Med Surg - Chapter 55 - Care of Patients with Stomach Disorders

Which statements should the nurse include when teaching patients and their families regarding prevention of gastritis? Select all that apply. 1 "Eating a well-balanced diet is important." 2 "Alcoholic beverages in excessive amounts should be avoided." 3 "Intake foods with strong spices such as pepper and mustard if necessary." 4 "Proton pump inhibitors may be used to suppress gastric acid secretion." 5 "Excessive intake of coffee or even decaffeinated drinks should be avoided." 6 "Protection against exposure to toxic substances in the workplace should be practiced."

1 "Eating a well-balanced diet is important." 2 "Alcoholic beverages in excessive amounts should be avoided." 5 "Excessive intake of coffee or even decaffeinated drinks should be avoided." 6 "Protection against exposure to toxic substances in the workplace should be practiced." A healthy lifestyle comprising a well-balanced diet helps to prevent complications. Excessive alcohol and caffeinated and decaffeinated drinks can lead to gastritis in adults, and these drinks should be avoided. A patient who is exposed to toxic substances, such as lead or nickel, at his or her workplace is also susceptible to gastric problems. Foods with strong spices such as pepper and mustard should be avoided because they can cause gastric distress. The use of proton pump inhibitors is reserved for patients who are already suffering from severe gastritis.

Which statement by the patient indicates high risk for esophageal cancer? 1 "I eat a lot of pickles." 2 "I do like fresh fruits and vegetables." 3 "I only drink alcohol 3 to 4 times a year." 4 "I've always had issues with constipation."

1 "I eat a lot of pickles." Pickles, which are high in nitrosamine, are associated with a high incidence of esophageal cancer. The patient should be eating fresh fruits and vegetables. Occasional alcohol intake is not suggestive of esophageal cancer. The patient has always had constipation issues, which does not signify a change in bowel habits and does not suggest esophageal cancer.

The nurse has placed a nasogastric (NG) tube in a patient with upper gastrointestinal bleeding to administer gastric lavage. The patient asks the nurse about the purpose of the NG tube for the procedure. What is the nurse's best response? 1 "Saline goes down the tube to help clean out your stomach." 2 "Medication goes down the tube to help clean out your stomach." 3 "We'll start feeding you through it once your stomach is cleaned out." 4 "The provider requested the tube to be placed just in case it was needed."

1 "Saline goes down the tube to help clean out your stomach." Gastric lavage involves the instillation of water or saline through an NG tube to clear out stomach contents and blood clots. It does not involve the instillation of medication. An NG tube is not typically placed in a patient without a particular purpose in mind. Gastric lavage does not involve enteral feeding.

Which patient has the highest risk of mortality associated with esophageal cancer? 1 32-year-old Asian male 2 68-year-old Hispanic female 3 52-year-old Caucasian female 4 44-year-old African-American female

1 32-year-old Asian male Men, regardless of race or ethnicity, have a higher incidence of mortality rates associated with esophageal cancer. The 44-, 52-, and 68-year-old females would have less risk of mortality associated with esophageal cancer.

Which is a clinical manifestation of early gastric cancer? 1 Feeling of fullness 2 Obstructive symptoms 3 Enlarged lymph nodes 4 Iron deficiency anemia

1 Feeling of fullness Early manifestations of gastric cancer involve indigestion, epigastric pain, and a feeling of fullness. Obstructive symptoms, enlarged lymph nodes, and iron deficiency anemia are clinical manifestations of advanced gastric cancer.

The nurse is caring for a patient with a nasogastric tube (NGT) who has undergone open-approach surgery for gastric cancer. What manifestation indicates acute gastric dilation because of a clogged NGT? 1 Hiccups 2 Bradycardia 3 Hypertension 4 Hypogastric pain

1 Hiccups Decreased patency caused by a clogged NGT can result in acute gastric dilation after surgery. This problem is usually manifested by hiccups, epigastric pain (rather than hypogastric pain), tachycardia (rather than bradycardia), and hypotension (rather than hypertension). Irrigation or replacement of the NGT can relieve these symptoms.

