Chapter 23: PrepU - Nursing Management: Patients With Gastric and Duodenal Disorders

The nurse is providing care to a client who has had a percutaneous liver biopsy. The nurse would monitor the client for which of the following? 1- Signs and symptoms of bleeding 2- Return of the gag reflex 3- Passage of stool 4- Intake and output

1

The nurse identifies a potential collaborative problem of electrolyte imbalance for a client with severe acute pancreatitis. Which assessment finding alerts the nurse to an electrolyte imbalance associated with acute pancreatitis? 1- Muscle twitching and finger numbness 2- Paralytic ileus and abdominal distention 3- Hypotension 4- Elevated blood glucose concentration

1

Endoscopy of a 60-year-old woman has revealed the presence of an esophageal peptic ulcer. The nurse who is providing this woman's care is assessing for risk factors that may have contributed to the development of this disease. What question most directly addresses these risk factors? 1- "Have you ever been diagnosed with reflux?" 2- "Do you consider yourself to have a healthy diet?" 3- "Have you been prone to infections over the past few years?" 4- "Do you ever find it difficult to swallow certain foods?"

1

A 32-year-old man who has a body mass index of 32 (morbidly obese) is considering bariatric surgery. In the time leading up to this surgery, which of the following nursing diagnoses will be the primary focus of interventions? 1- Knowledge deficit related to the implications of bariatric surgery 2- Altered growth and development related to obesity 3- Risk for injury related to obesity 4- Spiritual distress related to low body image

1

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? 1- Acute gastritis 2- Duodenal ulcer 3- Gastric cancer 4- Gastric ulcer

1

A client undergoes total gastrectomy. Several hours after surgery, the nurse notes that the client's nasogastric (NG) tube has stopped draining. How should the nurse respond? 1- Notify the health care provider. 2- Reposition the tube. 3- Irrigate the tube. 4- Increase the suction level.

1

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? 1- Hemorrhage 2- Penetration 3- Perforation 4- Pyloric obstruction

1

A nurse assesses the stools of a client diagnosed with peptic ulcer disease. Inspection reveals black, tarry stools. The nurse would use which term to document this finding? 1- melana 2- hematemesis 3- pyrosis 4- achlorhydria

1

The nurse reviews dietary guidelines with a client who had a gastric banding. Which teaching points are included? Select all that apply. 1- Eat six meals a day. 2- Limit meal size to 450 to 500 mL. 3- Do not eat and drink at the same time. 4- Drink plenty of water, from 90 minutes after each meal to 15 minutes before each meal. 5- Avoid fruit drinks and soda.

3,4,5

Which of the following are characteristics associated with the Zollinger-Ellison syndrome (ZES)? Select all that apply. 1- Constipation 2- Hypocalcemia 3- Severe peptic ulcers 4- Extreme gastric hyperacidity 5- Gastrin-secreting tumors of the pancreas

3,4,5

A 70-year-old woman with a complex medical history made an appointment with her primary care provider because she has recently been experiencing heartburn, abdominal pain, and nausea. The clinician has identified that the woman's symptoms are characteristic of acute gastritis. Which of the woman's following statements is suggestive of the etiology of her problem? 1- "I remember my father often complaining about heartburn and indigestion." 2- "I've been taking glucosamine supplements because I've been told they'll help my arthritis." 3- "My endocrinologist recently increased my dose of metformin that I take for my diabetes." 4- "I've changed from taking Tylenol for my arthritis pain to taking aspirin."

4

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: 1- Coronary artery disease 2- Diabetes 3- Use of lithium 4- Peptic ulcer disease

1

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? 1- Coffee-ground-like 2- Clay-colored 3- Black and tarry 4- Bright red

3

Clients with Type O blood are at higher risk for which of the following GI disorders? 1- Gastric cancer 2- Duodenal ulcers 3- Esophageal varices 4- Diverticulitis

2

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? 1- Vomiting 2- Hemorrhage 3- Awakening in pain 4- Weight loss

3

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 intial appropriate action by the nurse? 1- Notify the health care provider. 2- Irrigate the client's NG tube. 3- Place the client in the high-Fowler's position. 4- Assess the client's abdomen and vital signs.

4

Which of the following clients is at highest risk for peptic ulcer disease? 1- Client with blood type A 2- Client with blood type B 3- Client with blood type AB 4- Client with blood type O

4

A client who is being treated for pyloric obstruction has a nasogastric (NG) tube in place to decompress the stomach. The nurse routinely checks for obstruction which would be indicated by what amount? 1- 150 mL 2- 250 mL 3- 350 mL 4- 450 mL

4

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? 1- Duodenum 2- Esophagus 3- Pylorus 4- Stomach

1

The single modality of pharmacologic therapy for chronic type B viral hepatitis is: 1- Alpha-interferon 2- Hepsera 3- Epivir 4- Baraclude

1

Which is a true statement regarding gastric cancer? 1- Most clients are asymptomatic during the early stage of the disease. 2- Women have a higher incidence of gastric cancer. 3- The prognosis for gastric cancer is good. 4- Most cases are discovered before metastasis.

