Prep U - Ch 46
The nurse determines that teaching for the client with peptic ulcer disease has been effective when the client makes which statement? "I should stop all my medications if I develop any side effects." "I should continue my treatment regimen as long as I have pain." "I have learned some relaxation strategies that decrease my stress." "I can buy whatever antacids are on sale because they all have the same effect."
"I have learned some relaxation strategies that decrease my stress." 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." "It is a hereditary disease." "It is probably your nerves."
"It can be caused by ingestion of strong acids." "You may have ingested some irritating foods." "Is it possible that you are overusing aspirin." Acute gastritis is often caused by dietary indiscretion—the person eats food that is irritating, too highly seasoned, or contaminated with disease-causing microorganisms. Other causes of acute gastritis include overuse of aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), excessive alcohol intake, bile reflux, and radiation therapy. A more severe form of acute gastritis is caused by the ingestion of strong acid or alkali, which may cause the mucosa to become gangrenous or to perforate.
A client with a peptic ulcer is diagnosed with Helicobacter pylori infection. The nurse is teaching the client about the medications prescribed, including metronidazole, omeprazole, and clarithromycin. Which statement by the client indicates the best understanding of the medication regimen? "My ulcer will heal because these medications will kill the bacteria." "I should take these medications only when I have pain from my ulcer." "The medications will kill the bacteria and stop the acid production." "These medications will coat the ulcer and decrease the acid production in my stomach."
"These medications will kill the bacteria and stop the acid production" 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 (e.g., metronidazole [Flagyl] or amoxicillin [Amoxil] and clarithromycin [Biaxin]) plus a proton-pump inhibitor (e.g., 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.
A client comes to the clinic after developing a headache, abdominal pain, nausea, hiccupping, and fatigue about 2 hours ago. The client tells the nurse that the last food was buffalo chicken wings and beer. Which medical condition does the nurse find to be most consistent with the client's presenting problems? Acute gastritis Duodenal ulcer Gastric cancer Gastric ulcer
Acute gastritis A client with acute gastritis may have a rapid onset of symptoms, including abdominal discomfort, headache, lassitude, nausea, anorexia, vomiting, and hiccupping, 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 client with a duodenal ulcer will present with heartburn, nausea, excessive gas and vomiting. A client with gastric cancer will have persistent symptoms of nausea and vomiting, not sudden symptoms. A client with a gastric ulcer will have bloating, nausea, and vomiting, but not necessarily hiccups.
The nurse is evaluating a client's ulcer symptoms to differentiate ulcer as duodenal or gastric. Which symptom should the nurse at attribute to a duodenal ulcer? Vomiting Hemorrhage Awakening in pain Constipation
Awakening in pain The client with a duodenal ulcer is more likely to awaken with pain during the night than is the client with a gastric ulcer. Vomiting, constipation, diarrhea, and bleeding are symptoms common to both gastric and duodenal ulcers.
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? Coffee-ground-like Clay-colored Black and tarry Bright red
Black and tarry 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.
Which of the following clients is at highest risk for peptic ulcer disease? Client with blood type A Client with blood type B Client with blood type AB Client with blood type O
Client with type O blood Clients with blood type O are more susceptible to peptic ulcers than those with blood types A, B, and AB.
A morbidly obese client asks the nurse if medications are available to assist with weight loss. The nurse knows that the client would not be a candidate for phentermine if the following is part of the client's health history: Coronary artery disease Diabetes Use of lithium Peptic ulcer disease
Coronary artery disease Phentermine, which requires a prescription, stimulates central noradrenergic receptors, causing appetite suppression. It may increase blood pressure and should not be taken by people with a history of heart disease, uncontrolled hypertension, hyperthyroidism, or glaucoma.
