often requiring dilation. Acute systemic infection occurs following perforation. Perforation is not a common occurrence following ingestion of a corrosive substance. Gastrin is a hormone secreted in the stomach. It is not normally found in the esophagus. Peptic ulcer disease does not cause bruising.
A client has been taking famotidine at home. What teaching should the nurse include with the client?
Famotidine will inhibit gastric acid secretions. Explanation: 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. Famotidine will not neutralize acid in the stomach, but inhibits acid secretion. Famotidine will not shorten digestion time and will not improve food mixing with gastric secretions.
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 Explanation: The nurse interprets hematemesis as a sign/symptom of possible hemorrhage from the ulcer. Other signs that can indicate hemorrhage include tachycardia, hypotension, and oliguria/anuria.
A patient presents to the walk-in clinic complaining of vomiting and burning in his mid-epigastria. The nurse knows that to confirm peptic ulcer disease, the health care provider is likely to order a diagnostic test to detect the presence of what?
Infection with Helicobacter pylori Explanation: H. pylori infection may be determined by endoscopy and histologic examination of a tissue specimen obtained by biopsy, or a rapid urease test of the biopsy specimen. Other less invasive diagnostic measures for detecting H. pylori include serologic testing for antibodies against the H. pylori antigen, stool antigen test, and urea breath test. Excessive stomach acid secretion, NSAIDs, and dietary indiscretion may all cause gastritis; however, peptic ulcers are caused by colonization of the stomach by H. pylori.
Computed tomography of a patient with a sudden onset of severe nausea and vomiting has revealed the presence of a pyloric obstruction. Which of the following interventions is the nurse's priority in the immediate care of this patient?
Insertion of a nasogastric (NG) tube to suction to decompress the stomach Explanation: In treating the patient with pyloric obstruction, the first consideration is to insert an NG tube to decompress the stomach. Nutrition is not an immediate priority, and neither gastric lavage nor cleansing enemas is indicated.
An older adult patient had a gastrectomy performed several weeks ago and is being followed closely by the care team. Due to potential complications of this surgery, the nurse should closely monitor the patient's levels of:
Iron and vitamin B12 Explanation: Dietary deficiencies associated with gastrectomy include malabsorption of organic iron, which may require supplementation with oral or parenteral iron, and a low serum level of vitamin B12, which may require supplementation by the intramuscular route. The other given blood values are not directly affected by gastrectomy.
A 32-year-old man who has a body mass index of 32 (morbidly obese) is considering bariatric surgery. In the time leading up to this surgery, which of the following nursing diagnoses will be the primary focus of interventions?
Knowledge deficit related to the implications of bariatric surgery Explanation: Patient teaching is a priority in the preparation for bariatric surgery. Necessary counseling and education would be prioritized over growth and development and spiritual distress, although each may emerge and be addressed accordingly. In seeking bariatric surgery, the patient is likely already aware of the risks associated with obesity.
The nurse visits the home of a client recovering from acute gastritis. Which observation indicates that teaching about the disorder was effective?
Medications placed in a pillbox Explanation: The client with acute gastritis should be instructed on methods of keeping track of medications such as placing the doses into a pillbox. The client should also be instructed about foods and substances that may cause gastritis, including nicotine, spicy seasoned foods, and caffeine. Cigarettes in the ashtray, tomato sauce, and caffeinated coffee indicate that additional teaching is required.
The nurse is performing detailed patient education with a 40-year-old woman who will be soon discharged following a Roux-en-Y gastric bypass. The nurse and other members of the interdisciplinary team have been emphasizing the need for eating small amounts of food at a sitting and eating food slowly. What is the rationale for the nurse's advice?
Nausea and esophageal distention can result from eating too fast. Explanation: Because of the physical alterations to the upper gastrointestinal (GI) tract that are created during bariatric surgery, the patient is prone to nausea and esophageal distention if he or she eats too quickly. Eating quickly does not contribute to ulceration or weight gain following surgery. The cardiac sphincter is not modified during bariatric surgery.
Which medication classification represents a proton (gastric acid) pump inhibitor?
Omeprazole Explanation: 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?
Peptic ulcers Explanation: Chronic gastritis caused by Helicobacter pylori is implicated in the development of peptic ulcers. Chronic gastritis is sometimes associated with autoimmune disease, such as pernicious anemia, but not as a cause of the anemia. Chronic gastritis is not implicated in system infections and/or colostomies.
A 30-year-old obese female patient who underwent gastric banding 3 days ago is getting ready to go home. Essential postoperative teaching for this patient should include instruction related to the importance of abstaining from what for the next 2 years?
