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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? A. Dumping syndrome B. Gastric outlet obstruction C. Bile reflux D. Celiac disease

Answer: A 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).

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

Answer: A Signs of bleeding include tachycardia, tachypnea, hypotension, mental confusion, thirst, and oliguria.

As a nurse completes the admission assessment of a client admitted for gastric bypass surgery, the client states, "Finally! I'll be thin and able to eat without much concern." How should the nurse intervene? A. Evaluate the client's understanding of the procedure. B. Rejoice with the client. C. Notify the health care provider that the client is eager to sign the consent form. D. Ask the client about his or her plans for after surgery.

Answer: A The nurse should evaluate the client's understanding of the procedure. The client may not understand that surgery alone isn't a cure for obesity; lifestyle modifications and counseling are also necessary. Based on the client's comment, the client isn't fully informed; therefore, signing an informed consent form without further teaching would be inappropriate. Rejoicing with the client is inappropriate. Asking the client about plans for after surgery redirects the conversation away from the client's misinterpretation of the procedure.

A client diagnosed with a peptic ulcer says, "Now I have something else I have to worry about." Which actions will the nurse take to help reduce the client's anxiety? Select all that apply. A. Interact with the client in a relaxed manner. B. Inform the client the medication will solve the problem. C. Help identify the client's current stressors. D. Discuss potential coping techniques with the client. E. Offer information about relaxation methods.

Answer: A, C, D, E A client with a peptic ulcer may have a problem with anxiety. To help reduce the client's anxiety, the nurse should interact with the client in a relaxed manner and help the client identify stressors. The nurse can also discuss potential coping techniques and offer information about relaxation methods. Stating that medication will solve the problem may not be sufficient if stress and anxiety are contributors to the development of the ulcer.

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. drink liquids only with meals. C. don't drink liquids 2 hours before meals. D. drink liquids only between meals.

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

Answer: B 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 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. A. Cimetidine B. Omeprazole C. Nizatidine D. Famotidine

Answer: B 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.

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? A. Pyloric obstruction B. Hemorrhage C. Perforation D. Penetration

Answer: B 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.

The nurse visits the home of a client recovering from acute gastritis. Which observation indicates that teaching about the disorder was effective? A. Cup of caffeinated coffee on the kitchen table B. Medications placed in a pillbox C. Extinguished cigarettes in an ashtray D. Tomato sauce simmering on the stove

Answer: B 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.

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

Answer: B 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 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.

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 have to take vitamin B12 shots up to 1 year after surgery." D. "I will weight myself each day and record the weight."

Answer: C 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 health care provider suspects that a client has peptic ulcer disease. With which diagnostic procedure would the nurse most likely prepare to assist? A. Stool antigen test B. Gastric secretion study C. Endoscopy D. Barium study of the upper gastrointestinal tract

Answer: C 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 an H. pylori infection asks why bismuth subsalicylate is prescribed. Which response will the nurse make? A. "It enhances the function of the pyloric sphincter." B. "It improves digestion in the stomach." C. "It aids in the healing of the stomach lining." D. "It helps propel food from the stomach into the duodenum."

Answer: C Bismuth subsalicylate suppresses H. pylori bacteria in the gastric mucosa and assists with healing of mucosal ulcers. It does not affect digestion, enhance the function of the pyloric sphincter, or propel food from the stomach into the duodenum.

A nurse is teaching a client with gastritis about the need to avoid the intake of caffeinated beverages. The client asks why this is so important. Which explanation from the nurse would be most accurate? A. "Caffeine increases the fluid volume in your system, which irritates your digestive organs." B. "Caffeine can interfere with absorption of vitamin B12, which leads to anemia and further digestive problems." C. "Caffeine stimulates the central nervous system and thus gastric activity and secretions, which need to be minimized to promote recovery." D. "Caffeine intake can cause tears in your esophagus and intestines, which can lead to hemorrhage."

Answer: C Caffeine is a central nervous system stimulant that increases gastric activity and pepsin secretion. Caffeine is a diuretic that causes decreased fluid volume and potential dehydration. It does not lead to hemorrhage and does not interfere with absorption of vitamin B12.

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

Answer: C 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 with gastric ulcers caused by H. pylori is prescribed metronidazole. Which client statement indicates to the nurse that teaching about this medication was effective? A. "I can take this medication with my blood thinner." B. "I can have an alcoholic drink in the evenings." C. "It might cause a metallic taste in my mouth." D. "My appetite may increase while taking this medication."

Answer: C 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 peptic ulcer disease has a blood pressure of 88/40 mm Hg, dizziness, and nausea. Which complication will the nurse suspect is occurring with this client? A. Medication adverse effects B. Allergic response to the medication C. Evidence of ulcer healing D. Bleeding from the ulcer

Answer: D Bleeding peptic ulcers account for 27% to 40% of all upper GI bleeds and it may be manifested by hematemesis or melena. Faintness or dizziness and nausea may precede or accompany bleeding. A low blood pressure could indicate active bleeding. The client's symptoms do not indicate evidence of the ulcer healing. It is unlikely that the client's symptoms are adverse effects or allergic responses to the medications.