1

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. 1- Ranitidine (Zantac) 2- Cimetidine (Tagamet) 3- Famotidine (Pepcid) 4- Omeprazole (Prilosec)

4

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? 1- "Caffeine stimulates the central nervous system and thus gastric activity and secretions, which need to be minimized to promote recovery." 2- "Caffeine increases the fluid volume in your system, which irritates your digestive organs." 3- "Caffeine intake can cause tears in your esophagus and intestines, which can lead to hemorrhage." 4- "Caffeine can interfere with absorption of vitamin B12, which leads to anemia and further digestive problems."

1

A patient comes to the clinic complaining of pain in the epigastric region. The nurse suspects that the patient's pain is related to a peptic ulcer when the patient states the pain is relieved by what? 1- Eating 2- Drinking milk 3- Suppressing emesis 4- Having a bowel movement

1

A patient is scheduled for a Billroth I procedure for ulcer management. What does the nurse understand will occur when this procedure is performed? 1- A partial gastrectomy is performed with anastomosis of the stomach segment to the duodenum. 2- A sectioned portion of the stomach is joined to the jejunum. 3- The antral portion of the stomach is removed and a vagotomy is performed. 4- The vagus nerve is cut and gastric drainage is established.

1

A patient presents to the walk-in clinic complaining of vomiting and burning in his mid-epigastria. The nurse knows that to confirm peptic ulcer disease, the health care provider is likely to order a diagnostic test to detect the presence of what? 1- Infection with Helicobacter pylori 2- Excessive stomach acid secretion 3- Gastric irritation caused by nonsteroidal anti-inflammatory drugs (NSAIDs) 4- Inadequate production of pancreatic enzymes

1

A patient 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 patient? 1- Curling's ulcer 2- Peptic ulcer 3- Esophageal ulcer 4- Meckel's ulcer

1

An older adult patient had a gastrectomy performed several weeks ago and is being followed closely by the care team. Due to potential complications of this surgery, the nurse should closely monitor the patient's levels of: 1- Iron and vitamin B12 2- Prealbumin and bilirubin 3- Ionized calcium and C-reactive protein 4- Creatinine and blood urea nitrogen (BUN)

1

Diagnostic testing of a client with a history of dyspepsia and abdominal pain has resulted in a diagnosis of gastric cancer. The nurse's anticipatory guidance should include what information? 1- The possibility of surgery, chemotherapy and radiotherapy 2- The possibility of needing a short-term or long-term colostomy 3- The benefits of weight loss and exercise as tolerated during recovery 4- The good prognosis for clients who are treated for gastric cancer

1

Rebleeding may occur from a peptic ulcer and often warrants surgical interventions. Signs of bleeding include which of the following? 1- Mental confusion 2- Bradycardia 3- Bradypnea 4- Hypertension

1

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? 1- Hematemesis 2- Bradycardia 3- Hypertension 4- Polyuria

1

Which is an accurate statement regarding gastric cancer? 1- The incidence of stomach cancer continues to decrease in the United States. 2- Most gastric cancer-related deaths occur in people younger than 40 years. 3- Females have a higher incidence of gastric cancers than males. 4- A diet high in smoked foods and low in fruits and vegetables may decrease the risk of gastric cancer.

1

Which medication classification represents a proton (gastric acid) pump inhibitor? 1- Omeprazole 2- Sucralfate 3- Famotidine 4- Metronidazole

1

Which medication is classified as a histamine-2 receptor antagonist? 1- Famotidine 2- Lansoprazole 3- Metronidazole 4- Esomeprazole

1

Which of the following appears to be a significant factor in the development of gastric cancer? 1- Diet 2- Age 3- Ethnicity 4- Gender

1

Which of the following is the most common complication associated with peptic ulcer? 1- Hemorrhage 2- Vomiting 3- Elevated temperature 4- Abdominal pain

1

Which of the following is the most successful treatment for gastric cancer? 1- Removal of the tumor 2- Chemotherapy 3- Radiation 4- Palliation

1

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. 1- Ingestion of strong acids 2- Irritating foods 3- Overuse of aspirin 4- DASH diet 5- Participation in highly competitive sports

1,2,3

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.) 1- "It can be caused by ingestion of strong acids." 2- "You may have ingested some irritating foods." 3- "Is it possible that you are overusing aspirin." 4- "It is a hereditary disease." 5- "It is probably your nerves."