A nutritionist is asked to assist in forming a plan for a patient with peptic ulcer disease (PUD). Which recommendation is most helpful for this patient? 1 Reducing caffeine intake 2 Consuming marshmallows to reduce PUD symptoms 3 Taking a dose of syrup of ipecac with each meal 4 Increasing spicy food to destroy pylori bacteria

1 Reducing caffeine intake Caffeine, specifically coffee, stimulates gastrin release, which worsens PUD. Marshmallow root is recommended for PUD treatment, but marshmallows do not contain marshmallow root. Ipecac induces vomiting, which is not beneficial to the patient with PUD. Spicy foods worsen most stomach disorders and diseases.

A patient is experiencing bleeding related to peptic ulcer disease (PUD). Which nursing intervention is the highest priority? 1 Starting a large-bore IV 2 Administering IV pain medication 3 Preparing equipment for intubation 4 Monitoring the patient's anxiety level

1 Starting a large-bore IV A large-bore IV should be placed as ordered so that blood products can be administered. IV pain medication is not a recommended treatment for gastrointestinal bleeding. Intubation is not a recommended treatment for bleeding related to PUD. The mental status of the patient should be monitored, but it is not necessary to monitor the anxiety level of the patient.

A nurse who is caring for a patient following conventional open approach surgery elevates the head of the bed. What rationale does the nurse tell the patient's family for this position? 1 To prevent aspiration 2 To prevent acute gastric dilation 3 To prevent abdominal distension 4 To prevent respiratory complications

1 To prevent aspiration The nurse will elevate the bed of a patient who underwent conventional open approach surgery in order to prevent aspiration from gastric reflux. Acute gastric dilation occurs because of clogging of the nasogastric tube (NGT). It can be prevented by irrigation or replacing the NGT. Abdominal distension occurs in patients with dumping syndrome because of fluid shifting into the gut during gastric emptying, so these patients should be asked to lie down to relieve these symptoms. Aggressive pulmonary exercises and early ambulation would be beneficial in patients to prevent respiratory complications.

Which diagnostic test is useful for providing an accurate staging of gastric cancer? 1 Computed tomography (CT) 2 Endoscopic ultrasound (EUS) 3 Magnetic resonance imaging (MRI) 4 Positron emission tomography (PET)

2 Endoscopic ultrasound (EUS) During endoscopy, EUS allows for the evaluation of the depth of the tumor and the presence of lymph node involvement. Therefore it is useful in more accurate staging of the gastric cancer. CT, MRI, and PET scans of chest, abdomen, and pelvis help in determining the extent of the tumor and planning therapy.

A patient is diagnosed with a malignant gastric tumor in the proximal portion of the stomach. Which surgical intervention does the nurse anticipate will be performed on this patient? 1 Total gastrectomy 2 Gastroenterostomy 3 Subtotal gastrectomy 4 Pancreatoduodenectomy

1 Total gastrectomy Malignant gastric tumors located in the proximal third of the stomach require total gastrectomy. Patients with tumors at the gastric outlet who are not candidates for subtotal or total gastrectomy may need gastroenterostomy as a palliative treatment option. Malignant gastric tumors located in the middle or distal portion of the stomach require subtotal or partial gastrectomy. Malignant gastric tumors invading the spleen and pancreas are indicated for the Whipple procedure, also called pancreaticoduodenectomy.

Which pathologic changes can occur in a patient with gastritis? Select all that apply. 1 Vascular congestion 2 Acute inflammatory cell infiltration 3 Prostaglandins providing a mucosal barrier 4 Histamine release and vagus nerve stimulation 5 Degenerative changes in the superficial epithelium of the stomach lining

1 Vascular congestion 2 Acute inflammatory cell infiltration 5 Degenerative changes in the superficial epithelium of the stomach lining In gastritis, due to the breakdown of the gastrointestinal barrier, hydrochloric acid diffuses into the mucosa and causes injury to small vessels. This can cause vascular congestion and acute inflammatory cell infiltration. This diffusion also causes erosion of the superficial epithelium of the stomach lining. Prostaglandins provide a protective mucosal barrier that prevents the stomach from digesting itself. Histamine release and vagus nerve stimulation are aggravating factors that may cause pathological changes in gastritis, but these are not changes caused by gastritis.

