Chapter 55: Care of Patients with Stomach Disorders

Which type of gastric ulcer does the nurse expect may occur when caring for a patient with extensive burns? A. Curlings ulcer B. Cushing's ulcer C. Stress ulcer D. Ischemic ulcer

A. Curlings ulcer

Which diagnostic test is the gold standard for diagnosing gastritis? A. Esophagogastrodudenscopy (EGD) B. Computed tomography (CT) scan C. Upper gastrointestinal (GI) series D. Cholangiogram

A. Esophagogastrodudenscopy (EGD)

The nursing student caring for a patient with a duodent ulcer is about to administer a proton pump inhibitor (PPI). Which statement about this medication is true? A. These drugs should not be used for a prolonged period of time because they may contribute to osteoprosis-related fractures B. PPI's may not be given via feeding tube C. These drugs help prevent stress-induced ucers D. PPI's work by coating the stomach with a protective barrier

A. These drugs should not be used for a prolonged period of time because they may contribute to osteoprosis-related fractures

Which types of ulcers are included peptic ulcer disease? (Select all that apply) A. Esophageal ulcers B. Gastric ulcers C. Pressure ulcers D. Duodenal ulcers E. Stress ulcers

B. Gastric ulcers D. Duodenal ulcers E. Stress ulcers

When teaching a patient about pernicious anemia, which statement does the nurse include? A. Patients with pernicious anemia are not able to digest fats B. Pernicious anemia results in a deficiency of vitamin B12 C. all patients with gastrointestinal bleeding will eventually develop pernicious anemia D. Oral iron supplements are an effective treatment for pernicious anemia

B. Pernicious anemia results in a deficiency of vitamin B12

The nurse is teaching a patient about ranitidine (Zantac) prescribed for gastritis. Which statement by the patient indicates effective teaching by the nurse? A. The drug will heal the areas of stomach that are sore B. This drug will block the secretions of my stomach C. Zantac will coat the inside of my stomach to protect it from acid D. This pill kills the bacterial infection I have in my stomach

B. This drug will block the secretions of my stomach

The nurse finds a client vomiting coffee-ground emesis. On assessment, the client 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? A. Administering a histamine2 (H2) antagonist B. Initiating enteral nutrition C. Administering intravenous (IV) fluids D. Administering antianxiety medication

C Administering IV fluids is necessary to treat the hypovolemia caused by acute gastrointestinal (GI) bleeding. Administration of an H2 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 client's change in mental status, which is hypovolemia.

The nurse and the dietitian are planning sample diet menus for a client who is experiencing dumping syndrome. Which sample meal is best for this client? A. Chicken salad on whole wheat bread B. Liver and onions C. Chicken and rice D. Cobb salad with buttermilk ranch dressing

C Chicken and rice is the only selection suitable for the client who is experiencing dumping syndrome because it contains high protein without the addition of milk or wheat products. The client with dumping syndrome should not be allowed to have mayonnaise, onions, or buttermilk ranch dressing; the dressing is made from milk products. The client can have whole wheat bread only in very limited amounts.

The nurse is teaching a client how to prevent recurrent chronic gastritis symptoms before discharge. Which statement by the client demonstrates a correct understanding of the nurse's instruction? A. "It is okay to continue to drink coffee in the morning when I get to work." B. "I will need to take vitamin B12 shots for the rest of my life." C. "I should avoid alcohol and tobacco." D. "I should eat small meals about six times a day."

C. "I should avoid alcohol and tobacco."

The nurse assesses that a client experiences regular epigastric discomfort that usually goes away after eating. Which initial nursing action is correct? Contact the provider to report these symptoms. Order a low-fat, bland diet to prevent discomfort. Request an order for an H2-receptor antagonist. Teach the client to avoid nonsteroidal antiinflammatory drugs and aspirin.

Clients with epigastric discomfort that usually abates after eating may have chronic gastritis and should be evaluated for this disease. The nurse should report these symptoms to the provider. Ordering a low-fat diet, requesting an order for an H2-receptor antagonist, and teaching the client to avoid NSAIDs and aspirin are all correct actions only after a diagnosis of gastritis has been made.

The nurse is monitoring a client with gastric cancer for signs and symptoms of upper gastrointestinal bleeding. Which change in vital signs is most indicative of bleeding related to cancer? A. Respiratory rate from 24 to 20 breaths/min B. Apical pulse from 80 to 72 beats/min C. Temperature from 98.9° F to 97.9° F D. Blood pressure from 140/90 to 110/70 mm Hg

D A decrease in blood pressure is the most indicative sign of bleeding. A slight decrease in respiratory rate, apical pulse, and temperature is not the primary indication of bleeding.