The nurse is providing preoperative care for a client with gastric cancer who is having a resection. What is the nursing management priority for this client? Discharge planning Correcting nutritional deficits Preventing deep vein thrombosis (DVT) Teaching about radiation treatment
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 ulcer is associated with extensive burn injury? Cushing ulcer Curling ulcer Peptic ulcer Duodenal ulcer
Curling ulcer Curling ulcer is frequently observed about 72 hours after extensive burns and involves the antrum of the stomach or the duodenum.
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 Peptic ulcer Esophageal ulcer Meckel's ulcer
Curling's ulcer 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 client with acute gastritis asks the nurse what might have caused the problem. What is a possible cause of acute gastritis? Select all that apply. Dietary indiscretion Overuse of allergy medicine Excessive alcohol intake Drinking fruit juices Radiation therapy
Diestary indiscretion, excessive alcohol intake, radiation therapy 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.
Clients with Type O blood are at higher risk for which of the following GI disorders? Gastric cancer Duodenal ulcers Esophageal varices Diverticulitis
Duodenal ulcers 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.
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? Duodenum Esophagus Pylorus Stomach
Duodenum Peptic ulcers occur mainly in the gastroduodenal mucosa because this tissue cannot withstand the digestive action of gastric acid (HCl) and pepsin.
Which medication is classified as a histamine-2 receptor antagonist? Famotidine Lansoprazole Metronidazole Esomeprazole
Famotidine Famotidine is a histamine-2 receptor antagonist. Lansoprazole and esomeprazole are proton pump inhibitors (PPIs). Metronidazole is an antibiotic.
A client has been taking famotidine at home. What teaching should the nurse include with the client? Famotidine will inhibit gastric acid secretions. Famotidine will neutralize acid in the stomach. Famotidine will shorten the time required for digestion in the stomach. Famotidine will improve the mixing of foods and gastric secretions.
Famotidine will 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. 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 conducting a community education program on peptic ulcer disease prevention. The nurse includes that the most common cause of peptic ulcers is: stress and anxiety. gram-negative bacteria. alcohol and tobacco. ibuprofen and aspirin.
Gram-negative bacteria The nurse should include that the most common cause of peptic ulcers is gram-negative bacteria (Helicobacter pylori).
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 Bradycardia Hypertension Polyuria
Hematemesis 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.
The nurse is cautiously assessing a client admitted with peptic ulcer disease because the most common complication that occurs in 10% to 20% of clients is: Hemorrhage Intractable ulcer Perforation Pyloric obstruction
Hemorrhage Hemorrhage, the most common complication, occurs in 10% to 20% of clients with peptic ulcers. Bleeding may be manifested by hematemesis or melena. Perforation is erosion of the ulcer through the gastric serosa into the peritoneal cavity without warning. Intractable ulcer refers to one that is hard to treat, relieve, or cure. 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.
Which is a true statement regarding the nursing considerations in administration of metronidazole? It may cause weight gain. The drug should be given before meals. Metronidazole decreases the effect of warfarin. It leaves a metallic taste in the mouth.
It leaves a metallic taste in the mouth Metronidazole leaves a metallic taste in the mouth. It may cause anorexia and should be given with meals to decrease gastrointestinal upset. Metronidazole increases the blood-thinning effects of warfarin.
A 66-year-old African-American client has recently visited a physician to confirm a diagnosis of gastric cancer. The client has a history of tobacco use and was diagnosed 10 years ago with pernicious anemia. He and his family are shocked about the possibility of cancer because he was asymptomatic prior to recent complaints of pain and multiple gastrointestinal symptoms. On the basis of knowledge of disease progression, the nurse assumes that organs adjacent to the stomach are also affected. Which of the following organs may be affected? Choose all that apply. Liver Pancreas Bladder Duodenum Lungs
Liver, pancreas, duodenum Most gastric cancers are adenocarcinomas; they can occur anywhere in the stomach. The tumor infiltrates the surrounding mucosa, penetrating the wall of the stomach and adjacent organs and structures. The liver, pancreas, esophagus, and duodenum are often already affected at the time of diagnosis. Metastasis through lymph to the peritoneal cavity occurs later in the disease.
