Exam 4 (Chapter 47) MGMT of Pt's w/Gastric and Duodenal Disorders

The most common site for peptic ulcer formation is the _____________.

duodenum

6. A patient is scheduled for a Billroth I procedure for ulcer management. A. A partial gastrectomy is performed with anastomosis of the stomach segmented to the duodenum B. a section portion of the stomach is joined to the jejunum C. The intro portion of the stomach is removed and a vagotomy is performed D. The vagus nerve was cut and gastric drainage is established

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

15. A patient has a BMI ranger greater than 40 kg/ M2. What would this patient's obesity classification be? A. Overweight B. Class I C. Class II D. Class III

D. Class III

10. A patient is in the hospital for the treatment of peptic ulcer disease. The nurse finds the patient vomiting and complaining of a sudden severe pain in the abdomen. The nurse then assess a board like abdomen. What does the nurse suspect these symptoms indicate? A. The treatment for the peptic ulcer is ineffective B. A reaction to the medication given for the ulcer C. Gastric penetration D. Perforation of the peptic ulcer

D. Perforation of the peptic ulcer

________________________ is the bacillus commonly associated with the formation of gastric, and possibly duodenal, ulcers.

Helicobacter pylori

A frequently prescribed proton pump inhibitor of gastric acid is ________________.

Nexium

The stomach pouch created by gastric bypass or bonding surgery can hold up to ___________mL of food and fluids.

30

Peptic ulcers occur with the most frequency in those between the ages of ____ and _____ years

40, 60

The average weight loss after bariatric surgery is about _________% of previous body weight.

60

11. A patient taking metronidazole (Flagyl) for the treatment of H pylori states that the medication is causing nausea. What suggestion can the nurse provide to the patient to alleviate this problem? A. Discontinue the use of the medication B. Tell the patient to ask the physician 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

C. Take the medication with meals to decrease the nausea

3. A patient 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 patient complained of cramping pains, dizziness, and palpitation. After having a bowel movement common the symptoms resolved. What should the patient be educated about regarding this event? A. Gastric Outlet obstruction B. Dumping syndrome C. Bile reflux D. Celiac disease

B. Dumping syndrome

5. The nurse is educating a patient about discharge medication. When should the nurse instruct the patient to take the antacid medication? A. With the meal B. 30 minutes before the meal C. 1 to 3 hours after the meal D. Immediately after the meal

C. 1 to 3 hours after the meal

12. The nurse is educating a patient with peptic ulcer disease about the disease process. What decreases the secretion of bicarbonate from the pancreas into the duodenum, resulting in increased acidity of the duodenum? A. Smoking B. Eating spicy foods C. Drinking carbonated beverages D. Taking antacids

C. Drinking carbonated beverages

2. The nurse is caring for a patient who has been diagnosed with gastritis. To promote fluid balance when treating gastritis, the nurse knows what minimal daily intake of fluids is required? a. 1.0L b. 1.5L c. 2.0L d. 2.5L

b. 1.5L

The most common complication of peptic ulcer disease that occurs in 10% to 20% of the patients is _______________.

hemorrhage

________________, ___________________, __________________, and __________________ are some of the major potential complications of a peptic ulcer.

hemorrhage, perforation, penetration, pyloric obstruction

20.) The nurse is conducting preoperative teaching to a patient prior to bariatric surgery. The nurse includes that the average weight loss of patients after bariatric surgery is which percent of their presurgical body weight? a. 25 to 35% b. 5 to 15% c. 35 to 45% d. 15 to 25%

• 25 to 35%- The nurse includes that the average weight loss of a patient after bariatric surgery is 25 to 35 % of their presurgical body weight.

24.) The nurse is assessing an 80-year-old patient for signs and symptoms of gastric cancer. The nurse differentiates which of the following to be a sign/symptom of gastric cancer in the geriatric patient, but not in a patient under the age of 75? a. Abdominal mass b. Hepatomegalia c. Agitation d. Ascites

• Agitation- The nurse differentiates that agitation, along with confusion and restlessness, may be the only signs/symptoms seen of gastric cancer in the older patient. Abdominal mass, hepatomegaly, and ascites may all be signs/symptoms of advanced gastric cancer.