A patient comes to the emergency department (ED) reporting rapid onset of epigastric pain with nausea and vomiting. The patient says the pain is worse than any heartburn he has had, and that he has not had an appetite for the past day. What does the nurse suspect this patient has? A. Peritonitis B. H. pylori infection C. Duodenal ulcer D. Acute gastritis

D. Acute gastritis

Which type of nonsteroidal antiinflammatory (NSAID) drug is less likely to cause mucosal damage to the stomach? A. Ibuprofen B. Asprin C. Acetaminophen D. Celecoxib

D. Celecoxib

A patient with acute gastritis is receiving treatment to block and buffer gastritis acid secretions to relieve pain. Which drug does the nurse identify as an antisecretory agent (protonpump) inhibitor? A. Sucralfate (Carafate) B. Ranitidine (Zantac) C. Mylanta D. Omperazole (Prilosec)

D. Omperazole (Prilosec)

Which client assessment information is correlated with a diagnosis of chronic gastritis? A. Anorexia, nausea, and vomiting B. Frequent use of corticosteroids C.Hematemesis and anorexia D. Treatment with radiation therapy

D. Treatment with radiation therapy all other options are acute

The nurse is caring for a patient who vomited coffee ground blood. Where does the nurse suspect the patient is bleeding? a. colon b. rectum c. small intestine d. upper GI system

D. upper GI system

The nurse is performing a health history on a client who is newly diagnosed with peptic ulcer disease (PUD). Which condition in the client's history prompts the nurse to question the client further? Cardiovascular disease Hyperlipidemia Osteoarthritis Urinary tract infections

Nonsteroidal anti-inflammatory drugs are a major cause of PUD and are often used by clients who have arthritis; a report of osteoarthritis should prompt the nurse to explore types of treatments the client is using. Cardiovascular disease, hyperlipidemia, and urinary tract infections do not predispose clients to PUD.

The nurse is assisting with an esophagogastroduodenoscopy (EGD) procedure on a client who has symptoms of gastritis. The provider collects tissue samples and will test for H. pylori infection using which diagnostic test? Cytologic examination IgG or IgM testing pH measurement Rapid urease testing

Rapid urease testing may be done on tissue samples collected during an EGD to detect H. pylori infection. Cytologic examination is used to detect cancer cells. IgG or IgM H. pylori antibody tests are blood tests to diagnose infection. pH measurement is used to evaluate acid in the upper gastrointestinal tract.

The nurse is teaching a client how to prevent recurrent chronic gastritis symptoms before discharge. Which statement by the client demonstrates a need for further teaching? "I need to avoid drinking coffee in the morning when I get to work." "I will not need to take vitamin B12 shots for the rest of my life." "I should avoid alcohol and tobacco." "I should eat small meals about six times a day."

The client should not eat six small meals daily as no evidence supports the theory that eating six meals daily promotes healing of the ulcer. This practice may actually stimulate gastric acid secretion. The client with chronic gastritis should avoid alcohol and tobacco. The client should eliminate caffeine from the diet. The client will need to take vitamin B12 shots only if he or she has pernicious anemia.

Which client assessment data are correlated with a diagnosis of chronic gastritis? Hematemesis Gastric hemorrhage Frequent use of corticosteroids Treatment with radiation therapy

Treatment with radiation therapy is known to be associated with the development of chronic gastritis. Gastric hemorrhage is a symptom of acute gastritis. Corticosteroid use and hematemesis are also more likely to be signs of acute gastritis.

The nurse is teaching a patient with dumping syndrome about diet. Which statement by the patient indicates that teaching has been effective? a. I will use sugar-free gelatin with caution b. I will avoid rice in my diet c. meat in my diet consist of a total ounces a day d. I will limit fluids with my meals to 8 ounces

a. I will use sugar-free gelatin with caution

Which statement about general principles of diet therapy for patients with dumping syndrome is true? a. patients with dumping syndrome should have liquids only between meals b. patients with dumping syndrome should be encouraged to eat a diet high in roughage c.patients with dumping syndrome should eat a high-carbohydrate diet d. The diet for a patient with dumping syndrome must be low in fat and protein

a. patients with dumping syndrome should have liquids only between meals

The nurse has provided instruction for a patient prescribed sucralfate (Carafate) to treat a gastric ulcer. Which statement by the patient indicates that teaching has been effective? a. this drug will stop the secretion of acid in my stomach b. I will take this drug on an empty stomach c. I will not be able to take ranitidine (Zantac) with this drug d. The main side effect of this drug that I can expect is diarrhea

b. I will take this drug on an empty stomach

Which drug would the health care provider prescribe to treat H. pylori infection? a. Ranitidine (Zantac) b. Omperazole (Prilosec) c. Clarithromycin (Biaxin) d. Pantoprazole (Protonix)

c. Clarithromycin (Biaxin)

The patient with a gastric ulcer suddenly develops sharp epigastric pain that spreads over the entire abdomen. What complication has the patient most likely developed? a. Hemorrhage b. gastric erosion c. perforation d. gastric cancer

c. perforation (hole in GI system, is medical emergency, where bacteria, bile, stomach acid, partially digested food, stool enter abdominal cavity, causes severe stomach pain, fever and vomiting)

What is the cause of late dumping syndrome? a. Rapid emptying of food into the the small intestine b. shift of fluids into the gut leading to abdominal distention c. release of an excessive amount of insulin d. rapid entry of high-protein foods into the jejunum

c. release of an excessive amount of insulin

Which statement about the use of antacids (neutralize gastric acids) in the treatment of gastric ulcers is true? a. Antacids should be administered with these meals b. Patients should take calcium carbonate (Tums) if they still have pain after taking their usual antacid c. The patient should take antacid on an empty stomach d. Avoid using antacids with phyentoin (Dilantin)

d. Avoid using antacids with phyentoin (Dilantin)

Which peptic ulcer disease drug is useful to protect patients against NSAID-induced (nonsteroidal inflammatory drug) ulcers? a. magnesium hydroxide (Maalox) b. Omperazole (Prilosec) c. Esmoperazole (Nexium) d. Misoprostol (Cytotec)

d. Misoprostol (Cytotec)