The nurse in the ED admits a client with suspected gastric outlet obstruction. The client's symptoms include nausea and vomiting. The nurse anticipates that the physician will issue which order? Pelvic x-ray Stool specimen Nasogastric tube insertion Oral contrast
Nasogastric tube insertion The nurse anticipates an order for nasogastric tube insertion to decompress the stomach. Pelvic x-ray, oral contrast, and stool specimens are not indicated at this time.
A client is prescribed a histamine (H2)-receptor antagonist. The nurse understands that this might include which medication(s)? Select all that apply. Nizatidine Lansoprazole Famotidine Cimetidine Esomeprazole
Nizatidine, famotidine, cimetidine H2-receptor antagonists suppress secretion of gastric acid, alleviate symptoms of heartburn, and assist in preventing complications of peptic ulcer disease. These medications also suppress gastric acid secretions and are used in active ulcer disease, erosive esophagitis, and pathological hypersecretory conditions. The other medications listed are proton-pump inhibitors.
A nurse practitioner prescribes drug therapy for a patient with peptic ulcer disease. Choose the drug that can be used for 4 weeks and has a 90% chance of healing the ulcer. Nizatidine Cimetidine Famotidine Omeprazole
Omeprazole Omeprazole (Prilosec) is a proton pump inhibitor that, if used according to the health care provider's directions, will result in healing in 90% of patients. The other drugs are H2 receptor antagonists that need to be used for 6 weeks.
The nurse is teaching a client with peptic ulcer disease who has been prescribed misoprostol. What information from the nurse would be most accurate about misoprostol? Works best when taken on an empty stomach Increases the speed of gastric emptying Prevents ulceration in clients taking nonsteroidal anti-inflammatory drugs (NSAIDs) Decreases mucus production
Prevents ulceration in clients taking NSAIDs Misoprostol (Cytotec) is a synthetic prostaglandin that protects the gastric mucosa against ulceration and is used in clients who take NSAIDs. Misoprostol should be taken with food. It does not improve emptying of the stomach, and it increases (not decreases) mucus production.
The nurse advises the patient who has just been diagnosed with acute gastritis to: Take an emetic to rid the stomach of the irritating products. Refrain from food until the GI symptoms subside. Restrict food and fluids for 12 hours. Restrict all food for 72 hours to rest the stomach.
Refrain from food until the GI symptoms subside It usually takes 24 to 48 hours for the stomach to recover from an attack. Refraining from food until symptoms subside is recommended, but liquids should be taken in moderation. Emetics and vomiting can cause damage to the esophagus.
A client is preparing for discharge to home following a partial gastrectomy and vagotomy. Which is the best rationale for the client being taught to lie down for 30 minutes after each meal? Slows gastric emptying Provides much needed rest Allows for better absorption of vitamin B12 Removes tension on internal suture line
Slows gastric emptying Dumping syndrome is a common complication following subtotal gastrectomy. To avoid the rapid emptying of stomach contents, resting after meals can be helpful. Promoting rest after a major surgery is helpful in recovery but not the reason for resting after meals. Following this type of surgery, clients will have a need for vitamin B12 supplementation due to absence of production of intrinsic factor in the stomach. Resting does not increase absorption of B12 or remove tension on suture line.
A client is admitted with a gastrointestinal bleed. What client symptom may indicate a peptic ulcer perforation to the nurse? Sudden, severe upper abdominal pain Hypertension Bradycardia Soft abdomen
Sudden, severe upper abdominal pain The client with a peptic ulcer perforation may have symptoms such as sudden, sever upper abdominal pain, vomiting, fainting, an extremely tender and rigid (board-like) abdomen, and hypotension and tachycardia, indicating shock. The client with a bleeding peptic ulcer will not experience hypertension or bradycardia. The client's abdomen with a peptic ulcer bleed will not be soft, but rigid.
