Prep U Chapter 46: Management of Patients With Gastric and Duodenal Disorders

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? a. 150 mL b. 250 mL c. 350 mL d. 450 mL

450 mL Explanation: A residual of greater than 400 mL strongly suggests obstruction.

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? a. Coffee-ground-like b.Clay-colored c. Black and tarry d. Bright red

Black and tarry Explanation: 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 medication classification represents a proton (gastric acid) pump inhibitor? a. Omeprazole b. Sucralfate c. Famotidine d. Metronidazole

Omeprazole

Which of the following is the most successful treatment for gastric cancer? a. Removal of the tumor b. Chemotherapy c. Radiation d. Palliation

Removal of the tumor Explanation: 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 nurse is teaching a group of middle-aged men about peptic ulcers. When discussing risk factors for peptic ulcers, the nurse should mention: a. a sedentary lifestyle and smoking. b. a history of hemorrhoids and smoking. c. alcohol abuse and a history of acute renal failure. d. alcohol abuse and smoking.

alcohol abuse and smoking. Explanation: The nurse should mention that risk factors for peptic (gastric and duodenal) ulcers include alcohol abuse, smoking, and stress. A sedentary lifestyle and a history of hemorrhoids aren't risk factors for peptic ulcers. Chronic renal failure, not acute renal failure, is associated with duodenal ulcers.

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. Gastric outlet obstruction b. Dumping syndrome c. Bile reflux d. Celiac disease

Dumping syndrome Explanation: Dumping syndrome is an unpleasant set of vasomotor and GI symptoms that occur in up to 76% of patients who have had bariatric surgery. Early symptoms include a sensation of fullness, weakness, faintness, dizziness, palpitations, diaphoresis, cramping pains, and diarrhea. These symptoms resolve once the intestine has been evacuated (i.e., with defecation).

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

Endoscopy Explanation: 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 peptic ulcer disease must begin triple medication therapy. For how long will the client follow this regimen? a. 4 to 6 days b. 7 to 9 days c. 10 to 14 days d. 15 to 20 days

10 to 14 days Explanation: 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 practitioner suspects that a patient may have a gastric ulcer after completing a history and physical exam. Select an indicator that can be used to help establish the distinction between gastric and duodenal ulcers. a. Amount of hydrochloric acid (HCL) secretion in the stomach b. Sensitivity to the use of nonsteroidal anti-inflammatory drugs (NSAIDs) c. Presence of H. pylori d. Patient's age

Amount of hydrochloric acid (HCL) secretion in the stomach Explanation: A duodenal ulcer is characterized by hypersecretion of stomach acid, whereas a gastric ulcer shows evidence of hyposecretion of stomach acid. The other three choices have similar characteristics in both types of ulcers.

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? a. Vomiting b. Hemorrhage c. Awakening in pain d. Constipation

Awakening in pain Explanation: The client with a duodenal ulcer is more likely to awaken with pain during the night than is the client with a gastric ulcer. Vomiting, constipation, diarrhea, and bleeding are symptoms common to both gastric and duodenal ulcers.

Which of the following appears to be a significant factor in the development of gastric cancer? a. Diet b. Age c. Ethnicity d. Gender

Diet

A client has been taking famotidine at home. What teaching should the nurse include with the client? a. Famotidine will inhibit gastric acid secretions. b. Famotidine will neutralize acid in the stomach. c. Famotidine will shorten the time required for digestion in the stomach. d. Famotidine will improve the mixing of foods and gastric secretions.

Famotidine will inhibit gastric acid secretions. Explanation: Famotidine is useful for treating and preventing ulcers and managing gastroesophageal reflux disease. It functions by inhibiting the action of histamine at the H-2 receptor site located in the gastric parietal cells, thus inhibiting gastric acid secretion. Famotidine will not neutralize acid in the stomach, but inhibits acid secretion. Famotidine will not shorten digestion time and will not improve food mixing with gastric secretions.

The nurse is assessing a client with an ulcer for signs and symptoms of hemorrhage. The nurse interprets which condition as a sign/symptom of possible hemorrhage? a. Hematemesis b. Bradycardia c. Hypertension d. Polyuria

Hematemesis Explanation: The nurse interprets hematemesis as a sign/symptom of possible hemorrhage from the ulcer. Other signs that can indicate hemorrhage include tachycardia, hypotension, and oliguria/anuria.

