Med Surg Test 2 GI (Chapters 42, 43)

A patient with a peptic ulcer begins vomiting. The nurse would expect and be concerned with which type of vomitus?

"Coffee ground";The appearance of blood exposed to hydrochloric acid and other digestive enzymes in the stomach is dark brown with a coffee-ground consistency. This should be reported by the nurse. Fecal vomitus would be experienced with a total bowel obstruction. Bilious vomitus or undigested food may be seen with various gastrointestinal disturbances, such as gallbladder disease, gastroenteritis, or gastritis. Text Reference - p. 925

The results of a patient's recent endoscopy indicate the presence of peptic ulcer disease (PUD). Which teaching point should the nurse provide to the patient based on this new diagnosis?

"It would likely be beneficial for you to eliminate drinking alcohol.";Alcohol increases the amount of stomach acid produced so it should be avoided. Milk may exacerbate PUD, so two to three glasses would not be recommended. There is no reason to puree or mince food, and a current diet is likely to be altered to minimize symptoms. Text Reference - p. 948

What surgical procedure involves the removal of two-thirds of the stomach and anastomosis of the gastric stump to the duodenum?

A Billroth I operation, also known as a gastroduodenostomy, is a partial gastrectomy in which the distal two thirds of the stomach is removed and there is an anastomosis of the gastric stump to the duodenum. A vagotomy is the severing of the vagus nerve totally or selectively. A pyloroplasty is the surgical enlargement of the pyloric sphincter in order to facilitate easy passage of contents from the stomach. A Billroth II operation is called a gastrojejunostomy; it is the removal of the distal two thirds of the stomach and anastomosis of the gastric stump to the jejunum. Text Reference - p. 949

Which diagnostic test is best suited to diagnosing gastric outlet obstruction?

A barium contrast study is used to diagnose gastric outlet obstruction in patients with peptic ulcer disease. An endoscopy is performed to determine the degree of ulcer healing after the treatment of ulcer. A urea breath test is a noninvasive method used to detect active infection. Rapid urease testing is used to check for a Helicobacter pylori infection. Text Reference - p. 945

Which outcome indicates effective treatment in a patient with a bowel control problem who is on dextranomer acid gel injection?

A dextranomer/hyaluronic acid gel injection narrows the anal canal, which allows better sphincter control. Therefore, when the patient does not experience involuntary passage of stools, it indicates effective treatment. The absence of hard stools indicates the effectiveness of treatment for constipation. The absence of watery and bloody stools indicates the effectiveness of antidiarrheal drugs. Text Reference - p. 965

Which diagnostic test detects reflux of gastric contents?

A radionuclide test detects reflux of gastric contents. A biopsy helps differentiate stomach or esophageal cancer from Barrett's esophagus. An endoscopy helps assess the lower esophageal competence, degree of inflammation, scarring, and potential strictures. Manometric studies help measure esophageal pressure and lower esophageal sphincter and esophageal motility function. Text Reference - p. 932

The primary health care provider is severing the vagus nerve in a patient with a peptic ulcer that is unresponsive to medical management. Which surgical procedure should the nurse expect for this patient?

A vagotomy is severing of the vagus nerve either totally (truncal) or selectively (highly selective vagotomy). These procedures are done to decrease gastric acid secretion. Billroth I involves a partial gastrectomy with the removal of two-thirds of the stomach and the anastomosis of the gastric stump to the duodenum. Billroth II is partial gastrectomy with the removal of two-thirds of the stomach and the anastomosis of the gastric stump to the jejunum. Pyloroplasty consists of surgical enlargement of the pyloric sphincter to facilitate easy passage of contents from the stomach. Text Reference - p. 949

A patient is diagnosed with gastrointestinal bleeding after a surgical operation for peptic ulcer disease. On a follow-up visit, the nurse identifies a block in the nasogastric (NG) tube. Which complication is likely to occur?

Abdominal distention occurs due to accumulation of fluid or air in the abdomen causing outward expansion beyond the normal girth of the stomach as a result of the blockage of the NG tube. Perforation is a complication of peptic ulcer disease involving the complete penetration of the wall of the gastrointestinal tract resulting in intestinal contents flowing into the abdomen. Dumping syndrome occurs as a complication of surgical operation of a large portion of stomach and pylorus. Gastric outlet obstruction is a complication of peptic ulcer disease in which there is an obstruction at the pylorus. Text Reference - p. 948

Where does Zenker's diverticulum occur?

Above the upper esophageal sphincter; Diverticula are the saclike outpouchings of one or more layers of the esophagus. Zenker's diverticulum occurs above the upper esophageal sphincter. Esophageal cancers occur at the wall of the esophagus. Traction diverticulum occurs near the esophageal midpoint. Esophageal varices occur at the lower portion of the esophagus. Text Reference - p. 939

Which treatment will the nurse expect will provide short-term relief to an elderly patient who has difficulty swallowing food and has chest pain immediately after meals?

Achalasia is a chronic disorder in which peristalsis of the lower two-thirds of the esophagus is absent. The pressure on the lower esophageal sphincter (LES) is increased, which causes difficulty swallowing and chest pain after meals. Injection of botulinum toxin endoscopically into the LES is beneficial in elderly patients with achalasia. It causes relaxation of smooth muscles and provides short-term relief to the patient. A Heller myotomy is a surgical procedure and is inappropriate for elderly patients. In endoscopic pneumatic dilation, the LES muscle is disrupted from within using balloons of progressively larger diameter, which is contraindicated in elderly patients. Endoscopic stapling diverticulotomy is a treatment for esophageal diverticula, not achalasia. Text Reference - p. 940

Which statement made by the nurse to an achalasia patient about how to manage symptoms needs correction?

Achalasia is a condition in which peristalsis of the lower two-thirds of the esophagus is absent. Patients with achalasia can also eat semisoft foods. The patient should eat food slowly. The patient should drink fluids with meals and should keep the head elevated while sleeping. Text Reference - p. 940

The nurse is preparing a care plan for a patient who underwent an open high abdominal incision. Which necessary interventions should the nurse include in the care plan? Select all that apply.

After an open high abdominal incision, respiratory complications can occur. Therefore, the nurse should monitor pulse rate and respiratory rate. Bowel sounds and blood glucose level are not altered after an open high abdominal incision. Serum creatinine levels are altered in kidney and liver diseases but not after an open high abdominal incision. Text Reference - p. 935

Which antacid used in the treatment of gastrointestinal reflux disease (GERD) causes phosphorus depletion with chronic use?

Aluminum hydroxide is an antacid used for treating GERD that causes phosphorus depletion with chronic use. Magnesium oxide causes diarrhea and hypermagnesemia. Calcium carbonate causes renal calculi, diarrhea, milk-alkali syndrome, and constipation. Sodium bicarbonate causes milk-alkali syndrome when used with large amounts of calcium. Text Reference - p. 934

The nurse is caring for a patient diagnosed with Helicobacter pylori (H. pylori) infection. Which medications should the nurse expect to be included in the triple-drug therapy? Select all that apply.

Amoxicillin, omeprazole, and clarithromycin are the medications included in triple-drug therapy to treat Helicobacter pylori (H. pylori) infection. Cimetidine is an H2-receptor blocker that is used to reduce gastric hydrochloric acid secretion. Tetracycline is an antibiotic that is included in quadruple therapy for the treatment of H. pylori infection. Text Reference - p. 942

The nurse is caring for a patient with suspected stress-related mucosal disease (SRMD). Which medication can be co-administered with anti-secretory agent for the patient's condition?

Antacids such as aluminum hydroxide are co-administered with anti-secretory agents to treat SRMD. Aluminum hydroxide helps by decreasing basal acid secretions and secretions stimulated by histamine. Ranitidine is a histamine-receptor blocker, which can be concurrently used with antacids to treat duodenal ulcers. Amoxicillin is included in triple-drug therapy to treat Helicobacter pylori (H. pylori) infection. Pantoprazole is a proton pump inhibitor used concurrently with antibiotics to treat H. pylori infection. Text Reference - p. 946

Which findings indicate that a patient with gastroesophageal reflux disease has aspirated gastric contents into the respiratory system? Select all that apply.

Asthma, pneumonia, and chronic bronchitis may develop as a result of aspiration into the respiratory system. Cough and bronchospasm cause irritation of the upper airway by gastric secretions. Text Reference - p. 932

A postmenopausal patient complains of back pain and burning pain in midepigastric region three hours after a meal. The medical history of the patient reveals hyperparathyroidism. Which condition does the nurse suspect in the patient?

Back pain and burning pain in the midepigastric region two to five hours after eating indicate a duodenal ulcer. These ulcers are more common in men but increasingly occur in postmenopausal women. They are associated with disease conditions such as renal failure, pancreatitis, hyperparathyroidism, and chronic obstructive pulmonary disease. Gastric ulcers are characterized by burning pain in the left epigastrium and upper abdomen. Zollinger-Ellison syndrome is a condition that involves severe peptic ulceration and hydrochloric acid secretion. Postprandial hypoglycemia is a postoperative complication of gastrectomy that occurs two hours after eating. Symptoms include sweating, weakness, confusion, palpitations, anxiety, and tachycardia. Text Reference - p. 944

A patient who is given a bisacodyl suppository asks the nurse how long it will take to work. The nurse replies that the patient will probably need to use the bedpan or commode within which time frame after administration?

Bisacodyl suppositories usually are effective within 15 to 60 minutes of administration, so the nurse should plan accordingly to assist the patient to use the bedpan or commode. Text Reference - p. 966

The patient states that he or she has had an episode of loose stool and does not want to take the scheduled dose of docusate sodium. What is the appropriate action by the nurse?