What are common assessment findings with esophageal trauma? Select all that apply. 1 Vomiting 2 Heartburn 3 Dysphagia 4 Chest pain 5 Regurgitation

1 Vomiting 3 Dysphagia 4 Chest pain Common assessment findings that appear with esophageal trauma include the presence of chest pain, dysphagia, and vomiting. Heartburn and regurgitation are common in conditions with esophageal reflux such as gastroesophageal reflux disorder (GERD) and hiatal hernia.

A patient with peptic ulcer disease (PUD) asks the nurse whether licorice and slippery elm might be useful in managing the disease. What is the nurse's best response? 1 "No, they probably won't be useful. You should use only prescription medications in your treatment plan." 2 "These herbs could be helpful. However, you should talk with your provider before adding them to your treatment regimen." 3 "Yes, these are known to be effective in managing this disease, but make sure you research the herbs thoroughly before taking them." 4 "No, herbs are not useful for managing this disease. You can use any type of over-the-counter drugs though. They have been shown to be safe."

2 "These herbs could be helpful. However, you should talk with your provider before adding them to your treatment regimen." Although licorice and slippery elm may be helpful in managing PUD, the patient should consult his or her health care provider before making a change in the treatment regimen. Alternative therapies may or may not be helpful in managing PUD. The patient should not use over-the-counter medications without first discussing it with his or her provider.

Following surgical resection of a malignant gastric tumor, the patient reports epigastric pain, feelings of fullness, and hiccups. The nurse notes the patient's heart rate to be 110 beats per minute and blood pressure is 104/72 mm Hg. Which complication does the nurse suspect? 1 Dumping syndrome 2 Acute gastric dilation 3 Alkaline reflux gastropathy 4 Septicemia following wound injury

2 Acute gastric dilation Acute gastric dilation is caused due to a decreased patency of the nasogastric tube following gastric surgery. This problem is manifested by epigastric pain and a feeling of fullness, hiccups, tachycardia, and hypotension. Dumping syndrome occurs as a result of rapid emptying of gastric contents into the small intestine, which is characteristically manifested by vertigo, tachycardia, syncope, palpitations, and the desire to lie down within half an hour of food intake. Alkaline reflux gastropathy is caused when pylorus is bypassed or resected. It is characterized by abdominal discomfort, vomiting, and early satiety. Septicemia following wound infection shows primary manifestations such as erythema, pus discharge, and pain at the incision site.

A patient with gastric cancer is scheduled to undergo surgery to remove the tumor once 5 pounds of body weight has been regained. The patient is not drinking the vanilla-flavored enteral supplements that have been prescribed. Which is the highest priority nursing intervention for this patient? 1 Ask the patient's family to try to persuade the patient to drink the supplements 2 Ask the patient if a change in flavor would make the supplement more palatable 3 Explain to the patient the importance of drinking the enteral supplements prescribed 4 Inform the patient that a nasogastric tube may be necessary if he or she fails to comply

2 Ask the patient if a change in flavor would make the supplement more palatable Asking the patient if a change in flavor would help shows that the nurse is attempting to determine why the patient is not drinking the supplements. Many patients don't like certain supplement flavors. The nurse should not assume that the patient does not understand the importance of drinking the supplements or that the patient requires persuasion to drink the supplements. The problem may be entirely different. Telling the patient that a nasogastric tube may be necessary could be construed as threatening the patient.

Which site has an increased risk of being affected by cancer in patients with Barrett's esophagus related to gastroesophageal reflux disease (GERD)? 1 Body 2 Cardia 3 Fundus 4 Pylorus

2 Cardia The patients with Barrett's esophagus due to GERD are at increased risk for cancer in the cardia, which is the point where the stomach connects to the esophagus. Cancer in the body, fundus, and pylorus is least likely to be found in patients with Barrett's esophagus.

What therapy is used in the treatment of esophageal cancer if surgery is not an option? 1 Radiation 2 Chemotherapy 3 Targeted therapies 4 Esophageal dilation

2 Chemotherapy Chemotherapy can be used as a primary treatment for esophageal cancer if the patient is not a candidate for surgery. Radiation is used to manage the esophageal cancer symptoms for palliation. Targeted therapies and esophageal dilation do not treat cancer.