Which diagnostic test would be used first to evaluate a client with upper GI bleeding? a. Upper GI series b. Endoscopy c. Hemoglobin and hematocrit d. Arteriography

Hemoglobin and hematocrit Explanation: The nurse assesses for faintness or dizziness and nausea, which may precede or accompany bleeding. It is important to monitor vital signs frequently and to evaluate for tachycardia, hypotension, and tachypnea. Other nursing interventions include monitoring the hemoglobin and hematocrit, testing the stool for gross or occult blood, and recording hourly urinary output to detect anuria or oliguria (absence of or decreased urine production). If bleeding cannot be managed by the measures described, other treatment modalities such as endoscopy may be used to halt bleeding and avoid surgical intervention. There is debate regarding how soon endoscopy should be performed. Some clinicians believe endoscopy should be performed within the first 24 hours after hemorrhaging has ceased. Others believe endoscopy may be performed during acute bleeding, as long as the esophageal or gastric area can be visualized (blood may decrease visibility). An upper GI is less accurate than endoscopy and would not reveal a bleed. Arteriography is an invasive study associated with life-threatening complications and would not be used for an initial evaluation.

A client is in the hospital for the treatment of peptic ulcer disease. The client reports vomiting and a sudden severe pain in the abdomen. The nurse then assesses a board-like abdomen. What does the nurse suspect these symptoms indicate? a. Ineffective treatment for the peptic ulcer b. A reaction to the medication given for the ulcer c. Gastric penetration d. Perforation of the peptic ulcer

Perforation of the peptic ulcer Explanation: Signs and symptoms of perforation include the following: Sudden, severe upper abdominal pain (persisting and increasing in intensity), which may be referred to the shoulders, especially the right shoulder, because of irritation of the phrenic nerve in the diaphragm; vomiting; collapse (fainting); extremely tender and rigid (board-like) abdomen; and hypotension and tachycardia, indicating shock.

Which of the following manifestations are associated with a deficiency of vitamin B12? Select all that apply. a. Pernicious anemia b. Macrocytic anemia c. Thrombocytopenia d. Loss of hair e. Lethargy

Pernicious anemia Macrocytic anemia Thrombocytopenia Explanation: Decreased vitamin B12 can result in pernicious anemia, macrocytic anemia, and thrombocytopenia. Decreased iron can result in lethargy and loss of hair.

A client is 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. Slows gastric emptying b. Provides much needed rest c. Allows for better absorption of vitamin B12 d. Removes tension on internal suture line

Slows gastric emptying Explanation: Dumping syndrome is a common complication following subtotal gastrectomy. To avoid the rapid emptying of stomach contents, resting after meals can be helpful. Promoting rest after a major surgery is helpful in recovery but not the reason for resting after meals. Following this type of surgery, clients will have a need for vitamin B12 supplementation due to absence of production of intrinsic factor in the stomach. Resting does not increase absorption of B12 or remove tension on suture line.

A 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.

drink liquids only between meals. Explanation: 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 nurse is caring for a client who is undergoing a diagnostic workup for a suspected gastrointestinal problem. The client reports gnawing epigastric pain following meals and heartburn. What would the nurse suspect this client has? a. peptic ulcer disease b. ulcerative colitis c. appendicitis d. diverticulitis

peptic ulcer disease Explanation: Peptic ulcer disease is characterized by dull, gnawing pain in the midepigastrium or the back that worsens with eating. Ulcerative colitis is characterized by exacerbations and remissions of severe bloody diarrhea. Appendicitis is characterized by epigastric or umbilical pain along with nausea, vomiting, and low-grade fever. Pain caused by diverticulitis is in the left lower quadrant and has a moderate onset. It's accompanied by nausea, vomiting, fever, and chills.

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. "It can be caused by ingestion of strong acids." b. "You may have ingested some irritating foods." c. "Is it possible that you are overusing aspirin." d. "It is a hereditary disease." e. "It is probably your nerves."

"It can be caused by ingestion of strong acids." "You may have ingested some irritating foods." "Is it possible that you are overusing aspirin."

A nurse is caring for a client who has had extensive abdominal surgery and is in critical condition. The nurse notes that the complete blood count shows an 8 G/dL hemoglobin and a 30% hematocrit. Dextrose 5% in half-normal saline solution is infusing through a triple lumen central catheter at 125 mL/hr. The physician orders include the following:Gentamicin 80 mg IV piggyback in 50 mL D5W over 30 minutesZantac 50 mg IV piggyback in 50 mL D5W over 30 minutesOne unit of 250 mL of PRBCs (packed red blood cells) over 3 hoursFlush the nasogastric tube with 30 mL normal saline every 2 hours.How many milliliters should the nurse record as the intake for the 8-hour shift? Enter the correct number ONLY.