Chart the dose as not given and update the nursing note;Whenever a patient refuses medication, the dose should be charted as not given. An explanation of the reason should then be documented in the nursing progress notes. In this instance, the refusal indicates good judgment by the patient, because docusate sodium would worsen already existing diarrhea. The nurse does not need to file an incident report, because this does not represent a medication error. The patient should not be coerced to take the medication later or by the spouse. Text Reference - p. 967

Which medications can be co-administered with antacids to provide ulcer relief? Select all that apply.

Cimetidine and famotidine are histamine-receptor blockers that can be concurrently used with antacids like aluminum hydroxide, because it neutralizes the acid to provide relief. Amoxicillin is used in triple-drug therapy to treat Helicobacter pylori (H. pylori) infection. Along with antibiotics, omeprazole reduces gastric secretion. Clarithromycin is included in antibiotic therapy to treat H. pylori infection. Text Reference - p. 945

A patient who is on anticoagulant therapy reports hard stools, abdominal distention, and increased flatulence. Which medication is contraindicated for the patient?

Constipation is infrequent bowel movements characterized by absent or hard, dry stools, abdominal distention, bloating, and increased flatulence. Docusate is a stool softener that lubricates the intestinal tract and softens the feces making the hard stools easier to pass. This medication blocks the absorption of fat-soluble vitamins, such as vitamin K, and increases the risk of bleeding. This medication is contraindicated for patients using anticoagulants to minimize the risk of bleeding. Linaclotide is an intestinal secretagogue that increases the fluid secretion and accelerates the intestinal tract. This medication does not produce any adverse reaction when used along with anticoagulation. Lubiprostone is a selective chloride channel activator that increases the intestinal fluid secretions and motility. This medication does not interact with anticoagulants, and is therefore, not contraindicated in a patient using anticoagulants. Methylcellulose is a bulk forming laxative used in the treatment of constipation. This medication does not pose any risk when used along with anticoagulants. This medication is not contraindicated for a patient using anticoagulants. Text Reference - p. 967

Which assessment data noted by the nurse indicate that bisacodyl has not been effective?

Constipation; Docusate sodium is a stool softener, and the best outcome is passage of a soft, formed stool; it will not affect chest pain or vital signs. Text Reference - p. 967

Which complication does the nurse expect in a patient with gastroesophageal reflux disease (GERD) who has been taking dexlansoprazole for one year?

Dexlansoprazole is a proton pump inhibitor (PPI). PPIs inhibit the proton pump responsible for the secretion of hydrochloric acid, which is an important mediator of calcium absorption. Long-term use of this medication will increase the risk of a bone fracture. Syncope is the temporary loss of consciousness leading to fainting. It occurs as a side effect of cholinergic drugs. Dyskinesia is a side effect of prokinetic medications. Renal calculi are a side effect of antacids. Text Reference - p. 934

Which diagnostic study is used to stage esophageal cancer?

EUS is used to stage esophageal cancer. Radionuclide tests help detect reflux of gastric contents. Manometric studies help measure pressure in the esophagus, lower esophageal sphincter, and esophageal motility function. Esophagram (barium swallow) shows the narrowing of the esophagus at the tumor site. Text Reference - p. 937

The nurse reviews the laboratory reports of patients with a history of renal insufficiency who experience constipation. Which patient's condition is due to the administration of a Fleet enema as per the nurse's suspicion?

Enemas are beneficial to constipated patients, because they are fast-acting and provide immediate treatment. A Fleet enema is a sodium phosphate enema used in the treatment of constipation. If this medication is used in a patient with renal insufficiency, it can lead to an electrolyte imbalance. The laboratory report for patient C shows increased sodium and potassium levels, and a decreased magnesium level, which indicates that patient C was likely to have received a Fleet enema. Patient A's laboratory report is within normal limits. Magnesium salts, when given to a patient with renal insufficiency, cause hypermagnesemia. Patient B's laboratory report shows an increased magnesium level, indicating that the patient was likely to have received magnesium salts. Patient D's laboratory report is within normal limits. Test-Taking Tip: Fleet enemas are sodium phosphate enemas used in the treatment of constipation that cause electrolyte imbalances when used in a patient with renal insufficiency. Recollecting the normal laboratory values of electrolytes will help you answer this question. Text Reference - p. 967

A patient experiences bloody diarrhea. Which organism is likely to be the cause of this condition?

Escherichia coli are common bacteria, which may cause infection and result in bloody diarrhea. Rotavirus is a virus that causes watery diarrhea. Cryptosporidium is a parasitic organism that causes watery diarrhea. This organism is not suspected when a patient has bloody diarrhea. Clostridium difficile is a bacterial organism that causes watery diarrhea. Text Reference - p. 962

Which condition is indicated by endoscopic findings of saclike pouches on the esophagus?

Esophageal diverticula are saclike outpouchings formed on one or more layers of the esophagus. Esophageal varices are dilated and tortuous veins observed in the lower portion of the esophagus due to portal hypertension. Narrowing of the esophagus is called esophageal stricture. Eosinophilic esophagitis is characterized by swelling of the esophagus. Text Reference - p. 939

A patient who is reestablishing bowel regularity reports fecal incontinence. Which medication may be beneficial to the patient, as per the nurse's understanding?

Fecal incontinence is the involuntary passage of stools that occurs when the structures that maintain continence are disrupted. Administering a bisacodyl glycerin suppository will stimulate the anorectal reflex and help in defecation. Administering senna stimulants will increase the peristalsis by irritating the colon wall and stimulate the enteric nerves; therefore, it is used in the treatment of constipation. Administering bismuth subsalicylate is used in treating diarrhea. This medication is especially helpful for patients that have traveler's diarrhea. Methylcellulose laxative is used in the treatment of constipation. Text Reference - p. 966

The nurse is providing care to a female patient who presents with the primary complaint of fecal incontinence. What information collected during the admission assessment would indicate the possible cause of this condition?

For women, obstetric trauma is the most common cause of sphincter disruption. Childbirth, aging, and menopause contribute to the development of fecal incontinence. Prolonged periods of sitting and exercise are not associated with the development of fecal incontinence. Text Reference - p. 965

Which condition does the nurse expect in a patient with gastroesophageal reflux disease (GERD) who has esophagitis and stenosis?

GERD associated with esophagitis and stenosis leads to a hiatal hernia. A hiatal hernia is a herniation of a portion of the stomach into the esophagus through a hiatus in the diaphragm. Achalasia is the absence of peristalsis in the lower two-thirds of the esophagus, characterized by nocturnal regurgitation, dysphagia, and foul-smelling breath. Esophageal stricture is the narrowing of the esophagus, which involves dysphagia, regurgitation, and weight loss. Eosinophilic esophagitis is the inflammation of the esophagus due to an infiltration of eosinophils. Text Reference - p. 936

The nurse explains to the patient with gastroesophageal reflux disease (GERD) that this is a disorder that can be aggravated by which of the following? Select all that apply.

GERD results when the defenses of the esophagus are overwhelmed by the reflux of acidic gastric contents into the lower esophagus. An incompetent lower esophageal sphincter (LES) is a common cause of gastric reflux. Decreased LES pressure can be caused by certain foods (e.g., caffeine, chocolate, orange juice, and peppermint) and drugs (e.g., anticholinergics). Cigarette and cigar smoking also can contribute to GERD. GERD is not exacerbated by intake of dietary fiber or a high protein diet. Text Reference - p. 933

A patient reports abdominal cramping, watery stools, and periumbilical pain. Which microorganism does the nurse suspect to be responsible for the patient's condition?

Giardia lamblia and Norovirus are the microorganisms that usually infect the upper gastrointestinal tract, causing abdominal cramping, watery stools, and periumbilical pain. Shigella, Salmonella, and Clostridium difficile are microorganisms that affect the colon and distal small bowel, causing fever and bloody diarrhea. Text Reference - p. 963

A patient with chronic constipation is diagnosed with hemorrhoids. Which other complications does the nurse expect? Select all that apply.

Hemorrhoids, also called piles, are inflamed and swollen veins around the anus and lower rectum that occur in chronic constipation. Diverticulosis, in which saclike pouches are present in the colon, results from chronic constipation. Tenesmus is a feeling of incomplete evacuation, which is observed in fecal incontinence. Obstipation, which is a severe form of constipation, leads to colonic perforation, which is characterized by abdominal pain, nausea, vomiting, and elevated leukocyte count. Rectal mucosal ulcers result from straining in chronic constipation. Cathartic colon syndrome occurs due to chronic use of laxatives. Text Reference - p. 856

The nurse is connecting a nasogastric tube (NG) to suction for a patient who underwent abdominal surgery. Which therapy should be maintained in this condition?

Intravenous (IV) therapy includes adding potassium and vitamin supplements to the infusion until oral feedings are resumed. Adjuvant therapy includes surgical resection and chemotherapy for stomach cancer. Triple-drug therapy that includes proton pump inhibitor, amoxicillin, and clarithromycin is prescribed for Helicobacter pylori infection. Cobalamin replacement therapy is prescribed for pernicious anemia. Text Reference - p. 951

Which treatment strategy does the nurse expect to be beneficial for an elderly patient with a hiatal hernia who has a cardiovascular complication?

Laparoscopic surgery is minimally invasive and when performed in elderly patients reduces the risk of complications and time for recovery and is beneficial. Antireflux surgery is a surgical intervention and is not recommended in elderly patients with cardiovascular and pulmonary complications. Calcium channel blocker therapy decreases lower esophageal pressure in elderly patients. Nonsteroidal antiinflammatory drugs (NSAIDs) may irritate the esophageal mucosa, which may aggravate the symptoms more. Text Reference - p. 937

The nurse would question the use of which cathartic agent in a patient with renal insufficiency?

Magnesium hydroxide may cause hypermagnesemia in patients with renal insufficiency. The nurse should question this prescription with the health care provider. Bisacodyl, lubriprostone, and cascara sagrada are safe to use in patients with renal insufficiency as long as the patient is not dehydrated currently. Text Reference - p. 967

Which medication for peptic ulcer disease causes hallucinations?

