Prep-U 47 (easy questions)

Which of the following is the most successful treatment for gastric cancer? A. Radiation B. Chemotherapy C. Palliation D. Removal of the tumor

D R: 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.

Rebleeding may occur from a peptic ulcer and often warrants surgical interventions. Signs of bleeding include which of the following? A. Mental confusion B. Bradypnea C. Hypertension D. Bradycardia

A

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 R: 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.

The nurse is assessing an 80-year-old patient for signs and symptoms of gastric cancer. The nurse differentiates which of the following to be a sign/symptom of gastric cancer in the geriatric patient, but not in a patient under the age of 75? A. Hepatomegalia B. Agitation C. Abdominal mass D. Ascites

B

The nurse determines that teaching for the client with peptic ulcer disease has been effective when the client states: A. "I should stop all my medications if I develop any side effects." B. "I have learned some relaxation strategies that decrease my stress." C. "I should continue my treatment regimen as long as I have pain." D. "I can buy whatever antacids are on sale because they all have the same effect."

B R: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 a BMI ranger greater than 40 kg/m2. What would this patient's obesity classification be? A. Class I B. Class II C. Class III D. Overweight

C R: Class III obesity is associated with a BMI of >40 kg/m2. Overweight is associated with a BMI of 25-30 kg/m2. Class I obesity is associated with a BMI of 30-35 kg/m2. Class II obesity is associated with a BMI of 35-40 kg/m2.

A nurse is caring for a client who is undergoing a diagnostic workup for a suspected GI problem. The client reports gnawing epigastric pain following meals and heartburn. The nurse suspects the client has: A. appendicitis. B. ulcerative colitis. C. diverticulitis. D. peptic ulcer disease.

D R:Peptic ulcer disease is characterized by dull, gnawing pain in the midepigastrium or the back that worsens with eating. Ulcerative colitis is characterized by exacerbations and remissions of severe bloody diarrhea. Appendicitis is characterized by epigastric or umbilical pain along with nausea, vomiting, and low-grade fever. Pain caused by diverticulitis is in the left lower quadrant and has a moderate onset. It's accompanied by nausea, vomiting, fever, and chills.

Which of the following represents the medication classification of a proton (gastric acid) pump inhibitor? A. Sucralfate (Carafate) B. Famotidine (Pepcid) C. Metronidazole (Flagyl) D. Omeprazole (Prilosec)

D R: 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.

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

A R: 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.

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 ulcer D. Gastric cancer

B R: 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.

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

B R: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 patient is in the hospital for the treatment of peptic ulcer disease. The nurse finds the patient vomiting and complaining of a sudden severe pain in the abdomen. The nurse then assesses a board-like abdomen. What does the nurse suspect these symptoms indicate? A. Gastric penetration B. A reaction to the medication given for the ulcer C. Perforation of the peptic ulcer D. The treatment for the peptic ulcer is ineffective.

C R: Signs and symptoms of perforation include the following: Sudden, severe upper abdominal pain (persisting and increasing in intensity), which may be referred to the shoulders, especially the right shoulder, because of irritation of the phrenic nerve in the diaphragm; vomiting; collapse (fainting); extremely tender and rigid (boardlike) abdomen; and hypotension and tachycardia, indicating shock.

The nurse is conducting a community education class on gastritis. The nurse includes that chronic gastritis caused by Helicobacter pylori is implicated in which of the following diseases/conditions? A. Systemic infection B. Colostomy C. Pernicious anemia D. Peptic ulcers

D R: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.

The nurse is assessing a patient with an ulcer for signs and symptoms of hemorrhage. The nurse interprets which of the following as a sign/symptom of possible hemorrhage? A. Hematemesis B. Bradycardia C. Hypertension D. Polyuria

A R: 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 client with a peptic ulcer is about to begin a therapeutic regimen that includes a bland diet, antacids, and famotidine (Pepcid). Before the client is discharged, the nurse should provide which instruction? A. "Avoid aspirin and products that contain aspirin." B. "Eat three balanced meals every day." C. "Stop taking the drugs when your symptoms subside." D. "Increase your intake of fluids containing caffeine."