Which organ is usually affected in chronic atrophic gastritis? 1 Glands of the antrum 2 Deeply located glands 3 Body of the stomach only 4 Fundus of the stomach only

2 Deeply located glands Chronic atrophic gastritis causes inflammation and destruction of deeply located glands and affects all layers of the stomach. Type B chronic gastritis usually affects the glands of the antrum and can also involve the entire stomach. Type A (nonerosive) chronic gastritis leads to inflammation of the fundus and body of the stomach.

Which adverse effect of radiation therapy is common when treating esophageal cancer? 1 Mediastinitis 2 Esophageal stenosis 3 Mediastinal hemorrhage 4 Tracheoesophageal fistula

2 Esophageal stenosis Esophageal stricture or stenosis is a common result of radiation therapy in patients with esophageal cancer. Mediastinal hemorrhage, mediastinitis, and tracheoesophageal fistula are all contraindications for radiation.

Which bacteria can cause gastric cancer? 1 Escherichia coli 2 Helicobacter pylori 3 Streptococcus bovis 4 Staphylococcus aureus

2 Helicobacter pylori Many patients diagnosed with gastric cancer have a previous history of H.pylori infection, which is precipitated by atrophic gastritis. Virulent strains of E.coli can cause gastroenteritis. Streptococcus bovis causes colorectal cancer. Staphylococcus aureus is associated with gastritis due to food poisoning.

What pathophysiologic finding is typically seen in chronic atrophic gastritis? 1 Prominent rugae 2 Intestinal metaplasia 3 Excessive inflammation 4 Thickened gastric mucosa

2 Intestinal metaplasia Intestinal metaplasia, or development of abnormal tissue, is a characteristic assessment finding in chronic atrophic gastritis. Other features include thinning of the gastric mucosa and minimal inflammation. Prominent rugae or mucosal folds are seen with acute gastritis.

What are the key assessment findings in a patient with esophageal tumors? Select all that apply. 1 Early satiety 2 Odonyphagia 3 Difficulty breathing 4 Weight loss of more than 20 pounds 5 Persistent and progressive dysphagia 6 Severe persistent chest and abdominal pain

2 Odonyphagia 4 Weight loss of more than 20 pounds 5 Persistent and progressive dysphagia 6 Severe persistent chest and abdominal pain Dysphagia is the most common symptom of esophageal tumors and it is persistent and progressive when stricture occurs. Other signs and symptoms observed with esophageal tumors are odonyphagia (the feeling of food sticking in the throat) and weight loss of more than 20 pounds over several months. In addition, severe, persistent pain or discomfort in the chest or abdomen is observed. Difficulty breathing and a feeling of fullness after eating (early satiety) is often observed in patients with a paraesophageal hiatal hernia.

A patient who has chronic gastritis is at increased risk for which condition? 1 Appendicitis 2 Pernicious anemia 3 Chronic constipation 4 Irritable bowel syndrome

2 Pernicious anemia Patients with chronic gastritis lose function of the parietal cells and thus the source of intrinsic factor leading to vitamin B 12 deficiency and pernicious anemia. It does not cause an increased risk of appendicitis, chronic constipation, or irritable bowel syndrome.

The nurse is caring for a patient recently diagnosed with gastric cancer who is symptomatic. What prognosis does the nurse anticipate for this patient? 1 Fair prognosis 2 Poor prognosis 3 Good prognosis 4 Excellent prognosis

2 Poor prognosis Gastric cancers are often asymptomatic in the early stages. Therefore a symptomatic patient would be in the advanced stages, making treatment difficult and mostly palliative. Therefore poor prognosis is expected from symptomatic gastric cancer. In cancers that can be detected in the early stages like skin cancer, breast cancer, and prostate cancer, the treatment intervention is early; therefore the prognosis may be fair, good, or excellent, based on the patient's response.

A patient has been diagnosed with rheumatoid arthritis and has a history of peptic ulcer disease (PUD). The physician has decided to prescribe misoprostol to help prevent further gastric damage. What concurrent condition should be ruled out prior to starting this medication? 1 Anemia 2 Pregnancy 3 Fecal incontinence 4 Autoimmune disorder

2 Pregnancy Misoprostol has two indications: protection of stomach lining and induction of labor. Therefore, the drug should not be given to a pregnant patient unless she is under the care of an obstetrician. Rheumatoid arthritis is an autoimmune disorder. Anemia can accompany peptic ulcer disease and is not a contraindication for misoprostol use. Fecal incontinence is not a contraindication for misoprostol use.