Metoclopramide is a prokinetic agent that causes central nervous system side effects such as hallucinations and anxiety. Nizatidine is a histamine (H2)-receptor blocker that causes abdominal pain, headache, diarrhea, and constipation. Sucralfate is an antiulcer medication that causes constipation. Omeprazole is a proton pump inhibitor that causes nausea, abdominal pain, headache, diarrhea, and flatulence. Text Reference - p. 934

Which medication used to treat nausea and vomiting may cause dyskinesia?

Metoclopramide is a prokinetic medication that causes extrapyramidal side effects such as tremor and dyskinesia. Nizatidine is a histamine (H2)-receptor blocker that causes abdominal pain, diarrhea, constipation, and headache as side effects. Sucralfate is an antiulcer medication that causes constipation. Omeprazole is a proton pump inhibitor that causes headache, nausea, vomiting, abdominal pain, and flatulence. Text Reference - p. 934

Which antidiarrheal medication suppresses serotonin secretion?

Octreotide acetate is a long-acting octapeptide analog of somatostatin that binds to somatostatin receptors, inhibiting serotonin secretion to control diarrhea. Paregoric is an opioid that decreases peristalsis and intestinal motility. Bismuth subsalicylate helps decrease secretions. Calcium polycarbophil is a bulk-forming agent that absorbs excess fluid from diarrhea to form a gel. Text Reference - p. 963

The nurse is teaching care management to a patient with gastroesophageal reflux disease (GERD). In the follow-up visit, the patient complains of severe heartburn. Which actions indicate the need for further teaching? Select all that apply.

Oranges are a source of citric acid. Eating acidic foods aggravates the symptoms of gastroesophageal reflux disease (GERD). Ice cream is rich in fatty acids. Fats tend to decrease lower esophageal sphincter (LES) pressure, resulting in regurgitation of stomach acid. Drinking a cup of milk at bedtime increases gastric acid secretion. Therefore, the nurse recommends that the patient avoid oranges, ice cream, and milk. Drinking 2 L of water neutralizes the pH of stomach acid and reduces the symptoms of GERD. Chewing gum increases the production of saliva, thereby helping neutralize the pH of gastric acid. Ginger is known for its antiinflammatory and antacid activities. Text Reference - p. 933

The nurse is caring for a patient diagnosed with gastric outlet obstruction. Which assessment findings support the diagnosis? Select all that apply.

Overtime dilation of the stomach and visible swelling in the upper abdomen occur as a result of gastric outlet obstruction due to edema, inflammation, and fibrous scar tissue formation. A rigid board-like abdomen is indicative of perforated ulcer. Audible abdominal sounds are clinical manifestations of dumping syndrome. Continuous epigastric distress occurs after meals in patients with bile reflex gastritis. Text Reference - p. 948

A patient reports pain in the upper abdomen after eating. Upon reviewing the medical reports, the nurse finds that the patient underwent pylorus surgery. Which medication does the nurse expect the primary health care provider to prescribe?

Pain in the upper abdomen after eating is known as epigastric distress. It occurs due to reflux of bile into the stomach in patients who underwent gastric surgery involving the reconstruction or removal of the pylorus. Cholestyramine is a bile acid sequestrant that binds bile in the gastrointestinal tract to prevent its reabsorption. Fluticasone is a corticosteroid used to treat eosinophilic esophagitis. Misoprostol is used to treat gastric ulcers caused by NSAIDs and aspirin. Isosorbide dinitrate is used to treat dysphagia. Text Reference - p. 950

A patient has had esophageal surgery, and a jejunostomy feeding tube is inserted to administer oral fluids. The nurse has been told to check for signs of intolerance and leakage of feeding into the mediastinum. Which signs should the nurse be observant for? Select all that apply.

Pain, dyspnea, increased temperature; With tube feedings, the patient should be observed for signs of intolerance of feeding or leakage of the feeding into the mediastinum. Symptoms that indicate leakage are pain, dyspnea, and increased temperature. Feeding is done through the tube in an upright position; therefore, the chance of acid reflux is unlikely. Tachycardia doesn't occur immediately as a sign of leakage into the mediastinum. Text Reference - p. 938

The nurse is preparing to give a dose of bisacodyl to a patient on the surgical unit. In explaining the medication to the patient, the nurse would state that it acts by:

Producing a bowel movement; Bisacodyl is a stimulant laxative that aids in producing a bowel movement. It is available in oral and suppository forms. Bisacodyl has no effect on appetite, reducing the risk of blood clots, or reduction of pain. Text Reference - p. 967

The nurse is assessing a patient who has suspected esophageal cancer. Which of these is the most common symptom of esophageal cancer?

Progressive dysphagia is the most common symptom of esophageal cancer and may be described as a substernal feeling, as if food were not passing. Initially, the dysphagia occurs only with meat, then with soft foods, and eventually with liquids. Weight loss, regurgitation, and epigastric pain during swallowing are also symptoms of esophageal cancer, but occur later and are not the most common symptom. Text Reference - p. 937

The nurse finds that a patient taking a prescribed medication for gastroesophageal reflux disease (GERD) had a miscarriage. Which medication does the nurse expect to be responsible for the miscarriage?

Prostaglandins are a class of medications that cause uterine rupture in pregnancy. Uterine rupture in pregnancy leads to miscarriage. Therefore, the nurse suspects prostaglandins to be the cause of miscarriage. Cholinergics cause syncope, diarrhea, stomach cramps, and dizziness. Antiulcer agents such as sucralfate cause constipation. Headache, abdominal pain, constipation, and diarrhea are the side effects of histamine (H2)-receptor blockers. Text Reference - p. 934

Which medication is responsible for causing flatulence in a patient on medication therapy for gastroesophageal reflux disease (GERD)?

Proton pump inhibitors such as dexlansoprazole are used to treat GERD and are associated with flatulence as a side effect. Sucralfate is an antiulcer agent that is associated with constipation. Famotidine is a histamine (H2)-receptor blocker that causes headaches, constipation, abdominal pain, and diarrhea as side effects. Abdominal pain, diarrhea, uterine rupture in pregnancy, and gastrointestinal bleedings are side effects associated with misoprostol. Text Reference - p. 934

Which medication is beneficial to a patient reporting coughing, dyspnea, and radiating pain to the back, neck, and jaw?

Respiratory symptoms such as coughing and dyspnea accompanied with radiating pain to the back, neck, and jaw indicate gastroesophageal reflux disease (GERD). GERD-related chest pain is similar to angina. Antacids such as aluminum hydroxide are used in the treatment of GERD-related chest pain. Nifedipine and isosorbide dinitrate are used in the treatment of achalasia. Prednisone is used in the treatment of eosinophilic esophagitis. Text Reference - p. 934

A 71-year-old patient with metastatic liver cancer is experiencing constipation. The nurse would plan to administer which medication?

Senna is a laxative that can be used to help treat constipation. Morphine would worsen constipation. Metoclopramide and ondansetron would be used for nausea/vomiting, and will not impact constipation. Text Reference - p. 967

Which findings in a patient's laboratory report support the nurse's conclusion that he or she has secretory diarrhea? Select all that apply.

Serum levels of gastrointestinal hormones such as gastrin and vasoactive intestinal polypeptide are elevated in patients with secretory diarrhea. Increased hematocrit, creatinine, and blood urea nitrogen levels are signs of fluid deficit in patients with long-standing diarrhea. Text Reference - p. 963

The nurse receives a prescription from the health care provider to administer a sodium phosphate enema for constipation. What nursing action should the nurse perform first?

Sodium phosphate enemas may cause an electrolyte imbalance in patients with renal and cardiac disease; therefore, the nurse should review the patient's past medical history. The enema should be administered after knowing the patient's renal status. Water intoxication is not a side effect of a sodium phosphate enema. Checking the vital signs should be done after administering the enema. Text Reference - p. 967

The nurse is caring for a patient with a long-term complication that exists post-operation of peptic ulcer disease. On a follow-up visit, the primary health care provider identifies spillage of gastric contents into the space between the abdominal cavity and the abdominal wall. Which complication may occur if the condition is untreated?

Spillage of gastric contents into the peritoneal cavity occurs in perforation post-operation of peptic ulcer disease. If the condition is untreated, bacterial infection can occur in the abdominal cavity and result in bacterial peritonitis. Pernicious anemia is a long-term complication of partial or total gastrectomy that occurs due to loss of intrinsic factor. Bile reflux gastritis is a complication of abdominal surgery of pylorus, and is characterized by epigastric distress. Postprandial hypoglycemia obstruction occurs as a complication after peptic ulcer disease surgery. Text Reference - p. 950

Which medication for treating constipation when taken with warfarin will cause an increased risk for bleeding?

Stool softeners such as docusate block the absorption of fat-soluble vitamins, such as vitamin K, which increases the risk of bleeding in patients who are on anticoagulants. Psyllium is a bulk-forming agent and does not increase the risk of bleeding. Linaclotide is an intestinal secretagogue and is used in the treatment of idiopathic constipation. Lubiprostone is a selective chloride channel activator used in the treatment of idiopathic constipation and irritable bowel syndrome that does not increase the risk of bleeding. Text Reference - p. 967

A patient who underwent surgical therapy for peptic ulcer disease complains of sweating, weakness, mental confusion, and increased heart rate two hours after eating. Which complication does the nurse anticipate?

Sweating, weakness, mental confusion, and increased heart rate are clinical manifestations of postprandial hypoglycemia that occur as a complication of peptic ulcer surgery. Achalasia is a primary motility disorder characterized by the absence of peristalsis and impaired relaxation of the lower esophageal sphincter (LES) in response to swallowing. Bile reflux gastritis is a complication of abdominal surgery of the pylorus and is characterized by epigastric distress. In dumping syndrome, the patient has sweating, palpitations, and dizziness. Text Reference - p. 950

A nurse assesses a patient with suspected peptic ulcer disease. Which symptom will the patient most likely report?