1470 Explanation: Regular IV at 125 mL x 8 hours = 1000 mL. Gentamicin = 50 mL. Zantac = 50 mL. PRBCs = 250 mL. NG flushes 30 mL x 4 = 120 mL. TOTAL = 1470 mL.

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. Duodenal ulcer c. Gastric cancer d. Gastric ulcer

Acute gastritis Explanation: 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.

A patient comes to the clinic with the complaint, "I think I have an ulcer." What is a characteristic associated with peptic ulcer pain that the nurse should inquire about? Select all that apply. a. Burning sensation localized in the back or mid-epigastrium b. Feeling of emptiness that precedes meals from 1 to 3 hours c. Severe gnawing pain that increases in severity as the day progresses d. Pain that radiates to the shoulder or jaw e. Vomiting without associated nausea

Burning sensation localized in the back or mid-epigastrium Feeling of emptiness that precedes meals from 1 to 3 hours Severe gnawing pain that increases in severity as the day progresses Explanation: As a rule, the patient with an ulcer complains of dull, gnawing pain or a burning sensation in the mid-epigastrium or the back. Although vomiting is rare in uncomplicated peptic ulcer, it may be a symptom of a complication of an ulcer.

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 antibiotics, prostaglandin E1 analogs, and bismuth salts will work together to suppress or eradicate H. pylori. b. The proton pump inhibitors, prostaglandin E1 analogs, and bismuth salts will suppress or eradicate H. pylori. c. The bismuth salts, antibiotics, and proton pump inhibitors will work together to suppress or eradicate H. pylori. d. The prostaglandin E1 analogs, antibiotics, and proton pump inhibitors will work together to suppress or eradicate H. pylori.

The bismuth salts, antibiotics, and proton pump inhibitors will work together to suppress or eradicate H. pylori. Explanation: The recommended combination of bismuth salts, antibiotics, and proton pump inhibitors will suppress or eradicate H. pylori. Prostaglandin E1 analogs enhance mucosal resistance to injury; they do not suppress or eradicate H. pylori.

A nurse is 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. Vasomotor symptoms associated with dumping syndrome b. Dehiscence of the surgical wound c. Peritonitis d. A normal reaction to surgery

Vasomotor symptoms associated with dumping syndrome Explanation: 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.

Clients with Type O blood are at higher risk for which of the following GI disorders? a. Gastric cancer b. Duodenal ulcers c. Esophageal varices d. Diverticulitis

Duodenal ulcers Explanation: 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.

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

Mental confusion Explanation: Signs of bleeding include tachycardia, tachypnea, hypotension, mental confusion, thirst, and oliguria.

The nurse in the ED admits a client with suspected gastric outlet obstruction. The client's symptoms include nausea and vomiting. The nurse anticipates that the physician will issue which order? a. Pelvic x-ray b. Stool specimen c. Nasogastric tube insertion d. Oral contrast

Nasogastric tube insertion Explanation: The nurse anticipates an order for nasogastric tube insertion to decompress the stomach. Pelvic x-ray, oral contrast, and stool specimens are not indicated at this time.

A 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. Nizatidine b. Cimetidine c. Famotidine d. Omeprazole

Omeprazole Explanation: Omeprazole (Prilosec) is a proton pump inhibitor that, if used according to the health care provider's directions, will result in healing in 90% of patients. The other drugs are H2 receptor antagonists that need to be used for 6 weeks.

The nurse is conducting a community education class on gastritis. The nurse includes that chronic gastritis caused by Helicobacter pylori is implicated in which disease/condition? a. Pernicious anemia b. Systemic infection c. Peptic ulcers d. Colostomy

Peptic Ulcers

The nurse recognizes that the client diagnosed with a duodenal ulcer will likely experience a. vomiting. b. hemorrhage. c. pain 2 to 3 hours after a meal. d. weight loss.

pain 2 to 3 hours after a meal. Explanation: The client with a gastric ulcer often awakens between 1 and 2 with pain, and ingestion of food brings relief. Vomiting is uncommon in the client with duodenal ulcer. Hemorrhage is less likely in the client with duodenal ulcer than the client with gastric ulcer. The client with a duodenal ulcer may experience weight gain.