A patient has been recently diagnosed with gastric cancer. What signs and symptoms suggest that the cancer is at an advanced stage? Select all that apply. 1 Indigestion 2 Retrosternal pain 3 Feeling of fullness 4 Nausea and vomiting 5 Enlarged lymph nodes 6 Iron deficiency anemia

2 Retrosternal pain 4 Nausea and vomiting 5 Enlarged lymph nodes 6 Iron deficiency anemia In advanced gastric cancer, nausea and vomiting is often present and the lymph nodes may be enlarged. Vomiting may occur due to excessive dilation or thickening of the stomach wall, or may be due to pyloric obstruction. Lymph node enlargement is due to metastasis. Iron deficiency anemia is also a sign of advanced gastric cancer that may be due to the reduction of iron or vitamin B 12 absorption. Indigestion, retrosternal pain, and a feeling of fullness are symptoms of early gastric cancer.

The nurse is assessing a patient who reports episodes of pain in the abdomen. What feature suggests the possibility of a duodenal ulcer? 1 The patient is 35 years old. 2 The patient has type O blood. 3 The patient is likely malnourished. 4 The patient experiences more pain after eating food.

2 The patient has type O blood. Patients with duodenal ulcers most often have type O blood. They are usually 50 years or older and are often well-nourished. Another key feature of a duodenal ulcer is a high secretion of gastric acid; abdominal pain due to a duodenal ulcer is therefore relieved by the ingestion of food. Pain usually occurs again about 90 minutes to 3 hours after eating food.

A health care provider advises esophagogastroduodenoscopy (EGD) to a patient suspected of having gastric cancer. Why is this test advised for this patient? 1 To evaluate the nodal metastasis 2 To provide a definitive diagnosis 3 To determine the depth of the tumor 4 To determine the extent of the tumor

2 To provide a definitive diagnosis The health care provider uses EGD with biopsy for definitive diagnosis of gastric cancer. Nodal metastasis and depth of the tumor are assessed by endoscopic ultrasound. Extent of the tumor is determined by computed tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography (PET).

The nurse is reviewing orders for a patient admitted to the intensive care unit with perforation of a duodenal ulcer. Which order does the nurse implement first? 1 Apply antiembolism stockings 2 Insert an indwelling catheter, and check output hourly 3 Place a nasogastric (NG) tube, and connect to suction 4 Give famotidine 20 mg intravenously (IV) every 12 hours

3 Place a nasogastric (NG) tube, and connect to suction To decrease spillage of duodenal contents into the peritoneum, NG suction should be rapidly initiated. This will minimize the risk for peritonitis. Antiembolism stockings will need to be applied, monitoring output is important, and famotidine will need to be administered, but the nurse's first priority is to minimize the risk for peritonitis.

The nurse finds a patient vomiting coffee ground-type emesis. On assessment, the patient has blood pressure of 100/74 mm Hg, is acutely confused, and has a weak and thready pulse. Which intervention is the nurse's first priority? 1 Initiating enteral nutrition 2 Administering an H 2 antagonist 3 Administering intravenous (IV) fluids 4 Administering antianxiety medication

3 Administering intravenous (IV) fluids Administering IV fluids is necessary to treat the hypovolemia caused by acute gastrointestinal (GI) bleeding. Administration of an H 2 antagonist will not treat the basic problem, which is upper GI bleeding. Enteral nutrition will not be part of the treatment plan for acute GI bleeding. Administration of antianxiety medication will not treat the basic problem causing the patient's change in mental status, which is hypovolemia.

What is a symptom of late dumping syndrome seen 90 minutes to 3 hours after eating? 1 Pallor 2 Vertigo 3 Confusion 4 Tachycardia

3 Confusion Confusion is a symptom of late dumping syndrome, which is caused by the secretion of excessive amounts of insulin. This is followed by a rapid rise in blood glucose levels due to the rapid entry of high-carbohydrate food into the jejunum. Vertigo, tachycardia, and pallor are symptoms of early dumping syndrome.