1,2,3

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. 1- Liver 2- Pancreas 3- Bladder 4- Duodenum 5- Lungs

1,2,4

A 30-year-old obese female patient who underwent gastric banding 3 days ago is getting ready to go home. Essential postoperative teaching for this patient should include instruction related to the importance of abstaining from what for the next 2 years? 1- Multivitamin supplements 2- Pregnancy 3- Antidepressants 4- Control-top panty hose

2

A client is prescribed tetracycline to treat peptic ulcer disease. Which instruction would the nurse give the client? 1- "Take the medication with milk." 2- "Be sure to wear sunscreen while taking this medicine." 3- "Expect a metallic taste when taking this medicine, which is normal." 4- "Do not drive when taking this medication."

2

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? 1- Gastric outlet obstruction 2- Dumping syndrome 3- Bile reflux 4- Celiac disease

2

A client with gastric cancer is having a resection. What is the nursing management priority for this client? 1- Discharge planning 2- Correcting nutritional deficits 3- Preventing deep vein thrombosis (DVT) 4- Teaching about radiation treatment

2

A health care provider suspects that a client has peptic ulcer disease. With which diagnostic procedure would the nurse most likely prepare to assist? 1- Barium study of the upper gastrointestinal tract 2- Endoscopy 3- Gastric secretion study 4- Stool antigen test

2

A nurse at a long-term care facility is conducting an intake assessment and health history with a new female resident and the resident's daughter. The daughter states that her mother had a Billroth II gastrectomy performed several years ago, a fact that must be accommodated into her care. The nurse would be justified in questioning the resident about her history of: 1- Peptic ulcer disease 2- Stomach cancer 3- Gastroesophageal reflux disease (GERD) 4- Pyloric stenosis

2

A nurse is caring for a patient who has had bariatric surgery and is developing a teaching plan for the patient. Which information is essential for the nurse to include in this teaching? 1- Drink a minimum of 90 mL (3 oz) of fluid with each meal. 2- Eat six small meals daily spaced at equal intervals. 3- Choose foods high in simple carbohydrates. 4- Limit calories to no more than 3,000 daily.

2

A nurse is performing discharge teaching with a client who had a total gastrectomy. Which statement indicates the need for further teaching? 1- "I'm going to visit my pastor weekly for a while." 2- "I will have to take vitamin B12 shots up to 1 year after surgery." 3- "I will call my physician if I begin to have abdominal pain." 4- "I will weight myself each day and record the weight."

2

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 1- Less than 5% 2- 15% 3- 25% 4- Greater than 50%

2

A patient comes to the bariatric clinic to obtain information about bariatric surgery. The nurse assesses the obese patient knowing that, in addition to meeting the criterion of morbid obesity, a candidate for bariatric surgery must also demonstrate what? 1- Knowledge of the causes of obesity and its associated risks 2- Emotional stability and understanding of required lifestyle changes. 3- Positive body image and high self-esteem 4- Insight into why their past weight loss efforts failed

2

Symptoms associated with pyloric obstruction include all of the following except: 1- Anorexia 2- Diarrhea 3- Nausea and vomiting 4- Epigastric fullness

2

The nurse is creating a discharge plan of care for a client with a peptic ulcer. The nurse tells the client to avoid 1- acetaminophen. 2- decaffeinated coffee. 3- skim milk. 4- octreotide.

2

The nurse is providing care for a client who has recently been diagnosed with chronic gastritis. What health practice should the nurse address when teaching the client to limit exacerbations of the disease? 1- Performing 15 minutes of physical activity at least three times per week 2- Avoid taking aspirin to treat pain or fever 3- Taking multivitamins as prescribed and eating organic foods whenever possible 4- Maintaining a healthy body weight

2

A client weighs 215 lbs and is 5' 8" tall. What would the nurse calculate this client's body mass index (BMI) as being? 1- 19.5 2- 24.8 3- 32.7 4- 44.9

3

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? 1- "My ulcer will heal because these medications will kill the bacteria." 2- "I should take these medications only when I have pain from my ulcer." 3- "The medications will kill the bacteria and stop the acid production." 4- "These medications will coat the ulcer and decrease the acid producation in my stomach."

