MS 2 - Chapter 45: Gastric & Duodenal Disorders (SATA only)

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

A patient comes to the clinic with the complaint, "I think I have an ulcer." What is a characteristic associated with peptic ulcer pain that the nurse should inquire about? Select all that apply. A. Burning sensation localized in the back or mid-epigastrium B. Feeling of emptiness that precedes meals from 1 to 3 hours C. Severe gnawing pain that increases in severity as the day progresses D. Pain that radiates to the shoulder or jaw E. Vomiting without associated nausea

c) Extreme gastric hyperacidity d) Severe peptic ulcers e) Gastrin-secreting tumors of the pancreas

Select all answer choices that apply. Which of the following are characteristics associated with the Zollinger-Ellison syndrome (ZES)? Select all that apply. a) Hypocalcemia b) Constipation c) Extreme gastric hyperacidity d) Severe peptic ulcers e) Gastrin-secreting tumors of the pancreas

A. Melena D. Tachypnea E. Thirst F. Mental confusion

The nurse is aware that hemorrhage is a common complication of peptic ulcer disease. Therefore, assessment for indicators of bleeding is an important nursing responsibility. Which of the following are indicators of bleeding? Select all that apply. A. Melena B. Polyuria C. Bradycardia D. Tachypnea E. Thirst F. Mental confusion

a) Macrocytic anemia b) Pernicious anemia d) Thrombocytopenia Explanation: Decreased vitamin B12 can result in pernicious anemia, macrocytic anemia, and thrombocytopenia. Decreased iron can result in lethargy and loss of hair.

Which of the following manifestations are associated with a deficiency of vitamin B12? Select all that apply. a) Macrocytic anemia b) Pernicious anemia c) Loss of hair d) Thrombocytopenia e) Lethargy

Age 55 years Previous infection with H. pylori

A client has a family history of stomach cancer. Which of the following factors would further increase the client's risk for developing gastric cancer? Select all that apply. Female gender Caucasian Age 55 years Previous infection with H. pylori

b) Diluted lemon juice d) Diluted vinegar Explanation: Emergency treatment consists of diluting and neutralizing the offending agent. To neutralize acids, common antacids (eg, aluminum hydroxide) are used; to neutralize an alkali, diluted lemon juice or diluted vinegar is used. If corrosion is extensive or severe, emetics such as syrup of ipecac and lavage are avoided because of the danger of perforation and damage to the esophagus.

A client with active schizophrenia has developed acute gastritis after ingesting a strongly alkaline solution during a psychotic episode. Corrosion is extensive. Which of the following emergency treatments might the team working with this client use? Select all that apply. a) Syrup of ipecac b) Diluted lemon juice c) Aluminum hydroxide d) Diluted vinegar e) Gastric lavage

A. Smoking cessation C. Avoidance of alcohol E. Following a regular schedule for rest, relaxation, and meals

A client with peptic ulcer disease wants to know nonpharmacological ways that he can prevent recurrence. Which of the following measures would the nurse recommend? Select all that apply. A. Smoking cessation B. Substitution of coffee with decaffeinated products C. Avoidance of alcohol D. Eating whenever hungry E. Following a regular schedule for rest, relaxation, and meals

Ans: A. Tachycardia B. Hypotension D. A rigid, board-like abdomen

A nurse is monitoring a client with peptic ulcer disease. Which of the following assessment findings would most likely indicate perforation of the ulcer? Choose all that apply. A. Tachycardia B. Hypotension C. Mild epigastric pain D. A rigid, board-like abdomen E. Diarrhea

A) Specific lifestyle changes associated with each procedure B) Implications of each procedure for eating habits C) Effects of different surgeries on bowel function

A nurse is presenting a class at a bariatric clinic about the different types of surgical procedures offered by the clinic. When describing the implications of different types of surgeries, the nurse should address which of the following topics? Select all that apply. A) Specific lifestyle changes associated with each procedure B) Implications of each procedure for eating habits C) Effects of different surgeries on bowel function D) Effects of various bariatric surgeries on fertility E) Effects of different surgeries on safety of future immunizations

b) Computed tomography (CT) d) Endoscopic ultrasound Explanation: Esophagogastroduodenoscopy for biopsy and cytologic washings is the diagnostic study of choice, and a barium x-ray examination of the upper GI tract may also be performed. Endoscopic ultrasound is an important tool to assess tumor depth and any lymph node involvement. Pelvic ultrasound is not used to confirm the diagnosis of gastric cancer.