A patient with a duodenal ulcer receives an order for pantoprazole tablets. The patient has a small-bore nasogastric (NG) tube and can take nothing by mouth. Which action by the nurse is appropriate? 1 Crush the tablet and dissolve in solution to give through the NG tube 2 Request an order for an intravenous proton pump inhibitor medication 3 Contact the provider to discuss giving omeprazole or lansoprazole instead 4 Dissolve the tablet in orange juice and administer through a large-bore NG tube

3 Contact the provider to discuss giving omeprazole or lansoprazole instead Pantoprazole should not be crushed before administration, since it is designed to dissolve after passing through the stomach. Omeprazole and lansoprazole may be dissolved and given through any size NG tube. If oral medications cannot be used, an intravenous medication may be ordered.

A patient with extensive burns reports severe abdominal pain and blood-tinged vomitus. Which ulcers might be the reason behind the patient's condition? 1 Peptic ulcer 2 Ischemic ulcer 3 Curling's ulcer 4 Cushing's ulcer

3 Curling's ulcer Curling's ulcers occur due to excessive stress hormones in the body. A patient suffering from extensive burns would be under extreme stress and would be susceptible to Curling's ulcers. Peptic ulcers occur when the mucosal barrier is disrupted due to gastrointestinal problems. Ischemic ulcers are associated with patients suffering from sepsis. Cushing's ulcers are found in patients with increased intracranial pressure.

The nurse is teaching a patient how to prevent gastritis. What are the appropriate instructions for prevention? Select all that apply. 1 Avoid coffee as it contains caffeine; have tea instead. 2 Take ibuprofen whenever there is pain in the abdomen. 3 Ensure that food and water are safe and not contaminated. 4 Try complementary and alternative therapies to manage stress. 5 Stay protected against exposure to toxic substances, such as nickel, at the workplace.

3 Ensure that food and water are safe and not contaminated. 4 Try complementary and alternative therapies to manage stress. 5 Stay protected against exposure to toxic substances, such as nickel, at the workplace. Protection against exposure to nickel helps prevent gastritis. Ensuring that food and water are safe and uncontaminated helps prevent type B gastritis, which is mostly caused by H. pylori infection. Stress and anxiety may contribute to gastritis; complementary and alternative therapies help to manage stress and can prevent gastritis. Both coffee and tea are caffeine-containing beverages and can trigger gastritis; they should both be avoided. Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that inhibits prostaglandin production in the mucosal barrier and increases the risk of gastritis.

Which layer of the gastric wall is first affected by adenocarcinoma? 1 Serosa 2 Submucosa 3 Gastric mucosa 4 Muscularisexterna

3 Gastric mucosa Gastric cancer develops in the mucosal cells that form the innermost lining of the stomach. As the tumor grows, it invades the serosa, submucosa, and muscularisexterna layers of the stomach.

Which route is responsible for spreading lung metastasis in patients with gastric cancer? 1 Lymphatic spread 2 Peritoneal seeding 3 Hematogenous spread 4 Direct invasion of gastric mucosa

3 Hematogenous spread Hematogenous spread via systemic circulation to the lungs is the most common mode of metastasis. Lymphatic spread may result in deposition of tumors into the lymph nodes. Peritoneal seeding from tumor to omentum, peritoneum, and ovary can occur. Direct invasion of gastric mucosa may result in metastases of the liver, pancreas, and transverse colon.

A patient is admitted with chronic peptic ulcer disease (PUD). What sign or symptom is suggestive of a pyloric obstruction? 1 Hyperkalemia 2 Metabolic acidosis 3 Nausea and vomiting 4 Tender and board-like abdomen

3 Nausea and vomiting Nausea and vomiting are symptoms of chronic PUD due to stasis and gastric dilation associated with pyloric obstruction. Abdominal bloating is another symptom of obstruction. A tender, board-like abdomen is a sign of peritonitis due to peptic ulcer perforation. The patient may have metabolic alkalosis due to the loss of large quantities of acid gastric juice in the vomitus. Vomiting or metabolic alkalosis may cause hypo kalemia.

Which part of the world has the lowest rate of gastric cancer? 1 Eastern Asia 2 South America 3 North America 4 Eastern Europe

3 North America North America and parts of Africa have the lowest incidence of gastric cancer. The highest incidence rates of gastric cancer are in Eastern Asia, South America, and Eastern Europe.