Symptoms of peptic ulcer disease (PUD) are variable and often absent. However, discomfort, if present, may occur before meals or two to three hours after meals and at bedtime. The discomfort may be relieved by eating because the food will dilute and buffer gastric acid. Although vomiting or abdominal distention after meals may occur, they are less likely to be associated with PUD than is the relief caused by eating. Text Reference - p. 942

The nurse is teaching an older patient about treatment and management of peptic ulcer disease. Which statement made by the patient indicates the need for further teaching?

The patient should report abdominal pain or discomfort to the primary health care provider, not to the nurse. For the treatment and management of peptic ulcer disease the nurse should instruct the patient to avoid irritating substances that cause peptic ulcer; take nonsteroidal antiinflammatory drugs (NSAIDs) and other gastric irritating substances along with food, milk, or antacids; and adhere to the proton pump inhibitor (PPI) and histamine-receptor blocker therapy as prescribed. Text Reference - p. 951

A female patient with irritable bowel syndrome has been advised to take alosetron hydrochloric (HCL). The nurse understands that the medication may cause severe, adverse side effects, that might require the medication to be discontinued. For what side effects should the nurse advise the patient to be observant and of which to notify the health care provider? Select all that apply

The patient should watch for symptoms like bloody stools, abdominal pain, and severe constipation and notify the health care provider if any of these adverse side effects occur. Alosetron may cause serious side effects like severe constipation and ischemic colitis. Ischemic colitis is caused by reduced blood flow to the intestines and is manifested as abdominal pain and blood in stools. If a patient experiences the side effects, the drug should be immediately stopped. Bloating and excessive flatulence are symptoms of irritable bowel syndrome and not specific to alosetron administration. Text Reference - p. 972

How does psyllium (Metamucil) in the diet benefit the patient with fecal incontinence?

The psyllium in Metamucil is a bulk-forming laxative and fiber supplement. Psyllium firms stool consistency due to absorption of water and gas in the small intestine and softens the colon, providing more size to the digested food. Loperamide helps slow intestinal transit time. Biofeedback therapy helps improve awareness of rectal sensation and increase the strength of external sphincter contraction. Text Reference - p. 965

A patient states, "I always get diarrhea when I am traveling." Which medication does the nurse expect will be beneficial to the patient?

Traveler's diarrhea is common when traveling to areas with poor sanitation. Bismuth subsalicylate is an anti-diarrheal drug that decreases the secretions, has weak antibacterial activity, and is beneficial for traveler's diarrhea. Dextranomer is used in the treatment of fecal incontinence. Metronidazole is beneficial for a patient who has diarrhea because of antibiotics. Methylcellulose is a bulk-forming laxative and is beneficial for a patient with constipation. This medication does not help relieve traveler's diarrhea. Text Reference - p. 963

While caring for a postoperative patient with a nasogastric tube, the nurse suspects that the tube is repositioned. What is the priority nursing intervention to prevent complications in the patient?

When the nurse suspects repositioning of the nasogastric tube, the primary health care provider should be called as soon as possible, because there is a danger of either perforation of the gastric mucosa or a disruption of the suture line. The nurse should not insert a new tube without the order of the primary health care provider. Irrigating the tube with normal saline solution is helpful in preventing tube clogging. Monitoring for the symptoms of edema and inflammation will put the safety of the patient at risk. Text Reference - p. 950

While providing fluids to a postgastrectomy patient, which symptoms support the nurse's suspicion that there is leakage from a jejunostomy feeding tube? Select all that apply.

When there is a leakage from the feeding tube, the patient experiences pain, high temperature, and dyspnea (difficulty breathing). Therefore, these symptoms support the nurse's suspicion. Cough and regurgitation are manifestations of esophageal cancer. Text Reference - p. 938

While caring for a patient with esophageal cancer, the nurse finds regurgitation of blood-flecked esophageal contents. What does the nurse expect to be the reason behind the patient's condition?

When there is severe narrowing of the esophagus, or stenosis, regurgitation of blood-flecked esophageal contents occurs. A tumor in the upper third of the esophagus causes sore throat, choking, and hoarseness. Achalasia occurs due to obstruction of the esophagus at the diaphragm. Cancer eroding through the esophagus and into the aorta leads to hemorrhage. Text Reference - p. 937

The nurse is completing a health history on a patient diagnosed with peptic ulcer disease. Which questions are appropriate while assessing the patient's cognitive-perceptual pattern? Select all that apply.

While assessing the effect of peptic ulcer disease on a patient's cognitive-perceptual pattern, the appropriate questions to ask are whether the patient has experienced any nocturnal pain and high epigastric pain one to two hours after eating. Asking the patient about hematemesis will determine the nutritional-metabolic pattern in the patient. Asking the patient about black, tarry stools will help in assessing the elimination pattern in the patient. Asking the patient if there is a family history of peptic ulcer disease will help assess the patient's health history. Text Reference - p. 948

The primary health care provider orders endoscopic nutrition via a nasogastric tube for a postsurgical patient whose nutrition is disrupted. Which interventions should the nurse perform for this patient? Select all that apply.

While providing care for a postsurgical patient with a nasogastric tube, the nurse should provide oral and nasal care to the patient. The nursing responsibilities also include assessing the drainage from the nasogastric tube. Irrigating and repositioning the tube should be performed only after consulting the primary health care provider. Text Reference - p. 939

Which teaching should the nurse include in the discharge instructions for a postgastrectomy patient?

"You should report it to the primary health provider if regurgitation occurs."; Regurgitation should resolve after the surgery. If regurgitation persist after the surgery, the patient should report it the primary health care provider. Solid foods should be gradually given to the patient to resume a normal diet. Heartburn should be resolved after the surgery. Dysphagia may be reported one month after the surgery. Text Reference - p. 935

A patient who underwent abdominal surgery complains of sweating, weakness, palpitations, and dizziness 20 minutes after a meal. Upon auscultation, the nurse finds the patient to have borborygmi. The laboratory test reports reveal decrease in the plasma volume. Which complication does the nurse suspect in the patient?

A patient experiencing sweating, weakness, palpitations, and dizziness 20 minutes after eating is suffering from dumping syndrome. The dizziness soon after eating is cause by a sudden decrease in the plasma volume which is confirmed by the laboratory test. Audible abdominal sounds produced by hyperactive intestinal peristalsis are called borborygmi, which are observed in the patient. Achalasia is the absence of lower esophageal peristalsis characterized by dysphagia. Bile reflux gastritis is a complication of abdominal surgery and is characterized by epigastric distress. Postprandial hypoglycemia shares symptoms with dumping syndrome; however, the symptoms of postprandial hypoglycemia occur two hours after eating. Text Reference - p. 949

The nurse is caring for a patient diagnosed with suspected posterior duodenal ulcer penetration of the pancreas. Which diagnostic test does the nurse anticipate to be most beneficial to the patient?

A serum amylase determination test is performed to determine the pancreatic function when posterior duodenal ulcer penetration of the pancreas is suspected. Rapid urease testing is done to identify the presence of Helicobacter pylori infection. Liver enzyme studies are done to detect liver problems that may complicate ulcer treatment. A CBC test is a blood count test used to detect anemia secondary to ulcer bleeding. Text Reference - p. 945

When a patient reports diarrhea, abdominal cramps, and nausea, the nurse suspects an infection from Giardia lamblia. Which statement of the patient supports the nurse's suspicion?

"I have started going to a swimming pool recently."; Giardia lamblia is a parasitic organism that is mostly found in contaminated lakes and pools. If a patient has been to a contaminated lake or pool and ingested the water, he or she could be infected by the Giardia lamblia organism and will experience diarrhea, abdominal cramps, and nausea. Clostridium difficile infection is suspected in a patient who is on clindamycin (Cleocin) therapy, because this organism is an antibiotic-associated diarrhea. Giardia lamblia infection is not suspected if the patient has low-fat foods in the diet. A patient who has diarrhea after eating chicken most likely has the Salmonella organism, because it is seen in uncooked eggs and chicken. Text Reference - p. 962

A patient presents to the outpatient clinic with concerns over persistent signs and symptoms of heartburn (pyrosis). What is the most appropriate response for the nurse?

"I know it is uncomfortable for you. Have you been taking your medication as prescribed and making the necessary dietary adjustments?"; It is important to ascertain the patient's adherence to prescribed medication and dietary parameters first. Instructing the patient to allow time for the medication to take affect is not addressing the dietary aspect of care. Although a sore throat and nocturnal episodes of coughing and choking are symptoms associated with pyrosis, they are not the initial questions the nurse should ask about. Test-Taking Tip: Look for answers that focus on the client or are directed toward feelings. Text Reference - p. 945

The nurse provides education to a patient about the management of constipation. Which statement made by the patient indicates the need for further teaching?

"I should have laxatives readily available and use them whenever I have difficulty passing stools."; Constipation is infrequent bowel movements coupled with absent or hard, dry stools. Laxatives are used to reduce constipation or whenever patients experience problems passing stools, but patients can become dependent on laxatives. Depending on laxatives will make the patient unable to have bowel movements without using them. Therefore, the nurse will instruct the patient not to use laxatives whenever he or she experiences difficulty passing stools. Drinking fruit juices and three quarts of water a day can soften hard stools and reduce constipation. Beans, metamucil, and citrucel are rich in fiber, so the nurse will instruct the patient to add fiber-rich foods to the diet, to help soften hard stools and promote evacuation. The nurse will instruct the patient to respond immediately to the urge to have a bowel movement, because delaying defecation will decrease the urge to go and can cause hard stools. Text Reference - p. 969

The nurse is teaching about home care to a patient with gastrointestinal reflux disease (GERD). Which statement made by the patient indicates the need for further teaching?