A healthcare provider prescribes a combination of drugs to treat reoccurring peptic ulcer disease, and the client asks the nurse the reason for all the medications. What teaching should the nurse review with the client? The antibiotics, prostaglandin E1 analogs, and bismuth salts will work together to suppress or eradicate H. pylori. The proton pump inhibitors, prostaglandin E1 analogs, and bismuth salts will suppress or eradicate H. pylori. The bismuth salts, antibiotics, and proton pump inhibitors will work together to suppress or eradicate H. pylori. The prostaglandin E1 analogs, antibiotics, and proton pump inhibitors will work together to suppress or eradicate H. pylori.
The bismuth salts, antibiotics, and proton pump inhibitors will work together to suppress or eradicate H. pylori The recommended combination of bismuth salts, antibiotics, and proton pump inhibitors will suppress or eradicate H. pylori. Prostaglandin E1 analogs enhance mucosal resistance to injury; they do not suppress or eradicate H. pylori.
A nurse is performing discharge teaching with a client who had a total gastrectomy. Which statement indicates the need for further teaching? "I'm going to visit my pastor weekly for a while." "I will have to take vitamin B12 shots up to 1 year after surgery." "I will call my physician if I begin to have abdominal pain." "I will weight myself each day and record the weight."
"I will have to take vitamin B12 shots for up to 1 year after surgery" 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 nurse is teaching a client who has experienced an episode of acute gastritis. The nurse knows further education is necessary when the client makes which statement? "I should feel better in about 24 to 36 hours." "My appetite should come back tomorrow." "I should limit alcohol intake, at least until symptoms subside." "Once I can eat again, I should stick with bland foods."
"My appetite should come back tomorrow" The gastric mucosa is capable of repairing itself after an episode of gastritis. As a rule, the client recovers in about 1 day, although the appetite may be diminished for an additional 2 or 3 days. Acute gastritis is also managed by instructing the client to refrain from alcohol and food until symptoms subside. When the client can take nourishment by mouth, a nonirritating diet is recommended.
A nursing student is caring for a client with gastritis. Which of the following would the student recognize as a common cause of gastritis? Choose all that apply. Ingestion of strong acids Irritating foods Overuse of aspirin DASH diet Participation in highly competitive sports
Ingestion of strong acids, irritating foods, overuse of aspirin Acute gastritis is often caused by dietary indiscretion-a person eats food that is irritating, too highly seasoned, or contaminated with disease-causing microorganisms. Other causes of acute gastritis include overuse of aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), excessive alcohol intake, bile reflux, and radiation therapy. A more severe form of acute gastritis is caused by the ingestion of strong acid or alkali, which may cause the mucosa to become gangrenous or to perforate. A DASH diet is an acronym for Dietary Approaches to Stop Hypertension, which would not cause gastritis. Participation in competitive sports also would not cause gastritis.
Rebleeding may occur from a peptic ulcer and often warrants surgical interventions. Signs of bleeding include which of the following? Mental confusion Bradycardia Bradypnea Hypertension
Mental confusion Signs of bleeding include tachycardia, tachypnea, hypotension, mental confusion, thirst, and oliguria.
Which of the following are characteristics associated with the Zollinger-Ellison syndrome (ZES)? Select all that apply. Constipation Hypocalcemia Severe peptic ulcers Extreme gastric hyperacidity Gastrin-secreting tumors of the pancreas
Severe peptic ulcers, extreme gastric hyperacidity, gastrin-secreting tumors of the pancreas ZES consists of severe peptic ulcers, extreme gastric hyperacidity, and gastrin-secreting benign or malignant tumors of the pancreas. Diarrhea and steatorrhea may be evident. The client may have co-existing parathyroid adenomas or hyperplasia and may therefore exhibit signs of hypercalcemia.