3

A nurse is conducting discharge teaching for a client who has undergone gastric surgery. After teaching the client about diet, which statement by the client indicates a need for more teaching? 1- "I'll lie down for about 20 minutes after eating." 2- "I'll avoid drinking fluids with my meals." 3- "I'll have meals that have more liquid-like foods than dry ones." 4- "I'll make sure to avoid foods that are really sweet"

3

A patient is recovering in the PACU following gastric surgery. The nurse who is providing this patient's care is performing frequent assessments of the character and quantity of the patient's nasogastric (NG) drainage. What are the nurse's expected findings during these assessments? 1- Copious quantities of straw-colored output 2- Scant amounts of greenish-colored output 3- Small amounts of blood-tinged output 4- Moderate amounts of clear output

3

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? 1- Discontinue the use of the medication. 2- Tell the patient to ask the physician to prescribe another type of antibiotic. 3- Take the medication with meals to decrease the nausea. 4- Crush the medication and put it in applesauce.

3

An older adult patient with a diagnosis of chronic gastritis has achieved acceptable control of his condition with the use of an H2 receptor antagonist. This patient's symptom control is a result of what therapeutic action of this drug? 1- The occlusion of parietal cells 2- An increase in the pH of gastric secretions 3- A decrease in HCl production by parietal cells 4- Activation of the gastric buffer system and release of alkaline gastric secretions

3

The nurse determines that teaching for the client with peptic ulcer disease has been effective when the client makes which statement? 1- "I should stop all my medications if I develop any side effects." 2- "I should continue my treatment regimen as long as I have pain." 3- "I have learned some relaxation strategies that decrease my stress." 4- "I can buy whatever antacids are on sale because they all have the same effect."

3

The nurse is completing a health history on a patient whose diagnosis is chronic gastritis. Which of the data below should the nurse consider most significantly related to the etiology of the patient's health problem? 1- Consumes one or more protein drinks daily 2- Takes over-the-counter antacids frequently 3- Smokes two packs of cigarettes daily 4- Reports a history of social drinking on a weekly basis

3

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? 1- Pernicious anemia 2- Systemic infection 3- Peptic ulcers 4- Colostomy

3

The nurse is performing detailed patient education with a 40-year-old woman who will be soon discharged following a Roux-en-Y gastric bypass. The nurse and other members of the interdisciplinary team have been emphasizing the need for eating small amounts of food at a sitting and eating food slowly. What is the rationale for the nurse's advice? 1- Eating too quickly can cause gastric ulceration. 2- The cardiac sphincter is unable to dilate quickly after bariatric surgery. 3- Nausea and esophageal distention can result from eating too fast. 4- Eating quickly is associated with weight gain.

3

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? 1- Works best when taken on an empty stomach 2- Increases the speed of gastric emptying 3- Prevents ulceration in clients taking nonsteroidal anti-inflammatory drugs (NSAIDs) 4- Decreases mucus production

3

A client is recovering from gastric surgery. Toward what goal should the nurse progress the client's enteral intake? 1- Three meals and 120 ml fluid daily 2- Three meals and three snacks and 120 mL fluid daily 3- Six small meals and 120 mL fluid daily 4- Six small meals daily with 120 mL fluid between meals

4

A client with morbid obesity and a history of severe sleep apnea and severe diabetes is being considered for bariatric surgery. When reviewing the client's medical record, the nurse would identify that which body mass index (BMI) would meet the criteria for such surgery? 1- 30kg/m2 2- 32 kg/m2 3- 34 kg/m2 4- 36 kg/m2

4

A nurse is preparing to discharge a client newly diagnosed with peptic ulcer disease. The client's diagnostic test results were positive for H. pylori bacteria. The health care provider has ordered the "triple therapy" regimen. Which medications will the nurse educate the client on? 1- H2-receptor antagonist and two antibiotics 2- H2-receptor antagonist, proton-pump inhibitor, and an antibiotic 3- Proton-pump inhibitor, an antibiotic, and bismuth salts 4- Proton-pump inhibitor and two antibiotics

4

A nurse is teaching a group of middle-aged men about peptic ulcers. When discussing risk factors for peptic ulcers, the nurse should mention: 1- a sedentary lifestyle and smoking. 2- a history of hemorrhoids and smoking. 3- alcohol abuse and a history of acute renal failure. 4- alcohol abuse and smoking.

4

A patient asks the home health nurse from what the distressing symptoms of dumping syndrome result. What physiological occurrence should the nurse explain? 1- Irritation of the phrenic nerve due to diaphragmatic pressure 2- Chronic malabsorption of iron and vitamins A and C 3- Reflux of bile into the distal esophagus 4- Osmotic transport of extracellular fluid into the gastrointestinal tract

4

Which statement correctly identifies a difference between duodenal and gastric ulcers? 1- Malignancy is associated with duodenal ulcer. 2- Weight gain may occur with a gastric ulcer. 3- gastric ulcer is caused by hypersecretion of stomach acid. 4- Vomiting is uncommon in clients with duodenal ulcers.

4