An older adult patient is admitted with an upper GI bleed. Which finding does the nurse expect to assess in the patient? A. decreased pulse b. increased hemoglobin and hematocrit c. acute confusion d. increased blood pressure

d. increased blood pressure

The nurse is teaching a patient about health promotion and maintence to prevent gastritis. Which information does the nurse include? (select all that apply) A. A balanced diet can help prevent gastritis B. To prevent gastritis, you should limit your intake of salt C. If you stop smoking, there is less of a chance that you will develop gastritis D. Yoga has been found to be effective in preventing gastritis E. Although regular exericise is good for you it has not been found to have an effect on the prevention of gastritis

A. A balanced diet can help prevent gastritis C. If you stop smoking, there is less of a chance that you will develop gastritis D. Yoga has been found to be effective in preventing gastritis

The nurse is teaching a client with peptic ulcer disease about the prescribed drug regimen. Which statement made by the client indicates a need for further teaching before discharge? A. "Nizatidine (Axid) needs to be taken three times a day to be effective." B. "Taking ranitidine (Zantac) at bedtime should decrease acid production at night." C. "Sucralfate (Carafate) should be taken 1 hour before and 2 hours after meals." D. "Omeprazole (Prilosec) should be swallowed whole and not crushed."

A. Nizatidine is most effective if administered once daily.

A patient with chronic gastritis is being admitted. Which sign/ symptom does the nurse identify as being associated with this patient's condition? A. Pernicious anemia B. Gastric hemorrhage C. Hematemesis D. Dyspepsia

A. Pernicious anemia

A client with peptic ulcer disease is in the emergency department and reports the pain has gotten much worse over the last several days. The client's blood pressure when lying down was 122/80 mm Hg and when standing was 98/52 mm Hg. What action by the nurse is most appropriate? a. Administer ibuprofen (Motrin). b. Call the Rapid Response Team. c. Start a large-bore IV with normal saline. d. Tell the client to remain lying down.

ANS: C This client has orthostatic changes to the blood pressure, indicating fluid volume loss. The nurse should start a large-bore IV with isotonic solution. Ibuprofen will exacerbate the ulcer. The Rapid Response Team is not needed at this point. The client should be put on safety precautions, which includes staying in bed, but this is not the priority.

A client 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? A. "No, they probably won't be useful. You should use only prescription medications in your treatment plan." B. "These herbs could be helpful. However, you should talk with your provider before adding them to your treatment regimen." C. "Yes, these are known to be effective in managing this disease, but make sure you research the herbs thoroughly before taking them." D. "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."

B Although licorice and slippery elm may be helpful in managing PUD, the client 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 client should not use over-the-counter medications without first discussing it with his or her provider.

A client has a long-term history of Crohn's disease and has recently developed acute gastritis. The client asks the nurse whether Crohn's disease was a direct cause of the gastritis. What is the nurse's best response? A. "Yes, Crohn's disease is known to be a direct cause of the development of chronic gastritis." B. "We know that there can be an association between Crohn's disease and chronic gastritis, but Crohn's does not directly cause acute gastritis to develop." C. "What has your doctor told you about how your gastritis developed?" D. "Yes, a familial tendency to inherit Crohn's disease and gastritis has been reported. Have your other family members been tested for Crohn's disease?"

B Crohn's disease may be an underlying disease process when chronic gastritis develops, but not when acute gastritis occurs. It is not known to be a direct cause of the disease. Although Crohn's disease tends to run in families, gastritis is a symptom of other disease processes and is not a disease process in and of itself. Asking the client what the doctor has said is an evasive response on the part of the nurse and does not help answer the client's question.

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

B Genetic counseling will help the client determine whether he or she is at exceptionally high risk to develop gastric cancer. The client 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 client what the provider has said is an evasive answer by the nurse and does not help answer the client'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.

The nurse is teaching a patient being discharged home about taking prescribed medications that include sucralfate (Carafate). Which statement by the patient indicates teaching has been effective? A. The main side effect sucrlafate is diarrhea B. I will take sucralfate with meals C. I will take sucralfate along with the antacid medication I take D. Sucraflate works to heal my ulcer

D. Sucraflate works to heal my ulcer

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

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 client has been recently diagnosed with gastric cancer. What signs and symptoms suggest that the cancer is at an advanced stage? Select all that apply. Indigestion Nausea and vomiting Retrosternal pain Feeling of fullness Enlarged lymph nodes 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 B12 absorption. Indigestion, retrosternal pain, and a feeling of fullness are symptoms of early gastric cancer.

A client with a duodenal ulcer receives an order for pantoprazole (Protonix) tablets. The client has a small-bore nasogastric (NG) tube. Which action by the nurse is appropriate? Contact the provider to discuss giving omeprazole or lansoprazole instead. Crush the tablet and dissolve in solution to give through the NG tube. Dissolve the tablet in orange juice and administer through a large-bore NG tube. Request an order for an intravenous proton-pump inhibitor medication.

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.

Which nursing action is best for the charge nurse to delegate to an experienced LPN/LVN? Retape the nasogastric tube for a client who has had a subtotal gastrectomy and vagotomy. Reinforce the teaching about avoiding alcohol and caffeine for a client with chronic gastritis. Document instructions for a client with chronic gastritis about how to use "triple therapy." Assess the gag reflex for a client who has arrived from the postanesthesia care unit (PACU) after a laparoscopic gastrectomy.