A R: The nurse should instruct the client to avoid aspirin because it's a gastric irritant and should not be taken by clients with peptic ulcer to prevent further erosion of the stomach lining. The client should eat small, frequent meals rather than three large ones. Antacids and ranitidine prevent acid accumulation in the stomach; they should be taken even after symptoms subside. Caffeine should be avoided because it increases acid production in the stomach.

Which of the following ulcers is associated with extensive burn injury? A. Curling's ulcer B. Duodenal ulcer C. Cushing's ulcer D. Peptic ulcer

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

A patient taking metronidazole (Flagyl) for the treatment of H. pylori states that the medication is causing nausea. What suggestion can the nurse provide to the patient to alleviate this problem? A. Tell the patient to ask the physician to prescribe another type of antibiotic. B. Take the medication with meals to decrease the nausea. C. Discontinue the use of the medication. D. Crush the medication and put it in applesauce.

B R:Metronidazole (Flagyl) should be administered with meals to decrease GI upset.

The nurse recognizes that the patient diagnosed with a duodenal ulcer will likely experience A. weight loss. B. vomiting. C. pain 2 to 3 hours after a meal. D. hemorrhage.

C R: 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.

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. A sectioned portion of the stomach is joined to the jejunum. B. The vagus nerve is cut and gastric drainage is established. 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 R: 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 client with peptic ulcer disease must begin triple medication therapy. For how long will the client follow this regimen? A. 4 to 6 days B. 7 to 9 days C. 10 to 14 days D. 15 to 20 days

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

D R: 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.

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

D R: Familial tendency also may be a significant predisposing factor. People with blood type O are more susceptible to peptic ulcers than are those with blood type A, B, or AB. Blood type is not a predisposing factor for gastric cancer, esophageal varices, and diverticulitis.

A client is admitted to the health care facility with a diagnosis of a bleeding gastric ulcer. The nurse expects this client's stools to be: A. bright red. B. black and tarry. C. coffee-ground-like. D. clay-colored.

B R: 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 is recovering from gastric surgery. Toward what goal should the nurse progress the client's enteral intake? A. Three meals and 120 ml fluid daily B. Three meals and three snacks and 120 mL fluid daily C. Six small meals daily with 120 mL fluid between meals D. Six small meals and 120 mL fluid daily

C R: 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.

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

D. R: Tetracycline may cause a photosensitivity reaction in clients. The nurse should caution the client to use sunscreen when taking this drug. Dairy products can reduce the effectiveness of tetracycline, so the nurse should not advise him or her to take the medication with milk. A metallic taste accompanies administration of metronidazole (Flagyl). Administration of tetracycline does not necessitate driving restrictions.

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, and labored breathing; the client also appears to be confused. Which of the following complications has the client most likely developed? A. Penetration B. Perforation C. Hemorrhage D. Pyloric obstruction

C R:Signs of hemorrhage following surgery include cool skin, confusion, increased heart rate, labored breathing, and blood in the stool. Signs of penetration and perforation are severe abdominal pain, rigid and tender abdomen, vomiting, elevated temperature, and increased heart rate. Indicators of pyloric obstruction are nausea, vomiting, distended abdomen, and abdominal pain.

A client is admitted to the hospital with an exacerbation of his chronic gastritis. When assessing his nutritional status, the nurse should expect a deficiency in: A. vitamin A. B. vitamin B6. C. vitamin B12. D. vitamin C.

C R: 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.

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 to his right shoulder. The initial appropriate action by the nurse is to A. Notify the health care provider. B. Irrigate the client's NG tube. C. Assess the client's abdomen and vital signs. D. Place the client in the high-Fowler's position.

C R: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 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. Dehiscence of the surgical wound B. A normal reaction to surgery C. Peritonitis D. Vasomotor symptoms associated with dumping syndrome

D R: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.

