A2 ch 40 gastric and duodenal disorders
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? -"Caffeine can interfere with absorption of vitamin B12, which leads to anemia and further digestive problems." -"Caffeine increases the fluid volume in your system, which irritates your digestive organs." -"Caffeine intake can cause tears in your esophagus and intestines, which can lead to hemorrhage." -"Caffeine stimulates the central nervous system and thus gastric activity and secretions, which need to be minimized to promote recovery."
"Caffeine stimulates the central nervous system and thus gastric activity and secretions, which need to be minimized to promote recovery." 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 client comes to the clinic reporting pain in the epigastric region. What assessment question during the health interview would most help the nurse determine if the client has a peptic ulcer? "Does your pain get worse if you get up and do some exercise?" "Do over-the-counter pain medications help your pain?" "Does your pain resolve when you have something to eat?" "Do you find that your pain is worse when you need to have a bowel movement?"
"Does your pain resolve when you have something to eat?" Pain relief after eating is associated with peptic ulcers. The pain of peptic ulcers is generally unrelated to activity or bowel function and may or may not respond to analgesics.
A client with an H. pylori infection asks why bismuth subsalicylate is prescribed. Which response will the nurse make? "It aids in the healing of the stomach lining." "It helps propel food from the stomach into the duodenum." "It enhances the function of the pyloric sphincter." "It improves digestion in the stomach."
"It aids in the healing of the stomach lining." 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 client recovering from the removal of a gastric tumor asks why radiation therapy is needed. Which response will the nurse provide? "It is to reduce your need for medication." "It is to prevent the development of a wound infection." "It is to heal the wound faster." "It is to kill any remaining cancer cells."
"It is to kill any remaining cancer cells." Radiation therapy may also be used alone or along with chemotherapy before surgery to decrease the size of the tumor, or after surgery to destroy any remaining cancer cells and to delay or prevent reoccurrence of the cancer.
A nurse is caring for a client who underwent a subtotal gastrectomy. To manage dumping syndrome, the nurse should advise the client to: don't drink liquids 2 hours before meals. drink liquids only with meals. drink liquids only between meals. restrict fluid intake to 1 qt (1,000 ml)/day.
"It might cause a metallic taste in my mouth 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 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? "I felt better but then just got really nauseated and threw up." "The pain stopped so I stopped taking the medications." "I only ate dinner yesterday and it gave me an upset stomach." "I think the soda that I drank irritated my stomach."
"The pain stopped so I stopped taking the medications." 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.
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 is probably your nerves." "You may have ingested some irritating foods." "It is a hereditary disease." "Is it possible that you are overusing aspirin." "It can be caused by ingestion of strong acids."
-"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 patient is scheduled for a Billroth I procedure for ulcer management. What does the nurse understand will occur when this procedure is performed? -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 sectioned portion of the stomach is joined to the jejunum.
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 recovering from a total gastrectomy has a low red blood cell count. Which medication will the nurse expect to be prescribed for this client? -Oral iron tablets -Transfusions of packed RBCs -Vitamin B12 injections -Erythropoietin injections
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.
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 Bright red Coffee-ground-like Clay-colored
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 B Client with blood type A Client with blood type AB Client with blood type O
Client with blood type O
Which diagnostic test would be used first to evaluate a client with upper GI bleeding? Endoscopy Arteriography Hemoglobin and hematocrit Upper GI series
Hemoglobin and hematocrit
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. Irritating foods DASH diet Participation in highly competitive sports Overuse of aspirin Ingestion of strong acids
Ingestion of strong acids Irritating foods Overuse of aspirin
A client is prescribed a histamine (H2)-receptor antagonist. The nurse understands that this might include which medication(s)? Select all that apply. Cimetidine Esomeprazole Famotidine Nizatidine Lansoprazole
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.
During a home visit the nurse notes that a client recovering from peptic ulcer disease is experiencing cool clammy skin and has a heart rate of 96 beats a minute. Which action will the nurse take? -Provide a dose of a proton pump inhibitor. -Discuss the types of foods the client has been eating. -Encourage the client to drink a warm beverage. -Notify the primary health care provider.
Notify the primary health care provider. The client with peptic ulcer disease is demonstrating signs of hemorrhage which include cool skin and tachycardia. The health care provider should be immediately notified. The client should not be given any additional medication. A warm beverage could enhance bleeding. It is inappropriate to provide any teaching while the client is experiencing an acute condition.
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 is conducting a community education class on gastritis. The nurse includes that chronic gastritis caused by Helicobacter pylori is implicated in which disease/condition? -Pernicious anemia -Peptic ulcers -Systemic infection -Colostomy
Peptic ulcers 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.
Which of the following is the most successful treatment for gastric cancer? Palliation Removal of the tumor Radiation Chemotherapy
Removal of the tumor 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.
Which of the following medications used for obesity improves cardiovascular disease risk factors in obese patients with metabolic syndrome? Alli Rimonabant (Acomplia) Orlistat (Xenical) Sibutramine (Meridia)
Rimonabant (Acomplia) Acomplia is the newest medication used to treat obesity. It stimulates weight reduction and improves cardiovascular disease risk factors in obese patients with metabolic syndrome. Meridia was recently pulled from the market because of the increased risk of heart attack and stroke associated with this medication. Orlistat, available by prescription and over the counter as Alli, reduces caloric intake by binding to gastric and pancreatic lipase to prevent digestion of fats.
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 -Six small meals and 120 mL fluid daily -Three meals and three snacks 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 has been prescribed sucralfate. What health education should the nurse provide to this client? -Take the medication at bedtime to accommodate sedative effects -Ensure adequate potassium intake during therapy -Blood levels will be evaluated after 1 week -Take the medication 2 hours before or after other medications
Take the medication 2 hours before or after other medications Sucralfate should be taken at least 2 hours before or after other medications. It does not decrease potassium levels and laboratory follow up is unnecessary. Sucralfate does not cause sedation.
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? -Dehiscence of the surgical wound -Peritonitis -Vasomotor symptoms associated with dumping syndrome -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.
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? "My appetite may increase while taking this medication." "I can take this medication with my blood thinner." "I can have an alcoholic drink in the evenings." "It might cause a metallic taste in my mouth."
Vitamin B12 injections 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 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? Duodenal Ulcer Acute gastritis 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 cautiously assessing a client admitted with peptic ulcer disease. The nurse is aware that which complications occur in 20% to 30% of clients with this diagnosis? perforation or mechanical obstruction pyloric obstruction or melena hemorrhage or perforation intractable ulcer or pyrosis
hemorrhage or perforation Hemorrhage and peformation are the most common complications, occuring in 20% to 30% 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. An 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 (mechanical obstruction) and stenosed from spasm or edema or from scar tissue that forms when an ulcer alternately heals and breaks down. Pyrosis refers to heartburn, a common symptom associated with peptic ulcers.
The nurse recognizes that the client diagnosed with a duodenal ulcer will likely experience weight loss. hemorrhage. pain 2 to 3 hours after a meal. vomiting.
pain 2 to 3 hours after a meal. 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.