Pregnancy Explanation: Women of childbearing age who have had bariatric surgery should avoid pregnancy for approximately 2 years until their weight stabilizes, and it is evident that their nutritional needs are being adequately met. Multivitamins are generally recommended for the patient to supplement dietary sources of nutrients. Antidepressants may be taken if clinically indicated. Control-top pantyhose may be uncomfortable postoperatively; however, they are not contraindicated.
Which of the following is the most successful treatment for gastric cancer?
Removal of the tumor Explanation: There is no successful treatment for gastric carcinoma except removal of the tumor. If the tumor can be removed while it is still localized to the stomach, the patient may be cured. If the tumor has spread beyond the area that can be excised, cure is less likely.
The nurse is completing a health history on a patient whose diagnosis is chronic gastritis. Which of the data below should the nurse consider most significantly related to the etiology of the patient's health problem?
Smokes two packs of cigarettes daily Explanation: Smoking is a significant risk factor for chronic gastritis. Alcohol ingestion can lead to gastritis; however, this generally occurs in patients with a history of daily consumption of alcohol. Protein drinks do not result in gastric inflammation. Antacids do not contribute to the etiology of chronic gastritis.
A nurse at a long-term care facility is conducting an intake assessment and health history with a new female resident and the resident's daughter. The daughter states that her mother had a Billroth II gastrectomy performed several years ago, a fact that must be accommodated into her care. The nurse would be justified in questioning the resident about her history of:
Stomach cancer Explanation: Gastrectomies such as the Billroth II are performed to treat gastric cancer, not GERD, pyloric stenosis or peptic ulcers.
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 Explanation: 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, board-like abdomen, tenderness, and fever. The client's signs and symptoms aren't a normal reaction to surgery.
A client recovering from a total gastrectomy has a low red blood cell count. Which medication will the nurse expect to be prescribed for this client?
Vitamin B12 injections Explanation: Intrinsic factor is secreted by the parietal cells in the stomach, which binds to vitamin B12 so it can be absorbed in the ileum. With the loss of some parietal cells, there is a deficiency in vitamin B12, which leads to a decreased production of red blood cells or pernicious anemia. Treatment would be vitamin B12 injections for life. Oral iron tablets would be prescribed for iron deficiency anemia. Erythropoietin injections would be prescribed for anemia caused by kidney disease. The client is not actively bleeding and would not need transfusions of packed RBCs.
A nurse is teaching a group of middle-aged men about peptic ulcers. When discussing risk factors for peptic ulcers, the nurse should mention:
alcohol abuse and smoking. Explanation: The nurse should mention that risk factors for peptic (gastric and duodenal) ulcers include alcohol abuse, smoking, and stress. A sedentary lifestyle and a history of hemorrhoids aren't risk factors for peptic ulcers. Chronic renal failure, not acute renal failure, is associated with duodenal ulcers.
A client is diagnosed with peptic ulcer disease secondary to NSAID use. When preparing this client's plan of care, which medication would the nurse anticipate being prescribed? Select all that apply.
famotidine omeprazole
A nurse assesses the stools of a client diagnosed with peptic ulcer disease. Inspection reveals black, tarry stools. The nurse would use which term to document this finding?
melena Explanation: Melena is the term used to denote black, tarry stools. Hematemesis refers to blood in vomit. Pyrosis is a burning sensation in the esophagus and stomach that moves up to the mouth. Achlorhydria refers to an absence of hydrochloric acid in the stomach.
The nurse recognizes that the client diagnosed with a duodenal ulcer will likely experience
pain 2 to 3 hours after a meal. Explanation: The client with a duodenal ulcer often awakens between 1 and 2 with pain, and ingestion of food brings relief. Vomiting is uncommon in the client with duodenal ulcer. Hemorrhage is less likely in the client with duodenal ulcer than in the client with gastric ulcer. The client with a duodenal ulcer may experience weight gain.pain 2 to 3 hours after a meal. Explanation: The client with a duodenal ulcer often awakens between 1 and 2 with pain, and ingestion of food brings relief. Vomiting is uncommon in the client with duodenal ulcer. Hemorrhage is less likely in the client with duodenal ulcer than in the client with gastric ulcer. The client with a duodenal ulcer may experience weight gain.
A client is admitted to the hospital with an exacerbation of chronic gastritis. When assessing the client's nutritional status, the nurse should expect to find what type of deficiency?
vitamin B12 Explanation: The nurse should expect vitamin B12 deficiency. Injury to the gastric mucosa causes gastric atrophy and impaired function of the parietal cells. These changes result in reduced production of intrinsic factor, which is necessary for the absorption of vitamin B12. Eventually, pernicious anemia will occur. Deficiencies in vitamins A, B6, and C aren't expected in a client with chronic gastritis.