Reinforcement of teaching done by the RN is within the scope of practice for an LPN/LVN. Retaping the nasogastric tube for a client who has had a subtotal gastrectomy and vagotomy is a complex task that should be done by the RN. Assessment and documenting instructions about how to use triple therapy are nursing functions that should be done by the RN.

Which is the priority nursing action for the client with a stress ulcer? Evaluating heart rate and blood pressure Maintaining a calm, stress-free environment Monitoring and treating gastric pain Preventing nausea and vomiting

The main manifestation of acute stress ulcers is bleeding caused by gastric erosion. The nurse should monitor for signs of bleeding, including heart rate and blood pressure. Stress ulcers are triggered by acute medical crises, trauma, and anxiety, but monitoring for bleeding is more important. Monitoring and treating pain, and preventing nausea and vomiting are not priority actions.

What statement about type A gastritis is most accurate? It has an autosomal recessive pattern of inheritance. It is associated with pernicious anemia. It is most often caused by H. pylori infection. It can occur due to exposure to benzene or lead.

A genetic link to type A gastritis has been found in the relatives of those who have pernicious anemia. The gene has an autosomal dominant pattern of inheritance. Type B gastritis is most often caused by H. pylori infection. Atrophic gastritis may occur due to exposure to toxins such as benzene or lead.

Which are pathologic changes associated with acute gastritis? (select all that apply) A. Vascular congestion B. Severe mucosal damage and ruptured vessels C. Edema D. Acute inflammatory cell infiltration E. Increased cell production in the superficial epithelium of the stomach lining

A. Vascular congestion B. Severe mucosal damage and ruptured vessels C. Edema D. Acute inflammatory cell infiltration

A nurse is preparing to administer pantoprazole (Protonix) intravenously. What actions by the nurse are most appropriate? (Select all that apply.) a. Administer the drug through a separate IV line. b. Infuse pantoprazole using an IV pump. c. Keep the drug in its original brown bag. d. Take vital signs frequently during infusion. e. Use an in-line IV filter when infusing.

ANS: A, B, E When infusing pantoprazole, use a separate IV line, a pump, and an in-line filter. A brown wrapper and frequent vital signs are not needed.

The nurse is caring for a client with peptic ulcer disease who reports sudden onset of sharp abdominal pain. On palpation, the client's abdomen is tense and rigid. What action takes priority? a. Administer the prescribed pain medication. b. Notify the health care provider immediately. c. Percuss all four abdominal quadrants. d. Take and document a set of vital signs.

ANS: B This client has manifestations of a perforated ulcer, which is an emergency. The priority is to get the client medical attention. The nurse can take a set of vital signs while someone else calls the provider. The nurse should not percuss the abdomen or give pain medication since the client may need to sign consent for surgery.

A client with a bleeding gastric ulcer is having a nuclear medicine scan. What action by the nurse is most appropriate? a. Assess the client for iodine or shellfish allergies. b. Educate the client on the side effects of sedation. c. Inform the client a second scan may be needed. d. Teach the client about bowel preparation for the scan.

ANS: C A second scan may be performed in 1 to 2 days to see if interventions have worked. The nuclear medicine scan does not use iodine-containing contrast dye or sedation. There is no required bowel preparation.

A nurse answers a client's call light and finds the client in the bathroom, vomiting large amounts of bright red blood. Which action should the nurse take first? a. Assist the client back to bed. b. Notify the provider immediately. c. Put on a pair of gloves. d. Take a set of vital signs.

ANS: C All of the actions are appropriate; however, the nurse should put on a pair of gloves first to avoid contamination with blood or body fluids.

A nurse is teaching a client about magnesium hydroxide with aluminum hydroxide (Maalox). What instruction is most appropriate? a. "Aspirin must be avoided." b. "Do not worry about black stools." c. "Report diarrhea to your provider." d. "Take 1 hour before meals."

ANS: C Maalox can cause hypermagnesemia, which causes diarrhea, so the client should be taught to report this to the provider. Aspirin is avoided with bismuth sulfate (Pepto-Bismol). Black stools can be caused by Pepto-Bismol. Maalox should be taken after meals.

For which client would the nurse suggest the provider not prescribe misoprostol (Cytotec)? a. Client taking antacids b. Client taking antibiotics c. Client who is pregnant d. Client over 65 years of age

ANS: C Misoprostol can cause abortion, so pregnant women should not take this drug. The other clients have no contraindications to taking misoprostol.

The nurse caring for clients with gastrointestinal disorders should understand that which category best describes the mechanism of action of sucralfate (Carafate)? a. Gastric acid inhibitor b. Histamine receptor blocker c. Mucosal barrier fortifier d. Proton pump inhibitor

ANS: C Sucralfate is a mucosal barrier fortifier (protector). It is not a gastric acid inhibitor, a histamine receptor blocker, or a proton pump inhibitor.

A nurse working with a client who has possible gastritis assesses the client's gastrointestinal system. Which findings indicate a chronic condition as opposed to acute gastritis? (Select all that apply.) a. Anorexia b. Dyspepsia c. Intolerance of fatty foods d. Pernicious anemia e. Nausea and vomiting

ANS: C, D Intolerance of fatty or spicy foods and pernicious anemia are signs of chronic gastritis. Anorexia and nausea/vomiting can be seen in both conditions. Dyspepsia is seen in acute gastritis.