Which ulcer is associated with extensive burn injury? a. Cushing ulcer b. Curling ulcer c. Peptic ulcer d. Duodenal ulcer

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

A client sustained second- and third-degree burns over 30% of the body surface area approximately 72 hours ago. What type of ulcer should the nurse be alert for while caring for this client? a. Curling's ulcer b. Peptic ulcer c. Esophageal ulcer d. Meckel's ulcer

Curling's ulcer Explanation: Curling's ulcer is frequently observed about 72 hours after extensive burns and involves the antrum of the stomach or the duodenum. Peptic, esophageal, and Meckel's ulcers are not related to burn injuries.

A client is prescribed a histamine (H2)-receptor antagonist. The nurse understands that this might include which medication(s)? Select all that apply. a. Nizatidine b. Lansoprazole c. Famotidine d. Cimetidine e. Esomeprazole

Nizatidine Famotidine Cimetidine Explanation: 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.

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. Hemorrhage b. Inability to clear secretions c. Perforation d. Penetration e. Pyloric obstruction f. Cachexia

Hemorrhage Perforation Penetration Pyloric obstruction Explanation: 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.

A client has recently been diagnosed with gastric cancer. On palpation, the nurse would note what two signs that confirm metastasis to the liver? Select all that apply. a. Ascites b. Hepatomegaly c. Distended bladder d. Sister Mary Joseph's nodules e. Petechiae at the palpation site

Ascites Hepatomegaly Explanation: The physical examination is usually not helpful in detecting the cancer because most early gastric tumors are not palpable. Advanced gastric cancer may be palpable as a mass. Ascites and hepatomegaly (enlarged liver) may be apparent if the cancer cells have metastasized to the liver. Palpable nodules around the umbilicus, called Sister Mary Joseph's nodules, are a sign of a GI malignancy, usually a gastric cancer. A distended bladder is not significant. Petechiae at the palpation site is a distractor for the question.

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? a. Works best when taken on an empty stomach b. Increases the speed of gastric emptying c. Prevents ulceration in clients taking nonsteroidal anti-inflammatory drugs (NSAIDs) d. Decreases mucus production

Prevents ulceration in clients taking nonsteroidal anti-inflammatory drugs (NSAIDs) Explanation: Misoprostol (Cytotec) is a synthetic prostaglandin that protects the gastric mucosa against ulceration and is used in clients who take NSAIDs. Misoprostol should be taken with food. It does not improve emptying of the stomach, and it increases (not decreases) mucus production.

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

"I will have to take vitamin B12 shots up to 1 year after surgery." Explanation: 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.

Which of the following clients is at highest risk for peptic ulcer disease? a. Client with blood type A b. Client with blood type B c. Client with blood type AB d. Client with blood type O

Client with blood type O Explanation: Clients with blood type O are more susceptible to peptic ulcers than those with blood types A, B, and AB.

A client is prescribed tetracycline to treat peptic ulcer disease. Which instruction would the nurse give the client? a. "Take the medication with milk." b. "Be sure to wear sunscreen while taking this medicine." c. "You will not experience GI upset while taking this medication." d. "Do not drive when taking this medication."

"Be sure to wear sunscreen while taking this medicine."

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

"I have learned some relaxation strategies that decrease my stress." Explanation: The nurse assists the client to identify stressful or exhausting situations. A hectic lifestyle and an irregular schedule may aggravate symptoms and interfere with regular meals taken in relaxed settings along with the regular administration of medications. The client may benefit from regular rest periods during the day, at least during the acute phase of the disease. Biofeedback, hypnosis, behavior modification, massage, or acupuncture may be helpful.

A 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? a. "My ulcer will heal because these medications will kill the bacteria." b. "I should take these medications only when I have pain from my ulcer." c. "The medications will kill the bacteria and stop the acid production." d. "These medications will coat the ulcer and decrease the acid production in my stomach."

"The medications will kill the bacteria and stop the acid production." Explanation: Currently, the most commonly used therapy for peptic ulcers is a combination of antibiotics, proton-pump inhibitors, and bismuth salts that suppress or eradicate H. pylori. Recommended therapy for 10 to 14 days includes triple therapy with two antibiotics (e.g., metronidazole [Flagyl] or amoxicillin [Amoxil] and clarithromycin [Biaxin]) plus a proton-pump inhibitor (e.g., lansoprazole [Prevacid], omeprazole [Prilosec], or rabeprazole [Aciphex]), or quadruple therapy with two antibiotics (metronidazole and tetracycline) plus a proton-pump inhibitor and bismuth salts (Pepto-Bismol). Research is being conducted to develop a vaccine against H. pylori.