"I should lie down two to three hours after eating."; After eating, the patient should wait for three hours to lie down. This will help maintain gravity, which in turn prevents the development of acid reflux. The patient should not bend over after eating. The patient should not eat food within three hours of bedtime. The head of the bed should be elevated during sleep. Test-Taking Tip: The teaching should alter the perception of the patient toward positive insight about health promotion. Text Reference - p. 933

Which medication is prescribed for the prevention of peptic ulcer caused by nonsteroidal antiinflammatory drugs (NSAIDs) and aspirin?

Because of its protective and antisecretory effects on gastric mucosa, misoprostol (a synthetic prostaglandin analogue) is prescribed to prevent peptic ulcers caused by NSAIDS and aspirin. Famotidine is a histamine-receptor blocker used to heal ulcers. Imipramine is a tricyclic antidepressant prescribed for patients with peptic ulcer disease. Clarithromycin is a medication included in triple-drug therapy for treating Helicobacter pylori (H. pylori) infection. Text Reference - p. 946

Which medication increases lower esophageal sphincter pressure?

Bethanechol increases the pressure in the lower esophagus. Diazepam, theophylline, and morphine sulfate are medications that decrease lower esophageal pressure. Text Reference - p. 934

While assessing a patient with constipation, the nurse finds that the patient is a chronic user of bisacodyl. Which complication does the nurse expect?

Bisacodyl is a laxative and is used to treat constipation. Cathartic colon syndrome occurs because of laxative abuse; the nerves of the colon are damaged, causing dilation of the colon, making it atonic. Obstipation is a severe form of constipation in which no gas or stool is expelled; it does not occur due to chronic use of bisacodyl. Toxic megacolon is colonic dilation greater than 5 cm. It is seen in patients with irritable bowel syndrome who are on antidiarrheal therapy. Idiopathic constipation is the presence of chronic constipation symptoms, which does not occur due to use of bisacodyl. Text Reference - p. 966

A patient with gastroesophageal reflux disease (GERD) is on cimetidine therapy. Which parameter does the nurse monitor to provide effective care?

Bowel sounds; Cimetidine is a histamine-receptor used in the treatment of peptic ulcer and GERD. Cimetidine decreases gastric motility and causes constipation. Therefore, the nurse monitors the patient for any changes in bowel sounds. This may help with early detection of constipation. Cimetidine does not have extrapyramidal side effects and does not cause motor incoordination. Cimetidine does not alter serum calcium or magnesium levels. Text Reference - p. 934

The nurse is caring for a patient with a hiatal hernia. Which instructions should the nurse include teaching? Select all that apply.

Caffeine and chocolate are reflux-inducing foods that irritate the esophagus or weaken the lower esophageal sphincter causing backward flow of stomach contents. Therefore, caffeine and chocolate should be avoided in patients with a hiatal hernia. Soda is acidic and should be avoided in patients with a hiatal hernia. Peppermint is a reflux-inducing food and should be avoided. Acidic pH beverages such as orange juice should also be avoided by patients with a hiatal hernia. Text Reference - p. 936

he nurse is caring for a patient with a hiatal hernia. Which instructions should the nurse include teaching? Select all that apply.

Caffeine and chocolate are reflux-inducing foods that irritate the esophagus or weaken the lower esophageal sphincter causing backward flow of stomach contents. Therefore, caffeine and chocolate should be avoided in patients with a hiatal hernia. Soda is acidic and should be avoided in patients with a hiatal hernia. Peppermint is a reflux-inducing food and should be avoided. Acidic pH beverages such as orange juice should also be avoided by patients with a hiatal hernia. Text Reference - p. 936

Which medication has a side effect of milk-alkali syndrome?

Calcium carbonate is an antacid used to treat gastroesophageal reflux disease (GERD). Ingestion of calcium carbonate may result in milk-alkali syndrome. Misoprostol causes abdominal pain, diarrhea, and gastrointestinal bleeding. Central nervous system side effects such as anxiety, hallucinations, and tremors are caused by metoclopramide. Aluminum hydroxide causes constipation. Text Reference - p. 934

Which medications decrease lower esophageal sphincter pressure in elderly patients with a hiatal hernia and gastroesophageal reflux disease (GERD)? Select all that apply.

Calcium channel blockers (nifedipine), antidepressants (imipramine), and nitrates (isosorbide dinitrate) are the medications commonly prescribed for elderly patients with a hiatal hernia and GERD. These medications result in decreased lower esophageal sphincter pressure. Nonsteroidal antiinflammatory drugs (aspirin) and potassium irritate the esophageal mucosa. Text Reference - p. 937

The nurse is caring for a patient who is experiencing continuous epigastric distress and vomiting after undergoing a peptic ulcer surgery. Which medication does the nurse expect to be beneficial for the patient?

Cholestyramine; Continuous epigastric distress and vomiting are symptoms associated with bile reflux gastritis, a disease that occurs as a complication of peptic ulcer disease surgery. Cholestyramine is administered before or with meals to treat reflux gastritis by binding with bile salts to prevent their reabsorption, which is the source of gastric irritation. Omeprazole is a proton pump inhibitor that reduces gastric acid secretion. Metronidazole is included in quadruple-drug therapy to treat Helicobacter pylori infection. Aluminum hydroxide gel is an antacid that is used as adjunct therapy for peptic ulcer disease. Text Reference - p. 950

The nurse would administer magnesium hydroxide medication if the patient reported which symptom?

Constipation; Milk of magnesia is an osmotic type of laxative that should produce a semifluid stool within 6 to 12 hours of administration. It is indicated for the treatment of constipation. This medication would not be effective in the treatment of indigestion or nausea and would worsen diarrhea. Text Reference - p. 967

Which intervention should the nurse perform when finding that a postgastrectomy patient has greenish yellow discharge eight hours after insertion of a nasogastric tube?

Discharge of bloody, greenish to yellow drainage from the nasogastric tube for 8 to 12 hours after insertion is a common observation. Therefore, the nurse should document it as a normal finding. The nurse should not remove the nasogastric tube without consulting the primary health care provider. Notifying the primary health care provider is not necessary, because discharge of bloody drainage is a normal finding. Placing the patient in a semi-Fowler's position will help prevent the risk of aspiration; however, it will not reduce the drainage from the nasogastric tube. Text Reference - p. 939

What should the nurse instruct the patient to do to best enhance the effectiveness of a daily dose of docusate sodium?

Docusate lowers the surface tension of stool, permitting water and fats to penetrate and soften the stool for easier passage. The patient should take the dose with a full glass of water and should increase overall fluid intake, if able, to enhance effectiveness of the medication. Mineral oil and extra salt are not recommended. Dietary fiber intake should be a minimum of 20 g daily to prevent constipation. Text Reference - p. 967

The patient asks the nurse how bisacodyl exerts its effects. Which reply by the nurse is most appropriate?

Dulcolax has a stimulant effect on the colon, increasing peristalsis, leading to soft but formed stools within 12 hours. Water content of the stool is not affected and there is no oil in the medication to lubricate the stool. Text Reference - p. 967

The nurse is caring for a patient who presents with burning pain in the midepigastric region five hours after eating. The patient's medical history reveals pancreatic disease. Which condition does the nurse suspect?

Duodenal ulcers are characterized by burning pain in the midepigastric region that occurs two to five hours after eating. Gastric ulcers are characterized by burning or gaseous pressure in the high left epigastrium and upper abdomen. Symptoms of acute gastritis include anorexia, nausea, vomiting, and feeling of fullness. Signs of stomach cancer include anemia, indigestion, weight loss, abdominal pain, and satiety. Text Reference - p. 944

Which dietary instructions should the nurse provide the caregiver of a postoperative patient with dumping syndrome? Select all that apply.

Eggs and meat contain proteins and fat, which help to rebuild body tissues and meet energy demands. Distention and fullness of the stomach can occur if fluids are consumed along with meals. Jelly and jam cause diarrhea and dizziness; these foods should be avoided. Cheese contains proteins and fats and should be provided to the patient. The meals of the patient should be divided into six small feedings to avoid overloading the stomach and intestine during meal times. Text Reference - p. 950

Which procedure involves the disruption of the lower esophageal sphincter using balloons?

Endoscopic pneumatic dilation is the procedure in which the lower esophageal sphincter is disrupted using balloons of increasing diameter. A Heller myotomy is a surgical procedure in which the lower esophageal sphincter is disrupted laparoscopically. Esophagectomy is the removal of part or the entire esophagus. Esophagoenterostomy is the resection of a portion of the esophagus and anastomosis of a segment of the colon to the remaining portion. Text Reference - p. 940

Why does a primary health care provider place stents endoscopically while preparing a patient with esophageal cancer for surgery?

Endoscopic stents are placed to improve nutrition and hydration. Placing the patient in an upright position will help prevent regurgitation and improve gastric emptying. Using an incentive spirometer will help prevent respiratory complications. Text Reference - p. 938

Which surgical therapy is used to treat pyloric obstruction?

Endoscopy; An endoscopy with balloon dilations is used in the treatment of pyloric obstruction. A vagotomy is the severing of the vagus nerve either totally or selectively to decrease gastric acid secretion. A gastrojejunostomy involves a partial gastrectomy with removal of two-thirds of the stomach and an anastomosis of the gastric stump to the jejunum. Gastroduodenostomy is a partial gastrectomy with removal of two-thirds of the stomach and an anastomosis of the gastric stump to the duodenum. Text Reference - p. 947

Which is the first indication of gastroesophageal reflux disease and a hiatal hernia in elderly patients?

Esophageal bleeding is the first indication of gastroesophageal reflux disease and a hiatal hernia in elderly patients. Halitosis is an indication of achalasia. Pernicious anemia and epigastric tenderness are indications of gastritis. Text Reference - p. 937

Which esophageal disorder does the nurse expect in a patient who has ingested a strong acid and is admitted to the emergency unit?