A client is scheduled for a total gastrectomy for gastric cancer. What preoperative laboratory result should the nurse report to the surgeon immediately? a. Albumin: 2.1 g/dL b. Hematocrit: 28% c. Hemoglobin: 8.1 mg/dL d. International normalized ratio (INR): 4.2

ANS: D An INR as high as 4.2 poses a serious risk of bleeding during the operation and should be reported. The albumin is low and is an expected finding. The hematocrit and hemoglobin are also low, but this is expected in gastric cancer.

A client is being taught about drug therapy for Helicobacter pylori infection. What assessment by the nurse is most important? a. Alcohol intake of 1 to 2 drinks per week b. Family history of H. pylori infection c. Former smoker still using nicotine patches d. Willingness to adhere to drug therapy

ANS: D Treatment for this infection involves either triple or quadruple drug therapy, which may make it difficult for clients to remain adherent. The nurse should assess the client's willingness and ability to follow the regimen. The other assessment findings are not as critical.

Which are possible complications of chronic gastritis? (select all that apply) A. Pernicious anemia B. thickening of the stomach lining C. Gastric cancer D. Decreased gastric acid secretion E. Peptic ulcer disease

A. Pernicious anemia C. Gastric cancer D. ac secretion E. Peptic ulcer disease

A client has dumping syndrome after a partial gastrectomy. Which action by the nurse would be most helpful? a. Arrange a dietary consult. b. Increase fluid intake. c. Limit the client's foods. d. Make the client NPO.

ANS: A The client with dumping syndrome after a gastrectomy has multiple dietary needs. A referral to the registered dietitian will be extremely helpful. Food and fluid intake is complicated and needs planning. The client should not be NPO.

An older female client has been prescribed esomeprazole (Nexium) for treatment of chronic gastric ulcers. What teaching is particularly important for this client? a. Check with the pharmacist before taking other medications. b. Increase intake of calcium and vitamin D. c. Report any worsening of symptoms to the provider. d. Take the medication as prescribed by the provider.

ANS: B All of this advice is appropriate for any client taking this medication. However, long-term use is associated with osteoporosis and osteoporosis-related fractures. This client is already at higher risk for this problem and should be instructed to increase calcium and vitamin D intake. The other options are appropriate for any client taking any medication and are not specific to the use of esomeprazole.

A client had an upper gastrointestinal hemorrhage and now has a nasogastric (NG) tube. What comfort measure may the nurse delegate to the unlicensed assistive personnel (UAP)? a. Lavaging the tube with ice water b. Performing frequent oral care c. Re-positioning the tube every 4 hours d. Taking and recording vital signs

ANS: B Clients with NG tubes need frequent oral care both for comfort and to prevent infection. Lavaging the tube is done by the nurse. Re-positioning the tube, if needed, is also done by the nurse. The UAP can take vital signs, but this is not a comfort measure.

A client has a pyloric obstruction and reports sudden muscle weakness. What action by the nurse takes priority? a. Document the findings in the chart. b. Request an electrocardiogram (ECG). c. Facilitate a serum potassium test. d. Place the client on bedrest.

ANS: B Pyloric stenosis can lead to hypokalemia, which is manifested by muscle weakness. The nurse first obtains an ECG because potassium imbalances can lead to cardiac dysrhythmias. A potassium level is also warranted, as is placing the client on bedrest for safety. Documentation should be thorough, but none of these actions takes priority over the ECG.

A client has a recurrence of gastric cancer and is in the gastrointestinal clinic crying. What response by the nurse is most appropriate? a. "Do you have family or friends for support?" b. "I'd like to know what you are feeling now." c. "Well, we knew this would probably happen." d. "Would you like me to refer you to hospice?"

ANS: B The nurse assesses the client's emotional state with open-ended questions and statements and shows a willingness to listen to the client's concerns. Asking about support people is very limited in nature, and "yes-or-no" questions are not therapeutic. Stating that this was expected dismisses the client's concerns. The client may or may not be ready to hear about hospice, and this is another limited, yes-or-no question.

The nurse is teaching a client about dietary choices to prevent dumping syndrome after gastric bypass surgery. Which statement by the client indicates a need for further teaching? A. "I will need to avoid sweetened fruit juice beverages." B. "I can eat ice cream in moderation." C. "I cannot drink alcohol at all." D. "It is okay to have a serving of sugar-free pudding."

B Milk products such as ice cream must be eliminated from the diet of the client with dumping syndrome. The client with dumping syndrome can no longer consume sweetened drinks. Alcohol must be eliminated from the diet. The client can eat sugar-free pudding, custard, and gelatin with caution.

The admission assessment for a client with acute gastric bleeding indicates blood pressure 82/40 mm Hg, pulse 124 beats/min, and respiratory rate 26 breaths/min. Which admission request does the nurse implement first? A. Type and crossmatch for 4 units of packed red blood cells. B. Infuse lactated Ringer's solution at 200 mL/hr. C. Give pantoprazole (Protonix) 40 mg IV now and then daily. D. Insert a nasogastric tube and connect to low intermittent suction.