After teaching a client who has had a Roux-en-Y gastric bypass, which client statement indicates the need for additional teaching? "I need to chew my food slowly and thoroughly." "I need to drink 8 ounces of water before eating." "A total serving should amount to be less than one cup." "I should pick cereals with less than 2 g of fiber per serving."
"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.
A client with peptic ulcer disease must begin triple medication therapy. For how long will the client follow this regimen? 4 to 6 days 7 to 9 days 10 to 14 days 15 to 20 days
10 to 14 days Recommended therapy for 10 to 14 days includes triple therapy with two antibiotics (e.g., metronidazole [Flagyl] or amoxicillin [Amoxil] and clarithromycin [Biaxin]) plus a proton pump inhibitor (e.g., 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 nursing student is preparing a teaching plan about peptic ulcer disease. The student knows to include teaching about the percentage of clients with peptic ulcers who experience bleeding. The percentage is Less than 5% 15% 25% Greater than 50%
15% Fifteen percent of clients with peptic ulcer experience bleeding.
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. A sectioned portion of the stomach is joined to the jejunum. The antral portion of the stomach is removed and a vagotomy is performed. The vagus nerve is cut and gastric drainage is established.
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. 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 has a family history of stomach cancer. Which factor would further increase the client's risk for developing gastric cancer? Select all that apply. High intake of fruits and vegetables Age 55 years Female gender Caucasian ancestry Previous infection with H. pylori
Age 55 years, previous infection with H. pylori The typical client with gastric cancer is between 40 and 70 years, but gastric cancer can occur in younger people. Men have a higher incidence of gastric cancer than women. Native Americans, Hispanic Americans, and African Americans are twice as likely as Caucasian Americans to develop gastric cancer. A diet high in smoked, salted, or pickled foods and low in fruits and vegetables may increase the risk of gastric cancer. Other factors related to the incidence of gastric cancer include chronic inflammation of the stomach, H. pylori infection, pernicious anemia, smoking, achlorhydria, gastric ulcers, subtotal gastrectomy more than 20 years ago, and genetics.
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 sedentary lifestyle and smoking. a history of hemorrhoids and smoking. alcohol abuse and a history of acute renal failure. alcohol abuse and smoking.
Alcohol abuse and smoking 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.
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 between gastric and duodenal ulcers. Amount of hydrochloric acid (HCL) secretion in the stomach Sensitivity to the use of nonsteroidal anti-inflammatory drugs (NSAIDs) Presence of H. pylori Patient's age
Amount of hydrochloric acid (HCL) secretion in the stomach A duodenal ulcer is characterized by hypersecretion of stomach acid, whereas a gastric ulcer shows evidence of hyposecretion of stomach acid. The other three choices have similar characteristics in both types of ulcers.
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? Notify the health care provider. Irrigate the client's NG tube. Place the client in the high-Fowler's position. Assess the client's abdomen and vital signs.
Assess the client's abdomen and vital signs 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.
Which of the following appears to be a significant factor in the development of gastric cancer? Diet Age Ethnicity Gender
Diet 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.
The nurse reviews dietary guidelines with a client who had a gastric banding. Which teaching points are included? Select all that apply. Eat six meals a day. Limit meal size to 450 to 500 mL. Do not eat and drink at the same time. Drink plenty of water, from 90 minutes after each meal to 15 minutes before each meal. Avoid fruit drinks and soda.
Do not eat and drink at the same time, drink plenty of water, from 90 minutes after each meal to 15 minutes before each meal, avoid fruit drinks and soda Total meal size should be restricted to less than 8 oz or 240 mL. Three meals a day are recommended.
A nurse is caring for a client who underwent a subtotal gastrectomy. To manage dumping syndrome, the nurse should advise the client to: restrict fluid intake to 1 qt (1,000 ml)/day. drink liquids only with meals. don't drink liquids 2 hours before meals. drink liquids only between meals.