A patient who has just undergone porfimer sodium therapy reports slight chest pain a short time after the procedure. What medication does the nurse anticipate administering to this patient? 1 Nitrates 2 Beta blocker 3 Opioid analgesics 4 Nonsteroidal anti-inflammatory drugs (NSAIDs)

3 Opioid analgesics Opioid analgesics are administered to patients who have porfimer sodium treatment and who experience chest pain a short time after the procedure; chest pain is an expected finding. Nitrates, beta blockers, and NSAIDs are not indicated.

A patient developed impaired skin integrity, fatigue, anorexia, and nausea following the treatment of gastric cancer. The nurse understands which therapy is likely responsible for these side effects? 1 Chemotherapy 2 Surgical resection 3 Radiation therapy 4 Combination chemotherapy

3 Radiation therapy High doses of radiation therapy are associated with impaired skin integrity, fatigue, anorexia, nausea, vomiting, and diarrhea. Chemotherapy may cause anemia due to bone marrow suppression and nausea and vomiting. Adverse effects of surgery include acute gastric dilation manifested with fullness of stomach, epigastric pain, tachycardia, and hypotension. Combination chemotherapy with multiple drugs may have the same adverse effects as chemotherapy, but the effects will be severe.

A patient with esophageal cancer is prescribed targeted therapy as a nonsurgical treatment option. Which drug is the most commonly used in targeted therapy for esophageal cancer? 1 Oxiplatin 2 Paclitaxel 3 Trastuzumab 4 5-Fluorouracil (5-FU)

3 Trastuzumab Targeted therapies interfere with cancer cell growth in different ways with less impact on normal cells. Some of the drugs used in targeted therapy for esophageal cancer are cetuximab, gefitinib, and trastuzumab. Oxiplatin, paclitaxel, and 5-Fluorouracil (5-FU) are used as chemotherapeutic agents in the treatment of esophageal cancer.

A patient who has undergone gastric surgery is advised a specific diet to prevent dumping syndrome. What type of breads and cereals are used with caution in this patient? 1 Muffins 2 White breads 3 Whole-grain breads 4 Breads with frosting

3 Whole-grain breads In patients who undergo gastric surgery, the diet should have relatively low-carbohydrate content. Whole-grain breads are used with caution to prevent dumping syndrome. White breads and muffins are allowed or encouraged. Breads with frosting are excluded from the diet altogether.

The nurse is instructing a patient about swallowing therapy in the nonsurgical management of esophageal cancer. Which statement by the patient indicates the need for further instruction? 1 "I should suck on a lollipop with my tongue and cheek." 2 "I should seal my lips and move my tongue while eating." 3 "I should reach for food particles on the lips and chin using my tongue." 4 "I should position my head in a backward extension position for swallowing."

4 "I should position my head in a backward extension position for swallowing." A speech therapist can assist the patient with swallowing therapy, which focuses on mouth exercises, positional techniques, and diet changes to improve swallowing and prevent food aspiration that can cause airway obstruction. The patient's head should be in a forward flexion position (chin tuck) and food placed at the back of the mouth before swallowing. Speech therapy exercises include teaching the patient to suck on a lollipop to enhance tongue strength, reaching food particles on the lips or chin using the tongue, and sealing the lips. Therapy also incorporates tongue movements while eating, which helps in swallowing and improves the strength of the tongue.

A patient with peptic ulcer disease (PUD) asks the nurse whether a maternal history of gastric cancer will cause the patient to develop gastric cancer. What is the nurse's best response? 1 "Have you spoken to your health care provider about your concerns?" 2 "Yes, it is known that a family history of gastric cancer will cause someone to develop gastric cancer." 3 "I wouldn't be too concerned about that as long as your diet limits pickled, salted, and processed food." 4 "If you are concerned that you are at high risk, I recommend speaking to your provider about the possibility of genetic testing."

4 "If you are concerned that you are at high risk, I recommend speaking to your provider about the possibility of genetic testing." Genetic counseling will help the patient determine whether he or she is at exceptionally high risk to develop gastric cancer. The patient cannot know for certain whether family history places him or her at exceptionally high risk to develop gastric cancer unless specific testing is done. Asking the patient what the provider has said is an evasive answer by the nurse and does not help answer the patient's question. Although a diet high in pickled, salted, and processed foods does increase the risk for gastric cancer, a family history of specific types of cancer can also increase the risk.