10.) Which of the following ulcers is associated with extensive burn injury? a. Peptic ulcer b. Duodenal ulcer c. Curling's ulcer d. Cushing's ulcer

• Curling's ulcer- Curling's ulcer is frequently observed about 72 hours after extensive burns and involves the antrum of the stomach or the duodenum.

16.) The nurse is creating a discharge plan of care for a patient with a peptic ulcer. The nurse tells the patient to avoid which of the following? a. Skim milk b. Tylenol c. Octreotide d. Decaffeinated coffee

• Decaffeinated coffee- The nurse should include avoidance of decaffeinated coffee in the patient's discharge teaching plan. Decaffeinated coffee is avoiding, to keep from overstimulating acid secretion.

12.) Which of the following is the first portion of the small intestine? a. Omentum b. Duodenum c. Pylorus d. Peritoneum

• Duodenum- The duodenum is the first portion of the small intestine, between the stomach and the jejunum. The pylorus is the opening between the stomach and duodenum. The peritoneum is the thin membrane that lines the inside of the abdominal wall and covers all the abdominal organs. The omentum is the fold of the peritoneum that surrounds the stomach and other organs of the abdomen.

15.) The nurse is conducting a community education program on peptic ulcer disease prevention. The nurse concludes that the most common cause of peptic ulcers is which of the following? a. Alcohol and tobacco b. Stress and anxiety c. Gram-negative bacteria d. Motrin and aspirin

• Gram-negative bacteria- The nurse should include that the most common cause of peptic ulcers is Gram-negative bacteria (Helicobacter pylori).

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

• Hematemesis- 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.

14.) The nurse in the ED is admitting a patient with bloody stools. The nurse documents this finding as being which of the following? a. Steatorrhea b. Melena c. Hematochezia d. Tarry stools

• Hematochezia- The nurse should document the finding of bloody stools as hematochezia. Melena is the term used for tarry black stools with occult blood. Steatorrhea is the term utilized for fatty stools that have an oily appearance and float in water.

21.) A patient who had bariatric surgery complains of diarrhea. The nurse recommends which of the following dietary changes? a. Increased fiber b. Increased protein c. Decreased carbohydrates d. Decreased fat

• Increased fiber- The nurse recommends that the patient increase fiber in the diet because a high-fiber diet can decrease both diarrhea and constipation after bariatric surgery.

11.) Which of the following is a true statement regarding the nursing considerations in administration of metronidazole (Flagyl)? a. It leaves a metallic taste in the mouth. b. Flagyl decreases the effect of Coumadin. c. The drug should be given prior to meals. d. It may cause weight gain?

• It leaves a metallic taste in the mouth- Flagyl leaves a metallic taste in the mouth. It may cause anorexia and should be given with meals to decrease GI upset. Flagyl increases the blood-thinning effects of warfarin (Coumadin).

7.) Which of the following is a true statement regarding gastric cancer? a. Women have a higher incidence of gastric cancer. b. The prognosis for gastric cancer is good. c. Most patients are asymptomatic during the early stage of the disease. d. Most cases are discovered prior to metastasis.

• Most patients are asymptomatic during the early stage of the disease- Most patients are asymptomatic during the early stage of the disease. Men have a higher incidence of gastric cancer than women. The prognosis is poor because the diagnosis is usually made late because most patients are asymptomatic during the early stage. Most cases of gastric cancer are discovered only after local invasion has advanced or metastases are present.

6.) Peptic ulcer disease occurs more frequently in people with which blood type? a. B b. A c. AB d. O

• O- People with blood type O are more susceptible to peptic ulcers than those with blood type A, B, or AB.