Morbid obesity is defined as being how many pounds over the person's ideal body weight? A. 75 B. 50 C. 90 D. 100

D R: Morbid obesity is a term applied to people who are more than two times their ideal body weight or whose body weight index (BMI) exceeds 30 kg/m2. Another definition of morbid obesity is body weight that is more than 100 pounds greater than the ideal body weight.

Symptoms associated with pyloric obstruction include all of the following except: A. Diarrhea B. Epigastric fullness C. Anorexia D. Nausea and vomiting

A R: Pyloric obstruction, also called gastric outlet obstruction (GOO), occurs when the area distal to the pyloric sphincter becomes scarred and stenosed from spasm or edema or from scar tissue that forms when an ulcer alternately heals and breaks down. The client may have nausea and vomiting, constipation, epigastric fullness, anorexia, and, later, weight loss.

Which of the following is the most common complication associated with peptic ulcer? A. Hemorrhage B. Elevated temperature C. Abdominal pain D. Vomiting

A R: 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.

Why are antacids administered regularly, rather than as needed, in peptic ulcer disease? A. To keep gastric pH at 3.0 to 3.5 B. To promote client compliance C. To maintain a regular bowel pattern D. To increase pepsin activity

A R:To maintain a gastric pH of 3.0 to 3.5 throughout each 24-hour period, regular (not as needed) doses of an antacid are needed to treat peptic ulcer disease. Frequent administration of an antacid tends to decrease client compliance rather than promote it. Antacids don't regulate bowel patterns, and they decrease pepsin activity.

A patient who had a Roux-en-Y bypass procedure for morbid obesity ate a chocolate chip cookie after a meal. After ingestion of the cookie, the patient complained of cramping pains, dizziness, and palpitation. After having a bowel movement, the symptoms resolved. What should the patient be educated about regarding this event? A. Gastric outlet obstruction B. Bile reflux C. Dumping syndrome D. Celiac disease

C R:A patient who had a Roux-en-Y bypass procedure for morbid obesity ate a chocolate chip cookie after a meal. After ingestion of the cookie, the patient complained of cramping pains, dizziness, and palpitation. After having a bowel movement, the symptoms resolved. What should the patient be educated about regarding this event?

A client admitted for treatment of a gastric ulcer is being prepared for discharge on antacid therapy. Discharge teaching should include which instruction? A. "Be sure to take antacids with meals." B. "Avoid taking antacids containing magnesium if you develop a heart problem." C. "You may take antacids with other medications." D. "Continue to take antacids even if your symptoms subside."

D R:Antacids decrease gastric acidity and should be continued even if the client's symptoms subside. Because other medications may interfere with antacid action, the client should avoid taking antacids concomitantly with other drugs. If cardiac problems arise, the client should avoid antacids containing sodium, not magnesium. For optimal results, the client should take an antacid 1 hour before or 2 hours after meals.

Which of the following appears to be a significant factor in the development of gastric cancer? A. Ethnicity B. Gender C. Age D. Diet

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

A nurse is performing discharge teaching with a client who had a total gastrectomy. Which statement indicates the need for further teaching? A. "I will call my physician if I begin to have abdominal pain." B. "I'm going to visit my pastor weekly for a while." C. "I will weight myself each day and record the weight." D. "I will have to take vitamin B12 shots up to 1 year after surgery."

D R:After a total gastrectomy, a client will need to take vitamin B12 shots for life. Dietary B12 is absorbed in the stomach, and the inability to absorb it could lead to pernicious anemia. Visiting clergy for emotional support is normal after receiving a cancer diagnosis. This action should be encouraged by the nurse. It's appropriate for the client to call the physician if he experiences signs and symptoms of intestinal blockage or obstruction, such as abdominal pain. Because a client with a total gastrectomy will receive enteral feedings or parenteral feedings, he should weigh himself each day and keep a record of the weights.

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. Pyloroplasty B. Billroth I C. Billroth II D. Vagotomy

B R: 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.