A patient asks the nurse how an infection such as H. pylori can cause gastric ulcers. What does the nurse tell the patient about this organism? 1 "It causes direct damage to the gastric mucosa." 2 "It reduces the function of the pyloric sphincter, causing reflux." 3 "It secretes acid that reduces the integrity of the mucosal barrier." 4 "It produces an enzyme that alters the pH of the gastric environment."

4 "It produces an enzyme that alters the pH of the gastric environment." H. pylori secretes urease, which produces ammonia, causing the gastric environment to become alkaline. This causes the release of hydrogen ions and increased acid, which causes mucosal damage. The organism does not damage the mucosa directly or secrete acid. It does not affect pyloric sphincter function.

A patient who currently takes phenytoin has been started on a multidrug regimen for treatment of peptic ulcer disease. What does the nurse tell this patient about taking these medications? 1 "These medications may be taken at the same time." 2 "Discuss discontinuing the phenytoin with your provider." 3 "Expect increased antacid effects when taking phenytoin." 4 "Take the phenytoin 1 to 2 hours before or after the antacid."

4 "Take the phenytoin 1 to 2 hours before or after the antacid." Antacids may interfere with the effectiveness of phenytoin, so patients should be taught to take them 1 to 2 hours apart. It is not necessary to discontinue the phenytoin; phenytoin does not increase the effects of the antacid.

Which diagnostic test, in addition to biopsy, yields a definitive diagnosis for gastric cancer? 1 Computed tomography (CT) 2 Endoscopic ultrasound (EUS) 3 Positron emission tomography (PET) 4 Esophagogastroduodenoscopy (EGD)

4 Esophagogastroduodenoscopy (EGD) EGD with biopsy helps in definitive diagnosis of gastric cancer. CT scan is useful in determining the extent of the tumor and planning therapy. EUS is used to evaluate the depth of the tumor and presence of lymph node involvement. PET is also useful in determining the extent of the tumor and planning therapy.

A patient scheduled for an esophagectomy tells the nurse about being very scared and nervous to undergo the procedure. What action by the nurse is priority? 1 Let the patient know that these feelings are normal 2 Provide privacy for the patient when discussing postoperative car 3 Provide the patient with information about community support groups 4 Involve a social worker or case manager with the family and patient support

4 Involve a social worker or case manager with the family and patient support It is a priority to provide support from the social worker and case worker in the hospital; this will allow the patient and family to ask questions and have support while the patient is hospitalized. It is good to let the patient know that feeling fear and nervousness are normal; however, providing support is the priority. Providing privacy is important, but it is not the priority. Giving the patient information about community support groups is an excellent idea; however, the patient will need support prior to being discharged.

Which manifestation occurs in advanced gastric cancer? 1 Indigestion 2 Epigastric pain 3 Stomach fullness 4 Progressive weight loss

4 Progressive weight loss Advanced gastric cancer is characterized by nausea and vomiting, obstructive symptoms, iron deficiency anemia, weakness and fatigue, and progressive weight loss. Early manifestations of gastric cancer involve indigestion, epigastric pain, and a feeling of fullness.

The nurse is teaching a patient how to prevent symptoms of dumping syndrome. What general principles guide the diet plan of the patient? 1 High roughage intake 2 Liquids along with meals 3 Relatively low fat content 4 Relatively low carbohydrate content

4 Relatively low carbohydrate content To prevent symptoms of dumping syndrome, the patient should implement a diet with relatively low-to-moderate carbohydrate content. Fat and protein content should be relatively high. The patient is also advised to consume a low amount of roughage. The patient should not take liquids along with meals, but rather 1 hour or more prior to and after eating. Liquids should be taken between meals only.

A patient is diagnosed with dumping syndrome. Which foods should be restricted in this patient's diet? 1 Eggs 2 Canned fruits 3 Peanut butter 4 Sweetened juice

4 Sweetened juice Dumping syndrome occurs due to rapid emptying of food contents into the intestine, resulting in abdominal distension due to fluid shift. This condition is a complication of surgical procedures of the abdomen and is prevented by eating many small meals in a day. Sweetened juice is contraindicated to these patients because juices are rich in carbohydrates. High-protein foods such as eggs are encouraged in patients with dumping syndrome. Low-carbohydrate foods like canned fruits and peanut butter are advised for this patient.