Gastric and duodenal disorders
A client with peptic ulcer disease must begin triple medication therapy. For how long will the client follow this regimen? 7 to 9 days 15 to 20 days 4 to 6 days 10 to 14 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).
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? Celiac disease Dumping syndrome Bile reflux Gastric outlet obstruction
Dumping syndrome 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).
Which medication classification represents a proton (gastric acid) pump inhibitor? Famotidine Omeprazole Sucralfate Metronidazole
Omeprazole ***omeprazole decreases gastric acid by slowing the hydrogen-potassium adenosine triphosphatase pump on the surface of the parietal cells. Sucralfate is a cytoprotective drug. Famotidine is a histamine-2 receptor antagonist. Metronidazole is an antibiotic, specifically an amebicide.
A client is recovering from gastric surgery. Toward what goal should the nurse progress the client's enteral intake? Three meals and 120 ml fluid daily Three meals and three snacks and 120 mL fluid daily Six small meals and 120 mL fluid daily 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 recovering from the removal of a gastric tumor asks why radiation therapy is needed. Which response will the nurse provide? "It is to prevent the development of a wound infection." "It is to kill any remaining cancer cells." "It is to reduce your need for medication." "It is to heal the wound faster."
"It is to kill any remaining cancer cells." Explanation: Radiation therapy may also be used alone or along with chemotherapy before surgery to decrease the size of the tumor, or after surgery to destroy any remaining cancer cells and to delay or prevent reoccurrence of the cancer. Radiation therapy is not used to heal the surgical wound, reduce the need for medication, or to prevent the development of a wound infection.
A client is prescribed a histamine (H2)-receptor antagonist. The nurse understands that this might include which medication(s)? Select all that apply. Cimetidine Famotidine Nizatidine Esomeprazole Lansoprazole
Cimetidine Nizatidine Famotidine
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. Pancreas Liver Bladder Lungs Duodenum
Liver Pancreas Duodenum 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.
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? Colostomy Peptic ulcers Pernicious anemia Systemic infection
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.
Which of the following medications used for obesity improves cardiovascular disease risk factors in obese patients with metabolic syndrome? Sibutramine (Meridia) Alli Orlistat (Xenical) Rimonabant (Acomplia)
Rimonabant (Acomplia) Explanation: Acomplia is the newest medication used to treat obesity. It stimulates weight reduction and improves cardiovascular disease risk factors in obese patients with metabolic syndrome. Meridia was recently pulled from the market because of the increased risk of heart attack and stroke associated with this medication. Orlistat, available by prescription and over the counter as Alli, reduces caloric intake by binding to gastric and pancreatic lipase to prevent digestion of fats.
A client is prescribed tetracycline to treat peptic ulcer disease. Which instruction would the nurse give the client? "You will not experience GI upset while taking this medication." "Do not drive when taking this medication." "Be sure to wear sunscreen while taking this medicine." "Take the medication with milk."
"Be sure to wear sunscreen while taking this medicine." Explanation: Tetracycline may cause a photosensitivity reaction in clients. The nurse should caution the client to use sunscreen when taking this drug. Dairy products can reduce the effectiveness of tetracycline, so the nurse should not advise him or her to take the medication with milk. GI upset is possible with tetracycline administration. Administration of tetracycline does not necessitate driving restrictions.
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.) "You may have ingested some irritating foods." "It is probably your nerves." "Is it possible that you are overusing aspirin." "It is a hereditary disease." "It can be caused by ingestion of strong acids."
"It can be caused by ingestion of strong acids." "Is it possible that you are overusing aspirin." "You may have ingested some irritating foods." Acute gastritis is often caused by dietary indiscretion—the person eats food that is irritating, too highly seasoned, or contaminated with disease-causing microorganisms. Other causes of acute gastritis include overuse of aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), excessive alcohol intake, bile reflux, and radiation therapy. A more severe form of acute gastritis is caused by the ingestion of strong acid or alkali, which may cause the mucosa to become gangrenous or to perforate.
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 Gastric penetration Ineffective treatment for the peptic ulcer A reaction to the medication given for the 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
A nurse is teaching a client with gastritis about the need to avoid the intake of caffeinated beverages. The client asks why this is so important. Which explanation from the nurse would be most accurate? "Caffeine increases the fluid volume in your system, which irritates your digestive organs." "Caffeine intake can cause tears in your esophagus and intestines, which can lead to hemorrhage." "Caffeine stimulates the central nervous system and thus gastric activity and secretions, which need to be minimized to promote recovery." "Caffeine can interfere with absorption of vitamin B12, which leads to anemia and further digestive problems."caf
"Caffeine stimulates the central nervous system and thus gastric activity and secretions, which need to be minimized to promote recovery." Explanation: Caffeine is a central nervous system stimulant that increases gastric activity and pepsin secretion. Caffeine is a diuretic that causes decreased fluid volume and potential dehydration. It does not lead to hemorrhage and does not interfere with absorption of vitamin B12.
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? "I felt better but then just got really nauseated and threw up." "The pain stopped so I stopped taking the medications." "I think the soda that I drank irritated my stomach." "I only ate dinner yesterday and it gave me an upset stomach."
"The pain stopped so I stopped taking the medications." Explanation:The client should be instructed to adhere to and complete the medication regimen to ensure complete healing of the peptic ulcer. Because most clients become symptom free within a week, it should be stressed to the client the importance of following the prescribed regimen so that the healing process can continue uninterrupted and the return of symptoms can be prevented. Since the client stopped taking the medication, the ulcer was not healed and became worse. The statements about soda, being nauseated, and eating only one meal would not explain the reason for the client's new onset of hematemesis during treatment for a peptic ulcer. 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.
A client with peptic ulcer disease has a blood pressure of 88/40 mm Hg, dizziness, and nausea. Which complication will the nurse suspect is occurring with this client? Bleeding from the ulcer Evidence of ulcer healing Medication adverse effects Allergic response to the medication
Bleeding from the ulcer Explanation: Bleeding peptic ulcers account for 27% to 40% of all upper GI bleeds and it may be manifested by hematemesis or melena. Faintness or dizziness and nausea may precede or accompany bleeding. A low blood pressure could indicate active bleeding. The client's symptoms do not indicate evidence of the ulcer healing. It is unlikely that the client's symptoms are adverse effects or allergic responses to the medications.
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? Removes tension on internal suture line Provides much needed rest Slows gastric emptying Allows for better absorption of vitamin B12
Slows gastric emptying 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