Esophageal stricture is the narrowing or tightening of the esophagus. It can occur due to ingestion of strong acids or alkalis, surgical anastomosis, and external beam radiation. Achalasia is a chronic disorder in which there is an absence of peristalsis of the lower two-thirds of the esophagus. Esophageal varices are dilated, tortuous veins in the lower part of the esophagus. EE is inflammation of the esophagus due to infiltration of eosinophils. Text Reference - p. 940

The nurse is giving discharge instructions to a patient who has been treated for severe constipation. Which statement(s) would the nurse include in the instruction of the patient? Select all that apply.

Establishing a regular time to defecate is an important part of bowel training. Defecation is easier when the knees are higher than the hips. A high-fiber diet, increased fluid intake, and regular exercise help prevent constipation. Encourage patients to exercise abdominal muscles and to contract abdominal muscles several times a day to increase abdominal muscle tone. This assists with elimination. A clear liquid diet is not helpful to avoid constipation. Text Reference - p. 967

Which factors increase intraabdominal pressure and lead to the development of a hiatal hernia? Select all that apply.

Factors increasing intraabdominal pressure include ascites, obesity, and pregnancy. They may lead to the development of a hiatal hernia. Fatty foods and peppermint are factors that decrease lower esophageal sphincter pressure. Text Reference - p. 936

Which medication used in gastroesophageal reflux disease decreases the conversion of pepsinogen to pepsin?

Famotidine is a histamine (H2)-receptor blocker that reduces the conversion of pepsinogen into pepsin. Misoprostol is a prostaglandin that increases the production of gastric mucosa. Rabeprazole is a proton pump inhibitor that results in a decrease of hydrochloric acid secretion. Metoclopramide increases gastric motility and emptying. Text Reference - p. 934

A patient with diarrhea due to Clostridium difficile infection who is on metronidazole therapy reports a relapse of diarrhea. Which treatment strategy does the nurse expect from the primary health care provider?

Fidaxomicin; Metronidazole and vancomycin are equally effective medications used in the treatment of diarrhea caused by Clostridium difficile. However, when the patient experiences a relapse, fidaxomicin is used; it is also prescribed for patients who are at risk for relapse or who have recurrent infections. Vancomycin, loperamide, and bismuth subsalicylate therapy are used in the treatment of diarrhea, but not for relapse of diarrhea. Text Reference - p. 963

Which complications does the nurse expect due to progression of Clostridium difficile infection in a patient?

Fulminant Colitis, intestinal perforation; Clostridium difficile is a bacterium that causes diarrhea. It colonizes the gastrointestinal tract after the alteration of normal gut flora by antibiotics and causes fulminant colitis. Clostridium difficile also causes intestinal (bowel) perforation. Hemorrhoids and diverticulosis are complications of chronic constipation. Toxic megacolon occurs in patients with irritable bowel syndrome due to antidiarrheal therapy. Text Reference - p. 963

Which surgery is used to attach the stomach subdiaphragmatically to prevent reherniation?

Gastropexy is the attachment of the stomach subdiaphragmatically to prevent reherniation. Herniotomy is the excision of the hernia sac. Herniorrhaphy is the closure of the hiatal defect. Heller myotomy is the surgical alteration of the lower esophageal sphincter. Text Reference - p. 936

The nurse is aware that the primary symptoms of a sliding hiatal hernia are associated with reflux and should assess the patient for:

Heartburn, regurgitation, and dysphagia; most common symptom of a hiatal hernia is heartburn, also known as pyrosis. It results from reflux of gastric secretions into the esophagus. Regurgitation of gastric contents and dysphagia are other common symptoms. Jaundice, ascites, and edema are associated with liver disorders. Abdominal cramps, diarrhea, and anorexia are associated with gastroenteritis. Low abdominal pain, fever, and boardlike abdominal rigidity are symptoms of appendicitis, ruptured ovarian cyst, and peritonitis. Text Reference - p. 936

Which laboratory results determine the type and amount of intravenous fluids administered? Select all that apply.

Hematocrit, electrolytes, and hemoglobin are laboratory test results that determine the type and amount of intravenous fluids administered based on the degree of dehydration, vomiting, and electrolyte imbalance. Liver enzymes are used to detect any liver problems that may complicate ulcer healing. Serum amylase helps in determining pancreatic function. Text Reference - p. 948

Which complication occurs when cancer erodes through the esophagus and into the aorta?

Hemorrhage occurs when esophageal cancer erodes through the esophagus and into the aorta. Choking and hoarseness occur when the tumor is in the upper third of the esophagus. Blood-flecked regurgitation occurs with severe esophageal stenosis. Text Reference - p. 937

Which symptoms support the nurse's suspicion that a patient with fecal incontinence has incontinence-associated dermatitis? Select all that apply.

Patients with fecal incontinence are at risk of incontinence-associated dermatitis (IAD), characterized by erythema and erosion of the upper thighs, buttocks, and perianal areas. Perforation, diverticulosis, and rectal mucosal fissures are complications observed in patients with chronic constipation. Text Reference - p. 965

A nurse is teaching an obese patient with gastroesophageal reflux disease (GERD) measures that should be taken to prevent complications. What instructions should the nurse give? Select all that apply.

In an obese person, the intraabdominal pressure is increased, which can exacerbate GERD. Maintaining a low-fat diet could help in losing weight and therefore relieve the condition. Tea, coffee, and nicotine (a component of cigarettes) are known to decrease the lower esophageal sphincter pressure, aggravating GERD. Patients with GERD are prescribed cholinergic drugs to relieve their condition. Anticholinergic drugs, on the other hand, affect the lower esophageal sphincter pressure and may therefore cause GERD. Lying down immediately after eating food may promote the movement of food toward the esophageal sphincter and increase the pressure on it, therefore exacerbating the condition. Text Reference - p. 933

The nurse is conducting patient teaching with an 82-year-old patient who has metastatic lung cancer and constipation. The nurse should include which instructions to prevent further episodes of constipation? Select all that apply.

Increased exercise, fluid intake, and a high-fiber diet reduce the incidence of constipation caused by immobility, medications, and other factors. Fluid and fiber provide bulk, which in turn increases peristalsis and bowel motility. Gravity and small frequent meals will not impact constipation. Text Reference - p. 967

The nurse is conducting discharge teaching for a patient with metastatic lung cancer who was admitted with a bowel impaction. Which instructions would be most helpful to prevent further episodes of constipation?

Increased fluid intake and a high-fiber diet reduce the incidence of constipation caused by immobility, medications, and other factors. Fluid and fiber provide bulk that in turn increases peristalsis and bowel motility. Analgesics taken for lung cancer probably cannot be reduced. Other medications may decrease constipation, but it is best to avoid laxatives. Eating several small meals per day and one's position while eating do not facilitate bowel motility. Defecation is easiest when the person sits on the commode with the knees higher than the hips. Text Reference - p. 967

The nurse is preparing to administer a dose of bisacodyl. In explaining the medication to the patient, the nurse would explain that it acts in what way?

Increases peristalsis by stimulating nerves in the colon wall; Bisacodyl is a stimulant laxative that aids in producing a bowel movement by irritating the colon wall and stimulating enteric nerves. It is available in oral and suppository forms. Fiber and bulk forming drugs increase bulk in the stool, water and stool softeners soften feces, and saline and osmotic solutions cause fluid retention in the intestinal tract. Text Reference - p. 967

Which changes in vital signs may accompany an inflamed and swollen structure around the anus and difficulty in defecating? Select all that apply.

Inflamed and swollen structures around the anus and difficulty in defecating indicate hemorrhoids, possibly due to chronic constipation. Patients with chronic constipation inspire deeply while straining and hold the breath while contracting abdominal muscles. This results in reduced venous return, decreased arterial pressure, and increased intrathoracic pressure. During straining, heart rate and cardiac output decrease. Text Reference - p. 966

Which complication does the nurse expect in a patient with constipation who is prescribed soapsuds enemas?

Inflammation of colon mucosa; Enemas are fast acting and beneficial in the immediate treatment of constipation. However, soapsuds enemas cause inflammation of colon mucosa. Water intoxication occurs due to tap water enemas. Sodium phosphate (fleet) enemas may result in electrolyte imbalances. Ulceration of rectal mucosa occurs due to stool stasis or straining in chronic constipation. Text Reference - p. 967

A stroke patient who primarily uses a wheelchair for mobility has diarrhea with fecal incontinence. What should the nurse first assess?

Patients with limited mobility are at risk for fecal impactions because of constipation that may lead to liquid stool leaking around the hardened impacted feces, so assessing for fecal impaction is the priority. Perineal hygiene can be assessed at the same time. Assessing the dietary fiber, fluid intake, and antidiarrheal agent use will be done next. Text Reference - p. 965

A hospitalized patient has just been diagnosed with diarrhea due to Clostridium difficile. Which is the highest priority nursing intervention that should be included in the patient's plan of care?

Initiation of contact isolation precautions must be done immediately with a patient with C. difficile. Visitors need to be taught to wear gloves and gowns and wash hands as soon as the isolation supplies are at the patient's room, but it's not the highest priority. Eating live yogurt cultures for snacks may not help the patient, but it will not hurt the patient, and it is not the highest priority. The room will be disinfected with 10% bleach solution when the patient is dismissed and may be done periodically during the patient's stay, depending on the agency policy, but it is not the highest priority. Text Reference - p. 964

A patient is admitted to the hospital with a severe duodenal ulcer. The patient suddenly complains of severe pain spreading over the entire abdomen, likely due to a perforation. What should be the most immediate intervention by the nurse, if prescribed?