B The client's most immediate concern is the hypotension associated with volume loss. The most rapidly available volume expanders are crystalloids to treat hypovolemia. A type and crossmatch, administration of pantoprazole, and insertion of a nasogastric tube must all be done, but the nurse's immediate concern is correcting the client's hypovolemia.

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

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

The nurse reviews a medication history for a client newly diagnosed with peptic ulcer disease (PUD) who has a history of using ibuprofen (Advil) frequently for chronic knee pain. The nurse anticipates that the health care provider will request which medication for this client? Bismuth subsalicylate (Pepto-Bismol) Magnesium hydroxide (Maalox) Metronidazole (Flagyl) Misoprostol (Cytotec)

Misoprostol is a prostaglandin analogue that protects against NSAID-induced ulcers. Bismuth subsalicylate is an antidiarrheal drug that contains salicylates, which can cause bleeding and should be avoided in clients who have peptic ulcer disease (PUD). Magnesium hydroxide is an antacid that may be used to neutralize stomach secretions, but is not used specifically to help prevent NSAID-induced ulcers. Metronidazole is an antimicrobial agent used to treat Helicobacter pylori infection.

The nurse is caring for a client with peptic ulcer disease (PUD). What signs and symptoms in the client suggest a surgical emergency? Select all that apply. Black, tarry stool Vomiting of bright red or coffee-ground blood Sudden, sharp pain in the mid epigastrium Tender, rigid, board-like abdomen Assuming the knee-chest position

Perforation of a peptic ulcer is a life-threatening surgical emergency. Perforation causes a sudden, sharp pain in the mid epigastric region. The client becomes apprehensive and the abdomen becomes tender, rigid, and board-like. To decrease the tension of the abdominal muscles, the client usually assumes a knee-chest position. Black, tarry stool or melena and vomiting blood (hematemesis) are common symptoms of PUD, but they do not indicate a surgical emergency.

The nurse is caring for several patients with gastric and duodenal ulcers. Which differential features of gastric ulcers compared to duodenal ulcers does the nurse identify? (select all that apply) a. normal secretion or hypo-secretion b. relieved by ingestion of food c. hematemesis more common than melena d. no gastritis present e. most often, the patient has type O blood

a. normal secretion or hypo-secretion c. hematemesis more common than melena

The student nurse is performing a gastric lavage on a patient with an active upper GI bleed. Which action by the student requires intervention by the supervising nurse? a. Using an ice-cold solution to perform lavage of the stomach b. instilling the lavage solution in volumes of 200 to 300 mL c. continuing the lavage until the solution returned is clear or light pink without clots d. positioning the patient on his left side during the procedure

a. Using an ice-cold solution to perform lavage of the stomach

The nurse is caring for a patient who under-went gastric resection. On assessment, the shiny, and appears "beefy." What does the nurse suspect has occurred? a. Vitamin B12 deficiency b. anemia c. hypovolemia d. inadequate nutrition

a. Vitamin B12 deficiency

The nurse is caring for an older adult male client who reports stomach pain and heartburn. Which symptom is most significant in determining whether the client's ulceration is gastric or duodenal in origin? A. Pain occurs 1½ to 3 hours after a meal, usually at night. B. Pain is worsened by the ingestion of food. C. The client has a malnourished appearance. D. The client is a man older than 50 years.

A A key symptom of duodenal ulcers is that pain usually awakens the client between 1:00 a.m. and 2:00 a.m., occurring 1½ to 3 hours after a meal. Pain that is worsened with ingestion of food and a malnourished appearance are key features of gastric ulcers. A male over 50 years is a finding that could apply to either type of ulcer.

The gastric ulcer patient's abdomen is rigid, tender and painful. He prefers lying in a knee-chest (fetal) position. What is the nurses priority action at this time? a. notify the health care provider b. administer an opioid pain mediation c. reposition the patient supine d. measure the abdominal circumference

a. notify the health care provider

A client has been discharged home after surgery for gastric cancer, and a case manager will follow up with the client. To ensure a smooth transition from the hospital to the home setting, which information provided by the hospital nurse to the case manager is given the highest priority? A. Schedule of the client's follow-up examinations and x-ray assessments B. Information on family members' progress in learning how to perform dressing changes C. Copy of the diet plan prepared for the client by the hospital dietitian D. Detailed account of what occurred during the client's surgical procedure

A Because recurrence of gastric cancer is common, it will be a priority for the client to have follow-up examinations and x-rays, so that a recurrence can be detected quickly. It may take family members a long time to become proficient at tasks such as dressing changes. Although the case manager should be aware of the diet, family members will likely be preparing the client's daily diet, and they should be provided with this information. It is not necessary for the case manager to have details of the client's surgical procedure unless a significant event has occurred during the procedure.

An older female client is diagnosed with gastric cancer. Which statement made by the client's family demonstrates a correct understanding of the disorder? A. "This may be related to her recurring ulcer disease." B. "This is probably curable with surgery." C. "Gastric cancer has a strong genetic component." D. "Thank goodness she won't have to undergo surgery."

A Infection with Helicobacter pylori is the largest risk factor for gastric cancer because it carries the cytotoxin-associated antigen A (CagA) gene. Clients with chronic ulcers are probably infected with this organism. Surgery is not curative; most gastric cancers do not present with symptoms until late in the disease and have a high fatality rate. There is no strong genetic predisposition to gastric cancer. Surgery is part of the treatment.

