PrepU Ch. 40 Gastric/Duodenal Disorders - Adult MedSurg

The nurse is teaching a client about peptic ulcers. The client understands the provided education when stating which of the following?

"Hemorrhage and gastritis are the most common complications."

A nurse is performing discharge teaching with a client who had a total gastrectomy. Which statement indicates the need for further teaching?

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

A client with an H. pylori infection asks why bismuth subsalicylate is prescribed. Which response will the nurse make?

"It aids in the healing of the stomach lining."

A client with gastric ulcers caused by H. pylori is prescribed metronidazole. Which client statement indicates to the nurse that teaching about this medication was effective?

"It might cause a metallic taste in my mouth."

A client with recurrent peptic ulcer disease asks, "How long do I have to take the medication?" Which response will the nurse make?

"Prophylactically for now."

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?

"The medications will kill the bacteria and stop the acid production."

A client being treated for a peptic ulcer seeks medical attention for vomiting blood. Which statement indicates to the nurse the reason for the client developing hematemesis?

"The pain stopped so I stopped taking the medications."

A patient has been diagnosed with acute gastritis and asks the nurse what could have caused it. What is the best response by the nurse? (Select all that apply.)

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

The nurse is caring for a client with hypovolemia related to prolonged vomiting and decreased intake of oral fluids. What activity(ies) should the nurse include in the client's plan of care? Select all that apply.

- Advise the client to avoid alcohol - Administer intravenous fluids as ordered

The nurse is caring for a client with hypovolemia related to prolonged vomiting and decreased intake of oral fluids. What activity(ies) should the nurse include in the client's plan of care? Select all that apply.

- Advise the client to avoid alcohol. - Administer intravenous fluids as ordered.

The nurse is preparing to administer ondansetron to an older adult client to prevent nausea and vomiting due to a chronic health condition. What safety warning(s) should the nurse consider when administering the medication? Select all that apply.

- Do not use if the client has heart block or prolonged QT interval. - Client will have increased sedation if used with opiates. - Emphasize prevention and take consistently to prevent nausea and vomiting.

The nurse is developing a plan of care for a patient with peptic ulcer disease. What nursing interventions should be included in the care plan? Select all that apply.

- Frequently monitoring hemoglobin and hematocrit levels - Observing stools and vomitus for color, consistency, and volume - Checking the blood pressure and pulse rate every 15-20 minutes

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.

- Ingestion of strong acids - Irritating foods - Overuse of aspirin

A client diagnosed with a peptic ulcer says, "Now I have something else I have to worry about." Which actions will the nurse take to help reduce the client's anxiety? Select all that apply.

- Interact with the client in a relaxed manner - Help identify the client's current stressors Discuss potential coping techniques with the client - Offer information about relaxation methods

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.

- Liver - Pancreas - Duodenum

A client is prescribed a histamine (H2)-receptor antagonist. The nurse understands that this might include which medication(s)? Select all that apply.

- Nizatidine - Famotidine - Cimetidine

The nurse is caring for a client with chronic gastritis. Which interventions will the nurse add to this client's plan of care? Select all that apply.

- Remind to avoid alcohol intake. - Review actions to reduce stress. - Provide omeprazole as prescribed. - Instruct to avoid foods that aggravate the condition.

Which of the following are characteristics associated with the Zollinger-Ellison syndrome (ZES)? Select all that apply.

- Severe peptic ulcers - Extreme gastric hyperacidity - Gastrin-secreting tumors of the pancreas

A client with peptic ulcer disease must begin triple medication therapy. For how long will the client follow this regimen?

10 to 14 days

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

A young adult client is prescribed misoprostol to prevent gastric ulcers caused by frequent use of nonsteroidal anti-inflammatory agents for an autoimmune disorder. For which reason will the nurse question giving the client a dose of this medication?

Awaiting the results of a pregnancy test.

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?

Curling's ulcer

The nurse is caring for a client who has undergone a total gastrectomy. Several hours after surgery, the nurse notes that the client's nasogastric (NG) tube has minimal drainage. How should the nurse respond?

Document the findings.

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?

Duodenum

The nurse is caring for a client who has developed dumping syndrome while recovering from a gastrectomy. What recommendation should the nurse make to the client?

Eat several small meals daily spaced out at equal intervals.

A client with gastric cancer is planning to receive chemotherapy. Which medication will be used as the primary agent to improve the tumor response rate?

Fluorouracil

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?

Hematemesis

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?

Hemorrhage

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?

Nasogastric tube insertion

During a home visit the nurse notes that a client recovering from peptic ulcer disease is experiencing cool clammy skin and has a heart rate of 96 beats a minute. Which action will the nurse take?

Notify the primary health care provider.

Which medication classification represents a proton (gastric acid) pump inhibitor?

Omeprazole

The nurse advises the patient who has just been diagnosed with acute gastritis to:

Refrain from food until the GI symptoms subside.

Which of the following is the most successful treatment for gastric cancer?

Removal of the tumor

A client is recovering from gastric surgery. Toward what goal should the nurse progress the client's enteral intake?

Six small meals daily with 120 mL fluid between meals

A client is newly diagnosed with stomach cancer. The nurse will plan to provide the client education on which treatment?