Insert an NG tube into the stomach;The immediate focus of management for a patient with a perforation is to stop the spillage of gastric or duodenal contents into the peritoneal cavity and restore blood volume. An NG tube is inserted into the stomach to provide continuous aspiration and gastric decompression to stop spillage through the perforation and thereby prevent peritonitis. Administering nitrates to such a patient will not be helpful in relieving the condition. Administration of pain medications and preparations for laparoscopic surgery are done later. Text Reference - p. 947

The nurse is caring for a patient who presents with tachycardia, lower abdominal pain, and nausea and vomiting. Upon clinical examination, the primary health care provider identifies a rigid and board-like abdomen. Which surgical therapy is beneficial for the patient?

Laparoscopy; Tachycardia, lower abdomen pain, nausea, and vomiting are the clinical manifestations of perforation, a complication of peptic ulcer disease. A laparoscopy involves a simple closure with an omentum graft, which will repair the perforation with appropriate source control and limit the parietal cell acid secretion. Billroth I involves a partial gastrectomy where two-thirds of the stomach is removed and there is an anastomosis of the gastric stump to the duodenum. A vagotomy involves severing the vagus nerve either totally or selectively. Pyloroplasty consists of surgical enlargement of the pyloric sphincter. Text Reference - p. 946

Which respiratory complication occurs due to irritation of the upper airway by gastric secretions?

Laryngospasm; Text reference - p. 932

Which medication is used to treat idiopathic constipation in men?

Linaclotide is an intestinal secretagogue that is used in the treatment of idiopathic constipation in men and women. Lubiprostone is a selective chloride channel activator, which is used to treat idiopathic constipation only in women. Methylcellulose is a bulk-forming agent, which is the best choice for initial treatment of constipation. Sodium phosphate is a saline osmotic solution used in the treatment of constipation, but not for treating idiopathic constipation in men. Text Reference - p. 967

After reviewing the medical reports of a patient with portal hypertension, the nurse concludes that the patient has esophageal varices. Which other finding supports the nurse's conclusion?

Liver cirrhosis;Esophageal varices are the dilated, tortuous veins that occur in the lower portion of the esophagus. They occur as a result of portal hypertension. Esophageal varices are common complications of liver cirrhosis. Therefore, liver cirrhosis is a finding that supports the nurse's conclusion. Kyphosis is associated with a hiatal hernia. Throat lacerations may cause esophageal strictures, and squamous cell carcinoma is associated with achalasia. Text Reference - p. 940

Which antacid does the nurse expect the primary health care provider to prescribe to a patient who reports mild, intermittent chest pain after meals?

Magnesium trisilicate helps relieve heartburn after meals by creating a foam barrier on the stomach acid. It is prescribed for mild and intermittent chest pain after meals. Sodium citrate, calcium carbonate, and aluminum carbonate are also antacids used in the treatment of gastroesophageal reflux disease causing heartburn; however, they are not used for mild and intermittent heartburn. Text Reference - p. 934

A nurse is teaching a patient about prevention of peptic ulcers. What instructions should the nurse give the patient? Select all that apply.

Nicotine, a component of cigarettes, causes gastric irritation, and therefore smoking should be avoided by those with peptic ulcers. Washing hands thoroughly with soap after using the restroom and before eating would help prevent the Helicobacter pylori infection that causes peptic ulcers. Any symptom of gastric irritation such as nausea and epigastric pain must be reported to the health care provider to prevent lethal consequences of peptic ulcer disease. Consumption of raw uncooked food increases the chance of H. pylori infection; therefore, it should be avoided. NSAIDs should not be taken over a long period of time, because they are a potent gastric irritant. Text Reference - p. 946

Which medication does the nurse expect to be beneficial to the patient who reports difficulty swallowing and is diagnosed with achalasia?

Nifedipine; Difficulty in swallowing is known as dysphagia. It is the most common symptom of achalasia. Calcium channel blockers such as nifedipine, when administered sublingually 30 to 45 minutes before meals, may help reduce dysphagia in patients with achalasia. Cisplatin is an antineoplastic agent used in the treatment of esophageal cancer. Prednisone is used in the treatment of eosinophilic esophagitis. Porfimer sodium is a photosensitizer that is injected intravenously during photodynamic therapy of esophageal cancer. Text Reference - p. 940

Which histamine-receptor blocker is available only for oral administration?

Nizatidine is available only for oral administration but not for intravenous (IV) administration; the medication is used to promote ulcer healing. Ranitidine, cimetidine, and famotidine are histamine (H2) blockers that can be given orally or through IV. Text Reference - p. 946

The nurse would administer a dose of magnesium hydroxide to a patient after evaluation of which assessment findings?

No bowel movement for 4 days; Magnesium hydroxide is an osmotic laxative that produces a soft, semisolid stool, usually within 6 to 12 hours. This medication would benefit a patient who has not had a bowel movement for four days. Poor oral intake, weight loss, and irritability and tachycardia are not indications for administration of a laxative. Text Reference - p. 967

Which condition is associated with symptoms of weight loss, halitosis, nocturnal regurgitation, and an inability to belch?

Nocturnal regurgitation, an inability to belch, weight loss, and halitosis may indicate achalasia. Achalasia is the absence of peristalsis in the lower two-thirds of the esophagus. Esophageal varices are dilated, tortuous veins that occur in the lower portion of the esophagus. Esophageal stricture is the narrowing of the esophagus. EE is the inflammation of the esophagus due to an infiltration of eosinophils. Text Reference - p. 940

Which otolaryngologic symptoms occur in gastroesophageal reflux disease (GERD)? Select all that apply.

Otolaryngologic symptoms in GERD include choking, hoarseness, and sore throat. Wheezing and dyspnea are the respiratory symptoms that occur in GERD. Text Reference - p. 932

Which neurologic condition causes constipation?

Parkinson's disease;Conditions or diseases that hamper neurologic function, such as Parkinson's disease, cause constipation. Dementia, spina bifida, and myelomeningocele are neurologic conditions that cause fecal incontinence. Text Reference - p. 966

The nurse is caring for a patient who underwent surgical therapy for peptic ulcer disease. Upon clinical examination, the primary health care provider suspected that a complication occurred due to loss of intrinsic factor. Which complication does the nurse suspect?

Pernicious anemia is a complication that occurs in a patient after undergoing a partial gastrectomy. It occurs due to loss of intrinsic factor, which is required for the production of vitamin B12. Bile reflux gastritis occurs as a complication of gastric surgery of the pylorus. Dumping syndrome occurs as a complication after surgical removal of the stomach and pylorus. Postprandial hypoglycemia is a variant of dumping syndrome that occurs due to uncontrolled gastric emptying of a bolus of fluid high in carbohydrate into the small intestine. Text Reference - p. 950

The patient with peptic ulcer disease is on sucralfate medication. Which outcome does the nurse anticipate?

Protection of ulcer from acid; Sucralfate acts by forming a protective layer around an ulcer that serves as a barrier against acid, bile salts, and enzymes in the stomach. Histamine blockers are used to promote ulcer healing. Proton pump inhibitors such as omeprazole reduce gastric acid secretion. Antacids increase gastric pH and neutralize gastric acid secretion. Text Reference - p. 947

A patient with a history of peptic ulcer disease has presented to the emergency department reporting severe abdominal pain and has a rigid, board-like abdomen that prompts the health care team to suspect a perforated ulcer. What intervention should the nurse anticipate?

Providing intravenous (IV) fluids and inserting a nasogastric (NG) tube; A perforated peptic ulcer requires IV replacement of fluid losses and continued gastric aspiration by NG tube. Oral bicarbonate would not be given, because the client would be nothing by mouth, and gastric pH testing is not a priority. Calcium gluconate is not a medication directly relevant to the patient's suspected diagnosis and parenteral nutrition is not a priority in the short term. Text Reference - p. 947

A patient is on drug therapy for a peptic ulcer. Which medication does the nurse anticipate to be prescribed to help reduce hydrochloric acid secretion?

Ranitidine, which is a histamine-receptor blocker, reduces hydrochloric acid (HCl) secretions by blocking histamine, a hormone responsible for HCl secretion. Sucralfate acts by forming a protective layer around the ulcer and serves as a barrier against acid, bile salts, and enzymes in the stomach. Tetracycline is an antibiotic prescribed concurrently with proton-pump inhibitors. Aluminum hydroxide gel is an antacid that neutralizes gastric HCl secretion. Text Reference - p. 946

Which cause of fecal incontinence is related to pelvic floor dysfunction?

Rectal prolapse is a pelvic floor dysfunction that increases the risk for fecal incontinence. Infection related to inflammatory changes may cause fecal incontinence. Pelvic fracture is an atraumatic risk factor that leads to fecal incontinence. Rectal surgery is a neurologic risk factor that leads to the development of fecal incontinence. Text Reference - p. 965

The nurse would incorporate what activities in implementing a plan of care for a patient experiencing fecal incontinence?

Regardless of the cause of fecal incontinence, bowel training is an effective strategy for many patients. Exercising after meals can aggravate symptoms of incontinence. Use of stool softeners is considered to stimulate anorectal reflex if bowel training is ineffective. Patients with fecal incontinence should avoid foods such as caffeine that worsen symptoms. Text Reference - p. 966

A patient with gastroesophageal reflux disease reports to the nurse, "I feel like there is a hot, bitter liquid in my mouth." What does the nurse document in the patient's medical record?

Regurgitation is described as a hot, bitter, or sour liquid coming into the throat or mouth. Dysphagia is difficulty swallowing food. Hypersalivation or water brash is the regurgitation of an excessive accumulation of saliva from the lower part of the esophagus. Hyperchlorhydria is the excessive secretion of acid in the stomach. Text Reference - p. 932

While reviewing the medical reports of a patient with constipation, the nurse finds that the primary health care provider has disallowed magnesium salts. What could be the reason for this action?