A 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. a. Liver b. Pancreas c. Bladder d. Duodenum e. Lungs

Liver Pancreas Duodenum Explanation: Most gastric cancers are adenocarcinomas; they can occur anywhere in the stomach. The tumor infiltrates the surrounding mucosa, penetrating the wall of the stomach and adjacent organs and structures. The liver, pancreas, esophagus, and duodenum are often already affected at the time of diagnosis. Metastasis through lymph to the peritoneal cavity occurs later in the disease.

Which of the following are characteristics associated with the Zollinger-Ellison syndrome (ZES)? Select all that apply. a. Constipation b. Hypocalcemia c. Severe peptic ulcers d. Extreme gastric hyperacidity e. Gastrin-secreting tumors of the pancreas

Severe peptic ulcers Extreme gastric hyperacidity Gastrin-secreting tumors of the pancreas Explanation: ZES consists of severe peptic ulcers, extreme gastric hyperacidity, and gastrin-secreting benign or malignant tumors of the pancreas. Diarrhea and steatorrhea may be evident. The client may have co-existing parathyroid adenomas or hyperplasia and may therefore exhibit signs of hypercalcemia.

A client is recovering from gastric surgery. Toward what goal should the nurse progress the client's enteral intake? a. Three meals and 120 ml fluid daily b. Three meals and three snacks and 120 mL fluid daily c. Six small meals and 120 mL fluid daily d. Six small meals daily with 120 mL fluid between meals

Six small meals daily with 120 mL fluid between meals Explanation: 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 taking metronidazole for the treatment of H. pylori states that the medication is causing nausea. What teaching should the nurse provide to the client to alleviate the nausea? a. Discontinue the use of the medication. b. Ask the healthcare provider to prescribe another type of antibiotic. c. Take the medication with meals to decrease the nausea. d. Crush the medication and put it in applesauce.

Take the medication with meals to decrease the nausea. Explanation: Metronidazole (Flagyl) should be administered with meals to decrease GI upset. The client should not stop the medication without discussing it with a prescribing healthcare provider. Crushing the medication will not help the nausea because it is the same medication.

A 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. A sectioned portion of the stomach is joined to the jejunum. c. The antral portion of the stomach is removed and a vagotomy is performed. d. The vagus nerve is cut and gastric drainage is established.

A partial gastrectomy is performed with anastomosis of the stomach segment to the duodenum. Explanation: 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.

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. Notify the health care provider. b. Irrigate the client's NG tube. c. Place the client in the high-Fowler's position. d. Assess the client's abdomen and vital signs.

Assess the client's abdomen and vital signs. Explanation: 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 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: a. Coronary artery disease b. Diabetes c. Use of lithium d. Peptic ulcer disease

Coronary artery disease Explanation: Phentermine, which requires a prescription, stimulates central noradrenergic receptors, causing appetite suppression. It may increase blood pressure and should not be taken by people with a history of heart disease, uncontrolled hypertension, hyperthyroidism, or glaucoma.

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. Hemorrhage b. Penetration c. Perforation d. Pyloric obstruction

Hemorrhage Explanation: 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.

Review the following four examples of ideal body weight (IBW), actual weight, and body mass index (BMI). Using three criteria for each example, select the body weight that indicates morbid obesity. a. IBW = 150 lbs; weight = 190 lbs; BMI = 26 kg/m2 b. IBW = 132 lbs; weight = 184 lbs; BMI = 28 kg/m2 c. IBW = 175 lbs; weight = 265 lbs; BMI = 29 kg/m2 d. IBW = 145 lbs; weight = 290 lbs; BMI = 31 kg/m2

IBW = 145 lbs; weight = 290 lbs; BMI = 31 kg/m2 Explanation: The criteria for morbid obesity are a body weight that is twice IBW and a BMI that exceeds 30 kg/m2.

The nurse advises the patient who has just been diagnosed with acute gastritis to: a. Take an emetic to rid the stomach of the irritating products. b. Refrain from food until the GI symptoms subside. c. Restrict food and fluids for 12 hours. d. Restrict all food for 72 hours to rest the stomach.

Refrain from food until the GI symptoms subside. Explanation: It usually takes 24 to 48 hours for the stomach to recover from an attack. Refraining from food until symptoms subside is recommended, but liquids should be taken in moderation. Emetics and vomiting can cause damage to the esophagus.