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

A. Gastric lavage involves the instillation of water or saline through an NG tube to clear out stomach contents and blood clots.

The nurse is providing discharge teaching for a patient after gastrectomy. Which teaching points will the nurse include to help the patient minimize dumping syndrome? (select all that apply) a. eat small frequent meals b. drink an 8 ounce glass of water with each meal c. eliminate alcohol and caffeine from you diet d. lie flat for a short time after eating e. take B12 injections as prescribed by your health care provider.

a. eat small frequent meals c. eliminate alcohol and caffeine from you diet d. lie flat for a short time after eating e. take B12 injections as prescribed by your health care provider.

When performing an assessment on a patient with an active upper GI bleed, which conditions does the nurse identify as common causes of upper GI bleeding? (select all that apply) a. esophageal cancer b. esophageal varices c. gastroesophageal reflux disease d. dudoenal ulcer e. gastritis f. gastric cancer

a. esophageal cancer b. esophageal varices d. dudoenal ulcer e. gastritis f. gastric cancer

Drug therapy for peptic ulcer disease is implemented for which purposes? (select all that apply) a. pain relief b. rebuild the mucosal lining of the stomach c. eliminate H. pylori infection d. Heal ulcerations e. prevent recurrence

a. pain relief c. eliminate H. pylori infection d. Heal ulcerations e. prevent recurrence

Which strategies does the nurse expect to implement in the management of dumping sydnrome? (select all that apply) a. provide more frequent smaller meals b. provide a high-carbohydrate diet c. eliminate liquids ingested with meals d. increase protein and fat in the diet e. Administer acarbose to decrease carbohydrate absorption

a. provide more frequent smaller meals c. eliminate liquids ingested with meals d. increase protein and fat in the diet e. Administer acarbose to decrease carbohydrate absorption

A client with peptic ulcer disease asks the nurse about taking slippery elm supplements. What response by the nurse is best? a. "Slippery elm has no benefit for this problem." b. "Slippery elm is often used for this disorder." c. "There is no evidence that this will work." d. "You should not take any herbal remedies."

ANS: B There are several complementary and alternative medicine regimens that are used for gastritis and peptic ulcer disease. Most have been tested on animals but not humans. Slippery elm is a common supplement used for this disorder.

A client has been diagnosed with terminal gastric cancer and is interested in obtaining support from hospice, but expresses concern that pain management will not be adequate. What is the nurse's best response? A. "Pain control is a major component of the care provided by hospice and its staff members." B. "What has your provider told you about participating in hospice?" C. "I can speak to your provider about requesting adequate pain medication." D. "You don't want to become too dependent on pain medication and become an addict."

A Telling the client that pain control is a major component of hospice care correctly describes the services provided by hospice and its staff members, and reassures the client about their expertise in pain management. Asking the client what the provider has said is an evasive response by the nurse and does not address the client's concerns. The nurse does not need to speak to the provider because pain control is an integral part of hospice services. It is inappropriate to tell a terminally ill client in need of pain control that he or she may become too dependent on pain medication.

A client is scheduled to be discharged after a gastrectomy. The client's spouse expresses concern that the client will be unable to change the surgical dressing adequately. What is the nurse's highest priority intervention? A. Providing both oral and written instructions on changing the dressing and on symptoms of infection that must be reported to the provider B. Asking the provider for a referral for home health services to assist with dressing changes C. Asking the spouse whether other family members could be taught how to change the dressing D. Trying to determine specific concerns that the spouse has regarding dressing changes

A. Providing both oral and written instructions on changing the dressing and on symptoms of infection that must be reported to the provider

The nurse working during the day shift on the medical unit has just received report. Which client does the nurse plan to assess first? A. Young adult with epigastric pain, hiccups, and abdominal distention after having a total gastrectomy B. Adult who had a subtotal gastrectomy and is experiencing dizziness and diaphoresis after each meal C. Middle-aged client with gastric cancer who needs to receive omeprazole (Prilosec) before breakfast D. Older adult with advanced gastric cancer who is scheduled to receive combination chemotherapy

A. Young adult with epigastric pain, hiccups, and abdominal distention after having a total gastrectomy

The nurse is reviewing admitting requests for a client admitted to the intensive care unit with perforation of a duodenal ulcer. Which request does the nurse implement first? A. Apply antiembolism stockings. B. Place a nasogastric (NG) tube, and connect to suction. C. Insert an indwelling catheter, and check output hourly. D. Give famotidine (Pepcid) 20 mg IV every 12 hours.

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

A patient with peptic ulcer disease is receiving Maalox (antiulcer, neutralize gastric acid follow dssolution in gastric contents, inactivates pepsin). Which actions does the nurse take when administering this medication? (select all that apply) a. give medication 2 hours after the patient's meal b. do not give other drugs within 1-2 hours of antacids c. assess the patient for a history of renal disease before giving Maalox e. observe the patient for the side effect of constipation

a. give medication 2 hours after the patient's meal b. do not give other drugs within 1-2 hours of antacids c. assess the patient for a history of renal disease before giving Maalox

A patient develops an active upper GI bleed. Which are the priority actions the nurse takes for caring for this patient? (select al that apply) a. provide oxygen b. start 1 and 2 large-bore IV lines c. Prepare to infuse 0.9% normal saline solution d. monitor serum electrolytes e. prepare for nasogastric tube insertion

a. provide oxygen b. start 1 and 2 large-bore IV lines c. Prepare to infuse 0.9% normal saline solution e. prepare for nasogastric tube insertion