2.) Which of the following medications used for the treatment of obesity prevents the absorption of triglycerides? a. Orlistat (Xenical) b. Sibutramine hydrochloride (Meridia) c. Fluoxetine hydrochloride (Prozac) d. Bupropion hydrochloride (Wilburton)

• Orlistat (Xenical)- Orlistat (Xenical) prevents the absorption of triglycerides. Side effects of Xenical may include increased bowel movements, gas with oily discharge, decreased food absorption, decreased bile flow, and decreased absorption of some vitamins. Bupropion hydrochloride (Wellbutrin) is an antidepressant medication. Sibutramine hydrochloride (Meridia) inhibits the reuptake of serotonin and norepinephrine.

5.) Which of the following are classified as a histamine-2 receptor antagonist? a. Flagyl b. Nexium c. Prevacid d. Pepcid

• Pepcid- Famotidine (Pepcid) is a histamine-2 receptor antagonist. Prevacid and Nexium are proton pump inhibitors (PPIs). Flagyl is an antibiotic.

23.) The nurse is teaching a patient on preventing dysphagia after bariatric surgery. The nurse tells the patient to avoid which of the following? Select all that apply. a. Cheese b. Steak c. Doughy bread d. Peas

• Steak; doughy bread- The nurse should include in the teaching the avoidance of eating tough foods, such as steak as well as doughy bread. Patients should also be instructed to eat slowly and to chew their food thoroughly.

13. A patient is complaining of diarrhea after having bariatric surgery what non-pharmacological treatment can the nurse suggest to decrease the incidence of diarrhea? A. Decrease the fat content in the diet B. Increase the fiber content in the diet C. Decrease the amount of fluid the patient is drinking D. Increase the protein content in the diet

A. Decrease the fat content in the diet

25.) The nurse is conducting a community health education program on obesity. The nurse includes which of the following diseases/disorders in the program? a. Rheumatoid arthritis b. Oral cancer c. Chronic obstructive pulmonary disease d. Obstructive sleep apnea

• Obstructive sleep apnea- The nurse includes that obstructive sleep apnea is a disease/disorder associated with obesity as well as asthma; breast, endometrial, prostate, renal, colon, and gallbladder cancer; osteoarthritis, coronary artery disease, cholecystitis, cholelithiasis, chronic back pain, diabetes, hypertension, coronary artery disease, heart failure, and pulmonary embolism.

8. The nurse is caring for a patient who is suspected to have developed a peptic ulcer Hemorrhage. Which action would the nurse perform first? A. Place the patient in a recumbent position with the legs elevated B. Prepare a peripheral and central line for intravenous infusion C. Assess vital signs D. Call the physician

A. Place the patient in a recumbent position with the legs elevated

14. A patient has a Class II classification of obesity. What level of health risk does this pose for the patient? A. Mild risk B. Moderate risk C. Severe risk D. Very severe risk

C. Severe risk

22.) The nurse is caring for a patient after bariatric surgery who experiences symptoms of gastric outlet obstruction. Which of the following are contraindicated? a. Surgical revision b. Balloon dilation c. NG tube d. Endoscopic procedure

• NG tube- NG tube insertion is contraindicated in patients who have had bariatric surgery. Alternative treatment options include endoscopic procedures, balloon dilation, and/or surgical revision.

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

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

13.) The nurse is conducting a community education class on gastritis. The nurse includes that chronic gastritis caused by Helicobacter pylori is implicated in which of the following diseases/conditions? a. Peptic ulcers b. Systemic infection c. Pernicious anemia d. Colostomy

• Peptic ulcers- Chronic gastritis caused by Helicobacter pylori is implicated in the development of peptic ulcers. Chronic gastritis is sometimes associated with autoimmune disease, such as pernicious anemia, but not as a cause of the anemia. Chronic gastritis is not implicated in system infections and/or colostomies.