The nurse is caring for a patient who has been diagnosed with gastritis. To promote fluid balance when treating gastritis, the nurse knows that what minimal daily intake of fluids is required? A. 2.0 L B. 2.5 L C. 1.0 L D. 1.5 L

Answer: D Daily fluid intake and output are monitored to detect early signs of dehydration (minimal fluid intake of 1.5 L/day, minimal output of 0.5 mL/kg/h).

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? A. The proton pump inhibitors, prostaglandin E1 analogs, and bismuth salts will suppress or eradicate H. pylori. B. The prostaglandin E1 analogs, antibiotics, and proton pump inhibitors will work together to suppress or eradicate H. pylori. C. The antibiotics, prostaglandin E1 analogs, and bismuth salts will work together to suppress or eradicate H. pylori. D. The bismuth salts, antibiotics, and proton pump inhibitors will work together to suppress or eradicate H. pylori.

Answer: D 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 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 partial gastrectomy is performed with anastomosis of the stomach segment to the duodenum. B. The antral portion of the stomach is removed and a vagotomy is performed. C. The vagus nerve is cut and gastric drainage is established. D. A sectioned portion of the stomach is joined to the jejunum.

Answer: A 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.

The nurse is caring for a client who has just returned from the PACU after surgery for peptic ulcer disease. For what potential complications does the nurse know to monitor? Select all that apply. A. Pyloric obstruction B. Cachexia C. Perforation D. Hemorrhage E. Inability to clear secretions F. Penetration

Answer: A, C, D, F Potential complications may include hemorrhage, perforation, penetration, and pyloric obstruction. A client who has had surgery for peptic ulcer disease may have a decreased appetite in the immediate postoperative stage, but it is not something the nurse would monitor for and would not cause cachexia. Inability to clear secretions is generally not a complication of peptic ulcer surgery.

Peptic ulcer disease occurs more frequently in people with which blood type? A. AB B. O C. A D. B

Answer: B People with blood type O are more susceptible to peptic ulcers than those with blood type A, B, or AB.

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? A. Place the client in the high-Fowler's position. B. Notify the health care provider. C. Irrigate the client's NG tube. D. Assess the client's abdomen and vital signs.

Answer: D 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.

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

Answer: D 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 recovering from gastric surgery. What is the correct position for the nurse to place this client? A. Trendelenburg B. Supine C. Fowler's D. Semi-Fowler's

Answer: C Placing the client in the Fowler's position after gastric surgery promotes comfort and allows emptying of the stomach.

A client with peptic ulcer disease caused by H. pylori is prescribed clarithromycin. Which information will the nurse include when teaching the client about this medication? A. Do not take this medication with grapefruit juice. B. Photosensitivity is an adverse effect of this medication. C. Abdominal pain and diarrhea are expected side effects. D. Always take this medication on an empty stomach.

Answer: A Clarithromycin is an antibiotic used to treat H. pylori infection. This medication should not be taken with grapefruit juice. Photosensitivity is an adverse effect of tetracycline. Amoxicillin can cause abdominal pain and diarrhea. Metronidazole can be taken with meals to decrease GI upset.

Which of the following medications is classified as a proton pump inhibitor (PPI)? A. Nizatidine B. Cimetidine C. Omeprazole D. Famotidine

Answer: C Omeprazole is classified as a PPI. Nizatidine, cimetidine, and famotidine are classified as H2 receptor antagonists.

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

Answer: A 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.

Which medication is classified as a histamine-2 receptor antagonist? A. Famotidine B. Esomeprazole C. Metronidazole D. Lansoprazole

Answer: A Famotidine is a histamine-2 receptor antagonist. Lansoprazole and esomeprazole are proton pump inhibitors (PPIs). Metronidazole is an antibiotic.

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.) A. "You may have ingested some irritating foods." B. "Is it possible that you are overusing aspirin." C. "It is a hereditary disease." D. "It can be caused by ingestion of strong acids." E. "It is probably your nerves."

Answer: A, B, D 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.

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

Answer: B 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.

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? A. Acute gastritis B. Gastric ulcer C. Gastric cancer E. Duodenal ulcer

Answer: A 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.

Which of the following manifestations are associated with a deficiency of vitamin B12? Select all that apply. A. Thrombocytopenia B. Macrocytic anemia C. Lethargy D. Pernicious anemia E. Loss of hair

Answer: A, B, D Decreased vitamin B12 can result in pernicious anemia, macrocytic anemia, and thrombocytopenia. Decreased iron can result in lethargy and loss of hair.

Which ulcer is associated with extensive burn injury? A. Cushing ulcer B. Duodenal ulcer C. Curling ulcer D. Peptic ulcer

Answer: C Curling ulcer is frequently observed about 72 hours after extensive burns and involves the antrum of the stomach or the duodenum.

A client with peptic ulcer disease must begin triple medication therapy. For how long will the client follow this regimen? A. 7 to 9 days B. 15 to 20 days C. 10 to 14 days D. 4 to 6 days

Answer: C 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).

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

Answer: D 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.

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? A. Colostomy B. Pernicious anemia C. Peptic ulcers D. Systemic infection

Answer: C 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 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? A. Provides much needed rest B. Removes tension on internal suture line C. Slows gastric emptying D. Allows for better absorption of vitamin B12

Answer: C 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.