Which are symptoms of early dumping syndrome (condition that can develop after surgery to remove all or part of your stomach or after surgery to bypass your stomach to help you lose weight. Also called rapid gastric emptying, dumping syndrome occurs when food, especially sugar, moves from your stomach into your small bowel too quickly)? (select all that apply) a. tachycardia b.confusion c. desire to lie down d. syncope e. occurs 30 minutes after eating

a. tachycardia c. desire to lie down d. syncope e. occurs 30 minutes after eating

The student nurse learns about risk factors for gastric cancer. Which factors does this include? (Select all that apply.) a. Achlorhydria b. Chronic atrophic gastritis c. Helicobacter pylori infection d. Iron deficiency anemia e. Pernicious anemia

ANS: A, B, C, E Achlorhydria, chronic atrophic gastritis, H. pylori infection, and pernicious anemia are all risk factors for developing gastric cancer. Iron deficiency anemia is not a risk factor.

The student nurse studying stomach disorders learns that the risk factors for acute gastritis include which of the following? (Select all that apply.) a. Alcohol b. Caffeine c. Corticosteroids d. Fruit juice e. Nonsteroidal anti-inflammatory drugs (NSAIDs)

ANS: A, B, C, E Risk factors for acute gastritis include alcohol, caffeine, corticosteroids, and chronic NSAID use. Fruit juice is not a risk factor, although in some people it does cause distress.

A client has a gastrointestinal hemorrhage and is prescribed two units of packed red blood cells. What actions should the nurse perform prior to hanging the blood? (Select all that apply.) a. Ask a second nurse to double-check the blood. b. Prime the IV tubing with normal saline. c. Prime the IV tubing with dextrose in water. d. Take and record a set of vital signs. e. Teach the client about reaction manifestations.

ANS: A, B, D, E Prior to starting a blood transfusion, the nurse asks another nurse to double-check the blood (and client identity), primes the IV tubing with normal saline, takes and records a baseline set of vital signs, and teaches the client about manifestations to report. The IV tubing is not primed with dextrose in water.

A client who had a partial gastrectomy has several expected nutritional problems. What actions by the nurse are best to promote better nutrition? (Select all that apply.) a. Administer vitamin B12 injections. b. Ask the provider about folic acid replacement. c. Educate the client on enteral feedings. d. Obtain consent for total parenteral nutrition. e. Provide iron supplements for the client.

ANS: A, B, E After gastrectomy, clients are at high risk for anemia due to vitamin B12 deficiency, folic acid deficiency, or iron deficiency. The nurse should provide supplements for all these nutrients. The client does not need enteral feeding or total parenteral nutrition.

A client has dumping syndrome. What menu selections indicate the client understands the correct diet to manage this condition? (Select all that apply.) a. Canned unsweetened apricots b. Coffee cake c. Milk shake d. Potato soup e. Steamed broccoli

ANS: A, D Canned apricots and potato soup are appropriate selections as they are part of a high-protein, high-fat, low- to moderate-carbohydrate diet. Coffee cake and other sweets must be avoided. Milk products and sweet drinks such as shakes must be avoided. Gas-forming foods such as broccoli must also be avoided.

An older client has gastric cancer and is scheduled to have a partial gastrectomy. The family does not want the client told about her diagnosis. What action by the nurse is best? a. Ask the family why they feel this way. b. Assess family concerns and fears. c. Refuse to go along with the family's wishes. d. Tell the family that such secrets cannot be kept.

ANS: B The nurse should use open-ended questions and statements to fully assess the family's concerns and fears. Asking "why" questions often puts people on the defensive and is considered a barrier to therapeutic communication. Refusing to follow the family's wishes or keep their confidence will not help move this family from their position and will set up an adversarial relationship.

A client with a nasogastric (NG) tube in place to help treat a gastric ulcer develops severe epigastric pain, and the nurse notes a rigid, boardlike abdomen. The nurse notifies the provider of this condition. Which subsequent action is correct? Check for placement of the NG tube. Irrigate the NG tube with saline solution. Maintain nasogastric suction. Withdraw the NG tube immediately.

This client is exhibiting signs of perforation. The nurse should maintain NG tube suction only to drain gastric secretions and prevent further peritoneal spillage. Unless there is reason to suspect incorrect placement, checking the placement of the tube is not the next action. The NG tube should not be irrigated in this instance, and it should not be withdrawn unless respiratory changes occur.

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

A A large-bore IV should be placed as requested, 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 client should be monitored, but it is not necessary to monitor the anxiety level of the client

Which statements about gastritis are accurate? (select all that apply) A. The diagnosis of gastritis is made solely on clinical symptoms B. The onset on infection with Helicobacter pylori can result in acute gastritis C. Long-term use of acetaminophen (Tylenol) is a high risk factor for acute gastritis D. Atrophic gastritis is a form of chronic gastritis that is seen most in older adults E. Type B chronic gastritis affects the glands in the antrum, but may affect all of the stomach

B. The onset on infection with Helicobacter pylori can result in acute gastritis D. Atrophic gastritis is a form of chronic gastritis that is seen most in older adults E. Type B chronic gastritis affects the glands in the antrum, but may affect all of the stomach