Choice Multiple question - Select all answer choices that apply. A client has given a confirmed diagnosis of gastric cancer. Two more procedures may be performed to assess tumor depth and lymph node involvement and surgical resectability. Which two are the procedures? Choose the two that apply. a) Esophagogastroduodenoscopy (EGD) b) Computed tomography (CT) c) Barium x-ray of the upper GI tract d) Endoscopic ultrasound

a) Hepatomegaly e) Ascites Explanation: The physical examination is usually not helpful in detecting the cancer because most early gastric tumors are not palpable. Advanced gastric cancer may be palpable as a mass. Ascites and hepatomegaly (enlarged liver) may be apparent if the cancer cells have metastasized to the liver. Palpable nodules around the umbilicus, called Sister Mary Joseph's nodules, are a sign of a GI malignancy, usually a gastric cancer. A distended bladder is not significant. Petechiae at the palpation site is a distractor for the question.

Select all answer choices that apply. A client has recently been diagnosed with gastric cancer. He has a history of tobacco use and was diagnosed 10 years ago with pernicious anemia. He and his family are shocked about the possibility of this diagnosis because he has been asymptomatic prior to recent complaints of pain and multiple gastrointestinal symptoms. On palpation, the nurse notes two signs that confirm metastasis to the liver. Which of the following are signs? a) Hepatomegaly b) Sister Mary Joseph's nodules c) Petechiae at the palpation site d) Distended bladder e) Ascites

b) Current use of warfarin (Coumadin) d) History of alcoholism Explanation: Clients who take metronidazole (Flagyl) should avoid alcohol. Flagyl also increases the blood-thinning effects of warfarin (Coumadin). Amoxicillin (Amoxil) is contraindicated in clients allergic to penicillin. A diet high in dairy products would limit the use of metronidazole (Flagyl). Tetracyclines might be problematic for those who work outdoors, because it can impose a photosensitivity reaction--clients taking it would need to use sunscreen.

Select all answer choices that apply. A nurse practitioner is considering pharmacological treatment options for a client with gastritis. Which of the following might limit the use of metronidazole (Flagyl) for this client? Select all that apply. a) Diet high in dairy products b) Current use of warfarin (Coumadin) c) Occupation as a landscape architect d) History of alcoholism e) Allergy to penicillin

C. Administer the ordered sedative before the procedure D. Assess for the client's gag reflex after the procedure E. Monitor the client's pulse oximetry during and after the procedure

Suspected ulceration of the stomach necessitates an esophagogastroduodenoscopy. The nurse will implement which of the following for this procedure? Select all that apply. A. Place the client in the supine position B. Maintain the client on NPO status for 2 hours prior to the examination C. Administer the ordered sedative before the procedure D. Assess for the client's gag reflex after the procedure E. Monitor the client's pulse oximetry during and after the procedure

a) Perforation c) Pyloric obstruction d) Hemorrhage e) Penetration Explanation: Potential complications may include hemorrhage, perforation, penetration, and pyloric obstruction. A client who has had surgery for peptic ulcer disease may have a decreased appetite in the immediate postoperative stage, but it is not something the nurse would monitor for and would not cause cachexia. Inability to clear secretions is generally not a complication of peptic ulcer surgery.

The nurse is caring for a client who has just returned from the PACU after surgery for peptic ulcer disease. For what potential complications does the nurse know to monitor? Select all that apply. a) Perforation b) Inability to clear secretions c) Pyloric obstruction d) Hemorrhage e) Penetration f) Cachexia

B. Frequently monitoring hemoglobin and hematocrit levels C. Observing stools and vomitus for color, consistency, and volume D. Checking the blood pressure and pulse rate every 15 to 20 min

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

A. Eating a high fiber diet B. Ensuring safety precautions C. Taking the drug on an empty stomach D. Encouraging frequent mouth care

The nurse is preparing a teaching plan for a patient who is receiving sucralfate. Which would the nurse need to address? (Select all that apply.) A. Eating a high fiber diet B. Ensuring safety precautions C. Taking the drug on an empty stomach D. Encouraging frequent mouth care E. Limiting fluid intake F. Using an antidiarrheal agent