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 client 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 client reported cramping pains, dizziness, and palpitation. After having a bowel movement, the symptoms resolved. What should the nurse educate the client about regarding this event? Gastric outlet obstruction Dumping syndrome Bile reflux Celiac disease
Dumping syndrome Dumping syndrome is an unpleasant set of vasomotor and GI symptoms that occur in up to 76% of patients who have had bariatric surgery. Early symptoms include a sensation of fullness, weakness, faintness, dizziness, palpitations, diaphoresis, cramping pains, and diarrhea. These symptoms resolve once the intestine has been evacuated (i.e., with defecation).
A nurse is providing follow-up teaching at a clinic visit for a client recovering from gastric resection. The client reports sweating, diarrhea, nausea, palpitations, and the desire to lie down 15 to 30 minutes after meals. Based on the client's assessment, what will the nurse suspect? Dumping syndrome Dehiscence of the surgical wound Peritonitis A normal reaction to surgery
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, board-like abdomen, tenderness, and fever. The client's signs and symptoms aren't a normal reaction to surgery.
A health care provider suspects that a client has peptic ulcer disease. With which diagnostic procedure would the nurse most likely prepare to assist? Barium study of the upper gastrointestinal tract Endoscopy Gastric secretion study Stool antigen test
Endoscopy 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.
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? Hemorrhage Penetration Perforation Pyloric obstruction
Hemorrhage 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.
Which medication classification represents a proton (gastric acid) pump inhibitor? Omeprazole Sucralfate Famotidine Metronidazole
Omeprazole 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 recognizes that the client diagnosed with a duodenal ulcer will likely experience vomiting. hemorrhage. pain 2 to 3 hours after a meal. weight loss.
Pain 2 to 3 hours after a meal The client with a gastric 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 the client with gastric ulcer. The client with a duodenal ulcer may experience weight gain.
Which of the following manifestations are associated with a deficiency of vitamin B12? Select all that apply. Pernicious anemia Macrocytic anemia Thrombocytopenia Loss of hair Lethargy
Pernicious anemia, macrocytic anemia, thrombocytopenia Decreased vitamin B12 can result in pernicious anemia, macrocytic anemia, and thrombocytopenia. Decreased iron can result in lethargy and loss of hair.
A client is recovering from gastric surgery. Toward what goal should the nurse progress the client's enteral intake? Three meals and 120 ml fluid daily Three meals and three snacks and 120 mL fluid daily Six small meals and 120 mL fluid daily Six small meals daily with 120 mL fluid between meals
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.
A client with peptic ulcer disease wants to know nonpharmacologic ways to prevent recurrence. Which of the following measures would the nurse recommend? Select all that apply. Smoking cessation Substituting decaffeinated products for all forms of coffee Avoidance of alcohol Eating whenever hungry Following a regular schedule for rest, relaxation, and meals
Smoking cessation, substituting decaffeinated products for all forms of coffee, avoidance of alcohol, following a regular schedule for rest, relaxation, and meals The likelihood of recurrence is reduced if the client avoids smoking, coffee (including decaffeinated coffee) and other caffeinated beverages, and alcohol. It is important to counsel the client to eat meals at regular times and in a relaxed setting and to avoid overeating.
A client taking metronidazole for the treatment of H. pylori states that the medication is causing nausea. What teaching should the nurse provide to the client to alleviate the nausea? Discontinue the use of the medication. Ask the healthcare provider to prescribe another type of antibiotic. Take the medication with meals to decrease the nausea. Crush the medication and put it in applesauce.
Take the medication with meals to decrease the nausea Metronidazole (Flagyl) should be administered with meals to decrease GI upset. The client should not stop the medication without discussing it with a prescribing healthcare provider. Crushing the medication will not help the nausea because it is the same medication.
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 Dehiscence of the surgical wound Peritonitis A normal reaction to surgery
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, board-like abdomen, tenderness, and fever. The client's signs and symptoms aren't a normal reaction to surgery.