7. The nurse is developing a plan of care for a patient with a peptic ulcer disease. What nursing interventions should be included in the care plan? select all that apply. A. Making a vascular checks every 4 hours B. Frequently monitoring hemoglobin and hematocrit levels C. Observing stools and vomit is for color, consistency, and volume D. Checking the blood pressure and pulse rate every 15 to 20 minutes E. Inserting an indwelling catheter for incontinence

A. Making a vascular checks every 4 hours B. Frequently monitoring hemoglobin and hematocrit levels C. Observing stools and vomit is for color, consistency, and volume D. Checking the blood pressure and pulse rate every 15 to 20 minutes

8.) The nurse is assessing a patient with progressive gastric cancer. The nurse anticipates that the assessment will reveal which of the following findings? a. Weight gain b. Bloating after meals c. Abdominal pain below umbilicus d. Increased appetite

• Bloating after meals- Symptoms of progressive disease include bloating after meals, weight loss, abdominal pain above the umbilicus, and loss or decrease in appetite.

19.) The nurse is conducting an admission assessment and determines that the patient's BMI is 37. The nurse documents the BMI as being which of the following classes of obesity? a. Overweight b. Class II c. Class I d. Class III

• Class II- The nurse documents the BMI of 37 as class II obesity (BMI 35 to 40). The other classifications are as follows: overweight (BMI 25 to 30); class I (BMI 30 to 35); class III (BMI> 40).

4. 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 knee pain that increases in severity as the day progresses D. Pain that radiates to the shoulder or jaw E. Vomiting without Associated nausea

A. Burning sensation localized in the back or mid epigastrium B. Feeling of emptiness that precedes meals from 1 to 3 hours C. Severe knee pain that increases in severity as the day progresses

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

• The incidence of cancer of the stomach continues to decrease in the United States- While the incidence continues to decrease, gastric cancer still accounts for 12,800 deaths annually. While gastric cancer deaths occasionally occur in younger people, most occur in people older than 40 years of age. Males have a higher incidence of gastric cancers than females. More accurately, a diet high in smoked foods and low in fruits and vegetables may increase the risk of gastric cancer.

1. 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 probably your nerves."

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 probably your nerves."

1.) Which of the following represents the medication classification of a proton (gastric acid) pump inhibitor? a. Omeprazole (Prilosec) b. Famotidine (Pepcid) c. Metronidazole (flagyl) d. Sucralfate (Carafate)

• Omeprazole (Prilosec)- Omeprazole decreases gastric acid by slowing the hydrogen-potassium adenosine triphosphate pump on the surface of the parietal cells. Sucralfate is a cytoprotective drug. Famotidine is a histamine-2 receptor antagonist. Medronidazole is an antibiotic, specifically an amebicide.

9.) Which of the following statements correctly identifies a difference between duodenal and gastric ulcers? a. Vomiting is uncommon in patients with duodenal ulcers b. Malignancy is associated with duodenal ulcer c. Weight gain may occur with a gastric ulcer d. A gastric ulcer is caused by hypersecretion of stomach acid

• Vomiting is uncommon in patients with duodenal ulcers- Vomiting is uncommon in patients diagnosed with duodenal ulcer. Malignancy is associated with a gastric ulcer. Weight gain may occur with a duodenal ulcer. Duodenal ulcers cause hypersecretion of stomach acid.

9. A patient sustained second and third degree burns over 30% of the body surface area approximately 72 hours ago. What type of ulcers should the nurse be alert for while caring for this patient? A. Curling's ulcer B. Peptic ulcer C. Esophageal ulcer D. Meckel's ulcer

A. Curling's ulcer

4.) The nurse is evaluating a patient's ulcer symptoms to differentiate the patient's ulcer as duodenal versus gastric. Which of the following symptoms should the nurse attribute to a duodenal ulcer? a. Hemorrhage b. Vomiting c. Weight loss d. Awaken in pain

• Awaken in pain- The patient with a gastric ulcer often awakens between 1 to 2 AM with pain, and ingestion of food brings relief. Vomiting is uncommon in the patient with duodenal ulcer. Hemorrhage is less likely in the patient with duodenal ulcer than the patient with gastric ulcer. The patient with a duodenal ulcer may experience weight gain.