Renal insufficiency; The gut poorly absorbs magnesium salts, such as magnesium citrate and milk of magnesia. Magnesium-containing laxatives are contraindicated in patients with renal insufficiency because they are at high risk of developing electrolyte imbalances resulting in hypermagnesemia. If the patient has appendicitis, acute hepatitis, or biliary tract obstruction, then bulk-forming agents are contraindicated. Text Reference - p. 967

Which medication does the nurse expect will be beneficial for the patient diagnosed with traveler's diarrhea caused by Escherichia coli?

Rifaximin is a nonabsorbable antibiotic that is used in the treatment of traveler's diarrhea caused by Escherichia coli. Rifaximin binds to the beta subunit of the bacterial deoxyribonucleic acid (DNA)-dependent ribonucleic acid (RNA) polymerase and inhibits bacterial RNA synthesis. Fidaxomicin is reserved for patients who are at risk for recurrent Clostridium difficile infections. Vancomycin and metronidazole are medications used in the treatment of diarrhea caused by Clostridium difficile. Text Reference - p. 963

A 72-year-old patient was admitted with epigastric pain caused by a gastric ulcer. Which patient assessment warrants an urgent change in the nursing plan of care?

Rigid abdomen and vomiting following indigestion; A rigid abdomen with vomiting in a patient who has a gastric ulcer indicates a perforation of the ulcer, especially if the manifestations of perforation appear suddenly. Midepigastric pain is relieved by eating, drinking water, or antacids with duodenal ulcers, not gastric ulcers. Back pain three to four hours after a meal is more likely to occur with a duodenal ulcer. Burning epigastric pain one to two hours after a meal is from an expected manifestation with a gastric ulcer related to increased gastric secretions and does not cause an urgent change in the nursing plan of care. Text Reference - p. 944

Which medication is contraindicated in patients with mechanical gastrointestinal obstruction?

Selective chloride channel activators, such as lubiprostone, are contraindicated in patients with mechanical gastrointestinal obstruction. Senna is a stimulant and is contraindicated in patients with obstipation and impaction. Psyllium and methylcellulose are bulk-forming agents that are contraindicated in patients with vomiting, nausea, appendicitis, biliary tract obstruction, and acute hepatitis. Text Reference - p. 967

A patient is on nonsteroidal antiinflammatory drugs (NSAIDs). Which complication does the nurse anticipate?

Silent peptic ulcers show no symptoms of ulcer disease until the presentation of their final, fatal illness. The ulcers occur in older patients or patients who take NSAIDs. Achalasia is a primary motility disorder characterized by the absence of peristalsis and impaired relaxation of the lower esophageal sphincter (LES) in response to swallowing. Duodenal ulcers occur due to excessive alcohol ingestion and smoking that result in increased hydrochloric acid secretion. Stomach cancer begins with a nonspecific mucosal injury as a result of infection, autoimmune-related inflammation, and tobacco use. Text Reference - p. 944

A patient reports a two-day history of watery diarrhea and abdominal pain. What factors should the nurse assess that relates to the patient's condition? Select all that apply.

Skin condition, BP, body temperature; A patient who has watery diarrhea for two days is at risk of dehydration, which may present as low grade fever and/or orthostatic changes in the pulse rate and blood pressure. The skin of the patient becomes dry when dehydrated. Therefore, the nurse should assess the skin, blood pressure, and body temperature. Diarrhea will have no effect on a patient's blood glucose or respiratory rate. Text Reference - p. 964

The nurse is caring for a patient with liver cirrhosis. Which medication should be used with caution in this patient?

Sodium citrate; Antacids high in sodium citrate need to be used with caution in a patient with liver cirrhosis because they interact with and reduce the absorption of the medications prescribed for liver cirrhosis. Magnesium oxide should be used with caution on patients with renal failure. Calcium carbonate should be cautiously prescribed to patients with hypercalcemia. Aluminum hydroxide should be used with caution on patients with hemorrhoids. Text Reference - p. 946

Which medication is prescribed for cryoprotective drug therapy?

Sucralfate provides cryoprotection for the esophagus, stomach, and duodenum by forming a protective layer and serves as a barrier against acids, bile salts, and enzymes. Tofranil is a tricyclic antidepressant that provides pain relief in peptic ulcer disease. Cimetidine is a histamine blocker that provides ulcer healing. Misoprostol is prescribed to prevent gastric ulcers caused by nonsteroidal antiinflammatory drugs. Text Reference - p. 947

Which side effect occurs in a patient with gastroesophageal reflux disease who is on bethanechol therapy?

Syncope; Bethanechol is a cholinergic medication used to treat gastroesophageal reflux disease. Cholinergics cause syncope, which is the partial or complete loss of consciousness. Proton pump inhibitors cause flatulence. Renal calculi can occur with antacid use. Prokinetic medications cause hallucinations. Text Reference - p. 934

Which action of the nurse is appropriate if, while administering fluids through a jejunostomy feeding tube to a patient who underwent an esophageal surgery, the nurse suspects that the tube is misplaced?

The nurse should notify the primary health care provider immediately if the tube is misplaced. The nurse should not reinsert or reposition the tube without an order from the primary health care provider. Documenting the findings and continuing to administer will put the patient's safety at risk. Test-Taking Tip: Recall the responsibilities of the nurse in postoperative care of a patient with enteral feeding and choose the correct answer. Text Reference - p. 939

In planning care for a patient with fecal incontinence, the goal the nurse is likely to establish is that the patient will:

The overall goals are that the patient with fecal incontinence will have predictable bowel elimination, maintain perianal skin integrity, participate in work and social activities, and avoid self-esteem problems related to bowel control. Elimination could occur more than once a day as long as it is predictable. Stool and moisture from stool left on the skin can cause impairment to the skin's integrity. Text Reference - p. 965

The nurse is interviewing a patient with a duodenal ulcer. Which characteristic of pain is the nurse likely to find?

The pain related to a duodenal ulcer is cramp like and appears five to six hours after a meal. The pain is located in the midepigastric region beneath the xiphoid process. The pain is relieved by food intake. Text Reference - p. 942

Following a gastrectomy performed for peptic ulcer disease, the patient has recovered and is ready for discharge. What instructions should the nurse include in discharge teaching to prevent dumping syndrome?

To prevent dumping syndrome after gastrectomy, the patient should avoid large meals, instead dividing meals into six small meals to avoid overloading the intestines at mealtimes. Fluids should not be taken with meals. Fluids can be taken at least 30 to 45 minutes before or after meals. This helps prevent distension or a feeling of fullness. Concentrated sweets should be avoided because they sometimes cause dizziness, diarrhea, and a sense of fullness. Protein and fats should be increased in the diet to help rebuild body tissue and to meet energy needs. Text Reference - p. 950

Which is a common antireflux surgery for repair of a hiatal hernia?

Toupet fundoplication is a common antireflux surgery for repair of a hiatal hernia. Cryotherapy, photodynamic therapy, and endoscopic mucosal resection are endoscopic therapies, not surgeries. Test-Taking Tip: Start by reading each of the answer options carefully. Usually at least one of them will be clearly wrong. Eliminate this one from consideration. Now you have reduced the number of response choices by one and improved the odds. Continue to analyze the options. If you can eliminate one more choice in a four-option question, you have reduced the odds to 50/50. While you are eliminating the wrong choices, recall often occurs. One of the options may serve as a trigger that causes you to remember what a few seconds ago had seemed completely forgotten. Text Reference - p. 935

Which enzyme activates the immune response with antibody production and the release of inflammatory cytokines?

Urease activates the immune response with body antibody production and the release of inflammatory cytokines, resulting in mucosal edema. Pepsin is an enzyme released in the stomach that degrades food particles into peptides. Bile salts are released by liver cells, which bind with cholestyramine and cause gastric irritation. Serum amylase levels determine pancreatic function. Text Reference - p. 946

The nurse is evaluating a patient after teaching about management of peptic ulcer disease. Which statement by the patient indicates the need for further teaching? Select all that apply.

While teaching a patient about management of peptic ulcer disease, the nurse should instruct the patient to take medications that include both antisecretory drugs and antibiotics, because of the development of antibiotic resistance organisms; this can be reduced by using antisecretory drugs concurrently with antibiotics. Over-the-counter (OTC) drugs that contain ingredients like aspirin should be avoided, because they destroy mucosal cells and increase the risk of ulcer development. The patient should report increased vomiting or epigastric pain. The patient should avoid smoking, because it may delay ulcer healing. The patient should follow dietary modifications by avoiding spicy and acidic food that may cause epigastric distress. Text Reference - p. 949

A nurse is caring for a patient diagnosed with peptic ulcer disease. On assessment, the nurse identifies spillage of gastric contents into the duodenal cavity. Which complication supports the finding?

With perforation, the ulcer penetrates the stomach's serosal surface and spillage of either gastric or duodenal contents into the peritoneal or duodenal cavity will occur. A hemorrhage is a complication that occurs due to the changes in the vital signs and an increase in the amount and redness of the aspirate, often signaling massive upper GI bleeding. Dumping syndrome is the direct result of surgical removal of a large portion of a stomach and the pyloric sphincter. Gastric outlet obstruction is a peptic ulcer complication that occurs in a patient whose ulcer is close to the pylorus. Text Reference - p. 947

The patient has a prescription for daily docusate. The nurse would include which information when teaching the patient about this medication?

You should notice an effect from this medication within 72 hours; Colace is indicated for constipation and should achieve an effect within 72 hours. Constipation is not an effect of this medication. Fluid intake should be increased; anticoagulant medication may need to be decreased. Text Reference - p. 967

Which condition can be diagnosed by measuring fasting serum gastrin levels?

Zollinger-Ellison syndrome can be diagnosed by measuring fasting serum gastrin levels, which will determine the amount of gastrin secreted by G cells of the stomach. Acute gastritis is diagnosed by endoscopic examination with biopsy. Pyloric obstruction is diagnosed by performing an endoscopy with dilated balloons. Gastric outlet obstruction is diagnosed by performing a barium contrast study. Text Reference - p. 945