Surgery

The nurse is cautiously assessing a client admitted with peptic ulcer disease. The nurse is aware that which complications occur in 20% to 30% of clients with this diagnosis?

hemorrhage or perforation

Which of the following interventions are appropriate for clients with gastritis? Select all that apply.

- Use a calm approach to reduce anxiety. - Discourage cigarette smoking. - Notify the physician of indicators of hemorrhagic gastritis. - Provide general education about how to prevent recurrences.

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 minutes Zantac 50 mg IV piggyback in 50 mL D5W over 30 minutes One unit of 250 mL of PRBCs (packed red blood cells) over 3 hours Flush 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

A client weighing 165 lb. (75 kg) is being treated for acute gastritis. Which amount of urine output for 4 hours would indicate an adequate fluid balance if the output should be 1 mL/kg/hour?

300

Which is a true statement regarding the nursing considerations in administration of metronidazole?

It leaves a metallic taste in the mouth.

Rebleeding may occur from a peptic ulcer and often warrants surgical interventions. Signs of bleeding include which of the following?

Mental confusion

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.

Omeprazole

A nurse is teaching a group of middle-aged men about peptic ulcers. When discussing risk factors for peptic ulcers, the nurse should mention:

alcohol abuse and smoking.

The nurse is creating a discharge plan of care for a client with a peptic ulcer. The nurse tells the client to avoid

decaffeinated coffee.

A nurse is caring for a client who underwent a subtotal gastrectomy. To manage dumping syndrome, the nurse should advise the client to:

drink liquids only between meals.

A nurse is teaching a client who has experienced an episode of acute gastritis. The nurse knows further education is necessary when the client makes which statement?

"My appetite should come back tomorrow."

A client with a peptic ulcer asks, "How does something that goes into my lungs, like smoking, affect my stomach?" Which response by the nurse is most appropriate?

"Smoking reduces the amount of bicarbonate needed to buffer stomach acid."

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.

- Ascites - Hepatomegaly

A client diagnosed with a peptic ulcer says, "Now I have something else I have to worry about." Which actions will the nurse take to help reduce the client's anxiety? Select all that apply.

- Interact with the client in a relaxed manner. - Help identify the client's current stressors. - Discuss potential coping techniques with the client. - Offer information about relaxation methods.

A nurse is monitoring a client with peptic ulcer disease. Which assessment findings would most likely indicate perforation of the ulcer? Select all that apply.

- Tachycardia - Hypotension - A rigid, board-like abdomen

The nurse is caring for a patient who has been diagnosed with gastritis. To promote fluid balance when treating gastritis, the nurse knows that what minimal daily intake of fluids is required?

1.5 L

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?

Acute gastritis

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.

Amount of hydrochloric acid (HCL) secretion in the stomach

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?

Assess the client's abdomen and vital signs.

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?

Awakening in pain

A client is scheduled for removal of the lower portion of the antrum of the stomach and a small portion of the duodenum and pylorus. What surgical procedure will the nurse prepare the client for?

Billroth I

A client is admitted to the health care facility with a diagnosis of a bleeding gastric ulcer. The nurse expects the client's stools to have which description?

Black and tarry

The nurse is assessing a client with advanced gastric cancer. The nurse anticipates that the assessment will reveal which finding?

Bloating after meals

The nurse is providing preoperative care for a client with gastric cancer who is having a resection. What is the nursing management priority for this client?

Correcting nutritional deficits

Which ulcer is associated with extensive burn injury?

Curling ulcer

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?

Dumping syndrome

Clients with Type O blood are at higher risk for which of the following GI disorders?

Duodenal ulcers

A client has received a diagnosis of gastric cancer and is awaiting a surgical date. During the preoperative period, the client should adopt what dietary guidelines?

Eat small, frequent meals with high calorie and vitamin content.

A health care provider suspects that a client has peptic ulcer disease. With which diagnostic procedure would the nurse most likely prepare to assist?

Endoscopy

Which medication is classified as a histamine-2 receptor antagonist?

Famotidine

A client has been taking famotidine at home. What teaching should the nurse include with the client?

Famotidine will inhibit gastric acid secretions.

A client is recovering from gastric surgery. What is the correct position for the nurse to place this client?

Fowler's

The nurse is caring for a client who is suspected to have developed a peptic ulcer hemorrhage. Which action should the nurse include in the plan of care?

Monitor hourly urine output.

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?

Peptic Ulcers

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?

Perforation of the peptic ulcer

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?

Prevents ulceration in clients taking nonsteroidal anti-inflammatory drugs (NSAIDs)

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?

Slows gastric emptying

A client is recovering at home after surgical removal of a malignant gastric tumor. The client reports feeling weak and fatigued. Which recommendation will the nurse provide the client?

Suggest a home health aide to help with ADLs.

A client with peptic ulcer disease has been prescribed sucralfate. What health education should the nurse provide to this client?

Take the medication 2 hours before or after other medications

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?

The bismuth salts, antibiotics, and proton pump inhibitors will work together to 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?

Vasomotor symptoms associated with dumping syndrome

The Zollinger-Ellison syndrome (ZES) consists of severe peptic ulcers, extreme gastric hyperacidity, and gastrin-secreting benign or malignant tumors of the pancreas. The nurse recognizes that an agent that is used to decrease bleeding and decrease gastric acid secretions is

octreotide (Sandostatin)